AC 439(1) TOTTENHAM (LAT??? M??? B) Tottenham Urban District Council. ANNUAL REPORT OF THE Medical Officer of Health FOR THE YEAR 1927 DAVID C. KIRKHOPE, M.D., Ch.M., D.P.H., Barrister-at-Law. TOT 7 Tottenham Urban District Council. REPORT ON THE HEALTH OF TOTTENHAM for the Year 1927. HARRINGAY: GREENWAY & Co., T.U. Printers, 435, Green Lanes. 2 SUMMARY OF STATISTICS FOR 1927. Area 3,014 acres. Population 162,000 Births 2,388 Birth-rate 14.7 per 1,000 of population. Deaths 1,664 Death-rate 10.2 per 1,000 of population. Deaths under 1 year of age 154 Infant Death-rate 64.4 per 1,000 births. Phthisis Death-rate 0'82 per 1,000 of population. Rateable Value £655,260 Amount Produced by 1d. Rate £2,580 3 Tottenham Urban District Council. HEALTH COMMITTEE: Chairman : Mr. Councillor H. Farthing. Members : (Ex-Officio) : Mr. Councillor T. Elderfield, J.P. (Chairman of the Council.) (Ex-Officio): Mr. Councillor C. Wise, (Vice-Chairman of the Council.) Mrs. Councillor F. C. Brighten. Mr. „ L. Clegg. Miss ,, R. . Cox. Mr. „ W. Fordyce. „ „ E. Frost. „ „ C. D. Grant. Major P. B. Malone, M.P., J.P. Mr. Councillor A. Reed, A.F.I. „ „ C. Stowe. ,, ,, S. Timms. ,, „ J. Wallace. Representatives on the Middlesex Districts Joint Small l-ox Hospital Board : Mr. Councillor T. Elderfield, J.P. ,, ,, 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:—Eric Townson, Esq., LL.B. Engineer and Surveyor:—Captain H. F. Wilkinson, R.E., A.M.Inst.C.E. Treasurer: —E. Young, Esq., A.S.A.A. Clerk, Education Committee :—W. Mallinson, Esq. Director of Education :—A. J. Linford, Esq., B.Sc. Superintendent, Fire Brigade:—I. Easton, Esq. Librarian:—W. J. Bennett, Esq., F.L.A. Superintendent of Baths:—T. J. Lewis, Esq. Staff. I. Health Department. Medical Officer of Health— §David C. Kirkhope, M.D., Ch.M., D.P.H., 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. Late St. Ann's Ward. (86, Chester Road.) Female Sanitary Inspector— §*Lamb, Miss M. *Certificate of the Royal Sanitary Institute. †Meat Inspector's Certificate. ¶Cert., San. Insp. Exam. Bd. ‡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. °Cert., San. Insp, Exam. Bd. ¶ 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. Clegg, E. S., Junior Clerk. Mortuary Attendant— H. Copder, 24, Loobert Road, Clyde Circus. Disinfectors— J. Wilson (Houses). J. Mitchell (Clothing). J. Collin „ Drain Testers,°Etc. H. Bysouth. J. W. Turner. F. Dowse. C. Vessey. 6 2. School Medical Department. School Medical Officer— David C. Kirkhope, M.D., Ch.M., D.P.H. of Gray's Inn and Middle Temple, Barrister-at-Law. Senior Assistant Medical Officer— Alice Stalker, M.B., Ch.B., D.P.H. Assistant Medical Officer— R. Hastings Smythe, L.R.C.P. & S.I. Ophthalmic Surgeon— T. W. Letchworth, F.R.C.S. (Part-time). Aurist— A. R. friel, M.A., M.D., F.R.C.S.I. (Part-time). Dental Surgeons — V. Sainty, L.D.S., R.C.S. (Eng.) L. S. Pilbeam, L.D.S., R.C.S. (Eng.) School Nurses— *†E. Johns. *M. Pickburn. *†W. Barnes. *‡C. Vine. *†L. Rogers. *†E. Lindsay. ‡E. Barratt. *†H. McMath. * General Training Certificate. † C.M.B. ‡ Fever Training Certificate. Clerical Staff— V. Goddard (Chief Clerk). E. Ing. T. E. Cohen, F.I.S.A. H. A. Thomas. J. E. Miller (and at Laboratory). 7 3. Maternity and Child Welfare Department. 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. (Lond.), M.R.C.P. (Lond.), D.P.H. (Lond.) Part Time Medical Officer, Ante and Post Natal Clinics: Margaret Salmond, M.D., B.S. (Lond.), M.R.C.S., L.R.C.P. (to March 31st), Esther Richards, M.S., M.B. (Lond.), F.R.C.S. (Eng.), L.R.C.P. (Lond.) (from April). Superintendent Health Visitor : §‡†Mrs. J. Kent Parsons. Health Visitors : †¶aB. Wallace. *†ºaFletcher. *†§aM. Blanchard *†abG. M. Hockin. *†G. Mason. *†abcE. M. Dunn. *†°N. Headley. *†¶M. F. Reynolds. § Health Visitor's Diploma. * General Training Cert. ‡ San. Insp. Exam. Bd. Cert. † C.M.B. ¶ R.S.I. Sau. Insp. Cert. ° Fever Training Cert. a R.S.I. Health Vis. 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. Gravillb 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, 1928. To the Chairman and other Members of the Tottenham Urban District Council. Ladies and Gentlemen, During the year 1927 nothing of outstanding importance occurred worthy of special mention. The Council has still no Infectious Diseases Hospital and during the year under review, patients suffering from infectious diseases and requiring Institutional treatment were admitted to the Metropolitan Asylums Board Hospitals, the Southgate Isolation Hospital and the London Fever Hospital. Notwithstanding the increasing incidence of small pox in the country, iand its occurrence in neighbouring districts, no case has occurred in Tottenham. I have the pleasure to report that the Staff continue to give loyal and devoted service. I am. Ladies and Gentlemen, Your obedient Servant, David b kir rhone. 10 POPULATION. The 1921 Census Population was returned by the Registrar-General at 146,711. The Treasurer's figure for the population at Midsummer, 1927— 162,000- as shown on page 11, has been taken as the basis of calculation of the vital statistics. The Registrar-General gives a lower figure—150,210. The discrepancy points to the desirability of a Census being taken at more frequent intervals. RATEABLE VALUE. The rateable value of the district in 1927 was £655,260, and a 1d. Rate produced £2,570. 11 Return of Houses, Population, etc., at Mid-Summer, 1927, 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 & Stoneleigh 404 4,343 266 4,609 21,350 52.8 88,004 Chestnuts 201 3,772 209 3,981 22,160 110.2 62,006 Green Lanes 203 2,795 222 3,017 15,510 76.4 79,259 Park and Coleraine 688 3,702 185 3,887 19,130 27.8 75,371 Stamford Hill 292 4,105 167 4,272 22,680 77.6 77,391 Town Hall 281 3,471 207 3,678 18,260 64.9 91,344 West Green 470 4,181 198 4,379 21,370 45.4 81,332 White Hart Lane 475 4,218 184 4,402 21,540 45.3 67,017 Throughout the Parish — — 15‡ 15‡ — — 33,536 Totals 3,014 30,587 1,653 32,240 162,000 53.7 £655,260 * 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. 12 BIRTHS. Births Registered:- Males 1,176 Females 1,212 Total 2,388 Including Illegitimate Births:— Male 42 Female 36 Total 78 Births occurring in the district 1,893 Births of Tottenham residents occurring outside the district 495 Total 2,388 Birth Rate, 14.7 per 1,000. Births notified under the Notification of Births Acts:— In district by Doctors 518 „ ,, Midwives 1,118 „ „ Parents and other persons 242 Notified from outside Institutions 555 2,433 Advised by Registrar 23 Total 2,456 Less Still Births 76 2,380 13 DEATHS. The total number of deaths registered in Tottenham was 1,143 Of these, the number of non-residents was 226 Deaths of residents registered in the district 917 Deaths of residents registered outside the district 747 1,664 Deaths of residents under 1 year occurring in district 89 Deaths of residents under 1 year occurring outside district 65 Total deaths of Tottenham infants 154 These deaths are distributed in age groups as follows:— Deaths under 1 year 154 Deaths from 1 to 5 years 64 Deaths from 5 to 15 years 47 Deaths from 15 to 25 years 77 Deaths from 25 to 65 years 638 Deaths 65 and upwards 684 1,664 The excess of births over deaths is 724. The death rate equalled 10.2 per 1,000 of the population. 14 Table showing the Population, Birth and Death Rates, in Wards, during 1927. Ward No. of Births No. of Deaths Population General Birth-rate General Death-rate No. of Deaths Under 1 Year Infant Mortality per 1000 of Population Infant Mortality per 1000 Births Bruce Grove & Stoneleigh 326 237 21,350 15.2 11.1 25 1.1 76.6 Chestnuts 348 242 22,160 15.7 10.9 23 1.0 66.0 Green Lanes 156 145 15,510 10.0 9.3 7 0.4 44.8 Park and Coleraine 265 188 19,130 13.8 9.8 17 0.8 64.1 Stamford Hill 360 209 22,680 16.3 9.2 16 0.7 44.4 Town Hall 285 199 18,260 15.6 10.9 25 1.3 87.7 West Green 257 207 21,370 12.0 9.6 11 0.5 42.8 White Hart Lane 391 237 21,540 18.1 11.0 30 1.3 76.7 Total 2,388 1,664 162,000 14.7 10.2 154 0.9 64.4 15 Ministry of Health Table I. Table showing the Population, Birth Rate, and Death Rale from all causes, in Tottenham during the last six years. Year Population estimated to Middle of each Year Births Total Deaths Registered in the District Deaths of Nonresidents registered in the District Deaths of Residents not registered in the District. Nett Deaths belonging to the District Uncorrected Number Nett Under 1 Year of Age At all Ages Number Rate Number Rate Number Rate per 1,000 Nett Births Number Rate 1922 152,000 2777 3167 20.8 1496 9.8 352 559 203 64.0 1703 11.2 1923 154,300 2641 3093 20.0 1021 6.6 194 581 180 58.1 1408 9.1 1924 156,000 2397 2853 18.2 1183 7.5 250 626 176 61.6 1559 9.9 1925 156,700 2275 2756 17.6 1105 7.0 213 704 150 54.4 1596 10.1 1926 159,500 2177 2601 16.3 1090 6.8 222 677 147 56.5 1545 9.6 1927 162,000 1893 2388 14.7 1143 7.0 226 747 154 64.4 1664 10.2 16 NOTES TO (Ministry of Health) 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 Sanatorium, Harefield. Metropolitan Asylums Board Hospitals (other than the North Eastern). London Fever Hospital, Islington. Isolation Hospital, Southgate. 3.—Other Institutions, the deaths in which have been distributed among the several localities in the District :— Guy's Hospital, Southwark. St. Bartholomew's Hospital, West Smithfield. Queen's Hospital for Children, Hackney Road. University College Hospital, Gower Street. Hospital for Sick Children, Great Ormond Street. City of London Maternity Hospital, City Road. German Hospital, Hackney. 17 King's College Hospital, Denmark Hill. The Mothers' Hospital, Clapton. London Hospital, Whitechapel. Westminster Hospital, Broad Sanctuary. St. Columbus Hospital, Hampstead. Springfield Hospital, Wandsworth. Royal Free Hospital, Gray's Inn Road. Metropolitan Hospital, Kingsland Road. Royal Northern Hospital, Holloway. Napsbury Asylum, St. Albans. St. Joseph's Hospice, Hackney. West End Hospital, Gloucester Gate. Elizabeth Garrett Anderson Hospital, St. Pancras. National Hospital for Diseases of the Heart, St. Marylebone. Queen Mary's Hospital, Carshalton. King's Lynn and North West Norfolk Hospital, King's Lynn. Gloucestershire Royal Infirmary, Gloucester. St. Elizabeth's Home, Much Hadham. Children's Hospital, Holborn. Enfield House, Enfield. Friern Barnet Infirmary. St. George's Hospital, Westminster. Middlesex Hospital, St. Pancras. Mildmay Mission Hospital, Bethnal Green. Homoeopathic Hospital, Gt. Ormond Street. Royal Free Hospital, St. Pancras. Central Home, Leyton. Convalescent Home, Burnham. Lambeth Hospital, Lambeth. Freemasons' Hospital, Chelsea. West London Hospital, Hammersmith. Queen Charlotte's Hospital, St. Marylebbne. Infants' Hospital, Vincent Square, Westminster. Cottage Hospital, Margate. Cancer Hospital, Chelsea. St. Thomas' Hospital, Lambeth. Hornsey Central Hospital, Hornsey. St. Luke's Hospital, Paddington. Eversfield Hospital, Hastings. Brompton Hospital Sanatorium, Frimley. 18 Ministry of Health Table II.-Table of cases of Infectious Disease coming to the knowledge of the Medical Officer of Health during the year 1927, in the Tottenham Urban District, classified according to diseases, ages, and localities. Notifiable Disease Number of Cases Notified. Total Cases Notified in Each Locality. Total Cases Removed to Hospital At all Ages At Ages—Years. Bruce Grove and Stoneleigh Chestnuts Green Lanes Park and Coleraine. Stamford Hill Town Hall West Green White Hart Lane Under 1 to 2 2 to 5 5 to 10 10 to 15 15 to 20 20 to 35 35 to 45 45 to 65 65 and over Scarlet Fever 466 1 10 88 222 86 29 23 7 ... ... 54 76 45 46 60 50 80 55 73 Diphtheria (including Membranous Croup) 398 2 11 89 174 60 27 24 7 4 ... 67 59 29 36 37 64 25 81 368 Pneumonia 198 9 13 34 27 9 16 22 26 29 13 15 42 20 19 50 20 12 20 Erysipelas 46 1 ... 1 ... 1 7 9 11 15 1 3 10 5 4 12 4 4 4 8 Enteric Fever 3 ... ... 1 ... ... ... 2 ... ... ... 1 ... ... ... 1 ... ... 1 2 Puerperal Fever 2 ... ... ... ... ... 1 1 ... ... ... 1 ... ... 1 ... ... ... ... 2 Puerperal Pyrexia 15 ... ... ... ... ... ... 8 6 1 ... 2 3 1 ... 4 2 2 1 5 Cerebro-spinal Meningitis 2 1 ... 1 ... ... ... ... ... ... ... ... 1 ... ... 1 ... ... ... 2 Encephalitis Lethargica 7 ... ... 1 1 1 1 3 ... ... ... 2 1 ... ... ... 3 1 ... 4 Polio Encephalitis 1 ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 1 Poliomyelitis 4 ... 2 1 1 ... ... ... ... ... ... 2 1 ... ... ... 1 ... ... 2 Malaria 5 ... ... ... ... ... ... 3 2 ... ... 1 ... ... ... 2 1 ... 1 ... Continued Fever 1 ... ... ... ... ... ... ... ... 1 ... ... ... ... 1 ... ... ... ... 1 Ophthalmia Neonatorum 10 10 ... ... ... ... ... ... ... ... ... 1 2 ... 2 3 1 ... 1 1 Pulmonary Tuberculosis 204 ... 2 4 4 7 31 77 46 32 1 24 34 15 24 31 29 19 28 ... Other forms of Tuberculosis 49 1 2 2 10 9 6 9 3 7 ... 4 7 5 6 6 11 4 6 ... Totals 1411 25 40 223 439 173 118 181 108 89 15 177 236 120 139 207 186 147 199 19 Ministry of Health Table 111. TABLE OF DEATHS during the Year 1927 in the Tottenham Urban Sanitary District, classified according to Diseases, Ages, and Localities. Causes of Death Deaths at the subjoined ages of "Residents" whether occurring in or beyond the District 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 and under 85 85 and upwards Bruce Grove & Stoneleigh. Chestnuts. Green Lanes. Park and Coleraine. Stamford Hill. Town Hall. West Green. White Hart Lane. Enteric Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Small Pox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Measles ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 12 Scarlet Fever 3 ... ... 1 2 ... ... ... ... ... ... ... ... 1 1 1 ... ... ... ... ... 5 Whooping Cough 11 6 2 2 1 ... ... ... ... ... ... ... ... 1 1 ... 2 ... 4 2 1 22 Diphtheria 13 ... 1 5 6 1 ... ... ... ... ... ... ... 1 1 4 1 1 2 2 1 36 Influenza 47 2 2 ... 2 ... 1 5 7 7 8 12 1 3 5 3 5 6 8 10 7 1 Erysipelas ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Phthisis (Pulmonary Tuberculosis) 134 ... ... 1 2 31 42 22 24 9 3 ... ... 22 26 9 12 9 18 13 25 1 Tuberculous Meningitis 10 ... 1 4 4 1 ... ... ... ... ... ... ... 1 1 ... 1 2 1 1 3 7 Other Tuberculous Diseases 8 1 1 ... 1 1 1 ... 1 2 ... ... ... 1 2 ... 2 ... 1 ... 2 4 Cancer, malignant disease 210 1 ... ... 1 ... 4 16 37 60 52 36 3 22 26 18 34 25 20 36 29 52 Rheumatic Fever 13 ... ... ... 4 5 1 ... ... 1 1 1 ... 2 1 ... 2 2 ... 4 2 2 Meningitis 10 2 ... ... 3 2 1 1 1 ... ... ... ... 2 ... 2 1 3 ... 1 1 4 Heart Disease 239 5 ... ... 1 7 6 8 25 40 55 70 22 40 38 20 28 26 24 39 24 28 Bronchitis 171 7 1 2 1 1 2 4 13 28 49 51 12 24 17 20 19 27 22 19 23 3 Pneumonia (all forms) 152 25 16 8 9 4 6 10 13 21 22 9 9 19 28 9 12 12 27 18 27 25 Other diseases of respiratory organs 33 ... ... ... 1 ... 2 4 4 6 8 8 ... 8 ... 5 3 8 1 4 4 ... Diarrhœa and Enteritis 6 6 ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... 1 2 ... 2 ... Appendicitis and Typhlitis 10 ... ... ... ... 2 1 2 3 2 ... ... ... 1 2 1 1 1 1 2 1 11 Alcoholism 3 ... ... ... ... ... ... 1 1 1 ... ... ... 1 ... ... 1 1 ... ... ... ... Nephritis and Bright's Disease 55 ... ... ... ... 6 3 2 12 9 14 7 2 6 12 5 4 6 7 7 8 21 Puerperal Fever 3 ... ... ... ... ... ... 2 1 ... ... ... ... ... 1 ... ... 1 ... 1 ... ... Other accidents and diseases of Pregnancy and Parturition 5 ... ... ... ... 1 2 2 ... ... ... ... ... ... 1 ... ... 1 1 1 1 ... Congenital Debility, Malformation and Premature Birth 81 78 1 2 ... ... ... ... ... ... ... ... ... 13 16 4 7 9 11 4 17 3 Violent Deaths, excluding Suicide 46 1 1 2 3 8 3 7 3 2 12 2 2 9 6 4 5 10 2 3 7 12 Suicide 18 ... ... ... ... 1 ... 7 4 2 4 ... ... 1 1 4 1 4 2 1 4 2 Cerebro-Spinal Meningitis 2 1 ... 1 ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... 1 2 Other Defined Diseases 378 18 4 6 6 4 4 21 52 54 85 96 28 58 54 36 47 54 44 39 46 77 Diseases ill-defined or unknown 1 ... ... ... ... 1 ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... Encephalitis Lethargica 2 1 ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 ... Totals 1664 154 30 34 47 77 79 114 201 244 313 292 79 237 242 145 188 209 199 207 237 330 20 Ministry of Health Table IV. INFANTILE DEATHS in Ages, Sexes and Localities, during the year 1927. CAUSE OF DEATH Under 1 week. 1-2 weeks. 2-3 weeks. 3-4 weeks. Total under 4 weeks. 1-3 months. 3-6 months. 6-9 months. 9-12 months. Total Deaths under 1 year. Males. Females. Bruce Greve & Stoneleigh Ward. Chestnuts Ward. Green Lanes Ward. Park and Coleraine Ward Stamford Hill Ward. Town Hall Ward. West Green Ward. White Hart Lane Ward. Small-pox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Chicken-pox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Measles ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Scarlet Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Whooping-cough ... ... ... ... ... ... 3 3 ... 6 3 3 1 1 ... ... ... 2 1 11 Diphtheria ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Erysipelas ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Tuberculous Meningitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Abdominal Tuberculosis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Other Tuberculous Diseases ... ... ... ... ... ... ... ... 1 1 ... 1 ... ... ... 1 ... ... ... ... Meningitis (not Tuberculous) ... ... ... ... ... ... ... 1 1 2 1 1 1 ... ... 1 ... ... ... ... Convulsions ... ... ... ... ... 1 ... 1 1 3 1 2 1 ... 1 ... ... ... ... 1 Laryngitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Bronchitis ... 1 ... ... 1 2 3 ... 1 7 3 4 3 ... ... 1 1 1 ... 1 Pneumonia (all forms) 1 ... 1 ... 2 1 7 9 6 25 17 8 3 3 ... 5 3 3 3 5 Diarrhœa ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Enteritis ... ... ... ... ... 1 3 2 ... 6 5 1 ... 1 1 ... ... 2 ... 2 Gastritis ... ... ... 1 1 ... 1 ... ... 2 1 1 ... ... ... ... 1 ... ... 1 Syphilis 1 ... ... 1 2 ... ... ... ... 2 1 1 ... ... ... 2 ... ... ... ... Rickets ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Suffocation, overlying ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Injury at Birth ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Atelectasis 3 ... ... ... 3 ... ... ... ... 3 2 1 1 ... ... ... ... 2 ... ... Congenital Malformations 8 1 2 ... 11 5 1 3 ... 20 15 5 3 2 1 1 2 4 2 5 Premature birth 32 5 3 2 42 2 ... 1 ... 45 24 21 6 12 3 4 4 5 2 9 Atrophy, Debility and Marasmus 3 1 1 1 6 7 ... ... ... 13 6 7 2 1 ... 2 3 2 ... 3 Other Causes 8 ... 2 1 11 2 2 1 3 19 13 6 4 3 1 ... 2 4 3 2 Totals 56 8 9 6 79 21 20 21 13 154 92 62 25 23 7 17 16 25 11 30 21 MALIGNANT DISEASES. Cancer continues to take its heavy toll. As this is a disease, or group of diseases, that principally attacks persons beyond middle life, reduction in the death rate from diseases of malignant type is not to be expected, unless research can show some means of cure that has not hitherto been widely applied. Cure mainly depends upon the early date at which the nature of the disease is discovered and the thorough removal, by surgical means, of the growth and neighbouring tissues involved. Recent investigations have shown that by the application of Radium, there is greater hope of recovery, without mutilation. The knowledge of its properties and the means of estimating the dosage of its emanations are being acquired, so that safety in its application may be assured. Notwithstanding this hope, the greatest expectation of recovery must be with those who come earliest under treatment. It is of the utmost importance that there shall be no delay in seeking medical or surgical skill by those who show signs or symptoms that may be attributable to malignancy. Therein lies their greatest safety. The following table gives particulars of the deaths from Malignant Growths. CANCER. Digestive System: Males. Females. Mouth 1 — Tongue 5 1 Œsophagus 13 1 Stomach 30 13 Pylorus 1 — Bowels (large and small intestines) 12 13 Rectum 8 15 Liver and Gall Bladder 7 9 Pancreas 2 2 22 Genito-urinary: Kidney 2 1 Bladder 3 2 Prostate 2 — Breast — 25 Uterus — 8 Ovary — 4 Respiratory:- Larynx 6 1 Lung 3 2 Various:— Cutaneous (face and lips) 1 5 Mediastinum 2 — Heart — 1 Peritoneum 1 2 Brain - 1 SARCOMATA. Kidney 1 1 Orbit - 1 Toe - 1 Pelvis 1 — 101 109 VIOLENCE. There were 64 deaths from Violence, including 18 which were suicidal. In 1926 the number was 50. Males. Females. Falls 2 2 „ from bicycle 1 — „ out of bed — 1 „ into fire 1 — „ from scaffolding 1 — „ down a hole 1 — Falling of wall 1 — „ metal storage bin 1 — 23  Males. Females. Collision between motor lorry and railway engine 1 — „ „ bicycle and motor 'bus — 1 „ „ bicycle and motor car 1 — „ „ motor cycle and motor bus 1 — Run over by steam waggon 1 1 „ motor van — 1 „ motor car — 1 „ motor lorry 1 — „ railway truck 1 — „ horse and van 1 — Knocked down by cyclist 1 — „ „ motor cyclist 1 2 „ „ motor car 1 1 „ „ motor lorry — 1 „ „ boys — 1 Crushed by motor lorry 1 — Thrown from motor cycle 1 — Murder (found on railway embankment) 1 — Drowning 2 — Bathing, heart failure 1 — Kick of horse 1 — Scalding — 1 Burns — 3 Haemorrhage caused by being struck — 1 Poisoning by coal gas (accident) 1 — Motor accident 1 — Wound of finger 1 — Impaled on iron fence 1 — SUICIDES. Drowning 5 - Poisoning 2 3 Poisoning (coal gas) 2 1 Hanging 2 — Gun-shot wound — 1 Jumping from balcony — 1 Cut throat 1 - 41 23 24 Mortuary Table for the Year 1927. Bodies Admitted. No. of Post Mortems Number of Inquests Deaths from Violence Deaths from Drowning Month Males Females Total Males Females Total January 5 ... 5 5 ... 5 5 1 1 February 5 1 6 3 2 5 5 2 ... March 3 4 7 4 2 6 7 2 ... April 4 3 7 4 3 7 7 2 ... May 7 1 8 7 1 8 5 1 1 June 6 1 7 5 1 6 6 3 1 July 4 6 10 4 5 9 10 8 1 August 5 4 9 5 3 8 7 4 ... September 6 2 8 6 2 8 6 3 ... October 7 3 10 6 3 9 4 1 2 November 5 2 7 4 2 6 3 2 ... December 8 5 13 6 5 11 1 1 ... Total 65 32 97 59 29 88 66 30 6 No. of bodies admitted to await Burial 27. The following List gives the Causes to which Deaths were attributed by the Coroner or Coroner s Juries:- Aorta, rupture of 4 Inanition 2 Atheroma 3 Inattention at birth 1 Arterio sclerosis 3 Meningitis 2 Bronchitis 7 Nephritis 1 Cystitis 1 Nicotine Poisoning 1 Cancer 1 Odoema of Lungs 2 Convulsions 1 Pneumonia 7 Cerebral Haemorrhage 6 Status Lymphaticus 3 Congestion of Lungs 2 Stillborn 1 Fatty degeneration of heart 9 Valvular disease of heart 4 25 Suicides: Accidents: Poisoning 2 Burns 1 Gas Poisoning 5 Run over by horsed van 1 Drowning 4 ,, motor car 4 Killed on railway 1 ,, motor lorry 3 Gunshot wound 1 motor 'bus 2 steam waggon 2 Fall from motor cycle 1 Manslaughter: „ steam waggon 1 Blow on head 1 Deaths under anaesthetic 4 Killed on railway 1 Knocked down by motor cycle 2 Drowning 2 Fall of wall 1 POOR LAW RELIEF. 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, 2,083 £39,218 2,244 £57,508 Institutional Relief. North Middlesex Hospital. No. of cases admitted from Tottenham during 1927 2,867 No. of days In-Maintenance of these patients during 1927 106,443 26 INFECTIOUS DISEASES. SCARLET FEVER. The majority of notified cases of this disease are nursed at home under the care of their own private practitioners. The Council's nurses assist the practitioners when required. Of the 466 notified cases, 388 were treated at home by the Council's Nurses, 5 were treated privately in their own homes, and 71 were removed to Isolation Hospital (6 of them privately). 2 Tottenham cases were removed to M.A.B. hospitals from General Hospitals in London. Of the cases sent to hospital by the Health Department, 43 went to the Metropolitan Asylums Board's Hospitals, 18 to the Southgate Isolation Hospital and 4 to the London Fever Hospital. The average duration of stay in hospital of the cases treated to a conclusion was: M.A.B. 56.6 days, Southgate 26.9 days, London Fever Hospital 37.5 days. 6 cases were removed privately to the London Fever Hospital. There were 3 deaths from Scarlet Fever. Two of these occurred in an Isolation Hospital, the causes of death being given as "Scarlet Fever, Broncho Pneumonia and "Scarlet Fever, Acute Endocarditis," and one occurred at home, the cause of death being given as "Scarlet Fever, Endocarditis". Seven of the cases removed to hospital had been wrongly diagnosed, 2 being Tonsillitis, 1 Measles, 1 Whooping Cough, 1 German Measles, 1 Erythema, 1 "Observation, not Scarlet Fever". The average residence in hospital of these patients was 37.1 days. DIPHTHERIA. The increased incidence of Diphtheria, commencing in September, 1926, continued with occasional intermissions until the end of March, 1927. In the latter part of the year 1927 there was again an increased number of weekly notifications, although fewer than in the corresponding weeks of 1926. 27 398 cases were notified during the year. 362 of these were removed to Isolation Hospital from Tottenham and 6 from General Hospitals in London. Deaths numbered 13. Of the cases removed to hospital from Tottenham, 246 were taken to the Metropolitan Asylums Board's Hospitals, 75 to the London Fever Hospital, and 41 to the Southgate Isolation Hospital. The average duration of stay in hospital of those cases treated to a conclusion was:- M.A.B. 74.3 days, London Fever Hospital 49.5 days, Southgate 36.0 days. 50 of the cases admitted to hospital had been wrongly diagnosed, as follows:—Tonsillitis 33; "Sore Throat," 4; "Not Diphtheria," 3; Scarlet Fever, 2; Tonsillitis and Rubella, 1; Peritonsillar Abscess, 1; Quinsy, 1; Tonsillitis and Mumps, 1; Diphtheric Laryngitis, 1; Rhinorrhoea, 1; Acute Laryngitis and Chronic Bronchitis and Asthma, 1; Acute Tonsillitis and Lobar Pneumonia and Bronchitis, 1. The average residence in hospital of these patients was 29.7 days. Quite a considerable number of patients discharged from hospital, and not a few persons who have been in contact with diphtheria patients at home, show by swabbing that they are harbouring the Klebs Loeffler Bacillus (or one indistinguishable from it microscopically) in nose or throat. With a view of shortening the period during which these patients and "positive" contacts will be excluded from school or kept in seclusion, Vaccine Treatment has been given with, in most cases, satisfactory result. In the remainder the enlarged condition of the tonsils or post nasal adenoid tissue points to the necessity for the rembval of these hypertrophical glands. Immunization against Diphtheria infection is urged in that section of the Report relating to Maternity and Child Welfare. 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. 28 SMALL POX. No case of Small Pox has been notified during the year, but all Tottenham contacts have been followed up systematically until the period of incubation had expired. The Vaccination Officer for Tottenham informs me that the number of Tottenham children vaccinated during 1927 was 892 and the number of declarations of conscientious objection to vaccination received was 1,041. MEASLES AND WHOOPING COUGH. Complicated cases of Measles and Whooping Cough have been admitted to the M.A.B. hospitals, as follows Measles and Pneumonia, 9; Whooping Cough and Pneumonia, 7; Whooping Cough, 2. OPHTHALMIA NEONATORUM. 10 cases of Ophthalmia Neonatorum were notified during the year. In no instance was the vision impaired. PUERPERAL FEVER AND PUERPERAL PYREXIA. During 1927, 2 cases of Puerperal Fever were notified and removed to hospital. 15 cases of Puerperal Pyrexia were notified, 5 of them being removed to hospital. 3 of the hospital cases proved fatal. MALARIA. 5 cases were notified of persons residing in this district suffering from Malaria. All these persons had contracted the ailment abroad. ENTERIC FEVER. 3 cases of Enteric Fever were notified during the year. There were no deaths from this disease. 29 POLIOMYELITIS. 4 cases were notified during the year. 2 of them proved fatal. CEREBRO-SPINAL MENINGITIS. 2 cases of Cerebro-Spinal Meningitis were notified. One of these was fatal and another death was certified as being due to this cause. POLIO-ENCEPHALITIS & ENCEPHALITIS LETHARGICA. There was 1 notified case of the former and 7 of the latter disease. The case notified as Polio Encephatitis died, the death certificate giving the cause as Poliomyelitis. None of the notified cases of Encephalitis Lethargica died. There were 2 deaths, however, in outside Institutions of Tottenham persons from this cause. EPIDEMIC CATARRHAL JAUNDICE. At the end of 1926 the occasional occurrence of jaundice amongst the children attending the School Clinics was observed. This was specially noticeable amongst children attending the Infants' Department of a particular school. The cases were limited to two classes. Two of the patients resided near one another and were often together out of school hours. In neither of these cases were other members of the family affected. In 1927 however, two instances of this disease came under notice in which families were affected. Particulars of these are as follows:— J. M. aet 7. Came under notice 6-4-27 with jaundice—claycoloured1 motions and dark urine. He had then been ill 3 days. On the first day he vomited and complained of abdominal pain (which lasted 3 days), headache, and was feverish. Jaundice appeared on the second day; seen again April 13th—jaundice still present and Otorrhcea on R. side. April 27th, all symptoms of jaundice gone—Otorrhcea was still present 11-5-27. 30 M. M. aet 5. Symptoms same as those of J.M., except that there was no Otorrhoea and the cervical glands were considerably enlarged at time of onset—April 19th. Last seen 4th May—all symptoms subsided. L. M. aet 6. Symptoms as in the case of M.M. Jaundice, etc., first noted April 23rd. Last seen May 4th—all symptoms subsided. D. M. aet 3. First seen May 9th, 1927. Onset May 7th, 1927, with headache, fever and cervical glands enlarged and tender. Vomited during the night and following day. Jaundice symptoms as in previous cases; abdominal pains for 3 days. 11-5-27, Icterus less marked— T.99:2, pulse 114. Had Otorrhoea since 1-5-27. 16-5-27, Icterus disappearing, urine and motions almost normal; Adenitis and Otorrhæa present. Another child in the family, aet 1½ years, was not affected. The house occupied by the family is clean and in good sanitary condition. Food stored in a cupboard for lack of a larder. No rats in the house but a good many mice. All water and milk consumed by the children boiled. Specimens of blood examined by a Pathologist threw no light upon the cause of the disease. D. C. aet 6. August 21st, jaundice and vomiting. All symptoms subsided at end of one week. H.C. aet 7. Sickened August 26th with headache, severe vomiting and jaundice. Three weeks later symptoms had disappeared. Mrs. R.C., 26 yrs. Onset September 18th with rigor, headache, vomiting, followed by jaundice—complaint also of vertigo. Patient was suckling infant of 6 months during the 3 weeks of her illness. The child remained in good health. Billy C. 4. This child was observed to be jaundiced 3 weeks after the onset of the mother's illness, but was not ill. Clay-coloured stools and bile-pigmented urine were common to all 4 cases. The water consumed was from the M.W.B. main. Investigations with regard to the presence of rats on the premises met with negative result. No other persons residing in the vicinity of the C. family were reported to be suffering from similar symptoms. All the evidence in both series of cases points to the infection having been conveyed from person to person. 31 ERYSIPELAS. 46 cases of Erysipelas occurred during the period under review, 8 of them being removed to hospital. There were no deaths 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 1207. 32 TUBERCULOSIS. Age Periods. New Cases. Deaths. Pulmonary. NonPulmonary. Pulmonary. NonPulmonary. Males Females Males Females Males Females Males Females Under 1 year ... ... ... 1 ... ... - 1 1 to 5 years 4 2 1 3 ... 1 1 5 5 to 10 „ 2 2 7 3 ... ... 2 2 10 to 15 „ 5 2 5 4 ... 1 2 ... 15 to 20 „ 15 16 2 4 3 8 1 1 20 to 25 ,, 15 10 4 1 14 6 ... ... 25 to 35 „ 26 26 1 3 16 25 ... 2 35 to 45 „ 31 15 3 ... 18 4 ... ... 45 to 55 ,, 12 6 1 2 19 5 1 ... 55 to 65 ,, 9 5 3 1 2 7 2 ... 65 and over 1 ... ... ... 2 1 ... ... Totals 120 84 27 22 74 58 9 11 Organs Affected (New Cases):— Males. Females. Lungs 120 84 Meninges 3 3 Kidney 2 Shoulder - 1 Spine 3 2 Wrist 1 - Thigh 1 - Foot - 1 Ankle 1 1 Hip 4 2 Knee - 1 Peritoneum 1 - Abdomen 1 1 Other 10 10 147 106 33 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 Asyl|ums Board, Southgate and London Fever 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:— 34 MOTOR AMBULANCE SERVICE, 1927. Months No. of Cases Mileage. Receipts. Surgical Children From Cases. From T.E.C. £ s. d. £ s. d. January 560 1,479 4,687 9 3 9 112 8 0 February 486 2,233 5,093 10 5 0 151 3 0 March 634 2,567 6,095 13 19 0 173 8 0 April 567 1,300 4,202 13 10 9 94 2 0 May 676 2,338 6,206 12 12 3 178 8 0 June 566 1,883 4,845 8 5 0 132 13 0 July 638 1,846 4,989 9 10 3 135 6 0 August 509 498 3,257 10 7 6 40 11 0 September 550 2,552 5,947 12 0 0 175 5 0 October 573 2,072 5,236 9 15 6 146 0 0 November 710 2,323 5,896 12 5 0 166 16 0 December 684 1,530 4,701 7 9 0 113 19 0 Year's Totals 7,153 22,621 61,154 129 3 0 1,619 19 0 29,774 £1,749 2 6 Treasurer's Dept. . £173 15 0 £1,922 17 6 Total Cases from 1915 to Date: Total Mileage to Date: 131,931. 370,483. The Ambulances are equipped with Oxygen apparatus, which have been in use on 7 occasions during 1927. LABORATORY. At the Town Hall Laboratory, 3,618 swabs from the throats or nose; of persons in contact with sufferers from Diphtheria, or themselves supposed to be suffering from Diphtheria, and 287 specimens of sputum from persons suspected to be suffering from Consumption, have been examined during the year. Of the swabs, 505 were positive, and of the sputa, 46 specimens. Other bacteriological and serological examinations are made by arrangement with the Prince of Wales's Hospital. 35 CLINICS AND TREATMENT CENTRES. Name and Situation. Nature of Accommodation. By whom Provided. Infant Welfare Clinic, "The Chestnuts," St. Ann's Road, N. 15 Consulting Room, Weighing Room, Waiting and Stock Room, Pram Room. Tottenham Maternity and Child Welfare Committee. Infant Welfare Clinic, Bruce Castle, Lordship Lane, N.17 Consulting Room, Weighing Room, Waiting and Stock Room, Pram Room. Do. Infant Welfare Clinic, Town Hall, N.15 Weighing Room and Waiting Room. Do. Maternity Clinic, "The Chestnuts." Consulting Room, Dressing Room, Waiting Room, Dining Room. Do. Maternity Clinic, Bruce Castle. Consulting Room, Dressing Room, Waiting Room, Do. Day Nursery, 240, St. Ann's Road. Receiving Room, Dining Room, and Nursery for Toddlers; 2 Nurseries for Infants; Isolation Room; Shelter in Garden. Do. Minor Ailments Clinic, Town Hall. Consulting and Treatment Room and Waiting Room. Tottenham Education Committee. Minor Ailments Clinic, Bruce Castle. Consulting Room, Treatment Room and Waiting Room. Do. Dental Clinic, Bruce Castle. Surgery, Recovery Room, and two Waiting Rooms. Do. Dental Clinic, "The Chestnuts." Surgery, Recovery Room, and Waiting Room. Do. Eye Clinic, Bruce Castle. Dark Room, Treatment, Fitting and Waiting Rms. Do. Ear Clinic, Bruce Castle. Treatment Room and Waiting Room. Do. Spray Bath Clinic, Town Hall. Bath Room and Waiting Room. Do. Tuberculosis Dispensary, 140, West Green Road, N. 15. Consulting Room, Dressing Room, Waiting Room, Laboratory, Office. Middlesex County Council Venereal Diseases Clinic, Prince of Wales's Hospital, N. 15. Two Consulting Rooms, Two Treatment Rooms, Two Waiting Rooms, and Laboratory. Do. 36 PROFESSIONAL NURSING IN THE HOME. In September, the Tottenham Branch of the Nursing Association was re-established. In the period that elapsed between the date of the appointment of the Nurses and the end of the year, 286 visits were paid by them on behalf of the Council to patients suffering from Influenzal or Primary Pneumonia, or Measles. The cost to the Council was £19 1s. 4d. The rate per visit is 1/4 in respect of the first member of a family and 1/- per visit in respect of the second and subsequent cases. Prior to the institution of the Tottenham Branch of the Association, the nursing in the homes was carried out under the same arrangement as that noted in last year's report. HEALTH WEEK. Health Week was observed by the writing of Essays by school children. The following subjects were set:—"The Use and Abuse of the Pocket Handkerchief"; "The Use and Abuse of Drains"; "Diphtheria; "Mouth Breathing"; "Eye Strain". Special lessons were given in the Schools, and approximately 13,000 Essays were written. 48 prizes were distributed at a Public Gathering at the Municipal Hall, on November 25th, and among the items upon the programme were Singing, Displays of Physical Exercises and Eurhythmies by the school children. 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 1927, 33 examinations were made by your Medical Officer. 37 STATUTES, BYE-LAWS. ETC., ADMINISTERED BY HEALTH DEPARTMENT. The Health Department is mainly concerned with carrying out the provisions of the following Acts, Bye-laws, Orders and Regulations. From time to time the Ministry of Health issue circulars relating to matters of outstanding importance, e.g., Cholera, Small Pox, Cerebrospinal Meningitis, Diarrhoea, Anthrax, Rabies, etc. These circulars are not enumerated in the following list:— Public Health Act, 1875. 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 Antitoxin (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. 38 Fabrics (Misdescription) 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. 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. Public Health (Infectious Diseases) Regulations, 1927. 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. 39 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.) †OtherShops Wednesday, 1 p.m. Thursday, 1 p.m. (non-exempted (or alternatively trades). Saturday, 1 p.m.) (or alternatively Saturday, 1 p.m.) EVENING CLOSING HOURS. *Butchers Monday 1 p.m. Tuesday, Wednesday and Thursday 7 p.m. Friday and Saturday 8 p.m. Confectioners Monday, Tuesday, Wednesday, Thursday and Friday 9.30 p.m. Saturday 10 p.m. Sunday 8 p.m. †Other Shops Monday, Tuesday, Wednesday, (non-exempted trades) Thursday and Friday 8 p.m. Saturday 9 p.m. Sunday 8 p.m. (subject to weekly half-holiday Order). Refreshments Special Licences 10 p.m. and 11 p.m. (consumed on premises) Exempted trades No closing hour. (newly-cooked provisions, etc.) 40 LEGAL PROCEEDINGS. Date Name Nature of Case Result March W. Gudgeon, 288 Hertford Rd., Edmonton Trading in Street after closing hour Fined 10s. June F. West. 51 West Green Road Servingin Shop after closing hour. Fined £5 „ T. Dakin, 774 Seven Sisters Rd do. Fined 20s. September B. Butcher, 282 Philip Lane Failure to give half-holiday to Assistants Fined 5s. « WATER SUPPLY. The Tottenham water supply is from the Metropolitan Water Board's mains, with the exception of premises in White Hart Lane, supplied from a shallow well. PUBLIC SWIMMING BATHS—CONSTANT FILTRATION. At the Central Baths a constant filtration plant was introduced at the beginning of the Season which has caused the baths to become more popular; the water is constantly clear, notwithstanding the large number of bathers. The Superintendent intimates that the installation has been a great success, both from the financial and hygienic point of view. 41 GENERAL SANITARY WORK. Hereunder is specified in tabular form the inspections by the Sanitary Officers during 1927, and the nature of the defects discovered:— Mr Redston (Green Lanes and Part Chestnuts) Mr. West (West Green) Mr. Smith (part Chestnuts and part Stamford Hill) Mr. Portman (Town Hall and part Stamford Hill) Mr. Miller and Mr. Bennett (Bruce Grove & Sigh. and part Park & Col.) Mr. Shillito (W. H. Lane and part Park and Col.) House to house inspections 153 252 291 171 228 367 Re-inspections 1283 1225 1154 1090 1422 1544 Drains examined, tested, etc 59 56 176 91 97 97 Drains unstopped 28 42 29 25 21 153 Drains re-constructed & repaired 15 17 47 24 27 41 Soil pipes and drains ventilated ... 5 39 35 58 38 R.W. pipes, wastes, etc., repaired 74 29 66 85 32 39 Dust bins provided 35 42 60 34 41 58 Roofs repaired 121 79 147 73 42 104 Gutters repaired and renewed 97 49 94 48 37 68 Cisterns cleaned, repaired, etc. 21 9 23 25 11 15 W.C. repaired, cleaned, etc. 54 66 93 53 39 194 Yards paved and drained 31 61 61 42 62 43 Premises cleaned, etc. 196 185 301 304 205 698 Defective floors 27 39 103 28 35 91 Defective window frames and sashes 51 23 96 31 50 224 Defective coppers 21 28 41 18 5 36 Defective fireplaces 32 47 97 16 4 56 Other defects 97 109 170 58 81 95 Smoke observations 44 29 32 23 20 8 Accumulations of refuse 27 7 16 4 3 12 Visits in connection with cases of infectious disease (including Tuberculosis) 174 147 163 169 160 231 Rooms inspected after disinfection 42 69 101 121 93 80 Other inspections 81 94 311 129 65 93 Factories, No. of inspections 57 60 31 9 12 41 Workshops & workplaces „ 35 85 37 15 21 72 Laundries ,, 11 15 3 2 ... ... Dairies, etc. „ 61 46 44 21 31 39 Cowsheds „ ... ... ... 3 ... ... Bakehouses „ 25 37 46 18 30 40 P.H. urinals „ 114 49 27 60 54 ... Stables and Mews ,, 51 70 50 18 56 ... Complaints investigated 89 175 421 250 95 154 Appointments 75 125 180 13 45 School inspections ... ... 4 6 ... ... Pawnbrokers 3 ... ... ... ... 4 Common Lodging Houses ... ... ... 19 ... 39 Slaughterhouses ... 102 44 79 ... 62 Knackers Yards ... ... ... 52 ... ... Brooks and Watercourses 4 ... 2 8 10 ... Butchers' shops 91 71 56 182 36 86 Fishmongers' shops 77 56 29 44 28 97 Fruiterers' shops 90 35 27 22 26 Ice Cream premises 4 13 8 ... ... 10 42 SANITARY WORK CARRIED OUT BY FEMALE SANITARY INSPECTOR. Visits to Outworkers' Premises 774 ,, Workshops 80 „ Laundries 6 ,, Factories 3 Complaints Investigated 78 Miscellaneous Visits 7 Re-inspections 347 Swabs Taken 1,543 S. F. Contacts Examined 371 FACTORY AND WORKSHOP ACT, 1901. In compliance with section 132, I have to submit a resume of the work effected during the year—under the provisions of the above Act—in the form prescribed by the Home Office:— 1.—Inspection of Factories, Workshops and Workplaces. Inspections made by Sanitary Inspectors. Premises Number of Inspections Written Notices Prosecutions Factories (including Factory Laundries) 232 54 ... Workshops (including Workshop Laundries) 373 Workplaces (other than outworkers' premises included in Part 3 of this Report). Total 605 54 ... 43 2.—Defects Found. Particulars Number of Defects Number of Prosecutions Found Remedied Referred to H.M. Inspector Nuisances under the Public Health Acts*— Want of Cleanliness 44 44 ... ... Want of ventilation 1 1 ... ... Overcrowding ... ... ... ... Want of drainage of floors 3 3 ... ... Other nuisances 2 2 ... ... Sanitary accommodation insufficient 6 6 ... ... unsuitable or defective 10 10 ... ... not separate for sexes 1 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 67 67 ... ... *Including those specified in sections 2, 3, 7 and 8, of the Factory and Workshop Act as remediable under the Public Health Acts. 44 3.—Home Work. OUTWORKERS' LISTS, SECTION 107 Number of Inspections of Outworkers' Premises Outwork in Unwholesome Premises, Section 108 Outwork in Infected Premises, Sections 109, 110 Nature of Work Lists received from Employers Number of Addresses of Outworkers received from other Councils Number of Addresses of Outworkers forwarded to other Councils Prosecutions Twice in the year Once in the year Falling to keep or permit inspection of Lists Failing to send Lists Instances Notices served Prosecutions Instances Orders made(Sec. l09) Prosecutions (Secs. 109, 110) Total Lists Outworkers Total Lists Outworkers 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 Wearing Apparel 36 205 3 24 451 78 ... ... 564 ... ... ... ... ... ... Boots and Shoes 8 32 ... ... 23 19 ... ... 36 ... ... ... ... ... ... Stationery 4 6 ... ... 2 ... ... ... 8 ... ... ... ... ... ... Cardboard, etc., Boxes 4 26 ... ... 8 7 ... ... 27 ... ... ... ... ... ... Brushes 2 2 ... ... 6 1 ... ... 7 ... ... ... ... ... ... Smallware 2 2 ... ... ... 1 ... ... 1 ... ... ... ... ... ... Knitted Goods ... ... ... ... 8 ... ... ... 8 ...... ... ... ... ... ... Furs 2 4 ... ... 13 ... ... ... 17 ... ... ... ... ... ... Umbrellas ... ... ... ... 4 ... ... ... 4 ... ... ... ... ... ... Fancy Goods 2 20 ... ... 9 2 ... ... 27 ... ... ... ... ... ... Artificial Flowers ... ... ... ... 2 ... ... ... 2 ... ... ... ... ... ... Lace Papers &Xmas Crackers 2 65 ... ... 7 37 ... ... 35 ... ... ... ... ... ... Leather Goods ... ... ... ... 4 ... ... ... 4 ... ... ... ... ... ... Needlework ... ... ... ... 14 ... ... ... 14 ... ... ... ... ... ... Lace Goods ... ... ... ... 12 ... ... ... 12 ... ... ... ... ... ... Hair Goods 2 7 ... ... ... ... ... ... 7 ... ... ... ... ... ... Feathers ... ... ... ... 1 ... ... ... 1 ... ... ... ... ... ... Totals 64 369 3 24 564 145 ... ... 774 ... ... ... ... ... ... 45 4.—Registered Workshops. Workshops on the Register (s. 131) at the end of the year Number Workshops 178 Laundries 22 Bakehouses 57 Total number of Workshops on Register 257 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) 2 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 17 Reports (of action taken) sent to H.M. Inspector 17 Other ... Underground Bakehouses (s. 101):— Certificates granted during the year ... In use at the end of the year 4 Note.—The Factory and Workshop Act, 1901 (s. 132), requires the Medical Officer of Health in his Annual Report to the District Council to report specifically on the administration of that Act in workshops and workplaces, and to send a copy of his Annual Report, or so much of it as deals with this subject, to the Secretary of State (Home Office). 46 UNSOUND FOOD. The Sanitary Inspectors have seized or had brought to them for condemnation the following articles:— Meat:— Fish:— 2 Pigs. 14 boxes Kippers. 56 lbs. Pork. 3 trunks Cod. 8 Pigs' Heads. 1 barrel, 1 box and 6 Ox Livers. 14 stone Skate. 88 lbs. Beef. 1 box Hake 1 leg and 16 lbs. Mutton. 4 boxes Fish Roes. 1 trunk Haddock. case Norway Herrings. 6 bags Winkles. 1 bag Whelks. 28 lbs. Rock Salmon. Fruit and Vegetables:— 73 boxes Tomatoes. 4 boxes and 22 lbs. Apples. 3 boxes Pears. 64 baskets Strawberries. 27 baths Peaches. 23 Grape Fruits. 14 bags Walnuts. 10 bags Savoys. 1 box Lettuce. 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 348 11 Milk, Separated 1 — Cream 9 1 Butter 7 — 47 Name of Article Samples Taken Found Adulterated Bacon 1 — Brawn 6 1 Bread 1 — Colouring Matter 1 — Fish Paste 12 — Fruit, dried 3 — Fruit, tinned 1 — Margarine 3 — Meat 15 3 Meat, cooked 4 — Prawns 3 — Preservatives 7 4 Sausages 32 8 Sausages, cooked 19 — Sausage Skins 1 — Seasoning 3 — Soup 1 — Suet 1 — Vegetables, tinned 4 — 483 28 Number of Prosecutions 6 Number of Convictions 6 Fines and Costs imposed £58 3s. 0d. The figures given for adulterated samples include some adulterated informal samples, in respect of which no proceedings could be taken. DISINFECTION AND DISINFESTATION. 1,406 rooms were disinfected. 16,649 articles were disinfected or destroyed. 360 library books were disinfected. 47 persons were bathed. 48 EXHUMATIONS. 2 exhumations 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 32 reports during 1927. 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. 15 applications for registration from retail purveyors of milk were received during the year. These were acceded to. There are at present 111 retail purveyors on the register. 5 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. No action was required to be taken under the Public Health (Prevention of Tuberculosis) Regulations, 1925. 49 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 1927 there were approximately 4,000 names upon the Treasurer's register of persons applying for houses on the Council's Estate. This number increased to 4,500 by the end of March, 1928. New Houses and Tenements erected during the Year. Houses. Flats and Tenements. Lock-up Shops. By private builders (no State assistance) 408 6 2 By the London County Council 290 22 — By the Tottenham Council 248 20 4 946 48 6 Unfit Dwelling Houses. Total number of dwelling-houses inspected for housing defects (under Public Health or Housing Acts) 3,690 Number of dwelling-houses which were inspected and recorded under the Housing Consolidated Regulations, 1925 1,462 Number of dwelling-houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation - Number of dwelling-houses (exclusive of those referred to under the preceding sub-heading) found not to be in all respects reasonably fit for human habitation 2,568 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 2,270 50 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 261 (2) Number of dwelling - houses which were rendered fit— By owners 217 By Local Authority in default of Owners 44 (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 37 (2) Number of dwelling-houses in which defects were remedied— By Owners 32 By Local Authority in default of Owners 5 (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— (2) Number of dwelling-houses in respect of which Closing Orders were made- (3) Number of dwelling-houses in respect of which Closing Orders were determined, the dwelling-houses having been rendered fit 3 (4s) Number of dwelling-houses in respect of which Demolition Orders were made — (5) Number of dwelling-houses demolished in pursuance of Demolition Orders - Tottenham Education Committee ANNUAL REPORT OF THE SCHOOL MEDICAL OFFICER for 1927. MEMBERS OF THE COMMITTEE. Mr. T. INGLIS (Chairman). Mr. E. FROST (Vice-Chairman). Mrs. F. C. BRIGHTEN. Mr. J. BRISTOW. Mrs. H. E. BYERS. Miss R. F. COX. Mr. T. ELDERFIELD. Mrs. E. L. FINCH. Mr. E. C. HARRIS. Mr. A. E. HARVEY. Mr. G. R. S, HOWSON. Mr. A. E. JAY. 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. F. E. SHARLAND. Mr. C. WISE. 2 INTRODUCTION. School Medical Department, Town Hall, Tottenham, March, 1928. To the Chairman and other Members of the Tottenham Education Committee. Ladies and Gentlemen, In this report particular attention is directed to the excellent results of treatment of otorrhæa by ionization. When this treatment was commenced, there were heavy arrears to overtake of cases of long standing resistant to the ordinary methods of treatment. The arrears are wiped out, and patients can be dealt with as they are discovered, without any period of waiting. While they are still in the acute stage, treatment is most effective, a rapid and complete recovery almost invariably resulting. It would be a considerable advantage to the chronic cases could they be retained under our own Ear Specialist for their operative treatment. During the year nothing has occurred to impede the harmonious and efficient working of the School Medical Department. What that has meant to the school population can very inadequately be expressed in terms of tables and script. Health and happiness are neither translatable nor measureable. May I on my own behalf and in the name of the staff express gratification in serving a Committee that so zealously, as does yours, safeguards the welfare of the school children ? I am, Ladies and Gentlemen, Yours faithfully, David b Kirkhore. 3 SCHOOL HYGIENE. The Surveyor has supplied the following statement of improvements and repairs to school premises. IMPROVEMENTS EFFECTED DURING THE YEAR ENDED MARCH, 1928, TO SCHOOL PREMISES, ETC. All Hallows. The provision of a new sliding partition between two classrooms. The redecoration of the interior. Belmont. The installation of a new heating boiler. The installation of a new "Kalor" boiler and domestic hot water supply. Redecoration internally and externally. Chestnuts Dental Clinic. Redecoration internally. Crowland Road. The installation of a new heating boiler. Culvert Road. The installation of a "Kalor" boiler and domestic hot water supply. Redecoration internally and externally. Coleraine Park. The installation of an improved method of artificial lighting. The formation of a new stock room. The provision of new pans and alteration of water supply to Boys' latrines and urinals. The provision of new pans and alteration of water supply to Boys' (Infants) latrines and urinals and Girls' (Infants) W.C.'s. Repairing and redressing of playgrounds. Downhills (Junior). The installation of a " Kalor " boiler and domestic hot water supply. 4 Downhills (Girls'). The provision of an additional exit from cloak room. Lancasterian. Improved method of artificial lighting. Repairing and redressing of Boys', Girls' and Infants playgrounds. Middle Class (New). The provision of entirely new furniture—made in the Committee's workshops. Orchard House. The provision and erection of a marquee for Open Air Class. Parkhurst Road. Redecoration internally and externally. Page Green. The formation of a new stock room. The provision of new pans and alterations of water supply to Boys (Infants) latrines. Stamford Hill (Infants). The removal of partition between two classrooms. Stamford Hill (Girls'). The re-division of three classrooms by the provision of two new partitions. The removal of the galleries in three classrooms and the levelling of floors. Seven Sisters (Boys' and Girls'). The provision of new pans and alteration of water supply to latrines. 5 St. Ann's (Boys'). Redecorations internally. St. Ann's (Infants'). The laying of a new solid floor in one classroom. St. Ignatius. The installation of a new heating boiler. Improved method of artificial lighting. St. Francis de Sales. Improved method of artificial lighting. Relaying playground. St. Katharine's. Redecorations internally. Redressing playground. Woodlands (Infants'). The installation of a new heating toiler. Improvements to heating of two classrooms. Woodlands (Boys' and Girls'). Re-arrangement of two large classrooms in each department in order to form three by the erection of new sliding partitions. The provision of top lighting to the middle room in the Boys' Department. Alterations to the heating of three classrooms in each department. 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, cupboards, remedial forms, needlework boxes, All blackboards requiring repairs have been repaired or renovated. 6 MEDICAL INSPECTION. The record of inspections, general and special, and the action arising thereout, including following-up and treatment, have been tabulated and are to be found on pages 25—32. INFECTIOUS DISEASE. The following infectious diseases amongst school children have been notified with the frequency stated. Scarlet Fever 308 Diphtheria 234 Erysipelas 1 Pneumonia 36 Encephalitis Lethargica 2 Poliomyelitis 1 T uberculosis—pulmonary 11 Tuberculosis—non-pulmonary 19 Voluntary Notifications.—Teachers, attendance officers, and others gave intimation of the occurrence of the following diseases:- Measles 158 Sore Throat 20 German Measles 35 T uberculosis 3 Mumps 693 Influenza 105 Whooping Cough 274 Eye Disease 9 Chicken Pox 228 Ringworm of Head 19 Scarlet Fever 112 Ringworm of Body 7 Diphtheria 116 Sores and Eczema 46 Scabies 9 Impetigo 21 Skin Disease 6 Rheumatism 3 Tonsilitis 13 Otorrhoea 7 Chorea 5 Children excluded owing to Infectious Disease in house 285 Pneumonia 2 Colds 6 Rash 5 Other Diseases 75 These cases were excluded from school so long as they were deemed to be in an infectious condition. 7 Bacteriological Examinations:—1945 Swabs were taken from children discharged from Hospital after diphtheria, and from home and school contacts. As the result of examination, 215 were found to carry diphtheria germs, 1,730 did not show such evidence, whilst 52 had germs similar to, but not identical with, diphtheria germs. Microscopical Examinations.—6 specimens of hairs were found to contain spores of ringworm out of 19 examined. Ringworm is a disease whose incidence has been greatly reduced by the application of X-Rays. But for the migratory character of our population, it could be extinguished immediately. FOLLOWING-UP. Visits by School Nurses numbered 5,694. These visits were to children absent from school on account of illnesses notified from the school, or because of failure to keep appointments at one or other of the treatment clinics. Children upon whom operations have been performed were also followed-up at home until they were fit to return to school. MEDICAL TREATMENT. Tonsils and Adenoids.—The North Middlesex Hospital and the Prince of Wales's Hospital undertake, for payment, the operative treatment of children found to be suffering from enlarged tonsils and hypertrophy of post-nasal adenoid tissue. Operations numbered 659 during the year. They were all successful. The operations are conducted under chloroform and ether anaesthesia, so that they may be deliberate and thorough. 8 Dr. Friel has furnished the following table and report in relation to Otorrhæa cases dealt with at the Aural Clinic:— Cause of Suppuration. Total Cured. Lost sight of. Still under treatment . Needing hospital Acute Suppurative Otitis Media 92 85 1 5 1 Chronic Suppurative Otitis Media, due to 1. Tympanic Conditions:— (a) Tympanic Sepsis 46 44 1 1 — (b) T.S. and Granulations 7 4 2 1 - (e) T.S. and Polypus 7 3 1 3 — 2. Tympanic Conditions, plus (a) Pharyngitis 1 1 - — — (b) Rhinitis 3 2 1 — — 3. Tympanic Conditions, plus (a) Attic Disease 14 6 2 3 3 (b) Mastoid Disease 12 3 — 1 8 External Otitis 20 17 2 1 — Cause Undetermined 2 1 1 - — Total 204 166 11 15 12 Percentage 100% 81.3 5.4 7.3 5.8 Four years have been completed since the Clinic for Chronic Otorrhoea was opened at Bruce Castle. THE POLICY followed is to have every case of otorrhæa sent to the clinic as soon as it is possible for the patient to be seen. 9 THE ORGANISATION adopted at the clinic has been designed so as to have the work carried out with as little inconvenience as possible. The co-operation of the mothers is ensured by seeing that their time is not wasted. Appointments are made for each patient—a definite time for a particular date being written on a card and handed to, or sent to, each patient. The patients are called up for examination and treatment in the order of time for which the appointments have been made, and not according to the order in which the patients may choose to come to the clinic. When a parent finds that order is strictly observed she comes at the time arranged. The times are arranged according to the periods required for treatment and to that most convenient to the parent. THE TREATMENT given has been described in previous reports. THE RESULTS. Comparing the statistics of 1924—5, 1926 and 1927 it will be seen that the cases in the first three years were mostly chronic cases. When the clinic was started there was a large accumulation of cases (well over 100) of chronic otorrhoea. It took more than two years to work through these and the fresh cases that were continually being added, until there was no waiting list. Very few cases of acute otorrhoea were treated during this time. Gradually the accumulation of chronic cases was worked off and it became possible to deal with cases of acute otorrhæa as they arose. There is now no waiting list and any case of acute otorrhæa can be seen and treated as soon as notified, thus:— Year. Number of ears treated. Number acute. 1924-25 213 6 1926 181 27 1927 204 92 The importance of seeing cases of otorrhæa when they are in the acute stage is that they can then be easily and quickly cured. The clinic is a unit in which a definite policy is followed; where an organisation is strictly adhered to; and where treatment (including zinc ionization if necessary) is given according to the condition present in each patient. Mr. Cohen has a clear idea of the organisation, and Nurse Lindsay has helped both the patients and myself. 10 OPEN-AIR EDUCATION. The Director of Education has kindly furnished the following statement respecting Open-Air Education, Physical Training and Provision of Meals:— (a) Playground Classes. Open-air shelters have continued in use at Page Green, Stamford Hill, and other schools. Owing to unsuitable weather it was not possible to make use of the playgrounds for class purposes to the extent desired. (b) School Journeys. For the year 1927, expenditure not exceeding £160 in aid of School Journeys was agreed to by the Education Committee and sanctioned by the Board of Education. The following grants were made to schools which undertook journeys:— £ Crowland Road Boys School 35 Down Lane Girls' Central School 60 Risley Avenue Boys' Central School 30 St. Paul's Girls' School 35 £160 The Committee first gave assistance to School Journeys in 1920. Since that time they have made the following grants:— 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 1927 160 160 £1,605 £1,423/10 11 The following are brief particulars of School Journeys carried out in 1927 1. CROWLAND ROAD BOYS' SCHOOL. This School organised for the first time a very successful journey to Niton, Isle of Wight, where 30 boys stayed for a fortnight (May 25th—June 8th). Visits were paid to St. Catharine's Lighthouse, Blackgang Chine, Newport and Carisbrooke Castle, Freshwater and the Needles, Ventnor and' Shanklin, Portsmouth Dockyard. The total cost was £79 12s., of which the Committee contributed £35. 2. DOWN LANE CENTRAL SCHOOL FOR GIRLS. Eighty-five girls, in two parties, spent a week at Tankerton, near Whitstable. The journey was made by road and the programme included motorcoach excursions to Canterbury, Dover, Deal, and Sandwich. The total cost was £201 15s. 3d., towards which the Committee contributed £60. 3. RISLEY AVENUE CENTRAL SCHOOL FOR BOYS. Twenty-two boys spent a week at the Rockland Boarding House, Swanage, from May 2nd—9th. They travelled by rail from Waterloo Station to which they were conveyed by char-a-bane. The usual excursions to neighbouring places of interest were successfully carried out. The total cost of the journey was £61 15s. 3d., of which £30 was paid by the Committee, 12 4. ST. PAUL'S GIRLS' SCHOOL. Thirty girls spent a fortnight at Folkestone in June. Excursions were made to Canterbury, Dover, Deal, and other places in the neighbourhood, the programme being similar to that of former visits made by girls from this school. The total cost of the journey was £82 11s. 10d., and the grant from the Committee was £35. It may be mentioned that, in connection with every school journey, a programme of study is prepared and this is submitted to the Board's Inspector for his approval. He also receives a report on the journey and sees the scholars' note books. (c) School Camps. No School Camps were held in 1927. (d) Open-Air Classrooms in Public Elementary Schools. The proposed additional department at Devonshire Hill, mentioned in last year's Report, is now in course of erection and is expected to be ready for occupation by October, 1928. It is planned on similar lines to those of the two existing departments, but modifications in the form of the movable portions of the walls are being made to avoid some disadvantages arising from the form previously adopted. (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 1927 with results that were quite good in spite of the bad weather experienced. The facilities provided for the Open-Air Class which has for several years been held at Orchard House, Park Lane, have been extended by the provision of a marquee, so placed as to receive the maximum amount of air and sunlight. The use of this, with the existing shelter, has made it possible for the class to remain at Orchard House throughout the year. 13 The proposed Open-Air School has not yet teen established. A suitable site has been obtained near a proposed large Recreation Ground and a site reserved for a School playing field. The site is at present under cultivation as allotments, but it is hoped that possession will be secured in a short time when the building of the School will be commenced. PHYSICAL TRAINING. Physical Training continues to receive full attention in the Schools. In addition to courses of instruction based on the Board's syllabus, Folk Dancing, Eurhythmies and other exercises are taught. The arrangements for Remedial Exercises for children selected by the Medical Staff remain as in former years. Organised Games are a regular part of the curriculum of the Schools. Valuable assistance is given by the District Council, who give facilities for the use of public parks and recreation grounds in and out of school hours. The Council has now provided a number of netball courts in the parks. These will be a valuable addition to the courts marked out in school playgrounds. The School Sports' Association, which organised Cricket, Football, Netball and Swimming, out of school hours, has again done most useful work. The Sports' Days of individual schools and the combined Sports Meeting were again most successful. Mora than 2,000 Swimming Certificates were awarded to scholars during the year. PROVISION OF MEALS. During the year 1927-28, 147,939 dinners were provided. Most of these were supplied frse to the children of parents whose family income fell below a fixed limit. Dinners were also provided at, or under cost, (according to circumstances) to pupils of Down Lane Central School who live at a distance from the School. In April, 1927, a new Meals Centre was opened at Culvert Road School. This is attended by pupils from Culvert Road, Seven Sisters, Stamford Hill, Vale Road, and St. Ann's Schools, who have dined in 14 recent years at neighbouring restaurants. The new Centre has worked admirably and has enabled children to receive good food under conditions which could not be expected at a public eating-house. The menus of the meals supplied are similar to those detailed in last year's report. REMEDIAL DRILL. In most girls' departments there is a special class for postural deformities. A school teacher who has special aptitude for this kind of work conducts the class. The schools are visited, in rotation, by a part-time remedial drill mistress. In addition to the suupervision by the latter, the school medical officer devotes one session a week to the reexamination of the children attending the class and to searching for others in need of remedial drill. Cases dealt with during year 1,828 Special examinations of new cases 1,250 New cases referred for treatment 216 The defects discovered in connection with these new cases are as follows:— Curvatures 72 Rickets 4 Other deformities 140 Number of cases cured during year 153 CO-OPERATION OF PARENTS, TEACHERS AND ATTENDANCE OFFICERS. Parents are invited to attend at the medical and dental inspections. Infants are usually accompanied by one or other parent. The attendance of parents with older children is not so general. Intimation of the occurrence of any defects requiring attention is sent to the parent who is advised to seek the aid of the private practitioner. Teachers and attendance officers assist the medical department in every way possible. Upon mutual co-operation depends the efficacy of the School Medical Services. 15 Head teachers are usually quite ready to put their private rooms at the disposal of the medical officers for the medical inspections, and otherwise assist the health department in making the examinations as comfortable and effective as possible. In not a few schools the head teacher sits with the medical officer throughout the inspections and learns the nature of the defects discovered and the degjree of urgency for their remedy. The medical officers welcome this co-operation and interest. CO-OPERATION WITH VOLUNTARY BODIES. The Education Committee have working arrangements with the Prince of Wales's General Hospital, a voluntary hospital situated in Tottenham, for the treatment of indoor and outdoor patients, as well as for consultations. During the past year there has been re-established in Tottenham a branch of the Queen Alexandra Nursing Association. There are five nurses on the staff available for illnesses requiring skilled nursing. Through the Invalid Children's Aid Association, treatment is provided for delicate children at Convalescent Homes. When the condition for which treatment is sought is likely to be of considerable duration, a place is found in one of those Institutions approved for the purposes of Education. The Education Committee contribute to the cost of surgical appliances, supplied through the agency of the Invalid Children's Aid Association, for children of school age. Convalescent Home Treatment.—During the year, 370 children were sent away for varying periods, namely:— No. of weeks 1 2 3 4 5 6 7 8 9 10 11 12 No. of Children 8 16 27 99 56 55 17 28 15 15 7 7 No. of weeks 13 14 15 16 17 18 20 25 27 30 37 — No. of Children 5 5 2 1 1 1 1 1 2 1 1 — In 28 of these cases, the treatment has been continued into 1928. 16 The following table gives the conditions on account of which children received convalescent treatment:— Nervous Debility 7 Tuberculosis:— Pre-tubercular Debility 20 Hip 1 Debility aft. Infectious Disease 15 Knee 1 Post-operative Debility 22 Chorea 35 Post-Pneumonic Debility 9 Enlargement of Glands 12 Post-Influenza Debility 7 Rheumatism 16 Anaemia and Debility 44 Tonsilitis 3 General Debility 65 Dyspepsia 6 Heart Affections and Anaemia Bronchitis and Bronchial 5 Paralysis 8 Empyema 1 Catarrh 54 Nephritis 2 Asthma 9 Adenitis 1 Other Non-tubercular Lung Disease 5 Pyrexia 1 Neurasthenia 1 Gastric 4 Other Cases 16 Provision of Surgical Instruments.—Surgical appliances were supplied, and repairs and replacements effected in 341 instances. This was in respect of 98 children who were found to be suffering from the following defects:— Infantile and other forms of Paralysis 30 Tuberculosis:— Hip 7 Knee 2 Spine 2 Flat-foot 15 Poliomylitis 6 Scoliosis 3 Club-feet 3 Other forms of Deformed Feet 7 Amputated Leg 1 Rickety Deformities 6 Other Cases 16 17 BLIND, DEAF, DEFECTIVE AND EPILEPTIC CHILDREN. Residential Schools. There is no Residential School established for defective school children belonging to Tottenham. To meet the need of defective children, for whom residential treatment is necessary, places are found outside the area. These are visited periodically by the Medical Officer. School for the Deaf. There were 60 children on the register at this school at the end of the year, 34 being Tottenham children. These are not all deaf, but are so dull of hearing as to be unable to derive advantage from attendance at ordinary elementary schools. Thus there are 45 children boardied outside the district, in Residential Schools, as follows:— Defects. Residential Institutions.  Mentally Defectives (16 cases). All Souls Special School, Hillingdon. Bigod's Hall, Dunmow, Essex. Allerton Priory, Woolton, Liverpool. Epileptics (7 cases). Chalfont Colony, Buckinghamshire. Liugfield Homes and School. St. Elizabeth's Colony, Much Hadham. Blind and Partially Blind (13 cases). East London Home, Clapton. London School for Blind, Hampstead. Barclay's Blind Institution, Brighton. Physically Defective and Crippled (6 cases). The Victoria Cripple Home, Bournemouth. St. Patrick's Open-Air School, Hayling Island. St. Andrew's Open-Air School, Hayling Island. Shaftesbury Cripple Home, Hastings. Hermitage Art-Craft School, Chailey. St. Michael's Cripple Home, Clacton-on-Sea. Deaf and Dumb (3 cases). St. John's Deaf School, Boston Spa. L.C.C. Special School, Penn. Royal Deaf and Dumb Institution, Margate. 18 Lordship Lane School for Partially Blind Children. Myopic children and others with visual defects necessitating special educational training are received by the Wood Green Authority at the above school. A report from the head teacher, relating to Tottenham children, has been received to the following effect:— Number of admissions:— On the roll 24 children (15 boys, 9 girls). Number admitted since school opened 33 Number left 9 3 allowed to return to elementary schools. 1 learning a trade. 2 in occupations. 1 at home. 1 at Centre in L.C.C. area. 1 lost sight of. Classification of the children:— 12 in the Senior class (10 to 14 years). 12 in the Junior class (5 to 12 years). Standard of Work and Intelligence:— 10 of the 24 are of average intelligence. 6 backward on account of visual defect. 8 definitely dull and backward. Some of these lack good physique and backwardness due partly to absences. The transfer of the school from Noel Park to the present premises is accompanied by marked environmental advantages. School for Physically Defective Children. During the year 77 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:- 19 Infantile Paralysis 25 Congenital Deformities 2 Cerebral Diplegia 7 Fragilitas Ossium 1 Heart Disease (Congenital) 6 Heart Disease (Acquired) 9 Double Congenital Dislocation of Hips 3 Single Congenital Dislocation of Hips 1 Hydrocephalus 1 Tuberculosis:— Spine 8 Knee 6 Hip 8 Oak Lodge Day School for Mentally Defective Children. We are indebted to the Head Teacher of Oak Lodge School for the following statement:— During the past year 43 children from Tottenham have received instruction at the Finchley, Hornsey and Wood Green Joint Special School. This school is at "Oak Lodge," Oak Lane, East Finchley, healthily situated on the Northern Heights, and has about 2 acres of ground attached. The home-like nature of the premises is a great asset to the work of the school in developing the qualities of initiative and self-reliance which are latent, and often overlooked, in the children. A hot meal is provided in the middle of the day, at a cost of 5d. per head, but this is given free in really necessitous cases. It may be mentioned here that children receiving free meals have, on an avlerage, gained 5½-lbs. in weight during the year. Hot milk is also available, at a small charge, during the morning recess. Particular attention is paid to the personal cleanliness and general health of the scholars. Most of them receive a bath once a week, and an attendant is at the school daily to superintend this feature of the work. The school nurse also examines every child each week, and special cases are under the observation of the School Medical Officer on his weekly visits. Minor ailments are treated daily at the Finchley Clinic in Oak Lane. Stress is laid in class-room teaching, upon personal hygiene; and the children have ample opportunity for out-door games, such as football, 20 cricket and badminton. In fine weather all suitable lessons are taken in the garden, and the abundance of fresh air and healthy exercise are responsible for a decided improvement in the physique and mentality of the children. The curriculum consists of the usual three R work, together with many and varied forms of handwork. Interesting crafts, such as leather and pewter work, barbola, gesso and dargeena, chair-caning and basketry are taught in the senior classes. The oldter boys also receive instruction in wood-work and gardening; and in connection with the latter occupation, each boy has his own plot of ground, in which he grows vegetables. On the girls' side of the school, the children are taught cookery, laundry and house-wifery, also every branch of plain and fancy needlework, including the repair and renovation of garments and simple dress-making. "Oak Lodge scholars have taken prizes for hand-work in open competition with children from normal schools in the Northern Metropolitan area. Drill and country dancing are also taught, and are greatly enjoyed by the children. Another interesting feature is the school library, which helps to inculcate a love of reading as a leisure occupation. Every opportunity is taken to interest the children, not only in their immediate environment, but in the greater world outside, and with a view to this, school journeys are taken to places of interest, such as the Natural History Museum at South Kensington, Westminster Abbey, and the Zoological Gardens, and such visits do much towards raising the standard of intelligence. The majority of the children, on leaving school, become selfsupporting. Many work in shops and factories, also in domestic service, and1 are not only able to obtain situations, but to remain in them for considerable periods. Orchard House Open-Air Class. The Open-Air Class at Orchard House has 35 boys in attendance. A marquee has been provided and this has proved to be a useful addition to the accommodation previously existing there. The boys are selected by the medical officers and are re-examined at frequent intervals. It is satisfactory to state that in practically every case there has been an increase in weight and improvement 21 in physical condition and appearance. In some cases a stay of from 3 to 6 months has been sufficient to enable certain of the boys to return to their ordinary schools. No hardship has resulted from exposure to the changes of temperature or climatic conditions; indeed the reverse has been the case and the boys appeared to enjoy the open-air life. Cod Liver Oil and Malt has been administered and extra milk supplied. Open-Air Classes. Open-Air Classes were held in connection with West Green Girls' School and Page Green Girls' School during the summer months, the former in the handstand situated in Downhills Park and the latter in a specially constructed shelter in the playground of the school. The physical defects from which the pupils in these classes suffered included arrested and threatened phthisis, tuberculosis of the glands, bones and joints, bronchial affections, chorea, anaemia and malnutrition. Notwithstanding the unfavourable conditions due to an inclement summer, the physical condition of the children, with very few exceptions, showed considerable improvement when the classes were disbanded in the month of October. At West Green School Open-Air Class, 18 girls were in attendance and the average increase in weight at the end of 5 months was 2-lbs., 13-ozs. At Page Green Open-Air Class 20 girls were in attendance and here the average gain in weight at the end of the same period was 3-lbs. 2-ozs. Grade "A" milk and cod liver oil and malt were supplied daily to all the pupils in attendance at both classes. 22 SECONDARY SCHOOLS. Table I sets out the number of children, under their separate ages, examined in the secondary schools during the year. Tables II-IV, pages 23-25, 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 1,978 lbs. Parrish's Food Cod Liver Oil Syrupus Fern Iodidi Syupus Calcii Lactophosphatis 1,532 lbs. 1,431 ozs. 3,822 ozs. 3,618 ozs. EXAMINATIONS BY THE MEDICAL OFFICER. 3 children have been medically examined and licensed to take part in entertainments. 1 attendance officer has also been examined. SECONDARY SCHOOLS. Table I.—Number of Pupils inspected 1st January, 1927, to 31st December, 1927. Ages Routine Inspections Total 10 11 12 13 14 15 16 17 18 Boys 1 85 88 32 126 106 20 - - 458 Girls 4 95 100 78 112 115 48 1 2 555 Totals 5 180 188 10 238 212 68 1 2 1013 23 Table II.—Return of Defects found in the course of Medical Inspection in 1927. Routine Inspections Defect or Disease (1) (2) Number referred for Treatment {3}Number requiring to be kept under Observation, but not referred for Treatment. Malnutrition 3 - Uncleanliness:— Head — - Body — - Skin. Ringworm— Head — - Body — - Scabies — - Impetigo 1 - Other Diseases (Non-Tubercular) 14 - Eye. Blepharitis 1 - Conjunctivitis 1 - Keratitis — - Corneal Opacities — - Defective Vision 70 1 Squint 1 - Other Conditions 1 - Ear. Defective Hearing 6 - Otitis Media 7 - Other Ear Diseases — - Nose and Throat. Enlarged Tonsils 19 2 Adenoids — — Enlarged Tonsils and Adenoids 2 - Other Conditions 8 - Enl. Cervical Glands (Non-Tubercular) 3 — Defective Speech 1 — Heart and Circulate. Heart Disease— Organic — 10 Functional — 5 Anaemia 12 — Lungs. Bronchitis and Bronchial Catarrh 4 - Other Non-Tubercular Diseases Pulmonary— 2 - Tuberculosis. Definite — — Suspected — — Non-Pulmonary— - - Glands — — Spine — — Hip — — Other Bones and Joints — — Skin — — Other Forms — — N ervous System. Epilepsy 1 — Chorea 2 — Other Conditions — — Rickets — — Deformities. Spinal Curvature 3 — Other Forms 25 — Other Defects and Diseases 39 - 24 Table IV.—Treatment of Defects of Pupils during 1927. Group I.—Treatment of Minor Ailments. Disease or Defect. Number of Defects Treated, or under Treatment during the Year. Under Local Education Authority's Scheme. Other wise. Total Skin— Ringworm—Head — — — Ringworm—Body — — — Scabies — — — Impetigo — 1 1 Minor Injuries - — — Other Skin Diseases — 9 9 Ear Disease — 6 6 Eye Disease— - - - External and other — 2 2 Miscellaneous - 3 3 Total — 21 21 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) 9 42 - 51 Other Defect or Disease of the Eyes (excluding those recorded in Group I.) - - - - Total 9 42 — 51 Total number of Pupils for whom spectacles were prescribed:— (а) Under the Authority's Scheme 9 (b) Otherwise 40 Total number of Pupils who obtained or received spectacles:— (a) Under the Authority's Scheme 9 (b) Otherwise 40 25 Group III.—Treatment of Defects ok Nose and Throat. Number of Defects. Received Operative Treatment. Received other forms of Treatment. Total Number treated. Under the Authority's Scheme, in Clinic or Hospital. By Private Practitioner or Hospital apart from the Authoritv's Scheme. Total (1) (2) (3) (4) (5) — 11 11 7 18 Group IV.—Dental Defects Number of Pupils who were:— Found to require treatment 149 Actually treated 97 ELEMENTARY SCHOOLS. Table I,—Number of Children Inspected 1st January, 1927, to 31st December, 1927. A.—Routine Medical Inspections. Number of Code Group Inspections— Entrants 2,454 Intermediates 1,667 Leavers 2,535 Total 6,656 Number of other Routine Inspections — B.—Other Inspections. Number of Special Inspections 7,695 Number of Re-Inspections 20,730 Total 28,425 26 Table II. A.—Return of Defects found by Medical Inspection in the Year ended 31st December, 1927. Defect or Disease. Routine Inspections. Special Inspections. No. of Defects. No. of Defects. Requiring Treatment. Requiring to be kept under observation, but not requiring Treatment Requiring Treatment. Requiring to be kept under observation, but not requiring Treatment. (1) (2) (3) (4) (5) Malnutrition 17 18 62 1 Uncleanliness:—(See Table IV., Group V.) Skin Ringworm:— Scalp — — 25 1 Body — 24 — Scabies — — 34 — Impetigo 11 — 697 — Other Diseases (Non-Tuberculous) 21 — 337 1 Eye Blepharitis 11 — 96 — Conjunctivitis 4 — 141 — Keratitis 1 — 26 — Corneal Opacities 1 — 1 — Defective Vision (excluding Squint 372 8 330 - Squint 32 — 105 — Other Conditions 5 — 115 1 Ear Defective Hearing 8 1 37 1 Otitis Media 25 6 243 1 Other Ear Diseases 13 — 116 1 Nose and Throat Enlarged Tonsils only 282 146 213 1 Adenoids only 5 1 15 2 Enlarged Tonsils and Adenoids 203 28 208 7 Other Conditions 12 3 264 — Enl. Cervical Glands (Non-Tuberculous) 5 3 95 2 Defective Speech 1 4 5 5 Teeth—Dental Diseases (See Table IV. Group IV.) Heart & Circulation Heart Disease:— Organic 4 14 20 1 Functional - 58 10 3 Anaemia 17 3 96 2 Lungs Bronchitis and Bronchial Catarrh 35 76 416 1 Other Non-Tubercular Diseases ... 3 1 42 6 Pulmonary:— Tuberculosis Definite — — 6 — Suspected 3 2 17 2 Non-Pulmonary:— Glands 6 1 — — Spine — — 2 1 Hip 1 — 6 — Other Bones and Joints — — 2 — Skin 3 — — — Other Forms — — — — Nervous System Epilepsy — 1 5 3 Chorea 9 5 89 — Other Conditions 5 3 46 17 Deformities Rickets 1 — 9 1 Spinal Curvature 6 1 80 — Other Forms 17 — 177 1 Other defects and diseases 81 29 1889 93 NOTE.—Defects reported in the previous year have not been recorded in this table. 27 Table II.—.continued. B. Number of individual children found at Routine Medical Inspection to Require Treatment (excluding Uncleanliness and Dental Diseases). Group Number of Children Percentage of Children found to require Treatment. Inspected Found to require Treatment (1) (2) (3) (4) Code Groups:— Entrants 2,454 390 15.9 Intermediates 1,667 307 18.4 Leavers 2,535 468 18.4 Total (Code Groups) 6,656 1,155 17.3 Other Routine Inspections — — — 28 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 4 2 6 Attending Public Elementary Schools - - - At other Institutions - - - At no School or Institution (ii.) Suitable for training in a School or Class for the partially blind Attending Certified Schools or Classes for the Blind 18 15 33 Attending Public Elementary Schools At other Institutions — — — At no School or Institution — 1 1 Deaf (including deaf and dumb and partially deaf) (i.) Suitable for training in a School or Class for the totally deaf or deaf and dumb Attending Certified Schools or Classes for the Deaf 15 15 30 Attending Public Elementary Schools At other Institutions — — — At no School or Institution — — — (it.) Suitable fortraining in a School or Class for the partially deaf Attending Certified Schools or Classes for the Deaf 3 4 7 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 Children ... ?n 30 57 Attending Public Elementary Schools 99 42 141 At other Institutions — — — At no School or Institution 25 11 36 Notified to the Local Authority dui ing the year Feebleminded - 2 2 Imbeciles 1 3 4 Idiots — 1 1 Epileptics Suffering from severe epilepsy Attending Certified Special Schools for Epileptics 3 4 7 In Institutions other than Certified Special Schools - - - Attending Public Elementary Schools - - - At no School or Institution 5 2 7 Suffering from epilepsy which is not severe Attending Public Elementary Schools 4 8 12 At no School or Institution — — — 29 TABLE III.—continued. — — — Boys Girls Total Physically Defective Infections pulmonary and glandular tuberculosis At Sanatoria or Sanatorium Schools approved by the Ministry of Health or the Board - 1 1 At other Institutions — — — At no School or Institution 1 3 4 Non-infectious but active pulmonary and glandular tuberculosis At Sanatoria or Sanatorium Schools approved by the Ministry of Health or the Board 5 4 9 At Certified Residential Open Air Schools - - - At Certified Day Open Air Schools — — — At Public Elementary Schools... 2 11 13 At other Institutions — — — At no School or Institution 1 2 3 Delicate children (e.g., pre—or latent tuberculosis, malnutrition.debility, anaemia, etc.) At Certified Residential Open Air Schools 1 1 2 At Certified Day Open Air Schools 35 — 35 At Public Elementary Schools... 105 197 302 At other Institutions 60 44 104 At no School or Institution — 1 1 Active Non-pulmonary tuberculosis At Sanatoria or Hospital Schools approved by the Ministry of Health or the Board 3 3 6 At Public Elementary Schools... 9 6 15 At other Institutions 1 1 2 At no School or Institution 3 2 5 Crippled Children (other than those with active tuberculous disease), e.g., children suffering from paralysis, etc., and including those with severe heart disease At Certified Hospital Schools... At Certified Residential Cripple Schools - 4 4 At Certified Day Cripple Schools 26 26 52 At Public Elementary Schools... 58 70 128* At other Institutions — 1 1 At no School or Institution 2 10 12 *Under the heading "Crippled Children" 7 boys and 17 girls require Special School accommodation. The remaining 51 boys and 53 girls are capable of receiving proper benefit from instruction in the ordinary public elementary schools. 30 Table IV.—Return of Defects Treated during the Year ended 31st December, 1927. TREATMENT TABLE. Group I.—Minor Ailments (excluding Uncleanliness, for which see Group V). Disease or Defect Number of Defects treated, or under treatment during the year. Under the Authority's Scheme Otherwise Total (1) (2) (3) (4) Skin— Ringworm-Scalp 21 5 26 Ringworm-Body 25 — 25 Scabies 35 — 35 Impetigo 703 6 709 Other skin disease 338 17 355 Minor Eye Defects 385 12 397 (External and other, but excluding cases falling in Group II). Minor Ear Defects 397 25 422 Miscellaneous 704 14 718 (e.g. minor injuries, bruises, sores, chilblains, etc.) Total 2,608 79 2,687 31 Group 11.—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) 965 15 11 991 Other Defect or Disease of the Eyes (excluding those recorded in Group I.) 48 — — 48 Total 1,013 15 11 1,039 Total number of children for whom spectacles were prescribed (a) Under the Authority's Scheme 744 (b) Otherwise 25 Total number of children who obtained or received spectacles (а) Under the Authority's Scheme 742 (b) Otherwise 24 Group III.—Treatment of Defects of Nose and Throat. Number of Defects Received Operative Treatment Received other forms of Treatment Total Number treated Under the Authority's Scheme, in Clinic or Hospital By Private Practitoner or Hospital, apart from the Authority's Scheme Total (D (2) (3) (4) (5) 659 42 701 287 988 32 TABLE IV.—continued. Group IV.—Dental Defects. (1) Number of Children who were: — (a) Inspected by the Dentist: Aged : Routine Age Groups 5 1,894 Total. 15,455 6 2,164 7 2,434 8 2,195 9 1,938 10 2,096 11 2,030 12 557 13 115 14 32 Specials 2,358 Grand Total 17,813 (b) Found to require treatment 11,811 (c) Actually treated 5,784 (d) Re-treated during the year as the result of periodical examination 2,003 (2) Half-days devoted to: Inspection 79 Total 810 Treatment 731 (3) Attendances made by children for treatment 7 465 (4) Fillings: Permanent Teeth 1,254 Total 1,711 Temporary Teeth 457 (5) Extractions: Permanent Teeth 1,226 Total 11,045 Temporary Teeth 9,819 (6) Administrations of genera anaesthetics for extractions 1,370 (7) Other operations Permanent Teeth 139 Total 164 Temporary Teeth 25 (8) Regulation cases: 30 Group V7.— Uncleanliness and verminous conditions. (i.) Average number of visits per school made during the year by the School Nurses 20 5 (ii.) Total number of examinations of children in the Schools by School Nurses 137,423 (iii.) Number of individual children found unclean 1,815 (iv.) Number of children cleansed under arrangements made by the Local Education Authority 56 (v.) Number of cases in which legal proceedings were taken: — (a) Under the Education Act, 1921. — (b) Under School Attendance Byelaws — Tottenham Maternity and Child Welfare Committee ANNUAL REPORT FOR THE YEAR 1927 2 LIST OF MEMBERS OF COMMITTEE (1927). Miss R. F. COX (Chairman). Mr. E. S. BROWN (Vice-Chairman). Mrs. C. L. ASHWORTH. Mrs. E. S. BROWN. Mrs. F. C. BRIGHTEN. Mrs. H. BYERS. Mrs. F. W. COX. Mrs. M. DRAWMER. Mrs. E. L. FINCH. Mr. H. FARTHING. Mr. W. FORDYCE. Mr. C. D. GRANT. Mrs. A. KITCHENER. Maior P. B. MALONE, M.P.. J.P. Mr. L. G. MORRELL. Miss L. B. PRESCOTT. Mr. A. REED, A.F.I. Mrs. S. E. SANDERS. Mrs. M. H. TIMMS. Mr. S. TIMMS. 3 Infant Welfare and Maternity Centres BRUCE CASTLE, BRUCE CASTLE PARK. INFANT WELFARE CLINICS. * Monday Afternoon at 2 o'clock Tuesday Afternoon at 2 „ Wednesday Afternoon at 2 „ *Thursday Morning at 9,30 MATERNITY CLINICS FOR EXPECTANT MOTHERS. *Tuesday Morning at 9.30 *Thursday Afternoon at 2 o'clock THE CHESTNUTS, THE CHESTNUTS PARK. INFANT WELFARE CLINICS. Tuesday Afternoon at 2 o'clock *Wednesday Morning at 9.30 Wednesday Afternoon at 2 o'clock *Thursday Afternoon at 2 „ *Friday Afternoon at 2 „ MATERNITY CLINICS FOR EXPECTANT MOTHERS *Tuesday Afternoon at 2 o'clock *Thursday Morning at 9.30 TOWN HALL CENTRE. INFANT WELFARE CLINIC. Wednesday Afternoon at 2 o'clock DAY NURSERY, 240 St. Ann's Road. Open Daily from Monday to Friday inoluslve, 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, 1928. Ladies and Gentlemen, The year 1927 has been singularly uneventful. Dr. Esther Rickards commenced duty as ante-natal clinician in April in the place of Dr. Margaret Salmond, resigned. The District Nursing Association for Tottenham was re-established in September with three nurses, which have subsequently been added to. It is in the pre-school age that preventive measures against infectious diseases should be employed. Although measures were taken to explain the efficacy of inoculation against Diphtheria and an offer made to administer the treatment free of charge, the response has not encouraged me to hope that the incidence and fatality from that disease will be materially reduced. Maternal mortality and morbidity and the neo-natal death rate demand exhaustive enquiry and appropriate remedy. The staff have loyally devoted themselves to the duties assigned to them. I am, Ladies and Gentlemen, Yours faithfully, David Medical Officer of Health, 5 BIRTHS, 1927. LIVE BIRTHS. Registrar-General's Figures—M. 1,176 F 1,212 2,388 Local Information :— Total Births notified 2,456 Less Still Births 76 Total Live Births *2,380 *Births outside the District included in above Council cases in District Maternity Home 66 Other cases notified from District Maternity Home 258 Notified from other Outside Institutions 231 555 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 1,812 Part breast-fed—plus milk, dried milk or condensed 247 Bottle feeding—Cows' milk 123 Dried milk 73 Other artificial foods 50 Feedings unknown 39 Information refused 36 2,380 6 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 Revisits Notification of Births 2,539 7,543 293 18,256 28,631 Still-births 71 54 — — 125 Deaths 33 12 13 3 61 Ophthalmia Neonatorum and Discharging eyes 20 55 - - 75 fOther Infectious Diseases 53 125 118 171 467 Total 2,716 7,789 424 18,430 29,359 Maternity Visits— 1st Visits Re-visits Ante-Natal 428 578 — - 1,006 Post-Natal 778 755 — — 1,533 Puerperal Fever 5 4 — — 9 Puerperal Pyrexia 11 17 — - 28 * Other Visits 1st Visit Re-Visits 457 383 — — 840 Total Visits — — — — 32,775 †Other Infectious Diseases include Measles and German Measles, Bronchial Pneumonia, Tuberculosis, Whooping Cough, Poliomyelitis. *Other visits and revisits include visits to hospital with swabs in connection with suspected contagious disease; massage cases, complaints of neglect and inspection of premises as to their suitability for nursing of children after operation and visits for assisted milk supply. 7 INFANT WELFARE CLINICS. Total Attendances New Cases No. of Sessions Average Attendance per Session No. of Children on the Register 1—5yrs. Morning Aft'noon Morning Aft'noon St. Ann's (The Chestnuts) 11,345 733 52 205 33-80 46-75 1,405 Bruce Castle 8,379 563 52 151 32-65 44-24 1,159 Town Hall 1,674 113 — 52 — 32-19 234 Total 21,398 1,409 104 408 — — 2,798 Medical Inspections Total Number New Cases Number of Sessions Average No. of Inspections per Session St. Ann's (The Chestnuts) 3,982 675 154 25.85 Bruce Castle 2,836 516 100 28.36 Town Hall — — — — Town Hall 6,818 1,191 254 — Infant Mortality of Infants Attending the Infant Welfare Centres during 1927 Centre 1927 Births. Infantile Death-rate No. on Register Deaths of Infants St. Ann's (The Chestnuts) 480 4 8.3 Bruce Castle 345 3 8.6 Town Hall 78 — — 903 Infant Mortality rate for whole area 64.4 per thousand births, 8 ANTE AND POST NATAL CLINICS. Medical Examinations Ante Natal Post Natal Total Number of Sessions Average Attendance per Session St. Ann's (The Chestnuts) 860 138 998 101 9.9 Bruce Castle 652 116 768 100 7.68 Total 1,512 254 1,766 201 — New Cases St. Ann's (The Chestnuts) 243 86 329 — — Bruce Castle 177 54 231 — — 420 140 560 — — MATERNITY HOMES AND HOSPITALS. The arrangements with the Guardians, whereby Tottenham patients are admitted to the Maternity Home are still active and satisfactory. The following table sets out the number of cases subsidised by your Committee, treated in this Institution and the Mothers' Hospital, and the details relating to them:— District Maternity Home, Edmonton Mothers' Hospital. Total Discharged before Confinement Confinements Total Mothers Delivered by Tota Live Births Still Births Midwives Doctors 66 0 — — 64 2 66 63 3 66 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 Nil Nil 1 Nil 1 5 £ s. d. Cost of patients admitted to Maternity Home 312 18 0 Contributions by patients towards maintenance 288 13 6 Net cost to Council £24 4 6 Average duration of stay, 15.8 days. CRECHE ATTENDANCES, The attendances from 1st January to 31st December, 1927, were as follows:— Number of days on which the Creche was opened, 247. Quarter Attendances under 3 years of age Attendances over 3 years of Age Total 1st January to 31st March 687 490 1,177 1st April to 30th June 862 451 1,313 1st July to 30th September 1,079 481 1,560 1st October to 31st December 1,135 512 1,647* 3,763 1,934 5,697 Number of children admitted :— Under three years (when admitted) 77 Over three years ,, 37 Total 114 Average daily attendance, 23.06 *Includes 47 attendances for half a day. 10 Applications for assistance have been dealt with as follows: Assisted Milk Supply.—621 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 57,695 qts. or their equivalent. Assistance has been given towards the payment of Midwives' Fees on 5 occasions and for a Home Help in one instance. CONVALESCENT HOME TREATMENT. The arrangement with the Invalid Children's Aid Association for the maintenance of child en at Convalescent Homes has been continued during 1927 as follows:— 38 children were sent away for varying periods, namely:— Number of Weeks 1 2 3 4 5 6 7 8 9 10 11 12 Number of Children — 1 4 8 2 7 2 5 — 2 1 1 Number of Weeks 13 14 15 16 17 18 19 20 21 22 23 24 Number of Children — 1 1 — 1 1 — — 1 — — — HOSPITAL TREATMENT FOR CHILDREN UNDER 5 YEARS OF AGE. The arrangement with the Prince of Wales's Hospital, Tottenham, and the North Middlesex Hospital, Edmonton, for children referred from the Welfare Centres for consultation and treatment was continued during the year:— The following table sets out the number of cases referred to these hospitals under the Local Authority's Scheme: Total Number Consultations only. Tonsils and Adenoids. Other Diseases. Sunlight Treatment. Operations. Retained in Hospital. No. of Days In-patients. treated as No. for Outpatients Inpatients 23 4 15 2 1—1 night 1— 3 days 1 Hernia 2 1 11 DISTRICT NURSING ASSOCIATION—HOME VISITS. CHILDREN UNDER 5 YEARS OF AGE. Number of Home Visits 300, in respect of 20 cases. Pneumonia and Influenzal Pneumonia 7 cases Bronchial Pneumonia and Congenital Heart 2 „ Whooping Cough 1 „ Whooping Cough and Pneumonia 4 „ Measles 1 ,, Measles and Whooping Cough 2 „ Measles and Pneumonia 2 „ Ophthalmia Neonatorum 1 „ 20 cases EXPECTANT AND NURSING MOTHERS. Number of Home Visits—61, in respect of 4 mothers. Puerperal Pyrexia 3 Puerperal Fever 1 4 The Committee are indebted to the following donors, for gifts to the Centres and the Creche:— To the Welfare Centres:- From the Harringay Scouts' Association, per Mrs. M. B. Inward- Xmas parcels for needy families; from the Dorcas Society of the High School for Girls—gifts of baby clothing; from Mr. W. Vincent—a sewing machine.; To the Creche: 10s. 6d. from the North Tottenham Labour Party for toys, and gifts from the following : Miss Councillor R. F. Cox, Miss Byatt, Miss Boyle, Miss Brown, Mrs. S. Brown, Co-operative Society Members, Mrs. Collier, Mrs. Devereux, Mrs. Dicks, Mrs. Finch, Mrs. Kitchener, Mrs. Kent Parsons Mrs. Schuger, Mrs. N. Smith, Dr. Smythe. Miss Cremolina continues to give her services for part of the sewing at the Creche. The matron of the Creche and the staff provided a party for the children. INDEX PART I. Health Department. A Page Ambulance Service 33 B Bacteriological Laboratory 34 Births 12 c Cancer 21 Cerebro-Spinal Meningitis 29 Clinics 35 Common Lodging-Houses.. 49 Cowsheds 48 D Dairies, etc. 48 Deaths 13 Diphtheria 26 Disinfection 47 E Encephalitis Lethargica 29 Enteric Fever 28 Epidemic Catarrhal Jaundice 29 Erysipelas 31 Exhumations 48 F Factory and Workshop Act 42 Filtration, Swimming Baths 40 Food and Drugs Act 46 Food, Unsound 46 H Health Services 33 Health Week 36 Hospitals 33 Housing 49 I Infantile Mortality 14 Infectious Diseases 26 Introduction 9 J Jaundice 29 L Laboratory 34 Legal Proceedings 40 Lodging-Houses 49 M Page Malaria 28 Malignant Diseases 21 Measles 28 M. of H. Tables 15 etc. Mortuary Table 24 N North Middlesex Hospital 25 Nursing in the Home 36 O Ophthalmia Neonatorum. 28 P Polio-Encephalitis 29 Poliomyelitis 29 Poor Law Relief 25 Population 10 etc. Puerperal Fever and Puerperal Pyrexia 28 R Rateable Value 11 S Sanitary Work, General 41 Scarlet Fever 26 Shops Acts 39 Slaughter-Houses 48 Small Dwellings Acquisition Act 48 Smallpox 28 Staff 4 Statutes, etc., Administered 37 Superannuation Scheme 36 Swimming Baths 40 T Treatment Centres 35 Tuberculosis 31 U Unsound Food 46 V Violent Deaths 22 W Water Supply 40 Whooping Cough 28 PART II. School Medical Department. A Page Adenoids 7 Attendance Officers 14 Aural Clinic 8 B Bacteriological Examinations 7 Blind Children 17, 18 c Convalescent Home Treatment 15 Crippling Defects 18 D Deafness 17 Dental Defects 32 E Ear Diseases 8 Epileptic Children 17 Extent of Medical Inspection 25 External Eye Diseases 30 Eye Clinic 31 Examinations by Medical Officers 22 F Findings of Medical Inspection 26 Following-up 7 Food Accessories and Drugs 22 H Home Visits 7 Hygiene, School 3 I Infectious Diseases 6 Invalid Children's Aid Association 15 Introduction 2 M Page Meals, Provision of 13 Mentally Defective Children 19 Menus, School Meals 14 Minor Ailments 30 Myopic School 18 o Oak Lodge Special School 19 Open-Air Centre 20 Open-Air Classes 21 Open-Air Education 10 Otorrhoea Clinic 8 P Parents, Co-operation of 14 Physical y Defective School 18 Physical Training 13 Playground Classes 10 R Residential Schools 17 Ringworm 7 Remedial Drill 14 S School for Deaf 17 School Journeys and Camps 10 Secondary Schools 22 Staff (see page 6, Health Department portion) Statistics 22-32 Surgical Instruments 16 T Teachers, Co-operation of 14 Tonsils and Adenoids 7 u Uncleanliness 32 V Verminous Conditions 32 Vision 31 Voluntary Bodies 15 PART III. Maternity and Child Welfare Department. A Page Ante Natal Clinic 8 do. Visits 6 Assisted Milk Supply . 10 B Bruce Castle 7, 8 Births 5 (and page 13, Health Department portion) Breast Feeding 5 c Chestnuts (The) 7,8 Creche 9 Centres, List and Attendances 3, 7, 8 Convalescent Home Treatment (I.C.A.A.) 10 D District Nursing Association, Home Visits 11 G Gifts 11 H Hospital Treatment 10 Home Visits 6 Home Nursing 11 I Introduction 4 Infant Mortality 7 (and page 15 of Health Department portion) L Page Lower Ward, Bruce Castle Centre 7,8 M Materni'y Cases 8,9 Midwives' Fees 10 N Notification of Births' Acts —Visits 6 O Ophthalmia Neonatorum Visits 6 (and page 31 of Health Department portion) P Puerperal Fever and Puerperal Pyrexia 6, 11 s Staff (see page 7, Health Department portion) T Town Hall Centre—Attendance 7 W Welfare Centres (list of) 3