Tottenham Urban District Council. ANNUAL REPORT OF THE Medical Officer of Health FOR THE YEAR 1926. DAVID C. KIRKHOPE, M.D., Ch.M., D.P.H., Barrister-at-Law. TOT 6 Tottenham Urban District Council. Report ON THE HEALTH OF TOTTENHAM FOR THE YEAR 1926. Crusha it Son, Ltd , Tottenham, Enfield. Wood Green and Palmers Green. 2 SUMMARY OF STATISTICS FOR 1926. Area 3,014 acres. Population 159,500 Births 2,601 Birth-rate 16.3 per 1,000 of population. Deaths 1,545 Death-rate 9-6 per 1,000 of population. Deaths under 1 year of age 147 Infant Death-rate 56-5 per 1,000 births. Phthisis Death-rate 0-89 per 1,000 of population. Rateable Value £650,704 Amount Produced by 1d. Rate £2,565 3 Tottenham Urban District Council. HEALTH COMMITTEE: Chairman: Mr. Councillor H. Farthing. Members: (Ex-Officio): Mr. Councillor W. R. Jackson, J.P. (Chairman of the Council.) (Ex-Officio): Mr. Councillor A. Reed, A.F.I. (Vice-Chairman of the Council.) Mrs. Councillor F. C. Brighten. Miss ,, R. F. Cox. Mr. ,, F. Easton. Mr. ,, W. Fordyce. Mr. ,, F. C. Gilbert. Mr ,, A. E. Jay. Mrs. ,, A. Kitchener. Major P. B. Malone, M P., J.P. Mr. Councillor D. Nott. Mr. ,, C. Stowe. Mr. ,, A. R. Turner. Representatives on the Middlesex Districts Joint Smallpox Hospital Board: Mr. Councillor T. Elderfield. ,, ,, T. Inglis. Major P. B. Malone, M.P., J.P. Council's Representative on the Metropolitan Water Board under the Metropolis Water Act, 1902: Major P. B. Malone, M.P., J.P. 4 Heads of Departments: Clerk and Solicitor:—Reginald C. Graves, Esq., LL.D. (to September). Clerk and Solicitor:—Eric Townson, Esq., LL.B. (from September). 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) Late Harringay Ward. (117, Broadwater Road) §†*PoRTMAN, W. C. Late High Cross Ward. (98, Lansdowne Road.) §†*WEST, W. P. West Green Ward. (33, Drayton Road.) §†*Miller, H. W. Late Middle Ward. (119, Sperling Road.) §†*Shillito, J. A. Late Lower Ward. (9, Cedar Road.) §†*Smith, J. B. (Cert., S.I. Ex. Brd.) Late 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. Shops Acts— Inspector.—Lock, F. T. G. Assistant Inspector.—Sendall, A. A. 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. ¶ Nursing of Sick Children, 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 Officer— R. Hastings Smythe, L.R.C.P. and S.I. Ophthalmic Surgeon— T. W. Letch worth, 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. *†V. 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. E. S. Glegg. J. E. Miller (and at Laboratory). 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. (to May). Margaret Salmond, M.D., B.S. (Lond.), M.K.C.S., L.R.C.P. (from May). Superintendent Health Visitor— §‡†Mrs. J. Kent-Parsons. Health Visitors. †¶aB. Wallace. *†§aM. Blanchard. *†G. Mason. *†°N. Headley. § Health Visitor's Diploma. ‡ San. Insp. Exam. Bd. Cert. ¶ R-S.I. San. Insp. Cert. a R.S.I. Health Vis. Cert. *†°aF. Fletcher. *†a bG. M. Hockin. *†a bcE. M. Dunn. *†¶M. F- Reynolds. * General Training Cert, † C M.B. º Fever Training Cert. b Moorfields Eye Hosp. Cert. c Alton T.B. 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., Health 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. Cattle, 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, 1927. To the Chairman and other Members of the Tottenham Urban District Council. Ladies and Gentlemen, The Report of 1926 is mainly statistical. The previous Report was of a comprehensive character, such as will be required once in five years only. Reference therefore should be made to the larger (1925) Report for details of the Health Services. My thanks are due to the Health Committee for their support, to my Colleagues for their co-operation and to my Staff for their loyalty. I am, Ladies and Gentlemen, Your obedient Servant, 10 SOCIAL CONDITIONS OF THE AREA. The social conditions of the area have not altered during the past year. Population. The 1921 census population was returned by the Registrar-General at 146,711. The figure furnished by the Treasurer for 1926 is 159,500, and it is upon the Treasurer's estimate that the vital statistics have been calculated, as in previous years. The declension in the Birth Rate has the effect of causing the population as a whole to become more aged. The meaning of this expression is seen by a comparison of the percentage Census figures for 1911 and 1921. It will be seen by reference to the accompanying Table that the percentages of persons over the age of 35 in 1921 exceed those in 1911, and that the percentages of persons under that age, with the exception of the 10 to 20 gears' group, were materially reduced at the last Census. 1] Censuses 1911 and 1921.—Percentage, of each sex in quinquennial age groups. Age Group. 1911. 1921 Percentages. Percentages. Males. Females. Males. Females. Under 5 years 13.1 12.2 9.9 8.5 5 arid under 10 years 11.8 10.9 11.0 9.9 10 „ 15 10.5 9.7 11.3 10.2 15 „ 20 9.3 9.0 9.4 9.2 20 „ 25 8.1 9.0 7.6 8.8 25 ,, 30 8.7 9.0 7.5 8.4 30 ,, 35 8.5 8.4 7.4 7.9 35 ,, 40 7.2 7.2 7.3 7.6 40 ,, 45 6.0 5.9 6.9 6.9 45 ,, 50 4.6 4.7 6.2 5.8 50 ,, 55 3.9 4.0 5.0 4.8 55 ,, 60 3.0 3.1 3.6 3.5 60 ,, 66 2.2 2.4 2.7 3.0 65 ,, 70 1.5 1.9 2.0 2.3 70 ,, 75 0.9 1.3 1.2 1.6 75 ,, 80 0.4 0.7 0.6 1.0 80 ,, 85 0.2 0.4 0.3 0.4 85 and over 0.1 0.2 0.1 0.2 Rateable Value. The Rateable Value of the District in 1926 was £650,704, and a Id. Kate produced £2,565. Return of Houses, Population, etc., at Mid-Summer, 1926, 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. £ Bruce Grove & Stoneleith 404 4,324 227 4,551 21,140 52.3 87,191 Chestnuts 201 3,766 201 3,966 22,040 109.6 61,738 Green Lanes 203 2,773 180 2,968 15,410 75.9 77,169 Park and Coleraine 688 3,030 175 3,811 18,550 26.9 73,783 Stamford Hill 292 4,089 164 4,253 22,530 77.1 76,699 Town Hall 281 3,484 185 3,649 18,120 64.4 90,875 West Green 470 4,062 165 4,227 20,620 43.8 79,338 White Hart Lane 475 4,138 134 4,272 21,090 44.4 64,835 Throughout the Parish — — 15‡ 15‡ — — 39,076 Totals 3,014 30,257 1,455 31,712 159,500 52.9 £650,704 *Houses, Houses and Shops, and Flats. † Lock-up Shops, Stables, Workshops, Garages, Schools, Factories, Glasshouses, Land, etc. ‡ Railways, Tramways, Reservoirs, Gas, Water and Electric Mains. 13 BIRTHS. Births Registered:—Males 1,309 Females 1,292 Total 2,601 Including Illegitimate Births:—Male 53 Female 39 Total 92 Births occurring in the district 2,177 Births of Tottenham residents occurring outside the district 424 Total 2,601 Birth Rate, 16.3 per 1,000. Births notified under the Notification of Births Acts:— In district by Doctors 617 ,, ,, Midwives 1,248 ,, ,, Parents and other persons 233 Notified from outside Institutions 487 2,585 Advised by Registrar 30 Total 2,615 Less Still Births 62 2,553 14 DEATHS. The total number of deaths registered in Tottenham was 1,090 Of these, the number of non-residents was 222 Deaths of residents registered in the district 868 Deaths of residents registered outside the district 677 1,545 Deaths of residents under 1 year occurring in district 97 Deaths of residents under 1 year occurring outside district 50 Total deaths of Tottenham infants 147 These deaths are distributed in age groups as follows:— Deaths under 1 year 147 Deaths from 1 to 5 years 83 Deaths from 5 to 15 years 47 Deaths from 15 to 25 years 81 Deaths from 25 to 65 years 579 Deaths 65 and upwards 608 1,545 The excess of births over deaths is 1,056. The death rate equalled 9.6 per 1,000 of the population. The death occurred, in the North Middlesex Hospital, on Christmas Day, of our oldest resident—aged 104 years. 15 Table showing the Population, Birth and Death Rates, in Wards, during 1926. 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 Populat:on. Infant Mortality per 1,000 Births. Bruce Grove & Stoneleigh 359 222 21,140 17.0 10.5 23 1.1 64.1 Chestnuts 325 217 22,040 14.7 9.8 13 0.6 40.0 Green Lanes 177 116 15,410 11.5 7.5 5 0.3 28.2 Park and Coleraine 317 159 18,550 17.1 8.6 13 0.8 41.0 Stamford Hill 375 227 22,530 16.6 10.1 20 0.9 53.3 Town Hall 347 181 18,120 19.2 10.0 22 1.2 63.4 West Green 276 208 20,620 13.4 10.1 16 0.8 58.0 White Hart Lane 425 215 21,090 20.2 10.2 35 1.7 82.4 Total 2,601 1,545 159,500 16.3 9.6 147 0.9 56.5 16 M. of H. Table 1. Table showing the Population, Birth Rate, and Death Rate from all causes, in Tottenham during the last six years. Year. Population estimated to Middle of each Year. Births. Total Deaths Registered in the District. Deaths of Nonresidents registered in the District. Deaths of Residents not registered in the District. Nett Deaths Belonging to the District. Uncorrected Number. Nett.. Under 1 Year of Age. At all Ages. Number. Rate. Number. Rate. Numbor. Rate per 1,000 Nett Births. Number. Rate. 1 2 3 4 5 6 7 8 9 10 11 12 13 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 9.8 352 559 203 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 7.0 213 704 150 54.4 1,596 10.1 1926 159,500 2,177 2,601 16.3 1,090 6.8 222 677 147 56.5 1,545 9.6 17 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). Heatherwood Hospital, Ascot. Royal Sea Bathing Hospital, Margate. 3.—Other Institutions, the deaths in which have been distributed among the several localities in the District Hospitals, etc.:■— Guys', 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. 18 City of London Maternity, City Road. County Mental, Devizes. German Hospital, Hackney. Manor House Hospital, Golders Green. Bancroft Lodge, Stepney. Darenth Training Colony, Dartford. Chest Hospital, Bethnal Green. Isolation Hospital, Bishop's Stortford. Colney Hatch Mental, Friern Barnet. London Fever Hospital, Liverpool Road. Children's Hospital, Paddington. London Jewish, Stepney Green. King's College, Denmark Hill. The Mothers', Clapton. London, Whitechapel. Westminster, Broad Sanctuary. Royal Chest, City Road. St. Columbus, Hampstead. Bethlem Royal, Southwark. Springfield Hospital, Wandsworth. Royal Free, Gray's Inn Road. Metropolitan, Kingsland Road. Hampstead General, Hampstead. Royal Northern, Holloway. Leavesden, Watford. Napsbury, St. Albans. St. Anthony's, Cheam. St. Joseph's Hospice, Hackney. Seamen's Hospital, Greenwich. Mental Hospital, Brookwood. Queen's, Chislehurst. West End Hospital, Gloucester Gate. St. Peter's, Westminster. Passmore Edwards Cottage, Wood Green. National, Queen Square, W.C.1. Mildmay Memorial, Newington Green. Elizabeth Garrett Anderson, St. Pancras. Hospital of St. John and St. Elizabeth, St. Marylebone. National, for Diseases of the Heart, St. Marylebone. Queen Mary's, Caterham. Royal London Ophthalmic, City Road. Epileptic Colony, Silver Street. 19 M. of H. Table II.—Table of cases of Infectious Disease coming to the knowledge of the Medical Officer of Health during the year 1926 in the Tottenham Urban District, classified according to Diseases, Ages and. Localities. NOTIFIABLE DISEASE. Number or Cases Notified. Total Casks Notified in Each Locality Total Cases Removed to Hospital At all Ages At Ages—Years Brnce Grove and Stone leign Chestnuts Green Lanes Park and Colcraine Stamford Hill Town Hall West Green White Hart Lane Under 1 1 to 2 2 to 5 5 to 10 10 to 15 15 to '20 20 to 3!> 35 to 45 45 to 65 65 and over Encephalitis Lethargica 8 — — 1 — — 1 2 — 2 2 — 2 2 — — 3 1 — 1 Diphtheria (including Membranous Croup) 495 3 14 99 240 87 26 19 6 1 — 131 34 19 33 60 98 64 56 470 Erysipelas 49 — — 2 — 2 2 10 9 21 3 4 8 4 4 9 8 5 7 7 Scarlet Fever 481 4 12 124 207 87 28 12 5 2 — 63 61 59 32 74 61 60 71 96 Enteric Fever 7 — — — 4 1 — 1 — 1 — 2 1 1 — — 2 1 — 4 Pneumonia 160 17 10 26 18 6 6 12 15 32 18 11 45 6 6 46 16 20 10 — Puerperal Fever 4 — — — — — — 3 1 — — 1 — 2 — 1 — — — — Puerperal Pyrexia 7 — — — — — 1 6 — — — 1 1 — — 3 1 — 1 — Cerebro-spinal Meningitis 3 1 — — — 1 — 1 — — — 1 — — 1 — 1 — — 1 Poliomyelitis 2 — — 1 1 — — — — — — 2 — — — — — — — — Malaria & Dysentery 2 — — — — — — 1 1 — — 1 1 — — — — — — — Ophthalmia Neonatorum 13 13 — — — — — — — — — 1 1 2 — 4 — 2 3 — Pulmonary Tuberculosis 277 — 1 2 10 15 32 115 49 49 4 43 46 22 22 44 31 37 32 — Other forms of Tuberculosis 47 2 3 10 10 5 4 7 2 4 — 7 9 2 5 9 5 — 10 — Totals 1,555 40 40 265 490 204 100 189 88 112 27 268 209 119 103 250 226 190 190 579 20 M. of H. Table III. TABLE OF DEATHS during the Year 1926 m the lottenham Urban sanitary District,classified according to Diseases, Ages and Localities. Causes of Death. Deaths at the subjoined ages of "Residents" whether occurring in or beyond the District 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. All Ages. Under 1 year. 1 and under 2. 2 and under 5. 5 and under 15. 15 and under 25. 25 and under 35. 35 and under 45. 45 and under 55. 55 and under 65. 65 and under 75. 75 aDd under 85. 85 and upwards. Bruce Grove & Stoneloish. Chestnuts. Green Lane . Park and Colaraine. Stamfoid Hill. Town Hail. West Green. White Hart Lane. Enteric Fever — — — — — — — — — — — — — — — — — — — — — — Smallpox — — — — — — — — — — — — — — — — — — — — — — Measles 19 4 9 5 1 — — — — — — — — 4 5 — 2 1 3 — 4 15 Scarlet Fever — — — — — — — — — — — — — — — — — — — — — 10 Whooping Cough 15 6 6 2 1 — — — — — — — — 5 1 — 3 3 — — 3 1 Diphtheria 19 I 1 7 10 — — — — — — — — 6 1 1 2 2 2 4 1 41 Influenza 20 1 — — 1 — 1 2 5 5 3 1 1 4 1 1 1 4 1 2 6 1 Erysipelas 1 — 1 — — — — — — — — — — — — — — — — — 1 — Phthisis (Pulmonary Tuberculosis) 142 — 1 — 3 37 18 31 37 10 3 — — 26 24 7 14 17 14 20 20 8 Tuberculous Meningitis 23 — 6 12 3 — 1 1 — — — — — 1 4 1 1 4 5 — 7 4 Other Tuberculous Diseases 12 1 — 1 2 2 3 1 1 1 — — — — 2 1 1 4 2 1 1 2 Cancer, malignant disease 20 — — — 2 2 5 10 32 56 56 31 8 31 24 12 21 30 25 32 2/ 42 Rheumatic Fever 9 — — — 2 4 2 — — — 1 — — — 1 — 1 2 — 3 2 — Meningitis 5 1 — 2 1 — — — 1 — — — — 1 1 1 — 2 — — — 3 Heart Disease 226 — — 1 2 8 10 8 17 50 64 53 13 27 30 22 27 34 27 33 26 23 Bronchitis 146 7 — 1 — 2 1 4 9 19 50 41 12 29 25 9 13 18 23 14 15 10 Pneumonia (all forms) 101 15 8 6 5 4 4 7 13 14 16 7 2 9 12 10 9 17 12 15 17 17 Other diseases of Respiratory Organs 10 — — — — — — — 1 2 5 1 1 2 1 1 2 1 1 2 — — Diarrhoea and Enteritis 20 14 1 — — — 1 1 1 — 1 1 — 1 5 1 2 — 4 3 4 6 Appendicitis and Typhlitis 8 — — 1 1 4 1 — — 1 — — — 1 — — — 2 1 3 1 9 Alcoholism 6 — — — — — — — — 5 1 — — — 1 — 1 — 1 3 — — Nephritis and Bright's Disease 26 — — 1 1 2 2 3 3 6 5 3 — 6 3 2 1 4 3 4 3 1 Puerperal Fever 1 — — — — — — 1 — — — — — — — — — 1 — — — — Other accidents and diseases of Pregnancy and Parturition 5 — — — — 1 2 2 — — — — — 2 — — 1 1 — — 1 — Congenital Debility, Malformation, and Premature Birth 74 73 1 — — — — — — — — — — 13 6 3 11 10 9 8 14 4 Violent Deaths, excluding Suicide 31 4 — 2 3 2 2 1 2 6 3 3 3 3 3 5 3 3 3 9 17 Suicide 19 — — — — 1 3 3 5 5 2 — — 1 2 3 2 1 5 3 3 Cerebro spinal Meningitis — — — — — — — — — — — — — — — — — — — — — — Other Defined Diseases 399 17 5 3 9 11 9 22 49 57 87 99 31 49 65 38 38 64 43 52 50 96 Diseases ill-deflned or unknown 3 1 — — — — — —. 1 1 — — — — — 2 — 1 — — — — Encephalitis Lethargica 3 — — — — 1 1 — 1 — — — — — 1 — — — 1 1 — — Totals 1545 147 39 44 47 81 66 97 178 238 297 240 71 222 217 116 159 227 181 208 215 319 21 M. of H. Table IV. INFANTILE DEATHS in Ages, Sexes and Localities, during the year 1926. CAUSE OF DEATH. Under 1 week. 1—2 weeks. 2—3 weeks. 3—4 weeks. Total under 4 week9. 1—3 months. 3—6 months. 6—9 months. 9—12 month-. Total Deaths under l ynr. Males. Females. Bruce Grove & Stoneleteh Ward. Chestnuts Ward. Green Lams Ward. Park and Coleraine Ward. Stamford Hill Ward. Town Hall Ward. West Green Ward. Whits Hart Lane Ward. Smallpox — — — — — — — — — — — — — — — — — — — — Chickenpox — — — — — — — — — — — — — — — — — — — — Measles — — — — — — — — 4 4 3 1 1 1 — — — — — 2 Scarlet Fever — — — — — — — — — — — — — — — — — — — — Whooping Cough 2 — — — 2 1 — — 3 6 4 2 2 1 — — 1 — — 2 Diphtheria and Croup — — — — — — — — 1 1 — 1 — — — — 1 — — — Erysipelas — — — — — — — — — — — — — — — — — — — — Tuberculous Meningitis — — — — — — — — — — — — — — — — — — — — Abdominal Tuberculosis — — — — — — — — — — — — — — — — — — — — Other Tuberculous Diseases — — — — — — — — 1 1 1 — — — — 1 — — — — Meningitis (not Tuberculous) — — — — — — 1 — — 1 1 — 1 — — — — — — — Convulsions 2 — — — 2 1 2 1 — 6 2 4 1 — — 1 — — 1 3 Laryngitis — — — — — — — — — — — — — — — — — — — — Bronchitis — — 1 — 1 2 — 1 3 7 5 2 1 — 1 — 1 1 2 1 Pneumonia (all forms) 1 — 1 — 2 2 4 4 3 15 9 6 1 2 — — 3 4 2 3 Diarrhoea — — — — — — 1 — — 1 1 — — — — — — 1 — — Enteritis — — 1 — 1 3 3 — — 7 5 2 — — 1 1 — 2 — 3 Gastritis — — 1 1 2 1 2 — 1 6 4 2 1 1 — — — — 2 2 Syphilis — — — — — — — — — — — — — — — — — — — — Rickets — — — — — — — — — — —— — — — — — — — — — Suffocation (Overlying) — — — — — 1 — — — 1 1 — — — — — — — 1 — Injury at Birth 3 — — — 3 — — — — 3 3 — — 1 — — — 2 — — Atelectasis 4 — — — 4 — — — — 4 4 — 1 — — — 1 — — 2 Congenital Malformations 2 — — — 2 1 3 1 — 7 4 3 3 1 — 1 — 2 — — Premature Birth 20 10 5 3 47 — — — 1 48 29 19 4 5 3 8 7 6 8 7 Atrophy, Debility and Marasmus 3 2 1 — 6 3 2 3 — 14 6 8 5 — — 1 2 1 — 5 Other Causes 2 1 — — 3 1 2 2 7 15 11 4 2 1 — — 4 3 — 5 Totals 48 13 10 4 75 16 20 12 24 147 93 54 23 13 5 13 20 22 16 35 22 CANCER. Digestive System:— Males. Females. Mouth 2 — Tongue 9 — Œsophagus 3 1 Stomach 19 17 Pylorus 1 1 Bowels (large and small intestines) 14 17 Rectum 13 5 Liver and Gall Bladder 5 5 Pancreas 3 2 Genito-urinary:— Kidney 1 1 Bladder 4 3 Prostate 4 — Breast — 19 Uterus — 19 Ovary — 2 Respiratory:— Nose — 1 Tonsil 1 — Larynx 6 2 Lung 2 2 Various:— Cutaneous (face and lips) 2 1 Mediastinum 2 1 Leg — 1 Peritoneum — 1 Undefined — 1 SARCOMATA. Testicle 1 — Humerus 2 — Thigh 2 1 Jaw 2 — Retroperitoneal 1 — 99 103 23 VIOLENCE. There were 50 deaths from Violence, including 19 which were suicidal. In 1925, the number was 58. Males. Females. Falls — 3 ,, Downstairs 2 2 ,, at play 1 — ,, into River from Pleasure Steamboat 1 — ,, from ladder 1 — ,, from window (cleaning) 1 — Collision with Motor Lorry 1 2 ,, ,, Motor Car 1 1 Run over by Motor Car 1 2 ,, Horse-drawn Pantechnicon 1 — ,, Motor-bus (under which he was working) 1 — Injuries by Motor Car 2 — Knocked down by Motor Car — 2 ,, ,, MotorCycle 1 — ,, ,, Motor Van 1 — Wedged between axle spring and wheel of van 1 — Scalding 1 1 Swallowing apple peel 1 — SUICIDES. Drowning 4 2 Cut Throat 1 — Coal Gas Poisoning 3 2 Hanging 1 1 Poisoning 2 3 29 21 24 Mortuary Table for the Year 1926. Bodies Admitted. Total No. of Post-Mortems. No. of Inquests Deaths from Violence Deaths from Drowning Month Male* Females Males Females Total January 9 4 13 7 4 1 1 13 4 1 February 5 4 9 5 4 9 9 2 — March 4 3 7 4 3 7 7 3 — April 11 7 18 11 7 18 18 4 — May 3 2 5 3 2 5 5 3 — June 4 3 7 3 3 6 7 3 1 July 10 3 13 10 2 12 13 3 — August 2 2 4 2 1 3 4 2 2 September 4 1 5 4 1 5 5 1 — October 2 1 3 2 1 3 3 4 — November 4 4 8 4 4 8 8 3 1 December 10 5 15 10 5 15 15 6 — Total 68 39 107 65 37 102 107 38 5 No. of bodies admitted to await Burial 42. The following List gives the Causes to which Deaths were attributed by the Coroner or Coroner's Juries:— Aneurism 1 Inanition 2 Aorta, rupture of 1 Intussusception of Bowel 1 Arterio sclerosis 1 Marasmus 2 Bronchitis 4 Nephritis 3 Cancer 3 Pneumonia 10 Cerebral Anaemia 1 Pulmonary Tuberculosis .. 2 Cerebral Haemorrhage 9 Mitral Stenosis 1 Convulsions 4 Syncope 13 Congestion of Lungs 2 Stillborn 3 Diphtheria 1 Tetanus 1 Haemorrhage 1 Suicides :•— Burns 1 Poisoning 5 Scalds 1 Drowning 4 Knocked down by Tramcar. . 1 Gas Poisoning 3 Knocked down by Pantechnicon 1 Hanging 2 Cut Throat 1 Knocked down by Horsed Van Drowning 1 Accidents :•— Fall from Roof 1 Knocked down by Motor Fall from Motor Cycle 1 Vehicle 9 Fall from Pedal Cycle 1 Suffocation 3 Fall downstairs 1 Death under Anaesthetic 3 Gas Poisoning 1 (a) POOR LAW RELIEF, (b) NORTH MIDDLESEX HOSPITAL 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, 2,999 £37,943 4s. 11d. 2,056 £56,077 11s 5d. North Middlesex Hospital. No. of cases admitted from Tottenham during 1926 2,701 No. of days In-Maintenance of these patients during 1926 101,867 THE CARE OF THE AGED. Great difficulty is experienced occasionally in determining the proper procedure to adopt in the case of old people, living alone and unfit by reason of decrepitude to look after themselves or their homes. They resent the suggestion that they should go into the "Institution"; their relatives are none too eager to accept responsibility for the proper care of the old people; their neighbours' intervention is resented, or they (the neighbours) have sufficiently weighty responsibilities without accepting others. Circumstances of the kind indicated come to the notice of the department with sufficient frequency to warrant sympathetic consideration being given to the problem, with a view of a satisfactory solution being found. 20 INFECTIOUS DISEASES. Scarlet Fever.—The Metropolitan Asylums Board receive into their Institutions such cases of Scarlet Fever as have been referred to them by the Medical Officer of Health. During 1926, 93 cases have thus been received from Tottenham into the Metropolitan Asylums Board Hospitals and one patient was admitted into the London Fever Hospital. Two Tottenham cases were removed to M.A.B. Hospitals from General Hospitals in London. In October the M.A.B. determined to limit the admissions to their Institutions of patients suffering from Scarlet Fever during periods of undue prevalence of Measles. This procedure is dictated by the relative mildness of Scarlet Fever as it is now met with. In 1926—the third year in succession—no deaths of Tottenham patients were registered as being due to Scarlet Fever. The determination of the Metropolitan Asylums Board appears to be justified by the experiences of this district. Five years ago it was found expedient to limit admissions to hospital of patients suffering from Scarlet Fever to those who could not, without grave risk to themselves or others, be kept at home. It will thus be seen from the accompanying Table that of 481 cases notified, only 94 were admitted to hospital from Tottenham (including three who received a few days' treatment by the Council's Nurses prior to removal). Two Tottenham children were removed to Isolation Hospital from General Hospitals in London. 379 patients were treated to a conclusion by the Council's Nurses and six were treated privately in their own homes. The patients treated by the Council's Nurses in their own homes were distributed as follows:— 298 premises in which 1 case occurred=298 cases. 26 ,, ,, 2 cases ,, =52 ,, 8 ,, ,, 3 ,, ,, = 24 ,, 1 ,, ,, 4 =4,, 1 ,, ,, =5 ,, 334 premises. *383 cases. 27 * The actual number of cases dealt with up to December 31st was 382. It will be seen however, that 383 are accounted for. From that number has to be deducted one, which occurred in 1927, but in the same premises as cases notified during 1926. This case has been included in order that a complete record may be given of the multiple cases. Multiple Home Cases, 1926 (including one treated in 1927) :•— No. occurring within 1 week after previous case 24* „ „ 2 weeks „ „ 4 „ „ 3 „ „ „ 9 „ „ 4 „ „ „ 7 „ „ 5 „ „ „ 2 „ „ 6 „ „ „ 1 „ „ 11 „ „ „ 1 „ „ 25 „ „ „ 1 49† * In 11 of these instances, dual notifications were received simultaneously, and in 1 instance triple notifications. f This number includes certain cases wrongly diagnosed. Number of cases removed to hospital after treatment commenced 3 Number of notifications withdrawn 5 Number of cases wrongly diagnosed or indefinite 57 There were complications in 63 of the cases (including cases wrongly diagnosed or indefinite). The complications were as follows:'— Glands 21# Otorrhoea 11 Albuminuria 11 Rheumatism 8 Rhinorrhoea 3 Rhinorrhoea and Glands 3 Rhinorrhoea and Otorrhoea 2 Gland and Rheumatism 1 Nephritis 1 Gland and Otorrhoea 1 Otorrhoea and Albuminuria 1 63 * None of these suppurated. 23 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 (March, 1927) they had cleared up, with one exception (Albuminuria). During 1926, 81 persons were discharged from M.A.B. Hospitals, having been admitted during 1924, 1925 and 1926 as suffering from Scarlet Fever. Their stay in hospital extended to the following periods :•— Under 30 days .. 4 cases. 30 and under 60 days 56 ,, 60 and under 90 days 13 ,, 90 and under 120 days 7 ,, 735 days .. .. 1 case. The average duration of residence was 62.0 days. The shortest period of residence was 11 days and the longest 735 days. Nine of the cases removed to hospital had been wrongly diagnosed, 3 being Erythema, 2 Tonsillitis, 1 Measles, 1 Measles and Bronchitis, 1 Flannel Rash and 1 "Not Scarlet Fever." The average residence in hospital of these patients was 41 days. Diphtheria.—Commencing the middle of September, the incidence of Diphtheria rapidly increased from an average of 4 per week to 36 in the week ended October 6th. Thereafter there was a gradual declension, but at the end of March. 1927, the date of writing, the normal level has not been reached. Of the 495 cases notified, 459 were removed to M.A.B. Hospitals from Tottenham, and 10 from General Hospitals in London. 1 case was removed to the London Fever Hospital. Deaths numbered 19. 11 cases were removed from the local general hospital; 7 were in-patients who came from other districts and 4 were nurses. The duration of residence in hospital of those patients who were discharged during 1926, having been admitted during 1925 and 1926 as suffering from Diphtheria, was as follows:— 29 Under 30 days 47 cases 30 and under 60 days 128 60 and under 90 days 73 „ 90 and under 120 days 34„ 120 and under 150 days 13 ,, 150 and under 180 days 7 ,, 180 and under 210 days 4 ,, 210 and under 240 days 2 ,, 240 and under 270 days 2 „ 270 and under 300 days 1 case. 300 and under 330 days 1 ,, 494 days 1 ,, The residence of shortest duration was 9 days and that of longest duration 494 days. The average stay in hospital was 68.0 days. Of the cases admitted to hospital as Diphtheria, 45 had been wrongly diagnosed, as follows Tonsillitis, 28; Measles, 3; Sore Throat, 3; '•Not Diphtheria," 3; Scarlet Fever, 2; Rhinitis, 2; Ulcerative Tonsillitis, 1; Pharyngitis, 1; Catarrh, 1; Catarrhal Sore Throat, 1. The average residence in hospital of these patients was 29 days. The control of Diphtheria is, and is likely to continue, one of the most difficult propositions until immunization of the young becomes generally practised. Before patients leave hospital it is required that six consecutive swabs from them shall prove negative. Nevertheless it is no infrequent experience to find that within a fortnight following discharge the bacillus of diphtheria is found in throat or nose, so that admission to school cannot be granted. Repeated weekly swabbings continue to reveal the presence of these organisms, which prove fatal to the guinea-pig when the virulence test is applied. Your Medical Officer of Health does not suggest that a longer stay in hospital would add anything to the safety of the public. The report on Diphtheria of the Ministry of Health, 1921, states p.5 (a):—"Notifiable Diphtheria.—The notification of cases of diphtheria under the Infectious Diseases (Notification) Acts should be limited to persons actually suffering from Diphtheria, i.e., those exhibiting clinical signs of the disease, with or without bacteriological evidence of the presence 30 of diphtheria bacilli. In the practice of some districts and of many medical practitioners, including, often, the Medical Officers of hospitals and residential schools, notification is frequently extended to include diphtheria carriers who themselves present no sign of illness. It is doubtful whether this practice is justifiable." It is at least arguable whether it is justifiable to retain in hospital patients who have no longer clinical symptoms but have positive throat cultures, and at the same time exclude from hospitals, because not notifiable, persons who have positive throat cultures but no clinical signs. The Council approved the application of the toxin-antitoxin method of immunization against Diphtheria to members of the public who sought it on their own or their dependents' behalf. Information has been communicated to the public through the Press and otherwise, but the actual administration of the prophylactic was not commenced until February, 1927. To residents of Tottenham no charge is made. Applications for the protection afforded by this means may be made to the Medical Officer of Health or at the School Medical and Maternity and Child Welfare Centres. Diphtheria Anti-toxin may be had upon a Doctor's request at the Town Hall during office hours and at the Central Fire Station, adjoining the Town Hall, at all hours (day and night), when the Town Hall is closed. The home address of the Sanitary Inspector on duty is posted at the front door of the Town Hall, and application may be made to him for his attention in respect of cases of infectious disease requiring removal at any time when the Town Hall is closed. Smallpox.'—No case of Smallpox has been notified during the year. Contacts are kept under observation until the likelihood of themselves developing the disease is passed. The Vaccination Officer for Tottenham informs me that the number of Tottenham children vaccinated during 1926 was 1,050; the number of declarations of conscientious objection to vaccination received was 1,105. 31 Measles and Whooping Cough.—Complicated cases of Measles and Whooping Cough have been admitted to the M.A.B. hospitals. The :omplications in these institutionally-treated cases were as follows:— Measles and Pneumonia, 12; Measles, 3; Measles and Bronchitis, 2; Measles and ? Encephalitis Lethargica. 1; Whooping Cough and Pneumonia, 4. Ophthalmia Neonatorum.—13 cases of Ophthalmia Neonatorum were notified during the year. In no instance was the vision impaired. Puerperal Fever and Puerperal Pyrexia.—The Public Health (Notification of Puerperal Fever and Puerperal Pyrexia) Regulations, 1926, came into operation on October 1st, 1926. During the year, 4 cases of Puerperal Fever and 7 of Puerperal Pyrexia were notified and dealt with. 1 death was recorded as due to Puerperal Fever. Dysentery and Malaria.—1 case of Dysentery and 1 case of Malaria occurred during the year. No deaths were attributed to either of these causes. Enteric Fever.—7 cases of Enteric Fever were notified during the year, 5 of them from the local Hospital (2 being "non residents'"). 4 cases were removed to Isolation Hospital, 1 being discharged as suffering from Influenza and not Enteric Fever. There were no deaths from this disease. Poliomyelitis.—There were 2 cases of Poliomyelitis during the period under review. Neither was fatal. Cerebro-Spinal Meningitis.—3 cases were notified during the year from Cerebro-Spinal Meningitis. There were no deaths from this cause. Encephalitis Lethargica.—8 cases of this disease were notified, 7 in the District and 1 from an outside Institution. 2 of these were fatal, and a third death from this cause (a "resident" who died outside Tottenham) was debited to this District. 32 Erysipelas.—49 cases of Erysipelas occurred during the period under review, 7 of them being removed to Hospital. There was 1 death from this cause. 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 1,132. 33 TUBERCULOSIS. Age Periods. New Cases. Deaths. Pulmonary. NonPulmonary . Pulmonary. NonPulmonary. Males Females Males Females Males Females Males Females Under 1 year 1 — — 1 1 1 1 — 1 to 5 years. 2 2 5 8 1 — 7 12 5 to 10 „ 7 3 3 6 3 — 2 1 10 to 15 ,, 2 12 4 2 — — 2 15 to 20 ,, 13 19 1 4 7 9 1 — 20 to 25 ,, 20 18 1 2 10 11 — 1 25 to 35 „ 33 43 1 3 9 9 2 2 35 to 45 ,, 32 16 — 2 18 13 2 — 45 to 55 ,, 29 12 3 — 24 13 — 1 55 to 65 ,, 9 — 1 — 5 5 1 — 65 and over 2 2 — — 2 1 — — Totals 150 127 19 28 80 62 16 19 Organs Affected (New Cases):— Males. Females Lungs 147 127 Meninges 3 7 Kidney 1 2 Spine 1 — Thigh 1 1 Foot 1 — Arm — 1 Hip 2 1 Knee — Peritoneum 2 1 Abdomen 2 1 Other 6 12 Dual Organs:— Lungs and Urogenital 2 — Lungs and Hip 1 — 169 155 34 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. The Prince of Wales's Hospital, when accommodation allows, admit cases of Puerperal Fever. (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 Council's ambulances are available for the removal of noninfectious cases to the Local and Metropolitan Institutions. The following table furnishes particulars of the work done by the Ambulance Service during the past year:— 35 MOTOR AMBULANCE SERVICE, 1926. No. of Cases. Mileage. Receipts. Surgical. Defective Children. From Cases. From T.E.C. £ s. d. £ s. d. January 579 1,422 4,247 11 1 6 105 18 0 February 515 1,900 4.899 9 3 0 144 0 0 March 666 2,047 5,786 14 4 6 155 5 0 April 481 1,314 4,097 11 9 6 97 2 0 May 769 1,370 5,822 12 17 6 105 16 0 June 683 2,077 5,326 15 3 6 144 18 0 July 653 1,567 4,820 16 1 0 115 10 0 August 459 350 2,580 15 16 9 26 13 0 September 601 2,123 5,624 12 0 0 151 10 0 October 505 2,021 5,182 8 16 0 145 17 0 November 594 2,357 5,492 9 8 3 161 5 0 December 523 1,812 4,781 14 9 3 119 11 0 Year's Totals 7,028 20,360 58,656 150 10 9 1,473 5 0 27,388 £1,623 15 9 Treasurer's Dept., etc. £144 8 0 £1.768 3 9 Total Cases from 1915 to Date: Total Mileage to Date: 102,157. 309,329. The Ambulances are equipped with Oxygen apparatus, which have been in use on 7 occasions during 1926; in 6 of the cases the efforts were successful. LABORATORY. At the Town Hall Laboratory, 3,526 swabs from the throats or noses of persons in contact with sufferers from Diphtheria, or themselves supposed to be suffering from Diphtheria, and 286 specimens of sputum from persons suspected to be suffering from Consumption, have been examined during the year. Of the swabs, 579 were positive, and of the sputa, 42 specimens. Other bacteriological and serological examinations are made by arrangement with the Prince of Wales's Hospital. 36 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 j 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, Bruoe 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. 37 PROFESSIONAL NURSING IN THE HOME. General Nursing facilities are provided by the North London Nursing Association, 413, Holloway Road, N.7 (Telephone, North 3548) for the area on the western side of the London & North-Eastern Railway line, and extending northwards as far as Lordship Lane. The Hackney District Nursing Association, 6 and 8, Lower Clapton Road, E.5 (Telephone, Clissold 929) deal with the area east of the railway line, and extending northwards as far as Lansdowne Road. The Sisters of Charity of St. Vincent de Paul, 15, Church Street, Edmonton, N.9 (Telephone, Tottenham 3166) have undertaken the work in the area extending northwards from Lordship Lane and Lansdowne Road. An effort is being made to establish a District Nursing Association for Tottenham. HEALTH WEEK. Health Week was observed by the writing of Essays by schoolchildren. The following subjects were set:—"The Use and Abuse of the Bath"; "The Use and Abuse of Windows"; "The Use and Abuse of the Dustbin"; "The Spitting Habit"; "Rheumatism". Special lessons were given to 15,492 children, and 12,991 Essays were written. 15 prizes were distributed at a Public Gathering at the Municipal Hall, on November 15th, by the Countess of Warwick; and among the items upon the programme were Singing, Displays of Gymnastics, Physical Exercises and Eurhythmies by the School-children, and an exhibition of Folk Dancing. / LOCAL GOVERNMENT AND OTHER OFFICERS SUPERANNUATION ACT, 1922. All entrants to the Council's permanent service are medically examined for the purposes of the Superannuation Scheme now in operation in Tottenham. In 1926. 47 examinations were made by your Medical Officer. 38 STATUTES, BYE-LAWS, Etc., ADMINISTERED BY HEALTH DEPARTMENT. The Health Department is mainly concerned with carrying out the provisions of the following Acts, Bye-Laws, Orders and Regulations. From time to time, the Ministry of Health issue circulars relating to matters of outstanding importance, e.g., Cholera, Smallpox, Cerebrospinal Meningitis, Diarrhoea, Anthrax, Rabies, etc. These Circulars are not enumerated in the following list:— Public Health Act, 1875. 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). Tottenham Local Board Act, 1890. Cleansing of Persons Act, 1897. Tottenham Urban District Council Act, 1900. Factory and Workshop Acts, 1901, etc. Notification of Births Act, 1907. (Adopted, 17/12/07). Public Health Acts Amendment Act, 1907. (Parts adopted, 17/12/09). Diphtheria Anti-toxin (Outside London) Order, 1910. Public Health (Tuberculosis) Regulations, 1911 and 1912, etc. 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. 39 Fabrics (Mis-description) Act, 1913. Public Health (Shell-fish) Regulations, 1915. Milk and Dairies (Consolidation) Act, 1915. Rent and Mortgage Interest Restrictions Acts, 1920 and 1923. Public Health (Acute Encephalitis Lethargica and Acute PolioEncephalitis) Regulations. 1918. 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. Housing Consolidated Regulations, 1925. Milk and Dairies Order, 1926. Public Health (Ophthalmia Neonatorum) Regulations, 1926. Public Health (Notification of Puerperal Fever and Puerperal Pyrexia) Regulations, 1926. Sanitary Officers' Order, 1926. 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 Monday, 1 p.m. (or alternatively Saturday, 1 p.m.) (or alternatively Saturday, 1 p.m.) Bakers .. Wednesday, 2 p.m Thursday, 2 p.m. (or alternatively Saturday, 2 p.m.) (or alternatively Saturday, 2 p.m.) †Other Shops Wednesday, 1 p. m Thursday, 1 p. m. (or alternatively Saturday, 1 p.m.) (or alternatively Saturday, 1 p.m.) (non-exempted trades). 40 * Butchers Confectioners tOther Shops (non-exempted trades) Refreshments .. Special Licenses (consumed on premises) Exempted Trades .. No closing hour, (newly-cooked provisions, etc.) Evening Closing Hours. Monday.. 1p.m. Tuesday, Wednesday and Thursday.. 7 p.m. Friday and Saturday .. .. .. 8 p.m. Monday. Tuesday, Wednesday, Thursday and Friday 9.30 p.m. Saturday .. 10 p.m. Sunday 8 p.m. Monday, Tuesday, Wednesday, Thursday and Friday. 8 p.m. Saturday . 9 p.m. Sunday 8 p.m. (subject to weekly half-holiday Order). 10 p.m. and 11 p.m. 41 LEGAL PROCEEDINGS. Date. Name. Nature of Case. Result. January G. Jeoffroy, 348, High Road Serving in Shop after closing hour Fined 40s. and costs. ,, T. Smith, 369, High Road •• Fined 20s. and costs. April Franklin, 37, Braemar Road Repairs to Stables, 37, Braemar Road Order made for abatement of nuisance and carrying out of remedial works; also payment of 10s. 6d. costs May Levy, Mile End Road, E. Repairs to drainage, 25, Paignton Road Fined 20s. and costs. June Robinson, 497, Green Lanes Serving in Shop after closing hour Fined 20s. ,, Wood, 797, High Road •• Glucksberg. 3, High Cross Road •• •• W. E. Mills, West St.. Walthamstow Repairs, 61 and 63, Summerhill Road Order made for payment of Council's A/c by monthly instalments of £1. October .. Luccarini, 728, High Road Serving in Shop after closing hour Fined 20s. Raphael. 1, Grand Parade „ Fisher, London Rd., Wickford Repairs to drainage, 25 and 27, Cornwall Road Fined 10s. (Work subsequently carried out by Owner.) November Edgar, 319, West Green Road Not displaying requisite notices (Shops Act; Fined 10s. December Cook, 16, Black Boy Lane Removal of refuse, etc. Order made for carrying out of work. Defendants to pay costs of legal proceedings . WATER SUPPLY. In last year's Report it was noted that the Metropolitan Water Act requires the provision of a cistern for the storage of water in all premises. In many, probably most, houses in Tottenham the drinking water is derived from the storage cistern, which is seldom or never cleansed. It is worthy of consideration whether these cisterns serve any useful purpose and their provision should be insisted upon, or whether in new houses or in those where water fittings are being overhauled, it would not be more advantageous to derive the household supply from the main pipe, without the intervention of a cistern. PUBLIC SWIMMING BATHS—CONSTANT FILTRATION. The closure of the Public Swimming Baths at the end of the season gave the Council the opportunity of installing a Bell Constant Filtration Plant. When the Swimming Season opens in 1927, it may confidently be expected that the purity of the water of the Bath will add to its increased popularity and usefulness. 43 GENERAL SANITARY WORK. Hereunder is specified in tabular form the inspections by the Sanitary Officers during 1926. and the nature of the defects discovered:— Late Harringay. Ward (Mr. Redston) West Green Ward | (Mr. West). Lato St Ann b Ward (Mr. Smith). Late High Cross Ward j (Mr. Portman). Late Middle Ward | (Mr. Miller). Late Lower Ward | (Mr. Shillito). House-to-house inspections 119 196 118 160 146 222 Re-inspections 1184 1172 1197 1511 1406 1456 Drains examined, tested, etc. 67 77 170 115 57 64 Drains unstopped 31 29 30 25 18 102 Drains reconstructed and repaired 17 25 66 31 38 26 Disconnecting traps inserted — — 1 2 2 4 Soil pipes and drains ventilated — 4 8 16 89 26 R.W. pipes, wastes, etc. disconnected — 7 28 — 57 10 Dustbins provided 42 47 32 56 49 48 Roofs repaired 92 69 98 34 56 73 Gutters repaired and renewed 87 71 80 23 27 40 Cisterns cleaned, repaired, etc. 15 19 16 19 13 33 W.C. repaired, cleaned, etc. .. 67 62 95 35 47 183 Yards paved and drained 26 43 56 37 55 39 Premises cleaned, etc. 147 167 198 371 182 472 Defective floors 22 27 85 7 14 60 Defective window frames and sashes .. 49 29 64 25 15 220 Defective coppers 22 21 27 25 3 35 Defective fireplaces 27 28 26 19 9 56 Other defects 85 97 103 45 55 74 Smoke observations 31 17 23 12 16 9 Accumulations of refuse 29 9 18 5 10 11 Visits in connection with cases of infectious disease (including 163 135 127 199 223 191 culosis) Rooms inspected after disinfection .. 40 73 65 183 100 72 Other inspections, etc. 87 59 332 126 107 112 Factories—No. of inspections 35 34 23 15 25 52 Workshops & workplaces ,, 43 73 38 29 33 80 Laundries ,, - 26 — 2 6 — Dairies, etc. ,, 84 79 102 46 85 68 Cowsheds ,, Bakehouses ,, 38 - 46 - 42 4 18 - 29 - 48 P.H. urinals ,, 131 52 39 68 68 52 Stables and Mews ,, 54 70 53 16 80 10 Complaints investigated 113 159 397 250 98 218 Appointments 62 138 206 30 90 127 School inspections - — 6 4 3 3 Pawnbrokers 3 — — 2 18 60 — 4 Common Lodging Houses Slaughter-houses - 93 32 - 35 80 Knackers' Yards — — — 56 — — Brooks and Watercourses 6 4 6 6 20 3 Butchers'shops 88 60 42 94 93 97 Fishmongers'shops 89 46 41 59 71 60 Fruiterers'shops 119 33 27 47 50 56 Ice Cream premises 8 11 10 2 3 15 44 SANITARY WORK CARRIED OUT BY FEMALE SANITARY INSPECTOR. Visits to Outworkers' Premises 825 ,, Workshops 130 ,, Laundries 6 ,, Factories 8 Complaints Investigated 97 Visits re Infectious Diseases 3 Miscellaneous Visits 7 Re-inspeetions 350 Swabs Taken 1,560 S. F. Contacts Examined 324 FACTORY AND WORKSHOP ACT, 1901. In compliance with Section 132, I have to submit a resume of the work effected during the year—under the provisions of the above Act— in the form prescribed by the Home Office:— I —Inspection of Factories, Workdups and Workplace*. Inspections made by Sanitary Inspectors. Premises. Number of Inspections. Written Notices. Prosecutions Factories (including Factory Laundries) 220 Workshops (including Workshop Laundries) Workplaces (other than outworkers' premises included in Part 3 of this Report) J Total 400 69 — 680 69 — 45 2.—Deferts Found. Particulars. Number of Defects. Number of Prosecutions. Found. Remedied. Referred to H.M. Inspector. Nuisances under the Public Health Acts*— Want of cleanliness 51 51 — — Want of ventilation — — — — Overcrowding — — — — Want of drainage of floors — — - — Other nuisances 13 12 — — Sanitary accommodation insufficient unsuitable or defective not separate for sexes 15 1 15 1 — — 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 80 79 — — * Including those specified in sections 2, 3, 7 and 8, of the Factory and Work shop Act as remediable under the Public Health Acts. 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. i 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 20 145 6 26 458 60 — — 621 — — — — — — Boots and Shoes 8 48 — — 28 30 — — 46 — — — — — — Stationery 4 8 — — — — — — 8 — — — — — — Cardboard, etc. Boxes 2 23 — — 11 7 — — 27 — — — — — — Brushes — — 1 1 6 1 — — 6 — — — — — — Smallware — — — — — 2 — — — — — — — — — Knitted Goods — — — — 0 — — — 2 — — — — — — Furs — — — — 17 — — — 17 — — — — — — Umbrellas - - - - 6 - — - 6 - - - - - - Fancy Goods — — — — 11 — — — 6 — — — — — — Artificial Flowers — — — — 6 2 — — 4 - - - - - - Lace Paper & Xmas Crackers 2 81 - - 4 40 - - 45 - - - - - - Leather Goods - - - - - - - - - - - - - - - Tennis Balls — — — — 3 — — — 3 — — — — — — - - - Needlework Lace Goods — — — — 4 15 — — — 4 15 — — — — — — Hair Goods 2 9 — — — — — — — — — — — — — Feathers — — - - 1 - - - 1 - — — — — - Silk Goods — — — — 2 — — — 2 — — — — — — Totals 40 316 7 27 572 142 — — 825 — — — — — — 47 4.—Registered Workshops. Workshops on the Register (a. 131) at the end of the Year. Number. Workshops 241 Laundries 28 Bakehouses 64 Total Number of Workshops on Register 333 5.—Other Matters. Class. Number. Matters notified to H.M. Inspector of Factories:- Failure to affix Abstract of the Factory and Workshop Act (Sec. 133) 3 Action taken in matters referred by H.M. Inspector as remediable under the Public Health Acts, but not under the Factory and Workshop Act (s. 5). Notified by H.M. Inspector Reports (of action taken) sent to H.M. Inspector 7 7 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 (a. 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). 48 PUBLIC HEALTH (MEAT) REGULATIONS, 1924. The attention of your Medical Officer of Health was directed to a type of shop window that a butcher of the District was employing, so as to meet the requirements of the Public Health (Meat) Regulations, 1924, in the spirit as well as in the letter. An Officer of the Ministry of Health visited the premises with your Medical Officer of Health, and was so satisfied with the design of the window and the protection afforded to the meat from contamination that he advised that members of the Society of Medical Officers should be given the opportunity of inspecting the arrangements. It is claimed for the window that in the heat of summer there is a difference between the outside and inside temperature of about 40 degrees. This effort to protect the food supply is in striking contrast to the open-windowed shops with stalls in front, exposed to the dust raised by wind and fast-travelling vehicles. The Public Health (Meat) Regulations, 1924, should be repealed, and adequate provision made for all articles intended for the food of man being properly protected from contamination. UNSOUND FOOD. The Sanitary Inspectors have seized, or had brought to them for condemnation, the following articles:— Meat:— 2 Pigs. 3 Pigs' Heads. 89 lb. Pork. 264 lb Beef 21 lb. Mutton. 5 Ox Livers. 1 case Rabbits. Fish:— 12 stone and 1 box Skate. 4 stone and 2 trunks Cod. 2½ stone and 1 box Plaice. 1 trunk Hake. stone and 2 boxes Haddocks. 2 boxes Whiting. 5 boxes Kippers. 1½ bags and 5 bushels Winkles. Fruit and Vegetables:— 1 barrel Grapes. 38 boxes Apples. FOOD POISONING. American Canned Corned Beef caused the illness of a dozen or more residents in Tottenham. The meat was sold from a shop in a neighbouring district. Samples of the meat were sent to the Ministry of Health for examination, and serological tests of the blood of certain of the sufferers 49 were employed with a view of determining the responsible organism. As the result of the investigation it was concluded that the sterilization of the meat in the process had killed the germs, but that after ingestion of the food the poisons contained in the germs (endotoxins) were liberated by digestion, causing their harmful effects. Several of the patients were acutely ill, but all recovered. FOOD AND DRUGS I am obliged to the County Council (who are the Authority for administering the provisions of the Sale of Food and Drugs Act, 1875), for the following information respecting samples taken in Tottenham:— Name of Article. Samples. Taken Found Adulterated. Milk 614 19 Butter 20 — Cream 4 — Apples 8 1 Arrowroot 6 — Cinnamon 1 — Egg Powder 2 — Gin 20 12 Ginger, ground 1 — Lard 2 — Margarine 1 — Mineral Water 1 — Mustard 13 7 Oatmeal 2 — Olive Oil 1 — Pepper 4 — Sweets 1 — 701 39 Number of Prosecutions 3 Number of Convictions 2 Fines and Costs imposed £6 2s. The figures given for adulterated samples include some adulterated informal samples, in respect of which no proceedings could be taken. 50 DISINFECTION AND DISINFESTATION. 1,713 rooms were disinfected. 16,787 articles were disinfected or destroyed. 164 library books were disinfected. 2 persons were bathed. EXHUMATIONS. 1 exhumation took place at the Tottenham Cemetery, under the supervision of the Sanitary Inspector. The Home Office requirements were complied with. SMALL DWELLINGS ACQUISITION ACT. The Sanitary Inspectors are required to report upon the condition of properties proposed to be acquired under the Small Dwellings Acquisition Act. The sanitary conditions of such properties have been the subject of 6 reports during 1926 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 licensed. They are periodically visited, and it has not been found that any offence has been created. DAIRIES, COWSHEDS AND MILKSHOPS. 16 applications for registration from retail purveyors of milk were received during the year. These were acceded to. There are at present 139 retail purveyors on the register. 4 purveyors were licensed for the sale of "Grade A (Tuberculin Tested)" Milk, 2 for the sale of "Certified" Milk, 1 for the sale of "Pasteurised" Milk (supplementary license), and 1 for the sale of "Certified" Milk (supplementary license). Periodical inspection is made of the premises where Graded Milk is bottled, and samples are taken in accordance with the Ministry of Health's scheme. No action was required to be taken under the Public Health (Prevention of Tuberculosis) Regulations, 1925. 51 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. HOUSING. At the end of the year, approximately 3,500 families were registered by the Treasurer as seeking accommodation on the Council's housing estate. As there are no more than 160 acres available for building purposes, it is manifest that with dwellings built 12 to the acre, space is not available in Tottenham for the housing of that number of families. In the meantime these families are lodged somehow in the district, resulting in serious overcrowding, in many instances without visible means of remedy. New Houses and Tenements erected during the Year. By private builders (no State assistance) (Houses) 290 By the London County Council (Tenements) 132 By the Tottenham Council (Houses) 64 486 Unfit Dwelling-houses. Total number of dwelling-houses inspected for housing defects (under Public Health or Housing Acts) 3,331 Number of dwelling-houses which were inspected and recorded under the Housing Consolidated Regulations, 1925 961 Number of dwelling-houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation 3 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 1,891 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 1,674 52 Action under Statutory Powers. (a) Proceedings under Section 3 of the Housing Act, 1925— (1) Number of dwelling-houses in respect of which notices were served requiring repairs 174 (2) Number of dwelling-houses which were rendered fit— By owners 129 By Local Authority in default of Owners 28 (3) Number of dwelling-houses in respect of which Closing Orders became operative in pursuance of declarations by owners of intention to close — (b) Proceedings under Public Health Acts— (1) Number of dwelling-houses in respect of which notices were served requiring defects to be remedied 43 (2) Number of dwelling-houses in which defects were remedied— By owners 48 By Local Authority in default of owners 3 (c) Proceedings under Sections 11 to 15 of the Housing Act, 1925— (1) Number of representations made with a view to the making of Closing Orders 3 (2) Number of dwelling-houses in respect of which Closing Orders were made 3 (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 25 (5) Number of dwelling-houses demolished in pursuance of Demolition Orders 9 Tottenham Education Committee. ANNUAL REPORT of the SCHOOL MEDICAL OFFICER for 1926. MEMBERS OF THE COMMITTEE. (As constituted in October, 1926 ) Mr. A. E. JAY (Chairman). Mr. A. J. WRAMPLING (Vice-Chairman). Mr. J. BRISTOW. Miss R. F. COX. Mr. I. DAVIS. Mr. E. G. DICK1N. Mr. T. ELDERF1ELD. Mrs. E. L. FINCH. Mr. E. FROST. Mr. E. C. HARRIS. Mr. A. E. HARVEY. Mr. T. INGLIS. Mrs. A. KITCHENER. Mrs. J. D. LYNCH. Major P. B. MALONE, M.P., J.P. Mr. A. MANSFIELD. Mr. W. E. MONTAGUE. Mr. D. NOTT. Miss L. B. PRESCOTT Mr. A. REED, A.F.I. Mr. C. WISE. Mr. F. E. SHARLAND. 2 INTRODUCTION. School Medical Department, Town Hall, Tottenham, March, 1927. To the Chairman and other Members of the Tottenham Education Committee. Ladies and Gentlemen, The only outstanding event during 1926 in relation to the School Medical Service was an epidemic of diphtheria commencing soon after the Summer Holidays. The 1926 report has been condensed, as far as possible, into tabular form. The Staff have fulfilled their duties loyally, and the success that has attended their efforts is attributable, in large measure, to your Committee's constant anxiety for the welfare of the school children. I am, Ladies and Gentlemen, Yours faithfully, 3 SCHOOL HYGIENE. The following report of the Surveyor indicates the improvements effected to school premises. SURVEYOR S REPORT OF IMPROVEMENTS CARRIED OUT FROM 31st MARCH, 1926, TO 31st MARCH, 1927. All Hallows' School. Improved method of artificial lighting. Allison Road School. Alterations and additions to W.C. accommodation. Belmont Road School. Improved method of artificial lighting. School for the Deaf. Provision of blinds to Caretaker's house. Devonshire Hill School. Provision of blinds to Caretaker's house. Provision of dark blinds and fittings for lantern rooms and classrooms. Installation of chemical fire appliances. Down Lane Central School. Removal of galleries in Room G and levelling floor. Earlsmead School. Installation of new heating boiler. Page Green School, Boys', Girls' and Infants". Internal and external redecorations. Installation of new gearing. Improved method of artificial lighting. New sliding partition in Infants' School. New doorway into Infant's classroom. 4 Parkhurst Road School, Boys', Girls' and Infants'. Improved method of artificial lighting. Risley Avenue School. Internal and external redecorations. Improvements to heating at East end of school. St. Katharine's School. Improved method of artificial lighting. Seven Sisters School, Boys', Girls' and Infants'. New pans and water supply on the gravity system to Infants' latrines. Infants' corridors relaid. Internal and external redecorations. Improved method of artificial lighting. Stamford Hill School, Boys' and Girls'. Installation of new heating boiler and alterations to heating system. (Old gas radiators removed.) Installation of "Kalor" boiler. Stamford Hill School, Infants'. Installation of new heating boiler and alterations. Vale Road School. Land in front of school dug over, levelled and grassed. Alterations to furniture and fixing pin rails suitable for conversion to Infants' Department. Woodlands Park School. Installation of new heating boiler. Improvements to heating of old cookery. Woodberry Down School. Internal redecorations. 5 Offices, Philip Lane. External redecorations. Additional heating. Music and Dancing Licences. Alterations to the structures, secondary lighting and the lighting of W.C.'s and latrines to comply with the regulations of the Middlesex County Council at the undermentioned schools:— Belmont Road School. Crowland Road School, Downhills Central School. Down Lane School. Risley Avenue School. Woodlands Park School. Asphalt Repairs to Playgrounds. Attention has been given to the playgrounds of the following schools:— Coleraine Park School, Boys'. Seven Sisters School, Boys' and Girls'. Furniture. In addition to the repairs and renovations to the school furniture, new furniture has been supplied to many of the schools, i.e., blackboards, tables, remedial forms, needlework boxes, cupboards. Devonshire Hill School Infants' Department has also been fitted with sliding wall blackboards. MEDICAL INSPECTION. The details of medical inspections and the subsequent following-up and treatment of children found to be defective are set out in tabular form at the end of this report. INFECTIOUS DISEASE. Notifications under the Infectious Disease Notification Acts, 18891899, were received in respect of the following diseases occurring amongst children of school age, with the noted frequency:— Scarlet Fever 294 Diphtheria 327 Enteric Fever 5 Erysipelas 2 Pneumonia 24 Poliomyelitis 1 Cerebro Spinal Meningitis 1 6 Voluntary Notifications.—The following cases were voluntarily notified by teachers and attendance officers during the year:— Measles 1195 German Measles 25 Mumps 402 Whooping Cough 159 Chicken pox 313 Scarlet Fever 113 Diphtheria 206 Scabies 10 Skin Diseases 13 Verminous 5 Tonsilitis 16 Chorea 15 Pneumonia 3 "Colds" 52 Rash 14 Sore Throat 65 Tuberculosis 6 Influenza 50 Eye Diseases 6 Ringworm of Head 28 Ringworm of Body 8 Sores and Eczema 47 Impetigo 24 Other Diseases 94 Children excluded owing to infectious disease in house 642 Rheumatism 5 Otorrhoea 4 These cases were followed up by the School Nurses and were not re-admitted to school until they were free from infection and the possibility of communicating the disease to others. Bacteriological Examinations.—Swabs have been taken from children discharged from Isolation Hospital after diphtheria, and from children who have been in contact with cases of diphtheria, and examined bacteriologically. 2,056 such examinations were made, 243 were found to be positive, 1,768 negative, and 45 contained bacteria morphologically similar to Klebs Lœffler bacilli. Microscopical Examinations.—Hairs were taken from children who were suspected to be suffering from ringworm in 27 instances and submitted to microscopical examination. 16 were positive. FOLLOWING UP. My last Report describes the system of following up school children who have been found to be defective, also the method employed for dealing with children found to be in a verminous or uncleanly condition. The School Nurses paid, during the year, 6,848 home visits. 7 MEDICAL TREATMENT. Dr. Friel has furnished the following table in relation to Otorrhoea cases dealt with at the Aural Clinic:— Cause of Suppuration. Total Ears. Cured. Lost Sight of. Under treatment. Sent for operation. Acute Suppurative Otitis Media 27 25 - 2 - Chronic Suppurative Otitis Media. due to 1. Tympanic Condition:— (a) Tympanic Sepsis 58 57 1 — — (b) T.S. and Granulations 21 21 — — — (c) T.S. and Polypus 7 5 — — 2 (d) T.S. and Caries — — — — — (e) T.S. and Other Conditions 1 — — 1 — 2. Tympanic Conditions, plus (a) Tonsils and Adenoids 2 1 1 — — (6) Nose Conditions 3 2 — (c) Mouth Conditions — — — — — 3. Tympanic Condition, plus (a) Attic Disease 26 3 5 8 10 (b) Mastoid Disease (No Operation) 16 8 4 3 1 (c) Mastoid Disease (Operation Already) 2 1 — 1 — External Otitis—Diffuse 11 3 8 — Localised 7 7 — — — Totals 181 128 17 22 14 8 Tonsils and Adenoids. Similar arrangements have been made with the Prince of Wales's Hospital, as were noted in my report of last year as obtaining at the North Middlesex Hospital, for the operative treatment of children suffering from enlarged tonsils and adenoids. These include provision for retention of cases in hospital, when necessary. The following Report with respect to Open-Air Education, Physical Training and Provision of Meals has been received from the Director of 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. Note.—The proposals with respect to Woodlands Park Girls' School were postponed by the Board. (b) and (c) School Journeys and Camps. For the year 1926, the Board of Education sanctioned the expenditure of a sum not exceeding £120. OPEN-AIR EDUCATION. The actual expenditure was as follows:— £ s. d. Down Lane Central School 76 0 0 Risley Avenue Central School 25 0 6 St. Paul's Girls' School 30 0 0 £131 0 6 9 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 1926 120 131 £1,445 £1,263/10 The following are brief particulars of the Journeys carried out during 1926:— 1. DOWN LANE CENTRAL SCHOOL. All the pupils of the First Year, numbering over 80, spent a week at Tankerton, near Whitstable, where they were lodged in the Marine Hotel. The time fixed for the visit unfortunately coincided with the General Strike. Considerable difficulty was, therefore, experienced in securing the conveyance of the girls. In order to carry out her undertaking with the hotel proprietors, and to avoid disappointing the girls, who had looked forward to the outing, the Head Mistress thought it advisable to carry out her programme. Additional expense was entailed for conveyance, etc., and the Committee made an additional grant of £16 to meet this outlay. Excursions were made to Dover, Sandwich, Canterbury and other places, and a visit by motor-boat was paid to the Fleet, then stationed near Dover. In spite of the difficulties encountered, the journey was carried out, and the girls derived much educational benefit and enjoyment from it. The total cost was £202 10s. 10d., towards which the Committee contributed £76. 10 2. RISLEY AVENUE CENTRAL SCHOOL. A party of 21 senior boys and two teachers spent a week at the Rockland Boarding House, Swanage, in May. They made a thorough study of the interesting geology and geography of the Isle of Purbeck and its surroundings. Visits were made to Corfe Castle, Studland and Agglestone, and to Lulworth Cove. An excellent guide book was compiled by the School Staff, and the arrangements made resulted in an excellent week's work and pleasure. The total cost of the journey was £54 4s. 6d., towards which the Committee contributed £25. 3. ST. PAUL'S GIRLS' SCHOOL. A party of 24 girls, in charge of the Head Mistress, spent a fortnight at Folkestone. They were favoured with excellent weather, and their programme was carried out with complete success. The total cost was about £80, towards which the Committee contributed £30. (d) Open-Air Classrooms. Last year's report stated that a school of two departments, on openair lines, to accommodate 800 children, was in course of erection. This school (Devonshire Hill) was opened in April, 1926. Although it is too soon to judge the permanent effects of open-air conditions on the children in attendance, the first year's working of the school shows promising results. The school is already over full, and the Board of Education have agreed to its extension by the erection of another department for 500 children. This will be planned on the same lines as the existing departments. (e) Day Open-Air Schools. The Open-Air Class, which has been held for several years during the Spring and Summer in the bandstand at Downhills Park, was continued in 1926 with the usual very satisfactory results. The admirable situation of the Class, providing open-air conditions in beautiful surroundings, permits of very good work 11 The Class at Orchard House was continued up to October, when, by permission of the District Council, it was transferred for the winter to a more suitable position in Bruce Castle Park, where it has been possible for the Class to work under improved conditions. It will return to Orchard House in April, and will probably be accommodated in a marquee placed in such a position as will secure the maximum amount of sunshine and fresh air. The Three-Year Programme of the Local Education Authority includes the provision of a permanent Open-Air School for about 120 pupils. It is hoped that the consent of the Board for the establishment of this school may soon be obtained. 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 speciallv selected class teachers, acting under the direction of the School Medical Officer and of an expert adviser, who is engaged for half-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, compete 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 the Association and by the London Schools Swimming Association. In 1926 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. 12 PROVISION OF MEALS. During the year 111 ,369 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:— 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. 13 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. The Education Committee have now decided to re-establish a meals' centre at Culvert Road School for the use of children who now have dinners at local dining rooms. The Committee are of opinion that this plan will result in the supply of more suitable meals under improved conditions. CO-OPERATION OF PARENTS, TEACHERS AND ATTENDANCE OFFICERS. The parents, teachers and attendance officers have co-operated with us in the past year as hitherto. CO-OPERATION OF VOLUNTARY BODIES. The Invalid Children's Aid Association has provided for the maintenance of children at Convalescent Homes and the supply of surgical instruments, as follows:— Convalescent Home Treatment.—During the year, 375 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 6 16 18 102 46 61 27 38 11 15 9 6 6 No. of Weeks 14 15 16 — 19 20 21 — 27 29 — — — No. of Children 4 1 2 2 2 1 — 1 1 — — In 30 of these cases, the treatment has been continued in 1927. 14 The following table gives the affections on account of which children received convalescent treatment:— Nervous Debility 10 Peritoneum 1 Pre-tubercular Debility 27 Hip 1 Debility aft. Infectious Disease 36 Chorea 37 Post-operative Debility 23 Enlargement of Glands 10 Post-Pneumonic Debility 7 Rheumatism 7 Anaemia and Debility 46 Tonsilitis 3 General Debility 47 Dyspepsia 5 Heart Affections and Anaemia 19 Paralysis 4 Bronchitis and Bronchial Catarrh 35 Empyema 2 Rheumatic Fever 3 Asthma 7 Marasmus 4 Other Non-tubercular Lung Disease 6 Nephritis 1 Encephalitis Lethargica 1 Gastric Catarrh 2 Malnutrition 7 Gastric 5 Appendicitis 3 Tuberculosis:— Other Cases 14 Glands 2 Provision of Surgical Instruments.—Surgical appliances were supplied, and repairs and replacements effected in 218 instances. This was in respect of 80 children who were found to be suffering from the following defects:— Infantile and other forms of Paralysis 36 Tuberculosis:— Hip 3 Knee 3 Ankle 1 Spine 1 Flat-foot 9 Club-feet 2 Pes Cavus 1 Other forms of Deformed Feet 5 Amputated Leg 1 Rickety Deformities 4 Weak Ankles 4 Other cases 10 BLIND, DEAF, DEFECTIVE AND EPILEPTIC CHILDREN. Residential Schools. There are 42 children from this district being maintained in Special Residential Schools. 5 of these are crippled and physically defective children, 12 blind, 17 mentally defective, 5 epileptic and 3 deaf and dumb. 15 School for Deaf Children. At the end of 1926 there were 66 children on the register at this school, 35 of these being Tottenham children. Myopic School. 20 children suffering from defective vision (myopia, etc.) are in daily attendance at the Wood Green Special School for children with defective vision. School for Physically Defective Children. During the year 60 children have been in attendance, the number on the register at the end of the year being 52. The defects from which the children suffered were as follows:— Infantile Paralysis 25 Congenital Deformities 2 Cerebra Diplegia 4 Fragilitas Ossium 1 Heart Disease (Congenital) 5 Double Congenital Dislocation of Hips 1 Hydrocephalus 1 Tuberculosis:— Spine 11 Knee 5 Hip 5 Oak Lodge Day Special School for Mentally Defective Children. Children attending Oak Lodge Special School for the Mentally Defective have been increased in numbers from 20 to 42. This has been rendered possible by causing them to be assembled at collecting points convenient for their conveyance by ambulance. The cost per case of conveyance has thus been reduced. Open-Air Class. There are 37 boys in attendance at the Open-Air Class. In accordance with the new arrangements the boys attend at Orchard House during the summer months and at the pavilion in Bruce Castle Park during the winter. These boys, who are selected by the medical officers, are re-examined at frequent intervals in order to ascertain what progress has been made. 16 SECONDARY SCHOOLS. Table I, below, sets out the number of children, under their separate ages, examined in the secondary schools during the year. Tables II-IV, pages 17-19, show in detail the defects discovered during the inspections, and the number of defective children who were subsequently found to have received treatment. FOOD ACCESSORIES AND DRUGS. During the year, Cod Liver Oil, Malt and Oil, Parrish's Food, Syrupus Ferri Iodidi, and Syrupus Calcii Lactophosphatis have been supplied at the Treatment Centres to necessitous cases recommended by the Medical Officers. The following quantities have been dispensed at cost price, at less than cost price, or gratuitously, according to circumstances:— Cod Liver Oil and Malt 2,035 lbs. Parrish's Food 1,567 lbs. Cod Liver Oil 1,617 ozs. Syrupus Ferri Iodidi 3,566 ozs. Syrupus Calcii Lactophosphatis 3,591 ozs. EXAMINATIONS BY THE MEDICAL OFFICERS. 14 teachers, 2 caretakers and 1 junior clerk have been examined by the Medical Officers. 6 children have been medically examined and licensed to take part in entertainments. SECONDARY SCHOOLS. Table I.—Numbeb of Pupils inspected 1st January, 1926, to 31st December, 1926. Ages. Routine Inspections. Total. 10 11 12 13 14 15 16 17 18 Boys - 112 119 68 93 101 16 1 - 508 Girls 4 141 111 95 103 90 33 6 2 587 Totals 4 253 230 163 196 191 49 7 2 1095 17 Table II.—Return of Defects found in the Course of Medical Inspection in 1926. Defect or Disease Routine Inspections. Number referred for Treatment. Number requiring to be kept under Observation, but not referred for Treatment. (1) (2) (3) Malnutrition 1 Uncleanliness:— Head — — Body — — Skin Ringworm:— Head — — Body — — Scabies — — Impetigo — — Other Diseases (Non-Tubercular) 10 — Eye Blepharitis 1 — Conjunctivitis — — Keratitis — — Corneal Opacities — — Defective Vision 111 3 Squint 2 — Other Conditions 9 - Ear Defective Hearing 4 1 Otitis Media 5 — Other Ear Diseases 7 — Nose and Throat Enlarged Tonsils 38 — Adenoids 1 — Enlarged Tonsils and Adenoids 14 — . Other Conditions 5 —- Enl. Cervical Glands (Non-Tubercular) 1 — Defective Speech 2 1 Heart and Circulation Heart Disease:— Organic 1 15 Functional 3 6 Anaemia 10 - Lungs Bronchitis and Bronohial Catarrh 7 1 Other Non-Tubercular Diseases 5 2 Tuberculosis 'Pulmonary:— Definite — — Suspected — — Non-Pulmonary:— Glands — — Spine — — Hip — — Other Bones and Joints — — Skin — — Other Forms — — Nervous System 'Epilepsy 1 — Chorea 1 — Other Conditions 3 — Deformities Rickets — — Spinal Curvature 8 — Other Forms 26 — Other Defects and Diseases 60 - 18 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 — 3 3 Ear Disease — 6 6 Eye Disease:— External and other — 1 1 Miscellaneous — — - Total 10 10 Group II.—Defective Vision and Squint (excluding Minor Eye Defects treated as Minor Ailments—Group I). Defect or Disease. (1) No. of Defects dealt with. Under the Authority's Scheme. (2) Submitted to refraction by private practitioner or at hospital, apart from the Authority's Scheme. (3) Otherwise. (4) Total. (5) Errors of Refraction (including Squint) 71 71 Other Defect or Disease of the Eyes (excluding those recorded in Group I.) - - - - Total — 71 — 71 Total number of Pupils for whom spectacles were prescribed:— (а) Under the Authority's Scheme Nil (b) Otherwise 70 Total number of Pupils who obtained or received spectacles:— (а) Under the Authority's Scheme Nil (b) Otherwise 69 19 Group III.—Treatment of Defects of Nose and Throat. Number of Defects. Received Operative Treatment. Received other forms of Treatment. (4) Total Number treated. (5) Under the Authority's Scheme, in Clinic or Hospital. (1) By Private Practitioner or Hospital apart from the Authority's Scheme. (2) Total (3) — 15 15 2 17 Group IV.—Dental Defects. Number of Pupils who were:— Found to require treatment 125 Actually treated 86 ELEMENTARY SCHOOLS. Table I.—Number of Children Inspected 1st January, 1926 to 31st December, 1926. A.—Routine Medical Inspections. Number of Code Group Inspections:— Entrants 3,168 Intermediates 1,781 Leavers 2,477 Total 7,426 Number of other Routine Inspections — B.—Other Inspections. Number of Special Inspections 6,638 Number of Re-Inspections 22,327 Total 28,965 20 Table II. A.—Return of Defects found by Medical Inspection in the Year ended 31st December, 1926. Defect or Disease. Routine Inspections. Special Inspections. No. of Defects. No. of Defects. Requiring Treatment. Requiring to be kept under observation, but not requiring Treatment. Requiring Treatment. Requiring to be kept under observation ,but not requiring Treatment. (1) (2) (3) (4) ] Malnutrition 17 15 91 1 Uncleanliness:—(See Table IV., Group V.) Skin Ringworm:— Scalp 5 - 46 — Body 3 - 35 — Scabies 8 - 51 — Impetigo 26 - 613 — Other Diseases (Non-Tuberculous) 18 - 298 2 Eye Blepharitis 14 - 105 — Conjunctivitis 2 - 136 — Keratitis - - 11 — Corneal Opacities 1 - 2 — Defective Vision (excluding Squint) 359 24 374 - Squint 63 - 190 — Other Conditions 5 - 211 — Ear 'Defective Hearing 3 1 30 1 Otitis Media 32 1 203 — Other Ear Diseases 23 — 97 — Nose and Throat Enlarged Tonsils only 251 188 170 8 Adenoids only 10 9 26 — Enlarged Tonsils and Adenoids 207 27 241 6 Other Conditions 9 1 245 7 Enlarged Cervical Glands (Non-Tuberculous) 9 10 67 1 Defective Speech 3 3 3 3 Teeth—Dental Diseases — — — — (See Table IV., Group IV.) Heart and Circulation Heart Disease:— Organic 4 29 10 7 Functional 11 59 10 7 Anaemia 36 7 347 2 Lungs Bronchitis 58 91 416 2 Other Non-Tuberculous Diseases 2 5 61 1 Tuberculosis Pulmonary:— Definite — — 10 — Suspected 4 8 12 3 Non-Pulmonary:— Glands 2 4 5 — Spine — — 2 — Hip — — 3 — Other Bones and Joints — — 5 — Skin 1 — 4 1 Other Forms — — 2 — Nervous System Epilepsy 1 3 8 2 Chorea 8 2 134 — Other Conditions ??? 4 61 11 Deformities Rickets 3 — 4 — Spinal Curvature 9 — 52 — Other Forms 36 8 167 13 Other defects and diseases 83 37 1,817 76 21 Table II.—Continued. B. Number of individual children found at Routine Medical Inspection to Require Treatment (excluding Uncleanliness and Dental Diseases). Group. (1) Number of Children. Percentage of Children found to require Treatment. (4) Inspected. (2) Found to require Treatment. (3) Code Groups:— Entrants 3,168 507 16.0 Intermediates 1,781 275 15.5 Leavers 2,477 432 17.4 Total (Code Groups) 7,426 1,214 16.3 Other Routine Inspections - - - 22 Table III.—Return of all Exceptional Children in the Area. — — Boys Girls Total Blind (including partially blind) (i) Suitable for training in a School or Class for the totally blind Attending Certified Schools or Classes for the Blind 8 4 12 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 10 10 20 Attending Certified Schools or Classes for the Blind .. Attending Public Elementary Schools At other Institutions — — — At no School or Institution — 1 i 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 14 13 27 Attending Public Elementary Schools At other Institutions — — — At no School or Institution — — — (ii) Suitable for training in a School or Class for the partially deaf Attending Certified Schools or Classes for the Deaf 4 7 11 Attending Public Elementary Schools _ 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. 28 27 55 Attending Public Elementary Schools 87 48 135 At other Institutions 2 — 2 At no School or Institution 14 12 26* Notified to the Local Authority during the year. Feebleminded 2 1 3 Imbeciles 2 2 4 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 2 7 9* Suffering from epilepsy which is not severe Attending Public Elementary Schools 8 9 17 At no School or Institution — * One boy and four girls included under these headings are both Epileptic and Feeble-Minded. 23 Table III.—Continued. — — — Boys Girls Total Infectious pulmonary and glandular tuberculosis At Sanatoria or Sanatorium Schools approved by the Ministry of Health or the Board 1 1 2 At other Institutions — — — At no School or Institution 3 3 6 Non-infectious but active pulmonary and glandular tuberculosis At Sanatoria or Sanatorium Schools approved by the Ministry of Health or the Board 6 3 9 At Certified Residential Open Air Schools — — — At Certified Day Open Air Schools ,. — — — At Public Elementary Schls. 9 8 17 At other Institutions — 1 1 At no School or Institution — 1 1 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 37 37 At Public Elementary Schls. 68 216 284 At other Institutions 1 — 1 At no School or Institution — 2 2 Active Non-pulmonary tuberculosis At Sanatoria or Hospital Schools approved by the Ministry of Health or the Board 3 6 9 At Public Elementary Schls. — 3 3 At other Institutions — — — At no School or Institution 4 2 6 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. At Certified Residential Cripple Schools 3 2 5 At Certified Day Cripple Scs. 27 25 52 At Public Elementary Schls. 67 87 154† At other Institutions — — — At no School or Institution 5 11 16 24 Table IV.—Return of Defects Treated during the Year ended 31st December, 1926. TREATMENT TABLE. Group 1.—Minor Ailments (excluding Uneleanliness, 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 49 5 54 Ringworm—Body 35 — 35 Scabies 50 — 50 Impetigo 612 6 618 Other skin disease 287 25 312 Minor Eye Defects 462 21 483 (External and other, but excluding cases falling in Group II.) Minor Ear Defects 312 19 331 Miscellaneous (e.g., minor injuries, bruises, sores, chilblains, etc.) 608 13 621 Total 2,415 89 2,504 25 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) 941 12 8 961 Other Defect or Disease of the Eyes (excluding those recorded in Group I.) 34 5 — 39 Total 975 17 8 1,000 Total number of children for whom spectacles were prescribed :— (а) Under the Authority's Scheme 717 (b) Otherwise 19 Total number of children who obtained or received spectacles :— (a) Under the Authority's Scheme 715 (b) Otherwise 19 Group III.—Treatment of Defects of Nose and Throat. Number of Defects. Received Operative Treatment. Under the Authority's Scheme,in Clinic or Hospital. By Private Practitioner or Hospital, apart from the Authority's Scheme. Total Received other forms of Treatment. Total Number treated. (1) (2) (3) (4) (5) 772 64 836 254 1,090 26 Table IV.—Continued. Oroup I V.—Dental Deject*. (1) Number of Children who were :— (a) Inspected by the Dentist— Aged: 4 .. 180 5 .. 1,827 6 .. 2,143 7 .. 1,901 8 .. 2,303 Routine Age Groups 9 .. 2,495 10 .. 2,626 Total 16,754 11 .. 2,390 12 .. 722 13 .. 85 14 .. 82 Specials 1,836 Grand Total 18,590 (6) Found to require treatment 12,399 (c) Actually treated 5,557 (d) Re-treated during the year as the result of periodical examination 1,975 (2) Half-days devoted to Inspection Treatment 68 Total 827 759 (3) Attendances made by children for treatment 7,936 Permanent Teeth 1,539 2,040 (4) Fillings Temporary Teeth 501 Total Permanent Teeth 1,554 Total 11,927 (5) Extractions Temporary Teeth 1 10,373 (6) Administrations of general anaesthetics for extractions 1,197 (7) Other operations Permanent Teeth Temporary Teeth Total 150 25 (8) Regulation cases 24 Group V.— Uncleanliness and verminous conditions. (i.) Average number of visits per school made during the year by the School Nurses 20'2 (ii.) Total number of examinations of children in the Schools by School Nurses 120,443 (iii.) Number of individual children found unclean 2,342 (iv.) Number of children cleansed under arrangements made by the Local Education Authority 48 (v.) Number of cases in which legal proceedings were taken:— 6 (a) Under the Education Act, 1921 (b) Under School Attendance Bye-laws — Cottenham Maternitn and Child Melfare Committee. ANNUAL REPORT FOR THE YEAR 1926. 2 LIST OF MEMBERS OF COMMITTEE (1926). Mr. W. E. MONTAGUE (Chairman). Mrs. E. L. FINCH (Vice-Chairman). Mr. E. S. BROWN. Mrs. H. BYERS. Mrs. E. CHEETHAM. Mrs. F. W. COX. Miss R. F. COX. Mrs. E. DEVEREUX. Mrs. D. DICKS. Mr. H. FARTHING. Mr. W. FORDYCE. Mr. E. C. HARRIS. Mrs. A. KITCHENER. Mr. A. MANSFIELD. Mrs. G. E. MORRISON. Mr. D. NOTT. Mr. A. REED, A.F.I. Mrs. S. E. SANDERS. Mr. C. STOWE. Mr. A. J. WRAMPLING. 3 Anfant Melfare and Maternitn Centeres. BRUCE CASTLE, BRUCE CASTIE 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:— Tuesday 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, 1927. Ladies and Gentlemen, The Infant Mortality Rate and the Birth Rate are lower than last year. The mothers attending the Welfare Centres collected a sum of money for the purchase of one or more ultra violet ray lamps. The Ministry of Health have advised that their installation be deferred until more is known about the type of case ultra violet rays may be confidently expected to benefit. In the meantime arrangements for light treatment have been made with the North Middlesex Hospital, which has an efficient installation and competent staff. During the year new regulations came into operation respecting Ophthalmia Neonatorum, Puerperal Fever and Puerperal Pyrexia. Endeavours have been made to find hospital accommodation for patients suffering from puerperal fever, but they have not yet met with entire satisfaction. Medical Officers from the Ministry of Health have visited the Centres on various occasions. It is gratifying to report that the work conducted in the department over which your Committee exercise control has been favourably commented upon as the results of these visits. The Centres also afforded facility to the Ministry for an enquiry into the physical condition of children of pre-school age. I would again express the thanks of the Staff to your Committee for kindness shown and encouragement given. I am, Ladies and Gentlemen, Yours faithfully, Medical Officer of Health. 5 BIRTHS, 1926. LIVE BIRTHS. Registrar-General'8 Figures—M. 1,309 F 1,292 *2,601 Local Information Total Births notified 2,615 Less Still Births 62 Total Live Births 2,553 *Births outside the District included in above :— Council cases in District Maternity Home and Mothers' Hospital 54 Other cases notified from District Maternity Home 230 Notified from other Outside Institutions 203 487 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 1,968 Part breast-fed.—plus milk, dried milk or condensed 187 Bottle feeding.—Cows'milk 112 Dried milk 92 Other artificial foods 68 2,427 6 Not included in Feedings. Deaths under one month 75 Information refused, and removals 52 127 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 2,712 7,899 219 16,712 27,542 Still-births 58 40 - - 98 Deaths 42 9 11 1 63 Ophthalmia Neonatorum and Discharging eyes .. 16 40 - - 56 fOther Infectious Diseases 119 285 231 425 1,060 Total 2,947 8,273 461 17,138 28,819 Maternit y Visits. 1st Visits. Re-visits. Ante-Natal 414 556 — — 970 Post-Natal 773 920 — — 1,693 Puerperal Fever 2 — — — 2 Puerperal Pyrexia 7 7 — — 14 Other Visits. Mothers. Children. *357 276 — — 633 Total Visits .. — — — — 32,131 fOther Infectious Diseases include Measles 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. 7 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 Chestnuts) 12.211 74!) 52 205 37 00 50 00 1.492 Bruce Castle .. 8.535 596 52 151 39 00 43 10 1 209 Town Hall 1,958 126 — 52 — 37-65 300 Total 22,704 1,471 104 408 — 3,001 Medical Inspections. Total Number. New Cases. Number of Sessions. Averago No. of Inspections per Session. St. Ann's (The Chestnuts) 4,092 709 154 26 .57 Bruce Castle 2,715 548 100 27.15 Town Hall — — ' — Total 6,807 1,257 254 — Infant Mortality of Infants Attending the Infant Welfare Centres during 19SC. 1926 Births. Centre. No, on Reg ster. Deaths of Infants. Infantile Death-rate St. Ann's 522 *6 115 (The Chestnuts) Bruce Castle 357 5 14 0 Town Hall 105 — — Total 984 Infant Mortality rate for whole area 54.4 per thousand births. * 5 of these children only attended once. 8 ANTE AND POST-NATAL CLINICS. Medical Examinations. AnteNatal. PostNatal. Total. Number of Sessions. Average Attendance per Session. St. Ann's (The Chestnuts) 785 222 1,007 102 9.87 Bruce Castle .. 602 170 772 102 7-56 Total New Cases— St. Ann's (The Chestnutsl 1,387 213 392 69 1,779 282 204 — Bruce Castle .. 151 41 192 — — Total 364 110 474 — 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:— To Expectant and Nursing Mothers. To Toddlers. Total. In respect of— 716 618 1,334 • 15 mothers 11 toddlers 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 Mothers Delivered by:— Live Births Still Births Total Midwives Doctors Total 50 4 54 — 53 1 54 52 2 54 MATERNITY HOMES AND HOSPITALS. The arrangements with the Guardians, whereby Tottenham patients are admitted to the Maternity Home are still active and satisfactory. 9 Notified as Puerperal Sepsis. Maternity Deaths. No. of cases in which temperature rose above 100.4 for 24 hours Notified as Ophthalmia Neonatorum. Inflammation of the eyes. Not Entirely breast-fed. — — — 1 £ s. d. Cost of patients admitted to Maternity Home .. 256 4 0 Contributions by patients towards maintenance 209 4 (J Net cost to Council £46 19 6 Average duration of stay, 15-94 days. CRECHE ATTENDANCES. The attendances from 1st January to 31st December, 1926, were as follows:— Number of days on which the Creche was opened, 248. Quarter. Attendances under 3 years of Age. Attendances over 3 years of Age. Total. 1st January to 31st March 828 581 1,409 1st April to 30th June 971 713 1,684 1 st July to 30th September 1,140 638 1,778 1st October to 31st December 785 633 1,420 3,724 2,567 6,291 Number of children admitted:— Under three years (when admitted) 79 Over three years 29 Total 108 Average daily attendance, 25.26 10 Applications for assistance have been dealt with as follows:— Assisted Milk Supply.—689 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 distributed (fresh and dried milk) was 62,582 quatrs or their equivalent. Assistance has been given towards the payment of Midwives' Fees on 9 occasions, and for Home Helps in 1 instance. CONVALESCENT HOME TREATMENT. The arrangement with the Invalid Children's Aid Association for the maintenance of children at Convalescent Homes has been continued during 1926 as follows:— 27 children were sent away for varying periods, namely:— Number of Weeks 1 2 3 4 5 6 7 8 9 10 11 12 Number of Children 2 1 6 3 2 1 3 — 3 1 2 Number of Weeks 13 14 15 16 17 18 19 20 21 22 23 24 Number of Children — 1 1 1 HOSPITAL TREATMENT FOR CHILDREN UNDER 5 YEARS OF AGE. Children referred to the Prince of Wales's and North Middlesex Hospitals from the Welfare Centres:'— Number of Children. Number of Consultations. Treated as In-Patients. Operations for Tonsils and Adenoids. 33 61 3 8 11 VOLUNTARY SERVICES. It is reported with regret that Mrs. Pickford, who has conducted the sewing class at The Chestnuts, has been compelled to resign owing to illhealth. The supervision over the class is exercised by one of the health visitors. Miss Cremolina continues to give her services for part of the sewing at the Day Nursery. The Committee are indebted to the following donors, for gfts to the Centres and the Creche during the year :— Towards the Sunlight Lamp.—From M. Hollison, Esq., Potters Bar, per Mrs. Byers, £2 2s. Od. From Mrs. G. Lindsay Blee, Eastbourne, per Mrs. Byers, £1 Is. Od. From Edward Ward, Esq., Secretary, Tottenham and Wood Green Philanthropic Society, £2 15s. Od. From the North Tottenham Labour Party, West Green Ward, Women's Section, 10s. 6d. To the Welfare Centres.—From the Harringay Scouts' Association, per Mr. B. Inwood, Christmas Parcels for poor families. From the Dorcas Society of the High Schools for Girls, several gifts of baby clothing. From Mrs. Fred King, baby clothing. For the Creche.—Gifts have been received from Miss Boar (Crouch End), Mrs. Stanley Brown, Mrs. Cheetham, Mrs. Devereux, Mrs. Dicks, Mrs. Grytoin, Mrs. Kolte, Mrs. Matthias and the Co-operative Ladies' Guild. The Matron of the Creche and the Staff provided a party for the children. INDEX. PART I. Health Department. A page Aged, the care of the 25 Ambulance Service 34 B Bacteriological Laboratory 35 Births 13 C Cancer 22 Care of the Aged 25 Cerebro-Spinal Meningitis 31 Clinics 36 Common Lodging-Houses 51 Cowsheds 50 D Dairies, etc. 50 Deaths 14 Diphtheria . 28 Disinfection 50 Dysentery 31 E Encephalitis Lethargica 31 Enteiic Fever 31 Erysipelas 32 Exhumations 50 F Factory and Workshop Act 44 Filtration, Swimming Baths 42 Food and Drugs Act 49 Food Poisoning 48 Food,Unsound 48 H Health Services 34 Health Week 37 Hospitals 3 Housing 1 I Infantile Mortality 15 Infectious Diseases 26 Introduction 9 L Laboratory 35 Legal Proceedings 41 Lodging-Houses 51 M page Malaria 31 Measles 31 Meat Regulations 48 M. of H. Tables 16 etc. Mortuary Table 24 N North Middlesex Hospital 25 Nursing in the Home .. 37 0 Ophthalmia Neonatorum 31 P Poliomyelitis 31 Poor Law Relief 25 Population 10 etc. Public Health (Meat) Regulations. 1924 48 Puerperal Fever and Puerperal Pyrexia 31 R Rateable Value 11 S Sanitary Work, General 43 Scarlet Fever 26 Shops Acts 39 Slaughter-Houses 50 Small Dwellings Acquisition Act 50 Smallpox 30 Social Conditions of the Area 10 Staff 4 Statutes, etc., Administered 38 Superannuation Scheme 37 Swimming Baths 42 T Treatment Centres 36 Tuberculosis 32 U Unsound Food 48 V Violent Deaths 23 W Water Supply 42 Whooping Cough 31 PART II. School Medical Department. A page Adenoids 8 Attendance Officers 13 Aural Clinic 7 B Bacteriological Examinations 6 Blind Children 14 C Convalescent Home Treatment 13 Crippling Defects 14 D Deafness 15 Dental Defects 26 E Ear Diseases 7 Epileptic Children 14 Extent of Medical Inspection 19 External Eye Diseases 24 Eye Clinic 25 Examinations by Medical Officers 16 F Findings of Medical Inspection 20 Following-up 6 Food Accessories and Drugs 16 H Home Visits 6 Hygiene, School 3 I Infectious Diseases .. 5 Invalid Children's Aid Association 13 Introduction .. 2 M page Meals, Provision of .. 12 Mentally Defective Children 14 Menus, School Meals 12 Minor Ailments 18 Myopic School 15 0 Oak Lodge Special School 15 Open-Air Centre 15 Open-Air Education 8 Otorrhoea Clinic 7 P Parents. Co-operation of 13 Physically Defective School 15 Physical Training 11 Playground Classes 8 R Residential Schools 14 Ringworm .6 S School for Deaf 15 School Journeys and Damps 8 Secondary Schools 16 Staff (see page 4, Health Department portion) Statistics 16-26 Surgical Instruments 14 T Teachers, Co-operation of 13 Tonsils and Adenoids 8 U Uncleanliness 6 V Verminous Conditions 6 Vision 18 Voluntary Bodies 13 PART III. Maternity and Child Welfare Department. A page Ante-Natal Clinic 8 do. Visits 6 B Bruce Castle 7,8 Births 5 (and page 13 Health Department portion) C Chestnuts (The) 7,8 Creche 9 Centres, List and Attendances 3,7.8,9 Convalescent Home Treatment (I.C A A.) 10 D Dinners in Necessitous Cases 8 G Gifts 11 H Hospital Treatment 10 I Introduction 4 Infant Mortality 7 (and page 15 of Health Department portion) L page Lower Ward, Bruce Castle Centre 7,8 M Maternity Cases 8,9 Midwives' Fees 10 N Notification of Births' Acts —Visits 6 0 Ophthalmia Neonatorum— Visits 6 (and page 31 of Health Department portion) P Puerperal Fever and Puerperal Pyrexia 6 S Staff (see page 4, Health Department portion) T Town Hall Centre—Attendance 7 W Welfare Centres (list of) 3 V Voluntary Services 10