AC 439(1) Public Health Dept. REPORTS COLLECTION COPY BOROUGH OF TOTTENHAM ANNUAL REPORT OF THE MEDICAL OFFICER OF HEALTH FOR THE YEAR - 1934 - DAVID C. KIRKHOPE, M.D., CH M., D.P.H.. BARRISTER-AT-LAW. 66058 TOT 8 Borough of Tottenham. report ON THE HEALTH OF TOTTENHAM FOR THE YEAR 1934. Crusha 6? Son, Ltd. Tottenham, Enfield, Wood Green and Palmers Green. 2 SUMMARY OF STATISTICS FOR 1933 and 1934. 1933. 1934. Area 3,014 acres. 3,014 acres. Population 154,700 152,694 Births 2,138 2,091 Birth-rate (per 1,000 of population) 13.8 13.7 Deaths 1,618 1,572 Death-rate (per 1,000 of population) 10.5 10.3 Deaths under 1 year of age 118 108 Infant Death-rate (per 1,000 births) 55.2 51.6 Phthisis Death-rate (per 1,000 of population) 0.77 0.78 Rateable Value.. £891,107 £957,472 Amount produced by Id. Rate £3,615 £3,823 3 HEALTH AND HOUSING COMMITTEE (as at 31st December, 1934). Chairman: Councillor A. Reed, A.C.I.I., J.P. Members: (Ex-Officio) His Worship the Mayor (Alderman W. R. Jackson, J.P.). (Ex-Officio) The Deputy Mayor (Alderman A. E. Jay). Alderman C. D. Grant. ,, Major Sir P. B. Malone, J.P. ,, J. H. Morrell. Councillor M. Doran. ,, Mrs. A. M. Ellis. ,, F. A. F. Keay. ,, Mrs. A. Kitchener. ,, Mrs. J. D. Lynch. ,, Mrs. G. E. Morrison. ,, J. F. Tidder. ,, S. Timms . ,, A. R. Turner. ,, R. H. Warren. Council's Representative on the Metropolitan Water Board under the Metropolis Water Act, 1902: Alderman Major Sir P. B. Malone, J.P. 4 Heads of Departments: Town Clerk:—Eric Townson, Esq., LL.B. Engineer and Surveyor:—Captain H. F. Wilkinson, R.E., M.Inst.C.E. Treasurer:—E. Young, Esq., A.s.A.A. Director of Education:—C. F. Strong, Esq., M.A., Ph.D. Superintendent, Fire Brigade:—I. Easton, Esq., M.I.Fire E. Librarian:—W. J. Bennett, Esq., F.L.A. Superintendent of Baths:—T. J. Lewis, Esq. STAFF. 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. Chief Sanitary Inspector— §¶†*smith, J. B. Male Sanitary Inspectors— §†*West, W. P. §†*shillito, J. A. §*Bennett, P. W. T. §°†Glegg, E. S. §°†‡ ¶Goodfellow, J. §°Kerridge, L. J. Female Sanitary Inspector— §*Lamb, Miss M. *Certificate of the Royal Sanitary Institute. ¶Cert., San. Insp. Exam. Bd. °Cert., R.S.I. and S.I.E. Jt. Bd. †Meat Inspector's Certificate. ‡Smoke Inspector's Certificate. ||R.S.I. Cert, in San. Science. §Contribution to salary from Exchequer Funds. 5 Shops Acts Inspector.—Lock, F. T. G. Assistant Shops Acts Inspector.—Sendall, A. A. Nurse for Infectious Diseases— s. s waffield. (General Training Certificate. C.M.B. Cert. Fever Training Certificate.) Clerical Staff— Garvey, R. (Cert., Roy. San. Inst.), Chief Clerk. Gilbert, H. R., Clerk. Potter, W. do. Chappell, R. H. T. (B.Sc.). do. Perry, L. R., do. Kent, W. P., Junior Clerk. Disinfectors— F. Dowse (Houses). J. Wilson (Clothing). J. Collin ,, E. Mannell (Driver, Disinfecting Vans). Drain Testers, Etc. H. Bysouth. W. Jackson. S. Reid. J. W. Turner. S. R. Thursby to 7th November. 6 Addresses of other Public Officers, more or less connected with Public Health Work. Registrars of Births and Deaths— East Tottenham: Mr. L. J. AtherTon, The Grange, White Hart Lane. West Tottenham: Mr. C. H. Dunkley, 135, West Green Road. Public Assistance Officials— Area Officer: Mr. L. A. Franklin. Relieving Officers: "Elmslea," Lordship Lane: Mr. Axford, Mr. Burchall, Mr. Gibson, Mr. He afield and Mr. Lister. "Dorset Hall," Dorset Road: Mr. Lee, Mr. Mister and Mr. Williams. Public Vaccinators— Dr. Golding (Temp.), 181, Lordship Lane, and The Surgery, Colsterworth Road. Dr. F. L. Cattle, 326, Philip Lane. Dr. A. Wilson, 707, High Road. Dr. J. Devine, 629, High Road. Vaccination Officer— Mr. L. J. Atherton, The Grange, White Hart Lane. Coroner's Officer— Mr. V. Bonn, 16, Waltheof Gardens. 7 Health Department, Town Hall, Tottenham. May, 1935. To The Mayor, Aldermen and Councillors of the Borough of Tottenham. Mr. Mayor, Ladies and Gentlemen., Circular 1417 of the Ministry of Health, dated 25th October, 1934, requests the Council to direct that the Annual Report of the Medical Officer of Health be drawn up on lines indicated therein. The requirements of the Ministry will be strictly observed in this report, which is an ordinary or general report, and not a survey or exhaustive report, such as is required at five-yearly intervals. It will be noted that the department is actively engaged in the matter of housing adequately the population of the district. The five year plan of tackling the housing problem, suggested by the Housing Act of 1930, is being proceeded with. There have been three local enquiries by the Minister of Health's representatives, namely on February 7th, 1933, January 23rd, 1934, and November 13th, 1934, and preparation is well advanced for the fourth, which, it is expected, will be held in the latter half of 1935. The routine work of the year is, as far as practicable, expressed in statistical form. I take this opportunity of thanking the Council for their kindness to me during my absence from duty on account of illness in the early part of the year, my colleagues for their valued co-operation, and my assistants and staff for their loyalty and devotion to duty. I am, Mr. Mayor, Ladies and Gentlemen, Your obedient Servant, 8 POPULATION. The population of Tottenham at the 1931 Census was 157,772. ,, ,, ,, at mid-year 1934 (Registrar-General's estimate) was 152,694. HOUSES, POPULATION, ETC. According to the rate-books the number of houses in December, 1934, was 30,730. The Treasurer has kindly furnished me with the following particulars relating to their distribution in Wards:— Ward. Acreage. Total Number of Houses. Other Buildings and †Assessments. Total Number of Assessments. Rateable Value. Bruce Grove & Central 246 2,756 188 2,944 £ 86,518 Chestnuts 126 2,634 135 2,769 62,428 Coleraine 329 2,329 90 2,419 53,490 Green Lanes 214 2,581 253 2,834 114,865 High Cross & Stoneleigh 284 2,319 205 2,524 74,568 Park 480 2,963 250 3,213 90,588 Seven Sisters 162 2,559 216 2,775 67,211 Stamford Hill 209 2,114 81 2,195 68,398 Town Hall 276 3,111 269 3,380 107,000 West Green 343 3,704 191 3,895 110,625 White Hart Lane 345 3,660 111 3,771 72,762 Throughout the District — — 14‡ 14‡ 49,019 Totals 3,014 30,730 2,003 32,733 £957,472 *Houses, Houses and Shops, Flats, and Tenements. †Lock-up Shops, Stables, Workshops, Garages, Schools, Factories, Land, etc. ‡Railways, Tramways, Reservoirs, Gas, Water and Electric Mains. 9 SOCIAL CONDITIONS, INCLUDING THE CHIEF OCCUPATIONS OF THE INHABITANTS, AND THE INFLUENCE OF ANY PARTICULAR OCCUPATION ON PUBLIC HEALTH. These have not altered materially since the 1930 Report was issued. EXTENT OF UNEMPLOYMENT. The total number of persons normally in regular employment who were registered as wholly unemployed midway through December, 1934, was 4,525. In addition, 199 persons were registered as temporarily stopped. There were also registered as unemployed 105 men who normally are engaged in casual employment, making a grand total registered of 4,829. RATEABLE VALUE. The rateable value of the district in December, 1934, was £957,472. A Penny Rate produced £3,823. BIRTHS. Births Registered:—Males 1,074 Females 1,017 Total 2,091 Births of Tottenham "Residents" occurring in the district .. 1.262 ,, ,, ,, outside the district 829 Total 2,091 Of these there were 74 born out of wedlock:— 37 males. 37 females. =3.5% illegitimate. Birth Rate, 13.7 per 1,000 of the population 10 Stillbirth Rate per 1,000 total births (live births and stillbirths) 27 9 Notification of Births:— Doctors, Parents and other persons 1,298 Midwives 814 Total 2,112 Less Stillbirths 60 2,052 DEATHS. The tables showing the number of deaths from different causes, and according to age groups and Ward distribution, are set out on pages 16 and 17. Epitomised, it will be seen that— The total number of deaths registered in Tottenham was 1,129 Number of Non-residents dying in the district 311 818 Deaths of residents occurring in the district 818 ,, ,, ,, elsewhere 754 Deaths of residents—Total 1,572 Deaths of children under 1 year occurring in the district 56 ,, ,, ,, ,, outside the district 52 Total of deaths under 1 year 108 11 Death Rate of Infants under one year of age All infants per 1,000 live births 51.6 Legitimate infants per 1,000 legitimate live births 51.1 Illegitimate infants per 1,000 illegitimate live births 67.6 Total deaths distributed according to age groups:— Deaths under 1 year numbered 108 Deaths from 1 to 5 years numbered 41 Deaths from 5 to 15 years numbered 44 Deaths from 15 to 25 years numbered 74 Deaths from 25 to 65 years numbered 591 Deaths, 65 and upwards 714 The excess of births over deaths, or natural increase of population, was 519. The death-rate equalled 10.3 per 1,000 of the population. Deaths from puerperal causes:— Deaths. Rate per 1,000 total (live and still) births. Puerperal sepsis 5 2.3 Other puerperal causes 6 2.8 Total 11 5.1 12 COMPARISON OF DEATH INCIDENCE—YEARS 1933 & 1934. Cause of Death. 1933. 1934. Difference. Typhoid and Paratyphoid Fevers — — .. Measles — 9 + 9 Scarlet Fever 1 3 + 2 Whooping Cough 4 8 + 4 Diphtheria 10 12 +2 Influenza 44 6 — 38 Encephalitis Lethargiea 1 1 .. Cerebro-Spinal Fever 1 4 + 3 Tuberculosis of Respiratory System 119 120 + 1 Other Tuberculous Diseases 17 11 — 6 Syphilis — 2 + 2 General Paralysis of the Insane, Tabes Dorsalis 4 4 .. Cancer, Malignant Disease 234 215 — 19 Diabetes 10 14 + 4 Cerebral Haemorrhage, etc. 75 74 — 1 Heart Disease 366 366 .. Aneurysm 4 1 — 3 Other Circulatory Diseases 85 94 + 9 Bronchitis 66 109 + 43 Pneumonia (all forms) 133 128 — 5 Other Respiratory Diseases 31 21 — 10 Peptic Ulcer 3 8 + 5 Diarrhoea, etc. 24 7 — 17 Appendicitis 6 3 — 3 Cirrhosis of Liver 2 5 + 3 Other Diseases of Liver, etc. 5 3 — 2 Other Digestive Diseases 30 48 + 18 Acute and Chronic Nephritis 51 52 + 1 Puerperal Sepsis 3 5 + 2 Other Puerperal Causes 10 6 — 4 Congenital Debility, Premature Birth, Malformations, etc. 55 35 — 20 Senility 24 22 — 2 Suicide 19 20 Other Violence 47 69 + 22 Other Defined Diseases 131 84 — 47 Causes Ill-defined or Unknown 3 3 .. Totals 1618 1572 —177 +131 = net —46 13 Table showing the Population, Birth and Death Rates, in Wards, during 1934. Ward. No. of Births. No. of Deaths. *Population. Birth-rate. Death-rate. No. of Deaths Under 1 Year. Infant Mortality per 1,000 of Population. Infant Mortality per 1,000 Births. Bruce Grove & Stone- leigh 267 233 20,460 13.0 11.4 14 0.7 52-4 Chestnuts 268 196 18,655 14.4 10.5 20 1.1 74-6 Green Lanes 179 152 13,405 13.3 11.3 5 0.4 27-9 Park and Coleraine 260 188 18,399 14.1 10.2 15 0.8 57-7 Stamford Hill 274 219 19,918 13.8 11.0 10 0.5 36-5 Town Hall 243 175 16,473 14.7 10.6 16 1.0 65-8 West Green 309 216 21,458 14.4 10.1 14 0.6 45-3 White Hart Lane 291 193 23,926 12.2 8.1 14 0.6 48-1 Total 2,091 1,572 152,694 13.7 10.3 108 0.7 51-6 *The Population for Mid-year 1934 is distributed over the various wards in the same proportion as that obtaining at the Census, 1931. During the latter part of the year, Tottenham was divided into 11 Wards: this and other statistical tables, for the purpose of clarity, retain for the present year the old distribution of Wards. 14 Table showing the Population, Birth Rate, and Death Rate from all causes, in Tottenham during the last six years. Year. 1 *Population estimated to Middle of each Year. 2 Births. Total Deaths Registered in the District. Deaths of Nonresidents registered in the District. 8 Deaths of Residents not registered in the District. 9 Nett Deaths Belonging to the District. Uncorrected Number. 3 Nett. Under 1 Year of Age. At all Ages. Number. 4 Rate. 5 Number. 6 Rate. 7 Number. 10 Rate per 1,000 Nett Births. 11 Number. 12 Rate. 13 1929 168,000 1,940 2,561 15.2 1,238 7.4 281 882 162 63.2 1 ,839 10.9 1930 170,000 1,868 2,510 14.8 1,083 6.4 292 778 137 54.6 1,569 9 .2 1931 159,300 1,639 2,345 14.7 1,098 6.9 259 782 124 52.9 1,621 10.2 1932 156,800 1,487 2,214 14.2 1,153 7.3 347 785 114 51.4 1,591 10.1 1933 154,700 1,397 2,138 13.8 1,060 6.9 275 833 118 55.2 1,618 10.5 1934 152,694 1,262 2,091 13.7 1,129 7.4 311 754 108 51.6 1,572 10.3 *1931, 1932, 1933 & 1934—Registrar General's Estimate of Population. 1929/1930—Treasurer's Estimate. Table of cases of Infectious Disease coming to the knowledge of the Medical Officer of Health during the year 1934 in the Borough of Tottenham, classified according to Diseases, Ages and Localities. NOTIFIABLE DISEASE At all Ages Number of Cases Notified. Total Cases Notified in Each Locality Total. Cases Removed to Isolation Hospital Bruce Grove Chestnuts Green Lanes Park and Coleraine Stamford Hill Town Hall West Green 1 Whlto Hart Lane Under 1 I to 2 2 to 3 3 to 4 4 to 5 & to 10 10 to 15 15 to 20 20 to 35 35 to 45 45 to 65 65 and over Scarlet Fever 628 3 14 42 53 54 247 102 24 62 17 9 1 69 63 67 68 86 79 88 108 228 Diphtheria 300 5 11 13 28 34 119 47 15 22 4 2 — 35 63 15 22 43 54 27 41 291 Pneumonia 128 4 6 5 6 4 15 7 8 18 22 19 14 10 21 11 7 35 18 12 14 — Erysipelas 68 1 2 — — 1 — 3 3 7 11 35 5 8 9 4 12 8 8 10 9 25 Puerperal Fever 12 — — — — — — — — 12 — — — — — 1 1 3 o 4 1 10 Puerperal Pyrexia 22 — — — — — — — — 18 4 — — — 5 1 2 5 3 5 1 4 Typhoid Fever 1 - - - - - - - - 1 - - - - - - - - - - 1 1 Ophthalmia Neonatorum 21 21 - - - - - - - - - - - 3 3 2 — 4 1 1 7 — Cerebro-Spinal Meningitis 1 1 - - - - - - - - - - - - - - - - 1 - - 1 Poliomyelitis 1 - - - - - - - - - - - - - - - - - - - - — Pulmonary Tuberculosis 181 — — 1 — — 8 8 15 82 34 29 4 18 13 27 18 17 24 27 37 — Other forms of Tuberculosis 26 — 1 1 1 3 3 1 3 9 2 2 — 4 1 6 5 4 1 1 4 — Totals 1,389 35 34 62 89 96 392 168 68 231 94 96 24 147 178 134 135 205 192 175 223 560 15 16 TABLE OF DEATHS during the Year 1934 in the Borough of Tottenham, classified according to Diseases, Ages and Localities. Cause 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. 9 2 3 1 3 - - - - - - - - 1 3 - 1 2 - 2 - 71 3 — — 1 1 1 - - - - - - - - - - 2 1 - - 5 8 3 2 2 1 - - - - - - - - 1 3 1 1 1 — — 1 28 12 1 2 2 6 1 - - - - - - - 1 1 1 — 1 2 1 5 52 6 1 — — 3 — — — — 2 — — — 1 1 1 1 1 — 1 — 1 Encephalitis Lethargica 1 — — — — — — — — 1 — — — — — — — — 1 — — — 4 4 - - - - - — - — — — 1 1 — — — 2 — — 1 Pulmonary Tuberculosis 120 - — — 3 30 34 25 14 6 7 — 1 14 11 11 19 21 10 17 17 4 Other Tuberculous Diseases 11 — — — 2 3 1 3 2 — — — — 2 1 — — 1 2 2 3 2 Syphilis 2 - - - - - - - 1 1 - - - - - - - - - 1 1 1 General Paralysis of Insane, Tabes 4 - - - - - - 1 3 - - - - 1 1 - - 1 1 - - - Cancer, Malignant Disease 215 — — — 2 2 3 18 29 58 63 33 7 45 25 21 26 33 15 30 20 46 14 — — — — — - — 1 1 7 5 — 4 4 1 1 1 - 1 2 3 74 5 — 1 — 1 2 3 6 12 20 18 6 7 8 5 14 11 9 10 10 9 Heart Disease 366 1 — 2 9 7 6 12 35 56 83 121 34 50 43 35 46 53 48 51 40 33 1 — — — — — — — — — — 1 — — 1 — — — — — — — Other Circulatory Diseases 94 - - - - - - 2 2 12 31 36 11 14 12 11 14 12 7 17 7 6 109 2 1 1 — 1 — 2 7 25 26 37 7 13 9 12 17 11 12 13 22 6 Pneumonia (all forms) 128 21 8 3 — 5 6 11 11 16 25 18 4 20 16 16 12 22 10 13 19 24 Other Diseases of Respiratory Organs 21 — — — 1 1 2 5 3 2 4 2 1 4 2 2 1 2 3 3 4 2 8 — — — — — 1 — 5 — 1 1 — — 1 1 — — 1 3 2 — 7 5 - - - - 1 - - - 1 - - - 1 - 3 1 1 1 — 6 3 - - - - - - - - - - - - - - - - - 1 1 — Cirrhosis of Liver 5 — — — — 1 1 — 1 2 — — — 1 1 — 1 1 1 — — — 3 — — — — — — — 1 2 — — — — — 1 1 — 1 — — — Other Digestive Diseases 48 2 — — — 2 4 8 10 7 7 6 2 10 8 4 3 8 6 4 5 16 52 1 — — 3 2 4 2 7 14 13 6 — 10 6 4 6 6 7 9 4 — 5 — — — — — 4 1 — — — — — — 1 — 1 — 1 2 — — Other Puerperal Causes 6 - - - - - 2 4 - - - - - - - 1 1 1 1 1 1 - 35 35 - - - - - - - - - - - 4 3 1 3 4 6 8 6 3 22 - - - - - - - - 1 12 9 5 6 2 1 2 — 4 2 — 20 — — — — 2 2 3 7 — 2 4 — 5 2 4 — 3 2 3 1 3 Other Violence 69 4 3 3 7 8 4 3 7 11 6 11 2 8 8 8 5 9 12 7 12 27 Other Defined Diseases 84 21 3 2 7 1 5 10 12 14 6 1 10 16 8 9 9 13 11 8 38 Causes 111-defined or Unknown 3 — — — — — 1 1 — — 1 — — 1 1 — 1 — — - - — Totals 1572 108 23 18 44 74 79 110 162 240 312 317 85 233 196 152 188 219 175 216 193 387 INFANTILE DEATHS in Ages, Sexes and Localities, during the year 1934. 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 mouths. Total Deaths under l year. Males. Females. Bruce Grove A Stonelelgh Ward. Chestnuts Ward. Green Lanes Ward. Park and Coleraine Ward. Stamford Hill Ward. Town Hall Ward. West Green Ward. White Hart Lane Ward. Measles - - - - - - 1 1 - 2 1 1 - 1 - - - - 1 - Whooping Cough - - - - - - 2 - 1 3 1 2 1 1 - - - - - 1 Diphtheria — — — — - - — 1 — 1 - 1 — 1 — — — — — — Erysipelas — — — — — — 2 - — 2 1 1 — — 1 1 — — — — Meningitis (not Tuberculous) - - - - - - 2 - 2 4 1 3 1 1 1 - - 1 - - Pneumonia — 1 — 1 2 3 6 3 7 21 9 12 4 7 1 2 3 — — 4 Bronchitis — — - — - - 2 - — 2 1 1 - 1 - 1 - — — — Convulsions - 1 - - 1 - - 1 - 2 1 1 1 - - - - - 1 — Gastritis - - 1 - 1 - — - 1 2 1 1 1 1 - - - - - - Diarrhoea and Enteritis 1 - - - 1 1 1 1 1 5 2 3 - 1 - 3 - 1 - - Suffocation - 1 - - 1 - - - - 1 - 1 - - - - 1 - - - Injury at birth 2 — — — 2 - — - - 2 — 2 - 1 — - — 1 — — Atelectasis 3 1 — — 4 - — - - 4 2 2 — — — - 1 — 1 2 Congenital Malformations 2 — 1 — 3 1 — - — 4 3 1 — — — - 1 2 1 — Premature Birth 24 1 2 - 27 — — - — 27 17 10 3 3 1 3 2 4 7 4 Atrophy, Debility and Marasmus 1 - 2 - 3 1 - - - 4 - 4 1 - - - 1 - - 2 Other Causes 11 2 1 — 14 2 1 3 2 22 15 7 2 2 1 5 1 7 3 1 Totals 44 7 7 1 59 8 17 10 14 108 55 53 14 20 5 15 10 16 14 14 17 13 DEATHS FROM VIOLENCE. There were 89 deaths from Violence. 20 were suicidal. Deaths resulting from motor accidents numbered 20. Males. Females. Falls 7 10 Fall from pedal cycle (skid) 2 — ,, ,, under lorry 1 — Knocked down by motor car 2 4 ,, ,, cycle 1 — ,, ,, lorry 2 2 ,, ,, cab 1 — ,, ,, railway train 4 — ,, ,, pedal cycle 1 — Collision between two motor cars 1 — ,, ,, motor lorry and motor cycle 2 — ,, ,, ,, car and motor cycle 1 — ,, ,, ,, ,, and pedal cycle 1 — Crushed between Trailer and Van 1 — by mangle 1 — ,, ,, fall of bricks 1 — Thrown from motor cycle, racing 1 — Electrocuted by cables 1 — Slipped mounting brewer's dray 1 — Suffocated in bed — 1 ,, epileptic fit 2 — ,, by food — 2 Burns 2 5 Poisoning 1 — Drowning 4 — Other forms of violence 2 2 SUICIDES. Coal-gas poisoning 3 7 Corrosive poisoning 4 1 Drowning 1 1 Decapitated by train 1 — Jumped under electric train 1 — Abortion self induced — 1 53 36 19 GENERAL PROVISION OF HEALTH SERVICES. LABORATORY FACILITIES. No alteration has taken place in laboratory facilities during 1934. The following is a statement of the examinations made during the year. Swabs examined for Diphtheria:—Positive, 412; Negative, 2,609. Specimens of Sputa examined for Tuberculosis:—Positive, 34; Negative, 188. Virulence tests, Diphtheria:- Positive, 5; Negative, 1. Blood examined for Typhoid group:—Positive, 1; Negative, 1. Hairs examined for RingwormPositive, 2; Negative, 5. Fluid from pleural effusion examined for Tuberculosis :—Negative, 1. AMBULANCE FACILITIES. The ambulance facilities for the district are mentioned in the 1930 Report. No alteration has taken place in the number of vehicles owned and controlled by the Council, but during 1934 a new Daimler Ambulance was acquired to replace one that had been in use since 1915. The Superintendent of the Fire Brigade, to whose department the Tottenham Ambulance Service has been committed, has furnished me with the following table, which relates to non-infectious cases only:- 20 Tottenham Motor Ambulance Service, 1934. No. of Cases. Mileage. Receipts. Surgical. School Children. (Journeys) £ s. d. January 766 2,037 5,861 167 2 6 February 592 2,434 5,529 188 0 6 March 660 2,289 5,720 235 18 0 April 601 1,887 4,958 148 0 6 May 656 2,178 5,559 167 4 6 June 626 2,807 6,038 257 7 0 July 790 2,196 6,685 194 4 0 August 691 508 3,305 58 2 0 September 598 2,527 6,002 228 5 6 October 631 2,664 6,070 194 18 0 November 601 2,312 5,794 172 2 0 December 600 1,762 5,034 164 19 0 Year's Totals 7,812 25,601 66,555 £2,176 3 6 Total Mileage to Date: 831,098 The Ambulances are equipped with Oxygen Resuscitators, which have been in use on 5 occasions during 1934. Number of Street Accidents and Cases of Illness for the year: 544. NURSING IN THE HOME. The arrangements for nursing in the home are the same as in 1933. CLINICS AND TREATMENT CENTRES No changes have taken place in the Clinics and Treatment Centres. 21 HOSPITALS. The observations relating to hospitals made in the 1932 Report are equally applicable to the year 1934. HEALTH WEEK. The school teachers prepared a booklet which appealed to school children of all ages. For the younger children there were tests in handwork; for the older children crossword puzzle and essays. Diet was the main theme discussed. Prizes were awarded to the successful candidates in the essay competition. POOR LAW RELIEF. The following information has been kindly supplied by the Local Public Assistance Officer and the Director of Public Assistance:— Out-Door Relief: Unemployed: Ordinary: No. of cases 2,119 Amount. £39,488 7s. 5d. No. of cases. 2,295 Amount. £45,780 10s. 0d. Institutional Relief—North Middlesex Hospital. No. of cases admitted from Tottenham during 1934 3,446 No. of days In-Maintenance of these patients during 1934 90,661 SHOPS ACTS. Contraventions of these Acts were dealt with as follows:—34 first warning notices and 20 second warning notices were served upon offenders, and in 3 cases legal proceedings were taken, viz.:— Date. Name. Nature of Case. Result. June Thomas Eden, 10, Derby Road Serving after the closing hour Fined 5s. or seven days. June Edward Martin, 63, Rangemore Road Serving after the closing hour Fined 5s. or seven days. July Thomas Martin, 13, Bruce Grove Serving after the closing hour Fined 10s. or seven days. 22 Shops Acts, 1912 to 1930. Half Holidays. Harringay Area. Tottenham Remainder Area * Butchers Monday, 1 p.m. Monday, 1 p.m. (or alternatively Saturday, 1 p.m.) (or alternatively Saturday, 1 p.m.) Bakers Wednesday 2 p.m. Thursday, 2 p.m. (or alternatively Saturday, 2 p.m.) (or alternatively Saturday, 2 p.m.) †Other Shops Wednesday 1 p.m. Thursday, 1 p.m. (non-exempted (or alternatively (or alternatively Saturday, 1 p. m.) trades). Saturday, 1 p.m.) Evening Closing Hours. *Butchers Monday, Tuesday, Wednesday and Thursday 7 p.m. Friday and Saturday 8 p.m. (subject to Weekly Half-holiday Order.) Confectioners Sunday, Monday, Tuesday, Wednesday, Thursday and Friday 9.30 p.m. Saturday 10 p.m. †Other Shops Sunday, Monday, Tuesday, Wednes(non-exempted trades) day, Thursday and Friday 8 p.m. Saturday 9 p.m. (subject to weekly half-holiday Order). Hairdressers and Premises to be closed all day on Sunday. Barbers (or, alternatively, Saturday for Jewish Hairdressers and Barbers.) Exempted Trades No closing hour. (newly-cooked provisions, etc.) MEDICAL EXAMINATIONS. In 1934, 30 examinations were made of persons entering the permanent service of the Council, the Education Committee and the Maternity and Child Welfare Committee. 23 SANITARY CIRCUMSTANCES OF THE BOROUGH. WATER. The Metropolitan Water Board supply water to Tottenham. It is of good quality and quantity. The drought during the Summer caused supplies for non-essential purposes—principally the watering of gardens— to be curtailed. There was, however, an ample supply for culinary and other domestic purposes. DRAINAGE AND SEWERAGE. For the most part drainage is on the dual system. When drains taking both soil and surface effluent come under scrutiny, measures are taken where practicable to instal the dual system. During 1934, 176 premises were converted from the single to the dual system of drainage. Soil sewage is taken into the L.C.C. system. Surface drainage passes into the River Lee. RIVERS AND STREAMS. The Lee Conservancy Catchment Board are responsible for the cleansing of streams in the area and (jointly with the Lee Conservancy Board) the River Lee. CLOSET ACCOMMODATION. There are 4 Cesspools, 3 Earth Closets and 3 Chemical Closets in the district. The other closets are on the water carriage system. PUBLIC CLEANSING. This branch of the Council's work was within the purview of the Engineer's Department during the year under review. There are weekly collections of house refuse, which is disposed of at the Council's Destructor, together with shop refuse. Street refuse is disposed of at the Council's "Shoot." Inhabitants are encouraged to burn all combustible refuse. 24 SANITARY ADMINISTRATION OF THE BOROUGH. The Chief Sanitary Inspector reports to me as follows in relation to the sanitary administration of the Borough:— CLEARANCE AREAS. During the year a further step was taken in the matter of providing accommodation for persons displaced from Clearance Areas. The Council have accepted a tender for the erection of 80 houses on the Weir Hall Estate. In October, 1933, the Ministry of Health confirmed Clearance Orders with respect to 32 houses and 4 shops with dwellings attached in the Waggon Lane Area. In May, 1934, the Ministry of Health confirmed the Council's application for Clearance Orders with respect to Nos. 1, 2, 3, 4, 5 and 6, Roebuck Court, Nos. 824, 826, 828, 830, 832, 834 and 836, High Road, Nos. 1, 2, 3, 4 and 5, Ward's Cottages, Nos. 1, 2, 3, 4 and 5, Stack Yard, Nos. 644, 646, 646a, 648, 650 and 652, High Road, Nos. 4, 6 and 8, Hampden Lane, No. 10, Boon's Yard, Nos. 1, 2, 3, 2a and 3a, Collins Yard, Nos. 4 and 6, Church Road, Nos. 1, 2 and 3, Fountain Place, Nos. 1, 2, 3, 4, 5 and 6, Fountain Square, and Nos. 1 and 2. Brewer's Yard, in all comprising 51 premises, namely:—44 dwelling-houses, and 7 shops with dwelling accommodation. In May, 1934, official representation was made with respect to the following premises: Nos. 2, 3, 4, 5, 6, 7, 8, 9, 10, 11 and 12, Hope Place, Nos. 1, 3, 5, 7, 9, 11, 13, 15, 17 and 19, Scotland Green, Nos. 62, 64, 68 and 70 to 94 (even numbers), Scotland Green, Nos. 1, 2 and 3, Tubby's Alley, Nos. 1, 2, 3, 4, 5, 6, 7, 8, 9 and 10, Willow Terrace, Nos. 616, 616a, 618, 620 and 624, High Road, Nos. 1, 2 and 3, Bull Yard, Nos. 1, 2, 3 and 4, Grove Court, Nos. 1, 2, 3, 4, 5, 6, 7 and 8, Brook Street, Nos. 37 and 38, Brook Street, and Nos. 1, 2, 3, 4 and 5, Waggon Lane. The Ministry of Health held an Inquiry into the Council's application for Clearance Orders in November, 1934 : most of the owners were represented thereat by their legal advisers and surveyors. In January, 1935, the Ministry confirmed the Orders with the exception 25 of the shop premises No. 1, Scotland Green and Nos. 616, 616a, 618, 620 and 624, High Road, and a workshop, No. 5, Waggon Lane. Up to date, 157 premises—-namely, 146 dwelling-houses and 11 shops with dwelling accommodation—have been scheduled for closure as a result of Clearance Orders under the Housing Act, 1930. The total number of occupiers to be displaced and rehoused amounts to 575. HOUSE INSPECTION. The total number of houses inspected during the year amounted to 4,710, namely:— 1,319 as a result of House-to-house Inspection; 2,122 „ „ Complaints; 1,269 „ „ Infectious Cases. Defects were discovered at 2,452 premises, and 2,402 Preliminary Notices and 238 Statutory Notices were served on the owners to remedy the defective conditions. 12,002 visits were made to the premises for the purpose of supervising work, and for ascertaining whether notices had been complied with. In 12 instances the work was carried out by the Council either at the request of the owners or in their default. The 1,319 houses visited for the purpose of house-to-house inspection were situate in the following roads:—Brook Street, Charles Street, Chester Road, Clyde Road, Dawlish Road, Dongola Road, Devon Road, Durham Road, Elmar Road, Gladesmore Road, Glenwood Road, Gloucester Road, Greyhound Road, Holcombe Road, Handsworth Road, Harringay Road, Junction Road, Love Lane, Malvern Road, Markfield Road, Manor Road, Mitchley Road, Newton Road, Nursery Street, Paignton Road, Ranelagh Road, Richmond Road, Stamford Road, Stanley Road, Templeton Road, Wingmore Road. 709 drains were tested during the year. 312 were found to be defective, and in 105 instances entire reconstruction was necessary. All reconstructed drains were tested with water and smoke. 26 The following table shows the principal defects discovered:— 267 Stopped drains. 490 Defective W.C. cisterns and pans. 643 „ rain-water pipes, gutters and waste pipes. 193 „ soil pipes and vents. 678 „ roofs. 213 „ sinks. 681 „ window frames. 506 „ floors. 788 „ coppers and fireplaces. 1,461 Houses with dirty walls and ceilings. 308 „ defective yard paving. 481 „ damp walls. 64 „ defective drinking water cisterns. 554 Miscellaneous defects. HOUSING STATISTICS. Number of Houses erected during the Year. By private builders (no State assistance) 176 houses and 3 flats By London County Council (no State assistance) 29 houses Inspection of Dwelling-houses during the Year. (1) (a) Total number of dwelling-houses inspected for housing defects (under Public Health or Housing Acts) 4,710 (b) Number of inspections made for the purpose 16,712 (2) (a) Number of dwelling-houses (included under head (1) above) which were inspected and recorded under the Housing Consolidated Regulations, 1925 1,319 (6) Number of inspections made for the purpose 7,307 (3) Number of dwelling-houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation *121 *These were dealt with under Part 1, Housing Act, 1930. 27 (4) Number of dwelling-houses (exclusive of those referred to under the preceding sub-head) found not to be in all respects reasonably fit for human habitation 2,402 Remedy of Defects during the Year without Service of formal Notices. Number of defective dwelling-houses rendered fit in consequence of informal action by the Local Authority or their officers 1,913 Action under Statutory Powers during the Year. (A) Proceedings under sections 17, 18 and 23 of the Housing Act, 1930: (1) Number of dwelling-houses in respect of which notices were served requiring repairs 180 (2) Number of dwelling-houses which were rendered fit after service of formal notices:— (a) By owners 228† (b) By local authority in default of owners 3 †Including premises in respect of which notices were served in 1933. (B) Proceedings under Public Health Acts: (1) Number of dwelling-houses in respect of which notices were served requiring defects to be remedied 56* (2) Number of dwelling-houses in which defects were remedied after service of formal notices:— (a) By owners 58 (b) By local authority in default of owners 1 (c) By local authority at request of owners 8 *Included in this figure are 4 houses in respect of which notices were also served under Section 17 of the Housing Act, 1930. In 1 instance notices under 2 different sections of the Public Health Acts were served on the same premises. 28 (C) Proceedings under the Tottenham Local Board Act, 1890: (1) Number of dwelling-houses in respect of which notices were served requiring defects to be remedied 1 (2) Number of dwelling-houses in which defects were remedied— (a) By owners 1 (b) By local authority in default of owners Nil (D) Proceedings under the Housing Acts, 1909 and 1925:— 4 premises in respect of which Demolition Orders had been served under the Housing Act, 1925, were demolished by the owners, and 1 house in respect of which a Closing Order under the Housing Act, 1925, was outstanding was demolished by the owner. ***** No action was taken during 1934 under Sections 19, 20 and 21 of the Housing Act, 1930. BUG INFESTATION OF HOUSES. A full year's experience has been gained in carrying out this work, and during 1934:— 285 rooms in 140 houses were disinfested; 8½ cwt. of sulphur, equivalent to 3.3 lbs. per room, were used. In 85 per cent. of the premises the disinfestation appears to have been completely effective. One of the difficulties in dealing with this problem is the reluctance of the people whose houses are infested with bugs to admit the fact. No class of the population is exempt from this scourge, and when a house becomes infested it is with the utmost difficulty that the unaided householder can rid the house of bugs completely. By the vigorous methods employed by the Council's staff, there is a reasonable prospect of premises being effectually cleared of these pests. 29 INFECTIOUS CASES. In connection with infectious cases, including smallpox contacts, 1,269 visits were made by the sanitary inspectors. The female sanitary inspector examined 1,103 scarlet fever patients and contacts prior to return to school, and also took swabs from 1,180 diphtheria patients and contacts. During the year 1934 the following disinfection was carried out:— 12,254 articles were disinfected in the steam disinfector; 1,199 rooms were disinfected with the formalin spray, namely:— 309 after diphtheria; 616 after scarlet fever; 179 in cases of tuberculosis; 63 after miscellaneous diseases; 32 wards and rooms in institutions and schools; 443 library books were disinfected and returned to the libraries; 1,013 aricles of clothing and bedding, etc., were destroyed at the request of the owners; 50 lots of bedding from verminous houses, and 12 lots of bedding from houses where scabies was present, were treated in the steam disinfector. SMALL DWELLINGS ACQUISITION ACTS. The sanitary inspectors test the drains and report on the condition of all houses (except newly-erected premises) where application is made to the Council for an advance under the above Acts. During the year 56 such properties were examined. 30 OTHER INSPECTIONS. In addition to the inspections mentioned in the preceding paragraphs, the sanitary inspectors have carried out the following work:— Inspections of public house urinals 188 ,, stables 292 ,, common lodging houses and sublet houses 132 ,, pawnbrokers' premises 6 ,, brooks 4 ,, schools 10 602 appointments have been kept with owners, builders, etc., relative to notices. One common lodging house which was not kept in accordance with the byelaws was closed during the year. Representations were made during the year to the Managers of a non-provided school that the water closet and urinal accommodation was not satisfactory, and they are now considering the question of reconstruction. SMOKE ABATEMENT. From time to time complaint is received of the issue of black smoke from factory chimneys. The sanitary inspectors keep periodical observations upon them, and it has not been found necessary to take legal action in respect of contravention of the Council's byelaws. The factory owners have been found amenable to reasonable suggestions, and have co-operated to mitigate annoyance. SCHOOLS. The water supply to schools is the same as for the rest of the district —namely from the Metropolitan Water Board's mains. The schools are maintained in a satisfactory sanitary condition. See also the Report of the School Medical Officer for 1934. 31 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 Actin 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) 307 12 - Workshops (including Workshop Laundries) 361 27 - Workplaces (other than outworkers' premises included in Part 3 of this Report) 170 16 - Total 838 55 — 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 45 45 — — Want of ventilation — — — — Overcrowding — — — — Want of drainage of floors 1 1 - — Other nuisances 13 13 — — Sanitary accommodation "insufficient - - - - unsuitable or defective 8 8 — — 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 68 68 - - *Including those specified in sections 2, 3, 7 and 8, of the Factory and Work shop Act as remediable under the Public Health Acts. 32 3.—Home Work. OUTWORKERS' LISTS, SECTION 107. Number of Inspections of Outworkers' Premises. Outwork in Unwholesome Premises, Section 108. Outwork in Infected Premises, Sections 109, 110. Nature of Work. Lists received from Employers. Number of Addresses of | Outworkers received from other Councils. Number of Addresses of Outworkers forwarded to other Councils Prosecutions Twice in the year. Once in the year. Failing to keep or permit inspection of Lists. Failing to send Lists Instances. Notices served. Prosecutions. Instances. Orders made (Sec. 109). Prosecutions (Secs. 109, 110). Total Lists. Outworkers. Total Lists. Outworkers. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 Wearing Apparel 33 146 5 30 347 107 - - 429 - - - - - - Boots and Shoes 6 7 — — 14 19 — — 2 - - - - - - Stationery 8 30 - - - 3 - - 27 - - - - - - Cardboard, etc., Boxes 2 7 - - 8 8 - - 7 - - - - - - Brushes - - - - 5 - - - 5 - - - - - - Furs - - 1 6 10 - - - 16 - - - - - - Umbrellas - - - - 1 - - - 1 - - - - - - Fancy Goods 4 55 — — 10 25 — — 40 — — — — — — Artificial Flowers — — — — 1 — — — 1 — — — — — — Lace Paper & Xmas Crackers 4 9 — — 8 9 — — 8 — — - - - - Leather Goods — — — — 4 — — - 4 - - - - - - Needlework — — — — 6 — — — 6 — — — — — — Pencils — — 1 5 — 1 — — 4 — — — — - - Chemists' Sundries - - - - 1 - - - 1 - - - - - - Totals 57 254 7 41 415 172 - - 551 - - - - - - 33 4.—Registered Workshops. Workshops on the Register (s. 131) at the end of the Year. Number. Workshops 207 Laundries 14 Bakehouses 67 Total number of Workshops on Register 278 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) 1 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 9 Reports (of action taken) sent to H.M. Inspector 9 Other - Underground Bakehouses (s. 101):— Certificates granted during the year - In use at the end of the year 3 Note.—The Factory and Workshop Act, 1901 (s. 132) requires the Medical Officer of Health, in his Annual Report to the 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). 34 INSPECTION AND SUPERVISION OF FOOD. MILK. 14 persons were registered as retail purveyors of milk during the year. There are now 145 purveyors of milk on the register and during the year 362 visits were made to their premises. There are no cowsheds in the district. In 1934, licences under the Milk (Special Designations) Order, 1923' were granted as follows:— For the sale of Grade A (Tuberculin Tested) Milk 23 (including 5 supplementary licences). For the sale of Pasteurised Milk 21 „ 4 „ „ For the sale of Certified Milk 6 „ 3 „ „ For the sale of Grade A Pasteurised Milk 6 „ 3 „ „ The scheme by which school children who appear to be in some degree undernourished are supplied with one-third of a pint of milk in school daily requires that the Medical Officer shall satisfy himself of the quality of the milk supplied and the conditions under which it is pasteurised and bottled. With the exception of one local firm, which supplies milk to one school only, all the purveyors are large companies who distribute from 6 centres. All were visited and satisfied the Medical Officer's requirements . ICE CREAM. 95 visits were made to premises where ice cream is manufactured. One factory was not kept in a satisfactory condition. A sample of ice cream from this factory when submitted to analysis showed that the number of organisms present per cubic centimetre was 297,000 and that 35 B. Coli was present in 1/1000 c.c. Structural alterations and improved methods of handling the products were made and on further samples being submitted for analysis it was reported that ''The sample was of a high standard of bacterial purity and in this respect is a clean product." There is no legal standard of cleanliness for ice cream. BREAD. There are 53 bakehouses in the district and during the year 142 visits were made to these premises by your inspectors. MEAT, FISH AND FRUIT. There are now 3 registered and 6 licensed slaughterhouses in the district. One licensed slaughterhouse was removed from the register during the year. One slaughterhouse carries on a wholesale trade. There are in Tottenham 116 butchers' shops, 153 fruiterers' and greengrocers' shops, and 80 fish shops. During the year, 610 visits were made to the butchers' shops, 343 to the fish shops and 253 to the fruiterers' and greengrocers' shops. Visits are made at all hours of the day. Slaughtermen are required by law to notify the Council of the times at which they propose to slaughter animals. If the slaughtering is carried on at fixed hours on regular days of the week, there is no need to give a daily notification. When irregular slaughtering is carried on your officers endeavour to be present at the time of slaughtering. At places where slaughtering is carried on all day, your officers examine the carcases before these leave the slaughterhouses. During the year 1,964 visits were made to slaughterhouses, and the following animals were inspected:—Bulls 12, Bullocks 112, Cows 12, Heifers 35, Calves 1,498, Sheep 8,107, Swine 13,833. Disease was found to exist in:—Bulls 9.4 per cent., Bullocks 22.2 per cent., Cows 30 per cent., Heifers 14.2 per cent., Calves 0.2 per cent., Sheep 2.1 per cent., Swine 5.7 per cent. Of the 5.7 per cent. swine affected, 4.8 per cent. were suffering from Tuberculosis, mostly in the neck glands, and Tuberculosis accounted for one-third of the diseased conditions found in the Bovines. 36 The following is a summary of the various parts affected:— Swine.—39 whole carcases, 508 heads, 178 livers, 151 mesenteries, 90 lungs, 6 spleens, 4 hearts, 2 kidneys. Bovines.—1 cow, 1 calf, 31 livers, 18 lungs, 8 tongues, 7 heads, 4 mesenteries, 3 spleens, 2 kidneys, 1 heart, 1 skirt. Sheep.—3 carcases, 114 livers, 60 lungs, 1 heart. MISCELLANEOUS FOODSTUFFS CONDEMNED. Many foodstuffs are bought by retailers subject to examination, and the wholesalers accept the certificates of your Inspectors as to their quality. Doubtful canned goods and dried fruit are occasionally released from the Docks with the consent of your Medical Officer and these are subjected to special examination by your officers on their arrival in this district. Under these arrangements the following goods have been condemned and destroyed:— 7 boxes of Haddock. ½ cwt. Mussels. 2 tinned Hams. 1 box of Plaice. 15 Pheasants (these were seized and condemned). 1 Turkey. 27 Rabbits. 3 tins Corned Beef. 3 boxes of Cod Roes. 2 tins of Salmon. ADULTERATION, ETC. I am indebted to the County Council (the Authority for administering the provisions of the Food and Drugs (Adulteration) Act) for the following information respecting samples taken in this district:— Name of Article. Samples Taken. Found Adulterated. Milk 353 8 Milk, Sterilised 36 — Aspirin 1 — Brawn 1 — Bread 1 — Butter 5 — Cheese 1 — 37 Name of Article. Samples Taken. Found Adulterated Cream 1 — Cream Pastry 5 3 Gin 5 5 Hake 9 2 Lemon Sole 1 — Meat 1 — Meat Pie 1 — Minced Beef 10 2 Sausages 8 — Whisky 12 3 451 23 Number of prosecutions 4 Number of convictions 4 PREVALENCE OF, AND CONTROL OVER, INFECTIOUS AND OTHER DISEASES. The beginning of September, 1933, marked the commencement of an increased incidence of Scarlet Fever. The peak was reached in the week ended November 4th. There was a gradual decline from that date. Whereas in 1933 551 cases of Scarlet Fever were notified, in 1934 there were 628. Diphtheria, although more prevalent in 1934 than in 1933, was less pronounced and less sudden in its incidence, the most sustained increase being in the last quarter of the year. The number of notified cases in 1933 was 194, in 1934, 300. Most of the other notifiable infectious diseases showed a distinct decline. Although there has been an increased incidence it will be seen from the table of deaths that there was an increased fatality of two only in each group. It is probable that the number of deaths from Scarlet Fever could hardly have been reduced having regard to the severity of type of the 28 disease in each of the 3 cases, but there is little doubt that 12 deaths from Diphtheria is excessive and that number could have been substantiallyreduced if antitoxin had been administered early. Notwithstanding all that has been said and written many parents and doctors will not begin to regard a throat with membrane as being a case of Diphtheria until a "positive swab" is recorded. This is a courting of danger. Too often the intimation is received from the hospital of the occurrence of death with the note "moribund on admission." There can be no excuse for failure to administer antitoxin early on the ground of expense. Doctors may have it free of charge on application at the Town Hall, or (after office hours) the Central Fire Station or Coombes Croft Fire Station. Friday forenoons are set apart for the immunization of children against Diphtheria. The outbreak of this disease in different parts of England aroused parents' anxiety to such an extent that the Press gave prominence to the danger of infection. Increased numbers of children attended the Clinic, the parents not realizing probably that little or no protection is afforded until a period of months has elapsed. Arrangements are proceeding with the Southgate Borough Council for the acquisition of an interest in their hospital which it is proposed shall be enlarged. The practice is being adopted at the Southgate Hospital, so successfully followed in several other hospitals, of treating all cases of Scarlet Fever at the earliest available moment with antitoxin and ignoring desquamation as a potent means of spreading infection—thus shortening the stay of the patient in hospital to a period of about 3 weeks. It is not the practice in Tottenham to hospitalize Scarlet Fever cases generally. Provided there are no cogent reasons to the contrary patients are treated at home. School teachers notify weekly all children absent from school on account of infectious disease. The latter are followed up at home by the school nurses. SCARLET FEVER. The following table shows the number of patients removed to the different hospitals receiving Tottenham cases and the average duration of stay in each:— 39 Hospital. Diagnosis correct and cases treated to a conclusion. Diagnosis incorrect. Fatal cases. Number of cases. Average stay in Hospital (days). Number of cases. Average stay in Hospital (days). Number of cases. Average stay in Hospital (days). Southgate 119 33.7 9 9.4 2 22.0 Hornsey 72 36.4 4 25.0 — — L.C.C. 18 37.1 1 31.0 1 20.0 Enfield & Edmonton 1 113.0 — — — — London Fever 1 42.0 — - - - Wrongly diagnosed cases were re-classified as follows:—No evidence of Scarlet Fever, 6; Measles, 1; German Measles, 1; Mumps, 1; Chicken Pox, 1; Tonsillitis, 1; Bronchitis, 1; Stomatitis and Gingivitis, 1; Septic Rash, 1. DIPHTHERIA. The following table shows the hospitals receiving our cases and the average duration of their stay:— Hospital. Diagnosis correct and cases treated to a conclusion. Diagnosis incorrect. Fatal cases. Number of cases. Average stay in Hospital (days). Number of cases. Average stay in Hospital (days). Number of cases. Average stay in Hospital (days). Southgate 125 44.3 *13 31.6 4 1.5 Hornsey 103 43.7 15 22.2 6 15.8 L.C.C. 18 52.1 1 15.0 2 2.0 London Fever 3 61.3 - - - - Enfield & Edmonton — — 1 6.0 — — *Two cases proved fatal—causes of death: Heart Disease, Whooping Cough. Wrongly diagnosed cases were re-classified as follows:—No evidence of Diphtheria, 9; Scarlet Fever, 4; Tonsillitis, 6; Scarlet Fever and 40 Streptococcal Inieotion, 1; Croup, 1; Mumps, 1; Laryngitis, 1; Bronchitis, 1; Stomatitis, 1; Rhinitis, 1; Croup, Laryngitis and Bronchitis, 1; Post-pharyngeal abscess, 1; Acute unilateral tonsillar abscess, 1; Whooping Cough, 1. PUERPERAL FEVER AND PUERPERAL PYREXIA. 12 cases of Puerperal Fever and 22 cases of Puerperal Pyrexia were notified during 1934. Puerperal Sepsis accounted for 5 deaths, all of which occurred in hospitals outside the Borough. CASES OF NON-NOTIFIABLE INFECTIOUS DISEASE REMOVED TO HOSPITAL. 44 Measles and Pneumonia. 4 „ and Bronchitis. 2 „ and Toxic Condition. 1 „ Mumps and Pneumonia. 1 „ Whooping Cough and Pneumonia. 1 „ and Whooping Cough. 1 „ and Croup 1 „ Pneumonia and Croup. 1 „ Pneumonia and Convulsions. 1 „ Cellulitis and Bronchitis. 1 „ and Otitis Media. 1 „ Otitis Media and Mastoiditis. 1 „ and Mastoiditis. 1 „ and Mastoid. 1 „ and Ophthalmia. 1 „ and Marasmus. 1 „ and Nephritis. 8 Whooping Cough and Pneumonia. 3 „ and Bronchitis. 2 „ and Mastoiditis. 1 „ Bronchitis and Marasmus. 1 „ Emaciation and Debility. 1 „ and Congenital Syphilis. 1 Chicken Pox and Mastoid. 1 „ and Bronchitis. 1 „ and Cellulitis. 1 „ (patient required operative treatment after ing a screw). 41 SMALLPOX. There were no cases of Smallpox during 1934. I am obliged to the Vaccination Officer for the following information:—Number of successful vaccinations during 1934, 450; number of declarations of conscientious objection to vaccination, 765. DIABETES. With the approval of the Ministry of Health, Insulin was supplied to 6 patients suffering from Diabetes. The number of units amounted to 59,700 and the cost was £26 13s. Reports upon the progress of the cases were furnished to the Ministry according to their requirements. TUBERCULOSIS. The County Council are responsible for the treatment of Tuberculosis. 207 notifications were received during 1934—Pulmonary, 181; other than Pulmonary, 26. Cases remaining on the register at the end of the year were: Pulmonary, 629; Non-Pulmonary, 175. 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 and Contacts, 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. Dr. Davies, the Tuberculosis Officer, willingly co-operates with the Medical Officer of Health in the matter of keeping the register correct and in giving his expert opinion upon all cases referred to him. 42 Age Periods. New Cases. Deaths. Pulmonary. NonPulmonary. Pulmonary. NonPulmonary. Males Females Males Females Males Females Males Females Under 1 year - - - - - - - - 1 to 5 years 1 — 4 2 — — — — 5 to 15 „ 6 10 2 2 2 1 1 1 15 to 25 „ 13 36 3 2 8 22 2 1 25 to 35 „ 18 30 5 2 17 17 1 — 35 to 45 „ 23 11 2 — 17 8 2 1 45 to 55 „ 8 7 — — 9 5 1 1 55 to 65 „ 9 5 — 2 5 1 — — 65 years and upwards 4 — — — 6 2 — — Totals 82 99 16 10 64 56 7 4 Organs affected (New Cases):- Males. Females Lung 82 99 Glands — 3 Spine 1 1 Meninges 5 — Peritoneum 3 — Kidney 1 — Hip 2 1 Shoulder — 1 Leg — 1 Neck — 1 Ovary — 1 Other 4 1 98 109 43 MALIGNANT DISEASES. The deaths from Malignant Diseases in 1934 numbered 215, or 19 less than in 1933. The organs affected and the sex distribution are as indicated, viz.:— Digestive System:— Males. Females. Mouth.. 4 1 Tongue 2 — Œsophagus 6 4 Stomach 12 27 Bowels (large and small intestines) 1 4 Rectum 14 8 Liver and Gall Bladder 8 8 Pancreas 5 2 Colon 6 8 Peritoneum — 1 Duodenum 1 — Genito-urinary:— Kidney 3 — Bladder 8 1 Prostate 5 — Breast — 18 Uterus — 9 Ovary — 7 Cervix — 5 Vulva — 3 Testicle 1 - 44 Respiratory:— Males. Females Larynx 5 1 Pharynx 1 - Lung 11 4 Bronchus 1 1 Antrum - 1 Various:— Ear 1 1 Glands 5 - Hip - 1 100 115 _ Tottenham Education Committee. ANNUAL REPORT of the SCHOOL MEDICAL OFFICER for 1934. MEMBERS OF THE COMMITTEE. Alderman Major Sir P. B. MALONE, J.P. (Chairman). Councillor Miss R. F. COX (Vice-Chairman). Alderman E.J. FIELD. Alderman A. E. JAY. Alderman J. H. MORRELL. Councillor H. R. BAWCUTT. Councillor J. C. BRISTOW. Councillor E. STANLEY BROWN. Councillor E. W. COX. Councillor M. DORAN. Councillor L. C. A. DUBERY, J.P. Councillor A. E. HARVEY. Councillor Mrs. A. KITCHENER. Councillor A. J. LYNCH. Councillor Mrs. M. C. MANN (to June). Councillor W. E. MONTAGUE (deceased). Councillor W. J. TYLER. Councillor J. WALLACE. Councillor R. H. WARREN. Councillor C. WISE. *Miss A. M. OTTLEY, M.A. *Mr. F. A. RING. *Co-opted Members. 2 School Medical Department. School Medical Officer : David C. Kirkhope, M.D., Ch.M., D.P.H., of Gray's Inn and Middle Temple, Barrister-at-Law. Senior Assistant Medical Officer: Alice Stalker, M.B., Ch.B., D.P.H. Assistant Medical Officer: R. Hastings Smythe, L.R.C.P. and S.I. Ophthalmic Surgeon: T. W. 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.). Remedial Drill Instructress: Miss I. C. Moore, C.S.M.M.G. (Part-time). School Nurses: *†E. Johns. *†W. Barnes. *‡C. Vine. *†L. Rogers. ‡E. Barratt. *†H. McMath. *†§°B. Whitaker. *†‡R. Bentley-Corner. *General Training Certificate. †C.M.B. ‡Fever Training Certificate. §Health Visitor's Diploma. °Nursing of Sick Children, Massage, Electricity and Nervous Diseases Certificate. Clerical Staff: V. Goddard (Chief Clerk). T. E. Cowan, F.I.S.A. D. Osborne. R. E. Tuson. H. J. Dunham. (and at Laboratory). 3 SUNTRAP SPECIAL SCHOOL. Hayling Island. MEDICAL STAFF. Medical Officer (Part-time) : A. J. Mat, B.A., M.B. Honorary Consulting Surgeon : Sir Henry Gauvain, M.A., M.D., F.R.C.S. Matron-in-Charge : Miss 0. P. E. Hann, S.R.N., D.N. Miss D. Weetman, Bay Sister. Miss E. Hutton, Night Sister. 11 Probationary Nurses. GENERAL INFORMATION. Total School Population. Elementary. Secondary. Central. Special. Private. Total. 18,970 1,450 1,152 173 483 22,228 Number of Scholars on Roll. Elementary, Central and Special Schools. Provided Departments 58 On Roll 17,689 Non-Provided Departments 12 „ 2,384 Central Departments 3 „ 1,152 Special Day Schools in other Districts 2 „ 70 75 21,295 Boys. Girls. Infants. Mixed. Central. Special. Totals. Numbers on Roll 6,140 5,840 5,368 2,552 1,152 173 21,225 Average Attendance 5,627 5,380 4,470 2,309 1,095 147 19,028 Percentage of Average Attendance 91.6 92.3 83.3 90.5 95.0 85.0 89.4 4 INTRODUCTION. School Medical Department, Town Hall, Tottenham. March, 1935 To the Chairman and other Members of the Tottenham Education Committee. Ladies and Gentlemen, The School Medical Report for 1934 is of the less detailed type. Periodically—about once in five years—the Board of Education requires an exhaustive report of all the activities comprehended in the School Medical Services. The reports of the intervening years are expected to give particular information respecting new developments only and more general information respecting the other work of the department. It is expected that the report for 1935 will be of a comprehensive character. At the end of the year your Committee is without a drill instructress for children suffering from minor deformities and postural defects. In filling the vacancy created by the resignation of Miss Moore, opportunity is being taken of reviewing the whole field of orthopaedics and remedial drill instruction in their application to school children attending Tottenham schools, with a view of establishing that branch of the service on the most approved foundations of science and practice. I welcome this further opportunity of thanking your Committee and my colleagues and staff for their co-operation and loyal assistance, especially during the period of my enforced absence from duty. I am, Ladies and Gentlemen, Yours faithfully, 5 CO-ORDINATION. Arrangements for the co-ordination of the work of the School Medical Service with that of other Health Services. All branches of the Health Services are co-ordinated under the Medical Officer of Health, who is also the School Medical Officer and Medical Officer of the Maternity and Child Welfare Committee. The arrangements whereby this co-ordination takes place are recorded in the report for 1932. THE SCHOOL MEDICAL SERVICE IN RELATION TO PUBLIC ELEMENTARY SCHOOLS. School Hygiene.—The Committee's Surveyor has kindly furnished me with the following list of repairs and alterations to schools during the year. Reference should be made to the 1932 report for fuller details of the hygienic arrangements in schools. Belmont School. Improvements to gas lighting. Removal of steppings and forming level floors to two classrooms. Bruce Grove School. Removal of steppings and forming level floors to three classrooms. Provision of new desk-tables and chairs. Coleraine School. Re-decorations—External and Internal. Provision of additional classroom in playground, complete with furnishing. Removal of steppings and forming level floors to two classrooms. Crowland School. Provision of facilities for feeding of necessitous children. Culvert School. Removal of stepping and forming level floor in one classroom. 6 School for the Deaf. New wall blackboards in all classrooms in connection with the special teaching of deaf and dumb children. Devonshire Hill School. Provision of 100 desk-tables and 200 chairs. Downhills Central School. Remodelling of Girls' Domestic Centre; provision of new equipment. Downhills School. Remodelling Girls' range of offices on the gravitation system. New Staff-Room facilities for female teaching staff and remodelling the Staff-Room for male teaching staff. Down Lane Central School Re-decorations—External and Internal. Removal of stepping and forming level floor to one classroom. Earlsmead School. Removal of steppings and forming level floors to two classrooms. Provision of 20 new tables and 40 chairs for Infants. Lancasterian School. Provision of 50 new tables and 100 chairs for Infants. Removal of steppings and forming level floors to three classrooms. Page Green School. Provision of 20 new desk-tables and 40 chairs. Adaptation of disused Infants' Department as a Meals Centre for necessitous children. Parkhurst School. Removal of steppings and forming level floors to two classrooms. Risley Avenue School. Provision of 20 new tables and 40 chairs for Infants. Provision of 20 new table-desks and 40 chairs. Removal of steppings and forming level floors to three classrooms. 7 Seven Sisters School. Removal of steppings and forming level floors in ten classrooms. Provision of 80 new table-desks and 160 chairs. Installation of domestic hot water over children's wash basins. Remodelling of heating services. Stamford Hill School. Removal of steppings and forming level floors in four classrooms. Provision of 80 new desk-tables and 160 chairs. West Green School. Provision of facilities for feeding of necessitous children. Provision of new tables and chairs for infants. Removal of stepping and forming level floor to one classroom. St. Katharine's School. Internal re-decorations. Provision of 40 new locker desks. St. Ann's School. Provision of new table-desks and chairs and teachers' tables. St. Francis de Sales' School. Internal re-decorations. Provision of 25 new table-desks and 50 chairs. St. Ignatius School. Internal re-decorations. Provision of facilities for feeding necessitous children. Provision of 44 new tables and 88 chairs, for infants. Provision of 25 new desk-tables and 50 chairs. Bruce Castle School Clinic. Internal re-decorations. Chestnuts Dental Clinic. Internal re-decorations. St. Paul's School. Internal re-decorations. 8 General. In addition to the general maintenance work connected with the schools, a considerable number of new blackboards, desks, tables and cupboards have been made and supplied to the schools by the Works Department. In connection with the scheme of Re-organisation, practical rooms complete with equipment have been provided as follows:— Stamford Hill Girls' School.—Domestic Subjects Centre. Practical Work Room. Art Room. Stamford Hill Boys' School.—Handicraft Centre. Practical Work Room. Seven Sisters School.—The formation of Assembly Halls in Boys' and Girls' Departments. Practical workrooms complete with equipment have also been provided at the following schools:— Parkhurst Girls' School. St. Ann's Senior Mixed School. Lancasterian Girls' School. Lancasterian Boys' School. Bruce Grove Girls' School. Crowland Girls' School. Crowland Boys' School. MEDICAL INSPECTION. Description of arrangements made and methods adopted for the medical inspection of children:— All children coming within the three age-groups, "entrants," "intermediates'' and "leavers'' have been inspected during the year, and those found to be unsatisfactory have been re-inspected. See statistical tables, page 39. FINDINGS OF MEDICAL INSPECTION. Malnutrition.—Malnutrition was noted in 60 children at routine medical inspection as requiring treatment and 50 as requiring to be kept under observation. This is a marked increase over the 1933 figures and 9 indicates less an increase of malnourished children than the expression of the prominence given to slight degrees of departure from robust health by the Board's circular. Milk was supplied to 250 children on medical grounds in accordance with the recommendations of the Board of Education's circular No. 1437. Uncleanliness1.311 children were found to be unclean during 1934. The average number of children in attendance at school was 19.028. The percentage of unclean children was therefore 6.89. In 1933 it was 6.64 per cent. Minor Ailments and Diseases of the Skin.—There is very little change from year to year in the incidence of minor ailments, judged by the numbers recorded in attendance at the minor ailments clinics. There is nothing noteworthy to state with regard to the methods of ascertainment of these defects. It may be claimed, however, that the ailments generally are more amenable to treatment because of two factors, (a) the early date at which treatment is sought, (b) improved methods of treatment as the result of experience. Visual Defects and External Eye Diseases.—It will be observed from Table IV, Group II, that of the 757 children for whom spectacles were prescribed, 756 obtained them. Nose and Throat Defects.—There is a substantial reduction in the number of children returned as suffering from defects of nose and throat. This is probably due to the instructions given to the school doctors that only definitely pathological conditions are to be regarded. There was a corresponding reduction in the number of operations under your Authority's scheme. See Table II A, and Table IV, Group III. Ear Disease and Defective Hearing.—Organic defects of the ear show a gratifying reduction amongst the children examined, both in the routine and special inspections and likewise amongst children submitted to special inspection for hearing defect. The audiometer has been used systematically for the measurement of hearing acuity and has proved valuable in assessing the degree of hearing loss and the measure of gain as the result of treatment. For the special report upon the work done at the ear clinic, see page 13. 10 Dental Defects.—It will be seen from Table IV, Group V, page 47, that of 18,863 children inspected by the dentists, 13,013, or approximately 70 per cent., required treatment, and of those requiring it about 45 per cent., only, availed themselves of the treatment offered. In the matter of acceptances this cannot be regarded as satisfactory. Nevertheless,. there has been a considerable reduction in the number of extractions and an increase in the number of fillings and other conservative measures. Orthopaedic and Postural Defects.—Miss Moore, the remedial drill instructress, retired from the Committee's service on October 31st, 1934. At the end of the year her place had not been filled. During the interregnum the teachers are continuing to exercise the children under the supervision of one of the school doctors. The opportunity is being taken to revise the whole school system of orthopaedic treatment and remedial instruction. There is nothing of special note either in regard to the number or kind of deformities recorded. Heart Disease and Rheumatism.—There has been a reduction in the number of children found to be suffering from organic heart disease, viz., 58 in 1933, 44 in 1934; and the number of functional heart disorders have been halved. Rheumatism and heart diseases depend upon so many known and unknown factors, mostly intangible, that it must not be assumed that all the credit for these welcome reductions are due to the School Medical Services. Credit may be taken justly for the placing suitably of all early and doubtful cases coming to the knowledge of the department. Tuberculosis.—Tuberculosis of the lungs is such a disabling disease that one may be surprised that amongst school children so many as 11 should be found to be definitely afflicted with it and 16 more as being suspected to be sufferers. The same observation applies to tuberculosis of hip and spine, of which types 4 were noted. Yet so it is—the explanation probably being that the early stages are so insidious and the inspections were sufficiently thorough. FOLLOWING-UP. Review of the arrangements for the following-up of children suffering from physical defects, including a summary of the work undertaken by School Nurses:— 11 Children found on inspection or by special examination to be suffering from defects are followed-up in school or at home by a school medical officer, school nurse or attendance officer according to the nature of the defect in each case. For instance, crippled children absent from school are visited by a school doctor. Children suffering from general ailments and infectious or contagious disorders are followed-up by the school nurses, as are also children excluded from school by the medical officer at any of the school clinics or by the authority of a hospital doctor. Attendance officers follow-up cases whose absence from school does not seem to be warranted on medical grounds. The school nurses gave 116 baths to 57 children suffering from scabies. They paid 5,630 home visits, made 696 attendances at clinics and 445 school attendances for purposes of medical inspection. Table IV, Group VI, describes in statistical form the further activities of the school nurses. MEDICAL TREATMENT. Review of the methods employed or available for the treatment of defects and a statement of the ascertained results of treatment— SCHOOL CLINICS. Minor Ailments Clinics. Town Hall.—Monday, Tuesday, Thursday and Saturday mornings. Bruce Castle.—Monday, Wednesday and Friday mornings. Eye Clinic, Bruce Castle. Wednesday morning and afternoon. (Attendance by appointment only.) Aural Clinic, Bruce Castle. Tuesday and Friday mornings. (Attendance by appointment only.) Dental Clinics, Bruce Castle and The Chestnuts. Open daily from Monday to Friday inclusive. 12 Special directions have been issued to the Head Teachers respecting the attendance of school children at each of the above-mentioned Clinics. No change has been made in the arrangements for treatment of defects in school children during the past two or three years. They work satisfactorily. The proximity of the Prince of Wales's Hospital, the North Middlesex County Hospital and the great general and special hospitals in London makes it possible for every defect to receive appropriate treatment conveniently. Institutional treatment is provided at your Committee's Open-Air School, Hayling Island, and at various hospitals and institutions for special purposes. A list of these is appended (page 25), with the numbers who have been admitted to residence in each, during the year 1934. To Dr. Davies, the Tuberculosis Officer, and to the physicians and surgeons of the Institutions enumerated, your Committee is greatly indebted for their kindly help, always willingly given. 13 Ear Diseases and Hearing.—Dr. Friel's report is as follows:— AURAL REPORT. TABLE A. Aural Clinic—Otorrhœa Cases. Work carried out at the Clinic during the Year ended 31s£ December, 1934. Cause of Suppuration. Total Ears. Cured. Lost sight of. Still under treatment. Needing Hospital. Acute Suppurative Otitis Media 61 55 2 4 — Chronic Suppurative Otitis Media, due to (a) Tympanic Sepsis 29 24 4 1 — (b) T.S. and Granulations 15 13 1 1 — (c) T.S. and Polypus 2 2 — — — (d) T.S. and Rhinitis 9 5 1 3 — Tympanic Conditions and Attic Disease 7 - — 3 4 Mastoid Disease 8 1 — 5 2 External Otitis 18 16 - 2 - Not Diagnosed 5 1 2 — 2 Totals 154 117 10* 19 8 * Of the cases "lost sight of" 1 is being treated at hospital, 8 have left the District, and 1 refuses further treatment. The Table (A) of discharging ears shows the conditions found in the ears and also the results of treatment. The lines of treatment followed are the same as have been described in reports for several years. 14 TABLE B. AUDIOMETER TESTS. Total Number of Children Tested 4,022 Total with no Defect 3,665 or 91 2 per cent. Total found Defective 357 or 8.8 per cent. ROUTINE AUDIOMETER TESTS. Type of School. Total Number Tested. Total found with Defect. Defect found in:— Both Ears. One Ear. Junior Boys 1,438 131 62 69 Other Boys 1,185 105 38 67 Totals—Boys 2,623 236 100 136 Junior Girls 940 89 38 51 Other Girls 459 32 14 18 Totals—Girls 1,399 121 52 69 Totals—Boys 2,623 236 100 136 Girls 1,399 121 52 69 Grand Totals 4,022 357 152 205 The children found on first examination to have defective hearing are re-tested before the results are recorded. Table (B) gives the number of children tested for hearing power by means of the Audiometer, and also the number who show defect in hearing in one or both ears. TABLE C. Total Ears. Number of Ears, showing Hearing Loss in Units of Hearing, as follows:— 9 12 15 18 21 24 27 30 Boys 338 85 109 80 38 11 6 2 7 Girls 171 46 49 36 16 18 3 2 1 Totals 509 131 158 116 54 29 9 4 8 Table (C) shows the amount of the defects found. Tables (B) and (C) relate to children of 7 years old or over who are quite able to write. 15 TABLE D. ROUTINE FRAME TESTS OF INFANTS. (Ages 4 to 7 Years.) Total Tested. Total Found with Defect. Defect found in :— Both Ears. One Ear. Boys 280 31 5 20 Girls 357 47 11 36 Totals 637 78 16 62 Defect of hearing in 94 ears. Table (D) shows the results of the tests carried out on younger children by means of the Audiometer and Mr. Cowan's Test Frame. The tables and graphs, so far as they relate to children so tested, are intended to indicate the hearing power of children of from 4 to 7 years who have been discovered in the routine tests in the schools, and they furnish a comparison between the hearing conditions found in infants as a group, and older children. The summary of the two foregoing tables is as follows:— Of children under 7 years of age found with defective hearing, 79 per cent. showed hearing loss in one ear only and 21 per cent. in both ears, whereas in older children 58 per cent. have hearing loss in one ear only and 42 per cent. in both ears. The children showing hearing loss in both ears had exactly doubled. The importance of remedial measures being employed at the earliest possible moment could hardly be demonstrated more tellingly. Testing the Hearing of Children aged 4 to 7. Fig. 1. —Cowan Picture Test Frame. 16 It will be realised that young children unable to write, or those who are just acquiring that art, have great difficulty in concentrating upon two matters at one time—hearing and writing. Mr. Cowan's apparatus appears in large measure to overcome that difficulty. The apparatus consists of pictures of common objects, each mounted separately on a tablet sliding in two vertical grooves. These tablets are upright in frames in front of the child, and he is asked to press down a picture if he hears the name of it spoken. The pictures are 15 in number, mounted for convenience in three frames, which form an arc when joined end to end. The Audiometer gramophone plays a record speaking five pairs of names in graduated intensities. The words for the five remaining pictures are not spoken. These pictures are interspersed among the ten. The object of these surplus pictures is to make sure that the child actually hears the names of the pictures he selects. The name words were selected at a conference held in the Department of Applied Physiology of the London School of Hygiene and Tropical Medicine. The children take an interest in the test. The day before a routine test is held the teacher in the school explains what is going to be done, shows them a Frame and allows them to press down the tablets on which the pictures are mounted. The earphone is also applied to accustom the child to it. Six children can have their hearing tested at the same time. The results of the test are read off at once. Over 100 "infants" can be tested at a single session. This picture Test Frame is of economic importance, for some degree of deafness in one or both ears is not uncommon in young children. This is usually the result of earache, otorrhoea or catarrh of the nose extending to the pharynx, eustachian tube, and middle ear. There is more prospect of successful treatment if a disease is treated shortly after its onset. Catarrh, etc., can usually be easily dealt with if detected and treated early. It is probable that many of the defects in hearing, discovered in older children, are a continuation of defects begunearly in life. A further advantage of the Frame test seems to be that it is reliable and is not generally influenced by other conditions, such as nervousness, inattention, etc. There is a general correspondence between the hearing defects found by the hearing tests with the Cowan Frame and the Audiometer, and the condition found in the ear on clinical examination. 17 TABLE E. EARS TREATED IN WHICH HEARING LOSS WAS DUE TO — CATARRHAL DEAFNESS, EFFECTS OF SUPPURATION AND EXTERNAL OTITIS. Number of Ears with their Loss before Treatment. Loss reduced after treatment to :— 6 units or less. 9 units. 12 units. 15 units. 18 units. 62 ears had 9 units loss 53 9 - — — 60 „ 12 „ 54 5 1 - — 37 „ 15 „ 29 5 0 1 — 23 „ 18 „ 19 — 2 1 1 10 „ 21 „ 4 4 2 — — 6 „ 24 „ 3 — 2 1 — 3 „27 „ 1 1 — 1 — 5 ,, 30 „ 1 — 3 — 1 3 „ +30 „ 1 — 1 — 1 209 ears had loss of 9 to 30 units.. 166 24 13 4 3 Table (E) shows the amount of defect in hearing power found in children over 7 years of age before treatment, and the results of treatment. This is shown more strikingly when expressed in graphs. (See graph CC). Special cases, who have been referred from the Clinic and other sources have been tested in addition. The youngest child to be tested successfully was aged 3 years. He had suppuration in both ears following diphtheria. Unfortunately he was not tested before treatment commenced, but after treatment, and when his ears were dry there was found to be no hearing loss. Infants found to have some hearing loss have been referred for examination and necessary treatment at the Aural Clinic. Although a considerable number of children have been dealt with in this manner, there is not yet a sufficient bulk of data for preparing graphs similar to those referring to older children. 18 In the cases dealt with, however, the condition responsible for the hearing loss has yielded readily to treatment and there has been substantial improvement in hearing in almost every case. The parents co-operate by attending with their children regularly. The results of the Audiometer Tests and Treatment, as represented in the preceding tables, are also presented in graphic form (see following pages). Graphs AA and BB relate to the Audiometer Tests and show the comparative percentages; in the case of Graph AA, of children who passed and failed, in two groups, that is, Infants (4 to 7 years) and Older children (over 7 years), and are further sub-divided into groups of Boys and Girls. Graph BB shows in percentages, three groups, the result of the hearing tests:— A. Those with normal hearing. B. Those with slight defect. C. Those with severe defect. Graph CC is a record of the ears which were treated and not a record of ears in which some defect was found. In a number of cases, e.g., where there was a large dry perforation, no treatment was given. The figures represented by the check columns relate to the measure of hearing defect BEFORE treatment, that is to say, there were 95 ears included within the degrees of normal hearing. These are shown to the left of the vertical dotted line. This line indicates the division between 6 units and 9 units and is the threshold of defective hearing. These 95 ears were the better ears of children who had defective hearing in one ear only. Those to the right of the vertical line were of varying degrees of subnormal hearing in one or both ears. AFTER treatment the redistribution of the totals at each intensity is shown by the black columns. As a result of the treatment instituted for the defective ear, the hearing in the better ear frequently became more acute. This is seen in the column relating to 6 units loss on Graph CC, where the numbers of these ears are less after treatment than before, some having been transferred to other columns showing greater acuity of hearing. The tests have been carried out by Mr. Cowan and Nurse Whitaker, and the Department is indebted to them for the enthusiasm they have shown. The graphs have been prepared and drawn by Mr. Cowan. The illustration (Fig. 1) is reproduced by courtesy of the Editor of "The Teacher of the Deaf." " AA " AUDIOMETER TESTS. COMPARATIVE PERCENTAGES OF PASSES AND FAILURES IN ALL CHILDREN TESTED. "BB" AUDIOMETER TESTS. COMPARATIVE PERCENTAGE DISTRIBUTION OF HEARING LOSS, IN GROUPS. A. (-3 to 6 units) ; B. (9 to 18 units), and C. (21 to 20 units). IN ALL EARS TESTED. "CC" CLASSIFICATION OF ACUITY OF HEARING IN BOTH EARS OF PATIENTS TREATED. Defect when present was due to;— CATARRHAL DEAFNESS, SUPPURATION OR EXTERNAL OTITIS. BEFORE AND AFTER TREATMENT. Total Ears .. .. .. 302 UNITS HEARING LOSS 19 INFECTIOUS DISEASES. Review of the action taken to detect and prevent the spread of infectious diseases:- The precautions taken to prevent the spread of infectious diseases are in accordance with the recommendations of the "Memorandum on Closure of and Exclusion from School" of the Ministry of Health and Board of Education, 1927. In addition, all absentees from school on account of infectious diseases, except those removed to hospital, are followed-up at their homes, and they and contacts with cases of scarlet fever and diphtheria are medically examined before re-admission to school. At the following schools the attendance fell below 60 per cent. for the periods stated, and certificates were granted (Circular No. 1,348 of the Board of Education) declaring that the fall in attendance was due to the prevalence of measles and whooping cough— St. Ann's Infants' School 5 weeks Vale Road Infants' School 4 „ Earlsmead Infants' School 3 „ Holy Trinity Infants' School 2 „ Lancasterian Infants' School 2 „ Parkhurst Infants' School 1 week The following table states the incidence of infectious diseases amongst school children:— Scarlet Fever 349 Diphtheria 168 Erysipelas 3 Pneumonia 22 Tuberculosis—pulmonary 16 ,, non-pulmonary 4 Voluntary Notifications. Teachers, attendance officers and others gave intimation of the occurrence, amongst school children, of the following diseases with the stated incidence:— 20 Measles 1,930 Sore Throat 39 German Measles 189 Influenza 26 Mumps 656 Eye Disease 4 Whooping Cough 371 Skin Diseases 32 Chickenpox 555 Sores and Impetigo 61 Scarlet Fever 335 Rheumatism 6 Diphtheria 154 Other Diseases 188 Scabies 27 Children excluded owing to Infectious Disease Tonsilitis 33 Chorea 5 in house 940 Bronchitis 37 Bacteriological Examinations. 1,252 swabs were taken from children discharged from Hospital after diphtheria, and from home and school contacts. As the result of examination, 185 were found to carry diphtheria germs, 988 did not show such evidence, whilst 79 had germs similar to, but not identical with, diphtheria germs. Microscopical Examinations. Seven specimens of hairs were examined and two of these were found to contain the spores of ringworm. OPEN-AIR EDUCATION. Review of the arrangements made for the provision of facilities for open-air education and of the results obtained. (a) Open-air classrooms in public elementary schools. (b) School journeys and school camps. (c) Physical training. I am indebted to the Director of Education for the following information under the above headings:— (a) Open-Air Classrooms. The Open-Air Classes which have been conducted for several years, for boys, at Orchard House (all the year round), and for girls at the Bandstand in Downhills Park (May to October), have been continued with the usual good results. For further details concerning these two classes, see pages 31-33. 21 (b) School Journeys and Camps. For the year 1934, expenditure not exceeding £400 was agreed to by the Education Committee, and approved by the Board of Education. The following grants were sanctioned:— £ Belmont Senior Boys' 25 Crowland Road Boys' 40 Downhills Senior Girls' 55 Down Lane Central Girls' 55 Earlsmead Junior Boys' 36 Earlsmead Junior Girls' 15 Risley Avenue Senior Girls' 40 St. Katharine's Girls' 35 St. Paul's 45 Deaf 25 Shaftesbury Society's Journeys (Fares, etc.) 29 £400 The Committee first gave assistance to School Journeys in 1920, and since 1925 the following grants have been made:— Year. Amount sanctioned. Amount paid. £ s. d. £ s. d. 1925 190 0 0 168 3 0 1926 120 0 0 131 0 0 1927 160 0 0 160 0 0 1928 130 0 0 125 0 0 1929 270 0 0 247 0 0 1930 285 0 0 252 13 0 1931 365 0 0 306 11 5 1932 290 0 0 290 0 0 1933 280 0 0 265 0 0 1934 400 0 0 374 0 0 Brief particulars of the Journeys carried out in 1934 are appended. 22 1. BELMONT SENIOR BOYS' SCHOOL. For its first School Journey this School sent a party of 22 boys and 2 teachers to Swanage for ten days in May. The total cost was £57. Committee's contribution, £25. 2. CROWLAND ROAD BOYS' SCHOOL. Niton, Isle of Wight, was once more chosen as the Centre for the Journey. The party of 40 boys and 2 teachers spent a week there in May, and, as in previous years, they were accommodated in cottages and had ample opportunity of joining in the life of a village community. The inhabitants of Niton again made the party very welcome and were extremely helpful to them. The total cost of the Journey was £105, of which the Committee contributed £40. (A balance of £10 was returned from the grant of £50.) 3. DOWNHILLS SENIOR GIRLS' SCHOOL. For its first School Journey this School sent two parties (40 girls in each) to Folkestone for a week in May. The total cost was £168. Committee's contribution, £55. 4. DOWN LANE CENTRAL SCHOOL FOR GIRLS. 75 girls and 4 teachers, in two parties, visited Stratford-on-Avon for a week in May. Many excursions were made to places of interest in the neighbourhood. The total cost was £225. Committee's contribution, £55. 5. EARLSMEAD JUNIOR BOYS' SCHOOL. A party of 30 boys and 2 teachers spent a fortnight at Shanklin, Isle of Wight, in May. This was the fifth visit organised by this Junior School, and, as on previous occasions, the Journey was thoroughly enjoyed by the boys, and the Head Master reports that considerable benefit was derived. The total cost was £99. Committee's contribution, £36. 6. EARLSMEAD JUNIOR GIRLS' SCHOOL. 20 girls and 2 teachers visited Sandown, Isle of Wight, for a week in April. Total cost, £51. Committee's contribution, £15. 23 7. RISLEY AVENUE SENIOR GIRLS' SCHOOL. 36 girls and 2 teachers visited Sandown, Isle of Wight, for a fortnight in May. Total cost, £126. Committee's contribution, £40. 8. ST. KATHARINE'S SENIOR GIRLS' SCHOOL. 34 girls and 2 teachers spent a fortnight in May at Seaford, Sussex. Total cost, £90. Committee's contribution, £35. 9. ST. PAUL'S JUNIOR GIRLS' SCHOOL. For its fifteenth Journey this School sent a party of 40 girls and 2 teachers to Folkestone for a fortnight in May. Total cost, £110. Committee's contribution, £45. 10. DEAF SCHOOL. 33 children, in charge of 2 teachers, spent a fortnight at a Holiday Camp near Chichester. Total cost, £75. Committee's contribution, £25. 11. JOURNEYS ORGANISED BY THE SHAFTESBURY SOCIETY. Two parties of children, 40 boys and 25 girls, each in charge of 2 teachers, spent a fortnight at the Shaftesbury Society's Hostels at Dovercourt and Whitstable in July. Maintenance costs were borne by the Society, but the Committee made a grant of £29 towards fares, incidental expenses and maintenance of the teachers who accompanied the parties. (c) Physical Training. Physical training is regarded in the Area as a subject of highest importance. The new and lively interest in the subject engendered by the issue of the Board of Education's new Syllabus of Physical Training in 1933 has been well maintained, and the appointment in October of two Physical Training Organiseis by the Tottenham, Finchley, Hornsey and W ood Green Education Committees jointly to serve the four authorities will, it is confidently hoped, do much to extend and develop Physical Training work in schools throughout the Area. An impressive series of demonstrations with classes of children was given just before the close of the year to all Head Teachers of schools within the four Areas. 24 Part-time courses are being planned for selected teachers from all types of schools, and these will be held in the Spring Term, 1935. Arrangements are also being made for the provision of mobile apparatus necessary to give full effect to the Board of Education Syllabus, 1933. Swimming Instruction. Swimming instruction has continued throughout the year at the Indoor Bath at the Town Hall, and during the Summer Season at the Open-air Bath. The number of awards of certificates for swimming various distances continues to be highly gratifying. No less than 2,579 such certificates were gained by pupils of the schools during the year (ending 31st March, 1934). PROVISION OF MEALS. The arrangements for associating the School Medical Service with the work by the Education Committee under Sections 82—84 of the Education Act, 1921, particularly as regards the selection of children for meals, the approval of dietaries, the suitability, adequacy, and results of the arrangements made, remain as they have been for several years. During the year ended 31st December, 1934, 279,599 dinners were provided to children in the Schools. Of these, 265,128 were provided free to children of necessitous parents, and 14,471, on payment, to children in Central Schools. In addition, 5,966 cod liver oil and malt "meals" were given to children attending Special Schools or Open-Air Classes. There has been a large increase in the supply of morning milk. The average number of children receiving milk daily during the year was 12,422—12 172 on payment, under the voluntary schemes organised by the Head Teachers of 68 school departments, and 250 free, on the recommendation of the School Medical Officer. CO-OPERATION OF PARENTS, TEACHERS, SCHOOL ATTENDANCE OFFICERS AND VOLUNTARY BODIES. The methods employed to enlist the assistance of each group are the same as in 1930. 25 INSTITUTIONAL TREATMENT. During the year 507 children were sent away for varying periods as follows:— Suntrap Special School, Hayling Island 296 Other Residential Schools 16 Convalescent Homes selected by the Invalid Children's Aid Association 191 King Edward VII Memorial Seaside Hostel, Bexhill-on-Sea 4 The following table gives the conditions on account of which children received convalescent treatment:— Nervous Debility 15 Bronchitis and Bronchial Catarrh 33 Debility after Infectious Disease 16 Asthma 8 Post-operative Debility 10 Non-tubercular Lung Disease 17 Anaemia and Debility 84 General Debility 204 Chorea 26 Heart Affections and Anaemia 15 Enlargement of Glands .. 1 Rheumatism 21 Other Cases .. 57 PROVISION OF SURGICAL INSTRUMENTS. Surgical appliances were supplied, and repairs and replacements effected in 240 instances. These were in respect of 84 children who were suffering from the following defects:— Infantile and other forms of Paralysis 28 Flat-foot 18 Talipes 2 Tuberculosis:— Other forms of Deformed Feet 10 Hip 4 Spine 2 Amputated Leg 4 Bones and Joints 1 Genu Valgum 4 Other Cases 11 BLIND, DEAF, DEFECTIVE AND EPILEPTIC CHILDREN. (a) Review of the methods adopted for ascertaining and dealing with children who are defective within the meaning of Part V of the Education Act, 1921, and of the adequacy of such methods. 26 Through parents, attendance officers, health visitors and nurses, children afflicted with these conditions are brought to the notice of your Committee's medical officers. The blind are sent to Institutions for the blind. There are seven Tottenham children in the following Institutions for the blind and partially blind:— East London Home, Clapton 2 children. White Oak, Swanley, Kent 4 ,, Royal Normal College, Norwood 1 child. Myopic children attend the Wood Green Myopic Centre. These are first examined by your Eye Specialist, whose advice is acted upon. The deaf attend the Tottenham School for the Deaf, and children from neighbouring authorities are, by arrangement, likewise admitted. A school nurse visits twice weekly for cleansing the ear passages. One deaf and dumb child is resident at the Royal Deaf and Dumb School, Margate, and another at St. John's, Boston Spa, Yorkshire. Physically defective children attend the Vale Road Physically Defective Centre. 9 children who require residential treatment are accommodated as follows, namely, at:— Sir William Treloar's Home Alton 1 child Heritage Art and Craft School, Chailey 1 ,, The Warren Home, Lancing, Sussex 1 ,, Edward VII Memorial Hostel. Bexhill 2 children St. John's Institution, Buckhurst Hill 2 ,, Royal Sea Bathing Hospital, Margate 1 child St. John's, Brighton 1 ,, Higher Grade mentally defective children, for whom your Committee are responsible, attend Oak Lodge Special School, Finchley. Those who require institutional education are, when accommodation has been found, admitted to residential special schools. Thus there are:— Three children at All Souls' Special School, Hillingdon, and one child at St. Joseph's, Lambourne, Astwood Bank, near Redditch. Low-grade defectives are referred to the County Authority. 27 For epileptic children, institutional treatment has been provided as follows:— At Lingfield Home and School, 1 boy and 2 girls. Before reaching the age of 16 years, all children in Institutions are examined to determine whether, after reaching that age, further supervision will be necessary, in which case the County Authority is notified. Annual visits are paid by your School Medical Officer to all Institutions where Tottenham children are resident under your Committee's scheme, and reports are furnished to your Committee. In all other respects the arrangements for defective children are the same as last year. (b) Statement of the arrangements made for the supervision of mentally defective children not in Special Schools:— An Occupation Centre has been established by the Central Association for Mental Welfare and provides accommodation for 30 Tottenham children. Medical inspection and treatment are carried out by arrangement with the County Authority. The School for the Deaf. The report of Miss Beckinysale (Head Teacher) is as follows:— The School for the Deaf serves the areas of Tottenham, Edmonton, Wood Green and Enfield. By arrangement children may be accepted from other districts and county authorities. The Edmonton, Wood Green and Enfield Authorities provide guides for the groups of pupils attending the school from their respective districts. Scholars from Hornsey and certain younger Tottenham children are conveyed by ambulance. Pupils from Middlesex, Hertfordshire and Essex and the majority of the boys and girls living in Tottenham travel independently. The pupils remain at school during the mid-day interval. A twocourse hot dinner is prepared on the premises, and is supplied for the sum of 3d. daily. A few scholars bring their own cold meal, which may be supplemented by hot cocoa, and necessitous scholars are given the school dinner free of charge. 28 The elder girls take cookery in the dinner hut one morning weekly and the elder boys are taught woodwork by a visiting master. Drill and country dancing are taken, but owing to the fact that the school has no hall, it is not easy to arrange for these lessons in inclement weather. Speech and language being normally learned by imitation, the congenitally and totally deaf are also dumb unless they receive special instruction. Not only are they dumb, but they have the deeper disability of being without language. The school therefore strives to give the pupils a mastery of their mother tongue so that they may express their thoughts and receive the thoughts of others. The pupils leave school at the end of the term in which their 16th birthday occurs, and before each child reaches the maximum age work is found for him, so that he goes straight from school to employment. Among the types of work the deaf undertake are lettering, signwriting and all branches of commercial art, cabinet making and various branches of work in wood; dressmaking, millinery and embroidery. During the year a School Journey was undertaken. Twenty-seven of the senior boys and girls in the care of three mistresses spent a fortnight in June at Nutbourne Camp, Hambrook, near Chichester. The mornings were given to lessons, chiefly on the surrounding countryside; during the afternoons walks were taken, and in the evenings there were games. A part of every day was set apart for free time and rest. The pupils kept their sleeping quarters clean and tidy, but otherwise had no domestic duties. The food was good and abundant and the conditions of the camp were excellent. It is hoped that the boys and girls learned something of country life and also of good citizenship during their time of living together. Oak Lodge School for Mentally Defective Children. The Head Teacher has furnished the following report with regard to Tottenham children attending Oak Lodge:— During the year 1934, 72 children attended this school from the Tottenham area. Of these, 20 were new admissions and 14 were withdrawn . 29 Of the latter, 6 left the district, 1 entered an institution, 1 went to the Occupation Centre, 1 was excluded by the School Medical Officer, and 5 left. These 5 were between the ages of 14 and 16 and were allowed to leave when suitable work was found for them. If they can find jobs in shoe repairer's shops, they should do well, as all of them have had experience in repairing shoes. Old scholars frequently visit the school to report progress, and some are doing very well; keeping the same positions for four and five years, some being in positions of responsibility, with others working under them. Vale Road School for Physically Defective Children. The following report is based upon information supplied by Miss Hubbard (Head Mistress of the school):— The School for Physically Defective Children is situated in Vale Road. It consists of three classrooms and hall; quite modern in lighting, flooring and equipment. Attached to the school is a playing field in which lessons are given in the summer. Adjoining this is the school garden where the senior boys grow many varieties of vegetables, and the girls flowers. Half the children arrive in ambulances at 9.30 a.m., when lessons are started. The remainder arrive at 10 a.m. and stay later in the afternoon to complete the work of the day. The morning curriculum varies little from that of a normal elementary school. The afternoon session is devoted to handicraft. The senior boys attend a woodwork centre at Stamford Hill School once a week. The boys also learn chair-seating in cane and cord, bookbinding, weaving, rug-making, leather and pewter work, and poster-writing. Many posters have been prepared for dances held by various associations. The girls specialise in embroidery and plain needlecraft. This year a selection of cushion covers embroidered by the girls was sent to South America. Samples of boys' and girls' work have also been shown at the Middlesex Exhibition and in South Africa. 30 The children partake of a two-course dinner sent from the meals centre at Down Lane. Milk, heated in the cold weather, is provided at the lunch break; cod-liver oil and malt and chemical food are administered to special cases. A trained nurse is in attendance to supervise remedial exercises and to massage where such treatment has been prescribed and is present in care of the children during the daily rest period of an hour. Records are kept of past scholars and much care is given to aid children to obtain suitable employment. During the year there were 21 admissions and 15 removals. Of the latter, 2 were sent back to ordinary school cured, 5 removed from the district; the remainder obtained the following employment: clerical 3, tailoring 1, wireless apparatus work 1, greengrocer's boy 1. One boy now attends a special cripple institution to learn tailoring. Attempts are made to keep in touch with old scholars by visiting or by letter. The school was established 10 years ago and the list of old scholars is lengthy. There have been on the school lists 240 scholars, accounted for as follows:— 78 are still in attendance. 2 are in convalescent homes. 51 have been transferred to ordinary schools. 16 have died. 2 have gone to industrial schools. 83 obtained employment. 8 are unfit for employment. The following is a list stating the nature of the infirmities of the children who attended the school during the year, and their respective numbers:— Infantile Paralysis 15 Cerebral Diplegia 4 Other forms of Paralysis 5 Congenital Deformities 2 Genu Valgum 1 Amputation of Leg 4 31 Congenital Dislocation of Hips 2 Hydrocephalus 2 Tuberculosis:— Spine 6 Hip 8 Knee 3 Heart Disease 27 Lordship Lane School for Partially Blind Children. I am indebted to the Head Teacher for the particulars from which the following statement is made:— Number of Tottenham children on roll, March, 1934 13 Number of Tottenham children on roll, January, 1935 13 Number left during 1934 3 Number admitted during 1934 3 Of the present scholars, 6 are boys, 7 are girls. With the exception of one boy, all scholars have made good progress during the year. The school work was on exhibition during an "Open-Day" in July, and a concert was given by the school children in December. At the latter function tea was served by the senior girls, and handwork was exhibited and sold. The boys spend two half-days a week in the woodwork centre and girls over eleven years of age spend two half-day sessions in the cookery centre. As a result of the publication of the Board of Education's Report on Schools for the Partially Sighted, printed reading books take the place of large sheets hand-printed by the teacher, much to the improvement of reading, spelling and general knowledge. The girls are now permitted to do needlework with thick wool and large needles. This is a new departure. Orchard House Open-Air Centre. Report for the year ended 31s( December, 1934. During the year there were 46 children on the school roll. 21 scholars were admitted and 17 left. 32 Of the 17 who left, 2 were returned as "lit" to their ordinary schools, 1 left the district and 14 left on account of age exemption. The boys who left are in work and follow the following occupations :— 1 vanboy, 2 hawkers, 1 office work, 2 engineering, 8 factory work (wood and boots). The boys who were admitted in 1934 were, on the whole, very backward, both physically and educationally, but signs are evident that they are gradually improving in physique and educational attainments. On March 11th, 1934, a new classroom was opened by the ViceChairman of the Education Committee. It has been much appreciated and has given every satisfaction. The old classroom has been equipped as a manual room with benches and tools, and the elder boys may now resume their woodwork instruction. The average increase in weight of the scholars was about 7 J lbs. The scholars were drawn from the following schools:—Lancasterian, Devonshire Hill, Risley Avenue, Parkhurst and Coleraine Park. Downhills Park Open-Air Class. This class was opened in the bandstand on April 30th and closed on October 26th. The number of pupils on roll was 23. Of these, 9 were admitted from Downhills Senior Girls, 7 from Culvert Senior Girls, 2 from Page Green Senior Girls, 3 from Downhills Junior Mixed and 2 from West Green Junior Mixed Schools. The class was composed of children suffering from the following defects Anaemia 4 Debility 2 Debility and Cervical Adenitis 1 Bronchitis and Bronchial Catarrh 8 Tuberculosis of Cervical Glands 1 Quiescent Tuberculosis of Knee 1 Erythema Nodosum 1 Subnormal Nutrition 5 33 One-third of a pint of fresh milk was provided daily to all the pupils and 18 were supplied with cod-liver oil and malt. The average gain in weight of the scholars was 4"8 lbs., and considerable improvement in health was noted in the majority of the children after their period of open-air education. The class consisted entirely of girls, whose ages ranged from 8 to 14 years, which constituted a problem for the teacher. This difficulty was met, partly by keeping the roll as small as possible, but mainly by the exceptional competence for this kind of work of the teacher in charge. In Geography, unusual ingenuity was shown in discovering topics which were of interest and profit to all members of the class. Dramatic Work was a successful feature, and a very wide use was made of the educational and health-giving advantages offered by a park. It would be difficult to find a happier class. Full-time Courses of Higher Education for Blind,Deaf, Defective and Epileptic Students:— These cases are dealt with by the County Authority. Suntrap Home, Hayling Island. At the beginning of 1934— 111 children were in residence; 425 were admitted in 1934; 421 were discharged; 115 remained at the beginning of 1935. These include children from districts other than Tottenham. All the children derived substantial benefit from their stay at the Home. NURSERY SCHOOLS. Statement of the work of the School Medical Service in connection with Nursery Schools, including results of medical inspection and treatment. There are no Nursery Schools in Tottenham. 34 Two Nursery Classes for children from 3-4 years of age, and one Transitional Class for infants of 4-4½ years, with accommodation for 65 children, are held in bright and airy classrooms at Lancasterian School. Admission is granted at the request of parents and on the recommendation of the medical officer in charge of the Infant Welfare Centre in the northern area of the Borough. The children undergo routine medical inspection annually, and the School Nurse pays weekly visits, during which she carries out cleanliness inspections, treats minor ailments and gives simple instruction in hygiene. Casual visits to the Nursery Classes are also paid at frequent intervals by the Senior Assistant Medical Officer and School Nurse. As the Bruce Castle Treatment Centre is within easy access of Lancasterian School, any child requiring medical attention is immediately referred to the School Clinic for treatment. Each child is provided with individual toilet accessories, including comb and toothbrush, and a high standard of personal hygiene has been maintained. One-third of a pint of pasteurized milk is supplied to every child daily and the weekly weighings have disclosed a steady gain in weight in the majority of the little pupils. SECONDARY SCHOOLS AND OTHER INSTITUTIONS OF HIGHER EDUCATION. Statement of the work of the School Medical Service in connection with pupils attending secondary schools and other institutions of higher education, showing the provision made for medical inspection and treatment. I.—Medical Inspection :— Schools provided by the County Authority and numbers on the register of each:— 35 Boys. Girls. Totals. County School 284 266 550 High School — 489 489 Grammar School 409 - 409 Junior Commercial School 21 70 91 Junior Technical School 185 — 185 899 825 1,724 Your Committee's Medical Officers inspect children in attendance at secondary schools in Tottenham, by arrangement with the County Council. Full medical inspection is made of all pupils in secondary schools as follows:— (i) During the year of entrance to school. (ii) Between 13 and 14 years of age. (iii) Between 15 and 16 years of age. Special examinations of selected pupils are carried out by the Medical Officers when requested by the Head Teachers. During 1934 there were inspected 518 boys and 494 girls. II.—Following-up and Medical Treatment:— Following up is undertaken by the Head Teachers, who submit reports to the School Medical Officer. Ophthalmic and dental treatment is available for necessitous cases °nly. 39 boys and 67 girls were examined by Mr. Letch worth for visual defects and suitable spectacles were advised where necessary. 36 8 boys and 15 girls received dental treatment, which necessitated 53 attendances at the clinics. There were 22 extractions and 27 fillings. PARENTS' PAYMENTS. Arrangements for recovering the cost of treatment from parents:— The same arrangements obtain as were stated in the report for 1933. EXAMINATIONS BY THE MEDICAL OFFICERS. Your Medical Officers examine all entrants into your Committee's permanent service, and children engaging in theatrical performances are examined, and periodically re-examined. 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 when necessary, on the recommendation of the Medical Officers, to children attending the Treatment Centres. The following quantities have been dispensed at cost price, at less than cost price, or gratuitously, according to circumstances:— Cod Liver Oil and Malt 9811bs. Parrish's Food 3881bs. Cod Liver Oil 370ozs. Syrupus Ferri Iodidi l,901ozs. Syrupus Calcii Lactophosphatis l,814ozs. SECONDARY SCHOOLS. Table I.—Number of Pupils inspected 1st January, 1934, to 31st December, 1934. Routine Inspections. Ages. 11 12 13 14 15 16 17 Total. Boys 113 72 112 118 77 21 5 518 Girls 135 92 98 101 68 — — 494 Totals 248 164 210 219 145 21 5 1,012 37 SECONDARY SCHOOLS (contd.). Table II.— Return op Defects Found in the Course of Medical Inspection in 1934. Defect or Disease. Routine Inspections. Number referred for Treatment. Number requiring to be kept under Observation, but not referred for Treatment. (1) (2) (3) Malnutrition 5 - Uncleanliness:— Head 2 — Body — — Skin Ringworm:— Head — — Body — — Scabies — — Impetigo — — Other Diseases (Non-Tubercular) 10 — Eye Blepharitis — — Conjunctivitis 1 — Keratitis — — Corneal Opacities — — Defective Vision 100 2 Squint — — Other Conditions 4 — Ear Defective Hearing 3 — Otitis Media 2 — Other Ear Diseases 4 — Enlarged Tonsils 9 4 Nose and Throat Adenoids — — Enlarged Tonsils and Adenoids 1 — Other Conditions 4 — Enl. Cervical Glands (Non-Tubercular) — — Defective Speech — — Heart and Circulation Heart Disease:— Organic 2 2 Functional — 1 Anaemia 1 — Lungs Bronchitis and Bronchial Catarrh 3 — Other Non-Tubercular Diseases 4 — Tuberculosis Pulmonary:— Definite — — Suspected — — Non-Pulmonarv Glands — — Spine — — Hip — — Other Bones and Joints.. — Skin — — Other Forms — — Nervous System Epilepsy 1 — Chorea — — Other Conditions — — Deformities Rickets — ' — Spinal Curvature 3 — Other Forms 20 — other Defects and Diseases 27 3 Table III. relates to "Exceptional Children" and is not required in connection with Secondary Schools 38 SECONDARY SCHOOLS (contd.). Table IV.— Treatment of Defects of Pupils during 1934. Group I.— Treatment of Minor Ailments. Disease or Defect. No. of Defects Treated, or under Treatment during the Year. Under Local Education Authority's Scheme. Otherwise. Total. Skin:— Ringworm—Head — — — Ringworm—Body — — — Scabies — — — Impetigo — — — Minor Injuries — — — Other Skin Diseases - 8 8 Ear Disease - 4 4 Eye Disease-:— External and other — 2 2 Miscellaneous - 1 1 Total - 15 15 Group II.— Defective Vision and Squint (excluding Minor Eye Defects treated as Minor Ailments— Group I). Defect or Disease. No. of Defects dealt with. Under the Authority's Scheme. Submitted to refraction by private practitioner or at hospital, apart from the Authority's Scheme. Otherwise. Total. (1) (2) (3) (4) (5) Errors of Refraction (including Squint) 71 16 - 87 Other Defect or Disease of the Eyes (excluding those recorded in Group I) - - - — Total 71 16 — 87 Total number of Pupils for whom spectacles were prescribed:— (а) Under the Authority's Scheme 70 (б) Otherwise 16 Total number of Pupils who obtained or received spectacles: — (a) Under the Authority's Scheme 70 (b) Otherwise 16 39 SECONDARY SCHOOLS (contd.). Group III.— Treatment of Defects of Nose and Throat. Number of Defects. Received Operative Treatment. Received Other Forms of Treatment. Total Number Treated. Under the Authority's Scheme in Clinic or Hospital. By Private Practitioner or Hospital, apart from the Authority's Scheme. Total. (i) (ii) (iii) (iv) (i) (ii) (iii) (iv) (i) (ii) (iii) (iv) (i) (ii) (iii) (iv) (i) (ii) (iii) (iv) - — — — 6 — 1 — 6 — 1 — 1 — — 4 7 — 1 4 (i) Tonsils only. (ii) Adenoids only. (iii) Tonsils and Adenoids, (iv) Other defects of the nose and throat. Group IV.—Dental Defects . Number of Pupils who were:— Found to require treatment 94 Aotually treated 62 ELEMENTARY SCHOOLS. Table I.— Number of Children Inspected 1st January to 31st December, 1934. A.— Routine Medical Inspections. Number of Code Group Inspections:— Entrants 2,022 Second Age Group 1,971 Third Age Group 2,211 Total 6,204 Number of other Routine inspection — B.— Other Inspections. Number of Special Inspections 6,875 Number of Re-Inspections 13,691 Total 20,566 40 Table II. A.— Return of Defects found by Medical Inspection in thk Year ended 31st December, 1934. 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 60 50 189 - Uncleanliness:—(See Table IV, Group VI) Skin Ringworm: — Scalp — — 5 - Body 1 — 17 - Scabies — — 52 - Impetigo 6 — 203 - Other Diseases (Non-Tuberculous) 6 - 326 2 Eye Blepharitis 8 — 55 — Conjunctivitis 10 — 128 — Keratitis — — 8 — Corneal Opacities — — 1 — Defective Vision (excluding Squint) 352 32 429 - Squint 25 — 147 — Other Conditions 4 — 90 — Ear Defective Hearing 26 — 7 — Otitis Media 23 — 77 — Other Ear Diseases 2 — 95 2 Enlarged Tonsils only 157 167 136 5 Nose and Throat Adenoids only 2 2 — 1 Enlarged Tonsils and Adenoids 93 15 53 2 Other Conditions 57 2 224 1 Enlarged Cervical Glands (Non-Tuberculous) 5 14 85 — Defective Speech 4 3 3 — Teeth—Dental Diseases (See Table IV, Group V) Heart and Circulation Heart Disease:— Organic 3 16 21 4 Functional — 27 6 2 Anaemia 19 2 102 — Lungs Bronchitis & Bronchial Catarrh 24 96 408 — Other Non-Tuberculous Diseases 5 4 37 1 Tuberculosis Pulmonary:— Definite — — 11 — Suspected 6 4 6 — Non-Pulmonary: — Glands 4 1 30 — Bones and Joints — — 4 — Skin 1 — — — Other Forms — — — — Nervous System Epilepsy — 1 3 — Chorea 9 1 93 — Other Conditions 8 4 72 5 Deformities 'Rickets — — 6 — Spinal Curvature 7 — 48 1 Other Forms 62 3 163 2 Other defects and diseases 120 36 2273 12 Total 1109 480 5613 40 41 Table II.— Continued. B. Number or individual children found at Routine Medical Inspection to Require Treatment (excludino Uncleanliness and Dental Diseases), Group. Number of Children. Inspected. Found to require Treatment. (1) (2) (3) Code Groups:— Entrants 2,022 316 Second Age Group 1,971 319 Third Age Group 2,211 410 Total (Code Groups) 6,204 1,045 Other Routine Inspections - — Grand Total 6,204 1,045 42 Table III.— RETURN OF ALL EXCEPTIONAL CHILDREN IN THE AREA. Children Suffering from Multiple Defects. Children suffering from any combination of the following types of defects:— Blindness (not partial Blindness), Deafness (not partial Deafness), Mental Defect, Epilepsy, Active Tuberculosis, Crippling (as defined in the penultimate category of the Table), Heart Disease—Total 12. Dcfects. Type of School Attending (if any). 3 Girls Crippling and Mental Defective Day Special School for Mentally Defective Children. 5 Boys and 1 Girl Crippling and Heart Disease Day Special School for Physically Defective Children. 1 Boy Crippling and Deafness Unfit to attend School. 1 Girl Crippling and Heart Disease Unfit to attend School. 1 Boy Tuberculous Cervical Glands and Heart Disease Unfit to attend School. BLIND CHILDREN. At Certified Schools for the Blind. At Public Elementary Schools. At Other Institutions. At no School or Institution. Total. 3 — — — 3 PARTIALLY BLIND CHILDREN. At Certified Schools for the Blind. At Certified Schools for the Partially Blind. At Public Elementary Schools. At Other Institutions. At no School or Institution. Total. 4 13 — — — 17 43 DEAF CHILDREN. At Certified Schools for the Deaf. At Public Elementary Schools. At Other Institutions. At no School or Institution. Total. 19 — — — 19 PARTIALLY DEAF CHILDREN. At Certified Schools for the Deaf. At Certified Schools for the Partially Deaf. At Public Elementary Schools. At Other Institutions. At no School or Institution. Total. 9 — — — — 9 In addition 1 boy and 1 girl suffering from Aphasia attend the School for the Deaf. MENTALLY DEFECTIVE CHILDREN. Feeble-minded Children. At Certified Schools for Mentally Defective Children. At Public Elementary Schools. At Other Institutions. At no School or Institution. Total. 60 77 — 6 143 EPILEPTIC CHILDREN. Children Suffering from Severe Epilepsy. At Certified Special Schools. At Public Elementary Schools. At Other Institutions. At no School or Institution. Total. 3 — — 1 4 44 PHYSICALLY DEFECTIVE CHILDREN. A,— Tuberculous Children. I.- Children Suffering from Pulmoniry Tuberculosis (Including pleura and intra-thoracic glands.) At Certified Special Schools. At Public Elementary Schools. At Other Institutions. At no School or Institution. Total. 10 — — 8 18 II.— Children Suffering from Non-pulmonary Tuberculosis. At Certified Special Schools. At Public Elementary Schools. At Other Institutions. At no School or Institution. Total. 19 1 — 5 25 B.— Delicate Children. At Certified Special Schools. At Public Elementary Schools. At Other Institutions. At no School or Institution. Total. *89 287 22 6 404 * Of the 89 children at Certified Schools, 56 are at Suntrap Special School, Hay ling, for a period of not less than 6 weeks, for convalescent treatment. C.— Crippled Children. At Certified Special Schools. At Public Elementary Schools. At Other Institutions. At no School or Institution. Total. 45 19 — 3 67 D.— Children with Heart Disease. At Certified Special Schools. At Public Elementary Schools. At other Institutions. At no School or Institution. Total. 29 27 — 8 64 45 Table III.— Continued. Statement of the Number of Children Notified during the Year ended 31st December, 1934, by the Local Education Authority to the Local Mental Deficiency Authority. Total number of children notified, 12. Analysis of the Above Total. Diagnosis. Boys. Girls. (1) (i) Children incapable of receiving benefit or further benefit from instruction in a Special School:— (a) Idiots — 1 (b) Imbeciles 3 2 (c) Others 2 1 (ii) Children unable to be instructed in a Special School without detriment to the interests of other children:— (a) Moral Defectives — — (b) Others — — (2) Feeble-minded children notified on leaving a Special School on or before attaining the age of 16 1 2 (3) Feeble-minded children notified under Article 5 of the 1914 Regulations or under Article 3 of the 1928 Regulations, i.e., "special circumstances" cases (4) Children who, in addition to being mentally defective, were blind or deaf — - Grand Total 6 6 In addition, 1 girl under seven years of age, who came under our notice, haa been intimated, at his request, to the Officer under the Mental Deficiency Act. 46 Table IV.— Return of Defects Treated during the Year ended 31st December, 1934. TREATMENT TABLE. Group I.— Minor Ailmints (excluding Uncleanliness, for which see Group VI). 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 (treated by X-Rays) 2 1 3 ,, ,, (other treatment) 2 — 2 Ringworm— Body 17 1 18 Scabies 55 1 56 Impetigo 203 5 208 Other Skin Disease 306 29 335 Minor Eye Defects 282 8 290 (External and other, but excluding cases falling in Group II) Minor Ear Defects 194 32 226 Miscellaneous 915 40 955 (e.g., minor injuries, bruises, sores, chilblains, etc.) Total 1,976 117 2,093 Group 11.— Defective Vision and Squint (excluding Minor Eye Defects treated as Minor Ailments— Group I). Defect or Disease. No. of Defects dealt with. No. of children for whom Spectacles were Under the Anthority's Scheme. Otherwise. Total. Prescribed (1) Obtained (2) (i) Under the Authority's Scheme. (ii) Otherwise. (i) Under the Authority's Scheme. (ii) Otherwise. (1) (2) (3) (4) Errors of Refraction (including squint) 909 33 942 Other Defect or Disease of the Eyes (excluding those recorded in Group I) 9 8 17 757 33 756 38 Total 018 41 959 Group III.—Treatment of Defects of Nose and Throat. Number of Defects. Received Operative Treatment. Received Other Forms of Treatment. Total Number Treated. Under the Authority's Scheme in Clinic or Hospital. By Private Practitioner or Hospital, apart from the Authority's Scheme. Total. (i) (2) (3) (4) (5) (i) (ii) (iii) (iv) (i) (ii) (iii) (iv) (i) (ii) (iii) (iv) 1 - 407 1 - - - - 1 - 407 1 283 901 Unclassified 209 Unclassified 209 (i) Tonsils only, (ii) Adenoids only, (iii) Tonsils and adenoids, (iv) Other defects of the nose and throat. 47 Group IV.— Orthopaedic and Postural Defects. Under the Authority's Scheme. Otherwise. Residential treatment with education. (i) Residential treatment without education. (ii) Nonresidential treatment at an orthopaedic clinic, (iii) Residential treatment with education. (i) Residential treatment without education. (ii) Nonresidential treatment at an orthopaedic clinic, (iii) Total number treated. Number of children treated 2 2 — — — 108 112 563 children with minor orthopaedic and postural defects have carried out remedial exercises in the schools under the supervision of a Medical Officer and the Remedial Drill Instructress. Group V— Dental Defects. (1) Number of Children who were:— (a) Inspected by the Dentist— Aged 1: 4 273. Total 16,450 Routine Age Groups 5 1,667 6 1,758 7 1,981 8 2,262 isj 9 2,504 1 10 2,171 11 2,029 12 1,368 13 205 14 .. 232 Specials 2,413 Grand Total 18,863 (b) Found to require treatment 13,013 (c) Actually treated 5,891 (2) Half-days devoted to Inspection 65 Total 818 Treatment 753 (3) Attendances made by children for treatment 8,304 W Fillings Permanent Teeth 1,749 Total 1,957 Temporary Teeth 208 (5) Extractions Permanent Teeth 1,530 Total 9,416 Temporary Teeth 7,886 (6) Administrations of general anaesthetics for extractions 461 (7) Other operations Permanent 1eeth 167 Total 176 Temporary Teeth 9 (8) Regulation cases 16 Group VI.— Uncleanliness and verminous conditions. (i) Average number of visits per school made during the year by the School Norses 16.6 (ii) Total number of examinations of children in the Schools by School Nurses 99,471 (iii) Number of individual children found unclean 1,311 (iv) Number of children cleansed under arrangements made by the Local Education Authority 30 (v) Number of cases in which lesal proceedings were taken:— (a) Under the Education Act , 1921 12 (b) Under School Attendance Byelaws — Tottenham Maternity and Child Welfare Committee. ANNUAL REPORT FOR THE YEAR 1934. 2 MATERNITY AND CHILD WELFARE COMMITTEE. As at the 31 st December, 1934. Alderman Mrs. W. A. Kent. Alderman Major Sir Patrick B. Malone, J.P. Alderman J. H. Morrell (Chairman). Councillor Mrs. L. Banfield. Councillor Mrs. E. M. Coles Councillor M. Doran. Councillor Mrs. A.M. Ellis. Councillor Mrs. Kitchener. Councillor Mrs. A. E. Lyons (Vice-Chairman). Councillor G. H. Ottaway Councillor Mrs. A. Peake. Councillor J. F. Tidder. Councillor S. Timms. Councillor J. Wolsey. 3 Maternity and Child Welfare Department. STAFF. 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: Esther Rickards, M.S., M.B. (Lond.), F.R.C.S., (Eng.), L.R.C.P. (Lond.). Superintendent Health Visitor: §‡†Mrs. J. Kent-Parsons. Health Visitors: ¶†aB. Wallace. *†abG. M. Hockin. *†§aM. Blanchard. *†abcE. M. Dunn. *†G. Mason. §†*Miss N. A. Lennon. *†¶M. F. Reynolds *‡M. Timlin. (to October). *†§K. Goodwin (temporary staff from June to October; appointed on permanent staff October). §Health Visitor's Diploma. *General Training Cert. ‡San. Insp. Exam. Bd. Cert. +C.M.B. Cert. ¶R.S.I. San. Insp. Cert. bMoorfields Eye Hosp. Cert. aR.S.I. Health Vis. Cert. cAlton T.B. Hosp. Cert. Creche: Matron—F. E. Trewinnard (Creche Trained). Nurses—M. L. Banyard (Creche Trained). Miss E. Evans (Creche Trained, W.N.T.A.). Probationer—Miss D. Powell. Clerical Staff: E. Horton (C.I.S. Inter.). E. E. Fisher. G. A. Elliott. N. L. Petty. D. H. Ball. 4 Infant Melfare and Maternity Centres. BRUCE CASTLE, BRUCE CASTLE PARK. Infant Welfare Clinics. *Monday Afternoon 2 o'clock Tuesday Afternoon 2 „ *Wednesday Morning 9.30 „ *Thursday Morning 9.30 „ Thursday Afternoon 2 „ Maternity Clinics for Expectant Mothers are held on :— *Tuesday Morning 9.30 o'clock *Wednesday Afternoon 2 „ THE CHESTNUTS, CHESTNUTS PARK. Infant Welfare Clinics. Tuesday Afternoon 2 o'clock Wednesday Morning 9.30 „ *Wednesday Afternoon 2 „ *Thursday Afternoon 2 „ *Friday Afternoon 2 „ Maternity Clinics for Expectant Mothers are held on:— *Monday Afternoon 2 o'clock *Thursday Morning 9.30 „ *Friday Morning 9,30 „ *Lady Doctor in attendance. TOWN HALL CENTRE. Infant Welfare Clinic. Wednesday Afternoon 2 o'clock. DAY NURSERY, 227, West Green Road. Open Daily from Monday to Friday inclusive, from 8 a.m. to 6 p.m. In addition to the above Clinics, a Sewing Class for Mothers who attend the Centres, is held on Wednesday afternoons, at The Chestnuts, and Tuesday afternoons at Bruce Castle. MOTHERS' WELFARE CLUB .—A Social is held at each Centre once a month. 5 INTRODUCTION. Medical Officer's Department, Town Hall, Tottenham, N.15. To the Chairman and other Members of the Maternity and Child Welfare Committee. April, 1935. Ladies and Gentlemen, There has been nothing of outstanding note during the year under review. The work of your Department is now so consolidated and linked with that of the health and school medical departments that expansion of present services seems to be the appropriate line of advance rather than new departures. Nevertheless, there are at least two directions in which the Maternity and Child Welfare services might be improved. The first is a more comprehensive dental scheme for mothers and children under five. The mothers are reluctant to have teeth extracted without the hope, for financial reasons, of having them replaced by dentures. The second has relation to the orthopaedic treatment of children at the earliest possible moment. The pronounced policy of the Council in regard to your Committee's branch of public service and the nearer prospect of having more suitable premises wherein to render that service, seem to indicate that hopes may not unreasonably be entertained that at no distant date mothers and young children may have the advantages suggested. The year has been one of great activity and loyal service by your stafi, who, through me, and with me, thank your Committee for encouragement and enthusiastic co-operation. I am, Mr. Chairman, Ladies and Gentlemen, Your obedient Servant, David Kirkhone. Medical Officer of Health. 6 Births, 1934. LIVE BIRTHS. Registrar-General's Figures—M. 1,074 F. 1,017 *2,091 Local Information :— Total Births notified 2,112 Less Still Births 60 Live Births 2,052 *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, of those children registered within the year. MATERNITY SERVICES. Arrangements for Maternity Cases have been made, in respect of patients able to pay the whole or part of the fee, with the Mothers' Hospital, Clapton; for others, at the North Middlesex County Hospital. The following table shows the various institutions in which the confinements of Tottenham residents took place, and the numbers in each:— The Mothers' Hospital, Clapton :— Under the Council's Scheme 51 Own arrangements 140 191 The North Middlesex (County) Hospital 397 Other Outside Institutions 261 849 The remainder were confined within the District. BREAST FEEDING. As the result of the Health Visitors' enquiries, it was ascertained that the infants have been fed as follows:— Breast fed 1,681 Part Breast-fed—plus milk, dried milk or condensed milk 218 Bottle feeding—Cow's milk 64 Dried milk 49 Other artificial foods 28 Feedings unknown 36 *2,076 * Counted in feedings—transfers into district 100 Not counted in feedings—removals and deaths 86 7 MATERNITY AND CHILD WELFARE. The work of the MATERNITY AND CHILD WELFARE STAFF is set out in tabular form hereunder: — HOME VISITS MADE UNDER THE NOTIFICATION OF BIRTHS ACTS, MATERNITY AND CHILD WELFARE ACT, AND CHILDREN ACT, 1908, PART I, AS AMENDED BY THE CHILDREN ACT, 1932, PART V. Children under 1 year. Children over 1 year. Total. 1st Visits. Re-visits. 1st Visits. Re-visits. Notification of Births 2,070 7,904 419 14,641 25,034 Still-births 50 9 - - 59 Deaths 33 2 7 — 42 Ophthalmia Neonatorum and Discharging Eyes 30 47 - - 77 †Other Infectious Diseases 54 45 113 117 329 Total 2,237 8,007 539 14,758 25,541 Maternity Visits. 1st Visits. Re-visits. Ante-Natal 572 801 - - 1,373 Post-Natal 240 152 — - 392 Puerperal Fever 14 10 - - 24 Puerperal Pyrexia 10 12 — — 22 Other Visits. Mothers. Children. 703 406 — — 1,109 Total Visits — — — — *28,461 †Other Infectious Diseases include Measles and German Measles, Bronchial Pneumonia, Tuberculosis, Whooping Cough, Poliomyelitis. Other visits and re-visits include visits to hospital with swabs in connection with suspected contagious disease; massage cases, complaints of neglect and inspection of premises as to their suitability for nursing of children after operation, and visits for assisted milk supply; visits to foster-mothers and children registered under the Children Act, 1908, Part I, as amended by the Children Act, 1932, Part V. *Unsuccessful visits included in above total 2,980. CHILDREN BETWEEN 1 AND 5 YEARS OF AGE. Under the Notification of Births Acts. It will be noted that visits were made to children between 1 and 5 years of age totalling 15,060. 8 INFANT WELFARE CLINICS. Attendances. New Cases. Sessions. Average per Session. Under 1 Year. Over 1 Year. Total. Under 1 Year. Over 1 Yr. Total. a.m. p.m. a.m. p.m. The Chestnuts (St. Ann's) 7,378 6,074 13,452 614 115 729 51 204 39.43 56.08 Bruce Castle 5,995 5,093 11,088 481 84 565 52 151 35.96 61.04 Town Hall 1,263 1,132 2,395 85 20 105 — 51 — 46.96 Total 14,636 12,299 26,935 *1,180 219 1,399 103 406 — — * Percentage of Notified Live Births represented by above figure 57.54 Number of Children on Registers. Under 1 Year. Over 1 Year. Total. Under 1 Year (at the end of the year). Over 1 Year (at the end of the year). Total. Became 5 during the year. (on 1st att endance.) The Chestnuts (St. Ann's) 920 666 1,586 501 1,036 1,537 49 Bruce Castle 664 689 1,353 415 886 1,301 52 Town Hall 152 136 288 70 212 282 6 Total 1,736 1,491 3,227 986 2,134 3,120 107 Infant Mortality of Infants Attending the Infant Welfare Centres during 1934. Centre. No. on Register. (Under 1 year.) Deaths of Infants. Infantile Death-rate The Chestnuts (St. Ann's) 920 10 10.80 Bruce Castle 664 4 6.00 Town Hall 152 0 0.00 Total 1,736 14 8.06 Infant Mortality rate for whole area 51.6 per thousand births. 9 Medical Examinations. Total Number. New Cases Number of Sessions. Average per Session. The Chestnuts (St. Ann's) 3,822 728 153 24.98 Bruce Castle 2,648 521 101 26.21 Town Hall — — — — Total 6,470 1,249 254 — Children attending the Town Hall Centre are referred to The Chestnuts or Bruce Castle, for medical advice. ANTE AND POST-NATAL CLINICS. Medical Examinations Ante Natal. PostNatal. Total. Number of Sessions. Average per Session. The Chestnuts (St. Ann's) 1,924 146 2,070 162 13.61 Bruce Castle 1,519 127 1,646 101 16.29 3,443 273 3,716 253 — Ante Natal Cases. Number of Mothers on the Registers. At the beginning of the year. New Cases. Total. The Chestnuts (St. Ann's) 103 460 563 * Percentage of total notified births (live and still) represented by mothers on the Register. Bruce Castle 76 346 422 Total 179 806 986 *46.63 10 ASSISTED MILK SUPPLY. Assistance in the supply of milk is given to expectant and nursing mothers, and children under 5 years of age, where the income of the family is within the scale recognised by the Committee as a basis for the supply of milk free, or at less than cost price. The progress of recipients of the milk is noted at the Centres. 1,090 families were assisted during the year. The amount of milk distributed (Grade A, Tuberculin tested, and dried milk) was 31,802 gallons, or their equivalent. MIDWIVERY SERVICES. Midwives Acts, 1902-1926. (Order under Sec. 62 L.G. Act, 1929.) The following Midwives were registered as practising at the end of the year:— Resident in Tottenham. Resident Outside. Total. Number of cases attended. Total. As Midwives. As Maternity Nurses. 13 16 29 805 40 845 Routine Inspection of Midwives.-Midwives have had their premises and equipment examined at three-monthly intervals. After attendance upon an infectious case they have had their equipment sterilized and they, themselves, have been instructed how to disinfect. RECORDS OF SENDING FOR MEDICAL AID. 137 calls were made by Midwives for Medical Aid, under the following headings:— 11 For Mothers: Hemorrahage. Labour trouble. Perinneal tear. Temperatures:— Miscarriages and Abortions. Miscellaneous. Total. Puerperal Fever & Pyrexia. Other causes. Ante natal. Postnatal . 11 33 19 4 1 1 9 3 81 For Infants: Dead, Feeble or Stillborn. Eye Cases. Miscellaneous. Total Inflammation of or Discharging Eyes. Notified as Ophthalmia. 17 18 13 8* 56 *Tongued-tied, 1; foot, 1; jaundiced, 1; abscess on head, 1; malformation of face, 1; hare lip and cleft palate, 2; swollen arm, 1. LECTURES AND DEMONSTRATIONS TO MIDWIVES. Lectures and Demonstrations to Midwives have been arranged during the year under the joint auspices of the London and Middlesex County Councils, and Tottenham midwives have availed themselves of the privilege to attend. MIDWIVES' FEES. During the year your Committee paid, or contributed to the Fees of Midwives in 27 cases, namely:— Authorisation of attendance in necessitous cases 18 Compensation for loss of practice where the patient was taken to the Ante Natal Clinic, and was recommended and subsequently admitted to hospital for confinement 6 Compensation for loss of practice, where a midwife was in contact with an infectious disease and debarred from attending other patients, a substitute being employed 3 Total 27 12 HOME HELPS. Ass stance towards the services of Home Helps was granted in 27 cases. ACCOUCHMENT BAGS. These are available at the Centres and are loaned to the mothers in suitable cases. CASES OF DISCHARGING EYE AND NOTIFIED OPHTHALMIA NEONATORUM. 39 cases of Discharging Eye occurred during the year, 21 of which were notified as Ophthalmia Neonatorum. The following table shows the final result in each case:— Notified as Ophthalmia Neonatorum. Advised as Discharging Eye. Total. In Attendance at Confinement. Removed to Hospital. Final Result. Eyes Clear. Removed, no information. Doctors' Cases. Midwives' Cases. Occurred . in Hospital. 21 18 39 — 31 8 — 37 2 PUERPERAL FEVER AND PUERPERAL PYREXIA. The Council provides consultants and arranges for pathological or bacteriological examinations in cases of puerperal fever or pyrexia at the request of the medical practitioner in attendance. Special Consultant's Fees were paid in 2 cases. Hospital treatment is also arranged for in suitable cases. 13 The following table shows the final result of the cases on the register at the end of the year:— Total Notified. Occurred at Home. Recovered. Died at Home. Removals from Home. Occurred in Hospitals. Recovered. Died. Total Deaths. Removed to Hospital. Recovered. Under Treatment. Died. Sepsis. Other Causes Puerperal Pyrexia 22 6 2 0 4 2 — 2 16 16 0 1 *1 Puerperal Fever 12 10 0 0 10 5 1 4 2 2 0 4 0 Total 34 16 2 0 14 7 1 6 18 18 0 5 1 *Pulmonary embolism. MATERNAL MORTALITY. A Special Report is forwarded to the Ministry of each Maternal Death, with the available history. This report is based on the result of the enquiries made of every nurse, midwife, or doctor who has been engaged in attendance upon or treatment of the mother. 11 deaths were so reported. Maternal Deaths .—There were 5 deaths from Sepsis. 6 deaths were due to other Puerperal Causes than Sepsis. One of these was notified as Puerperal Pyrexia and 5 were not. The cause of death of the 1 case notified as Puerperal Pyrexia was stated as a Pulmonary Embolism (see Table Puerperal Pyrexia). 1 case was that of a mother suffering from ante partum haemorrhage removed to hospital, who died undelivered. 1 case died at home, 3 weeks after the birth, from pneumonia and post partum haemorrhage. 14 The other 3 cases occurred in hospitals outside the district from:— (1) General Peritonitis. (2) Eclampsia: heart failure. (3) Heart failure and obstetric shock. The Death Rate per 1,000 live and still births—based on the Registrar-General's figure, namely 2,151—was:— From Puerperal Sepsis 2.3 From Other Puerperal Causes 2.8 Total 5.1 MATERNITY AND NURSING HOMES. The number of Nursing Homes on the register at the beginning of the year was 2. (i) Applications for registration nil (ii) Registered during the year nil (iii) Orders made refusing or cancelling registration nil (iv) Appeals against such orders nil (v) Number confirmed on appeal nil (vi) Applications for exemption 2 *(vii) Application for exemption granted 2 Of the 2 homes registered one is authorised to receive 3 maternity eases, and 6 chronic cases. The other is approved for 1 maternity case only. * Hospitals exempt for registration:— The Prince of Wales's General Hospital. The Home and Hospital for Jewish Incurables. 15 The Creche.—The Creche, situated at 227, West Green Road, has had the following attendances:— Number of days on which the Creche was opened, 239. Quarter. Attendances under 3 years of Age. Attendances over 3 years of Age. Total. January to March 903 454 1,357 April to June 1,115 600 1,715 July to September 1,047 676 1,723 October to December 1,028 731 1,759 4,093 2,461 6,554 Number of children admitted:— Under 3 years (when admitted) 81 Over 3 years „ 28 109 Average daily attendance, 27.42 CONVALESCENT HOME TREATMENT. The arrangement with the Invalid Children's Aid Association for the maintenance of children at Convalescent Homes has been continued during 1934 as follows:— 41 children were sent away for varying periods. The periods of convalescence were as follows:— CHILDREN. Number of weeks 1 2 3 4 5 6 7 8 9 10 11 12 Number of Children 2 1 1 8 6 4 — 4 1 2 — 1 Number of weeks 13 14 15 16 17 18 19 20 21 22 23 24 or over 5 Number of Children — 4 1 — 1 — — — — - — 16 Surgical Instruments.—Two children were assisted towards the cost of surgical boots. One child was assisted with spectacles. 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. Arrangements still exist with the Prince of Wales's General Hospital for institutional treatment, and for the provision in the out-patients' department for the treatment of crippling conditions. One child continued at the Royal National Orthopaedic Hospital and 1 at Brookfields Orthopaedic Hospital during the year. One child received treatment at a special Eye Hospital. The following table sets out the number of cases referred to hospital under the Local Authority's Scheme:— Tonsils and Adenoids Cases. Other Cases. Total. Prince of Wales's Hospital. North Middlesex Hospital. Orthopaedic Hospitals. Eye Hospitals. 14 2 *2 1 19 * Continued from 1933—1 still in residence; special instruments also supplied. HEALTH VISITORS. There has been no alteration in the number of Health Visitors engaged by the Committee since 1921, although their duties now include the supervision of Foster Children. 17 INFANT LIFE PROTECTION (under Part I of the Children Act, 1908, as amended by the Children and Young Persons Act, 1932). All the Health Visitors now employed by your Committee are empowered under the Seal of the Council as Infant Life Protection Officers under Part I of the Children Act, 1908, as amended by the Children and Young Persons Act, 1932. 278 Home Visits have been paid by the Health Visitors under this Act. Number of foster parents on the Register:— (a) At the beginning of the year 72 (b) At the end of the year 70 Number of children on the Register:— (a) At the beginning of the year 79 (b) At the end of the year 80 (c) Died during the year 0 (d) On whom inquests were held during the year 0 A certain number of persons were found to be practising as fostermothers without having been registered. These cases were investigated and in three cases registration was refused. INSTITUTIONAL PROVISION FOR UNMARRIED MOTHERS, ILLEGITIMATE INFANTS AND HOMELESS CHILDREN. The Maternity and Child Welfare Department co-operates closely with the Tottenham Deanery Council for Moral Welfare, whose workers endeavour to get in touch with unmarried mothers in the district. One case has been assisted by a special grant from the Committee. 18 The expectant mothers are placed by the Deanery Council in suitable Mother and Baby Homes as early as can be arranged before confinement, and induced to stay with, and feed their babies, as long as possible. In some cases they pass on to hostels for mothers and babies, otherwise a foster-mother is found, or the child is admitted to the day nursery and the mother is helped to get work. In every case the mother is encouraged to keep in close touch with her baby. During 1934 the following homes have afforded hospitality to Tottenham cases:— Beacon Lodge, East Finchley. St. Helenas, Cricklewood. Enfield Hostel. City of London Hospital. Harrow Road Hospital. Main Memorial Home, Cartwright Gardens. Royal Free Hostel, Highbury Quadrant. St. John the Baptists Home, Tulse Hill. St. Faith's, Myddleton Square. Devon Nook, Chiswick. MOTHERCRAFT CLASSES—WELFARE CENTRES. 427 pupils from the Senior Girls' Departments of the under-mentioned schools have attended demonstrations at one or other of the Child Welfare Centres:— Down Lane Central School 83 girls Downhills Senior Girls' 113 „ Devonshire Hill Girls' 39 „ Page Green Girls' 31 „ Parkhurst Girls' 44 „ Risley Avenue Girls' 53 „ St. Katharine's 64 „ Graystoke Training College sent 21 students for lectures on Maternity and Child Welfare Work. 19 PUPIL MIDWIVES. Under an arrangement with the North Middlesex Hospital, Nurses from that hospital made 68 attendances at The Chestnuts. GIFTS TO CENTRES. The Committee is again indebted to the Dorcas Society of the High School for Girls for the generous gifts of parcels of infants' clothing throughout the year, which have been distributed to needy cases attending the Centres; also the gift of a pram from Mrs. Ashby. Gifts have also been received from certain local organisations, and friends, to the Creche. INDEX. PART I.—Health Department. A page Adulteration, etc 36 Ambulance Service 19 B Bacteriological Laboratory 19 Bakehouses 35 Births 9 Bread 35 Bug Infestation 28 C Cancer 43 Cleansing 23 Clearance Areas 24 Clinics 20 Closet Accommodation 23 D Dairies, etc. 34 Deaths 10 Diabetes 41 Diphtheria 39 Disinfection 29 Drainage and Sewerage 23 F Factory and Workshop Act 31 Food and Drugs Act 36 Food, Unsound 36 H Health Services 19 Health Week 21 Hospitals 21 House Inspection 25 Housing 26 I Ice Cream 34 Infantile Mortality 17, etc. Infectious Diseases 15 & 37 L Laboratory 19 Legal Proceedings 21 M page Malignant Diseases 43 Milk Supply 34 N Non-notifiable Infectious Diseases 40 North Middlesex Hospital 21 Nursing in the Home 20 P Population 8 Puerperal Fever and Puerperal Pyrexia 40 R Rateable Value 9 Rivers and Streams 23 S Sanitary Administration of the Borough 24 Scarlet Fever 38 Shops Acts 21 Slaughter-Houses 35 Small Dwellings Acquisition Act 29 Smallpox 41 Smoke Abatement 30 Social Conditions 9 Staff 4 Superannuation Scheme 22 T Treatment Centres 20 Tuberculosis 41 U Unsound Food 36 V Violent Deaths 18 W Water 23 PART II.—School Medical Department. A page Adenoids 9, 46 Attendance Officers 24 Aural Clinic 13-18 Audiometer 14-18 B Bacteriological Examinations 20 Baths, School 24 Blind Children 26, 31, 42 C Clinics 11 Convalescent Home Treatment 25 Co-ordination of Services 5 D Deaf, School for 27-28 Deafness 9, 13-18, 43 Dental Defects 10, 47 E Ear Diseases 9, 13 Epileptic Children 27, 43 External Eye Diseases 9, Examinations by Medical Officers 36 Exceptional Children 42-44 F Findings of Medical Inspection 8 Following-up 10 Food Accessories and Drugs 36 H Hayling Island 33 Hearing 9, 13 Heart Disease 10 Hygiene, School 5 I Infectious Diseases 19 Invalid Children's Aid Association 25 Introduction 4 Institutional Treatment 25 M page Malnutrition 8 Meals, Provision of 24 Mentally Defective Children 26, 28, 43 Microscopical Examinations 20 Milk Supplied 24 Minor Ailments. 9, 46 Myopic School 26, 31 N Nursery Schools 33 O Oak Lodge Special School 28 Occupation Centre 27 Open-Air Centre 31 Open-Air Class 32 Open-Air Education 20 Orthopaedics 10, 47 Otorrhoea 13 P Parents, Co-operation of 24 Physically Defective School 29-31 Physical Training 23 Population, School 3 Parents' Payments 36 R Remedial Exercises 10 Residential Schools 25-27 Rheumatism 10 S School Journeys and Camps 21, 23 Secondary Schools 34, 36 Skin Diseases 9, 46 Staff 2-3 Statistics 36-47 Surgical Instruments 25 Sun Trap Home 25, 33 Swimming 24 T Teachers, Co-operation of 24 Tonsils and Adenoids 9, 46 Tuberculosis 10, 44 V Verminous Conditions 9 Vision 9, 46 Voluntary Bodies 24 PART III.—Maternity and Child Welfare Department. A page Ante-Natal Clinics 4 Assisted Milk Supply 10 Attendances—Centres 8 & 9 Accouchement Bags 12 B Bruce Castle 8 Births (and page 9 Health Department portion) 6 Breast Feeding 6 C Chestnuts (The) 8 Creche 15 Centres, List 4 „ Attendances 8 & 9 Convalescent Home Treatment (I. C. A. A.) 15 Committee—Members of 2 Children Act, 1908/1932 17 D District Nursing Association, Home Visits 20 (Health Dept. portion) F Foster Children—Registrations 17 G Gifts 19 H Hospital Treatment 16 Home Visits 7 Home Nursing 12 Health Visitors 3 & 16 Home Help 12 I Introduction 5 Infant Mortality 8 (and pages 17, etc., of Health Dept. portion) Illegitimate Infants, institutional provision for 17 & 18 Infant Life Protection 17 L page Lectures to Midwives 11 M Maternal Mortality 13 Maternity and Midwifery Services 6, 10, 11 & 12 Medical Examinations .. 9 Midwives' Fees 11 Midwives 10 Medical Aid 11 Mothercraft Classes 18 Mothers' Hospital 6 N North Middlesex Hospital 6 Notification of Births Acts —Visits 7 Nursing Homes 14 O Ophthalmia Neonatorum— Visits 7 & 12 Orthopaedic Treatment 16 P Puerperal Fever and Puerperal Pyrexia 12&13 (and page 40 of Health Department portion) Pupil Midwives 19 S Staff 3 Still Births 6 T Town Hall Centre 4 & 8 V Visitors to Centres 18 W Welfare Centres (list of) 4