Cottenham Arban District Council. ANNUAL REPORT OF THE Medical Officer of Health FOR THE YEAR 1925. DAVID C. KIRKHOPE, M.D., Ch.M,, D.P.H., Barrister-at-Law. TOT 5 Cottendant Urban District Council. Report ON THE HEALTH OF TOTTENHAM FOR THE YEAR 1925. Crusha & Son, Ltd., Tottenham, Enfield and Wood Green. 2 SUMMARY OF STATISTICS FOR 1925. Area 3,014 acres. Population 156,700 Births 2,756 Birth-rate 17.6 per 1,000 of population. Deaths 1,596 Death-rate 10.1 per 1,000 of population. Deaths under 1 year of age 150 Infant Death-rate 54.4 per 1,000 births. Phthisis Death-rate 0.71 per 1,000 of population. Rateable Value £642,147 Amount Produced by 1d. Rate £2,550 3 Cottenham Urban District Council. HEALTH COMMITTEE: Chairman: Mr. Councillor A. Reed, A.F.I. Members: (Ex-Officio): Mr. Councillor T. Inglis, J.P. (Chairman of the Council.) (Ex-Officio): Mr. Councillor W. R. Jackson (Vice-Chairman of the Council.) Mrs. Councillor F. C. Brighten. Mr. ,, J. Bristow. ,, ,, E. S. Brown. Miss Councillor R. F. Cox. Mr. ,, F. Easton. ,, ,, T. Elderfield. ,, ,, H. Farthing. Mrs. ,, E. L. Finch. Mr. ,, E. Frost. Major P. B. Malone, M.P., J.P. Mr. Councillor W. E. Montague. Representatives on the Middlesex Districts Joint Smallpox Hospital Board: Mr. Councillor T. Elderfield. ,, ,, T. Inglis, J.P. 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.D. 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 :—I. Easton, 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) Harringay Ward. (117, Broadwater Road) §†*portman, W. C High Cross Ward. (13, West Road.) §†*West, W. p. West Green Ward. (33, Drayton Road.) §‡*Miller, H. W. Middle Ward. (119, Sperling Road.) §†*shillito, J. A. Lower Ward. (9, Cedar Road.) §†*Smith, J. B. (Cert., S.I. Ex. Brd.) St. Ann's Ward. (86, Chester Road.) Female Sanitary Inspector— §*Lamb, Miss M. *The Officials so marked hold the Certificate of the Royal Sanitary Institute. †The Officials so marked hold a Meat Inspector's Certificate. ‡This Inspector holds the Diploma of the Incorporated Institute of Hygiene. Contribution to salary from Exchequer Funds. 5 Inspector under the Shops Acts— Stacy, h. j. Nurses for Infectious Diseases— *†‡R. Bentley-Corner. *†‡§R. Hyatt. *†‡S. SWAFFIELD. *†‡M. Timlin. *†¶B. Whitaker. * General Training Certificate. † C.M.B. ‡ Fever Training Certificate. § Health Visitor's Diploma. ¶ Massage, Electricity and Nervous Diseases Certificates. Clerical Staff— Garvey, R., Chief Clerk (Cert., Roy. San. Inst.) Baker, S., Clerk. Bennett, P. W.T., Clerk (Cert., Roy. San. Inst.). Potter, W., Clerk. Lawrence, H. L., Junior Clerk. Mortuary Attendant— H. Corder, 24, Loobert Road, Clyde Circus. Disinfectors— A.. Smith (Houses). J. Mitchell (Clothing). J. Collin ,, Drain Testers, Etc. H. Bysouth. F. Dowse. J. Wilson. 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. (Part-time). Aurist— A. R. Friel, M.A., M.D., F.R.C.S.I. (Part-time). Denial 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. * General Training Certificate. † C.M.B. ‡Fever Training Certificate. Clerical Staff— V. Goddard (Chief Clerk). E. Ing. T. E. Cohen (A.I.S.A.). J. E. Miller. 7 3. 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. †¶aB. Wallace. *†§aM. Blanchard. *†G. Mason. *†°N. Headley. § Healtli Visitor's Diploma. ‡ San. Insp. Exam. 15d. Cert. ¶ R S.I. San. Insp. Cert. a R.S.I. Healtli Vis. Cert. a Alton T.B. Hosp, Cert. *†aF. Fletcher. *†abG. M. Hockin. *†abcE. M. Dunn. *†¶M. F. Reynolds. * General Training Cert, † C M.B. ° Fever Training Cert. b Moorfields Eye Hosp. Cert. Creche— Matron—F. E. Trewinnard (Creche Trained). Nurses—K. T. Brown (General Training Cert.), J. Byatt (San. Insp. Exam. Bd. Cert., C.M.B., Healtli Visitor's Diploma), M. Howe. Clerical Staff— E. Horton. M. E. Coleman. E. E. Fisher. G. A. Elliott. 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. Lister , 43 , Snells Park, Edmonton, and Mr. J. Sweet, Church Hall, Dorset Road, N.15. West Tottenham: Mr. J. Graville and Mr. A. J. Mister, Church Hall, Dorset Road, N.15. 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, 1926. To the Chairman and other Members of the Tottenham Urban District Council. Ladies and Gentlemen, I have the pleasure to submit this, my thirteenth Report upon the Health and Sanitary Conditions of the District. It is for the year 1925, and is of a comprehensive nature such as is required by the Ministry of Health at five-yearly intervals. Generally, the health conditions of the people—in so far as they can be ascertained from the Death-Rate level—may be regarded as favourable. It is not to be assumed from the low Death-Rate that the amenities of the District are all that could be desired; the reverse is the fact. There has been a swinging back of the pendulum. Until about 1907, the functions of the Health Authority consisted mainly in supervising and regulating the Sanitary and other environmental conditions of the people, at home and at work. Since the establishment of the School Medical and, subsequently, of the Maternity and Child Welfare Services the care of the Health Authority has been largely—indeed, principally—for the individual. It is true the Sanitary Services have not been neglected, but their operations have been seriously impeded by economic conditions. Sufficient houses have not been built to replace those that have fallen into decay, to house the increasing population and to afford a surplus of houses that will allow of some flotation of population. The result is that many families are living two or more to a house—and, occasionally, a family in a single room—notwithstanding the fact that they are both able and willing to pay rent for more commodious dwellings. 10 Environmental conditions are they which call most clamantly for reform, whilst the care of the individual is maintained, intensified and consolidated. At the moment of writing, there are upon the register of those who seek houses on the Council's Estate no fewer than 2,800 families. Very many of these families are living under most distressing conditions, and it is manifest that Tottenham has not the land available upon which to build houses for them all—unless, indeed, they are of the large tenement type, and I do not advise that system of housing. What appears to be wanted is cheap, clean and rapid transit from the Metropolis to an ever-widening circumference according to the needs of London's immense industrial and commercial population. Adequate means of transit are not available for Tottenham to and from the Metropolis. Trams and buses, morning and night, have been crammed to suffocation until police intervention caused the numbers carried to be limited, with the result of diminishing travelling accommodation. The Great Eastern Railway's passenger traffic is enormous, and the number said to be crowded at the "rush" hours into a compartment intended to seat 12 is incredible. The carriages themselves are not intended to appeal to the aesthetic sense of the traveller—and they do not. Only necessity would oblige the third-class traveller to seek this means of reaching his destination. At the busy morning and evening hours, the Underground Railways from Finsbury Park are likewise congested, and the multitude of people awaiting tram and bus service from Finsbury Park to the Northern Suburbs in the evening is an invitation to serious accident. Your Council have been active in presenting the urgency of the situation to the proper Authorities, and, while on every hand its seriousness is admitted, nothing is done or suggested on a scale commensurate with the need. The facilities for travelling to and from the City by omnibuses in ever-incieasing number are at the cost of greater peril to foot passengers; and the heavy vehicular road traffic is no doubt responsible for the repairs that the thoroughfares are constantly undergoing. The solution of the housing difficulty appears to lie in the extension and enlargement of the Underground system. 11 Pollution of the River Lee below Tottenham Lock has been the subject of your Council's deliberations on various occasions. The several Authorities concerned with the River and its tributaries have the matter under investigation. It is hoped that as the result of their enquiries and action arising thereout, that portion of the Lee below the Lock will be cleansed and further pollution prevented. The disposal of refuse is a subject that still requires careful consideration. For some years, neighbouring Authorities were permitted by the owner of vacant land adjoining Green Lanes to deposit refuse on the site. The result is that an unsightly heap obstructs the view from the back premises of many of the houses in Hermitage and adjacent roads. Legislature does not provide against the private owner of land using it in such a manner as seriously to impair the amenities of a District in the manner described. It is submitted that it ought to be made possible for Local Authorities to prohibit, subject to proper safeguards, the use of land to the detriment of the community. The method by which refuse should be disposed of has engaged your attention, and the problem cannot yet be said to be definitely and finally solved. Whilst the Destructor was undergoing renovation, barging out of the District was resorted to. Prior to that, when the Destructor was incapable of dealing with the amount daily being collected, quantities were deposited on the Marshes. The increased housing provision, and doubtless other factors, have rendered it impracticable to deal with the whole of the house and shop refuse by incineration. The Gravel Pit on the Devonshire Hill site has been taken advantage of for the deposit of surplus shop refuse, road sweepings and gullyslop. There can be no doubt of the propriety of having this Pit filled in. It constitutes a huge receptacle for stagnant water where, but for the precaution taken of spraying periodically with kerosene, opportunity is given for the maturation of mosquito larvae. But it is respectfully submitted that decaying and putrescible vegetable refuse should constitute no part of the filling material. Apart frjm the offence that will naturally arise from the odours of putrefaction, flies will find there a favourable breeding ground. The menace of the fly pest is one that must always be vigorously countered in view of the possibility of its effect on Infant Mortality by Summer Diarrhoea, which, in its epidemic incidence, is more easily avoided than remedied. In Tottenham Park—an estate belonging to the Burial Board—there is a Lake which, for all practical purposes, is stagnant. Ineffectual representation has been made to the Board, asking them to have the Lake 12 filled in. It is desirable that that should be done, or that the Lake be drained in order that it may not constitute a breeding place for mosquitoes. Your Council have had under consideration the making of ByeLaws requiring the slaughter of food animals by humane methods. With this end in view, your Health Committee received deputations of butchers and other interested parties, and heard arguments for and against the proposition. Bye-Laws were made in 1925, and received the approval of the Ministry of Health in 1926. Copies of these Bye-Laws requiring, inter alia, the slaughter of large animals intended for the food of man to be effected by mechanically-operated instruments, were sent to the butchers in the District. The Public Health (Meat) Regulations, 1924, came into operation on 1st April, 1925. These require that meat exposed for sale shall be protected effectively from dust, filth and flies. The proviso to these regulations, issued by the Ministry of Health, to the effect that they shall not be interpreted to imply an obligation on the part of meat vendors to protect meat by glass windows, renders their operation exceedingly difficult if not altogether nugatory. The provision of a sun-blind and side curtains to a stall established in front of a shop or even in the roadway, cannot conceivably be regarded as sufficient protection to meat displayed thereon from dust, flies and filth. The question of the establishment of a Public Abattoir is still under consideration. Deputations from the confectioners of the District who regarded the imposition of the provisions of the Shops Acts as prejudicial to their interests, waited upon your Health Committee and explained their position. Having regard to the fact that the Council are designated by the Acts as the Authority who are to administer them, they (the Council) felt that they had no option in the matter and must require confectioners to abide by the statutory provisions. Health Week was observed in 1925, as in the previous four years, by the distribution to school children of leaflets containing skeletons of five Essays. As the result of the Essay Competition arising thereout, 12,713 essays were submitted. The prizes—including gifts of valuable books and trinkets from two of your Councillors—were distributed at a meeting in the Municipal Hall, attended by a large section of the public. The Local Government and Other Officers' Superannuation Act, 1922, came into operation on 1st April, 1925. All entrants into the 13 permanent employment of your Council are required to pass a medical examination by one of your Medical Staff as an essential condition of admission. 66 candidates were thus examined, and satisfied the requirements of the examiners . Reference to the Birth and Death-Rate tables will show that while there has been a declension in the Birth-Rate (17.6 per 1,000 of the population in 1925, as against 18.2 per 1,000 in 1924), the Death-Rate has increased from 9.9 per 1,000 in 1924 to 10.1 per 1,000 in 1925. This increased Death-Rate is not reflected in the Infant Mortality Rate, which has declined from 61.6 per 1,000 children born in 1924 to 54 in 1925. Without engaging in the controversy as to whether a decreased Birth-Rate is desirable or otherwise, the increased Death-Rate and lowered BirthRate indicates an ageing population. Carried over a considerable number of years, the inevitable result would be that a sufficient number of children will not be born to replace those dying at the other end of man's span of life, and a process of depopulation would set in; that, from the Public Health point of view, would be unfortunate. It is to be noted that the Birth-Rate has been steadily falling since 1920. The generous support that the Council as a whole, and its members individually, have consistently given to the work of the Department— control of which they entrusted to me—is much appreciated by all the members of my s taff , who desire me to express their sincere thanks. I am, Ladies and Gentlemen, Your obedient Servant, 14 NATURAL AND SOCIAL CONDITIONS OF THE AREA. The area extends to 3,014 acres. Public open spaces occupy 245½ acres, and 54 acres have recently been purchased for an extension of the Downhills Recreation Ground. Approximately 10 acres, 2 roods are under water. The areas under water include Reservoirs, the Lee and its tributaries—Moselle Brook, Stonebridge Brook and Pymmes Brook. About 200 acres are still available for building and other purposes. It has been pointed out in the foreword of the Report that nearly 3,000 families are awaiting housing accommodation in Tottenham. On the reckoning that there should not be more than 12 houses to the acre, it will be seen that to house adequately the inhabitants of the District, acreage is not available in the District, even supposing all the disposable land were utilised for housing purposes. Population. The 1921 census population was returned by the Registrar-General at 146,711. The census figure of 1921 distributed equally over the whole District gives the average number of persons per inhabited house at 6.08, and per tenement 3.04. By this system of calculation, the Treasurer has deduced that the population at midsummer, 1925, was 156,700. The Registrar-General estimates by a different process that the midsummer population of Tottenham was 153,600. As in previous years, the vital statistical tables for this Report are based on the assumption that the Treasurer's figures are approximately correct. 15 Return of Houses, Population, etc., at Mid-Summer, 1925, as supplied to us by the Treasurer's Department. Ward. Acreage. Total Number of *Houses. Other Buildings and † Assessments. Total Number of Assessments. Estimated Population. Density of Population per Acre. Rateable Value. High Cross 463 5,081 218 5,299 27,000 58.3 £ 125,125 Middle 617 5,778 288 6,066 29,240 47.4 110,989 Lower 950 5,941 249 6,190 30,450 32.1 109,153 West Green 470 3,895 152 4,047 19,550 41.6 75,763 Harringay 263 4,264 270 4,534 22,550 85.7 98,921 St. Ann's 251 4,830 229 5,059 27,910 111.2 80,005 Throughout} the Parish } — — 15‡ 15‡ — 42,191 Totals 3,014 29,789 1,421 31,210 156,700 51.9 £642,147 *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. 16 Physical Features and General Character of the Area. Tottenham is due north of London—the "Queen's Head" being 5 miles north of Portland Place, and the milestone on the open space at the junction of West Green Road and Broadway, Tottenham, marking the 4-mile limit from London (Shoreditch Church). Tottenham is bounded on the south by the Metropolitan Boroughs of Hackney and Stoke Newington, on the west by the Borough of Hornsey and the Wood Green Urban District, on the north by Edmonton, and on the east by Walthamstow. The accompanying diagram, showing the various strata to a depth of over 400 feet, gives the composition of the soil upon which Tottenham stands. It represents particularly the site of the present Town Hall. The bore-hole indicated is that from which water is extracted for the supply of the Central Baths. 17 18 The highest point in the District is at the Downhills Water Tower, where the ground level reaches 100.9 feet above sea level. About the same level is reached at Devonshire Hill. The lowest level, viz., 25 feet above sea level, is reached on the Marshes, in the vicinity of the River Lee. This proximity of the Town to the River and its tributaries renders the lower-lying part of the District liable to mists and fogs. Number of Inhabited Houses, 1921. The Registrar-General's returns showed that there were 25,311 structurally separate dwellings occupied. The Treasurer's returns showed that houses, houses and shops and tenements numbered 28,685— 28,581 being then occupied, and 104 empty. The difference in the numbers given by the Registrar-General and Treasurer is due to the Treasurer calculating the number of separate assessments, there being many structurally separate dwellings in the District with two or more assessments each. At the census there were in Tottenham 35,386 private families. Rateable Value. The Rateable Value of the District in 1925 was £642,147, and a 1d. Rate produced £2,550. Social Conditions, including the Chief Occupations of the Inhabitants. The close proximity of Tottenham to the Metropolis makes the former one of the dormitories of the City. At the census, it was calculated that 26.5 per cent. of the population, viz., 38,903 persons, were occupied outside the District. The needs of the travelling public are served by the London and North Eastern Railway Co. and the London, Midland and Scottish Railway Co. There are altogether 10 stations in Tottenham. South Tottenham, St. Ann's Road and Harringay Park connect this District with Southend, Tilbury and Woolwich on the one side, and St. Pancras and Moorgate on the other. On the London and North Eastern Railway system, there are 2 stations on the Cambridge Branch at Tottenham Hale and Northumberland Park; on the Enfield Branch there are 4 stations, viz., Stamford Hill, Seven Sisters, Bruce Grove and White Hart Lane; and 19 on the Palace Gates Branch there is 1 station, in West Green Road. The L. & N.E. system communicates centrally with Liverpool Street Terminus. Trams and buses also connect the City with the District. The central termini of the trams are Liverpool Street, Holborn, Smithfield Market, Tottenham Court Road, Aldersgate and Aldgate. The buses convey passengers across London to Camberwell Green, Victoria, Southfields, Sidcup and Shooters Hill. The population is mainly of the working, artisan and clerical classes. Allusion has been made in the foreword to the numbers travelling to and from the City. The chief industries in the District are the following:—Cabinetmaking, pencil-making, piano-making, dress, blouse and mantle-making, building, the manufacture of sweets, stationery, indiarubber, emery cloth, brushes, cyclostyle materials, lamps, boots and shoes, toys, joinery, electrical fittings, silk braid weaving, brewing and mineral water manufacturing, bedstead and scientific instrument-making and motor manufacturing. BIRTHS. Births Registered:—Males 1,388 Females 1,368 Total 2,756 Including Illegitimate Births:—Male 31 Female 30 Total 61 Births occurring in the district 2,275 Births of Tottenham residents occurring outside the district 481 Total 2,756 Birth Rate, 17.6 per 1,000. Births notified under the Notification of Births Acts:— 20 In district by Doctors 603 ,, ,, Midwives 1,355 ,, ,, Parents and other persons 265 Notified from outside Institutions 452 2,675 Advised by Registrar 48 Total 2,723 Less 85 Still Births 85 2.638 DEATHS. The total number of deaths registered in Tottenham was 1,105 Of these, the number of non-residents was 213 Deaths of residents registered in the district 892 Deaths of residents registered outside the district 704 1,596 Deaths of residents under 1 year occurring in district 100 Deaths of residents under 1 year occurring outside district.. 50 Total deaths of Tottenham infants 150 These deaths are distributed in age groups as follows:— Deaths under 1 year 150 Deaths from 1 to 5 years 75 Deaths from 5 to 15 years 50 Deaths from 15 to 25 years 64 Deaths from 25 to 65 years 584 Deaths 65 and upwards 673 1,596 The excess of births over deaths is 1,160. The death rate equalled 10.1 per 1,000 of the population. 21 Table showing the Population, Birth and Death Rates, in Wards, during 1925. 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 366 220 22,550 16.2 9.7 18 0.8 49.2 West Green 280 193 19,550 14.3 9.9 14 0.7 50.0 St. Ann's 559 309 27,910 20.0 11.1 38 1.4 67.9 High Cross 467 290 27,000 17.3 10.7 23 0.8 49.3 Middle 492 298 29,240 16.8 10.2 27 0.9 54 9 Lower 592 286 30,450 19.4 9.4 30 0.9 50.7 Total 2,756 1,596 156,700 17.6 10.1 150 0.9 54. 22 M. of H. Table I. Table showing the Population, Birth Rate, and Death Rate from all causes, in Tottenham during the last six years. y ear. Population estimated to Middle of each Year. Births. Total Deaths Registered in the District. Deaths of Nonresidents registered in the District. Deaths of Residents not registered in the District. Nett Deaths Belonging to the District. Uncorrectec 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 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 8.8 352 559 203 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 9.1 1924 156,000 2,397 2,853 18.2 1,183 7.5 250 626 176 61.6 1 ,559 9. 9 1925 156,700 2,275 2,756 17.6 1,105 70 213 704 150 54.4 1,596 10. 1 23 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:— North Middlesex Hospital, Edmonton. Enfield and Edmonton Joint Hospital, Enfield. Clare Hall Sanatorium, South Mimms. Middlesex County Hospital, Isleworth. Middlesex County Sanatorium, Harefield. Metropolitan Asylums Board Hospitals (other than the North Eastern). 3.—Other Institutions, the deaths in which have been distributed among the several localities in the District:— Hospitals, etc.:— Guy's, Southwark. Middlesex, St. Marylebone. St. Bartholomew's, West Smithfield. Queen's Hospital for Children, Hackney Road. University College, Gower Street. London Temperance, Hampstead Road. Hospital for Sick Children, Great Ormond Street. City of London Maternity, City Road. Charing Cross, Strand. Women and Children, Paddington. 24 The Mothers', Clapton. Royal Waterloo, Lambeth. St. Mark's, City Road. London, Whitechapel. St. Luke's, Paddington. Westminster, Broad Sanctuary. Royal Chest, City Road. Epilepsy and Paralysis, St. Marylebone. St. Peter's, Stepney. St. Columbus, Hampstead. Kensington General, Kensington. Lambeth, Brook Street. Bethlem Royal, Southwark. Cancer, Chelsea. Springfield Hospital, Wandsworth. Royal Free, Grays Inn Road. Central London, Throat and Ear. Metropolitan, Kingsland Road. Hampstead General, Hampstead. Royal Northern, Holloway. Enfield House, Enfield. Paddington Infirmary, Harrow Road. City of Westminster Infirmary, Fulham Road. Brook House, Upper Clapton. Nursing Home, Amhurst Park. Ladywell, Lewisham. Park Prewett Hospital, Sherborne. Westcliff Nursing Home, Westclifi-on-Sea. Hackney Institution, Brentwood. St. Andrew's, Thorpe. Leavesden, Watford. Emergency, Ilford. Prince Albert Convalescent Home, Worthing. Infirmary, Harrogate. All Saints', Eastbourne. Royal Alexandra, Brighton. Napsbury, St. Albans. St. Anthony's, Cheam. M. of H. Table II.—Table of casts of Infectious Disease coming to the knowledge of the Medical Officer of Health during the year 1925 in the Tottenham Urban District, classified according to Diseases, Ages and. Localities. NOTIFIABLE DISEASE. Number ok Cases Notified. Total Cases Notified in Each Locality Total Cases Removed to Hospital At all Ages At Ages—Years 1 2 3 4 & 6 Harringay West Green ; St. Ann's High Cross Middle Lower Under 1 1 to 2 2 to 3 3 to 4 4 tlo 5 5 to 10 10 to 15 15 to 20 10 to 35 to 45 45 to 65 65 and over Encephalitis Lethargica 17 - - 1 — — — 1 3 2 4 6 — — 4 1 10 — 2 1 Diphtheria (including Membranous Croup) 252 2 14 11 13 27 116 33 14 19 3 — — 26 21 43 53 43 66 227 Erysipelas 44 2 — — 1 — 1 4 2 8 6 15 5 5 6 15 8 6 4 12 Scarlet Fever 427 — 16 12 27 42 196 82 18 28 6 — — 57 83 90 40 60 97 68 Enteric Fever 2 — — — — — 1 — — 1 — — — — — — 1 — 1 2 Pneumonia 149 16 9 6 8 7 15 4 8 21 19 26 10 26 22 38 19 14 30 — Puerperal Fever 6 — — — — — — — — 5 1 — — — — 2 2 2 — — Cerebro-spinal Meningitis 2 — 1 — — — 1 — — — — — — 1 1 — — — — 1 Poliomyelitis 1 1 - - - - - - - - - - - - - - - - - — Ophthalmia Neonatorum 13 13 - - - - - - - - - - - 4 — 4 2 1 2 — Pulmonary Tuberculosis 234 1 — — 1 2 12 15 30 91 40 34 8 30 19 39 44 46 56 — Other forms of Tuberculosis 53 1 2 2 2 5 15 7 5 11 2 1 — 3 1 16 10 8 15 — Totals 1,200 36 42 32 52 83 357 146 80 186 81 82 23 152 157 248 190 180 273 311 25 IO M. of H. Table III. . , T tar T.F. DF DEATHS during the Year 1925 in the Tottenham Urban Sanitary District, classified according to Diseases, Ages and Localities. Causes of Deatii. Deaths at the subjoined ages of "Residents" whether occurring in or beyond the District Deaths at all ages of "Residents" belonging to Localities, whether occurring in or beyond the District. Total Deaths, whether of "Residents" or "nonResidents" in Institutions in the District. \11 Ages. Under 1 year. 1 and under 2. 2 and under 5. 5 and under 15. 15 and ander 25. 25 and under 35. 35 and under 45. 45 and under 55. 55 and under 65. 65 and under 75.1 75 and under 85. 85 and upwards. Harringay. SVest Green. St. Ann*8. High Cross. Middle. Lower. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 is 20 Enteric Fever 2 - - - - - - 1 - - - - - - - - 1 - 1 - Smallpox - - - - - - - - - - - - - - - - - - - - Measles 2 — — 2 — — — - - - - - 1 - - - - - 10 Searlet Fever - - - - - - - - - - - - - - - - - - - 7 Whooping Cough 19 11 4 3 — 1 - - - - - - - 4 2 6 2 3 2 24 Diphtheria 9 — 1 3 5 - - - - - - - - 2 1 2 1 1 2 25 Influenza 26 2 — 1 — 1 1 5 3 2 5 4 2 3 2 8 2 7 4 - 4, 1 1 1 1 1 1 1 i Erysipelas ■piifViioia (Pnlmnnarv Tuboroiilosis). . 112 1 1 4 26 26 24 19 6 5 — — 11 ? 22 23 25 22 3 I llvlllblo UllltUUiU -L UUC1 • ■ i x x 2 2 2 1 Tuberculous Meningitis 8 19 i x i x 5 3 1 5 3 — 1 2 5 5 1 5 3 Other Tuberculous Diseases 198 2 1 2 7 17 35 43 61 26 4 29 34 30 35 37 33 42 Cancer, malignant disease 4 1 1 1 1 — — — — 2 1 1 — — Rheumatic Fever « x 2 2 1 — 1 1 1 2 1 2 Meningitis u 296 x 7 8 8 13 23 42 91 78 25 39 42 61 54 45 55 23 Heart Disease Q A A 2 3 12 22 44 42 9 17 21 32 26 36 19 4 Bronchitis 151 4 a 7 3 10 7 10 13 5 3 12 13 27 18 11 22 22 Pneumonia (all forms) 103 23 11 5 0 i 1 1 x 2 8 1 1 2 3 4 6 2 Other diseases of Respiratory Organs 18 16 8 1 1 1 1 1 2 1 3 2 1 4 5 4 3 Diarrhoea and Enteritis A TvnAn i/>it ic ft n r\ 'i'l'Ttll 1 if 1Q 16 4 3 1 1 — — 1 — — 2 — _2 — _2 4 4 Appendicitis ana jLypiiiiojs _ — — — — — — — ^TftnKfif ia o n/1 iirllf 'a T11QPJ1QO 31 1 1 1 3 4 7 6 5 3 — 5 3 4 9 3 7 6 is epnritis aiiu jDrigiiv s i/iseosc Puerperal Fever • • — — — — — — — — — — — — — — Other accidents and diseases of Pregnancy and Parturition 6 1 2 2 1 — — — — 2 — 2 1 1 — Congenital Debility, Malformation, and Premature Birth 74 74 A A 6 11 k 6 16 xx 11 5 14 7 16 4 3 14 Violent Deaths, excluding Suicide 38 1 2 1 6 2 3 4 4 4 4 L o D o 2 Suicide 20 — — — — 1 2 2 2 8 4 l 3 3 4 3 4 Cerebro-Spinal Meningitis Other Defined Diseases 413 16 2 9 9 9 14 21 46 68 91 92 36 69 44 63 79 85 73 101 Diseases ill-defined or unknown 3 — — — — — — — — 2 — 1 — — — ~~ 2 r 1 9 9 Encephalitis Lethargica 8 1 1 1 — — 1 1 2 1 3 2 i Ct Totals 1596 150 31 44 50 64 80 116 165 223 330 263 80 220 193 309 290 298 286 308 27 M. of H. Table IV. INFANTILE DEATHS in Ages, Sexes and Localities, during the year 1925. CAUSE OF DEATH Under 1 week. 1—2 weeks. 2—3 weeks. 3—4 weeks. Tota 1 under 4 weeks. 1—3 months. 3—6 1 months. 1 6—0 months. i 9—12 ' mon tin. Total Deaths under 1 v»rtr. Males. Females. Harringay Ward. West Green Ward. St. Ann's Ward. \High Cross Ward. Middle Ward. Lower Ward. Smallpox - - - - - - - - - - - - - - - - - - Chicken Pox - - - - - - - - - - - - - - - - - - Measles - - - - - - - - - - - - - - - - - - Scarlet Fever — — — — — — — — — — — — — — — — "7 Whooping Cough — — — — — 1 3 2 11 7 4 2 5 — 1 Diphtheria and Croup - - - - - - - - - - - - - - - - - - Erysipelas — — — — — — — — — — — - - - - - - - Tuberculous Meningitis - - - - - - - - 1 1 1 — — - - - - - Abdominal Tuberculosis - - - - - - - - - - - - - - - - - - Other Tuberculous Diseases — — — — — 1 — — 1 1 — — — — — — Meningitis (not Tuberculous) — — — — — — — 1 1 1 — Convulsions 3 1 — — 4 1 — — ft 3 2 — * Laryngitis — — — — — — — — — — — — — Bronchitis — — — — — 4 3 1 1 9 6 3 — — 6 - Pneumonia (all forms) — 1 — — 1 ft 7 4 23 18 5 3 5 2 1 Diarrhoea — — — — — — — — — — — — — — — Enteritis — — 1 — 1 3 2 1 9 6 3 — — — 2 4 Gastritis — — — 1 1 — 1 — — 1 1 — — — — Syphilis — — — — — 1 — — — 1 1 — 1 — Rickets - - - - - - - - - - - - - - - - - - Suffocation (Overlying) - - - - - - - - - - - - - - - - - - Tnjurv at Birth 1 — — — 1 — — — — 1 — 1 — — ' ' Atelectasis •J 2 — — 4 — — — 4 — 4 — — Congenital Malformations 2 3 — 2 7 3 1 — — 11 8 3 2 1 — Premature Birth 21 4 2 — 27 2 — — — 29 18 11 6 6 o Atrophv, Debility and Marasmus 4 2 4 1 11 8 6 — 2 27 16 11 1 }f 8 3 Other Causes 7 1 — 1 0 3 1 — 15 8 7 3 Totals 40 14 7 5 66 33 23 12 16 150 95 55 18 14 38 23 27 30 28 cause of death. Total Males. Females. Ages. 0 to I 1 to 2 2 to 5 5 to 11 10 to 1. 15 to 2< 20 to 25 25 to 35 35 to 45 45 to 55 55 to 60 60 to 65 65 to 75 75 to 85 85 and upwards. I. Epidemic, Endemic and Infectious Diseases Enteric Fever. (0) Typhoid Fever 2 - 2 - - - 1 - - - - 1 - - - - - - Measles 2 1 1 — — 2 — — — — — — — — — — — — Whooping Cough 19 11 8 11 4 3 - - - 1 - - - - - - - - Diphtheria 9 3 6 — 1 3 4 1 - - - - - - - - - - Influenza (a) 1. With pneumonic comp cations 8 2 6 - — 1 — — — 1 — 3 2 — — — 1 — 2. With other pulmona complications 1 1 - - - - - - - - - - - - - - 1 — (b) - 1. With non-pulmonary complications 9 3 6 1 — — — — — — 1 I — — 1 4 — 1 2. Without stated comp cations 8 4 4 1 - - - - - - - 1 1 2 — — 2 1 Erysipelas 4 1 3 - - - - - - - - - 1 1 — 1 1 — Encephalitis lethargica 8 2 6 1 1 1 — — — — 1 I 2 1 — — — — Meningococcal meningitis 2 2 Tuberculosis (All Forms). Respiratory system 112 70 42 — 1 1 1 3 14 12 26 24 19 4 2 5 — — Nervous system 8 7 1 1 1 4 — — — — — 1 1 - - - - - Intestines and peritoneum 4 1 3 Vertebral column - - - - - - - - - - - - - - - - - - Joints 1 1 — — — — 1 Other Organs (b) Bones (vertebral column excepted) 1 - 1 - - - - - - - - 1 - - - - - - (d) Oenito-urinary system 2 (e) Others in 36 3 1 2 — — 1 — — - — 1 1 — — — — — — Disseminated tuberculosis (a) Acute 5 2 3 1 1 1 — 1 1 - - - - - - - - - (6) Chronic or unstated 2 2 - - - - - - - - - - - - - - - - Syphilis 1 1 — 1 - - - - - - - - - - - - - - Purulent infection, septicaemia (2) Other forms 2 1 1 - - - 1 - - - - - - - - 1 — — 29 No. CAUSE OF DEATH. Total. Males. Females. Ages. 0 to 1 1 to 2 2 to 5 5 to 10 10 to 15 15 to 20 20 to 25 25 to 35 35 to 45 45 to 55 55 to 60 60 to 65 65 to 75 75 to 85 85 and upwards 43-69 II. General Diseases not Included in I. (1-42) 43-49 Cancer, Malignant Disease. 43 Buccal cavity 12 9 3 — — — 1 1 3 4 3 44 Pharynx, oesophagus, ach, liver and annexa 61 37 24 1 4 10 5 8 24 8 1 45 Peritoneum, intestines and rectum 39 21 18 — — — 1 1 4 7 5 13 6 2 46 Female genital organs 23 — 23 — — — — - — — 5 7 — 5 2 2 — 47 Breast 22 22 3 7 1 7 2 1 48 Skin 1 1 1 49 Other or unspecified organs 40 24 16 — — 2 1 1 — 1 1 10 0 11 4 — 50 Tumours not returned as malignant (brain and female genital organs excepted) 4 1 3 — — 1 1 - — — 1 — — — 1 — 51 Rheumatic fever 4 2 2 — — — 1 1 1 1 — 52 Chronic rheumatism, osteo-arthritis, gout (1) Chronic rheumatismt chronic arthritis (2) Rheumatoid and 4 3 1 - - - - - - - - - - - - - - - arthritis 1 1 1 54 Pellagra 1 — 1 - - - - - - - - - l - - - - - 57 Diabetes 14 5 9 — — — 1 2 1 2 1 5 2 — 58 Anaemia, chlorosis (a) Pernicious anaemia 6 1 5 1 1 1 1 2 60 Diseases of the thyroid gland (a) Exophthalmic goitre 8 1 7 1 3 1 1 1 1 2. Cretinism 1 1 1 63 Diseases of the adrenals 1 1 65 Leukaemia, lymphadenoma (a) Leukoemia 4 4 — — — 1 1 1 1 (6/ Lymphadenoma (Hodgkin's disease) 2 1 1 66 Alcoholism (acute or chronic) 2 1 1 69 Other general diseases (1) Purpura 1 1 —* — — — 1 — — — — — — — 30 No. CAUSE OF DEATH. Total Males Females Ages. 0 to 1 1 to 2 2 to 5 5 to 10 10 to 15 15 to 20 20 to 25 25 to 35 35 to 45 45 to 55 55 to 60 60 to 65 65 to 75 75 to 85 85 and upwards 70-86 III. Diseases of the Nervous System and Sense Organs. 71 Meningitis 6 4 2 1 2 2 - - - - - - - - - - - - 72 Tabes dorsalis (locomotor ataxy) 7 — — — — — — — — — — 1 — 2 4 — - 73 Other diseases of the spinal cord 2 1 1 - - - - - - - - - - - - - - - 74 Cerebral haemorrhage, apoplexy, etc. (a) 1 . Cerebral haemorrhage, so returned 63 28 35 — — 1 — — — 1 1 1 8 9 5 16 15 6 [2. Apoplexy, lesion unstated 4 2 2 - - - - - - - - - - - - 2 1 1 (b) Cerebral thrombosis 10 5 5 - - - - - - - - - - - 3 2 4 75 Paralysis of unstated origin (a) Hemiplegia 9 2 7 - - - i — — — 1 — — — — 3 4 — (b Other forms of paralysis 4 1 3 - - - - - - - - - - - - - - - 76 General paralysis of the insane 7 6 1 - - - - - - - 1 3 2 1 — — - - 77 Other forms of insanity 1 - - - - - - - - - - - - - - - - - 78 Epilepsy 5 2 3 - - - - - 1 — 1 2 1 - - - - - 79-80 Convulsions (non-puerperal) 5 3 2 5 - - - - - - - - - - - - - - 82 Hysteria and neuritis - - - - - - - - - - - - - - - - - - 83 Cerebral softening 3 1 2 - - - - - - - - - - - - - - - 84 Other diseases of the nervous system (1) Idiocyt imbecility 1 1 - - - - - - - - - - - - - - - - (2) Cerebral tumour 3 1 2 - - - - - - - 1 1 1 - - - - - (3) Disseminated sclerosis 2 2 - - - - - - - - - - - - - - - - (4) Paralysis agitans 3 3 - - - - - - - - - - - - - - - - (5) Other diseases included under £4 3 2 1 - 1 - - - - - - - - - - - - - 86 Diseases of the ear and of the mastoid sinus (2) Diseases of the ear 3 1 2 - - - - - 1 - - - - 1 - 1 - - 87-96 IV. Diseases of the Circulatory System. 87-90 Heart Disease. 88 Acute endocarditis and myocarditis 31 No. CAUSE OF DEATH. Total Males. Females. Ages. 0 to 1 1 to 2 2 to 5 5 to 10 10 to 15 15 to 20 20 to 25 25 to 35 35 to 45 45 to 55 55 to 60 60 to 65 65 to 75 75 to 85 Hb an upwards Heart Disease—(contd.) (1) Infective endocarditis 6 4 2 - - - - - - - 2 2 - 2 - - - - (2) Other acute endocarditis 11 7 4 1 — — 1 2 5 — — - 1 1 - - - - (3) Acute myocarditis 3 1 2 - - - - - - - - - - - - 1 2 - 89 Angina pectoris 1 1 - - - - - - - - - - - - - - 1 - 90 Other diseases of the heart 2 9 3 5 5 (1) Aortic valve disease 19 15 4 - - - - - - - 1 1 (2) Mitral valve disease 30 14 16 — — — — 2 — 2 3 (3) Aortic and mitral valve disease 32 15 17 — — — 1 1 — — 1 2 3 4 I 8 9 2 (4) Other or unspecified valve diseases 12 5 7 2 — I 3 4 1 (5) Fatty heart 10 1 9 - - - - - - - - - - - - - - - (6) Cardiac dilatation, cause unspecified 3 1 2 - - - - - - - - - - 1 — 1 1 — (7) Other or unspecified myocardial disease 99 44 55 — — — — 1 — 1 4 2 9 35 31 16 (8) Disordered action of the heart (9) Heart disease (undefined) . 69 34 35 - - - - - - 1 2 4 6 1 7 22 21 5 91 Diseases of the arteries (a) Aneurism 2 1 1 - - - - - - - - - - - - - - - (b) Arteriosclerosis (1) With record of cerebral vascular lesion 10 7 3 - - - - - - - - - - 2 1 4 1 2 (2) Without record of cerebral vascular lesion 38 15 23 - - - - - - - - - - 1 3 10 18 6 (c) Other diseases of the arteries 3 1 2 - - - - - - - - - - - - - - - 97-107 V. Diseases of the Respiratory System 99 Bronchitis (a) Acute 29 12 17 2 — 2 — — — — 1 — 2 2 1 9 9 1 (6) Chronic j. 42 28 14 - - - - - - - - 1 2 - - - - - (c) and (d) Not stated whether acute or chronic 0 51 20 7 4 2 — — — — 1 2 8 3 9 16 22 6 100-101 Pneumonia (All Forms) ] 3 1 100 Broncho-pneumonia 57 33 24 21 10 4 3 - - - - - - - - - - - No. CAUSE OF DEATH. Total Males Females. Ages. 0 to 1 1 to 2 2 to 5 5 to 10 10 to 15 15 to 20 20 to 25 25 to 35 1 35 to 45 45 to 55 55 to 60 60 to 65 65 to 75 75 to 85 85 and upwards . Pneumonia—(contd). 101 Pneumonia (lobar and not otherwise defined (a) Lobar 21 12 9 - 1 1 — 2 — — 2 5 3 2 1 2 2 — (6) Not otherwise defined 25 12 13 2 — — 1 — 2 3 1 2 3 — 5 4 — 2 102 Pleurisy (1) Empyema 3 1 2 — — 1 — — 1 — — — — — — — 1 — (2) Other pleurisy 5 4 1 — — — — 1 — — — 1 1 — 1 1 — — 103 Congestion and haemorrhagie infarction of lung 1 1 1 105 Asthma 5 5 — — — — — — — — — 1 2 1 1 —• — 106 Pulmonary emphysema 2 1 1 - - - - - - - - - - 1 1 - - - 107 Other diseases of the respiratory system (c) Other diseases included under 107 2 1 1 - - - - - - - - - - 2 - - - - 108-127 VI. Diseases of the Digestive System. 108 Diseases of the buccal cavity and annexa (1) Diseases of the teeth and gums 1 - 1 - - - - - - - - - - - - 1 - - 109 Diseases of the pharynx and tonsils (1) Tonsilitis, etc., adenoid vegetation 4 2 2 - - - 1 1 - 1 - - 1 - - - - - (2) Other diseases included under 109 2 2 - 1 - - - - - 1 - - - - - - - - 111 Ulcer of the stomach or duodenum (a) Ulcer of the stomach 17 10 7 - - - - - - - 3 2 6 2 1 2 1 — (6) Ulcer of the duodenum 5 4 1 — — — — — — — — — 3 1 — 1 — — 112 Other diseases of the stomach (1) Inflammation of the stomach 4 2 2 2 — 1 - - - - - - - - - 1 - - (2) Other diseases includec under 112 1 1 - 1 - - - - - - - - - - - - - - 113-114 Diarrhoea and enteritis (2) Colitis 2 1 1 - - - 1 - - - - 1 - - - - -i — 32 33 No. CAUSE OF DEATH. Total Males. Females Ages. 0 to 1 1 to 2 2 to 5 5 to 10 10 to 15 15 to 20 20 to 25 25 to 35 35 to 45 45 to 55 55 to 60 60 to 65 65 to 75 75 to 85 85 and upwards . (3) Other diseases included under 113-114 14 6 8 8 1 1 1 1 2 117 Appendicitis and typhlitis 10 6 4 — — — 3 1 2 1 1 1 — — — 1 — — 118 Hernia, intestinal obstruction (o) Hernia 10 6 4 1 1 4 — — 3 1 — (b) Intestinal obstruction 7 3 4 1 1 1 1 3 — — 119 Other diseases of the intestines 2 122 Cirrhosis of the liver (b) Not returned as alcoholic 5 3 2 _ 124 Other diseases of the liver 5 2 3 2 — 1 2 — VII. Non-Puerperal Diseases of the Genito-Urinary System. 128 Acute nephritis (including unspecified under 10 years of age) 6 3 3 1 1 2 1 1 __ 129 Chronic nephritis (including unspecified under 10 years of age) 25 10 15 1 1 3 7 2 3 5 3 131 Other diseases of the kidneys and annexa 4 4 1 2 1 132 Calculi of the urinary passages 1 133 Diseases of the bladder \\) Cystitis 5 3 2 1 — 1 3 — — (2) Other diseases 1 1 1 134 Diseases of the urethra, urinary abscess, etc (a) Stricture of the urethra 2 2 135 Diseases of the prostate 8 8 1 2 3 1 1 138 Salpingitis and pelvic abscess 139 Tumours of the uterus not returned as malignant 1 143-150 VIII. The Puerperal State 143 Accidents of pregnancy (a) Abortion 3 3 1 2 144 Puerperal haemorrhage 2 148 Puerperal albuminuria and convulsions 1 — 1 34 No. CAUSE OF DEATH. Total. Males. | Females, Ages. 0 to 1 1 to 2 2 to 5 5 to 10 10 to 15 15 to 20 20 to 25 25 to 35 35 to 45 45 to 55 55 to 60 60 to 65 65 to 75 75 to 85 85 and upwards . 151-154 IX. Diseases of the skin and Cellular Tissue 151 Gangrene (\) Senile gangrene 2 1 1 9 — (2) Other gangrene 1 1 153 Phlegmon, acute abscess (2) Acute abscess 2 i i 154 Other diseases of the skin and its annexa (2) Eczema 1 — i — 1 (4) Other diseases included under 154 3 2 i 155-158 X. Diseases of the Bones and Organs of Locomotion. 155 Diseases of the bones (1) Infective osteomyelitis and periostitis 1 159 XI. Malformations. (2) Congenital malformation of heart 4 3 i 4 (3) Other congenital malformations 7 6 i 7 160-163 XII. Diseases of Early Infancy. 160 Congenital debility, sclerema and icterus (1) Congenital debility and sclerema 25 14 11 25 (2) Icterus 2 1 i 0 161 Premature birth, injury at birth (1) Premature birth 29 17 12 29 (2) Injury at birth 1 — 1 1 — — — — — — — — — 162 Other diseases peculiar to early infancy (1) Atelectasis 4 — 4 4 — — . — — — — — — — — — — — 35 No. CAUSE OF DEATH. Total. Males Femalesc Ages. 0 to 1 1 to 2 2 to 5 5 to 10 10 to 15 15 to 20 20 to 25 25 to 35 35 to 45 45 to 55 55 to 60 60 to 65 65 to 75 75 to 85 85 and upwards. (3) Other diseases included under 162 2 2 - 2 - - - - - - - - - - - - - - 163 Lack of care 5 2 3 5 - - - - - - - - - - - - - 164 XIII. Old Age (1) Senile dementia 2 2 - - - - - - - - - - 1 - - - 1 - (2) Other forms of senile decay 67 24 43 - - - - - - - - - 1 2 8 37 19 165-203 XIV. External Causes. 165-174 Suicide. 165-166 By solid or liquid poisons and corrosive substances 4 1 3 - - - - - - 1 1 - - 1 1 — — — 167 By poisonous gas 8 4 4 - - - - - - - 1 - 2 1 2 2 - - 169 By drowning 1 1 - - - - - - - - - - 1 - - - - 171 By cutting or piercing ments 5 4 1 - - - - - - - - 2 - - 1 1 1 - 173 By crushing 2 2 - - - - - - - - - - - - 1 1 - 175-196 Violent Deaths, Excluding Suicide and Homicide. 178 Conflagration 1 1 - - - - - - - - - - - - - 1 - - 179 Burns (conflagration cepted) 3 - 3 - 2 1 - - - - - - - - - - - - 182 Accidental drowning 2 2 1 1 185 By fall 10 4 6 - - - - - - -- 1 2 - - 2 4 1 187 By machinery 1 1 - - - - - - - - - - - 1 - - - - 188 By other forms of crushing (vehicles, railways, etc. 18 16 2 - - - 3 3 1 1 2 3 2 1 1 1 197-199 Homicide. 198 By cutting or piercing ments 1 1 - 1 - - - - - - - - - - - - - - 199 By other means 1 201 Fracture (cause not specified 1 1 - - - - - - 1 - - - - - - - - - 204-205 XV. Ill-Defined Diseases. (2) Other ill-defined causes 2 1 1 - - - - - - - - - - 1 - - 1 - (3) Cause not specified 1 - 1 - - - - - - - - - - - 1 - - - Totals 1596 823 773 150 31 44 26 24 | 33 31 [ 80 116 165 98 125 330 263 80 36 MALIGNANT GROWTHS. CANCER. Digestive System:— Males. Females. Mouth 1 1 Tongue 5 — Pharynx 1 — (Esophagus 4 1 Stomach 19 14 Pylorus 1 3 Bowels (large and small intestines) 12 8 Rectum 8 10 Liver and Gall Bladder 3 5 Pancreas 2 4 Genito-urinary:— Kidney 4 1 Bladder 3 5 Penis 1 — Prostate 3 — Breast — 22 Uterus — 20 Ovary — 3 Respiratory:— Nose — 1 Tonsil 2 — Larynx 5 — Lung 6 4 Various:— Cutaneous (face and lips) 6 1 Mediastinum 2 1 Spleen — 1 SARCOMATA. Melanotic Sarcoma 1 — Osteo-sarcoma 1 — Thigh — 1 Fibia 1 — Frontal Linus 1 — 92 106 37 VIOLENCE. There were 58 deaths from Violence, including 20 which were suicidal. In 1924, the number was 58, and in 1923, 56. • Males. Females. Burnt to Death 1 — Scalding — 3 Drowning 2 — Falls:— From Building 1 — ,, Ladder 1 — At Play 1 — Into Lift Pit 1 — Other — 6 Crushing by Floor of Lift 1 — Run over by Motor-Car 1 — ,, Motor Lorry 1 — ,, Steam Waggon 1 — ,, Trailer — ,, Char-a-banc — 1 Collision of Motor and Van 1 — ,, Motor-Car and Motor Bicycle 1 — ,, Bicycle and Motor Lorry 1 — Knocked down by Motor Cycle 1 — ,, ,, Motor-Bus 1 — ,, ,, Motor Lorry — ,, ,, Train 1 — Struck by Tramcar 1 — Crushed between Buffer and Iron Post 1 — Cut Throat (infanticide) 1 — Other 2 2 SUICIDES. By Poisoning 1 3 ,, Coal Gas Poisoning 4 4 ,, Cut Throat 4 1 ,, Injuries by Train 2 — ,, Drowning — 1 37 21 38 Mortuary Table for the Year 1925. Bodies Admitted. No. of Post-Morteros. No. of Inquests Deaths from Violence Deaths from Drowning Month Males Femal ee Total Male; Females Total January 3 3 6 1 3 4 6 2 1 February 2 5 7 1 5 6 7 3 — March 2 7 9 — 6 6 9 3 — April 7 6 13 6 5 11 13 3 1 May 3 2 5 1 2 3 5 4 — June 5 3 8 4 2 6 8 2 — July 6 1 7 4 1 5 7 7 — August 5 3 8 5 3 8 8 5 1 September 8 6 14 8 4 12 14 — 1 October 8 3 11 7 3 10 11 3 — November 7 5 12 6 4 10 12 4 1 December 6 7 13 4 6 10 13 3 — Total 62 51 113 47 44 91 113 39 5 No. of bodies admitted to await Burial 37. The following List gives the Causes to which Deaths were attributed by the Coroner or Coroner's Juries:— Aneurism 1 Syphilis 1 Aorta, rupture of 8 Tumour on Kidney .1 Arteriosclerosis 1 Suicides:— Bronchitis 5 Poisoning 3 Cancer 1 Gas Poisoning 7 Convulsions 3 Hanging 1 Cerebral Haemorrhage 9 Cut Throat 5 Congestion of Lungs 1 Drowning 3 Gastric Ulcer 1 Killed on Railway 1 Haemorrhage 3 Accidents:— Inanition 1 Burns 1 Inattention at Birth 4 Run over by Motor 10 Marasmus 3 Run over by Tramcar 1 39 Nephritis 1 Drowning 2 Pneumonia 6 Knocked down by Motor 3 Septicaemia 2 Fall from Scaffold 1 Still-Born 2 Fall down Lift Shaft 1 Status Lymphaticus 1 Fall Downstairs 1 Syncope 14 Scalding 4 The amount of Poor Law Relief; the extent to which hospital and other forms of gratuitous medical relief are utilised. The following information has been kindly supplied by the Clerk of the Guardians:— Out-Door Relief. Unemployed : Ordinary : No. of Cases, Amount, No. of Cases, Amount, 1,994. £17519. 1901. £51568 North Middlesex Hospital. No. of cases admitted during 1925, 2,245 No. of days In-maintenance during 1925, ••• 94,895 Any causes of sickness or invalidity which have been specially noteworthy in the area during the period under review; and any conditions of occupation or environment which appear to have had a prejudicial effect on health. There have been no such noteworthy conditions, beyond the inadequate housing provision, which must have had a prejudicial effect on the health of those subjected thereto. It is not, however, reflected in the vital statistics. INFECTIOUS DISEASES GENERALLY. Smallpox.—No case of Smallpox has been notified in Tottenham in the period 1920 to 1925. From time to time, intimation is received of contacts with Smallpox cases elsewhere coming to visit or reside in this area. These contacts are visited and kept under scrutiny for the requisite period of a fortnight or more, but in no instance have they developed the disease. The Vaccination Officer for Tottenham informs me that the number of Tottenham children vaccinated during 1925 was 933; the number of declarations of conscientious objection to vaccination received was 1,196. * * * * The following table shows the incidence of notifiable infectious diseases for the period 1920—25:— NOTIFICATION OF INFECTIOUS DISEASES, 1920—1925. Cases Notified. Deaths. Death Rates. 1920 1921 1922 1923 1924 1925 1920 1921 1922 1923 1924 1925 1920 1921 1922 1923 1924 1925 Dysentery 3 1 - 1 - - - - - - - - - - - - - - Encephalitis Lethargica 7 6 2 4 31 17 1 2 1 2 7 8 .006 .013 .006 •012 .04 .051 Diphtheria (including Mem. Croup) 492 561 400 194 227 252 41 49 45 8 5 4 .26 .33 .29 .05 .03 .025 Erysipelas 51 65 35 43 22 44 1 4 1 2 1 4 .006 .027 .006 .012 .006 .025 Scarlet Fever 596 1062 919 385 367 427 7 6 6 3 — — .04 .04 .03 .019 — Enteric Fever 1 4 6 2 6 2 — 1 1 — 1 2 — .006 .006 .006 .012 Malaria 45 5 5 2 — — — — — — — __ Pneumonia 218 180 352 200 217 149 145* 102* 155* 118* 125* 104* .92 .65 1.0 .76 .80 .66 Puerperal Fever 8 5 6 3 5 6 4 3 2 4 3 .02 .02 .013 .025 .019 Cerebro-spinal Meningitis 3 1 1 2 3 5 2 .01 .032 .012 Poliomyelitis 4 2 - 2 1 1 - - - - - - - - - - - - Ophthalmia Neonatorum 32 29 15 15 12 13 - - - - - - - -- - - - Pulmonary Tuberculosis 342 258 254 242 231 234 133 119 125 113 124 112 .85 .79 .82 .73 .79 .71 Other forms of Tuberculosis 71 54 64 49 44 53 23 37 30 25 28 27 .14 .25 .19 .15 .18 .17 Measles 1164 166 2658 - - - 15 1 23 6 22 2 .09 .007 .15 .03 .14 .012 *It is to be noted that whereas only Acute Primary Pneumonia and Influenzal Pneumonia are notifiable and recorded above, the deaths and death-rates refer to deaths returned as due to all forms of Pneumonia. 40 41 Measles was notifiable during the first three of the six years for which figures are given in the table. With the reduction in numbers of cases of Scarlet Fever sent to hospital from Tottenham, the Metropolitan Asylums Board have been willing to admit complicated cases of Measles and Whooping Cough for whom institutional treatment was desirable. Thus 7 cases of Measles and 15 of Whooping Cough received hospital treatment in 1925. The complications in these institutionally-treated cases were as follows :—Measles and Pneumonia, 5; Measles and Meningitis, 1; Measles (In-patient, General Hospital), 1. Whooping Cough and Pneumonia, 13; Whooping Cough and Bronchitis, 1; Whooping Cough and Congestion of the Lungs, 1. Tuberculosis.—The County Council are responsible for the treatment of Tuberculosis. Notifications are made to the Medical Officer of Health of the District, who forwards the information respecting them to the County Medical Officer of Health. The Tottenham Tuberculosis Officer has his premises at 140, West Green Road. The days and hours of attendance at the Dispensary are as follows :■— Monday, Men, 10 a.m.; Tuesday, Women, 10 a.m.; children, 2.30 p.m. Wednesday, Women, 10 a.m.; cases who are working and unable to attend during the day, 7 p.m. Thursday, Children, 10 a.m. Friday, Men, 10 a.m. The number of persons suffering from Tuberculosis (all forms) appearing on the Register is 1,053. This number may be regarded as fairly accurate, as all cases have been recently visited or otherwise accounted for by the Tuberculosis Officer and the Medical Officer of Health. The declension in the Incidence Rate and Death-Rate is inconsiderable. The Pulmonary form of Tuberculosis ranks first amongst notifiable infectious diseases for its killing propensity, with Pneumonia following closely and. in times of Influenza prevalence, surpassing it. 42 TUBERCULOSIS. Age Periods. New Cases. Deaths. Pulmonary. NonPulmonary . Pulmonary. NonPulmonary. Males Females Males Females Males Females Males Females Under 1 year — 1 1 - — — 2 — 1 to 5 years 3 — 3 8 1 1 7 4 5 lo 10 ,, 6 6 7 8 1 — 1 — 10 to 15 ,, 7 8 3 4 2 1 — 2 15 to 20 ,, 12 18 3 2 8 6 1 — 20 to 25 ,, 30 61 5 6 / 4 8 — — 25 to 35 ,, (u 12 1 4 35 to 45 ,, 31 9 2 — 18 6 2 2 45 to 55 25 9 1 r- 13 6 1 — 55 (o 65 ,, | l- 4 2 — — 65 and over 3 5 — — 5 — — — Totals 117 117 25 28 70 42 15 12 Organs Affected (New Cases):— Males. Females. Lungs 115 116 Meninges — 1 Wrist 1 — Spine 4 4 Bones — 1 Foot 1 — Hip 5 4 Knee 2 4 Peritoneum 4 4 Abdomen 2 1 Other 6 9 Dual Organs:— Lungs and Kidneys 1 1 Lungs and Abdomen 1 — 142 145 43 Dysentery and Malaria.—In respect of Dysentery and Malaria, no notifications have been received for the past 2 years, and no deaths have been attributed to these causes for the past 6 years. Ophthalmia Neonatorum.-—The early notification of Ophthalmia Neonatorum has undoubtedly been effectual in preventing the loss of, or damage to, sight of many children. Prompt "following up" and insistence on immediate and thorough treatment has resulted in there being no damage to the eyes of the patients notified during the past 12 months. Puerperal Fever .—There has been no reduction in the number of cases of Puerperal Fever notified, but there is a gratifying reduction in the case mortality in 1925. No maternal deaths were recorded from this cause. Poliomyelitis remains sporadic in its incidence, and has not assumed fatal form in any instance for the 6 years under review. Cerebro-Spinal Fever, although also sporadic in its visitation, continues to take its toll of life. In 1923, it will be observed that although only 1 case was notified in the District, 5 deaths occurred of persons belonging to the District. Encephalitis Lethargica.—-This disease has, for the past 2 years, shown a marked exacerbation both in its incidence and fatality. Of the 17 cases notified in 1925, 10 were "resident" in the High Cross Ward; 2 of the 10, however, occurred in the Prince of Wales's Hospital. Duplicate cases have not been recorded, and so little is the disease considered to be infectious, that patients in hospital are allowed to remain in the General Ward; and only one case was removed from home to hospital, on account of domestic circumstances. The following particulars were ascertained for the Board of Education in relation to young persons who had suffered from Encephalitis Lethargica:— V. L.—Left school and at work since January, 1924, since when she has been to two situations. Appears not to have worked satisfactorily at first place. Attended Prince of Wales's Hospital from time of diagnosis until Christmas, 1924. Glasses prescribed. Mother states that there is still slight strabismus . Depression still present, but no sleepiness . 44 F. G.—Was an in-patient, West End Hospital for Nervous Diseases, for 14 weeks ; is still very ill. Is always tired, but does not sleep a great deal as she suffers from severe pains in head, which increase when gas is lit and continue to be severe during night, preventing sleep. Walks better than she stands, but tends to walk sideways. Drags legs. Often falls backwards when standing. Memory good. No squint or diplopia now, but says she can often see lights flashing before her eyes. No mental symptoms. Pupils react to light, but not accommodation. No Rhomberg sign. Speech slow. Happy, not depressed. K. B.—Scarlet Fever followed by Encephalitis Lethargica, and that by Enteric Fever. Treated for Encephalitis Lethargica at Evelina Hospital, and transferred from there to Isolation Hospital, where she contracted Enteric. Walks sideways, and gait slightly unsteady. Falls if she turns quickly. Has lost confidence in herself. Mentally no change, except that she is easily depressed. No untimely sleepiness; sleeps well at night. Reflexes normal. Pupils react to light and accommodation. Complains that at times L. hand and L. leg get "fixed." A. T. C.—Attending school. Resumed attendance 12 months after attack. In good health, except for periodic (infrequent) violent attacks of headache and night terrors and that he is somewhat nervous. Was very ill at time of attack, apparently comatose. Was in-patient, Hampstead Hospital. Mentally quite alert. E. E.—Almost constant violent tremors of left upper extremity; no paralysis. Walks well, but gait a little peculiar and tires easily. Reflexes active. Speech very slow and scanning. Sleep varies, some insomnia. Eyes frequently become fixed with a stare. Appetite good. Mentality, etc., unimpaired. Is under National Hospital for Paralysis, and is shortly going to Convalescent Home. (May, 1926.—Been in Convalescent Home. Improved, but speech still affected, and tremors, etc., occasionally present). N. B.—Was in-patient, M.A.B., Hospital, June—-July, 1924, for 7 weeks. Under private doctors since. Weakness of muscles of back and neck present. Can only walk a few hundred yards and then is fatigued; and when walking, is said to walk on toes'—sideways—and to bend body forwards. Tends to run. Often falls forwards when standing. No visual defects. Is occasionally depressed. Temper uneven, but was so before illness . Memory good ; appetite good. Sleeps well. Speech slow and slurring. Reflexes somewhat sluggish. 45 J. G.—Mentally unbalanced since attack. Was in-patient, General Hospital for 5 weeks. Has been under observation of School Medical Officers since 1922, when he had to be excluded from ordinary elementary school. Was then found to be mischievous, very excitable, uncontrolled and spiteful, etc., and unmanageable at home. Was transferred to Special (Residential) School, but after a short period had to be discharged from there on account of being unmanageable and vicious in habits. Has now been dealt with by Medical Officer under Mental Deficiency Act, and is an inmate of an institution. G. W. (4-6-26).-—Attack of Encephalitis Lethargica about a year ago. In-patient, National Hospital for Paralysis. Now mentally and physically changed. Has become spiteful and untruthful. Legs weak, and cannot walk far. Face immobile; mouth open; eyes, fixed stare. All movements sluggish. Speech very slow. Enteric Fever.—Two cases were notified in 1925, and both were removed to hospital. One of these proved fatal. A second death from Enteric Fever was debited to this District, and related to a female adult— an inmate of Napsbury Asylum. Facility is afforded for the verification of diagnosis by Widal's test at the Laboratories of the Prince of Wales's Hospital. Erysipelas.—For the hospital treatment of patients suffering from Erysipelas, we are indebted to the Enfield and Edmonton Joint Hospital Board. Dr. Haldane Cook, of that Institution, has come to Tottenham's aid generously when, but for the hospitality of his Board, Tottenham's patients in need of institutional care would have been deprived of that advantage. Of the 44 cases notified, 12 were removed to hospital, and 32 were nursed at home. Diphtheria.—The "peak" in respect of the incidence of this disease was reached in 1921, with 561 notifications. The notifications in 1923 were 194, the "trough" of the wave—almost exactly one-third of that of the ' 'peak'' year. The number of deaths, and the Death-Rate, were correspondingly high in 1921. Although since 1923 there has been an increase in the numbers notified, there has been a steady declension in the deaths and Death-Rate; so that for 1925, with 4 deaths and a DeathRate of .025 per 1,000 of the estimated population, the mortality has been the lowest for the past 6 years—the period under review. 36 cases removed to hospital, supposed to be suffering from Diphtheria, were 46 subsequently found to be wrongly diagnosed. The corrected diagnoses (as supplied by the hospitals) were:—Tonsillitis, 20; "Not Diphtheria," 5; Vincent's Angina, 3; Erythema, 1; Bronchial Catarrh, 1; Catarrh, 1; Stomatitis, 1; Lobar Pneumonia, 1; Scarlet Fever, 1; Cardiac Irregularity, 1; Gingivitis and Pyorrhoea, 1. Of the 252 notified cases, 227 were removed to hospital. Bacteriological examination of swabs for the presence of the Diphtheria organism is undertaken at the Health Department's Laboratory. 1,994 swabs were examined, and 255 proved to be positive. Where successive swabs prove the continuance of the presence of Diphtheria Bacilli, virulence tests are made for the department by the Prince of Wales's Hospital Pathologist. Scarlet Fever.—Reviewing the incidence of Scarlet Fever for each of the past 6 years, it will be noted that the year 1921 showed a very marked accentuation. The incidence of the disease reached its low level in 1924, and in this instance—as in the case of Diphtheria—the numbers notified were practically as 3 to 1; and again, it is to be noted that the deaths and Death-Rate have shown a steady declension, so that for the past 2 years there has been no mortality at all. During the period under review a reversal of policy has taken place in Tottenham with regard to Scarlet Fever administration. The 1921 epidemic proved that in time of real stress the hospital accommodation available for Tottenham patients was totally inadequate, and in April, 1922, resort was had to other means than hospitalisation of handling the epidemic. Nurses were appointed to treat patients in their own homes, and thus pressure on hospital beds was relieved. The experience gained by the experiment thus forced upon us indicated that for a large proportion of Scarlet Fever patients institutional treatment was unnecessary, so far as the illness was concerned. In some respects, treatment at home had advantages over hospital treatment, notably in the avoidance of cross infections. The menace attaching to the retention of Scarlet Fever patients in their own homes is the occurrencec of secondary cases—one that must be admitted. On page 48 are set forth the details of the cases treated at home during 1925. In order to obviate the occurrence of secondary cases, recourse was had, in 1924, to the use of Scarlet Fever anti-toxin for the inoculation of susceptible contacts. A passive immunity appears to be conferred for a period of about a fortnight by the intramuscular injection of 5 c.cm. concentrated serum. The susceptibility to the disease is thus postponed 47 only, but not for a sufficient period to cover the infectivity of Scarlet Fever patients having nose or ear discharge, nor the interval occupied by the occurrence of intermediate cases. Thus, in two instances, the events were as follows:—On the notification of a primary case, susceptible contacts were inoculated. The mothers, however, declined inoculation. The mothers contracted the disease from the primary cases (presumably), and the inoculation of the contacts was found to be incapable of protecting them against the extended period covered by the mothers' illness. Under domiciliary conditions, where there is prolonged and intimate contact between susceptible persons and infective persons, passive immunisation on the scale employed will not prove effectual. But where the relations are less intimate and less prolonged, advantage may be gained from passive immunisation of contacts. This is exemplified in the case of a school where cases of Scarlet Fever were occurring in certain classes with disquieting frequency. Efforts to identify the infective child, or children, were unavailing. Resort was had to inoculation of the susceptible children in the classes affected. About 50 per cent, of the parents consented to the inoculation of their children attending the classes concerned. These immunised children were spaced in their classes alternately with the others. For a fortnight thereafter there was an entire cessation of the trouble, and subsequently the cases notified as occurring amongst the children attending this school were in proportion to the cases notified generally throughout the District. None of the inoculated children contracted the disease. The Council has quite definitely adopted the home treatment of Scarlet Fever as their policy, except in instances where that is precluded for cogent reasons. The use of the Scarlet Fever toxin, a vaccine of the organism—or both—as active immunising agents, is the direction that, at the moment, gives promise of most beneficial results in the protection of susceptible persons; and with that addition to the armamentarium of the Public Health Services, the need for hospitalisation of mild cases of Scarlet Fever would be further reduced. As an antidote to Scarlet Fever poison, Scarlatinal Anti-toxin is receiving favour. It is difficult, however, to gauge its efficacy accurately, since the type of Scarlet Fever now met with is so mild, as a rule; and in these cases in which serum is administered early—as it should be—and the patient runs a mild course, it cannot be determined whether the illness was originally of a mild type or whether the serum modified its severity. So mild is the ailment as at present seen, that frequently diagnosis is not made until desquamation appears, and the illness is 48 traced back to some slight indisposition; or the occurrence of a recognised case causes search to be made, and the primary (unnotified) case is found to be desquamating. The very mildness of the disease is the greatest hindrance to its recognition and the application of appropriate measures. Disinfection of premises is not carried out as a routine measure. No reliance is placed on it as a means of arresting the spread of infection. When disinfecti jn is asked for, it is not refused; but the request is acceded to only because of the sense of security it gives to those who ask for it, and not because any reliance is reposed in its efficacy. The number of Scarlet Fever cases notified in the district in 1925 was 427. 68 patients were removed to hospital (including 5 who received a few days' period of treatment by the Council's Nurses prior to removal). 355 patients were treated to a conclusion by the Council's Nurses and 4 were treated privately in their own homes. 4 of the cases removed to hospital were wrongly diagnosed, 3 being Tonsillitis and 1 Abscesses. The 360 patients treated by the Council's Nurses in their own homes were distributed as follows :— 272 premises in which 1 case occurred = 272 cases. 31 premises in which 2 cases occurred = 62 cases. 7 premises in which 3 cases occurred = 21 cases. 1 premises in which 5 cases occurred = 5 cases. 311 premises. 360 cases. Multiple Home Cases, 1925:— No. occurring within 1 week after previous case 26* ,, 2 weeks ,, ,, 6 ,, 11,, ,, ,, 1 49† *In 12 of these instances, dual notifications were received simultaneously, and in 2 instances triple notifications. †This number includes certain cases wrongly diagnosed. 49 Number of cases removed to hospital after treatment commenced 5 Number of notifications withdrawn 4 Number of cases wrongly diagnosed or indefinite 27 There were complications in 53 of the cases (including cases wrongly diagnosed or indefinite). The complications were as follows:— Rhinorrhoea 3 Otorrhoea 3 Glands *21 Albuminuria 9 Rheumatism 2 Gland and Rheumatism l Albuminuria and Glands 6 Albuminuria and Rheumatism 3 Mastoid 2 Glands and Otorrhoea 2 Glands, Otorrhoea and Rheumatism 1 53 * 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, 1926) they had cleared up. We have no means of ascertaining the frequency with which cases treated in hospital contract secondary diseases or other complications. The Infectious Disease (Notification) Act, 1889, Section 3, reads as follows:— "Where an inmate of any building used for human habitation "within a district to which this Act extends is suffering from an infectious "disease to which this Act applies, then, unless such building is a hospital "in which persons suffering from an infectious disease are received, the "following provisions shall have effect, that is to say— "every medical practitioner attending on or called in to visit the patient, "shall forthwith, on becoming aware that the patient is suffering from "an infectious disease to which this Act applies, send to the Medical "Officer of Health for the district a certificate stating the name of the "patient, the situation of the building, and the infectious disease from "which, in the opinion of such medical practitioner, the patient is "suffering.'' Hence, notifications are not received of infectious diseases contracted in the Metropolitan Asylums Board Isolation Hospitals. 50 GENERAL PROVISION OF HEALTH SERVICES IN THE AREA. HOSPITALS PROVIDED OR SUBSIDISED BY THE LOCAL AUTHORITY OR BY THE COUNTY COUNCIL. (1) Tuberculosis.—Provided by the County Council; Harefield Sanatorium. Subsidised by the County Council; Clare Hall Sanatorium. (2) Maternity.—Maintenance charges of patients paid by Local Authority; North Middlesex Hospital and Mothers' Hospital, Clapton. (3) Children.—Maintenance charges paid by Local Authority; Prince of Wales's Hospital, North Middlesex Hospital, Central London Throat, Nose and Ear Hospital. The London Heart Hospital receives fees for cases submitted for special examination. The Local Authority contribute towards the maintenance of children admitted to the London Orthopaedic Hospital, Great Ormond Street Hospital and Queen's Hospital, Hackney Road. (4) Fever.—The Metropolitan Asylums Board hospitals provide accommodation for Tottenham patients, and the Enfield and Edmonton Joint Hospital Board have voluntarily accepted Erysipelas cases from Tottenham. (5) Smallpox.—Tottenham is a contributory Authority to the Middlesex Districts' Joint Smallpox Hospital Board. AMBULANCE FACILITIES. The M.A.B. provide ambulances for the conveyance of infectious diseases. The Local Authority provide and maintain 5 ambulances for non. infectious and accident cases. These are garaged at the Central Fire Station (telephone "Tottenham 100" and "Mountview 100"), and are available, day and night, free of charge to Tottenham residents for removal to hospitals in the District or to the hospitals in the Metropolitan area. For the conveyance of patients home from the Metropolitan hospitals, the charge is 5s., and from the North Middlesex Hospital. 2s. 6d. The Ambulance Service began in 1915, and the following table shows to what extent it has been taken advantage of:— 51 MOTOR AMBULANCE SERVICE, 1925. No. of Cases. Mileage. Receipts. Surgical. Defective Children. From Cases. From T.E.C. £ s. d. £ s. d. January 597 1,427 4,984 9 14 6 112 8 0 February 591 1,750 4,933 11 17 0 128 9 0 March 719 1,977 5,474 9 19 6 143 10 0 April 592 1,249 4,397 9 8 6 92 10 0 May 621 1,740 5,466 19 13 3 135 19 0 June .. 562 1,530 5,001 13 19 6 117 3 0 July 562 1,351 4,886 23 5 3 114 0 0 August 432 453 2,662 9 18 0 38 13 0 September 483 1,839 4,981 10 0 0 140 9 0 October 540 1,765 5,405 16 11 6 128 4 0 November 491 1,931 5,185 12 4 9 138 3 0 December 497 1,611 4,452 7 13 6 108 2 0 Year's Totals 6,687 18,523 57,826 154 5 3 1397 10 0 25,210 £1551 15 3 Treasurer's Dept. £123 10 0 £1675 5 3 Total Cases from 1915 to Date: 742,769. Total Mileage to Date: 250,673. The Ambulances are equipped with Oxygen apparatus which have been in use on 7 occasions during 1925; in 6 of the cases it was successful. LABORATORY. At the Town Hall Laboratory, 1,994 swabs from the throats or noses of persons in contact with sufferers from Diphtheria, or themselves supposed to be suffering from Diphtheria, and 300 specimens of sputum from persons suspected to be suffering from Consumption, have been examined during the year. Of the swabs, 255 were positive, and of the sputa, 48 specimens. Other bacteriological and serological examinations are made by arrangement with the Prince of Wales's Hospital. 52 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 Dental Clinic, Bruce Castle Consulting Room, Treatment Room and Waiting Room Surgery, Recovery Room and 2 Waiting Rooms Do. Do. Dental Clinic, "The Chestnuts" Surgery, Recovery Room and Waiting Room Do. Eye Clinic, Bruce Castle Ear Clinic, Bruce Castle Spray Bath Clinic Town . Hall Dark Room, Treatment, Fitting and Waiting Rooms Treatment Room and Waiting Room Bath Room and Waiting Room Do. Do. Do. Tuberculosis Dispensary, 140, West Green Road, N.15 Consulting Room, Dressing Room, Waiting Room, Laboratory, Office Middlesex County Council. Venereal Diseases Clinic, Prince of Wales's Hospital, N.15 Two Consulting Rooms. Two Treatment Rooms, 2 Waiting Rooms and Laboratory Do. 53 PROFESSIONAL NURSING IN THE HOME. (а) General.—The District Nursing Association has no branch in Tottenham. For the purpose of giving nursing care to the sick in their own homes, the Central Council for District Nursing in London have made the following arrangements for dealing with Tottenham cases:— 1. The area on the eastern side of the London & North Eastern Railway line, and extending northwards as far as Lansdowne Road, undertaken by the Hackney District Nursing Association, 6 and 8, Lower Clapton Road, E.5. (Telephone, Clissold 929). 2. The area on the western side of the Railway line, and extending northwards as far as Lordship Lane (excepting St. Ann's Parish), undertaken by the North London Nursing Association, 413, Holloway Road, N.7. (Telephone, North 3548). 3. The area extending northwards from Lordship Lane and Lansdowne Road, undertaken by the Sisters of Charity of St. Vincent de Paul, 15, Church Street, Edmonton, N.9. (Telephone, Tottenham 3166). (b) Infectious Diseases.—Five nurses are engaged by the Local Authority for the treatment of Scarlet Fever patients in their own homes. The Local Authority undertake to subsidise the 3 Nursing Associations mentioned above in respect of treatment given to children suffering from Pneumonia, Influenza, Measles, Whooping Cough and Ophthalmia Neonatorum. (c) Midwives.—The supervision of Midwives is exercised by the County Council. No subsidy is given to any individual Midwives by the Local Authority to enable them to carry on their practices in Tottenham; but necessitous women have the Midwives' fees paid in whole or in part by the Maternity and Child Welfare Committee after sources of income have been ascertained, and it appears to the Committee that the circumstances warrant payment of the Midwives from the public purse. 18 Midwives are registered for practice in the area. HEALTH WEEK. It has been the custom during the past 4 years for Health Week to be observed in the District by the setting of subjects to be written upon by the schoolchildren. A digest of 5 essays is fixed for each year, and for the year 1925 the subjects for consideration were:—(a) "How our food supply is safeguarded"; (b) "How to ensure the purity of drinking water"; (c) "My teeth"; (d) "Carriage and exercise"; (e) "Some facts about our clothing." 12,713 essays were written, and 26 prizes 54 and 4 certificates were distributed to the successful competitors at a Public Meeting held on 2nd December at the Municipal Hall. 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). Diphtheria Anti-toxin (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 (Mis-description) 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. 55 Public Health (Pneumonia, Malaria, Dysentery, etc.) Regulations, 1918. Milk and Dairies (Amendment) Act, 1922. Milk (Special Designations) Order, 1923. Public Health (Meat) Regulations, 1924. Housing Act, 1925. Public Health Act, 1925. 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. Tottenham Remainder Area. * Butchers Monday, 1 p.m. (or alternatively Saturday, 1 p.m.) Monday, 1 p.m. (or alternatively Saturday, 1 p.m.) Bakers Wednesday, 2 p.m. (or alternatively Saturday, 2 p.m.) Thursday, 2 p.m. (or alternatively Saturday, 2 p.m.) †Other Shops Wednesday, 1 p.m. (or alternatively Saturday, 1 p.m.) (non-exempted trades). Thursday, 1 p.m. (or alternatively Saturday, 1 p.m.) Evening Closing Hours. * Butchers Monday 1p.m. Tuesday, Wednesday and Thursday 7 p.m. Friday and Saturday 8p.m. Confectioners Monday, Tuesday, Wednesday, Thursday and Friday 9.30 p.m. Saturday 10 p.m. Sunday 8p.m. † Other Shops (non-exempted trades) Monday, Tuesday, Wednesday, Thursday and Friday 8p.m. Saturday 9p.m. Sunday 8p.m. (subject to weekly half-holiday Order). Refreshments (consumed on premises) Special Licences 10 p.m. and 11 p.m. Exempted Trades (newly cooked provisions, etc.) No closing hour. 56 LEGAL PROCEEDINGS. Date. Name. Nature of Case. Result. April Mills, 13, West Street, Walthamstow Execution of repairs at 63, Summerhill Road Order made for payment of expenses of repairs. July E. Moss 30, Hartington Road Serving in Shop after closing hour Fined 5s. „ S. Cohen, 669, Green Lanes „ „ 10s. „ L. Levy, 513, Green Lanes „ „ 10s. „ P. F. Teasdale, 383, Green Lanes „ „ 5s „ R. Raphael, 1, Grand Parade „ „ 5s „ W. H. Speller, 527, Seven Sisters Road „ „ 20s „ P. Laccarini 728, High Road „ „ 20s „ N. Berg, 514, High Road Not giving Assistant half-holiday and keeping shop open „ 40s „ Mayhew, Bradfield, Reading Execution of repairs at 2, Sidlaw Terrace Jansons Road Council's account and cost of summons paid prior to hearing of case. October Martin, 10, Moreton Road Serving in Shop after closing hour Fined 20s. and costs. „ P. Laccarini, 728, High Road „ „ „ Straker, 43, West Green Road „ „ „ Colman, 149, Welbourne Road „ „ „ G. Colletta, 14, Park Road „ „ „ W. H. Goodwin, 271, Park Lane „ „ 57 SANITARY CIRCUMSTANCES OF THE AREA. WATER. The District is supplied with water by the Metropolitan Water Board, the sources being the River Lee and the New River. The Central Public Baths' supply is derived from an artesian well—at a depth of 453 feet—at the rear of the Town Hall; the amount of water pumped and used for the Public Swimming and Slipper Baths at The Green, Tottenham, and for the supply of hot and cold water for the Town Hall and School Clinic amounting, approximately, to 30,300,000 gallons per annum. The water from these sources is of great purity. The Metropolis Water Act requires that in all premises in which water is used there shall be supplied a cistern for the storage of water, and the Council have made Bye-Laws imposing upon occupiers of premises the obligation of cleansing these cisterns half-yearly. Complaints are received from time to time respecting the purity of the water. Invariably, it has been found that the cause of the complaint has arisen from these Bye-Laws being honoured in the breach rather than the observance. RIVERS AND STREAMS. The streams in the District are all tributaries of the River Lee. The Metropolitan Water Board are responsible for the condition of the portion of the Pymmes Brook in this District, and the County Council for the remainder of the streams. As has been pointed out in the foreword to this Report, complaint has been made respecting the pollution of the River Lee below Tottenham Lock. The condition of the water above the Lock is entirely satisfactory; but for a period of years, the water below the Lock has been grossly polluted. This pollution—so far as Tottenham's contribution to it is concerned—has arisen mainly from the Pymmes Brook, which enters the River Lee about 50 yards below Tottenham Lock. It is the opinion of your Medical Officer that if Pymmes Brook were purified and the bed of the river below the Tottenham Lock dredged and cleansed, the water below the Lock would be almost as good as that above it, except perhaps after storm, when there is some slight pollution from the Stonebridge Brook, arising from overflow at the Pumping Station. This qualification is deliberate, for this portion of the river receives the surface-water drainage from Tottenham and neighbouring districts, and the pollution from the road surfaces finds its way into this part. 58 DRAINAGE AND SEWERAGE. The drainage of Tottenham is, for the most part, upon the dual system. The surface-water drainage is, as has been stated above, received into the various streams and finds its way ultimately into the River Lee below Tottenham Lock. The soil sewage is received at the Pumping Station, situated in the neighbourhood of the junction of the Stonebridge Brook with the River Lee, and is conveyed into the sewerage system of the London County Council. The dual system has not been introduced into all parts of the District. There still remain certain areas where the single sewer receives both surface water and soil discharges. It thus happens that in times of heavy rainfall the amount of sewage that is delivered at the Pumping Station is greater than the L.C.C. will allow to pass into their sewerage system, except at very heavy charges, and the surplus is received into a storm-water tank, to be disposed of when the pressure upon the sewerage system is relieved. CLOSET ACCOMMODATION. The closets in Tottenham are entirely upon the water carriage system. 4 only drain into cesspools, and these latter are cleansed at frequent intervals by the owners. PUBLIC CONVENIENCES. There are 4 Public Conveniences in the District, situated as follows. The hours of opening and closing are stated:— Bruce Grove Open 8 a.m. to 11 p.m. Seven Sisters Corner Green Lanes (opposite "Queen's Head") Tottenham Hale 8 a.m. to 10 p.m. The receipts from these conveniences for the year amounted to £975 6s. SCAVENGING. Scavenging is undertaken by the staff of the Engineer's Department of the Council, and the material is disposed of by the burning of house refuse at the Refuse Destructor Works, near the Tottenham Marshes, and by a deposit of slop and street refuse at the Council's tip, White Hart Lane. The Engineer has reported to the Council the inadequacy of the plant at the Destructor Works in times of pressure, and suggested certain alterations and extensions. These are now under the consideration of the Council. Portable dustbins are the chief means employed for the storage of house refuse, pending removal once weekly. 59 GENERAL SANITARY WORK. Hereunder is specified in tabular form the inspections by the Sanitary Officers during 1925, and the nature of the defects discovered:— 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 j (Mr. Shillito). House-to-house inspections 110 187 108 70 110 200 Re-inspections 1473 1066 1402 914 1549 1245 Drains examined, tested, etc. 72 46 189 71 98 106 Drains unstopped 11 39 35 7 23 69 Drains reconstructed and repaired 46 12 36 20 43 35 Disconnecting traps inserted 2 3 1 1 1 8 Soil pipes and drains ventilated 20 6 23 4 37 14 R.W. pipes, wastes, etc. disconnected 6 9 49 5 26 14 Dustbins provided 51 41 185 32 42 53 Roofs repaired 107 79 92 49 43 62 Gutters repaired and renewed 102 68 58 23 21 32 Cisterns cleaned, repaired, etc. 21 12 25 16 14 26 W.C. new apparatus provided 12 4 19 13 15 I 96 W.C. repaired, cleaned, etc. 41 28 41 — 17 j v W.C. Water Fittings repaired 49 43 38 23 22 50 Yards paved and drained 34 33 26 31 45 17 Premises cleaned, etc. 157 175 177 59 176 163 Ventilation below floor provided 14 15 39 5 5 4 Defective window frames and sashes 24 46 60 13 9 195 Other defects 42 108 216 30 54 — Smoke observations 35 26 39 16 12 8 Accumulations of refuse 22 12 10 9 6 17 Visits in connection with cases of infectious disease (including Tuberculosis) j 129 119 142 122 108 227 Rooms inspected after disinfection 19 46 89 112 90 59 Other inspections, etc. 38 104 210 53 94 — Factories—No. of inspections 45 50 43 3 16 41 Workshops & workplaces ,, 60 63 42 6 24 75 Laundries ,, 4 10 4 — 4 — Dairies, etc. ,, 68 51 44 20 40 39 Cowsheds ,, — — — — — 6 Bakehouses ,, 32 27 44 7 58 48 P.H. urinals ,, 121 52 54 45 75 59 Stables and Mews ,, 63 73 66 3 58 42 Complaints investigated v. 111 153 382 233 111 189 Appointments 121 112 85 21 96 300 School inspections 2 3 6 4 4 10 Pawnbrokers 3 — — — — z Common Lodging Houses — — — 27 — 28 Slaughter-houses — 81 28 30 — 80 Knackers' Yards — — — 48 — — Brooks and Watercourses 6 — — 1 20 6 Butchers'shops 98 77 32 106 97 107 Fishmongers'shops 95 29 30 34 79 61 Fruiterers'shops 83 28 35 16 54 47 Ice Cream premises 6 18 13 1 6 9 60 SANITARY WORK CARRIED OUT BY FEMALE SANITARY INSPECTOR. Visits to Outworkers' Premises 864 ,, Workshops 140 ,, Laundries 3 ,, Factories 8 Complaints Investigated 119 Visits re Infectious Diseases 2 Miscellaneous Visits 21 Re-inspections 552 Swabs Taken 923 S. F. Contacts Examined 320 FACTORY AND WORKSHOP ACT, 1901. In compliance with Section 132, I have to submit a resume of the work eSected during the year—under the provisions of the above Act— in the form prescribed by the Home Office:— 1.—Inspection of Factwies, Workshops and Workplaces. Inspections made by Sanitary Inspectors. Premises. Number of Inspections. Written Notices. Prosecutions. Factories (including Factory Laundries) 228 74 — Workshops (including Workshop Laundries) 424 Workplaces (other than outworkers' premises included in Part 3 of this Report) Total 652 74 — 61 2.—Defects Found. Particulars. Number of Defects. Number of Prosecutions. Found. Remedied. 1 Referred to H.M. Inspector. Nuisances under the Public Health Acts*— Want of Cleanliness 58 58 — — Want of ventilation 1 1 — — Overcrowding — — — — Want of drainage of floors — — — — Other nuisances 5 5 — — Sanitary accommodation insufficient — — — — unsuitable or defective 8 7 — — not separate for sexes 3 3 — — 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) — — Total 75 74 — — * Including those specified in sections 2, 3, 7 and 8, of the Factory and Workshop Act as remediable under the Public Health Acts. 62 3.— Home Work. OUTWORKERS' LISTS, SECTION 107. Number of Inspections of Outworkers' Premises. Outwork in Unwholesome Premises, Section 108. Outwork in Infected Premises, Sections 109, 110. Nature of Work. Lists received from Employers. Number of Addresses of Outworkers received from other Councils. Number of Addresses of Outworkers forwarded to other Councils. Prosecutions Twice in the year. Once in the year. Failing to keep or permit inspection of Lists. Failing to send Lists Instances. Notices served. Prosecutions. Instances. Orders made (Sec. 109). Prosecutions (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 16 160 8 43 518 103 — — 671 — — — — — — Boots and Shoes 8 77 — — 30 51 — — 56 — — — — — — Stationery 4 10 — — 1 — — — 11 — — — — — — Cardboard, etc. Boxes 4 28 — — 10 10 — — 28 — — — — — — Brushes 2 4 — — 8 3 — — 9 — — — — — — Smallware — — 1 1 — 1 — — — — — — — — — Upholstery — — — — 1 — — — 1 — — — — — — Furs — — — — 16 — — — 16 — — — — — — Umbrellas — — — — 8 — — — 8 — — — — — — Fancy Goods 2 3 — — 8 — — — 11 — — — — — — Artificial Flowers — — — — 5 — — 5 — — — — — — Christmas Crackers 2 49 — — 8 32 — — 25 — — — — — — Leather Goods — — — — 1 — — — 1 — — — — — — Tennis Balls — — — — 1 — — — 1 — — — — — — Toys 2 3 — — — — — — 3 — — — — — — Lace Goods — — — — 12 — — — 12 — — — — — — Lamp Shades — — — — 4 — — — 4 — — — — — — Totals 40 334 9 44 631 200 — — 864 — — — — — — 63 4.—Registered Workshops. Workshops on the Register (s. 131) at the end of the Year. Number. Workshops 235 Laundries 28 Bakehouses 64 Total Number of Workshops on Register 327 5.—Other Matters. Class. Number. Matters notified to H.M. Inspector of Factories:— Failure to affix Abstract of the Factory and Workshop Act (Sec. 133) 3 Action taken in matters referred' by H.M. Inspector as remediable under the Public Health Acts, but not under the Factory and Workshop Act (a. 5). Notified by H.M. Inspector 12 Reports (of action taken) sent to H.M. Inspector 12 Other — Underground Bakehouses (a. 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). 64 UNSOUND FOOD. The Sanitary Inspectors have seized, or had brought to them for condemnation, the following articles:— Meat:— Fish:— 2 Pigs. 1 Sheep 12 Ox Livers 19 Pigs' Heads. 2 forequarters Veal. 18½ stone Beef. Fruit and Vegetables:— 5 barrels Grapes. 131 boxes Tomatoes. 50 baskets Greengages. 2 sacks Chestnuts. 5 lb. Raspberries. 18 stone and 3 boxes Haddocks. 16 stone and 1 box Skate. 6 stone Plaice. 1 box Dabs. 1 box Roe. 1 box Cat Fish. 2 boxes Herrings. 5 boxes Fillets. 1 box Kippers. 1½ bushels Whelks. 1 cwt. and 2 bushels Winkles. 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 65 Act, 1875), for the following information respecting samples taken in Tottenham:— Name of Article. Samples. Taken. Found Adulterated Milk 564 24 Milk, condensed 1 — Butter 24 — Cream 5 3 Coffee 7 — Fish Paste 1 — Sausage 2 — Spice, mixed 1 — Arrowroot 7 3 Cinnamon 8 3 Cornflour 3 — Ham 7 — Margarine 1 — Meat Paste 1 — Mustard 6 — Pepper 4 — Prescription 4 3 Whisky 12 4 658 40 Number of Prosecutions 10 Number of Convictions 5 Fines and Costs imposed £16 The figures given for adulterated samples include some adulterated informal samples, in respect of which no proceedings could be taken. DISINFECTION AND DISINFESTATION. Infected rooms are sprayed with Formalin when the infected patient is removed to hospital. 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 disinfested by steam. 66 1,700 rooms were disinfected. 8,931 articles were disinfected or destroyed. 361 library books were disinfected. 26 persons were bathed. EXHUMATIONS. Three exhumations took place at the Tottenham Cemetery, under the supervision of the Sanitary Inspector. The Home Office requirements were complied with. SMOKE ABATEMENT. Observations have been kept upon the factory chimneys, and com munications have been sent to proprietors to abate nuisances arising from smoke on 8 occasions. No legal procedure was required. PREMISES AND OCCUPATIONS WHICH CAN BE CONTROLLED BY BYE-LAWS OR REGULATIONS. SLAUGHTER HOUSES.—There are 12 private Slaughter-Houses in the District, 5 being registered and 7 licenced. They are periodically visited, and it has not been found that any offence has been created. DAIRIES, COWSHEDS AND MILKSHOPS. 13 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, 183 retail purveyors of milk. 2 purveyors were 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). 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. COMMON LODGING HOUSES. There are 5 Common Lodging Houses in the District. All have been kept under observation, and appropriate action was taken to remedy any defects found. 67 OFFENSIVE TRADES. Although no Offensive Trades have been established in the District, notice was taken of bone-boiling and fat-melting in connection with a knacker's yard. The attention of the proprietors was directed to this fact, and an undertaking was given that these irregularities would be terminated forthwith. UNDERGROUND SLEEPING ROOMS. The number of Underground Sleeping Rooms in the District is so small that regulations in respect of them under the Housing Act, 1925, Sec. 18 (1) are uncalled for. In only one instance has any difficulty arisen with reference to the habitation of an underground dwelling during the past 12 months. SCHOOLS. The sanitary condition of the Schools is reported upon in a separate section. HOUSING. I. General Housing Conditions in the Area. 1. General Housing Conditions.—The great majority of the houses in Tottenham are of the artisan type. The method of building was generally long terraces of uniform pattern until the operation of the housing schemes. On the new estates, a more ornate type of building is erected, and the general effect is one of improvement. On the London County Council's White Hart Lane Estate, tenement buildings have been erected (Topham Square), and although for the area occupied by the houses greater accommodation is afforded, it is hoped that further building of tenement houses will not be proceeded with. 2.—(a) Extent of shortage or excess of houses.—The extent of the shortage of houses may be gauged by the statement in the foreword that approximately 3,000 families are entered upon the Treasurer's waiting list. (b) Measures taken or contemplated to meet any shortage.—The Council have at present under consideration a scheme for the erection of 300 houses. The extent to which private enterprise has contributed to a solution of the difficulty will be appreciated by the fact that during 1925, 324 houses were erected by this means. II. Overcrowding. The exact extent to which overcrowding prevails in the District cannot definitely be stated. That it does exist to some considerable 68 degree is a matter of common knowledge. The employment of statutory measures to enforce the abatement of it is a course that your Council has very reluctantly considered, having regard to the hopelessness of providing adequate alternative accommodation. The cause of the overcrowding is mainly due to the overflow from the London area. All that it has been possible to do to relieve congestion in houses has been for the Sanitary Inspectors to advise re-distribution of families in their dwellings so as to make the best use of the available accommodation. III. Fitness of Houses. 1. The general standard of housing in the area is tolerably good, and particulars of the defects found are referred to in the Table on page 59. These defects are due, in many instances, to lack of supervision and proper care by the owners, and damage and neglect by the tenants. 2. The Table on page 69 indicates the general action that has been taken under the Housing and Public Health Acts with regard to unfit houses. No insuperable difficulties have been found in having the remedies effected. It will be observed, however, by reference to the Table on page 56, that in two instances it was necessary to appeal to the Court to recover monies expended in carrying out the work under Section 3 of the Housing Act, 1925. IV. Unhealthy Areas. No complaints have been received, and no representations have been made or action taken, with regard to Unhealthy Areas in the District during the year. V. Bye-Laws relating to Houses let in Lodgings, and to Tents, Vans, Sheds, etc. The Bye-Laws relating to Houses let in Lodgings are now obsolete, and to be effective require to be revised, for, amongst other reasons, the rentals specified under the existing Bye-Laws are much too low for present purposes. No action has been called for under the Tents, Vans and Sheds ByeLaws during the year under review. VI. General and Miscellaneous. Any other matters relating to Housing engaging the attention of the Department during the year have been set out in tabular form, and are to be found on page 69 of this Report. 69 New Houses erected during the Year. By private builders (no State assistance) 324 By the London County Council 8 By the Tottenham Council 42 374 Unfit Dwelling-Houses. Total number of dwelling-houses inspected for housing defects (under Public Health or Housing Acts) 2,820 Number of dwelling-houses which were inspected and recorded under the Housing (Inspection of District) Regulations, 1910, or the Housing Consolidated Regulations, 1925 794 Number of dwelling-houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation 17 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 1,724 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 1,444 Action under Statutory Powers. (a) Proceedings under Section 28 of the Housing, Town Planning, &c., Act, 1919, and Sec. 3 of the Housing Act, 1925 (1) Number of dwelling-houses in respect of which notices were served requiring repairs 228 (2) Number of dwelling-houses which were rendered fit— By owners 197 By Local Authority in default of Owners 8 (3) Number of dwelling-houses in respect of which Closing Orders became operative in pursuance of declarations by owners of intention to close — 70 (b) Proceedings under Public Health Acts. (1) Number of dwelling-houses in respect of which notices were served requiring defects to be remedied 50 (2) Number of dwelling-houses in which defects were remedied— By owners 42 By Local Authority in default of owners — (c) Proceedings under Tottenham Local Board Act. (1) Number of dwelling-houses in respect of which notices were served requiring defects to be remedied 2 (2) Number of dwelling-houses in which defects were remedied— By owners 2 By Local Authority in default of owners — (d) Proceedings under Sections 17 and 18 of the Housing, Town Planning, &c., Act, 1909, and Sec. 11 of the Housing Act, 1925. (1) Number of representations made with a view to the making of Closing Orders 17 (2) Number of dwelling-houses in respect of which Closing Orders were made 17 (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 — Tottenham Maternity and Child Welfare Committee. ANNUAL REPORT FOR THE YEAR 1925. 2 LIST OF MEMBERS OF COMMITTEE (1925.) Mr. H. FARTHING (Chairman). Miss R. F. COX (Vice-Chairman). Mrs. F. C. BRIGHTEN. Mr. J. BRISTOW. Mr. E. S. BROWN.' Mr. F. W. COX. Mr. F. EASTON. Mr. T. ELDERFIELD. Mrs. E. L. FINCH. Mr. W. FORDYCE. Mr. E. C. HARRIS. Major P. B. MALONE, M.P., J.P. Mr. W. E. MONTAGUE. Mr. E. J. MORLEY. Mr. A. REED, A. F. I. Mr. S. TIMMS. CO-OPTED MEMBERS. Mrs. H. BYERS. Mrs. F. W. COX. Mrs. A. M. ELLIS. Mrs. A. KITCHENER. Mrs. J. D. LYNCH. Mrs. S. E. SANDERS. 3 Infant Welfare and Matrnity Centres. BRUCE CASTLE, BRUCE CASTLE PARK. Infant Welfare Clinics. *Monday Afternoon 2 o'clock Tuesday Afternoon 2 ,, Wednesday Afternoon 2 ,, *Thursday Morning 9.30 ,, Maternity Clinics for Expectant Mothers are held on :— *Tuesday Morning 9.30 o'clock *Thursday Afternoon 2 ,, THE CHESTNUTS, CHESTNUTS PARK. Infant Welfare Clinics. Tuesday Afternoon 2 o 'clock *Wednesday Morning 9.30 ,, Wednesday Afternoon 2 ,, *Thursday Afternoon 2 ,, *Friday Afternoon 2 ,, Maternity Clinics for Expectant Mothers are held on :— *Monday Afternoon 2 o'clock *Thursday Morning 9.30 ,, TOWN HALL CENTRE. Infant Welfare. Wednesday Afternoon 2 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, *Lady Doctor in attendance. 4 INTRODUCTION. Medical Officer's Department, Town Hall, Tottenham, N.15. To the Chairman and other Members of the Maternity and Child Welfare Committee. April, 1926. Ladies and Gentlemen, The year to which this report relates has been marked by incidents, amongst which the following are worthy of record:— The first International Congress on Child Welfare was held at Geneva in August. Your Medical Officer was privileged to attend, and presented a paper on "The Education of Public Opinion in matters relating to Child Welfare." A comprehensive report upon the proceedings at Geneva engaged your Committee's attention. The Town Hall Centre was established and furnished, and forms a very useful addition to your Committee's equipment. An arrangement was entered into with the Prince of Wales's Hospital for the treatment of children under 5 years of age. In October last, Grade A "Tuberculin Tested" Milk was substituted for the ordinary Milk supplied to necessitous mothers and children under the provisions of the Maternity and Child Welfare Act, 1918, and Pamphlet M. and C. W. 4. Likewise, Grade A "Tuberculin Tested" Milk was substituted for the ordinary Milk supplied at the Crèche. During the summer holiday period of 1925, the Crèche was kept open for the reception of children whose mothers were at work. The attendance justified the experiment. The usefulness of the Open-Air Shelter at the Crèche was added to by a water supply being laid on. Two Crèche children were awarded £5 each in the Empire's Mother and Baby Competition, held at Wembley, and organised by the National Baby Week Council. 5 Students attending the Winter School of the Women's Sanitary Inspectors' and Health Visitors' Association visited the Welfare Centres and the Crèche in January, and about 50 members in July from the Summer School organised by the National Baby Week Council. Special groups of students attending Mothercraft Classes visited the Centres and Crèche from Greystoke and St. Katherine's Training Colleges, and from West Green, Stamford Hill, Coleraine Park and Downhills Council Schools. A demonstration lesson to the elder girls was given by the Superintendent Health Visitor at Downhills and Coleraine Park Schools. The mothers attending the Bruce Castle Centre presented the Centre with an oak, overstrung, upright piano. (The Chestnuts Centre mothers made a like addition at their Centre in the previous year). The Mothers' Social Clubs at the Chestnuts and Bruce Castle continue to prosper. The work of the year is set out in detail in the following pages. For the encouragement given to the staff by your Committee, I desire to express sincere thanks. The enthusiasm with which the Members of the Committee entered into the activities of the Department has been an inspiration to all actively engaged in it. I am, Ladies and Gentlemen, Yours faithfully, Medical Officer of Health. 6 BIRTHS, 1925. LIVE BIRTHS. Registrar-General's Figures—M. 1,388 F 1,368 *2,756 Local Information:— Total Births notified 2,723 Less Still Births 85 Total Live Births 2,638 *Births outside the District included in above:— Council cases in District Maternity Home 70 Other cases notified from District Maternity Home 220 Notified from other Outside Institutions 162 452 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. 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 2,215 Part breast-fed—plus milk, dried milk or condensed 165 Bottle feeding—Cows' milk 123 Dried milk 80 Other artificial foods 55 2,638 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 2,692 7,100 250 16,171 26,213 Still-births 73 41 - - 114 Deaths 41 7 14 3 65 Ophthalmia Neonatorum 14 34 - - 48 †Other Infectious Diseases 152 245 160 273 830 Total 2,972 7,427 424 16,447 27,270 Maternity Visits. 1st Visits. Re-visits. Ante-Natal 366 427 - - 793 Post-Natal 604 948 — — 1,552 Puerperal Fever 6 20 — — 26 Other Visits. Mothers. Children. *374 282 — — 656 Total Visits — — — — 30,297 † Other Infectious Diseases include Measlos and German Measles, Bronchial Pneumonia, Tuberculosis, Whooping Cough, Poliomylitis. *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 (The Chestnnts) 12,934 742 52 205 35.17 54.42 1,539 Bruce Castle 9,302 575 53 152 37.20 48.22 1,298 Town Hall 1,709 117 — 48 — 33.52 269 Total 23,945 1,434 105 405 — — 3,106 Medical Inspections. Total Number. New Cases. Number of Sessions. Average No. of Inspections per Session. St. Ann's (The Chestnuts) 4,067 677 153 26.58 Bruce Castle 2,678 493 101 26.5 Town Hall — — — — Total 6,745 1,170 254 — Infant Mortality of Infants Attending the Infant Welfare Centres during 1925. Centre. 1925 Births. Infantile Death-rate No. on Register. Deaths of Infants. St. Ann's (The Chestnuts) 456 *3 6.5 Bruce Castle 352 4 11.36 Town Hall 91 — — Total 899 *Includes babies referred for Medical Examination from the Town Hall Clinic. Infant Mortality rate for whole area 54.4 per thousand births. 9 ANTE AND POST-NATAL CLINICS. Medical Examinations. AnteNatal. PostNatal. Total. Number of Sessions. Average Attendance per Session. St. Ann's (The Chestnuts) 791 517 1,308 104 12.57 Bruce Castle 652 367 1019 98 1.400 Total 1,443 884 2,327 202 — New Cases— St. Ann's (The Chestnuts) 217 102 319 — — Bruce Castle 121 67 188 — — Total 338 169 507 — — 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. 800 465 1,265 21 mothers 11 toddlers MATERNITY HOMES AND HOSPITALS. The arrangements with the Guardians, whereby Tottenham patients are admitted to the Maternity Home are still active and satisfactory. The following table sets out the number of cases treated in this Institution and the Mothers' Hospital subsidised by your Committee, and the details relating to them:— District Maternity Home, Edmonton Mothers' Hospital. Total Discharged before Confinement Confinements Total Mothers Delivered by:— Total Live Births Still Births Midwives Doctors 65 5 70 1 69 1 70 64 5 69 *The difference between the 69 Confinements and the 70 Births is accounted for by the birth of twins. 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. 1 — 3 — — 1 £ s. d. Cost of patients admitted to Maternity Home 330 4 0 Contributions by patients towards maintenance 244 11 6 Net cost to Council £85 12 6 Average duration of stay, 16 days. CRECHE ATTENDANCES. The attendances from 1st January to 31st December, 1925, were as follows:— Number of days on which the Crèche was opened, 248. Quarter. Attendances under 3 years of Age. Attendances over 3 years of Age. Total. 1st January to 31st March 1,236 690 1,926 1st April to 30th June 1,009 515 1,524 1st July to 30th September 1,171 617 1,788 1st October to 31st December 1,050 509 1,559 4,466 2,331 6,797 Number of children admitted:— Under three years 67 Over three years 30 Total 97 Average daily attendance, 27.5. 11 Applications for assistance have been dealt with as follows:— Assisted Milk Supply.—659 families were assisted in the supply of milk on behalf of expectant and nursing mothers and children under 5 years of age. The amount of milk authorised for distribution (fresh and dried milk) was 62,704 quarts or their equivalent. Assistance has been given towards the payment of Midwives' Fees on 11 occasions, and for Home Helps in 2 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 1925 as follows:— 19 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 — 1 — 2 — - 1 2 2 1 1 2 Number of Weeks 13 14 15 16 17 18 19 20 21 22 23 47 Number of Children 1 3 — — — 1 — 1 — — — 1 1 child was provided with a Leg Instrument. VOLUNTARY SERVICES. The Mothers' Welfare Clubs still continue their activities (social and otherwise) 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. The Sewing Class at The Chestnuts is under the supervision of Mrs. N. Pickford, 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. 12 The Committee are indebted to the following donors for gifts to the Centres and the Crèche during the year:— From Mrs. H. Byers.—A cheque for £3 10s., being the proceeds of the "Y" Choir Concert, to provide toys for the Centres and the Crèche. From Mr3. Councillor F. C. Brighten.—A piano-stool for Bruce Castle Centre. From the Dorcas Society of the High School for Girls.—Babies' clothing. Harringay Brotherhood, from the Scoutmaster, through Mr. Inwood. —Parcels, which were sent to 20 selected poor families, whose names were supplied by the Superintendent Health Visitor. From Mrs. Jennings, 45, Peabody Buildings.—The gift of a pram. For the Crèche.—From Miss Boar (Crouch End), Miss Councillor R. F. Cox, Mrs. A. M. Ellis, Mrs. Councillor Finch, Mr. Councillor F. Easton, Mrs. Fawcett, Kensington (through Dr. Alice Stalker), Mrs. Kitchener, Miss Todd, Crowland Road Infants' School (through Dr. Alice Stalker). The matron of the Crèche and the staff provided a party for the children which was much appreciated. Tottenham Education Committee. ANNUAL REPORT OF THE SCHOOL MEDICAL OFFICER for 1925. MEMBERS OF THE COMMITTEE. Mr. T. ELDERFIELD (Chairman). Mr. T. INGLIS (Vice-Chairman). Mrs. F. C. BRIGHTEN. Mr. J. BRISTOW. Mr. C. E. BROWN. Miss R F. COX. Mr. F. EASTON. Mr. H. FARTHING. Mrs. E. L. FINCH. Mr. E. FROST. Mr. A. E. HARVEY. Mr. W. R. JACKSON. Mr. M. E. JAMES. Mr. W. W. LEWIN, J.P. Major P. B. MALONE, M.P., J.P. Mr. E. J. MORLEY. Mr. A. REED, A.F.I. Mr. C. WISE. Miss E. GOWAN, B.A Mr. F. E. SHARLAND 2 INTRODUCTION. School Medical Department, Town Hall, Tottenham, March, 1926. To the Chairman and other Members of the Tottenham Education Committee. Ladies and Gentlemen, The 1925 Report upon the School Medical Services follows closely the lines suggested in the Schedule to Form 6M prescribed by the Board of Education. The Report is of an exhaustive character and under the various headings of the activities of the Service will be found a somewhat detailed account of the methods employed to conserve the health and remedy the defects occurring amongst children attending Tottenham Elementary Schools. The scheme in operation is a comprehensive and economical one. Those who have watched the development of the School Medical Services, and contrast the physique of the children to-day with that of the children of 1908, will be obliged to acknowledge that the nation is making marked progress towards an A1 population. The success attending the efforts of your officers to raise the standard of fitness amongst the young has been due to the wise foresight of your Committee and its predecessors, and to the stimulation and encouragement that has, without fail, been afforded to your staff in the fulfilment of this important branch to the Service. Grateful acknowledgement is made of your Committee's sympathetic consideration of all matters submitted for deliberation. I am, Ladies and Gentlemen, Yours faithfully, 3 CO-ORDINATION OF THE WORK OF THE SCHOOL MEDICAL SERVICES WITH THAT OF INFANT AND CHILD WELFARE. The School Medical Officer is the Medical Officer exercising supervision over Maternity and Child Welfare. There is being effected a gradual amalgamation of both services, so that the nurses supplying the Medical Services of the Council shall be equipped and available for any of its sections. Children under school age are cared for at the Child Welfare Centres, and Crèche. Details of the work accomplished there are to be found in another section of this report. The records of progress are carefully preserved and, at the date of transfer. these are filed in an envelope, constituting the dossier of the child, and passed to the School Medical Department. This dossier may contain (a) Birth Card and Child Welfare Doctor's records; (b) Infectious Diseases records; (c) Health Visitor's records; (d) Crèche records; (e) Reference to mother's attendance at Ante and Post-Natal Clinic. To this dossier is added during the school curriculum (a) the Medical Inspection card; (b) Records of attendance at Minor Ailments and other clinics; (c) Following-up cards; (d) Treatment received at Hospitals; (e) Convalescent Home treatment, etc. The completed dossier is available for the Juvenile Employment Committee when the child leaves school. The clinics of the School Medical Service for the northern part of Tottenham are housed in the same premises as the Child Welfare Centre for that area—namely, at Bruce Castle—and no hard and fast line is drawn between the child of school age and the child under school age when the question of treatment for an ailment is under consideration. For instance, the dentist, whose clinic is established here, is frequently requested to advise, or operate, upon the teeth of children under school age, and the Doctor who refers the case to him will give her aid if an anaesthetic is required. The dental clinic for the southern part of the district is located in the same premises as the Child Welfare Centre for that area, namely, at the " Chestnuts," St. Ann's Road, and a similar freedom is exercised between the departments, although the dentists are whole-time officers of the Education Committee. Similarly, tile Eye Specialist employed by the Education Committee has always 4 been ready to give his advice in the case, for instance, of a squinting child under school age. Indeed, the feeling is engendered and fostered in the Health Department generally, that each officer shall do what is necessary, so far as he can, for the young folk of the district, irrespective of the fact that they may, or may not, have passed their fifth birthday, and that the attachment of the officers to this, or that section, is only a matter of financial and administrative expediency. In the home visitation of infants by the health visitors, cognizance is taken of matters affecting children attending school, or of school age, and vice versa, visiting school nurses concern themselves with infants under school age—their health and environment. Not only does this arrangement reduce irritability by lessening the number of official visitors and visits; it broadens the vision and interest of the officers in the work appertaining to health services. So closely akin are the two sections, infant welfare and the medical care of school children, that similar provisions are made for hospital and convalescent treatment by the respective Committees. These provisions will be considered in detail under the headings to which they severally relate. There are no nursery schools in Tottenham. SCHOOL HYGIENE. Surroundings. In some of the older schools, whose playgrounds have been in use for a long period, there are depressions, allowing of accumulations of water in wet weather. Where the schools are immediately adjacent to a busy thoroughfare, the noise of the passing heavy traffic causes disturbance to the school curriculum, and it was pointed out at Page Green School, by one of the teachers, that between 180 to 200 heavy lorries and other vehicles pass per hour. Of his scholars he gave the following record, namely:—14: out of 35 are nailbiters, 4 stammerers, and a number are reported to have night terrors. Middle Class School.—The environment of this school is quite unsatisfactory, having regard to its proximity to a public urinal, a fried fish shop and a public-house. The playground is small. Discontinuance of the use of the premises is called for. 5 Holy Trinity School.—This school suffers from the proximity of the London General Omnibus Company's Garage in Philip Lane and from numerous stoppings at, and startings from, High Cross. Stamford Hill School.—The playground accommodation is inadequate, but measures are being take to provide increased space. School for Deaf and Vale Road Schools.—These are new schools and the playgrounds are still in an unfinished condition. Earlsmead School.—At this school there is a large playground used by the girls and infants. This might be divided with advantage. Ventilation. The ventilation throughout the schools is satisfactory generally, except where rooms have been divided, causing one of the rooms to ventilate into the other. Lighting. The lighting in some of the classrooms in the schools is from the right of the scholar and not from the left as it should be. In the following schools the window-sill is so far above the floor level as to deprive the rooms of a good deal of natural lighting:— West Green School. Stamford Hill „ Earlsmead Boys' „ Page Green Girls' „ In the undermentioned schools the gas lighting is unsatisfactory, both in respect of position and the number of brackets. Bruce Grove School. Holy Trinity School. Crowland Road „ St. Katharine's Girls' „ Seven Sisters Infants' „ St. Ann's Boys' „ Lancasterian Boys' „ Parkhurst Boys' & Girls' Schools. St. Ann's Boys' and Girls' Schools.—The natural lighting is inadequate. 6 Warming. The system of heating is, generally, by hot water radiators supplied from a central boiler. At Lancasterian Boys' and Girls' Schools open coal fires are still used. In certain of the schools the heating arrangements are inadequate during cold weather in those classrooms which have a northerly aspect. Equipment and Sanitation. Downhills Girls' School.—Arrangements for admission to, and egress from the cloakroom are unsuitable, and an improvement could be effected by an additional door being made to open into the playground. Bruce Grove and West Green Boys' Schools.—The floors of the classrooms are worn and in want of planing and relevelling. Risley Avenue School.—The lavatories, cloakrooms, playgrounds and classrooms are inadequate owing to the present overcrowded state of the school. Observation on the Type and Condition of Desks and Blackboards. Dual desks, or desks of the modern type having movable seats and desk, have been installed in most of the schools. The exceptions are at Seven Sisters Boys' and Girls' Schools (many). Lancasterian Boys' and Girls' „ (mostly). Stamford Hill Boys' and Girls' „ (throughout). Lancasterian Infants' School (3 rooms). Yale Road „ (few). Middle Class „ (many). Earlsmead Infants' School.—In Room 2, children under 5 years are using dual desks and the room also has the disadvantage of having platforms . Risley Avenue Boys' School.—The type of desk in use is satisfactory, but a number of scholars are too tall for the desks provided. 7 Sanitary Conveniences and Lavatories. At the following schools the sanitary conveniences have an entrance which has to serve as a means of egress also. Facilities should be afforded for scholars to leave by a different portal. Earlsmead Boys' School. Woodlands Park Boys' and Girls' Schools. Seven Sisters' Infants' School. Seven Sisters Infants' School.—The girls' w.c. accommodation is inadequate. Three more w .c.'s are desirable. Allison Road School.—There is one set of w.c.'s only for both sexes. Woodlands Park Girls' and Infants' Schools.—The floor surface of the offices is defective, allowing pools of water to collect. Bruce Grove Infants' School.—The closets are without doors. Water Supply for Washing and Drinking Purposes. West Green Girls' School.—There are 4 wash-hand basins for 330 children. To make up the deficiency, pails of water are brought into the cloakrooms, when necessary. Stamford Hill Girls' School.—Two lavatory basins only are provided. These are in the lower cloakroom and are inadequate for 560 scholars. Risley Avenue Boys' School.—There are two taps in the playground for supplying drinking water. These are stated to be insufficient in the summer when the number on the roll is 850 to 900. Holy Trinity School.—The drinking water is supplied from the tap over the washing bowl. Cleanliness of Schoolrooms and Cloakrooms. The provision of a roller towel per day for drying the hands and faces of a school department is, from the sanitary point of view, insufficient. At the time of the examination it was found, at one of the schools, that before mid-day the towel was practically unusable. Allison Road School.—This school is in need of redecoration. Arrangements for Drying Clothes and Boots. In the schools, generally, there is no separate provision for drying clothes and boots. The drill shoes of the children are used on wet days 8 to replace wet boots, which are dried on, or under, the hot-water pipes. These pipes, which are fixed in the cloakrooms of most of the schools, are usually placed against the wall, and, except in those instances where the clothes pegs are above or otherwise in close proximity to the pipes, they do not facilitate in any considerable degree the drying of clothes. It is suggested that, in future, arrangements be made for the hot-water pipes to pass between the adjacent rows of clothes pegs. Stamford Hill Girls' School.—At this school the cloakroom accommodation is inadequate. St. Katharine's Girls' School.—The main cloakroom is inadequate in size. Arrangements for Warming-up of Meals brought to School by Children, Service of Meals, and Supervision of Children during Meals. At the Central Schools where the children come from a considerable distance, arrangements have been made for the provision of school meals. At Down Lane and Downhills Schools they are obtained in the Feeding and Domestic Centres respectively, and at Risley Avenue School the meals are prepared by the caretaker's wife, and served in the basement room. Apart from the Central Schools very few children remain at school during the dinner-hour. On rare occasions, when it is not convenient for the child to go home, lunch is brought to the school and eaten in one of the classrooms. In these instances a teacher is present. SURVEYOR 'S REPORT OF IMPROVEMENTS CARRIED OUT FROM 31st MARCH, 1925 to 31st MARCH, 1926. Coleraine Park. Alterations to the h.w. system, rebuilding a new stokehole above flood level, and installing a new heating boiler. Crowland Road. Installation of a new heating boiler. Down Lane. Formation of two of the large classrooms into a Feeding Centre. Alterations to the heating of the Dining Hall and Classrooms, also to the h .w. domestic supply. 9 Downhills Central. Formation of a housewifery centre. Deaf. Chemical fire appliances fixed. New blinds fitted. Earlsmead. Division of a classroom by a half glass partition in the Girls' and Boys' Departments. Redecorations internally and externally. Green, Girls'. Redecorations internally. Alterations and improvements to the artificial lighting. Holy Trinity. Redecorations internally. Orchard House. Improvements to the Open-Air Class Shed. Page Green Boys' and Girls'. Installation of new heating boiler. Page Green Infants'. Removal of gallery and levelling floor in one classroom. Page Green Boys' and Girls'. Improvements to the natural lighting in rooms 4b and 2g. Stamford Hill Boys', Girls' and Infants'. Redecorations internally and externally. Stamford Hill Girls'. Formation of a lobby to classroom. St. Katharine's. Installation of a new heating boiler, and alterations to heating of classrooms and corridors. St. Paul's Girls' and Infants'. New ceilings to classrooms and cloakrooms. Improvements to artificial lighting. 10 Education Offices. Redecorations internally with the exception of the Board Room. Vale Road. Chemical fire extinguishers fixed. New blinds fitted. West Green. Redecorations internally and externally. Woodlands Park Boys', Girls' and Infants'. Alterations and improvements to artificial lighting. Playground Repairs. Attention has been given to West Green Boys' and Girls', Parkhurst Boys', Page Green Boys', Girls' and Infants', and Woodlands Park Girls' Schools. School Furnishing. The undermentioned schools have been supplied with the following articles of new furniture:— (a) Devonshire Hill. 20 Infants' tables. 120 4-seater collapsible tables. 11 2- „ „ 16 Single pedestal teachers' desks. 2 Double pedestal head teachers' desks. 36 Cupboards. 2 Ranges of lockers. 2 Tables. 7 Wall blackboards. 9 Easels. 9 Blackboards. 40 Locker desks. 11 (b) Parkhurst Physically Defective Centre. 48 Specially designed chairs (adjustable). 48 Table desks. 3 Adjustable couches. 3 Tables for couches. (c) Allison Road. 4 Cupboards. Generally. In addition to the above, cupboards, screens, remedial forms and ladders, blackboards and needlework boxes have been made and supplied. MEDICAL INSPECTION. The schedule of the Board of Education respecting the age groups to be examined was adhered to, and during the year 1925 all children belonging to these groups, with the exception of those who were absent from school at the time of medical inspection, or whose parents offered objection to medical inspection by the school medical officers, were examined. Objections were few in number, and many of these were withdrawn when the head teachers of the departments used their persuasive influence. Statistical Table I at the end of the report particularises the work accomplished under this heading. FINDINGS OF MEDICAL INSPECTION. (a) Uncleanliness. It may be said, generally, that uncleanliness amongst school children is declining. So far as verminous conditions of the body and clothing are concerned they may be considered to have been reduced to a minimum. In a place like Tottenham, where there is always a fairly large section of the population in great poverty and living in conditions that favour the communication of vermin from person to person, it is not feasible to expect perfect cleanliness. On the other hand, as success attends the efforts of the nurses to gain greater cleanliness, so the standard they set is raised and the numbers of children reported to be 12 verminous does not sensibly decline, although the actual verminous conditions are greatly reduced. This is especially the case with regard to verminous conditions of the hair. The detection of one or two nits is sufficient to stigmatize the child as verminous. It seems harsh, but unless such a high standard is fixed, no workable standard can be set at all. We believe it can be attained and we aim at it. Thus, the number of children found to be unclean in 1925 was approximately the same as in the preceding year, viz., 2,847 in 1925, 2,918 in 1924. That 165 children have been cleansed under arrangements made by the Local Education Authority, compared with 78 in the previous year, might suggest a falling off in the matter of cleanliness of body and clothing. This would not be strictly true. The increased number is due to the efforts of one of the nurses to rid the schools, over which she exercises supervision, of all evidence of vermin. The result has been that she herself cleansed the hair of 110 of the 165 children noted. The complexion of some of the schools, however, has been materially altered since building operations were commenced a year or two ago. This is especially noticeable in the neighbourhood of the London County Council Estate. Any falling off in the condition of cleanliness in the schools is due to the importation of dishoused families from the London area, but already there has been a noticeable improvement. With regard to nits, cutting off of all the hair is seldom now required. The custom of girls to wear the hair short makes it less liable to verminous infestation, and the constant supervision by the nurses causes the children and their parents to be vigilant against gross infestation. At the worst only a few strands require removal. The use of the hygienic comb at home has had a material influence on reducing the incidence of verminous conditions of the hair. (b) Minor Ailments. The number of defects discovered during 1925 was very similar to the 1924 figures. The impression is conveyed, by a comparison of the figures for the two years, that when provision is made for a particular type of ailment, cases coming within the type appear to be discovered more frequently. For instance, a class was established for stammerers in March, 1925, and whereas in 1924 the number of speech defects discovered at inspections was 12, in 1925 it was 46. I do not consider stammerers increased fourfold within the year, but prefer to believe that the fact of provision having been made for their treatment led to a more thorough search for children who could benefit therefrom. 13 (c) Tonsils and Adenoids. The above observations are applicable to Tonsils and Adenoids also. Whilst in the Routine Inspections the numbers closely correspond for 1924 and 1925, in the special examinations the numbers discovered to be requiring treatment increased threefold. The interpretation is, in all probability, that a much more rigorous standard was set and the excellence of the arrangements for treatment caused it to be sought for more frequently. (d) Tuberculosis. The total number of children noted as suffering from Tuberculosis in 1924 was 119—in 1925, 116. (e) Skin Diseases. There has been a declension in the number of skin diseases, with the exception of impetigo, during 1925, and with the provision made by your authority for their treatment there is no reason why they should not be further and greatly reduced. (f) External Eye Diseases. This group calls for no comment. With the exception of those unclassified affections—viz., other conditions, there has been a reduction in all. (g) Vision. From the numbers of defects in vision discovered during 1925, it would appear that there has been a substantial improvement in sight of the school children examined. The numbers are:—1924—958; 1925— 770. (h) Ear Diseases and Deafness. There is nothing worthy to be recorded under this heading. (i) Dental Defects. If. of the children examined during 1925, the same proportion had required treatment as in 1924, the number would have been 14,400. It was actually 12,977—an improvement of 6.2 per cent. 14 (j) Crippling Defects. The discrepancy in the figures for 1924 and 1925 is quite inexplicable except on the assumption that different standards were taken by the medical examiners. Rickets is reputed to have accounted for 7 cases in 1924 and 46 in 1925; spinal curvature for 226 in 1924 and 41 in 1925; and other forms of deformity gave 321 in 1924, against 794 in 1925. The fact that remedial exercise classes have been established in practically all the schools has resulted in the slightest departure from symmetry being searched for and noted. Infectious Diseases. Notification of the occurrence of an infectious disease is followed by action appropriate to its type. In the great majority of instances a child suffering from diphtheria is removed to hospital immediately upon receipt of the official notification. The room, or rooms, which the infected person inhabited, are disinfected by formalin spray, and the clothing is disinfected. All contacts in the household have swabs taken from throat or nose, or both, and the cultures are examined the following day. Children whose cultures are proved to be positive, that is, those who harbour the diphtheria bacilli in throat or nose are excluded from school until a swab shows no evidence of diphtheria bacilli, or that the bacilli are non-virulent. The virulence of the bacilli is determined for us by the pathologist of the Prince of Wales's Hospital. The presence of bacilli morphologically similar to the diphtheria bacilli is a matter that has given cause for thought to the medical officers. Several swabs are taken from children with Hoffmann's or kindred bacilli, before they are readmitted to school, to ascertain whether they are associated with true Klebs Loeffler Bacilli. The occurrence of two or more cases of diphtheria, amongst children attending the same classroom, causes a thorough search to be made amongst the remainder for a possible carrier. This is done by swabbing suspects. or the whole class as the circumstances "dictate, and examination of bacteriological cultures. The classrooms affected are also disinfected. My opinion is that healthy children who do not show bacteriological evidence of the presence of Klebs Loeffler Bacilli in throat or nose, may 15 safely be admitted to school immediately after removal of the patient to hospital and disinfection of premises. A rare occurrence is to find Klebs Lœffler Bacilli in discharge from the ear. In that case similar precautions are taken as when the bacillus is found in other parts. After discharge from hospital, and before return to school, the throats of children are swabbed to ascertain whether they are, in fact, free from infection. Parents are advised to consult their medical advisers in those cases in which return to school is not permitted to their children. It has been the custom in Tottenham not to send children suffering from scarlet fever into hospital as a routine measure. The great obstacle to the domiciliary treatment of scarlet fever has been the memorandum of the Board of Education. There it lays down as a principle that contacts are to be excluded from school for fourteen days after the disinfection of the premises. In the Health Department section of this report reference is made to the use of Dochez' serum. If this anti scarlatinal serum proves its efficacy, as it gives promise of doing, in the cure and prophylaxis of scarlet fever, I am of opinion that exclusion of contacts from school need not be extended over a longer period than, at the most, one week; that period being the limit of incubation of the disease. It is not claimed that prophylactic inoculation against scarlet fever with 5 c.c.'s will protect much beyond fourteen days, but by that time, in the average case of scarlet fever as we see it to-day, the patient is free from infection, especially if he had the advantage of adequate serum inoculation. The position is different, however, in those occasional cases where ear and nasal discharges accompany or follow the acute attack. So long as these continue, the contacts are liable, when the protection given by the serum is exhausted, to contract the malady, and exclusion from school may be warranted. In the light of present knowledge, exclusion should be exercised at the discretion of the Medical Officer of Health and no hard and fast rules insisted on. That is the procedure adopted in this area, and, so far as has been ascertained, without prejudioe to the school population. 16 In the last quarter of 1925 there was an unusual incidence of scarlet fever amongst scholars attending Belmont Road School. A daily inspection of the scholars failed to bring to light more than one or two suspicious cases. An offer was made to the parents of children attending infected classes that, if they wished it, I would be willing to inoculate the susceptible contacts with scarlatinal antitoxin; 136, or about 50 per cent. of the parents accepted. Each child was given 3 c.c.'s intramuscularly, and the children thus protected were spaced out in their classes alternately with the remainder of the children. For a fortnight there was no further notification of scarlet fever from the school. None of the inoculated contracted the disease and there was no further unusual incidence of the disease in the school thereafter. With regard to measles, whooping cough, chicken pox and mumps, the Board of Education's rules are observed. Notifications under the Infectious Disease Notification Acts, 18891899, were received in respect of the following diseases occurring amongst children of school age, with the noted frequency:— Scarlet Fever 279 Diphtheria 150 Enteric Fever 1 Erysipelas 5 Pneumonia 21 Encephalitis Lethargica 1 Cerebro Spinal Meningitis 1 The following cases were voluntarily notified by Teachers and Attendance Officers during the year:— Measles 228 Sore Throat 19 German Measles 105 Tuberculosis 15 Mumps 166 Influenza 190 Whooping Cough 462 Eye Diseases 9 Chicken Pox 556 Ringworm of Head 30 Scarlet Fever 114 Ringworm of Body 10 Diphtheria 118 Sores and Eczema 78 Scabies 20 Impetigo 16 Skin Diseases 5 Other Diseases 160 Verminous 8 Children excluded owing to infectious disease in house 385 Tonsilitis 15 Chorea 12 Pneumonia 2 Debility 16 Rheumatism 7 Otorrhœa 5 Rash 18 Heart Disease 8 17 FOLLOWING-UP. Defects of all kinds discovered at the routine medical inspections are noted on the inspection cards. From these cards the nurses, in attendance with the Medical Officer at the inspections, copy the Medical Officer's observations on a following-up card, which is retained by the nurse for her remarks. The Medical Officer, at the time of inspection, hands to the parent, or has conveyed to him, an intimation of the nature of the defect discovered, with a request that the private doctor should be consulted. This intimation and request applies only to such ailments as require medical supervision or treatment. Adequate time is given for the private medical practitioner to be consulted before the nurse visits the home of the child. It is then ascertained whether a doctor has been consulted and with what result. If nothing effective has been done, an invitation is sent inviting the child to attend the appropriate clinic. The nurse visits the home and emphasises the importance of early attention to the defect. In the great majority of cases the clinic is attended and the malady treated to a satisfactory conclusion. Irregularity of attendance at clinics is followed by home visitation. This regime is applicable to cases in which exclusion from school is advised. In those conditions, which allow of attendance at school while treatment proceeds, the "following-up" is done with the aid of the head teacher of the school who, by reference to the clinic attendance card, learns the date upon which the next visit to the clinic is due and allows time off for that purpose. Occasionally it happens that parents will do nothing themselves for the relief of the child's condition, nor will they allow the school authorities to do anything. In these circumstances, the question is taken into consideration whether the child should be allowed to remain at school. The question arises especially in connection with visual defects. If the ophthalmic surgeon is of opinion that the use of the eyes, unaided by spectacles, would be injurious to the child, the teacher is instructed to exclude it until the child is supplied with suitable glasses. Every reasonable facility is afforded to the parents to take advantage of the School Medical Services in having appropriate treatment for the visual defect of the child. Every week the head teachers supply to the Health Department a list of children absent from their department suffering from contagious or infectious diseases These are "followed-up" by the School Nurses. The Attendance Officer informs the Medical Department of cases of 13 ness occurring amongst absentees, and these latter are visited at home by the nurses. Children who have had operations for tonsils and adenoids at hospital, under the scheme approved by the Board of Education, are visited by the school nurses until they are fit for return to school. The School Nurses paid, during the year, 6,828 home visits. MEDICAL TREATMENT. (a) Minor Ailments. Clinics are held pt Bruce Castle and Town Hall Centres as follows :— Monday, Tuesday, Thursday and Saturday forenoons—Town Hall. Monday, Wednesday and Friday forenoons—Bruce Castle. At the Town Hall there is a spray bath for the treatment of scabies and other skin diseases. The temperature of the water delivered can be regulated as required. The Minor Ailments Clinic may quite properly be regarded as a clearing house, where conditions requiring a short period of treatment only are cared for, and from which children whose ailments require special or prolonged treatment are passed to the appropriate department. Of the other departments, it may be said they are fixed and determined. Their efforts are expended upon particular types of afflictions and the treatment is specialised and precise. At the Minor Ailments Clinic, cuts, septic sores, impetigo, ringworm of the body, blepharitis and such like are treated. There is a group of ill-defined diseases also that receive attention and for which it is necessary that more precise means of classification 19 and diagnosis shall be made available—anaemia, marasmus, inanition, debility, etc. The suspicion remains in one's mind that the diagnosis of these is a cloak to cover ignorance. Sufficient care has not been taken to seek out and ascertain the underlying conditions tnat give rise to the symptom that is given the title of " diagnosis." Probably it is beyond the scope of the Minor Ailments Clinic to inquire exhaustively after the metabolic irregularities that would account for anaemia and the rest, but it is not a sufficient answer to the difficulties to give Parrish's Food or Cod Liver Oil and Malt, and await developments. This "expectant" treatment should only be permitted after every channel of information as to the fundamental causes of the ailment has been explored. The pale complexioned child is not necessarily "anaemic." Before that appellation is applied, the hæmocytometer and haemoglobinometer should have revealed whether there is a deficiency of erythrocytes or haemoglobin, or both. This and kindred lines of inquiry are the directions along which advances might profitably be conducted. (b) Tonsils and Adenoids. Hitherto operations for these conditions were conducted at the School Clinic, Bruce Castle. In July, 1924, the Education Committee entered into a contract with the North Middlesex Hospital for these operations to be performed in that Institution. The results have been entirely satisfactory. The children, after having been seen by the throat specialist there, are given appointments. On the appointed day the child, prepared for operation according to a leaflet, a copy of which is given below, is taken in the morning to the hospital. The operation is performed in the forenoon under prolonged anaesthetic. Chloroform and Ether is employed as the anaesthetic and the enucleation of the tonsils from their bed is effected with deliberation. The duration of the anaesthetic enables a thorough clearance of the post-nasal space to be made and a digital examination to give assurance that the operation is complete. Thereafter, the children are put to bed for a period of several hours and are only released when there is no apprehension of after-trouble. The children are taken home by ambulance in the custody of a nurse. Children who are not, in all respects satisfactory and fit for return home, are detained as long as is necessary, the agreement making provision for hospital residence in such cases. 20 NORTH MIDDLESEX HOSPITAL. Silver Street, Upper Edmonton, N. 18. Date Name Age Address Please bring this patient to the Out-patient Department of this Hospital on at 9 o'clock. If any signs of illness of any kind develop in the meantime, keep the child at home, but if the child is going on in the usual way, on the night before you come give him/her a dose of castor oil to clear out the bowels, also a hot bath. On the morning of the operation, do not give the child the ordinary breakfast, but instead a thin slice of bread and butter and a cup of weak tea or Bovril. At the Out-patient Department ask for the Sister. The child will be kept until called for by the Ambulance at the end of the afternoon. If for any reason the child should be unable to go home in the Ambulance, he/she will be retained in the Hospital for the night and the School Nurse will be informed. 21 Have a bed ready for the child and keep him/her there for two days. He/she can have some warm milk, beef tea, Bovril or weak tea (not hot), and later on in the evening a small basin of bread and milk. On the day after the operation he/she may have any soft food to which he/she is accustomed. (c) Tuberculosis. The County Council is the Authority having supervision over the treatment of tuberculosis. Very friendly relations exist between the local Tuberculosis Officer and the School Medical Department. Cases in which doubt arises as to the nature of the ailment from which children suffer are referred to the Tuberculosis Officer, who gives us the advantage of his written advice. In those instances where no definite lesion can be discovered and in which convalescent treatment is indicated, the children are referred back to this department and enjoy the advantage of the scheme which your authority has entered into with the Invalid Children's Aid Association. (d) Skin Diseases. As described, under minor ailments, a spray bath at the Town Hall clinic is employed when necessary in the treatment of skin diseases. Beyond this, treatment consists in the use of lotion, ointment and such internal remedies as each individual case requires. Tuberculous lesions and those of a specific kind would, of course, be sent to the appropriate clinic under the County. Having tried various preparations claiming to cure ringworm safely and speedily, we have come to the conclusion that nothing is so certain as the X-Rays. In competent hands there is an assurance of safety. The X-Ray work for the School Medical Services is undertaken at the North Middlesex Hospital, and the results have been uniformly satisfactory. (e) External Eye Diseases. Blepharitis, styes, conjunctivitis, phyctenular ophthalmia and such like are treated at the minor ailments clinic. Cases of squint, corneal ulcer, and other eye defects that call for specially skilled attention or treatment, are referred to the eye clinic and are seen by Mr. Letchworth. On his recommendation the Assistant School Medical Officer administers 22 tuberculin to patients whose condition indicates this special method of treatment. The results have been equal to expectations. (f) Vision. Children whose vision is found to be 6/12 or less in either, or both eyes, are examined by Mr. Letchworth with a view to suitable spectacles being provided. The eye clinic occupies the whole of Tuesday in each school week, and an average of 25 is seen at each of the two sessions, morning and afternoon. The eyes are examined under the influence of a mydriatic, and the error of refraction, if any, estimated. The optician, with whom the Committee has entered into an arrangement for the supply of spectacles at special rates, measures for the frames, and the completed spectacles are available for use, as a rule, the following week. Mr. Letchworth satisfies himself that they are in all respects suitable, after the effect of the mydriatic has passed. The optician attends at the clinic on Tuesdays, so that the least possible inconvenience is caused to children and parents. (g) Ear Disease and Hearing. Wax in the ear, boils in the ear, eczema or impetigo of the ear or ear passages are treated by the Assistant School Medical Officers at the Minor Ailments Clinics. Dr. Friel attends Bruce Castle on Friday forenoons to treat cases of otorrhoea. The results of this treatment are given below. It consists mainly in the ionisation with zinc sulphate solution and incidental treatment with boric powder and other local applications. In longstanding cases of otorrhoea, with chronic mastoiditis, surgical intervention is called for if it is hoped to obtain freedom of discharge from the ears. The Committee has arrangements with the North Middlesex Hospital and the Prince of Wales's Hospital for the reception into their institutions, for operative purposes, of such cases as give promise of successful results. The arrangement has not continued long enough to make any valuable criticism upon it. 23 Dr. Friel has furnished the following report upon the Ionisation Clinic:— The Otorrhœa Clinic was started two years ago and is run on similar lines to the clinics of the London County Council for the treatment of discharging ears by zinc ionisation. It should first be stated that the work is carried out in co-operation with the Minor Ailments Treatment Centres, and there has been complete agreement and harmony between the two. This is essential for the success of the clinic. One session a week is held, on Friday mornings during term. Every child found by the school doctors, nurses or teachers, to have ear discharge has his, or her, name placed on a list which is kept in the office at Bruce Castle. The children are then called up to the clinic in rotation. During the first year it took considerable effort to work through the list; now we have to deal only with fresh cases as they arise, or are discovered among children entering schools. As this is the first detailed report of the work of this clinic it may be permitted to state the principles on which the work is carried on. As by far the greater number of cases seen are of chronic otorrhcea, this condition is dealt with more fully. The treatment of acute otitis media with discharge already present, consists in trying to prevent the development of the chronic condition by adopting some means to prevent the discharge from becoming a breeding ground for additional varieties of micro-organisms derived from the skin, air, handkerchiefs, etc. The insufflation of boracic acid powder has generally proved satisfactory. The case is otherwise in chronic otorrhcea. If the discharge is either (a) slight in amount; (b) does not come from some inaccessible part of the ear; or (c) is distinctly mucoid in character, the insufflation of boracic acid usually suffices. But in other cases we need treatment more vigorously antiseptic, such as zinc ionisation. Each case is examined with a view to determining what is keeping up the discharge. Sepsis is the basic factor, but frequently one or more additional factors are present either in the ear, nose, throat, or mouth. If a polypus is present in the ear, this is first removed. If there is rhinitis or inflamed tonsils, these require treatment as well as the ear itself. Every effort is made to remove additional factors when present and so to convert cases which, when first seen were unsuitable, into ones suitable for treatment by zinc ionisation. The cases suitable for zinc 24 lonisation are those in which sepsis alone, in an accessible area is responsible for keeping up the discharge. In these cases zinc ionisation is so effective that often one application is found to be sufficient to bring about complete cessation of the discharge. When the sepsis is in an inaccessible area such as the mastoid antrum or attic, operation in hospital is usually required. In most cases it is possible, at the first visit, to decide on the extent of the area involved, but in some, owing to generalised inflammation of the tissues this is impossible. However, after zinc ionisation has been carried out we find that the generalised redness and swelling of the tissues of the tympanum subside, leaving localised evidence at one part pointing to the seat of the disease. It is then possible to make an accurate diagnosis and to send cases requiring operation, to hospital, without delay. Table No. 1-This Table expresses in General Terms the Various Conditions found, and the Treatment they require. Cause of Chronicity. Treatment. I . Accessible Sepsis, e.g. Tympanic Sepsis Zinc Ionisation with, or without, Boracic Powder Insufflation. For slight cases, Boracic Powder is often sufficient. II. Accessible Sepsis with Second Factor in Ear, e.g., Polypus Remove Second Factor, then Ionise Ear. III. Accessible Sepsis with Inflammation in a neighbouring organ, e.g., Rhinitis Treat neighbouring organ, and Ionise Ear. IV. Inaccessible Sepsir, e.g., cavity in Mastoid opening directly into Tympanum. Attio Disease, Chronic Mastoiditis Use special instrument to gain access :— (а) Attic Canula (б) Gelatin-covered wire, or make area of Sepsis accessible, e.g., destroy outer Attic Wall. O.-siculectomy. Partial or complete Mastoid Operation, and then Ionise. TABLE No. 2.—An analysis is given of the causes of chronicity and of the results of treatment, as well as a summary of the number of ears, under the various headings. 25 Cases requiring operation on the mastoid are now sent to the Prince of Wales's Hospital and come under the care of the Aural Surgeon, Mr. Ibbotson, whose courteous co-operation I much appreciate. Cause of Suppuration. Total. Cured. Lost Sight Of. Still under Treatment. Sent for. Operation. Other Treatment. Acut Inflammation (Acute Suppurative Otitis Media) 6 6 — — — — Chronic Suppurative Otitis Media, due to:— I. Tympanic Conditions— (a) Tympanic Sepsis 96 84 7 5 — — (6) T. S.and Granulations 14 9 2 3 — — (c) T.S. and Polypi 18 12 3 3 — — (d) T.S. and Cholesteatoma 1 — — 1 — — II. Tympanic Conditions and Throat, Nose or Mouth Conditions 5 3 - 2 - III. Tympanic Conditions and Attic Disease 17 5 5 6 1 — Mastoid Disease:— (a) Operation Cases (b) Operation already performed 32 4 5 - 4 - 7 - 16 - 4 IV. Tympanic Conditions and External Otitis 3 1 2 — - — External Otitis 21 15 — 6 - — Cause undetermined 2 1 1 — - — Totals 219 141 24 33 17 4 (h) Dental Defects. Two whole-time dentists are employed for the treatment of dental defects occurring in children of school age. The district is divided into two, each dentist having an equal share in the work. One dentist, Mr. Sainty, is stationed in the northern area at Bruce Castle, and the other, Mr. Pilbeam, in the southern area, at The Chestnuts, St. Ann's Road. 26 Besides the ordinary routine medical inspections by the School Medical Officers, the Dentists themselves make periodical visits at the schools, and schedule those children requiring dental treatment. The system has been employed of commencing with the entrant group of school children and giving such treatment to their defective teeth as they require. The following year the entrants are examined and the group of the previous year also. The next year three groups are examined, and so on. Thus four groups are now kept under regular supervision. In addition to this routine method of inspection and treatment, the Head Teachers of all the departments are permitted to refer for treatment urgent cases, to the number of four from each department, on a particular day each week. On that day one of the Assistant School Medical Officers is deputed to be in attendance at the clinic for the administration of an anaesthetic. Unless in the most urgent cases, where time and expediency do not allow of it, the parent's written consent is required to the operation or, alternatively, the parent accompanies the child. It is much regretted that a large percentage of refusals of dental treatment are still received. Much time is spent in urging unwilling parents to reconsider their decision not to allow of treatment, that could more profitably be occupied in visiting schools and in treating and reexamining those who have already profited by the dental services. The obstinacy of the objecting parents is exceedingly unreasonable, for the utmost care is taken by the dentists to avoid causing pain, and the children themselves appear to have no fear of the dental chair. Regulation of teeth forms part of the work of the dentists, and their efforts are accompanied by gratifying results. (t) Crippling Defects and Orthopaedics. A register is kept of all children in Tottenham known to be suffering from crippling defects. Information is supplied for the purpose of this registration by the medical officers attached to both branches of the service, by health visitors, school nurses, teachers, and attendance officers. The children are diligently followed up to ascertain whether the utmost is being done, and, if not. to urge that it shall be done for the restoration to the fullest amount of usefulness of the disabled member. There is no general scheme applicable to crippled children in the area. The Prince of Wales's Hospital, situated as it is in Tottenham, 27 affords treatment for a large proportion of the crippling defects occurring in the district. The proximity of Tottenham to the large hospitals in London allows of these institutions being made use of for a certain number. Orthopaedic instruments are provided for crippled children by the Invalid Children's Aid Association, and the Education Committee recoup the Association as to 75 per cent, of their outlay. The parents are required to contribute to the cost according to their means. Two years ago. June, 1924, the Committee set apart two class rooms at Parkhurst Road School for the education of physically defective children. The pupils are conveyed to and from school by the Council's ambulance. A nurse, who has been appointed to attend to these children, accompanies them on their journeys and also when they are required to visit hospital, so that she may learn the wishes of the orthopaedic surgeon in charge of the oases and know how to follow out his instructions. It is seen that the children wear their instruments regularly and properly, that necessary adjustments are made where and when required, and massage is given according to directions. In those cases where it is inadvisable that the children should attend a day school the Education Committee makes suitable provision for them in residential institutions. The following Report with respect to Open-Air Education, Physical Training and Provision of Meals has been received from the Director of Education :— OPEN-AIR EDUCATION. (a) Playground Classes. Open-air shelters have continued in use at Page Green, Stamford Hill and other schools. In most schools playsheds, and the playgrounds generally, have been freely utilised in suitable weather for open-air classes. Proposals for the erection of a shelter at Woodlands Park Girls' School are before the Board. It is hoped that this will be ready for use early in the Summer of 1926. (b) and (c) School Journeys and Camps. For the year 1925, the Board of Education sanctioned the expenditure of a sum not exceeding £190 in aiding School Journeys. The actual expenditure was as follows:— 28 £ s. d All Hallows' Boys' School 53 3 1 Down Lane Central School 60 0 0 Rislev Avenue Central School 25 0 0 St. Paul's Girls' School 30 0 0 £168 3 1 The following table shows the expenditure on School Journeys since the Committee decided to aid them :— Year. Amount Sanctioned. Amount Spent. £ £ 1920 300 221 1921 250 209.10 1922 187.10 138.17 1923 187.10 185 1924 210 210 1925 190 168.3 1,325.0 1,132.10 The following are brief particulars of the Journeys carried out during 1925:— 1. ALL HALLOWS' BOYS' SCHOOL. Twenty-four boys, accompanied by two teachers, camped for 17 days near Le Havre, France, in July. The boys travelled 660 miles. The journey was most successful from every point of view. Valuable educational work was done and much physical benefit was gained by the boys, who made an average increase in weight of 2½ lb. As the Camp was self-contained, the work of assembly and transporting tents, cooking apparatus, food, etc., to France was very considerable. Careful preparation in school had fitted the boys for making the most of the journey. The camp was visited by H.M. British Consul at Le Havre, who made a thorough inspection of the camp and the work of the boys. Letters from him to the teachers in charge and to the Head Master 29 pressed his high opinion of the excellence of the arrangements, the good discipline, orderliness and intelligence of the boys and the value of the visit. The total cost of the camp was £122 13s. Id., towards which the Committee contributed £53 3s. Id. A very successful parents' meeting was recently held at the School, when descriptions of the journey, illustrated by slides, were given. 2. DOWN LANE CENTRAL SCHOOL. Ninety-one girls (the whole of the first year) and six teachers, in two parties, spent a week at Tankerton, near Whitstable, Kent, where they stayed at the Marine Hotel. Visits were paid to Canterbury, Sandwich, Deal, Dover, and other places in the neighbourhood. An excellent guide book had been prepared and much very useful educational work was done. The total cost of the journey was £210 3s. 8d., towards which the Committee contributed £60. 3. RISLEY AVENUE CENTRAL SCHOOL. Twenty-four boys and two teachers spent a week at the Rockland Boarding House, Swanage, in May. They made a thorough study of the geography and geology of the district, particularly of the Isle of Purbeck. Visits were paid to Lulworth Cove, Southampton, Corfe Castle and other places. Excellent preparations for the journey had been made and the arrangements were carried out most satisfactorily. The total cost of the journey was £61 10s. 9d., towards which the Committee contributed £25. 4. ST. PAUL'S GIRLS' SCHOOL. Twenty-five girls and two teachers spent fifteen days at Folkestone, from which centre they visited Dover, Lyminge, Hythe, Boulogne and other places. The journey was admirably organised and conducted. Good work was done. 30 The total cost of the journey was £91 8s., the Committee's contribution being £30. (d) Open-Air Classrooms in Public Elementary Schools. A two-department school to accommodate 800 children has been in course of erection during 1925 and will be opened in April, 1926. All the rooms open on one side on to a covered, but not enclosed verandah, so that all classes will work in the open air whenever conditions are suitable. (e) Day Open-Air Schools. For several seasons Open-Air Classes have been held during the Spring and Summer in the Bandstand at Downhills Park, for girls, and in a shelter at Orchard House, North Tottenham, for boys. Pupils are selected, by the School Medical Officers, from the neighbouring schools. The improvement in the physical and mental condition of the scholars has been most marked. The shelter at Orchard House was recently altered so as to make it available all the year round. It has been occupied throughout the Winter of 1925-6, and application is now to be made to the Board for its recognition as a temporary Open-Air Day School until more suitable arrangements can be made. The Education Authority are making enquiries for a suitable site on which to establish an Open-Air School for about 120 pupils. (/) Residential Open-Air Schools. None of these is in operation. PHYSICAL TRAINING. Physical Training in the schools receives much attention. In addition to the courses of instruction following the Board's syllabus and regulations, many schools give instruction in Folk Dancing, Eurythmics and other forms of Physical Exercises. Remedial Exercises are given in nearly all schools by specially selected class teachers, acting under the direction of one of the Assistant School Medical Officers and of an expert adviser, who is engaged for half- 31 time for this work. Children are selected and inspected and the exercises are prescribed by the Medical Staff. Organised Games are a regular part of the curriculum of all the schools. Valuable assistance in these is given by a flourishing Schools' Sports Association, which organises Cricket, Football and Netball Competitions on a League system; and an Annual Sports Meeting, in which school representatives, chosen on the results of their own School Sports Meeting, complete for challenge shields or cups. Combined displays of Physical Drill and Country Dancing are features of the Annual Sports. Swimming Instruction is given to Senior boys and girls, who attend at the Public Baths during school hours. Under the direction of the School Swimming Association, scholars are encouraged to take examinations for certificates issued by that Association and by the London Schools Swimming Association. In 1925 nearly 2,000 certificates were awarded, these being shared almost equally between girls and boys. These included a large number of certificates for proficiency in life-saving. PROVISION OF MEALS. During the year, 116,055 school meals (dinners) were provided. Necessitous children only, with the exception mentioned below, were provided with meals and no charge was made. The income of the parents must be within the scale fixed. The dietaries at the various Cookery and Feeding Centres are submitted to, and approved by, the School Medical Officer who periodically visits the Centre. Dinners are provided for payment at the Down Lane Central Girls' School, but part payment is accepted in cases where the parents are in poor circumstances. The following are the menus of the meals supplied at the Down Lane and Lancasterian Centres:— 32 Down Lane Centre. Monday. Boiled mutton, pearl barley and potatoes. Jam tart. Tuesday. Minced meat, baked potatoes and green peas. Rice pudding. Wednesday. Shepherd's pie and butter beans. Currant pudding. Thursday. Meat pudding, green peas and potatoes. Tapioca pudding. Friday. Leg of beef stew, dumplings and potatoes. Apple tart. Lancasterian Centre. Monday. Meat, potatoes and plain pudding. Tuesday. Hashed beef, potatoes and butter beans. Wednesday. Meat pudding and potatoes. Baked rice and custard. Thursday. Hashed beef and potatoes. Rice pudding. Friday. Pea soup and bread. Date, currant or jam pudding. SCHOOL BATHS. None provided. CO-OPERATION OF PARENTS. The parents are invited to be present at the inspection of their children. In the case of infants and 8-year-olds, the mothers usually attend very well. Parents do not frequently accompany senior boys at the medical inspections, but senior girls have often their mothers with them. The parents, when they are present, are told of any defects revealed by the examination, and a note advising consultation with the family practitioner is handed to them. Should no parent accompany a child, the note would be sent by the child. The subsequent events are related under the heading "Following-up." This method of securing co-operation with parents has proved entirely satisfactory. 33 CO-OPERATION OF TEACHERS. As far as is possible, the convenience of teachers is consulted in arranging for inspections in the schools and for other work connected with the School Medical Services. It may be stated, generally, that the teachers are sympathetic towards the Medical Services, and are very helpful in carrying them out. Very frequently, for lack of provision of a special consulting room, the head teacher places his or her private room for the purpose of the inspection at the disposal of the School Medical Officer. It is also gratifying to record that the teacher himself is often present at the examinations, hears the observations made, notes the defects discovered and emphasises the need for treatment. In the matter of following-up, facility is usually given unhesitatingly to the nurses for access to individual scholars. In respect of those who attend periodically at clinics, the teachers note the date of next attendances on the clinic cards, and allow of opportunity for the appointment to be kept. CO-OPERATION OF SCHOOL ATTENDANCE OFFICERS. The Attendance Officers, in the fulfilment of their routine duties, come to the knowledge of children absent from school on account of conditions with which the School Medical Officers ought to be acquainted. On the other hand, the School Medical Officers, after examination of scholars, are able to advise the Attendance Officers what action they ought to take. The reciprocity existing between the two departments makes for the maximum benefit accruing to the scholars. In individual cases where it is desired particularly to make a special examination of a pupil and difficulty is experienced in having an appointment kept, the Attendance Officer seldom fails to achieve the desired end. Similarly, with regard to treatment. When difficulty is experienced in having the appropriate treatment applied, for instance, the wearing of instruments for disease or deformity, or operative intervention, the aid of the Attendance Officer is invoked, usually with satisfactory results. The School Attendance Officer's Department and the School Medical Officer's Department are so intimately related that it cannot properly be said a scheme for their cooperation is in existence. When one has need of the other, the necessary assistance is asked for and the required services are rendered without demur. CO-OPERATION OF VOLUNTARY BODIES. The Invalid Children's Aid Association accepts for Convalescent Home treatment the school children recommended for that kind of treatment. Cripple children of school age are supplied, through the agency of the 34 I.C.A.A., with the necessary instruments, and in respect of both of these kinds of assistance the Education Committee pay to the I.C.A.A. 75 per cent, of their out-of-pocket expenses. The Association makes the necessary arrangements with the parents for the payment of their (the parents) quota, and collects it. The School Medical Officers see cases going to Convalescent Homes and approve the treatment advised, and the Senior Assistant School Medical Officer examines the instruments supplied to cripple children and ascertains whether they are so satisfactory as to enable the children to attend school. It is seldom that the aid of the National Society for the Prevention of Cruelty to Children is invoked, but they render useful service when requested. The National Hospital for Diseases of the Heart, the Central London Throat, Nose and Ear Hospital and the Prince of Wales's Hospital, have arrangements with the Education Committee for the treatment of specific types of disease. The Committee have also an agreement with the North Middlesex Hospital Authorities for the hospital treatment of such ailments as ringworm, tonsils and adenoids, and mastoid disease. It may be stated generally that the Education Committee have such complete arrangements for the treatment of the diseases of school children, either at their own clinic or on their behalf at one, or other, of the great London Hospitals, that there is no reason why any Tottenham child should have his ailment unattended. Convalescent Home Treatment.—During the year, 327 children were sent away for varying periods, namely:— No. of Weeks 1 2 3 4 5 6 7 8 9 10 11 12 13 No. of Children 2 13 15 79 35 43 9 53 14 16 5 8 8 No. of Weeks 14 15 16 18 19 20 22 23 27 30 31 48 52 No. of Children 7 5 2 3 1 2 1 1 1 1 1 1 1 In 30 of these cases, the treatment has been continued in 1926. 35 The following table gives the afiections on account of which children received convalescent treatment:— Nervous Debility 10 Hip 2 Pre-tubercular Debility 34 Spine 3 Debility aft. Infectious Disease 19 Colitis 2 Post-operative Debility 13 Lupus 1 Post-Pneumonic Debility 4 Chorea 24 Anaemia and Debility 54 Enlargement of Glands 10 Heart Affections and Anaemia 26 Rheumatism 10 Bronchitis and Bronchl. Catarrh 44 Tonsilitis 2 Asthma 2 Dyspepsia 3 Other Non-tubercular Lung Dis. 17 Paralysis 4 Gastric Catarrh 2 Rheumatic Fever 5 Gastric Nephritis 2 Tuberculosis:— Malnutrition 4 Knee 1 Appendicitis 2 Peritoneum 4 Other Cases 13 Provision of Surgical Instruments.—Surgical appliances were supplied, and repairs and replacements effected in 233 instances. This was in respect of 91 children who were found to be suffering from the following defects:— Infantile and other forms of Club-feet 3 Paralysis 39 Pes Cavus 1 Tuberculosis:— Hip 5 Knee 2 Ankle 1 Spine 4 Flat-foot 5 Other forms of Deformed Feet 14 Amputated Leg 2 Rickety Deformities 5 Weak Ankles 2 Other cases 8 36 BLIND, DEAF, DEFECTIVE AND EPILEPTIC CHILDREN. The Nurses attached to the Maternity and Child Welfare Section of the Health Services bring to the notice of the School Medical Officer children who would, if attending school, come within the provisions of Part V of the Education Act, 1921. The Attendance Officers and the School Nurses, in their visitation of the homes of the children, are informed of children of school age who, because of physical and mental defects, are unable to attend school. The school teachers, from their intimate knowledge of the domestic circumstances of their pupils, learn of other children in the family suffering from disabilities. Following-up of the cases reveals the nature and degree of the defect, and appropriate action is taken in each instance. These various sources of knowledge serve to supply the Education Authority with the necessary information relating to blind, deaf, defective and epileptic children. Until mentally defective children of high grade are admitted to special schools, they are permitted to remain in the ordinary schools, unless their conduct is such as seriously to disturb the school curriculum. With that exception and the occasional visit by the school nurse at the homes of the defective children, no official supervision is exercised over them until their admission to a special school suitable to their defect. School for Deaf Children. This school was removed to new premises on 8th September, 1924, the new building having been erected on vacant ground in the rear of the old structure which had served as a temporary school for many years. By arrangements with the neighbouring Education Authorities of Hornsey, Wood Green, Enfield and Edmonton, deaf children from these districts attend the Tottenham School for the Deaf. There are at present 73 children on the roll, 29 of these being Tottenham children. During the year under review 4 Tottenham children 37 were admitted to the School and 7 were discharged, for the following reasons:— Attained maximum age 1 Educational attainments on reaching age of 14 years equal to those of Standard VII in ordinary Elementary Schools (hard of hearing cases only) 4 Removed from district 1 Transferred to Residential Institution 1 Classification of Defects. Deaf Mutes 21 Hard of hearing 7 Aphasia 1 Class for Stammerers. This class met for the first time on 25th March, 1925. There were 8 pupils present (including 6 Tottenham children), 7 boys and 1 girl. The children were taught speech control by means of speech analysis. They were shown how to examine a word and find out the different sounds of which it was composed. Their control was strengthened by their being taught how to hold on to a sound for a given number of beats. The children remained in the class until their speech had improved, when they returned to their former school and other stammerers were admitted to take their places. Various letters of appreciation reached the Head Mistress from the Head Teachers of the schools to which the children returned. The class was disbanded in September owing to the illness of the teacher in charge. By this time 11 children had been treated to completion and 6 were still under treatment. 14 of these came from Tottenham Schools and 3 from other districts. The class was re-organised and re-opened on 25th January, 1926, with 10 boys and girls on the roll, all Tottenham children. The class consists of children who were being treated when the class was disbanded, 1 boy who was reported as having failed to maintain the improvement effected in his speech by previous treatment, and others who did not avail themselves of the opportunity of joining the class when it was first offered. Transport of Tottenham children residing at any considerable distance from the school is effected by means of motor ambulance. A hot meal is provided at mid-day for all the children in attendance at the school 38 at a cost of 3d. per head, and gratis in necessitous cases. The children assist in the cooking of the food and domestic work entailed by the provision of the meals, these duties being part of the school curriculum. School for Physically Defective Children. At the end of 1925 there were in attendance at this School 51 children suffering from the following defects:— Infantile Paralysis 19 Cerebral Diplegia 5 Congenital Heart Disease 6 Acquired Heart Disease 1 Tuberculosis of Hip Joint 4 Tuberculosis of Knee Joint 3 Tuberculosis of Spine 4 Tuberculosis of Spine and Bones of Leg 1 Tuberculosis of Spine and Cervical Glands 1 Congenital Dislocation of Hips 2 Congenital Deformities of Limbs 2 Talipes Equino Varus 1 Rheumatoid Arthritis 1 Fragilitas Ossium 1 Total 51 During the year the names of fourteen children were removed from the register for the following reasons:— Scholastic attainments equal to Standard VII on reaching age of fourteen years 2 (Both these children commenced suitable work on leaving school). Transferred to Residential Institutions 2 Transferred to Trade School at Alton 1 Reached age of sixteen years 2 Medically unfit to attend School 2 Died in Hospital (Haemophilia) 1 Left District 4 Total 14 39 The School has now been equipped throughout with chairs and desks specially suited to the requirements of Cripple Children. This furniture has been designed and made in the Committee's own workshops under the supervision of Mr. Newbury (Work's Superintendent to the Education Committee) and has been found to suit all requirements exceedingly well. A couch for massage has been provided from one of the Committee's Clinics. The full-time services of a nurse were made available for the School on 23rd June, 1925, and her services have proved invaluable in adding to the comfort and well-being of the children. Besides attending to their bodily needs the nurse performs massage, practises remedial exercises, supervises and adjusts instruments, and at frequent intervals accompanies the children to the various hospitals. These visits to the hospital have proved of great value. The nurse is present when the patients are examined by the surgeons and receives verbal instructions regarding treatment, such as rest, massage, remedial exercises, and the wearing of instruments. Since the nurse commenced her duties she has administered massage to eight children and has instructed five children in remedial exercises, and in every case these forms of treatment have been followed by improvements in walking and movement. The nurse also attends at the School Clinics with all children requiring such treatment as is there available. Cod Liver Oil and Malt and Parrish's Chemical Food are administered under medical direction, and every child is provided with a cup of hot Grade "A" milk during each morning session at a charge of a halfpenny. At mid-day a hot meal is supplied at a cost of threepence. In necessitous cases the morning milk and the mid-day meal are provided free of charge. These meals are cooked at Down Lane Feeding Centre and are transported to Parkhurst Road School in a closed cart. The serving of the meals is undertaken by the nurse and a woman assistant, who also sets the table and washes up. The transport of the children between their homes and the School is effected by means of motor ambulances. Taking into consideration the difficulty of conducting such a school in two classrooms of an ordinary Elementary School with no separate cloak rooms or lavatory accommodation, the work accomplished is in every way praiseworthy. The majority of the children are apt pupils, and, as far as their physical disabilities 40 will allow, speedily acquire many attainments. A casual visit to the School makes apparent the fact that school is an important contributory factor to their happiness. Oak Lodge Day Special School for Mentally Defective Children. During the year 1924 arrangements were completed for the admission of a number of Tottenham children to the Finchley, Hornsey and Wood Green Joint Special School for Mentally Defective Children. At the end of 1925, 26 Tottenham children were in attendance. These are classified as follows:— Dull and Backward 3 Mentally Defective 22 Mongolian Imbecile 1 During 1925 two children have been removed from the School, one because she was paralysed and her physical disability interfered with her progress at this type of school, the other because she was found after admission to suffer from epilepsy. The School is situated in Oak Lane, Finchley. It is a large mansionhouse in semi-rural surroundings, the rooms of which are utilized for class rooms, and in other respects the house has been modified to suit school requirements. A spacious garden in the rear is utilised by the pupils for games and instruction in gardening. Hand work naturally forms an important part of the curriculum and there is a well-equipped workshop where the boys are instructed in woodwork and carpentry. A domestic centre for the girls where cookery, laundry and housework are taught has been established. Baths are provided. The majority of the children partake of hot dinners provided at mid-day at a cost of fivepence, but a number bring their own food, which is heated up for them in the school kitchen. During 1925, an average of ten Tottenham children received free dinners provided by the managers of the School. Nineteen Tottenham children received hot milk every morning, this being provided at a charge of 7d. per week. All the Tottenham children are, with one exception, reported by the School Nurse to be well clad. The School is visited at regular intervals 41 by the Medical Officers of the Tottenham Education Committee, for the purpose of examining Tottenham children. Transport to and from the School is effected by means of Motor Ambulance. Open-Air Centre, Orchard House. The school is intended to provide an environment suitable for those children suffering from malnutrition, anaemia or other physical disability for which open-air treatment is deemed to be essential. The ground in which the present open-air centre is placed has an area of one and onetenth acre, of which two-fifths of an acre is available for school purposes. The remaining portion is occupied by allotments. Fifteen poles are under cultivation by the scholars. The structure, used solely for educational purposes, consists of a wooden shelter, completely open on all sides and supplied with a concrete floor. Protection from bad weather conditions is given by heavy canvas curtains extending from the floor level upwards for about four feet, and above this by hinged shutters, which, on three sides (south, west and north) may be adjusted to suit the direction of the wind. The area covered by the shelter is 400 square feet—20 feet each way, and the seating is arranged so that the children face towards the south. Battened boards are placed over the concrete floor to protect the feet from cold. Lighting is natural, but in dark and foggy weather, unequal. Those children in front receive more than those in the rear benches, as the roof slopes downwards from south to north, namely from seven to five feet. A slow combustion stove, placed in the south-west corner, warms the interior of the shelter in cold weather and is also used for heating milk, etc. The question of artificial light or, alternatively, of natural light by means of the provision of a roof window is worthy of consideration. Seating accommodation is in the form of ordinary dual desks. If it is desired to have classes in the open sunlight, these desks should be replaced or supplemented by light movable tables or desks, and chairs. The playground surrounding the classroom south and west is of clay and in wet weather is unusable. The children are then more or less confined to the shelter. Sanitary conveniences have been suitably placed giving seating accommodation for two. The urinal is satisfactory. Two washhand basins have also been provided. The centre was opened on 15th June, 1925, with a roll of 20 scholars, aged 6 to 13 years, and this number was increased to 32 by 31st December—drawn from the following schools: Lancasterian Boys' Parkhurst Road Infants' Coleraine Park Boys' St. Katharine's Infants' Parkhurst Road Boys' Each scholar is given one tablespoonful of cod liver oil and malt and one 42 quarter of a pint of milk daily. Instruction in physical exercises and gardening constitute an important part of the school curriculum. On the coldest days boys who wish or feel the need for it are allowed a blanket to wrap round their feet and legs. This is precautionary, but it is rare to hear any complaint of cold. There has been practically complete freedom from colds and bronchial troubles, in spite of exposure to the changes of a somewhat severe winter. The children have improved physically and mentally. Anaemic and ill-nourished boys have gained in weight and muscular tone. Frequent examinations have been made and weights ascertained at regular intervals. The appended table gives details of the progress of the scholars. Considering the temporary nature of the centre and that ideal conditions do not obtain, the results so far have proved that the school has justified its existence and warrants an extension of its type. The great disability of having one centre only is that the children can only be drawn from adjacent schools. Delicate children cannot be expected to make the journey on foot from more distant schools, and parents are unwilling that they should. Again it is felt that some provision should be made whereby a warm meal could be had by those who, owing to poor family circumstances, cannot have proper nourishment at home. It is recognised that weaklings greatly benefit by a period of entire rest during school hours and provision of facilities for this rest period merits consideration. Many of the boys have very defective footwear, and in wet weather it is unhealthy for them to sit in soaking boots and stockings. It would be a great advantage were means of changing footwear made available, and were the footwear itself provided in necessitous cases. A good beginning has been made, and the direction has been shown in which progress can best be made to secure the greatest educational advantages, most economically, for debilitated scholars. Weights at Periodical Examinations:— Age. 9-10-25. 18-12-25. 5-2-26. H. H. 9 3st. l¼lb. 3st.7½1b. Absent. C. M. 11 Absent. Absent. Absent. T. D. 13 Absent. 4st. 3½lb. Absent. F. L. 9 Absent. 5st. 6½1b. Absent. C. W. 12 Absent. 6st. 31b. Absent. J. H. — Absent. 3st.8¼lb. Absent. G. W. 7 Absent. Absent. Absent. E. B. 10 4st. 6½1b. 4st. 9½1b. 4st. 8½lb. G. C. 9 4st.7¼lb. 4st. 11¾1b. . 5st. O½lb. R. P. 8 4st. O¾lb. Absent. 4st. 41b. 43  Age. 9-10-25. 18-12-25. 5-2-26. J. s. 11 4st. 8½1b. 4st. 12½1b. 4st. 11½1b F. B. 9 3st. 131b Absent. 4st. 31b. H. B. 9 4st. 5¼1b Absent. 4st. 8½lb. R. W. 9 2st. 8¼1b. 2st.ll½lb. 2st. 12¾lb w.s. 11 4st. O½lb. 4st. 31b. 4st. 21b. H P. 9 Absent. 4st. 5¼1b. 4st. 61b. E. G. 12 3st. lO½lb. 3st. 131b. 4st. 1½1b. W. R. 7 3st. O½lb. 3st. 2 lb. 3st.2½lb. D. B. 8 3st. lO½lb. 3st. 13¾1b. 4st. 01b. T. H. 7 3st. 6½lb. Absent 3st. 1O¾lb G. H. 8 4st. 31b. 4st. 71b. 4st. 7¾1b. W. B. 9 Absent 4st. 9¼1b. 4st. 111b. G. P. — 3st. 2¼1b. 3st.6¼lb. 3st. 7½1b. J. R. 13 Absent 5st. 5¾1b. 5st. 7¼1b. F. S. 9 4st. 71b. 4st. 11¼1b. 4st. lO½lb H.B. 13 5st. 5¼lb. 5st. lO¾lb. 5st. 121b. A. H. 13 4st. lO¼lb. 4st. 111b. 4st. 131b. B. C. 10 4st. 12¼1b. 4st. 13½1b. 5st. l½1b. A. B. 12 4st. lO½lb. 4st. 12½1b. 5st. 01b. E. F. — Absent 3st. 5¼1b. 3st. 5¾1b. A.J. 9 3st. lO¾lb. 3st. 12¼1b. 3st. 12½1b. R. W. 11 A new Scholar. 4st. 121bs. Special Residential Schools. There are 32 children from this district being maintained in Special Residential Schools. 10 of these are crippled and physically defective, 5 blind, 10 mentally defective, 5 epileptic, and 2 deaf. Secondary Schools. Table I, page 45, sets out the number of children, under their separate ages, examined in the secondary schools during the year. Tables II—IV, pages 46—47, show in detail the defects discovered during the inspections, and the number of defective children who were subsequently found to have received treatment. EMPLOYMENT OF CHILDREN AND YOUNG PERSONS. The following report, with respect to Employment of Children and Young Persons, has been submitted by the Organizing Officer for Juvenile Employment:— 44 Conditions of employment are, generally speaking, satisfactory. Unsatisfactory conditions have been reported to me on various infrequent occasions and the necessary steps have been taken to see that certain regulations were in future complied with. This is generally effected by co-operation with the local Factory Inspector. The number of situations filled by boys and girls in a year now reaches approximately 850, over 500 of this number being situations filled by boys. About 25 per cent, of these juveniles are insurable in the National Health and Unemployment Insurance Acts. Co-ordination of the School Medical Service with the Juvenile Employment Bureau is effected thus :— (a) School Medical Cards are forwarded to the Juvenile Employment Bureau after children have attained school leaving age. (b) The School-leaving Employment Card provides a space for " Health Report." Where this is conscientiously filled in by the Head Teacher, it serves a very useful purpose when the child applies for employment. Any special co-operation with the certifying Surgeon for the district has, up to the moment not been found necessary. (r.) In a few cases of young persons just left school the School Medical Service has been of definite and immediate use to the Juvenile Employment Officer by examination in cases of suspected goitre, myopia and other troubles which might affect success when applying to the employer for a particular vacancy. Apart from cripples, applicants for employment are, generally speaking in good physical condition. 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. 45 The following quantities have been dispensed at cost price, at less than cost price, or gratuitously, according to circumstances:— Cod Liver Oil and Malt 1,931 lbs. Parrish's Food 1,519 lbs. Cod Liver Oil 1,269 ozs. Syrupus Ferri Iodidi 2,376 ozs. Syrupus Calcii Lactophosphatis 2,308 ozs. Examinations by the Medical Officers. 41 teachers, 2 attendance officers, 1 caretaker, and 2 junior clerks have been examined by the Medical Officers. 1 child has been medically examined and licensed to take part in entertainments. 6 boys, between the ages of 15 and 16 years, have been examined and licences granted under the Bye-Laws relating to Street Trading. 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. 1,142 such examinations were made, 93 were found to be positive, 997 negative, and 52 contained bacteria morphologically similar to Klebs Loeffler bacilli. Microscopical Examinations. Hairs were taken from children who were suspected to be suffering from ringworm in 34 instances and submitted to microscopical examination. 29 were positive. SECONDARY SCHOOLS. Table I.—Number of Pupils inspected 1st January, 1925, to 31st December, 1925. Ages. Routine Inspections. Total. 10 11 12 13 14 15 16 17 18 Boys 2 52 31 62 55 75 13 - - 290 Girls 1 7 45 72 117 49 1 - - 292 Totals 3 59 76 134 172 124 14 — — 582 46 Table II.—Return of Defects found in the Course of Medical Inspection in 1925. 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 Uncleanliness:— Head — - Body — - Ringworm:— Skin Head — - Body — - Scabies — - Impetigo — - Other Diseases (Non-Tubercular) 6 - Eye Blepharitis 3 - Conjunctivitis 1 - Keratitis — - Corneal Opacities — - Defective Vision 38 - Squint 2 - Other Conditions 2 - Ear Defective Hearing 2 - Otitis Media 2 - Other Ear Diseases 2 - Nose and Throat Enlarged Tonsils 27 3 Adenoids 2 — Enlarged Tonsils and Adenoids 2 — Other Conditions 13 — Enl. Cervical Glands (Non-Tubercular) 2 — Defective Speech — — Heart and Circulation Heart Disease:— Organic 3 — Functional 2 1 Anaemia 9 — Lungs Bronchitis and Bronchial Catarrh 7 3 Other Non-Tubercular Diseases 3 1 Tuberculosis 'Pulmonary:— Definite — — Suspected - - Non-Pulmonary:— Glands — — Spine — — Hip — — Other Bones and Joints — — Skin — — Other Forms — — Nervous System Epilepsy — — Chorea 2 — Other Conditions 5 — Deformities Rickets - - Spinal Curvature 4 — Other Forms 19 — Other Defects and Diseases 25 - 47 Table IV.—Treatment of Defects of Pupils during 1926. 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 — 5 5 Ear Disease — 1 1 Eye Disease:— External and other - 5 5 Miscellaneous - — — Total .. — 11 11 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) - 33 33 Other Defect or Disease of the Eyes (excluding those recorded in Group I.) — — — — Total — 33 — 33 Total number of Pupils for whom spectacles were prescribed:— (а) Under the Authority's Scheme Nil (b) Otherwise 26 Total number of Pupils who obtained or received spectacles:— (а) Under the Authority's Scheme Nil (b) Otherwise 26 48 Group III.—Treatment of Defects of Nose and Thkoat. Number of Defects. Received Operative Treatment. Received other forms of Treatment. Total Number treated. Under the Authority's Scheme, in Clinic or Hospital. By Private Practitioner or Hospital apart from the Authority's Scheme. Total (1) (2) (3) (4) (6) — 5 5 4 9 Group IV.—Dental Defects. Number of Pupils who were:— Found to require treatment 92 Actually treated 53 ELEMENTARY SCHOOLS. Table I.—Number of Children Inspected 1st January, 1926 to 31st December, 1925. A.—Routine Medical Inspections. Number of Code Group Inspections:— Entrants 2,981 Intermediates 1,923 Leavers 2,144 Total 7,048 Number of other Routine Inspections B.—Otiier Inspections. Number of Special Inspect ions 7,161 Number of Re-Inspcctions 20,618 Total 27,779 49 Table II. A.—Return of Defects found by Medical Inspection in the Year ended 31st December, 1925. 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 requiring Treatment. (1) (2) (3) (4) (5) Malnutrition 15 5 81 7 Uncleanliness:—(See Table IV., Group V.) Skin Ringworm:— Scalp 3 — 89 1 Body — — 64 - Scabies 5 — 54 - Impetigo 15 — 547 - Other Diseases (Non-Tuberculous] 31 — 351 9 Eye Blepharitis 18 — 68 - Conjunctivitis 3 — 138 - Keratitis 2 — 4 - Corneal Opacities 1 — 7 - Defective Vision (excluding Squint) 305 14 451 - Squint 38 — 132 - Other Conditions 2 1 241 - Gar Defective Hearing 8 2 9 1 Otitis Media 45 2 225 3 Other Ear Diseases 41 — 112 1 Nose and Throat 'Enlarged Tonsils only 209 114 78 5 Adenoids only 30 15 40 2 Enlarged Tonsils and Adenoids 311 30 282 4 Other Conditions 11 2 201 12 Enlarged Cervical Glands (Non-Tuberculous) 9 13 91 4 Defective Speech 10 2 31 3 Teeth—Dental Diseases — — — — (See Table IV., Group IV.) Heart and Circulation Heart Disease:— Organic 7 18 31 11 Functional 11 40 17 10 Anaemia 64 8 319 23 Lungs Bronchitis 99 108 410 15 Other Non-Tuberculous Diseases 2 3 52 3 Tuberoulosis Pulmonary:— Definite — 1 14 — Suspected 6 4 30 7 Non-Pulmonary:— Glands 4 — 10 1 Spine 3 — 5 1 Hip 2 1 7 1 Other Bones and Joints 1 — 7 — Skin 1 — 4 — Other Forms 2 — 3 1 Nervous System Epilepsy 3 16 1 Chorea 7 2 87 1 Other Conditions 10 8 62 4 Deformities Rickets 4 2 40 — Spinal Curvature 14 1 26 — Other Forms 65 10 718 1 Other defects and diseases 107 42 1,346 72 50 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 2,981 674 22.6 Intermediates 1,923 332 17. 2 Leavers 2,144 400 18.6 Total (Code Groups) 7,048 1,406 199 Other Routine Inspections — — — 51 Table III.—Return of all Exceptional Children in the Area. — — — Boys Girls Total Blind (including partially blind) (i) Suitable for training in a School or Class for the totally blind Attending Certified Schools or Classes for the Blind .. 3 2 5 Attending Public Elementary Schools At other Institutions — — — At no School or Institution — — — (ii) Suitable for training in a School or Class for the partially blind Attending Certified Schools or Classes for the Blind 9 9 18 Attending Public Elementary Schools 1 1 At other Institutions — — — At no School or Institution 1 — 1 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 10 13 23 Attending Public Elementary Schools - - - At other Institutions — — — At no School or Institution — — — (it) Suitable for training in a School or Class for the partially deaf Attending Certified Schools or Classes for the Deaf - 7 7 Attending Public Elementary Schools 3 2 5 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. 21 15 36 Attending Public Elementary Schools 98 46 144 At other Institutions — 1 1 At no School or Institution 12 17 29* Notified to the Local Authority during the year Feebleminded 1 2 3 Imbeciles 1 1 2 Idiots — — — Epileptics Suffering from severe epilepsy Attending Certified Special Schools for Epileptics 2 3 5 In Institutions other than Certified Special Schools - - - Attending Public Elementary Schools - - - At no School or Institution 4 8 12* Suffering from epilepsy which is not severe Attending Public Elementary Schools 9 8 17 At no School or Institution - - - * Two boys and four girls included under these headings are both Epileptic and Feeble-Minded. 52 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 - 1 1 At other Institutions i — 1 At no School or Institution — 2 2 Non-infectious but active pulmonary and glandular tuberculosis At Sanatoria or Sanatorium Schools approved by the Ministry of Health or the Board 5 4 9 At Certified Residential Open Air Schools - - At Certified Day Open Air Schools - - At Public Elementary Schls. 6 7 13 At other Institutions — — — 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 32 32 At Public Elementary Schls. 149 236 385 At other Institutions — — — At no School or Institution 5 8 13 Active Non-pulmonary tuberculosis At Sanatoria or Hospital Schools approved by the Ministry of Health or the Board 3 3 6 At Public Elementary Schls. 1 4 5 At other Institutions — 1 1 At no School or Institution 1 2 3 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. 1 — 1 At Certified Residential Cripple Schools 7 2 9 At Certified Day Cripple Scs. 22 28 50 At Public Elementary Schls. 12 17 29 At other Institutions — — — At no School or Institution 4 10 14 Note on Table III.—Fifteen boys and two girls suffering from Stammering and other Speech Defects are in attendance at a special Speech Class at the School for the Deaf. One case of Aphasia also attends the School for the Deaf. 53 Table IV.—Return of Defects Treated during the Year ended 31st December, 1925. TREATMENT TABLE. Group 1.—Minor Ailments (excluding Uncleanliness, for which see Group V). Disease or Defect. Number of Defects treated, or under treatment during the year. Under the Authority's Scheme. Otherwise. Total. (1) (2) (3) (4) Skin:— Ringworm—Scalp 83 7 90 Ringworm—Body 64 — 64 Scabies 54 — 54 Impetigo 546 3 549 Other skin disease 329 30 359 Minor Eye Defects 453 11 464 (External and other, but excluding cases falling in Group II.) Minor Ear Defects 333 33 366 Miscellaneous 482 16 498 (e.g., minor injuries, bruises, sores, chilblains, etc.) Total 2,344 100 2,444 54 Group II.—Defective Vision and Squint (excluding Minor Eye Defects treated as Minor Ailments—Group I). Defect or Disease. No. of Defeots 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) 824 10 9 843 Other Defect or Disease of the Eyes (excluding those recorded in Group I.) 40 - — 40 Total 864 10 9 883 Total number of children for whom spectacles were prescribed : — (а) Under the Authority's Scheme 659 (b) Otherwise 16 Total number of children who obtained or received spectacles:— (a) Under the Authority's Scheme 659 (b) Otherwise 16 Group III.—Treatment of Defects of Nose and Throat. Number of Defects. Received Operative Treatment. Received other forms of Treatment. Total Number treated. Under the Authority's Scheme,in Clinic or Hospital. By Private Practitioner or Hospital, apart from the Authority's Scheme. Total (1) (2) (3) (4) (5) 631 76 707 211 918 55 Oroup V.—Uncleanliness and verminous conditions. (i.) Average number of visits per school made during the year by the School Nurses 18.7 (ii.) Total number of examinations of children in the Schools by School Nurses 112,101 (iii.) Number of individual children found unclean 2,847 (iv.) Number of children cleansed under arrangements made by the Local Education Authority 165 (v.) Number of cases in which legal proceedings were taken:— (a) Under the Education Act, 1921 (6) Under School Attendance Bye-laws 18 Table IV.—Continued. Group IV.—Dental Defects. (1) Number of Children who were:— (a) Inspected by the Dentist— Aeed: Routine Age Groups 5 2,080 Total 6 1,820 7 1,912 8 2,832 9 3,088 10 3,294 18,455 11 2,452 12 671 13 236 14 70, Specials 1,771 Grand Total 20,226 (6) Found to require treatment 12,977 (c) Actually treated 5,202 (d) Re-treated during the year as the result of periodical examination 1,737 (2) Half-days devoted to Inspection 69 Total 800 Treatment 731 (3) Attendances made by children for treatment 7,385 (4) Fillings Permanent Teeth 1,472 Total 1,912 Temporary Teeth 440 (5) Extractions Permanent Teeth 1,328 Total 10,805 Temporary Teeth 9,477 (6) Administrations of general anaesthetics for extractions 1,250 (7) Other operations Permanent Teeth 253 Total 265 Temporary Teeth 12 (8) Regulation cases 33 INDEX. PART I. Health Department. A PAGE Ambulance Service 50 B Bacteriological Laboratory 51 Births 19 C Cancer 36 Cerebro-Spinal Fever 43 Clinics 52 Closet Accommodation 58 Common Lodging-Houses 66 Cowsheds 66 D Dairies, etc 66 Deaths 20 Diphtheria 45 Disinfection 65 Drainage and Sewerage 58 Dysentery 43 E Encephalitis Lethargica 43 Enteiic Fever 45 Erysipelas 46 Exhumations 66 F Factory and Workshop Act 60 Food and Drugs Act 64 Food, Unsound 64 H Health Services 50 Health Week 53 Hospitals 50 Housing 67 Infantile Mortality 21 Infectious Diseases 39 Introduction 9 L Laboratory 51 Legal Proceedings 56 Lodging-Houses 66 M Malaria 43 Measles 41 M. of H. Tables 22 etc. Mortuary Table 38 N PAGE Natural and Social Conditions of the Area 14 etc. North Middlesex Hospital 39 Nursing in the Home 53 0 Offensive Trades 67 Ophthalmia Neonatorum.. 43 P Physical Features of the Area 16 Poliomyelitis 43 Poor Law Relief 39 Population 14 etc. Public Conveniences 58 Puerperal Fever 43 R Rateable Value 18 Rivers and Streams 57 S Sanitary Circumstances of the Area 57 Sanitary Work, General 59 Scarlet Fever 46 Scavenging 58 Schools 67 Shops Acts 55 Slaughter-Houses 66 Smallpox 39 Smoke Abatement 66 Social Conditions of the Area 18 Staff 4 Statutes, etc. Administered 54 Streams 57 T Treatment Centres 52 Tuberculosis 41 U Underground S eeping Rooms 67 Unsound Food 64 V Violent Deaths 37 W Water 57 PART II. Maternity and Child Welfare Department. A PAGE Ante-Natal Clinic 9 B Bruce Castle 8,9 Births 6 C Chestnuts (The) 8,9 Creche 10 Centres, List of Attendances 3,8 Convalescent Home Treatment (I.C.A A) 11 D Dinners in Necessitous Cases 9 G Gifts 12 I Introduction 4 Infant Mortality 8 L Lower Ward, Bruce Castle Centre 8,9 M PAGE Maternity Cases 9,10 Mid-wives' Fees 11 N Notification of Births' Acts —Visits 7 0 Ophthalmia Neonatorum— Visits 7 S Staff (see page 7, Health Department portion) T Town Hall Centre—Attendance 8 W Welfare Centres (list of) 3 V Voluntary Services .. 11 PART III. School Medical Department. A Adenoids 13, 19 Attendance Officers 33 B Bacteriological Examinations 45 Blind Children 36 C Co-ordination, Health Services 3 Convalescent Home Treatment 34 Crippling Defects 14,26 D Deafness 13,36 Dental Defects 13, 25 E Ear Diseases 13.22.23 Employment of Children and Young Persons 43 Epileptic Children 36 Extent of Medical Inspection 11, 48 External Eye Diseases 13, 21 Eye Clinic 22 F Findings of Medical Inspection 11 Following-up 17 Food Accessories and Drugs 44 H Hearing 22 Home Visits 18 Hygiene, School 4 I Infectious Diseases 14 Ionisation Clinic 23 Invalid Children's Aid Association 33 Introduction 2 M Meals. Piovision of 31 Mentally Defective Children 36, 40 Menus, School Meals 32 Minor Ailments12,18 0 Oak Lodge Special School.. 40 Open-Air Centre 41 Open-Air Education 27 Orthopaedics 26 Otorrhoea Clinic 23 P PAGE Parents, Co-operation of 32 Physically Defective School 27 , 38 Physical Training 30 Playground Classes 27 R Residential Schools 43 Ringworm 21 S School for Deaf 30 School Journeys and Camps 27 Secondary Schools 43. 45 S PAGE Skin Diseases 13,21 Stammerers37 Statistics 45-55 Surgical Instruments 35 T Teachers, Co-operation of 33 Tonsils and Adenoids 13, 19 Treatment 18 Tuberculosis 13,21 U Uncleanliness 11 V Verminous Conditions 11 Vision 13, 22 Voluntary Bodies 33