Ac 439(1) TOTTEN HAM BOROUGH OF TOTTENHAM ANNUAL REPORT OF THE MEDICAL OFFICER OF HEALTH FOR THE YEAR - 1935 - DAVID C. KIRKHOPE, M.D., Ch.M., D.P.H.. Barrister-at-Law. TOT 9 Borough of Tottenham. report ON THE HEALTH OF TOTTENHAM FOR THE YEAR 1935. Crusha & Son, Ltd. Tottenham, Enfield, Wood Green and Palmers Green. 2 SUMMARY OF STATISTICS FOR 1934 and 1935. 1934. 1935. Area 3,014 acres. 3,014 acres. Population 152,694 150,310 Births 2,091 1,969 Birth-rate (per 1,000 of population) 13.7 13.1 Deaths 1,572 1,456 Death-rate (per 1,000 of population) 10.3 9.7 Deaths under 1 year of age 108 108 Infant Death-rate (per 1,000 births) 51.6 54.8 Phthisis Death-rate (per 1,000 of population) 0.78 0.76 Rateable Value £949,780 £954,241 (at 1st April) (at 1st April) Amount produced by 1d. Rate £3,823 £3,850 3 HEALTH AND HOUSING COMMITTEE (as at 31st December, 1935). Chairman: Councillor R. H. Warren. Members: (Ex-Officio) His Worship the Mayor (Alderman A. E. Jay, J.P.). (Ex-Officio) The Deputy Mayor (Alderman J. H. Morrell). Alderman C. D. Grant. ,, Mrs. W. A. Kent. ,, Major Sir P. B. Malone, J.P. Councillor G. A. Armfield. ,, M. Doran. ,, Mrs. A. M. Ellis. ,, F. A. F. Keay. ,, Mrs. A. Kitchener. ,, Mrs. J. D. Lynch. ,, Mrs. G. E. Morrison. ,, A. Reed, A.C.I.I., J.P. ,, S. Timms . ,, A. R. Turner. 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. Chief Officer, Fire Brigade:—A. J. Taylor, Esq., G.I .Fire E. Librarian:—W. J. Bennett, Esq., F.L.A. Superintendent of Baths:—G. Swarbrick, Esq., M.N.A.B.S. Parks Superintendent:—G. E. Paris, Esq., F.R.H.S. Cleansing Superintendent:—H. Gurney, Esq., M.Inst.P.C. 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. (1), (2), (4). Male Sanitary Inspectors— *West, W. P. (1), (4). *Siiillito, J. A. (1), (4). *Bennett, P. W. T. (1), (4). *Glegg, E. S. (3), (4). *Goodfellow, J. (3), (4), (5), (6). *Kerridge, L. J. (3), (4). *Cass, H. V. (1), (4), (5). Female Sanitary Inspector— *Lamb, Miss M. (1), to 30th September. (1) Certificate of the Royal Sanitary Institute. (2) Cert., San. Insp. Exam. Bd. (3) Cert. R.S.I. and S.I.E. Jt. Bd. (4) Meat Inspector's Certificate. (5) Smoke Inspector's Certificate. (6) 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. Nurses for Infectious Diseases— S. Swaffield. W. Mathias (Part-time). (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 (to 24th September). 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'. 5, Lansdowne Road: Mr. Axford, Mr. Burchall, Mr. Gibson, Mr. Heafield and Mr. Lister. "Dorset Hall," Dorset Road: Mr.Lee, l'r.Mister and Mr. Williams. Public Vaccinators— Dr. M. J. Ckonin, 8. High 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— P.O. Jones, 94, Gloucester Road. 7 Health Department, Town Hall, Tottenham. May, 1936. To The Mayor, Aldermen and Councillors of the Borough of Tottenham. Mr. Mayor, Ladies and Gentlemen, 1 have pleasure in submitting the Report for the year 1935 upon the sanitary condition of Tottenham and the health of its inhabitants. It will be noted that the population, as estimated by the Registrar General, has declined by 2,384 in the past year. Since the 1931 Census the declension amounts to 7,462. Measures for the better housing of the population are being actively pursued. A full statement of the housing conditions is contained in the body of the Report. Insofar as the administration of health measures is concerned, the year has been singularly uneventful. Miss Lamb, who had given 24 years' faithful service to the Council, retired on account of ill-health on September 30th. I again express my gratitude to the Council and to all associated with me in the Council's service for their generous support. I am, Mr. Mayor, Ladies and Gentlemen, Your obedient Servant, David ??? 8 POPULATION. The population of Tottenham at the 1931 Census was 157,772. ,, ,, ,, at mid-year 1935 (Registrar-General's estimate) was 150,310 HOUSES. According to the rate-books, the number of houses at the end of 1935 was 30,803. RATEABLE VALUE. The rateable value of the Borough at 1st April, 1935, was £954,241. A Penny Rate produced £3,850. SOCIAL CONDITIONS, INCLUDING THE CHIEF INDUSTRIES CARRIED ON IN THE AREA, AND THE EXTENT OF UNEMPLOYMENT. The district is an industrial one, and also houses workers in the City, from which it is distant about five miles. The chief industries include cabinet making, joinery, bootmaking and fur dressing, and the manufacture of confectionery, stationery, wireless accessories, pianos and duplicators. The London Passenger Transport Board, by tram, bus and tube service, convey large numbers to and from the City, morning and evening. The L. & N.E. Railway Company have 7 stations in Tottenham, and the L.M. & S. Railway Company, 3 stations. All these travel facilities barely suffice to meet the needs of the district at rush hours. Toilers in the City do not reach their places of business or their houses in the evening except at considerable personal inconvenience. Your Council and neighbouring authorities have made repeated applications for an improved passenger transport service, and these ought not to be disregarded. The state of unemployment may be gauged from the following figures, supplied from the local Labour Exchange:— 9 The total number of persons normally in regular employment who were registered as wholly unemployed midway through December, 1935, was 3,916. In addition, 156 persons were registered as temporarily stopped. There were also registered as unemployed 121 men who normally are engaged in casual employment, making a grant total registered of 4,193. STATISTICS. BIRTHS. Live Births Registered:—Males 985 Females 984 Total 1,969 Live Births of Tottenham "Residents" occurring in the district 1,162 ,, ,, ,, ,, outside the district 807 Total 1,969 Of these there were 77 born out of wedlock:— 36 males. 41 females. =3'9 %illegitimate. Birth Rate, 13T per 1,000 of the population. Number of Stillbirths 67 Stillbirth Rate per 1,000 total births (live births and stillbirths) 32.9 DEATHS. The tables showing the number of deaths from different causes, and according to age groups and Ward distribution, are set out on pages 12 and 15. 10 Epitomised, it will be seen that— The total number of deaths registered in Tottenham was 833 Number of Non-residents dying in the district 189 644 Deaths of residents occurring in the district 644 ,, ,, ,, elsewhere 812 Deaths of residents—Total 1,456 Deaths of children under 1 year occurring in the district 44 ,, ,, ,, ,, outside the district 64 Total of deaths under 1 year 108 Death Rate of Infants under one year of age:— All infants per 1,000 live births 54.8 Legitimate infants per 1,000 legitimate live births 54.4 Illegitimate infants per 1,000 illegitimate live births 64.9 Total deaths distributed according to age groups:— Deaths under 1 year 108 Deaths from 1 to 5 years 25 Deaths from 5 to 15 years 43 Deaths from 15 to 25 years 67 Deaths from 25 to 65 years 553 Deaths, 65 and upwards 660 The excess of births over deaths, or natural increase of population, was 513. The death-rate equalled 9.7 per 1,000 of the population. Deaths from puerperal causes:— Rate per 1,000 Deaths. total (live and still) births. Puerperal sepsis 1 0.5 Other pueperal causes 5 2.4 Total 6 2.9 11 COMPARISON OF DEATH INCIDENCE—YEARS 1934 & 1935. Cause of Death. 1934. 1935. Difference. Typhoid and Paratyphoid Fevers - - .. Measles 9 2 - 7 Scarlet Fever 3 3 .. Whooping Cough 8 5 - 3 Diphtheria 12 14 + 2 Influenza 6 6 .. Encephalitis Lethargica 1 4 + 3 Cerebro-Spinal Fever 4 1 - 3 Tuberculosis of Respiratory System 120 114 - 6 Other Tuberculous Diseases 11 9 - 2 Syphilis 2 1 - 1 General Paralysis of the Insane, Tabes Dorsalis 4 11 + 7 Cancer, Malignant Disease 215 211 - 4 Diabetes 14 6 - 8 Cerebral Haemorrhage, etc. 74 68 - 6 Heart Disease 366 383 + 17 Aneurysm 1 1 .. Other Circulatory Diseases 94 64 - 30 Bronchitis 109 85 - 24 Pneumonia (all forms) 128 119 - 9 Other Respiratory Diseases 21 20 - 1 Peptic Ulcer 8 15 + 7 Diarrhoea, etc. 7 20 + 13 Appendicitis 3 3 .. Cirrhosis of Liver 5 3 - 2 Other Diseases of Liver, etc. 3 4 + 1 Other Digestive Diseases 48 27 - 21 Acute and Chronic Nephritis 52 51 - 1 Puerperal Sepsis 5 1 - 4 Other Puerperal Causes 6 5 - 1 Congenital Debility, Premature Birth, Malformations, etc. 35 47 + 12 Senility 22 16 - 6 Suicide 20 17 - 3 Other Violence 69 38 - 31 Other Defined Diseases 84 80 - 4 Causes Ill-defined or Unknown 3 2 - 1 Totals 1572 1456 -178 + 62 =net -116 12 Table showing the Population, Birth and Death Rates, in Wards, during 1935. 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 & Central 148 140 13,831 10.7 10.1 14 1.0 94.6 Chestnuts 158 139 11,332 13.9 12.3 6 0.5 38.0 Coleraine 113 86 10,857 10.4 7.9 5 0.5 44.2 Green Lanes 170 138 14,389 11.8 9.6 15 1.0 88.2 High Cross 163 103 11,838 13.8 8.7 7 0.6 42.9 Park 207 157 14,245 14.5 11.0 11 0.8 53.1 Seven Sisters 225 155 14,345 15.7 10.8 12 0.8 53.3 Stamford Hill 160 104 10,741 14.9 9.7 6 0.5 37.5 Town Hall 226 154 15,646 14.4 9.8 8 0.5 35.4 West Green 201 149 18,453 10.9 8.1 10 0.5 49.7 White Hart Lane 198 131 14,633 13.5 8.9 14 0.9 70.7 Totals 1,969 1,456 150,310 131 9.7 108 0.7 54.8 13 Table showing the Population, Birth Rate, and Death Rate from all causes, in Tottenham during the last six years. Year. *Population estimated to Middle of each Year. Births. Total Deaths Registered in the District. Deaths of Nonresidents registered in the District. Deaths of Residents not registered in the District. Nett Deaths Belonging to the District. Uncorrected Number. Nett. Under 1 Year of Age. At all Ages. Number. Rate. Number. Rate. Number. Rate per 1,000 Nett Births. N umber. Rate. 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 2,091 137 1,129 7.4 311 754 108 51.6 1,572 10.3 1935 150,310 1,162 1,969 13.1 833 5.5 189 812 103 54.8 1,456 9.7 *1931, 1932, 1933, 1934 & 1935—Registrar General's Estimate of Population 1930—Treasurer's Estimate. 14 Table of cases of Infectious Disease coming to the knowledge of the Medical Officer of Health during the year 1935 in the Borough of Tottenham, classified according to Diseases, Ages and Localities. NOTIFIABLE DISEASE At all Ages Number of Casks Notified. Total Casks Notified in Each Locality Total Cases Removed to Isolation Hospital Bruce Grove & Central. Chestnuts Coleraine. Green Lanes High Cross. Park. Seven Sisters. Stamford Hill Town Hall West Green White Hart Lane Under 1 1 to 2 2 to 3 3 to 4 4 to 5 5 to 10 10 to 15 15 to 20 20 to 35 35 to 45 45 to 65 65 and over Scarlet Fever 577 7 13 22 38 46 236 116 33 51 10 5 - 47 62 21 62 35 40 76 29 69 76 60 225 Diphtheria 286 4 6 14 23 27 135 43 12 17 4 1 - 22 10 15 13 25 30 36 10 26 20 79 275 Pneumonia 138 9 8 3 4 4 16 10 7 22 10 31 14 7 15 6 10 7 8 28 10 25 13 9 - Erysipelas 60 2 - - - - 1 2 3 11 12 22 7 6 7 5 6 2 1 8 5 4 12 4 31 Puerperal Fever 10 - - - - - - - 2 6 2 - - 3 1 - - 1 2 1 - 1 1 - 3 Puerperal Pyrexia 31 - - - - - - - 1 25 4 1 - 5 2 2 3 2 1 5 4 3 2 2 3 Typhoid Fever 3 - - - - - - - 1 1 1 - - - - - 1 - - - - 1 1 - 2 Dysentery 1 - - - - - - - - 1 - - - - - - - - - - 1 - - - - Ophthalmia Neonatorum 22 22 - - - - - - - - - - - 3 - - 1 - 2 9 1 4 - 2 2 Cerebro-Spinal Meningitis 1 - - - - - - - - - 1 - - - - - - - - 1 - - - - - Poliomyelitis 3 - - - - - 2 1 - - - - - - - - - - 1 - 1 1 - - - Pulmonary Tuberculosis 203 - - 1 1 - 8 6 20 95 26 40 6 12 16 8 20 12 22 23 19 29 20 22 - Other forms of Tuberculosis 32 - 1 - 1 1 3 7 7 6 4 2 - - 4 1 3 1 4 5 3 4 3 4 - Totals 1,367 44 28 40 67 78 401 185 86 235 74 102 27 105 117 58 119 85 111 192 83 167 148 182 541 TABLE OF DEATHS during the Year 1935 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 t he 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 & Central. Chestnuts. Coleraine. Green Lanes. High Cross. Park. Seven Sisters. Stamford Hill. Town Hall. West Green. White Hart Lane. Typhoid and Paratyphoid Fevers - - - - - - - - - - - - - - - - - - - - - - - - - Measles 2 - 1 - 1 - - - - - - - - - - - 1 - 1 - - - - - - Scarlet Fever 3 - - 1 2 - - - - - - - - - 1 - - - - - - 1 1 - 3 Whooping Cough 5 3 1 1 - - - - - - - - - - - 1 - - 1 1 - - - 2 22 Diphtheria 14 - - 3 11 - - - - - - - - 1 1 1 - 2 3 - 1 - 1 4 13 Influenza 6 - - - - - 1 1 2 1 1 - - - - 1 - 1 1 1 1 1 - - 1 Encephalitis Lethargica 4 - - - - 1 1 1 1 - - - - - 1 - 1 - 1 - - - - 1 - Cerehro-Spinal Fever 1 - - - - 1 - - - - - - - - - - - - - - - - 1 - - Tuberculosis of Respiratory System 114 - - - 1 32 29 11 20 15 6 - - 10 10 9 8 7 15 15 6 14 10 10 4 Other Tuberculous Diseases 9 - 1 1 4 1 1 - - - - - - - - - - - - - - - 1 4 3 Syuhilis 1 - - - - - - - - 1 - - - 1 - - - - - - - - - - - General Paralysis of the Insane, Tabes Dorsalis 11 - - - - - - 3 4 3 1 - - - 3 - - - - - - 1 6 1 1 Cancer, Malignant Disease 211 - - - 3 1 2 12 37 59 60 35 2 21 28 18 17 14 18 25 14 20 20 16 35 Diabetes 6 - - - - - - - - 2 1 3 - 1 - - - - 1 - 2 2 - - 2 Cerebral Haemorrhage, etc. 68 4 - - - 2 1 1 7 12 24 16 1 4 6 3 8 5 7 6 9 4 12 4 5 Heart Disease 383 - - - 7 8 4 11 18 57 119 119 40 42 35 23 35 25 39 40 27 48 44 25 24 Aneurysm 1 - - - - - - - - 1 - - - - - - - - - - - - 1 - - Other Circulatory Diseases 64 - - - - - 2 2 2 12 18 22 6 4 5 6 8 8 5 2 4 12 3 7 12 Bronchitis 85 5 - 1 - 2 1 - 7 12 21 25 11 7 9 3 11 9 10 7 5 9 8 7 6 Pneumonia (all forms) 119 18 10 3 3 5 2 3 9 24 22 19 1 15 9 7 15 5 12 13 11 5 7 20 11 Other Respiratory Diseases 20 - - - - 1 - 2 6 3 3 4 1 2 1 - 1 2 4 4 - 3 2 1 1 Peptic Ulcer 15 - - - - - - 2 5 4 3 1 - - 3 2 - - - 1 2 2 3 2 2 Diarrhoea, etc. 20 16 - - - - - 2 - - - 2 - 4 - 1 2 1 1 2 2 3 1 3 5 Appendicitis 3 - - - - - - - 2 1 - - - 1 - - - - - 1 - 1 - - 3 Cirrhosis of Liver 3 - - - - - - - - 2 1 - - - 1 - - - - - - 1 1 - 1 Other Diseases of Liver, etc. 4 - - - - - - - - 1 1 2 - 1 - - - - - 1 - 1 - 1 2 Other Digestive Diseases 27 1 - - 1 - 2 6 7 4 4 2 - 3 2 1 4 1 3 3 2 3 3 2 5 Acute and Chronic Nephritis 51 1 - - - 2 9 4 9 13 6 7 - 3 3 5 4 3 8 8 7 - 5 5 16 Puerperal Sepsis 1 - - - - - - - - - - - - - - - - - - - - - - - - Other Puerperal Causes 5 - - - - 1 4 - - - - - - - - - 1 1 - 1 - - 2 - 2 Congenital Debility, Premature Birth, Malformations 47 47 - - - - - - - - - - - 5 3 1 5 1 4 9 3 3 7 6 7 Senility 16 - - - - - - - - - 5 3 8 1 4 - - 4 2 3 1 - 1 - - Suicide 17 - - - - 1 - 2 6 4 4 - - 2 1 - 2 3 1 3 1 1 2 1 5 Other Violence 38 1 - - 4 4 3 3 6 7 5 4 1 4 4 - 6 3 6 3 2 5 2 3 8 Other Defined Diseases 80 12 - 2 6 5 7 9 5 17 8 7 2 8 6 4 7 8 14 4 4 14 5 6 22 Causes Ill-defined or Unknown 2 - - - - - - - - - 1 1 - - - - 1 - - 1 - - - - - Totals 1456 108 13 12 43 67 70 75 153 255 315 272 73 140 139 86 138 103 157 155 104 154 149 131 222 15 16 INFANTILE DEATHS in Ages, Sexes and Localities, during the year 1935. 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. l—9 months. 9—12 months. Total Deaths under 1 year. Males. Females. Bruce Grove & Central. Chestnuts. Coleraine. Green Lanes. High Cross. Park. Seven Sisters. Stamford Hill. Town Hall. West Green. White Hart Lane. Measles - - - - - - - - - - - - - - - - - - - - - - - Whooping Cough - - - - - 1 1 — 1 3 3 — — — — — — 1 1 — — — 1 Diphtheria - - - - - - - - - - - - - - - - - - - - - - - Erysipelas - - - - - 1- - - - 1 1 - - - - - 1 - - - - - - Meningitis (not Tuberculous) - - - - - - - 1 - 1 - 1 - 1 - - - - - - - - - Pneumonia 1 - 5 - 6 7 3 - 2 18 14 4 1 1 2 3 1 3 - 1 1 1 4 Bronchitis - 1 - - 1 - 2 1 1 5 3 2 1 - - 2 1 - - - - 1 - Convulsions - - - - - - - - - - - - - - - - - - - - - - - Gastritis - - - - - - - - - - - - - - - - - - - - - - - Diarrhoea and Enteritis 1 1 5 - 7 4 3 - 2 16 9 7 3 - 1 1 1 - 1 2 3 1 3 Suffocation - - - - - - 1 - - 1 1 - - - - - - - - - 1 - - Injury at birth - - - - - - - - - - - - - - - - - - - - - - - Atelectasis 1 - - - 1 - - - - 1 - 1 - - - - - - - - - - 1 Congenita] Malformations 3 2 — — 5 2 2 — 1 10 3 7 — — — — — — 2 1 2 5 — Premature Birth 20 1 5 2 28 - - - - 28 16 12 4 2 - 3 1 4 6 2 1 2 3 Atrophy, Debility and Marasmus - - 2 - 2 4 1 - 1 8 6 2 1 1 1 2 - - 1 - - - 2 Other Causes 8 1 1 - 10 4 1 1 - 16 8 8 4 2 1 3 3 2 1 - - - - Totals 34 6 18 2 60 23 14 3 8 108 64 44 14 6 5 15 7 11 12 6 8 10 14 17 DEATHS FROM VIOLENCE. There were 55 deaths from Violence. 17 were suicidal. Deaths resulting from motor accidents numbered 13. Males. es. Falls 5 6 Knocked down by motor car 2 - „ „ „ lorry 1 - „ „ „ cycle 1 - ,, ,, railway wagon 1 - „ „ „ engine 1 - Collision between tramcar and pedal cycle 1 - ,, ,, motor car and pedal cycle 1 - ,, ,, ,, ,, and motor cycle 1 1 ,, ,, ,, cycle and pedal cycle 2 - ,, ,, coach and motor car - 1 ,, ,, trade van and pedal cycle 1 - Run over by motor lorry 1 - ,, ,, car 1 - Fall from swing 1 - ,, roof 1 - Fall of timber and earth in pit 1 - Suffocated in bed 1 - Struck by cricket ball 1 - Drowning 3 - Other forms of violence 2 1 29 9 SUICIDES. Coal gas poisoning 3 4 Corrosive poisoning 2 1 Drowning 2 - Pistol shot wound 1 - Cut throat 2 - Abortion self induced - 2 10 7 18 MALIGNANT DISEASES. The deaths from Malignant Diseases in 1935 numbered 211, or 4 less than in 1934. The organs affected and the sex distribution were as indicated, viz.:— Digestive System:— Males. Females. Mouth 3 1 Tongue 3 1 Oesophagus 8 3 Stomach 30 22 Bowels (large and small intestines) 1 3 Rectum 13 4 Liver and Gall Bladder 6 3 Pancreas 2 2 Colon 10 9 Peritoneum 1 1 Genito-urinary Kidney 2 — Bladder 2 1 Prostate 4 — Breast — 13 Uterus — 9 Ovary — 2 Cervix — 5 Vulva — 3 Respiratory:— Lung 13 4 Larynx 5 1 Pharynx 3 — Bronchus 4 — Antrum — 2 Various:— Glands 1 2 Neck 1 — Spine — 2 Brain 1 — Eye 1 — Jaw — 1 Nose 1 — Tonsil — 1 Undetermined — 1 115 96 19 GENERAL PROVISION OF HEALTH SERVICES. LABORATORY FACILITIES. Throat swabs, sputa and hairs for ringworm are examined at the Council's laboratory. The Prince of Wales's Hospital undertakes for the Council Wassermann tests, Virulence tests, examination of blood for Typhoid, and other similar serological and bacteriological investigations. The following is a statement of the examinations made during the year. Swabs examined for Diphtheria:—Positive, 246; Negative, 3,421. Specimens of Sputa examined for Tuberculosis:—Positive, 38; Negative, 208. Virulence tests, Diphtheria:—Positive, 5; Negative, 1. Blood examined for Typhoid group:—Positive, 0; Negative, 5. Hairs examined for Ringworn:—Positive, 6; Negative, 2. AMBULANCE FACILITIES. The ambulance facilities for the district are described in the 1930 Report. No alteration has taken place in the number of vehicles owned and controlled by the Council, but during 1935 the Ford School Children's Bus was replaced by a modern Dennis machine. The Chief Officer 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, 1935 No. of Cases. Mileage. Receipts. Surgical. School Children. (Journeys) £ s. d. January 626 2,062 5,943 5 12 0 February 484 2,472 5,908 7 14 3 March 632 2,607 6,932 538 6 6 April 579 1,669 5,322 15 14 6 May 594 2,529 7,859 29 18 0 June 543 1,973 6,777 475 14 0 July 648 2,307 7,203 28 3 6 August 639 482 4,243 21 17 6 September 673 2,643 7,209 439 12 6 October 651 2,764 7,147 30 2 0 November 702 2,004 6,528 28 3 6 December 715 1,618 6,042 508 6 0 Year's Totals 7,486 25,130 77,113 £2,129 4 3 Total Mileage to Date: 908,211 The Ambulances are equipped with Oxygen Resuscitators, which have been in use on 11 occasions during 1935. Number of Street Accidents and Cases of Illness for the year:490. NURSING IN THE HOME. The Council employ a, whole-time nurse and the part-time services of a second to treat at home Scarlet Fever cases that it is considered expedient not to send to hospital. A subsidy is paid to the Tottenham District Nursing Association for the services of their nurses in tending the sick in their own homes whilst suffering from certain types of illness. 21 CLINICS AND TREATMENT CENTRES. These have been established by the Education and Maternity & Child Welfare Committees for the use of mothers and children coming within their purview. Reference to them will be found in the relevant parts of this Report. The Council will shortly establish a Gynaecological Clinic primarily intended for women who have reached the end of their child-bearing age. HOSPITALS : PUBLIC AND VOLUNTARY. There is one voluntary hospital in the district—the Prince of Wales's General Hospital—towards the expenses of which the Council make an annual contribution equal to a halfpenny rate. Arrangements have been made for the admission of children requiring operation for throat and nose disorders. The hospital staff give valuable assistance in the diagnosis of obscure conditions, and when necessary admit patients referred to them by the Council's officers. 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. Amount. No. of cases. Amount. 1,975 £33,683 11s. 8d. 2,516 £57,961 15s. 2d. Institutional Relief—North Middlesex Hospital. No. of cases admitted from Tottenham during 1935 3,907 No. of days In-Maintenance of these patients during 1935 79,805 HEALTH WEEK. The importance of paying constant attention to health was especially emphasised in the week commencing October 6th. 22 A booklet circularised amongst school children and obtainable also by other members of the public at the Libraries drew special notice to the importance of cleanliness, exercise and the care of the teeth. The booklet was designed for school children mainly, and was attractively compiled. Essays were written by the children upon the matters discussed in the booklets and dilated upon in school. Successful competitors were awarded prizes, which were presented at a public function. School children provided the entertainment, under the direction of their teachers. A Committee of Teachers compiled the booklet, so that Health Week was in every respect educational. MEDICAL EXAMINATIONS. In 1935, 92 examinations were made of persons entering the permanent service of the Council, the Education Committee and the Maternity and Child Welfare Committee. SANITARY CIRCUMSTANCES OF THE BOROUGH. WATER. The water supply is satisfactory in quality and quantity. It is obtained from the Metropolitan Water Board's mains. DRAINAGE AND SEWERAGE. There are still certain areas in the older parts of Tottenham drained on the single pipe system. Substantial progress is being made in converting the single drain system to the dual system as instances of the former come to light either by deliberate investigation or in the course of house inspection. A sum of money is allocated for the purpose yearly. 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. 23 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. A separate department has recently been set up—the Cleansing Department, under the control of a Cleansing Superintendent who is responsible directly to the Council. There is a weekly collection of house refuse. 29,420 tons of house refuse and 1,277 tons of trade refuse were dealt with at the Refuse Destructor during the year. SHOPS ACTS. The Shops Acts are administered by two whole-time officers. Herein under are indicated the provisions of the various Orders, the observance of which is required. Shops Acts, 1912 to 1934. 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.) tOther Shops Wednesday, 1 p.m. Thursday, 1 p.m. (non -exempted (or alternatively (or alternatively Saturday, 1 p.m.) trades) Saturday, 1 p.m.) Half-Holiday for Shop Assistants. Every shop assistant in every class of shop must be allowed a halfholiday once a week commencing not later than 1.30 p.m. The rule applies whether a shop is required to be closed for a weekly half-holiday or not. 24 Meal Times. Dinner.—If the hours of employment include the hours from 11.30 a.m. to 2.30 p.m. each assistant must be allowed an interval of threequarters of an hour for dinner within that time if the meal is taken on the premises, or an interval of a full hour within that time if the meal is taken off the premises. Tea.-—If the hours of employment include the hours from 4.0 p.m. to 7.0 p.m. each assistant must be allowed an interval of half an hour for tea within that time. Evening Closing Hours. * Butchers Monday, Tuesday, Wednesday and Thursday 7p.m. Friday and Saturday 8p.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 day, Thursday and Friday 8 p.m. trades) Saturday 9p.m. (subject to Weekly Half-holiday Order.) Hairdressers and Premises to be closed all day on Sunday. Barbers (or, alternatively, Saturday for Jewish dressers and Barbers.) Exempted Trades No closing hour. (newly-cooked provisions, etc.) During 1935, 55 first or warning notices were issued in respect of contraventions of the Acts, and 22 final notices. Legal proceedings were taken in 8 instances:— 25 Date. Name. Nature of Case. Result. February John Joseph Scott, 38, Durban Road Serving after the closing hour Fined 10s. or seven days. March William Wood, 797, High Road „ „ „ „ March William Wood, 797, High Road „ „ „ „ October Arthur Hall, 64, Summerhill Road Failure to give statutory half-holiday to assistant Fined 5s. October Arthur Hall, 64, Summerhill Road „ „ „ October Charles R. Spooner, 371, High Road „ „ Fined 10s. October Alfred Tombs, 32, Brookdale, New Southgate Failure to give statutory meal times to assistants employed at 464, Lordship Lane Fined 4s. October John Edward Tombs, 12, Raith Avenue, Southgate „ „ „ The Shops Act of 1934 which came into operation on the 31st day of December, 1934, stipulates the number of hours during which young persons under the age of 18 may be employed, and makes provision as to the arrangements in shops and warehouses for the health and comfort of workers. During 1935, 18 premises were exempted from the provision of sanitary conveniences and washing facilities, suitable and easily accessible accommodation being available; 2 premises were exempted from the provision of sanitary conveniences only. SANITARY ADMINISTRATION OF THE BOROUGH. STAFF. In April an additional Sanitary Inspector was appointed (Mr. Cass) who had been previously employed as a Sanitary Inspector in the City of Liverpool and the County Borough of Wallasey. 26 CLEARANCE AREAS. 1935 marks the rehousing of the first tenants from clearance areas. Prior to the removal to the new houses, the whole of the furniture and bedding was disinfested. A further step was taken with the five year programme. Clearance Areas were defined, and after local inquiries by officers of the Ministry of Health, clearance orders were confirmed with respect to 98-120, Tewkesbury Road; 1-10 and 5a, James Place; 1-6, Vine Road; 2 and 4, 52 and 1-19 (odd numbers), Love Lane; Rose Cottage and 1-7, Orchard Place; 1 and 2, Old Lane; 1-7 and Vine Cottage, Princes Street; 158168, White Hart Lane: 1-5, 7-12 and 11a, Queen Street; 1, 2 and 3, Ivy Terrace and 1 and 2, Rose Cottages, Queen Street; 1-6, Waterloo Place, Reform Row. Official representations were also made with respect to four individual houses, making a total for the year of 93 houses, the persons to be displaced being 435. The total number of houses closed from 1932 to the end of 1935 was 250, occupied by 1,010 persons. The total number of families rehoused to December 1935 was 34, representing 141 persons. The four individual houses dealt with were 2, Moulding's Cottages, Waggon Lane, 61a, Markfield Road, 680, High Road, and 6, Love Lane. 2, Moulding's Cottages and 61a, Markfield Road will be demolished when vacant, and the Council have accepted undertakings that 680, High Road and 6, Love Lane will not again be used for human habitation. HOUSE INSPECTION. The Chief Sanitary Inspector reports to me as follows in relation to the sanitary administration of the Borough :— The number of houses inspected during the year amounted to 4,588:— 1,442 were house-to-house inspections; 2,280 were upon complaint; 866 were consequent upon the occurrence of infectious disease. 27 Defects were discovered at 2,461 premises, and 2,461 preliminary notices and 397 statutory notices were served on owners requiring them to remedy the defective conditions. 10,520 visits were made to premises for the purpose of supervising work in hand, and to ascertain whether notices had been complied with. In 19 instances, the work was carried out by the Council in the owner's default or at the owner's request. The 1,442 houses visited for the purpose of house-to-house inspection were situate in the following roads:—Almond Road, Arthur Road, Chameleon Road, Chester Road, Clyde Road, Colsterworth Road, Conway Road, Catherine Road, Devon Road, Eastbourne Road, Elizabeth Place, Edith Road, Fairbourne Road, Falconer Road, Farningham Road, Ferndale Road, Gladesmore Road, Glenwood Road, Gloucester Road, Greyhound Road, Harringay Road, Henrietta Road, Howard Road, Lawrence Eoad, Laurel Terrace, Lismore Road, Love Lane, Newton Road, Northumberland Grove, Paignton Road, Paxton Road, Queen Street, Seven Sisters Road, Summerhill Road, Templeton Road, Tewkesbury Road, Thorpe Road, Victoria Road, Waverley Road, White Hart Lane, Winchelsea Road. 842 drains were tested during the year with smoke or water. Defects were discovered in drains at 367 premises. In 110 instances entire reconstruction was necessary. The following table shows the principal defects discovered, apart from structurally defective drains:— 250 drains found stopped. 478 defective W.C. cisterns and pans. 453 ,, rain water pipes, gutters and waste pipes. 136 ,, soil pipes and vents. 771 ,, roofs. 231 ,, sinks. 814 ,, window frames. 374 ,, floors. 998 ,, coppers and fireplaces. 312 ,, dustbins. 28 2,508 houses with dirty walls and ceilings. 409 ,, defective yard paving. 585 ,, damp walls. 121 ,, defective drinking water cisterns. 766 miscellaneous defects. Owners were induced to provide 154 houses with water supplies direct from the mains in substitution for supplies from storage cisterns. Damp proof courses were inserted in 80 premises to remedy dampness in walls. HOUSING ACT, 1935. The problem of overcrowding is being grappled with. The Housing Act of 1935 has set up a standard by which statutory overcrowding is to be measured. In order to ascertain the precise extent of overcrowding, the Act provides for a survey of its working-class houses by every local authority. Section 2 of the Act defines overcrowding as follows:— "2. (1) A dwelling-house shall be deemed for the purposes of this Act to be overcrowded at any time when the number of persons sleeping in the house either:— (a) is such that any two of those persons, being persons ten years old or more of opposite sexes and not being persons living together as husband and wife, must sleep in the same room; or (b) is, in relation to the number and floor area of the rooms of which the house consists, in excess of the permitted number of persons as defined in the First Schedule to this Act. (2) In determining for the purposes of this section the number of persons sleeping in a house, no account shall be taken of a child under one year old, and a child who has attained one year and is under ten years shall be reckoned as one-half of a unit." In the schedule referred to above there are two tables which read:- 29 Table I. Where a house consists of— The permitted number of persons is— (a) One room 2 (6) Two rooms 3 (c) Three rooms 5 (d) Four rooms 7½ (e) Five rooms or more 10 with an additional 2 in respect of each room in excess of five. Table II. Where a room in a house has a floor area of— (a) 110 sq. ft. or more 2 (persons) (b) 90 sq. ft. or more, but less than 110 1½ (c) 70 sq. ft. or more, but less than 90 1 (d) 50 sq. ft. or more, but less than 70 ½ (e) Under 50 sq. ft. Nil. After a day to be appointed by the Minister of Health, it will be illegal for the occupier or landlord to permit a dwelling-house to be overcrowded. "Dwelling-house" is defined as "any premises used as a separate dwelling by members of the working classes." Six months after the appointed day, every rent book shall contain a summary of the provisions of the Act with regard to overcrowding, and a statement of the permitted number of persons in relation to the house. It shall be the duty of the Council, on application by the owner or occupier, to supply the applicant in writing with the permitted number. The Survey was commenced in November 1935, and completed in February 1936. In order to apply Table II, 19,341 rooms were measured. 30,059 premises, accommodating 40,644 families, were visited. These figures do not include the 250 houses already mentioned as being within Clearance Areas. This number represents the whole of the working-class houses in the district, and of the 40,644 families, 1,322, or 3.2 per cent, were overcrowded. 30 Of the 30,059 premises visited :— 413 were empty. 19,719 were found to house one family. 8,985 ,, ,, two families. 847 ,, ,, three families. 95 ,, ,, four or more families. Taken as a whole, the district was not overcrowded. The number of persons per room, spread over the whole district, was about 0.9. Some of the overcrowding was very slight. On the other hand, 1,483 of the uncrowded houses were just outside the overcrowding standard. The Survey revealed that 3,112 persons were living alone. Of the 1,322 overcrowded houses:— 489 were overcrowded by one child under 10 years. 394 ,, ,, one adult or two children. 170 ,, ,, one adult and one child, or three children. 114 ,, ,, two adults or the equivalent. 66 ,, ,, two and a half adults ,, ,, 44 ,, ,, three adults ,, ,, 25 ,, ,, three and a half adults ,, ,, 13 ,, ,, four adults ,, ,, 2 ,, ,, four and a half adults ,, ,, 1 was ,, ,, five adults ,, ,, 2 were ,, ,, five and a half adults ,, ,, 2 ,, ,, six and a half adults ,, ,, Of the 40,644 families dealt with, 9,783 comprised the equivalent of two adult persons; 3,698 the equivalent of two and a half; and 8,063 the equivalent of three: i.e., more than 50 per cent. of the families were between two and three adult persons. Each of the eleven wards have been separately summarised. The following are the particulars:— 31 Bruce Grove and Central Ward. Number of premises visited, 2,638, of which 47 were empty. Number of families enumerated 3,713 ,, ,, overcrowded 52=1.4% ,, ,, uncrowded 3,661 1,521 premises were occupied by one family. 1,030 ,, ,, two families. 34 ,, ,, three families. 6 ,, ,, four or more families. The worst case of overcrowding was that of a family of 7 persons occupying accommodation suitable for 3; at the other end of the table is a family of 2 persons in accommodation sufficient for 18. Chestnuts Ward. Number of premises visited, 2,228, of which 33 were empty. Number of families enumerated 3,072 ,, ,, overcrowded 98=3.2% ,, ,, uncrowded 2,974 1,406 premises were occupied by one family. 713 ,, ,, two families. 66 ,, ,, three families. 10 ,, ,, four or more families. The worst case of overcrowding was that of a family of 7½ persons in accommodation suitable for 3; at the other end of the table is a family of 2 persons in accommodation sufficient for 16. Coleraine Ward. Number of premises visited, 2,241, of which 17 were empty. Number of families enumerated 2,751 ,, ,, overcrowded 78=2.8% ,, ,, uncrowded 2,673 1,715 premises were occupied by one family. 493 ,, ,, two families. 14 ,, ,, three families. 2 ,, ,, four families. 32 The worst case of overcrowding was that of a family of 7 persons occupying accommodation suitable for 3; at the other end of the table is a family of 3 persons in accommodation sufficient for 18. Green Lanes Ward. Number of premises visited, 2,535, of which 62 were empty. Number of families enumerated 3,890 ,, ,, overcrowded 69=1.77% ,, ,, uncrowded 3,821 1,199 premises were occupied by one family. 1,144 ,, ,, two families. 118 ,, ,, three families. 12 ,, ,, four or more families. The worst case of overcrowding was that of a family of 3½ persons occupying accommodation suitable for 2; at the other end of the table is a family of 1 person in accommodation sufficient for 12. High Cross and Stoneleigh Ward. Number of premises visited, 2,251, of which 27 were empty. Number of families enumerated 3,159 ,, ,, overcrowded 100=3.16% ,, ,, uncrowded 3,059 1,340 premises were occupied by one family. 838 ,, ,, two families. 43 ,, ,, three families. 3 ,, ,, four or more families. The worst case of overcrowding was that of a family of 10 persons occupying accommodation suitable for 5; at the other end of the table is a family of 2 persons in accommodation sufficient for 12½. Park Ward. (Included in Park Ward are the 28 houses in Bromley Road owned by the Tottenham Borough Council.) 33 Number of premises visited, 2,780, of which 38 were empty. Number of families enumerated 3,715 ,, ,, overcrowded 145=3.9% ,, ,, uncrowded 3,570 1,921 premises were occupied by one family. 687 ,, ,, two families. 118 ,, ,, three families. 16 ,, ,, four or more families. The worst case of overcrowding was that of a family of 10 persons occupying accommodation suitable for 6½; at the other end of the table is a family of 1 person in accommodation sufficient for 16. Seven Sisters Ward. Number of premises visited, 2,835, of which 25 were empty. Number of families enumerated 4,036 ,, ,, overcrowded 245=6.07% ,, ,, uncrowded 3,791 1,718 premises were occupied by one family. 944 ,, ,, two families. 141 ,, ,, three families. 7 ,, ,, four or more families. The worst case of overcrowding was that of a family of 9½ persons occupying accommodation suitable for 3; at the other end of the table is a family of 3 persons in accommodation sufficient for 17½. Stamford Hill Ward. Number of premises visited, 2,207, of which 45 were empty. Number of families enumerated 3,102 ,, ,, overcrowded 55=1.77% ,, ,, uncrowded 3,047 1,362 premises were occupied by one family. 706 ,, ,, two families. 82 ,, ,, three families. 12 ,, ,, four or more families. 34 The worst case of overcrowding was that of a family of 6i persons occupying accommodation suitable for 3; at the other end of the table is a family of 1 person in accommodation sufficient for 14½. Town Hall Ward. Number of premises visited, 3,035, of which 58 were empty. Number of families enumerated 4,346 ,, ,, overcrowded 161=3.7% ,, ,, uncrowded 4,185 1,734 premises were occupied by one family. 1,131 ,, ,, two families. 99 ,, ,, three families. 13 ,, ,, four or more families. The worst case of overcrowding was that of a family of 7 persons occupying accommodation suitable for 3; at the other end of the table is a family of 3 persons in accommodation sufficient for 20. West Green Ward. Number of premises visited, 3,691, of which 50 were empty. Number of families enumerated 5,032 ,, ,, overcrowded 67=1.33% ,, ,, uncrowded 4,965 2,380 premises were occupied by one family. 1,143 ,, ,, two families. 107 ,, ,, three families. 11 ,, ,, four or more families. The worst case of overcrowding was that of a family of 6½ persons occupying accommodation suitable for 3; at the other end of the table is a family of 1 person in accommodation sufficient for 20. White Hart Lane Ward. The Ward contains 787 houses belonging to the Tottenham Borough Council, 2,051 houses belonging to the London County Council, and 780 houses belonging to private owners. 35 Number of premises visited, 3,618, of which 11 were empty. Number of families enumerated 3,828 ,, ,, overcrowded 252=6.58% ,, ,, uncrowded 3,576 3,423 premises were occupied by one family. 156 ,, ,, two families. 25 ,, ,, three families. 3 ,, ,, four or more families. The worst case of overcrowding was that of a family of 10½ persons occupying accommodation suitable for 5; at the other end of the table is a family of 3 persons in accommodation sufficient for 20. DISINFESTATION. The work of disinfesting premises, commenced in 1934, is appreciated by both owners and occupiers. The cases dealt with have increased from 140 houses in 1934 to 265 in 1935. The Council have now adopted the policy of having the furniture of all new tenants of houses on their estates examined and disinfested before removal. INFECTIOUS CASES. In connection with infectious cases, including smallpox contacts, 1,136 visits were made by the sanitary inspectors. During the year 1935 the following disinfection was carried out:— 15,693 articles were disinfected in the steam disinfector; 1,163 rooms were disinfected with the formalin spray, namely:— 326 after diphtheria; 548 after scarlet fever; 144 in cases of tuberculosis; 60 after miscellaneous diseases; 85 wards and rooms in institutions and schools; 36 5,310 library books were disinfected and returned to the libraries; 566 articles of clothing and bedding, etc., were destroyed at the request of the owners; 152 lots of bedding from verminous houses, and 20 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 77 such properties were examined. 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 244 ,, stables 238 ,, common lodging houses and sublet houses 136 ,, pawnbrokers' premises 4 ,, brooks 15 ,, schools 33 827 appointments have been kept with owners, builders, etc., relative to notices. SMOKE ABATEMENT. Complaints are from time to time received about smoke nuisance from factories. Observations are constantly being made, but the byelaws are not sufficiently stringent to prevent considerable volumes of smoke escaping without infringement. The factory owners usually are willing to co-operate with the Health Department in mitigating as far as practicable nuisance arising from factory smoke. SWIMMING BATHS AND POOLS. The Central Swimming Baths—two in number—are on the constant filtration and chlorination principle. The numbers using these baths 37 made a severe demand upon the cleansing system, especially during the Summer months. There is also an open-air bath situated on the Tottenham Marshes. The water in the latter is supplied from the River Lee and changed periodically. A large "Lido" in Lordship Lane is in course of construction. 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 1935. HOUSING STATISTICS. Number of Houses erected during the Year. By private builders (no State assistance) 106 houses and 78 flats Inspection of Dwelling-houses during the Year. (1) (a) Total number of dwelling-houses inspected for housing defects (under Public Health or Housing Acts) 4,588 (b) Number of inspections made for the purpose 15,108 (2) (a) Number of dwelling-houses (included under head (1) above) which were inspected and recorded under the Housing Consolidated Regulations, 1925 1,442 (b) Number of inspections made for the purpose 7,125 (3) Number of dwelling-houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation *93 *89 of these were dealt with under Part 1, Housing Act, 1930, and 4 under Section 19, Housing Act, 1930. 38 (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 2,461 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 2,108 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 311 (2) Number of dwelling-houses which were rendered fit after service of formal notices :— (a) By owners †276 (b) By local authority in default of owners 5 †lncluding premises in respect of which notices were served in 1934. (B) Proceedings under Public Health Acts: (1) Number of dwelling-houses in respect of which notices were served requiring defects to be remedied *83 (2) Number of dwelling-houses in which defects were remedied after service of formal notices :— (a) By owners 54 (b) By local authority in default of owners 4 (c) By local authority at request of owner 1 *Included in this figure are 13 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. 39 (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 *2 (2) Number of dwelling-houses in which defects were remedied:— (a) By owners 2 (b) By local authority in default of owners Nil *Included in this figure is one house in respect of which a notice was also served under Section 17 of the Housing Act, 1930, and one house in respect of which a notice was also served under the Public Health Act. (D) Proceedings under the Tottenham Urban District Council Act, 1900: (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 (E) Proceedings under Sections 19,20 and 21 of the Housing Act, 1930: Two Demolition Orders were served under Section 19; in two other cases undertakings that the premises would cease to be used for human habitation were accepted from the owners. 40 FACTORY AND WORKSHOP ACT, 1901. In compliance with Section 132, I have to submit a resume of the work effected during the year—under the provisions of the above Act— in the form prescribed by the Home Office:— 1.—Inspection of Factories, Workshops and Workplaces. Inspections made by Sanitary Inspectors. Premises. Number of Inspections. Written Notices. Prosecutions. Factories (including Factory Laundries) 311 21 — Workshops (including Workshop Laundries) 379 21 — Workplaces (other than outworkers' premises included in Part 3 of this Report) 227 10 — Total 917 52 — 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 37 36 — — Want of ventilation — — — — Overcrowding — — — — Want of drainage of floors 1 1 — — Other nuisances 15 15 — — Sanitary accommodation insufficient 1 1 - - unsuitable or defective 9 9 — — 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) 1 1 - - Total 65 64 — — * Including those specified in sections 2, 3, 7 and 8, of the Factory and Work shop Act as remediable under the Public Health Acts. 41 3.—Home Work. OUTWORKERS' LISTS, SECTION 107. Number of Inspections of Outworkers' Premises. Outwork in Unwholesome Premises, Section 108. Outwork in Tnfected Premises, Sections 109, J10. Nature of Work. Lists received from Employers. Number of Addresses of Outworkers received from other Councils. Number of Addresses of Outworkors 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 30 266 5 15 273 119 — — 435 — — — — — — Boots and Shoes 4 24 2 11 9 29 — — 15 — — — — — — Stationery 2 12 1 2 — 3 — — 11 — — — — — — Cardboard , etc., Boxes 2 12 — — 6 5 — — 13 — — — — — — Brushes — — — — 4 — — — 4 — — — — — — Furs — — 1 4 7 2 — — 9 — — — — — — Umbrellas — — — — 1 — — — 1 — — — — — — Fancy Goods 2 143 1 3 9 49 — — 106 — — — — — — Artificial Flowers — — — — 3 — — — 3 — — — — — — Lace Paper & Xmas Crackers 4 22 — — 2 7 — — 17 — — — — — — Leather Goods — — — — 4 — — — 4 — — — — — — Needlework — — — — 3 — — — 3 — — — — — — Chemists' Sundries — — — — 4 — — — 4 — — — — — — Toys — — — — 1 — — — 1 — — — — — — Sweets — — — — 3 — — — 3 — — — — — — Paper Goods 2 13 — — — 1 — — 12 — — — — — — Totals 46 492 10 35 329 215 — — 641 — — — — — — 42 4.—Workshops, Laundries and Bakehouses on the Register at the end of the Year. Number. Workshops 219 Laundries 16 Bakehouses 62 Total 287 5.—Other Matters. Class. Number. Matters notified to H.M. Inspector of Factories:— Failure to affix Abstract of the Factory and Workshop Act (Sec. 133) — Action taken in matters referred by H.M. Inspector as remediable under the Public Health Acts, but not under the Factory and Workshop Act (s. 5), Notified by H.M. Inspector 4 Reports (of action taken) sent to H.M. Inspector 4 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 (5. 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). 43 INSPECTION AND SUPERVISION OF FOOD. MILK. 32 persons were registered as retail purveyors of milk during the year. There are now 169 purveyors of milk on the register and during the year 349 visits were made to their premises. There are no cowsheds in the district. In 1935, licences under the Milk (Special Designations) Order, 1923, were granted as follows:— For the sale of Grade A (Tuberculin Tested) Milk 25 (including 5 supplementary licences). For the sale of Pasteurised Milk 26 ,, 3 ,, ,, For the sale of Certified Milk7„4„„ For the sale of Grade A Pasteurised Milk 5 ,, 3 ,, ,, For the sale of Grade A Milk 1 BREAD. There are 52 bakehouses in the district and during the year 226 visits were made to these premises by your inspectors. MEAT, FISH AND FRUIT. There are now 3 registered and 6 licensed slaughterhouses in the Borough. One slaughterhouse carries on a wholesale trade. There are in Tottenham 116 butchers' shops, 145 fruiterers' and greengrocers' shops, and 84 fish shops. 44 During the year, 1,217 visits were made to the slaughterhouses, 731 to the butchers' shops, 332 to the fruiterers' and greengrocers' shops, and 398 to the fish shops. 35 licences to slaughter animals were issued in 1935. During the year the following animals were inspected:—Bulls 1, Bullocks 863, Cows 44, Heifers 166, Calves 1,525, Sheep 5,241, Swine 17,558. Disease was found to exist in :—Bulls nil, Bullocks 1.3 per cent., Cows 15.9 per cent., Heifers 15.0 per cent., Calves 1.6 per cent., Sheep 2.1 per cent., Swine 4.9 per cent. The following is a summary of the various parts affected:— Swine.—32 whole carcases, 427 heads, 188 livers, 128 lungs, 88 mesenteries, 18 collar pieces, 17 hearts, 4 spleens, 2 kidneys, 1 omentum, 1 neck, 61 lbs. pork. Bovines.—19 livers, 14 lungs, 3 tongues, 3 heads, 2 mesenteries, 1 spleen, 1 skirt, 1 hind quarter, 6 lbs. brisket. Sheep.—90 livers, 38 lungs, 5 hearts, 2 legs and loins, 40 stones mutton. 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 on their arrival in Tottenham these are subjected to special examination by your officers. Under these arrangements the following goods have been condemned and destroyed :— 90 Rabbits. 4 stone Rock Salmon. 5 tins Corned Beef. 90 lbs. Apples. 44 lbs. Ham. 1 box Lemons. 7 boxes Kippers. 28 lbs. Tomatoes. ½ cwt. Whelks. 45 tins Cherries. 6½ stone Skate. ADULTERATION, ETC. I am indebted to the County Council (the Authority for administering 45 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 365 - Milk, Sterilised 21 - Butter 3 - Coffee 1 - Gin 6 3 Hake 1 - Lemon Sole 2 1 Meat 2 - Minced Beef 5 - Rum 2 1 Sausages 7 2 Whisky 7 2 422 9 Number of Prosecutions 2 Number of Convictions 2 PREVALENCE OF, AND CONTROL OVER, INFECTIOUS AND OTHER DISEASES. The last quarter of the year was marked by an increase in the notifications of Scarlet Fever, the most marked rise being in the week ended October 12th. The disease was of a mild type generally. It was considered expedient to close one of the schools in July on account of the prevalence and severity of type of Diphtheria. Plans have been approved by the Ministry of Health for the enlargement of the Southgate Isolation Hospital to accommodate Tottenham patients. When completed, the hospital will have accommodation tor 200 patients. There is still an inadequate response to the invitation to parents to have their children immunized against Diphtheria, a service that is rendered to them free of charge, that is practically painless and creates no marking of the skin as does vaccination, and that gives almost complete protection against Diphtheria. No change has taken place for several years in the methods employed for controlling infectious diseases. Hereunder is set out in tabular 46 form an account of the use made by Tottenham of the Isolation Hospitals of other authorities. SCARLET FEVER. 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 173 26.3 8 20.7 1 46.0 Hornsey 30 30.7 2 21.5 1 4.0 L.C.C. 3 35.6 2 21.0 — — London Fever 3 43.3 — — 1 16.0 Enfield & Edmonton 1 30.0 — — — — Wrongly diagnosed cases were re-classified as follows:—Whooping Cough, 1; Bronchitis, 1; Measles, 5; Tonsillitis, 1; German Measles, 1; Not Scarlet Fever, 2; Food Rash, 1. DIPHTHERIA. 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 144 59.9 13 22.3 5 18.8 Hornsey 73 46.0 9 19.6 7 6.4 L.C.C. 13 58.7 2 23.0 — — London Fever 7 51.1 — — — — Enfield & Edmonton 2 13.0 — — — — Wrongly diagnosed cases were re-classified as follows:—Not Diphtheria, 8; Scarlet Fever, 3; Tonsillitis, 8; Croup, 1; Mumps, 2; Bronchitis, 1; Retro-Pharyngeal Abscess, 1. 47 CASES OF NON-NOTIFIABLE INFECTIOUS DISEASE REMOVED TO HOSPITAL. 8 Measles and Pneumonia. 3 ,, and Bronchitis. 2 ,, and Mastoid. 2 ,, and Eczema. 1 ,, and Appendicectomy. 1 ,, and Conjunctivitis. 1 ,, and Lacerated Leg. 1 ,, and Meningitis. 1 ,, and Nephritis. 1 ,, and Pyelitis. 1 ,, and Stomach Obstruction. 1 ,, and Whooping Cough. 17 Whooping Cough and Pneumonia. 3 ,, and Chicken Pox. 2 ,, and Bronchitis. 2 ,, and Mastoid. 1 ,, and Poisoning. 1 ,, Bronchitis and Mastoid. 1 Mumps and Gastritis. 1 ,, and Pneumonia. 1 Chicken Pox and Inguinal Abscess. 1 ,, and Septic Leg. 1 ,, Pneumonia and Fractured Skull. 1 ,, and T.B. Spine. SMALLPOX. There were no cases of Smallpox during 1935. I am obliged to the Vaccination Officer for the following information:—Number of successful vaccinations during 1935, 475; number of declarations of conscientious objection to vaccination, 771. DIABETES. With the approval of the Ministry of Health, Insulin was supplied to 8 patients suffering from Diabetes. The number of units amounted to 89,680 and the cost was £29 5s. 2d. Reports upon the progress of the cases were furnished to the Ministry according to their requirements. 48 TUBERCULOSIS. The County Council are responsible for the treatment of Tuberculosis. 235 notifications were received during 1935—Pulmonary, 204; other than Pulmonary, 31. Cases remaining on the register at the end of the year were: Pulmonary, 647; Non-Pulmonary, 172. 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. 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 1 1 2 — — 2 - 5 to 15 ,, 7 7 3 7 - 1 2 2 15 to 25 ,, 29 40 4 6 13 19 - 1 25 to 35 ,, 25 21 1 2 12 17 1 — 35 to 45 ,, 19 7 1 3 7 4 — - 45 to 55 ,, 9 6 — 2 14 6 — — 55 to 65 ,, 22 3 — — 13 2 — — 65 years and upwards 4 2 — — 3 3 — 1 Totals 116 87 10 22 62 52 5 4 49 Organs affected (New Cases):— Males. Females. Lung 116 87 Glands — 9 Spine 1 2 Meninges 2 – Peritoneum 1 1 Hip 1 2 Ear — 1 Knee — 1 Face — 1 Tongue — 2 Arm — 1 Ankle 1 — Eye — 1 Other 2 3 125 110 The deaths represent a death rate of 0.82 per 1,000 population. In 17.89 of the fatal cases no previous notification had been received. There was, however, no suggestion of wilful neglect or refusal to notify, and accordingly no proceedings were taken. Borough of Tottenham Education Committee ANNUAL REPORT of the SCHOOL MEDICAL OFFICER for 1935 MEMBERS OF THE COMMITTEE. (As at 31st December, 1935.) Councillor A. J. LYNCH, J.P. (Chairman). Alderman Mrs. W. A. KENT (Vice-Chairman). Alderman E. J. FIELD. Alderman C. D. GRANT. His Worship The Mayor (Alderman A. E. JAY, J.P.). Alderman Major Sir P. B. MALONE, J.P. The Deputy Mayor (Alderman J. H. MORRELL). Councillor M. DORAN. Councillor Mrs. A. M. ELLIS. Councillor A. E. HARVEY. Councillor W. H. HEALING. Councillor A. E. JOHNSON. Councillor D. JORDON. Councillor Mrs. A. KITCHENER. Councillor A. W. LOCK. Councillor Mrs. J. D. LYNCH. Councillor H. W. PEARCE. Councillor A. REED, A.C.I.I., J.P. Councillor H. W. TURNER. Councillor R. H. WARREN. 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. Letchwortb, F. R.C.S. Aurist: A. R. Friel, M.A., M.D., F.R.C.S.I. Dental Surgeons : Y. Sainty, L.D.S., R.C.S. (Eng.). L. S. Pilbeam, L.D.S., R.C.S. (Eng.). Orthopaedic Surgeon: H. J. Seddon, F.R.C.S. 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 O. P. E. Hann, S.R.N., D.N. Miss D. Weetman, Bay Sister. Miss E. Hutton, Night Sister. 10 Probationary Nurses. GENERAL INFORMATION. Total School Population. Number of Scholars on Roll. Elementary Schools:— Provided Departments 51 On Roll 17,853 Non-Provided Departments 12 „ 2,374 Central Departments 3 „ 1,132 Special Day Schools 3 „ 175 69 21,534 Special Day Schools in other Districts 2 „ 64 71 21,598 Secondary and Technical Schools 6 „ 1,516 Private Schools 10 „ 450 87 23,564 Boys. Girls. Infants. Mixed. Central. Special. Totals. Number on Roll 6,046 5,846 5,761 2,576 1,132 173 21,534 Average Attendance 5,513 5,268 4,787 2,309 1,061 150 19,088 Percentage of Average Attendance 91.2 90.1 83.1 89.7 93.7 86.7 88.7 4 INTRODUCTION. School Medical Department, Town Hall, Tottenham. March, 1936. To the Chairman and other Members of the Tottenham Education Committee. Ladies and Gentlemen, I have the pleasure to submit my report on the School Medical Services for the year 1935. It follows generally the lines of the reports for the past four years. Herein will be found an analytical statement of the year's work with explanatory notes, where necessary, in their appropriate sections. It will be noted that since my last report, by arrangement with the Middlesex County Council, the secondary school children are now privileged to participate in the benefits of dental and ophthalmic treatment provided by your authority. Orthopaedic treatment and remedial drill instruction for children suffering from deformities have been revised and established on an entirely new basis. Towards the end of the year, plans were approved for the new combined School Medical and Maternity and Child Welfare Departments in Lordship Lane to replace the existing centre at Bruce Castle. Plans were approved also for the complete remodelling of the convalescent home at Hayling Island. I thank your Committee for their continued generous support and my staff for their loyalty and devotion to 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. The Medical Officer of Health is the School Medical Officer and Medical Officer of the Maternity and Child Welfare Committee. He is in intimate relation with all Medical Services operating in the district— institutional and other—so that available facilities for diagnosis and treatment are at the disposal of all who need them, irrespective of age. THE SCHOOL MEDICAL SERVICE IN RELATION TO PUBLIC ELEMENTARY SCHOOLS. School Hygiene.—The following schedule of repairs and alterations to schools during 1935 has been furnished to me by your Committee's Surveyor:— Belmont School. Removal of steppings and forming level floor to one classroom. Provision of 20 tables and 40 chairs. Bruce Grove School. Provision of lavatory accommodation for female staff. Removal of steppings and forming level floor to one classroom. Provision of 20 new tables and 40 chairs. Provision of Head Teacher's room. Coleraine School. Provision of 20 new kindergarten tables and chairs. Providing facilities for feeding of necessitous children. Removal of steppings and forming level floor to one classroom. Crowland School. Redecorations—external and internal. Removal of steppings and forming level floors to three classrooms. Provision of 40 tables and 80 chairs. 6 Culvert School. Removal of steppings and forming level floors to two classrooms. Provision of 55 tables and 110 chairs. School for the Deaf. Eedecorations—external and internal. Devonshire Hill School. Provision of 20 tables and 40 chairs. Downhills School. Remodelling Infants' range of offices on the gravitation system. Modernisation of Girls' Domestic Subjects Room. Removal of classroom steppings and forming level floor. Provision of 45 tables and 90 chairs. Downhills (Central) School. Removal of classroom steppings (one room) and forming level floor to the Geography Room, and providing 20 tables and 40 chairs, and exhibition panelling to walls. Provision of 12 new woodwork benches to Handicraft Room. Down Lane (Central) School. Removal of classroom steppings (one room) and forming level floor. Earlsmead School. Providing staffroom facilities for the Infants' staff. Relaying complete new wood block floor in Assembly Hall. Lancasterian School. Remodelling Boys', Girls', and Infants' ranges of offices on the gravitation system. Installation of electric lighting. Removal of steppings and forming level floors to four classrooms. Page Green School. Installation of electric lighting. Provision of 10 new woodwork benches in Handicraft Room. 7 Parkhurst School. Installation of new central heating boiler. Removal of classroom steppings and forming level floor. Provision of 12 new woodwork benches to Boys' Handicraft Room, and 20 kindergarten tables and 40 chairs. Risley Avenue School. Enclosure of Open-Air classroom with glazed framing and casement doors, and providing heating, lighting and general equipment for ordinary class purposes. Removal of steppings and forming level floors to four classrooms. Provision of 60 tables and 120 chairs. Stamford Hill School. Installation of electric lighting. Improvements to central heating. Vale Road School (Physical Defective). Redecorations—external and internal. Construction of concrete carriageway for vehicular traffic to and from the school. Improved stock room provided. West Green School. Removal of steppings and forming level floors to two classrooms. Woodlands School. Redecorations: All Departments—external; Boys' and Girls' Departments—internal. Removal of steppings and forming level floors to two classrooms. Provision of 20 tables and 40 chairs. Middle Class School. Provision of 20 tables and 40 chairs. St. Ann's Infants' School. Provision of staff-room furniture. Holy Trinity School. Provision of new cupboards and chairs. 8 General. Provision of chemical fire extinguishers to all non-provided schools. 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 reorganisation carried out during 1935, practical work rooms, complete with equipment, have been provided as follows:— Risley Avenue School.—Practical work room for Boys' and Girls' Departments and Domestic Subjects room for Girls' Department. Devonshire Hill School.—Domestic Subjects room for Girls' Department. Improved staff-room facilities are being carried out generally, including the provision of some 300 bent-wood chairs, 60 adjustable easy chairs, rugs, and cooking apparatus. MEDICAL INSPECTION. Description of arrangements made and methods adopted for the medical inspection of children:— Medical Inspection usually takes place in the schools attended by the children. In those schools where facilities for inspection are lacking, the children are drafted to one or other of the treatment centres. The school medical officers are assisted by nurses, who weigh, measure and sight-test. The doctors conduct the rest of the examination. The school dentists make independent examinations in school. The audiometer is being increasingly used for the estimation of hearing. Parents are invited to be present at the medical inspections. Defects discovered are notified to parents, and the children are followed-up and re-examined in respect of these defects. 9 The three age-groups of the Board's choosing were all inspected, and for special reasons teachers presented for examination children outside the age-groups. See statistical tables, page 38. FINDINGS OF MEDICAL INSPECTION. Malnutrition.—The findings of the school medical officers in connection with the children examined at routine medical inspections are shown in the special Table, page 40. Action was taken to effect a remedy, viz., by convalescent treatment, the supply of medicinal accessories, etc., and in 278 cases free milk in school was provided. In addition, the medical officers have examined in school, children who have been specially referred to them on account of suspected malnutrition. As a result of these special inspections 135 children were recommended for free milk in school. 112 children were found at the school clinics to be suffering from malnutrition in varying degrees, and the following is an analysis of the treatment afforded:— Free Milk 38 Medicinal Food Accessories 36 Convalescent Treatment and Food Accessories 13 Convalescent Treatment 21 Referred to Hospital 4 Uncleanliness.—1,056 children were found on examination to be unclean—5.5 per cent. of the children examined. This is 1.3 per cent. better than in the previous year and a substantial improvement having regard to the thoroughness of the examinations. Minor Ailments and Diseases of the Skin.—In 1934 these accounted for the ailments of 3.9 per cent. of the children in average attendance at school. In 1935 the percentage was 3.38. Visual Defects and External Eye Diseases.—1,253 children were found at medical inspection in 1935 to have one or other of the above 10 type of defects. 783 had visual defect, two had corneal opacities and 468 had external eye defects or diseases. A reference to the treatment Table IV, Group II, will show that 923 children were examined for errors of refraction. Spectacles were prescribed for 792 and were obtained by all. Nose and Throat Defects.—The number of these defects found in 1935 was 1,094, in 1934, 917. The number of operations performed fell in 1935 by 38, compared with the previous year. The details will be found in Tables IIa and IV, Group III. Ear Disease and Defective Hearing.—There has been a slight decrease in the number of these defects discovered and is accounted for by the reduction in the otitis media group. The relative numbers for 1934 and 1935 being 100 and 79 respectively. Dental Defects.—15,437 inspections were made by the dentists. Of the 10,681 who were found to require treatment, 5,679 only, or 53 per cent. took advantage of it. This, however, is 8 per cent. better than the previous year. Orthopaedic and Postural Defects.—-Arrangements have been made with the Royal National Orthopaedic Hospital for attendance by their doctors and nurses at Tottenham Centres. Two centres have been established, one at Vale Road School—the School for Cripple Children, and one tentatively at Bruce Castle until the new School Medical Clinic to be established in Lordship Lane is available. Towards the end of the year, all children of school age known to have defects or deformities of the kind for which school orthopaedic clinics have been established, were submitted to examination by the Orthopaedic Surgeon. 272 cases in all were examined and classified as follows:— (1) Congenital Defects— Club Foot 2 Dislocation of the Hip 1 Other Conditions 3 11 (2) Birth Injuries— Torticollis 1 (3) Rickety Deformities— Knock Knees 21 (4) Postural defects of the Spine 138 (5) Structural Curvature of the Spine 54 (6) Flat Feet. 4 (7) Infantile Paralysis 1 (8) Tuberculous Joints 1 (9) Other Defects 1 (10) Not now Defective 45 Early in the New Year the clinics will be in full operation. This further branch of the School Medical Service may be regarded as satisfactorily established. Heart Disease and Rheumatism.—There has been a disquieting increase in the number of cases of heart disease brought to light. Of organic heart disease there have been recorded 75 cases and of functional heart disorder 47. The corresponding figures for 1934 were 44 and 35. The gravity of permanent disability of the heart is fully realised and every available measure is adopted to repair disordered function. Tuberculosis.—39 children were diagnosed provisionally to be suffering from tuberculosis in one form or another—19 pulmonary (7 definitely, 12 doubtfully), 20 non-pulmonary. It is unusual to find such a distribution among school children. The parts usually attacked in children are bones, joints and glands, the lungs being affected at a later age. Diagnosis of tuberculosis of the lungs is not lightly to be made, and in arriving at a conclusion on the matter the School Medical Officers are fortunate in having Dr. Davies (the local Tuberculosis Officer) to assist them, whose opinion is always ungrudgingly given. 12 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:— One of the school doctors pays periodical visits to children who wear surgical appliances, towards the cost of which the Education Committee have contributed. A link is thus established between the hospital or other institution prescribing the instrument and the patient, whereby attendance at the hospital can be ensured as circumstances require and repairs effected immediately they appear necessary. Weekly returns from, the schools are received by the School Medical Officer showing absences of the children from infectious or contagious piseases. The school nurses follow-up in the homes the children thus notified. Children excluded from school on the recommendation of the school medical officers are likewise followed-up by the school nurses when they fail in their regular attendance at the appropriate clinic. The attendance officers inform the medical department of absences from school for apparently inadequate reasons and suitable measures are taken. The school nurses gave 106 baths to 41 children suffering from scabies. They paid 5,135 home visits, made 686 attendances at clinics and 417 school attendances for purposes of medical inspection. The other work undertaken by the school nurses is set out in tabular form on page 46, Table VI. MEDICAL TREATMENT. Review of the methods employed or available for the treatment of defects and a statement of the ascertained results of treatment:—- The following is a list of the School Clinics. It is to be noted that the Clinics are available for children other than school children. 13 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. The measure of the work undertaken and the result of the treatment given may most conveniently be learned from a study of Tables IV and V, pages 44-46. There, under five groups, are set out the activities of various of the Clinics. The Aural Clinic has a section of this report to itself. With regard to the other Clinics they may be regarded as consolidated. The Aural Clinic is of more recent development and the limits of its capabilities have not yet been determined. For instance, there is a growing belief that impairment of hearing results more from infectious diseases and protracted common colds than from anything else. An arrangement has been come to with Infectious Disease Hospitals receiving Tottenham children, by which the School Medical Officer is advised of any patient who, during his illness, has shown indication of ear trouble. Immediately on discharge from hospital that patient is brought under the supervision of your Committee's Ear Specialist and receives such attention as may be necessary, until apprehension respecting hearing is allayed. Similarly, with the co-operation of the Director of Education and the teachers of one of your larger schools, children suffering from protracted catarrh are submitted to the scrutiny of the Aurist. Until the functions of the Ear Clinic have been definitely delineated the Aurist will be requested to furnish a special report to be incorporated in the School Medical Officer's annual statement for submission to the Board of Education. Children other than those found by the medical staff to be in need of treatment may be sent for sufficient reason to School Clinics by the head teachers of school departments. The latter know well what 14 ments have been made for the examination and treatment of school children, and co-operate heartily with the Medical Department in the interests of the children. Wherein the School Medical Service comes short of the needs of the children, Tottenham is fortunate in having in itself and in the immediate neighbourhood of Edmonton and London, hospitals for all purposes, to which ready access is available. For purposes of convalescence, the Tottenham Education Committee have their own Home—Suntrap Home —at Hayling Island, and, by arrangement, the advantages of other institutions are at your Committee's disposal (see Pages 23-4, where the residence of special cases and their numbers are set out in detail). Ear Diseases and Hearing.— AURAL REPORT. Aural Clinic—Otorrhoea Cases. Work carried out at the Clinic during the Year ended 31st December, 1935. Cause of Suppuration. Total Ears. Cured. Lost sight of. Still under treatment. Needing Hospital. Acute Suppurative Otitis Media 49 42 3 4 — Chronic Suppurative Otitis Media, due to— (a) Tympanic Sepsis 38 30 4 4 — (6) T.S. and Granulations 13 10 2 1 — (c) T.S. and Polypus 4 3 — 1 — (d) T.S. and Rhinitis 3 2 — 1 — (e) T.S. and Caries 1 — — 1 — Tympanic Conditions and Attic Disease 5 2 2 — 1 Mastoid Disease 8 2 — 1 5 External Otitis 6 5 — 1 — Not Diagnosed 3 3 — — — Totals 130 99 11* 14 6 *Of the oases "lost sight of," 1 is being treated at hospital, 8 have left the District, and 2 have left school owing to age. 15 I am indebted to Dr. Friel for the following statement : — " The Table printed above classifies the conditions found in the discharging ears in 1935 and summarises the results of treatment. In the chronic cases the basic factor keeping up the suppuration is the infected discharge stagnating in the ear and irritating the tissue with which it is in contact. The septic fluid may be in a space accessible in its whole extent or it may extend into an area totally inaccessible, such as the mastoid. Moreover, in some oases there may be additional factors—a polypus or granulations—present. Usually, these latter are in an accessible position and can be dealt with. If they (the sepsis or the granulations) are in a place difficult of access, such as the attic, recovery is delayed. Sepsis alone in an accessible position is responsible for the largest single class of cases of chronic suppuration. The inflammation shows degrees of severity. When the chronio condition has recently set in it is mild, and easy to treat successfully. Cleansing and insufflation of boracic powder a few times is sufficient. But when it is considerable and of long duration with much discharge there is only one method of treatment known to the writer which acts quickly and decisively—zinc ionisation. On the establishment of an ear clinic a considerable accumulation of such cases is found. Each ear must be examined to find out what is keeping up the discharge and whether the area involved is accessible or not. If it is inaccessible, operation in hospital to gain access to the area holds out the only prospect of cure. " The field of zinc, ionisation is in the treatment of those cases where the sepsis is in an accessible position. Usually, one treatment causes complete or almost complete cessation of suppuration. Its economic importance is in the rapidity with which it clears up these cases. " The arrears of chronic cases having been disposed of there is then time available to treat cases of ACUTE otitis media, whether suppurative or catarrhal, of nasal catarrh, and of obstruction of the Eustachian tube, etc. "As has been said, operation holds out the only prospect of a cure for a mastoid case. No hesitation is felt in sending a child to hospital when the inflammation is ACUTE. This is so for two reasons; first, the urgency to avoid extension to the interior of the skull or to the large blood vessels, and second, because good results are the rule. These two facts do not apply to the chronic oases of mastoid disease. Frequently the condition has existed for months or years, the results 16 obtained are not so good and the relatives may not be able to stand the expense. The word, '"expense" is used in a wide sense. The Committee pays the Hospital charges. There is in addition the expenditure in time and energy on the part of the patient and a relative, usually the mother. After the operation has been done and the patient is discharged from hospital a long and regular attendance at the Out-patient department follows. Each attendance often means a long wait in the hall with consequent disorganisation of the work at home, and discomfort. The visit to the hospital is necessary, but the long wait is unnecessary. " For the sake of the sick and their guardians, and in tha interests of the hospital itself and its staff, it would appear advantageous by good organisation and by a system of appointments, to avoid irksome delay. " The treatment of mastoid cases after operation is long and troublesome. As long as the conditions referred to exist, one hesitates before sending such cases to hospital. If attendance fails or becomes irregular, healing is impaired. An unhealed mastoid is a greater burden than a mastoid which has not been operated upon." INFECTIOUS DISEASES. Review of the action taken to detect and prevent the spread of infectious diseases:— School nurses make regular visits to schools principally in connection with cleanliness surveys. When infectious disease makes its appearance in schools, the nurses are alert to find out any children who present appearances suggestive of the early stages of infection and have them excluded. The teachers are equally vigilant to prevent the attendance at school of suspects. Children who have been absent from school on account of notifiable infectious diseases are, with their contacts, medically examined, including in the case of diphtheria, bacteriological examination, before re-admission is granted. Generally, the recommendations of the ' 'Memorandum on Closure of and Exclusion from School" of the Ministry of Health and Board of Education are complied with. 17 In respect of two schools only was it necessary to take action in the direction of certification for depleted attendances, namely:— Earlsmead Infants' School, for 2 weeks. St. Francis of Sales Infants' School, for 1 week. In the case of St. Francis of Sales it was also considered expedient to close the school, on account of the prevalence of diphtheria, from 2nd July to the end of the Summer term. The following table shows the incidence of infectious diseases, occurring amongst school children, as notified to the Health Department under the Infectious Disease (Notification) Act, and subsequent Orders:— Scarlet Fever 353 Diphtheria 180 Erysipelas 3 Pneumonia 27 Poliomyelitis 3 Tuberculosis—pulmonary 14 „ non-pulmonary 3 Voluntary Notifications. Teachers, attendance officers and others gave intimation of the occurrence, amongst school children, of the following diseases with the stated incidence:— Measles 201 Sore Throat 1 oL German Measles 43 Influenza Mumps 816 Eye Disease 4 Whooping Cough 568 Sores and Impetigo 74 Chickenpox 701 Rheumatism 3 Scarlet Fever 278 Other Diseases 102 Diphtheria 152 Children excluded owing to Infectious Disease in house 490 Scabies 19 Tonsillitis 27 Bronchitis 11 Microscopical Examinations. Six specimens of hairs were examined, all of which were found to contain ringworm spores. 18 Bacteriological Examinations. The results of examination of throat and nose swabs for diphtheria will be found in the Health section of the report. 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 30 and 31. (b) School Journeys and Camps. For the year 1935, expenditure on School Journeys, not exceeding £450, was agreed to by the Education Committee and approved by the Board of Education. Nine schools organised Journeys, and, in addition, 140 children, in. four parties, were sent for a fortnight to the Hostels of the Shaftesbury Society at Whitstable and Dovercourt, at reduced maintenance charges, or free maintenance. 19 The following are particulars of the Journeys:— School. No. of Children and Duration of Visit. No. of Teachers in Charge. Place of Visit. Total Cost. Committee' s Grant. Belmont Sr. B. 22 (10 days) 2 Swanage £ 60 £ 35 Crowland B. .. 40 (2 weeks) 2 Niton. Isle of Wight 120 40 Devonshire Hill Jr. G. 30 (1 week) 2 Swanage 69 30 Downhills Sr. G. 40 (10 days) 2 Folkestone 110 45 Down Lane Central G. 98 (1 week) 2 Isle of Wight 220 65 Earlsmead Jr. B. 20 (2 weeks) 2 Weymouth 135 40 Earlsmead Jr. G. 20 (1 week) 2 Isle of Wight 48 20 St. Katharine's Sr. G. 30 (2 weeks) 2 Folkestone 71 30 Deaf 34 (2 weeks) 2 Polegate, Sussex 81 26 Journeys organised by the Shaftesbury Society. Two parties of children, 70 boys and 70 girls, each in charge of 4 teachers, spent a fortnight at the Shaftesbury Society's Hostels at Whitstable and Dovercourt respectively in July. Maintenance costs in respect of the children were borne partly by the Society and partly by the Education Committee, the latter's share being £120. In addition, the Committee made a grant of £40 to meet the cost of fares, maintenance of teachers, and incidental items. (c) Physical Training. The year 1935 has seen various changes in Physical Education in the Elementary Schools of Tottenham. The new Syllabus, issued by the Board of Education, was introduced into the Schools in 1934. It is an accepted fact that this Syllabus is a great advance on its predecessors. 20 The spirit with which the children, as well as the teachers, acclaim it, is proof of its value. The actual standard of performance is improving and will be higher as time-tables permit of more periods of Physical Training being added. The value of posture is strongly emphasised and the new exercises promoting suppleness and agility should result in improved carriage and an understanding of good posture. Teachers' Classes.—During the Spring Term, Physical Training classes were attended by 110 teachers of Infant, Junior and Senior children, and additional demonstrations of all branches of Physical Education were given. It is hoped to hold further classes during 1936 for the benefit of those unable to attend previously. Equipment.—All departments have now been supplied with a satisfactory amount of minor apparatus for use on physical training lessons, and portable apparatus is to be provided in all departments with senior children during the year 1936. Pamphlet on P, ysical Education in the Classroom.—A pamphlet on Classroom Work with special emphasis on posture training has been prepared for use in Girls' and Infants' Schools and will be in the hands of teachers at an early date. 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. 1.550 such certificates were gained by pupils of the schools during the year (ended 31st March, 1935). 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. 21 During the year ended 31st December, 1935, 259,878 dinners were provided to children in the schools. Of these, 251,845 were provided free to children of necessitous parents, and 8,033, on payment, to children in Central Schools. The average number of children receiving milk daily during the year was 11,700—11,250 on payment, under the voluntary schemes organised by the head teachers, and 450 free, on the recommendation of the School Medical Officer. CO-OPERATION OF PARENTS, TEACHERS, SCHOOL ATTENDANCE OFFICERS AND VOLUNTARY BODIES. Co-operation of Parents.—Parents are informed of the time and place at which their children will be inspected and are invited to attend. The parents of infants take advantage of the invitation and are mostly present. With the older children the attendance of parents is less usual. By means of the invitation form, parents, if they are not to be present at the inspection, are asked to state what illnesses their children have suffered from and thus the personal history of each child can be ascertained and recorded. Intimation is given or sent to parents of defects noted at the inspections and suitable directions are given. The teachers also exercise their influence with parents to have children's defects attended to. The nurses "follow-up" in the homes children recommended by the school doctors for treatment and explain to parents the necessity for compliance with the medical advice. Hospital authorities frequently make the request that the school nurses shall visit the homes of their young patients and urge parents to be diligent in the keeping of appointments. The arrangements for keeping parents active in the welfare of their children are thorough and the results are good. Co-operation of Teachers.—Without the cordial co-operation of the teachers, especially in the matter of cleanliness, the benefits of the School Medical Service would be much reduced. 23 Their acquaintance and good relations with the parents generally enables many obstacles to be overcome to the benefit of the children. By the teachers' vigilance, also, early treatment is obtained, illness curtailed and suffering avoided. The teachers' knowledge of family circumstances is often helpful in determining the line of conduct in particular cases. Co-operation of School Attendance Officers.—Attendance Officers and members of the medical staff are mutually helpful in securing the regular attendance of children at school or treatment centre. Co-operation of Voluntary Bodies.—Two voluntary organisations have given useful service to the School Medical Department, namely, the Invalid Children's Aid Association and the National Society for the Prevention of Cruelty to Children. The Invalid Children's Aid Association have arranged for convalescent treatment for school children at institutions other than Suntrap Home, Hayling Island; for the regular attendance at hospital of cripple children, and for the supply of surgical instruments. The aid of the National Society for the Prevention of Cruelty to Children is seldom invoked. When other measures fail a visit from the officer of that Society usually suffices to create in a recalcitrant parent a sense of his responsibility towards his own children. No drastic action was found necessary during the year. CONVALESCENT HOME TREATMENT. 227 children suffering from debility, inanition, bronchitis, bronchial catarrh, etc., were sent to Suntrap Special School, Hayling, for a period of 6 weeks or more. 60 took advantage of the summer holiday arrangement at the same place. The Invalid Children's Aid Association sent 226 children to various convalescent homes and 8 were received in residence at the King Edward VII Memorial Seaside Hostel, Bexhill-on-Sea. 23 PROVISION OF SURGICAL INSTRUMENTS. Surgical appliances were supplied, and repairs and replacements effected in 254 instances. These were in respect of 80 children who were suffering from the following defects:— Infantile and other forms of Paralysis 27 Tuberculosis— Hip 2 Spine 1 Bones and Joints 1 Flat-foot 25 Talipes 5 Other forms of Deformed Feet 5 Amputated Leg 4 Other Cases 10 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. Information is received from many sources of the occurrence of defects in children under this heading, namely, at school inspections, from parents, attendance officers, health visitors and school nurses, from other authorities, where there has been change of address, and from hospitals and institutions. It is inconceivable that any can escape for any length of time from one or other of the means of information respecting them and available to the Local Health Authority. Usually the information is sent with a view of suitable provision being made for the defective child. Children supposed to come within the scope of Part V are referred, in the first instance, in the case of vision, to the Eye Specialist who advises to which Institution the child should be sent. Thus there are at:— Lordship Lane Day School for Partially Blind 10 children East London School for the Blind 3 „ White Oak, Swanley, Kent 2 „ In the case of deaf children, the Aurist is consulted, with the result that there are at the Tottenham School for the Deaf, 20 children. Two 24 children are receiving institutional treatment, one at the L.C.C. Deaf School, Anerley, and the other at the East Anglian Deaf School, Yarmouth Physically defective children attend the Vale Road Physically Defective Centre. Children who require residential treatment are accommodated as follows, namely, at:— West Wickham Heart School 4 children Heart Hospital School, Lancing 4 „ St. John's Institution, Woodford 2 Brookfield Orthopaedic Hospital 1 child Queen Mary's Hospital, Carshalton 1 „ Edgar Lee Heart Hospital 1 „ Royal Sea Bathing Hospital, Margate 1 „ St. John's, Brighton 1 „ Mentally defective children ascertained at the School Medical Officers' examination have been accommodated as follows:— Oak Lodge Special Day School, Finchley 49 children All Soul's Special School, Hillingdon 2 „ St. Joseph's, Lambourne, Astwood Bank, near Redditch 1 child Low grade defectives are referred to the County Authority. For epilepsy, one girl is receiving institutional treatment at Lingfield Home and School, and two boys are waiting for suitable accommodation. Tottenham children resident in outlying Institutions are periodically visited by the School Medical Officer and as they approach the age of 16 are specially examined with a view of ascertaining whether they require further supervision and training under the County Council's Scheme. High grade mentally defective children are not excluded from school, so long as they are well behaved, until a place in a suitable special school is found for them. If it appears probable that a child will, on reaching the age of 7 years, become notifiable to the Local Authority under the Mental Deficiency Act, information is sent as soon as the facts are known so that the Officer appointed under that Act may have knowledge of probable further claims upon his attention. 25 (6) Statement of the arrangements made for the supervision of mentally defective children not in Special Schools There is an Occupation Centre in Tottenham for mentally defective children of low grade. This is under the supervision of the Central Association for Mental Welfare. By arrangement with the County Authority the same provisions for medical inspection and treatment, as apply to elementary school children, are available for children attending this centre. The School for the Deaf. The report of Miss Beckingsale (Head Teacher) is as follows:— The School for the Deaf is certified for deaf, semi-deaf and aphasic boys and girls. It serves the areas of Tottenham, Edmonton, Wood Green, Hornsey and Enfield. In addition, pupils are sent by Middlesex, Hertfordshire and Essex County Authorities. Ambulances convey certain groups of children to and from their homes. Guides are responsible for the safe conduct of other groups, while many of the pupils travel independently. All the children remain at school during the mid-day recess and the majority have a two course hot meal which is prepared on the premises. A charge of 3d. is made for the dinner, except in necessitous cases. Advantage is taken of the Milk Marketing Board's Scheme, and many of the pupils have hot milk during the morning. The younger children are encouraged to have this mid-morning refreshment as many of them start early from their homes and travel considerable distances. During school hours the classes are hard at work learning to speak, lipread, write and read English, and later, when this means of communication is sufficiently established, they are able to take geography, citizenship, hygiene and other subjects. The children have physical exercises with games and country dancing. The girls learn needlework and cookery. The boys take cardboard work and bookbinding and have the advantage of a visiting master for woodwork. The pupils leave school at the end of the term in which their 16th birthday occurs. Work is found for them so that there is no risk of their being unemployed and experiencing the bitterness of feeling that 26 their services are unwanted. Furniture making and other forms of woodwork, lettering and other forms of commercial art are suitable occupations for the boys. Dressmaking, embroidery, millinery and housework are suitable occupations for the girls. A group of senior boys and girls in the care of three mistresses went on a School Journey to Jevington, near Eastbourne, at the end of June and they stayed in this Downland centre for two weeks. The mornings were occupied with lessons in connection with the Journey and the rest of the day with walks, periods of free time, games and sports. It is hoped that the pupils gained in good health and good manners and learned something more of the art of living unselfishly and joyfully. Oak Lodge School for Mentally Defective Children. The Head Mistress has submitted the following short statement:— During the year 1935 there have been 70 children from Tottenham on the roll of the above school. Twenty-eight of these were girls and 42 boys. Of the girls, 11 have left and 13 of the boys have also left, making the number in attendance at the present time 46. Those who have left include 10 excluded by the School Medical Officer as unsuitable for further attendance at this school and several of these are now at an Occupation Centre. Six are working in factories and are keeping their jobs well, 2 have removed from the district, 1 is at Suntrap School, Hayling Island, and the others are remaining at home. Four of the girls who left were able to spin wool and make the same into cloth. They could also make the cloth into garments using sewing machines. Four of the boys could repair shoes without any help. The senior boys now on the roll are learning to do likewise. Those senior children who cannot do woodwork or boot repairing well are generally employed in the garden and the heavy manual work is quite within their powers. Their basketry is also quite good. The older children are taken to various exhibitions in London to see other people's work. 27 On several occasions their own work has been included in the exhibitions. The love of animals is fostered in the children. The boys groom, clean and feed 20 Angora rabbits, whilst the girls learn to clip the wool. All the girls take a course of domestic science, including cookery, laundry, housewifery and needlework. Vale Road School for Physically Defective Children. The following report has been supplied by Miss Hubbard (Head Mistress of the school):— The situation of Vale Road School for Physically Defective Children is ideal with its spacious field and school garden. It is a one-storied building, with a long corridor running through it. There are five entrances, and in the summer, the doors are kept open and the corridor airy. The school has been re-decorated and the classrooms look very attractive. The playground has been reconstructed and a concrete track has been laid from one entrance gate to the other, thus making a firm path for the ambulances. Special furniture is provided for the children; desks, chairs with extending foot-rests and couches for recumbent cases. A remedial room has been added, so that children may receive treatment under the care of a specialist and a nurse. In the morning the time-table closely resembles that of a primary school, with the exception that in summer most work is done in the open air. Afternoon sessions are devoted to handicrafts. Senior boys learn book-binding, chair-seating and cane-work, leather, pewter, weaving and poster work. They also attend a woodwork centre. The senior girls specialize in plain and fancy needlework, often working their own designs. The junior boys and girls are taught preparatory craft-work. The children partake of a hot two-course dinner sent from Page Green meals centre. During the morning break, milk is provided, and 28 in the afternoon chemical food, and cod liver oil and malt is administered in special cases. A trained nurse is in constant attendance. Her duties include feeding helpless children and attending to general needs. She supervises remedial exercises when these have been prescribed. Every afternoon certain cases rest; this is taken in the open air when possible. The age ot the children varies from 5 to 16 years and the number on roll is 76. During the year 31 were admitted and 29 left. A record of the after-careers of children is kept, and a brief summary is given below:— Clerical Work 6 Factories 31 Shop Assistants 4 Hairdressing 1 Dressmaking 4 Signwriting 1 Decorating 1 Learning Tailoring 2 Hawking 2 Adult Occupational Centre for Cripples 3 Unemployed because of Defects 10 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 Pseudo-hypertrophic Muscular Dystrophy 1 Congenital Deformity 1 Amputation of Leg 3 Amputation of Hands 1 Injury to Head 1 Congenital Dislocation of Hips 1 Hydrocephalus 2 Tuberculosis— Spine 3 Hip 3 Knee 5 Heart Disease 38 Chronic Nephritis 1 29 Lordship Lane Partially Sighted School. The following is a report received from the Head Teacher of this school with respect to Tottenham children:— Number on Roll on April 1st, 1935 12 Number admitted during the year 5 Number left during the year 6 Number on Roll at the end of the year (6 boys and 5 girls) 11 Old Scholars.—Of the 6 leavers, 3 boys and 2 girls have gone to work and 1 girl left the district. The little information I have been able to receive about other old scholars has been through the children visiting the school. It is as follows:— 1927 S.H.— Milk round. 1933 L.B.—Grocer's assistant. Attends Moorfield's Hospital for eye treatment. 1934 W.G.—Still at home—is too small to get work. 1934 G.H.—Working as a presser in a factory and doing well. 1934 F.K.—Still working in a motor-cycle factory. 1935 W.W.—Toy factory—cutting out animals. Present Scholars.—The present scholars are all making satisfactory progress, and now we have no exceptionally backward child. In July the annual "Open Day" was held and there was the usual sale of handwork, and a concert given by the children. In December we had a "Parents' Day" when an entertainment was given by the children. There was also a sale of handwork, calendars and sweets of all kinds made by the girls in the Domestic Science Centre. Tea was served by the senior girls. The usual Christmas Tea-party and Games was held just before breaking up for the Christmas holiday, and this year the Mayor and Mayoress of Wood Green honoured us with a visit on the occasion. The boys still receive instruction two half-days a week in the Woodwork Centre and the girls, over 11 years of age, spend a whole day each week in the Domestic Science Centre. 30 The use of large-size printed reading books is being continued and we have not, as yet, received any unfavourable report as a consequence. Composition, spelling and general knowledge has improved as a result of the use of books in the school. The wireless set is still in use, and some of the school broadcast lessons are listened to with interest each week and are much enjoyed. Orchard House Open-Air Centre. Report for the year ended 31s£ December, 1935. During the year there were 38 boys on the school roll. 9 boys were lmitted and 10 withdrawn. Of the 10 scholars withdrawn, 2 left the district for other schools, and 8 found employment in the following trades, viz. :— 1 Polisher. 2 Woodwork. 1 Brass Moulder. 2 Gas Meter Makers. 1 at Pencil Factory. 1 at Rubber Factory. The scholars gave evidence of continued and increased physical and mental development. The average increase in weight was 9 lbs. The scholars received one-third of a pint of milk daily. 18 received |oz. of cod liver oil and malt daily and 8 received dinners daily. The curriculum includes the ordinary school subjects with gardening, woodwork and other manual tasks. The scholars were drawn from the following schools:— Lancasterian 22 Parkhurst 2 Devonshire Hill 2 Bruce Grove 1 Risley Avenue 1 31 Downhills Park Open-Air Class. This class of girls met in the bandstand from April 30th to October 26th. The number of pupils on roll was 23. Of these, 10 were admitted from Downhills Senior Girls, 7 from West Green Junior Mixed, 3 from Culvert Senior Girls, 2 from Page Green Senior Girls and 1 from Downhills Junior Mixed Schools. The ages of the scholars ranged from 8 to 14 years and the work, as in previous years, was conducted on individual lines. Nature study and dramatic work were notable features. The beauty of the surroundings was much appreciated by the children and they formed a very happy little community. The cases selected for admission were suffering from the following defects:— Subnormal Nutrition 8 Anaemia 6 Bronchitis and Bronchial Catarrh 5 Debility 2 Quiescent Tuberculosis of Lungs 1 Tuberculosis of Cervical Glands 1 An average of 5 lbs. gain in weight was noted after the period of open-air education and there was evidence of general improvement in the health of the girls. 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 1935— 115 children were in residence; 377 were admitted in 1935; 414 were discharged; 78 remained at the beginning of 1936. 32 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. Two Nursery Classes for children from 3-4½ years of age, and one Transitional Class for infants of 4½-5 years, with total accommodation for 116 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 attends one session weekly during which minor ailments are treated. Visits to these Classes are paid at frequent intervals by the Senior Assistant Medical Officer. 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 requisites, and a high standard of personal hygiene has been maintained. One-third of a pint of pasteurised milk is supplied daily to every child, free in necessitous oases. The health of the children in these classes during the past year has been very good, a low percentage of infectious cases being reported. 33 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:— Boys. Girls. Totals. County School 291 269 560 High School — 470 470 Grammar School 418 — 418 Junior Commercial School 16 75 91 Junior Technical School 156 — 156 St. Ignatius' College 523 — 523 1,404 814 2,218 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 1935 there were inspected 808 boys and 481 girls. 34 II.—Following-up and Medical Treatment:— Following-up is undertaken by the Head Teachers, who submit reports to the School Medical Officer. In respect of ophthalmic and dental treatment, the secondary schools have the same advantages as the children of the elementary schools. On pages 36-38 will be found a record of the treatment given. 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 866 lbs. Parrish's Food 374 lbs. Cod Liver Oil 233 ozs. Syrupus Ferri Iodidi 1,685 ozs. Syrupus Calcii Lactophosphatis 1,685 ozs. SECONDARY SCHOOLS. Table I.—Number of Pupils Inspected 1st January, 1935, to 31st December, 1935. Routine Inspections. Total. Ages. 9 10 11 12 13 14 15 16 17 Boys 13 11 159 147 166 128 157 17 10 808 Girls — 3 109 101 96 77 87 5 3 481 Totals 13 14 268 248 262 205 244 22 13 1,289 35 SECONDARY SCHOOLS (contd.). Table II.—Return of Defects Found in the Course of Medical Inspection in 1935. Defect or Disease. Routine Inspections. Number referred for Treatment. Number requiring to be kept under Observation, but not referred for Treatment. (1) (2) (3) Malnutrition — — Uncleanliness:— — — Head — — Bodv — — Skin Ringworm: — Head — — Body — — Scabies — — Impetigo — — Other Diseases (Non-Tubercular) 15 — Eye Blepharitis 1 — Conjunctivitis 1 — Keratitis — — Corneal Opacities — — Defective Vision 145 1 Squint 2 — Other Conditions 5 — Ear Defective Hearing 2 — Otitis Media 1 — Other Ear Diseases 5 — Nose and Throat Chronic Tonsillitis 26 7 Adenoids — — Chronic Tonsillitis and Adenoids 3 — Other Conditions 8 1 Enl. Cervical Glands (Non-Tubercular) 1 — Defective Speech — — Heart and Circulation I Heart Disease:— Organic 1 1 Functional 1 2 Anaemia 5 — Lungs j Bronchitis and Bronchial Catarrh 9 — Other Non-Tubercular Diseases 1 1 Pulmonary — — Tuberculosis Definite — — Suspected — — Non-Pulmonary:— Glands — — Spine — — Hip — — Other Bones and Joints.. — — Skin — — Other Forms — — Nervous System Epilepsy — — Chorea — 1 Other Conditions 1 — Deformities Rickets — — Spinal Curvature 4 — Other Forms 25 — Other Defects and Diseases 24 3 Table III. relates to " Exceptional Children " and is not required in connection with Secondary Schools 36 SECONDARY SCHOOLS (contd.). B.—Classification of Nutrition of Pupils Inspected During the Year in the Routine Examinations. Age. Number Examined. A. (Excellent.) B. (Normal.) C. (Sub-Normal.) D. (Bad.) 9 13 – 9 4 – 10 14 — 14 — — 11 269 32 214 20 3 12 247 26 211 10 — 13 262 16 231 14 1 14 205 30 172 3 — 15 244 42 202 — — 16 22 2 20 — — 17 10 2 8 — — 18 2 — 2 — — 19 1 — 1 — — Totals 1,289 150 1,084 51 4 Per cent. — 11.6 84.1 4 .3 Table IV.—Treatment of Defects of Pupils during 1935. 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 — 14 14 Ear Disease 3 3 Eye Disease:— External and other — 3 3 Miscellaneous — 1 1 Total — 21 21 37 SECONDARY SCHOOLS (contd.). 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) 146 1 – 147 Other Defect or Disease of the Eves (excluding those recorded in Group I) 1 — — 1 Total 147 1 — 148 Total number of Pupils for whom spectacles were prescribed:— (а) Under the Authority's Scheme 113 (b) Otherwise — Total number of Pupils who obtained or received spectacles:— (a) Under the Authority's Scheme 113 (b) Otherwise — 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 of 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) — — — — 9 — 1 — 9 — 1 — 4 — — 3 13 — 1 3 (i) Tonsils only. (ii) Adenoids only. (iii) Tonsils and Adenoids. (iv) Other defects of the nose and throat. 38 SECONDARY SCHOOLS (contd.). Group IV.—Dental Defects. (1) Number of Pupils who were:— (a) Inspected by the Dentist:— Ages .. 9 — Total 1,694 10 1 11 137 12 305 13 328 14 378 15 313 16 163 17 43 18 26 19 — Specials 7 Grand Total 1,701 (6) Found to require treatment 965 (c) Actually treated 298 (2) Half-days devoted to Inspection 11 (3) Attendances made by pupils for Treatment 655 (4) Fillings Permanent teeth 431 Total 431 Temporary teeth — (5) Extractions Permanent teeth 220 Total 259 Temporary teeth 391 (6) Administrations of general anaesthetics for extractions 1 (7) Other operations Permanent teeth 77 Total 77 Temporary teeth — (8) Regulation Case 1 ELEMENTARY SCHOOLS. Table I.—Number of Children Inspected 1st January to 31st December, 1935. A.—Routine Medical Inspections. Number of Code Group Inspections:— Entrants 2,273 Second Age Group 1,887 Third Age Group 2,020 Total 6,180 Number of other Routine Inspections — b.—Other Inspections. Number of Special Inspections 5,716 Number of Re-Inspections 13,598 Total 19,314 C.—Children Found to Require Treatment. Number of individual children Found at Routine Medical Inspection to Require Treatment (excluding UnCleanliness and Dental Diseases). Prescribed Groups:— Entrants 321 Second Age Group 350 Third Age Group 337 Total (Prescribed Groups) 1,008 Other Routine Inspections — 39 Table II. A.—Return of Defects found by Medical Inspection in the Year ended 31st December, 1935. 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) Skin Ringworm:— Scalp 1 — 6 — Body — — 12 — Scabies 2 — 62 — Impetigo 7 — 257 — Other Diseases (Non-Tuberculous) 13 384 2 TOTAL 23 — 721 2 Eye Blepharitis 11 — 62 — Conjunctivitis 7 — 120 — Keratitis 1 — 4 — Corneal Opacities — — 2 — Other Conditions (excluding Defective Vision and Squint 5 — 103 — TOTAL 24 — 291 — Defective Vision (excluding Squint) 298 28 457 — Squint 17 1 137 — Ear Defective Hearing 18 — 17 — Otitis Media 19 — 60 — Other Ear Diseases 25 — 72 1 Nose and Throat Chronic Tonsillitis only 142 184 264 1 Adenoids only 5 2 3 — Chronic Tonsillitis and Adenoids 100 26 30 1 Other Conditions 46 18 272 — Enlarged Cervical Glands (Non-Tuberculous) 12 10 59 1 Defective Speech 3 4 6 2 Heart and Circulation Heart Disease:— Organic 1 33 37 4 Functional 3 38 3 3 Anaemia 26 5 161 1 Lungs Bronchitis 33 101 407 1 Other Non-Tuberculous Diseases 2 5 22 — Tuberculosis Pulmonary:— Definite — — 7 — Suspected 2 4 6 — Non-Pulmonary:— Glands 2 1 6 — Bones and Joints 1 — 8 — Skin — — — — Other Forms .. — — 2 — Nervous System ' Epilepsy 3 1 5 — Chorea 14 1 74 — Other Conditions 6 8 72 4 Deformities f Rickets 2 — 3 — Spinal Curvature 11 — 68 — Other Forms 75 5 161 — Other defects and diseases 111 46 2202 19 Grand Total 1024 521 5633 40 40 B.—Classification of the Nutrition of Children Inspected During the Year in the Routine Age Groups. Age Groups Number of Children Inspected A (Excellent) B (Normal) C (Slightly subnormal) D (Bad) No. % No. % No. % No. % Entrants 2273 262 11.5 1857 81.7 143 6.3 11 0.5 Second Age Group 1887 212 11.2 1495 79.3 157 8.3 23 1.2 Third Age Group 2020 333 16.5 1559 77.2 116 5.7 12 0.6 Other Routine Inspections Total 6180 807 13.0 4911 79.5 416 6.8 46 0.7 Table III.—RETURN OF ALL EXCEPTIONAL CHILDREN IN THE AREA. 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. 2 10 — — — 12 DEAF CHILDREN. At Certified Schools for the Deaf. At Public Elementary Schools. At Other Institutions. At no School or Institution. Total. 17 — — — 17 41 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. 5 — — — — 5 In addition 2 boys 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. 52 68 — 7 127 EPILEPTIC CHILDREN. Children Suffering from Severe Epilepsy. At Certified Special Schools. At Public Elementary Schools. At Other Institutions. At no School or Institution. Total. 1 – – 2 3 PHYSICALLY DEFECTIVE CHILDREN. A.—Tuberculous Children. I.—Children Suffering from Pulmonary Tuberculosis. (Including pleura and intra-thoracic glands.) At Certified Special Schools. At Public Elementary Schools. At Other Institutions. At no School or Institution. Total. 11 — — 13 24 42 II.—Children Suffering from Non-pulmonary Tuberculosis. At Certified Special Schools. At Public Elementary Schools. At Other Institutions. At no School or Institution. Total. 17 — — 3 20 B.—Delicate Children. At Certified Special Schools. At Public Elementary Schools. At Other Institutions. At no School or Institution. Total. *66 291 32 2 391 * Of the 66 children at Certified Schools, 38 are at Suntrap Special School, Hayling, 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. 37 18 — 4 59 D.—Children with Heart Disease. At Certified Special Schools. At Public Elementary Schools. At other Institutions. At no School or Institution. Total. 41 34 — 5 80 43 CHILDREN SUFFERING FROM MULTIPLE DEFECTS. Combination of Defect. At Certified Special Schools. At Public Elementary Schools. At other Institutions. At no School or Institution. Total. Feeble-minded and Crippled 2 — — — 2 Feeble-minded and Epileptic 2 — — — 2 Crippled and Heart 4 — — — 4 Crippled and Epileptic 1 — — — 1 Crippled and Deaf — — — 1 1 Tuberculosis and Heart — — — 1 1 Table III.—Continued. Statement of the Number of Children Notified during the Year ended 31st December, 1935, by the Local Education Authority to the Local Mental Deficiency Authority . Total number of children notified, 24. 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 — — (b) Imbeciles 3 2 (c) Others 7 8 (ii) Children unable to be instructed in a Special School without detriment to the interests of other children:— (a) Moral Defectives — — (6) Others — — (2) Feeble-minded children notified on leaving a Special School on or before attaining the age of 16 2 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 12 12 In addition, 3 boys and 1 girl under seven years of age, who came under our notice, have been intimated, at his request, to the Officer under the Mental Deficiency Act. 44 Table IV.—Return of Defects Treated during the Year ended 31st December, 1935. TREATMENT TABLE. Group I.—Minor Ailments (excluding Uncleanliness, for which see Table 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) 3 — 3 „ „ (other treatment) 3 — 3 Ringworm—Body 12 — 12 Scabies 61 3 64 Impetigo 258 8 266 Other Skin Disease 375 23 398 Minor Eye Defects (External and other, but excluding cases falling in Group II) 291 26 317 Minor Ear Defects 162 23 185 Miscellaneous (e.g., minor injuries, bruises, sores, chilblains, etc.) 931 14 945 Total 2,096 97 2,193 Orowp II.—Defective Vision and Squint (excluding Minor Eye Defects treated as Minor Ailments—Group I. No. of Defects dealt with. No. of children for whom Spectacles were Under the Authority'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) 890 27 923 Other Defect or Disease of the Eyes (excluding those recorded in Group I) 9 9 18 705 27 765 27 Total 905 30 941 45 Group III .—Treatment of Defects of Nose and Throat. Number of Defects. Received Operative Treatment. Received Other Forms of Treatment . Total Number Treated. Under the Authority's Scheme in Clinic or Hospital. By Private Practitioner or Hospital, apart from the Authority's Scheme. Total. (1) (2) (3) (4) (5) (i) (ii) (iii) (iv) (i) (ii) (iii) (iv) (i) (ii) (iii) (iv) 286 864 — — 80 — — — 498 — — — 578 — (i) Tonsils only, (ii) Adenoids only, (iii) Tonsils and adenoids, (iv) Other defects of the nose and throat. Group IV.—Orthopaedic and Postural Defects. Under the Authority's Scheme. Otherwise. Total number treated; Residential treatment with education. Residential treatment without education. Nonresidential treatment at an orthopaedic clinic. Residential treatment with education. Residential treatment without education. Nonresidential treatment at an orthopaedic clinic. (i) (ii) (iii) (i) (ii) (iii) Number of children treated .. 3 — — — — — 84 205 children with minor orthopaedic and postural defects have carried out remedial exercises in the schools under the supervision of a Medical Officer. 46 Table V.—Dental Defects. 1) Number of Children Inspeoted by the Dentist— (a) Routine Age Groups— AGE 5 6 7 8 9 10 11 12 13 14 TOTAL Number 1,529 1,434 1,454 1,580 1,684 1,703 1,900 1,161 481 271 13,197 (6) Specials 2,240 (c) Total (Routine and Special) 15,437 (2) Found to require treatment 10,681 (3) Actually treated 5,679 (4) Attendances made by children for treatmen 7,178 (5) Half-days devoted to :— Inspection 50 Treatment7 Total 777 (6) Fillings:— Permanent Teeth 1,633 Temporary Teeth 335 Total 1,968 (7) Extractions:— Permanent Teeth 1,199 Temporary Teeth 6,906 Total 8,105 (8) Administrations of general thetics for extractions 435 (9) Other operations :— Permanent Teeth 149 Temporary Teeth 15 Tota164 Regulation cases 39 Table VI.—Uncleanliness and verminous conditions. (i) Average number of visits per school made during the year by the School Nurses 17.1 (ii) Total number of examinations of children in the Schools by School Nurses 106,055 (iii) Number of individual children found unclean 1.056 (iv) Number of children cleansed under arrangements made by the Local Education Authority 25 (v) Number of cases in which legal proceedings were taken:— (a) Under the Education Act, 1921 8 (b) Under School Attendance Byelaws — Cottenham arekternit Maternity and Child Welfare Committee. ANNUAL REPORT FOR THE YEAR 1935. MATERNITY AND CHILD WELFARE COMMITTEE. As at the 31st December, 1935. Alderman Mrs. W. A. Kent. Alderman Major Sir Patrick B. Malone, J.P. Alderman J. H. Morrell. Councillor G. A. Arnfield. Councillor Mrs. E. M. Coles Councillor M. Doran. Councillor Mrs .A.M. Ellis (Vice-Chairman). Councillor F. A. F. Keay. Councillor Mrs. A. Kitchener. Councillor A. W. Lock. Councillor Mrs. A. E. Lyons (Chairman). Councillor G. H. Ottaway Councillor Mrs. A. Peake. Councillor S. Timms. 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: Jf§Mrs. J. Kent-Parsons, M.B.E. Health Visitors: IffaB. Wallace. *†§cN. A. Lennon. *†§aM. Blanchard. *†§eK. Goodwin. *†G. Mason *†§M. Oldfield (since retired). (from 17th June). *†a6G. M. Hockin. *†§M. Sumpner *†a6cE. M. Dunn. (from 1st July). *†cM. Timlin. *†§c<ZW. C. Peverett (from 1st April, 1936). † C.M.B. Cert. * General Training Cert. b Eye Hosp. Cert. (Moorfields). § Health Visitor's Diploma. c Fever Cert. a R.S.I. Health Vis. Cert. d Tubeiculosis Cert. ¶R.S.I. San. Insp. Cert. e Ultra Violet Light Cert. i San. Insp. Exam. Bd. Cert. Creche: Matron—F. E. Trewinnard (Creche Trained) Nat. Soc. of Day Nurseries. Nursing Staff. Miss E. Evans (Creche Trained, Welgaith Nursery Training Cert.) (Kindergarten Cert., Gipsy Hill Training College.) Miss D. Powell (P.el. and Elementary Cert. Nat. Soc. Day Nurseries). Miss M.B. Ireson ( ditto ditto Clerical Staff: E. Horton (C.I.S. Inter.). E. E. Fisher. G. A. Elliott. N. L. Petty. D. H. Ball. 4 Infent Welfare 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, 1936. Madam Chairman, Ladies and Gentlemen, Herewith is submitted the Annual Report for the year 1936, of the activities of the Officers and Staff under your jurisdiction. Your Superintendent Health Visitor, Mrs. Kent-Parsons, was honoured by His Late Majesty by having had conferred upon her the Membership of the Most Excellent Order of the British Empire. The alterations that have taken place during 1935 have been rather by way of expanding the existing work than by addition of new ventures. Thus an additional session is now given at Bruce Castle under Dr. Alice King, making 3 sessions each at the two Infant- Welfare Centres. It will be observed that Orthopaedic clinic® have been added to the School Medical Servioe. Children under school age will have the advantage O'f such assistance as these clinics can afford. A fund was established by means of which enfeebled mothers are sent to coast and country for convalescent treatment. The fund was commenced by a grant, of .£50' from the Borough Council Jubilee Celebration Fund, and the mothers attending the Centres marked their appreciation by a donation of £6 6s. 0'd. The number of births in 1935 were 55 fewer than in 1934, and although the actual number of deaths under one year of age was the same—108—the infant mortality rate is greater by 3.2 On the other hand, the Maternal Mortality was only 2.9 per 1,000 births, whereas in the preceding year it was 5.1 6 Your Committee pursued diligently a progressive policy and are only deterred by the lack of available land in suitable localities for the extension of their benefieient work. One of the outstanding needs is that of dental treatment, and the supply of dentures to women in humble circumstances. Ways and means are being sought to meet the situation. I thank the Committee for their sympathetic consideration of all matters submitted to them, and the staff for their prompt and vigorous response to every call made upon them. I am , Madam Chairman, Ladies and Gentlemen, Your obedient Servant. Devid C. Kirkhope Medical Officer of Health. Births, 1935. LIVE BIRTHS. Registrar-General's Figures—M. .. .. .. .. 985 F. 984 *1,969 Local Information:— Total Births notified .. .. .. .. .. 2,019 Less Still Births .. .. .. .. .. . • 62 Live Births .. .. .. .. .. 1,957 *The Registrar's and the local figures do not agree because they relate to different periods. The local notifications are those of children bom within the year; the Registrar's, of those children registered within the year. 7 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 62 Own arrangements 159 — 221 The North Middlesex (County) Hospital 391 Other Outside Institutions 252 864 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:— Breastfed 1,542 Part Breast-fed—plus milk, dried milk or condensed milk 264 Bottle feeding—Cow's milk .52 Dried milk 66 Other artificial foods 15 Feedings unknown 11 *1,950 *Counted in feedings—transfers into district 88 Not counted in feedings—removals and deaths 97 MATERNITY AND CHILD WELFARE. The work of the MATERNITY AND CHILD WELFARE STAFF is set out in tabular form hereunder:— HOME VISITS TO CHILDREN. Notification of Births. Children under 1 year. Over 1 year. Total. 1st Visits. Re-visits. Re-visits. Live Births 1,930 8,357 18,220 28,507 Still Births 61 13 — 74 Total 1,991 8,370 18,220 28,581 8 Other Visits to Children. Children under 1 year. Children over 1 year. Total. 1st Visits. Re-visits. 1st Visits. Re-visits. In respect of:— Deaths 35 2 4 — 41 Ophthalmia, Neonatorum and Discharging Eyes 23 37 - - 60 Other Infectious Diseases* 37 37 58 44 176 Other visits to Children† — — — — 449 Total 726 *Other Infectious Diseases include Measles and German Measles, Bronchial Pneumonia, Tuberculosis, Whooping Cough. †Other visits to children include visits under the Children Acts, visits for giving assistance in the supply of milk, visits following operations and in connection with Convalescent Home Treatment. It will be noted that visits were made to children between 1 and 5 years of age, under the Notification of Births' Act, totalling 18,220. HOME VISITS TO MOTHERS. The following Ante-Natal Visits were made to Mothers:— First visits, 617; Re-visits, 937; total 1,554. Mothers specially visited post-natally were as follows:— First visits, 223; Re-visits, 135; Total 358. HOME VISITS—PUERPERAL FEVER AND PYREXIA. 41 cases of Puerperal Fever or Pyrexia were notified. All the homes were visited, either at the time of the occurrence of the disease, or after the mother returned from Hospital. Two mothers were not traced, as they did not return from hospital to the address given. (For table see page 14.) Other visits to mothers totalled 723, and included visits in respect of complaints of neglect, inspection of premises, visits in respect of assistance in the supply of milk, and applictions for registration as Foster Mothers. Unsuccessful visits to mothers and children totalled 2,754. 9 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) 7,031 7,195 14,226 653 98 751 51 203 26.94 63.31 Bruce Castle 5,701 5,103 10,804 452 107 559 77 150 29.57 56.84 Town Hall 1,081 1,268 2,349 98 18 116 — 51 — 46.05 Total 13,813 13,566 27,379 *1,203 223 1,426 128 404 — — *Percentage of Notified Live Births represented by above figure 61.2 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) 942 653 1,595 510 1,014 1,524 71 Bruce Castle 707 600 1,307 378 877 1,255 52 Town Hall 179 74 253 80 169 249 4 Total 1,828 1,327 3,155 968 2,060 3,028 127 Infant Mortality of Infants Attending the. Infant Welfare Centres during 1935. Centre. No. on Register. (Under 1 year.) Deaths of Infants Infantile Death-rate The Chestnuts (St. Ann's) 942 8 8.49 Bruce Castle 707 8 11.31 Town Hall 179 1 5.58 Total 1,828 17 9.29 Infant Mortality rate for whole area 54.8 per thousand births. 10 Medical Examinations. Total Number. New Cases Number of Sessions. Average per Session The Chestnuts (St. Ann's) 3,810 762 151 25.22 Bruce Castle 3,027 546 125 24.21 Town Hall — — — Total 6,837 1,308 276 — Children attending the Town Hall Centre are referred to The Chestnuts or Bruce Castle, for medioal advice. ANTE AND POST-NATAL CLINICS. Medical Examinations Ante Natal. PostNatal. Total. Number of Sessions. Average per Session. The Chestnuts (St. Ann's) 2,009 161 2,145 149 14.54 Bruce Castle 1,505 133 1,632 101 16.22 3,514 294 3,777 250 — Ante Natal Cases. Number of Mothers on the Registers. At the beginning of the year. New Cases. Total. The Chestnuts (St. Ann's) 156 413 569 *Percentage of total notified births (live and still) represented by mothers on the Register. Bruce Castle 63 300 363 Total 219 713 932 *45.9 11 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. 1,048 families were assisted during the year. The amount of milk distributed (Grade A, Tuberculin tested, and dried milk) was, Cow's Milk, 30,694| gallons, Dried Milk, 198 lbs. 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 18 31 735 33 768 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. 126 calls were made by Midwives for Medical Aid, under the following headings:— 0 12 Medical Aid for Mothers. 80 calls were made on behalf of 77 mothers, as follows:—- Hemorrahage. Labour trouble. Perinneal tear. Temperatures Miscarriages and Abortions. Miscellaneous. Total. Puerperal Fever & Pyrexia. Other causes. Ante natal. Postnatal . 9 23 30 1* 1 2 7 7 80 *Puerperal Fever and Pyrexia.—In addition to the one call for Puerperal Fever, 4 other cases were subsequently notified by the medical practitioner as Puerperal Fever, or Pyrexia, for which the medical aid calls were as follows:— One labour trouble (retained placenta); one prolonged labour; one for perineal tear, and later for severe sickness; and one for acute pain r. side. Medical Aid for Infants. 46 calls were made on behalf of 47 infants, as follows (one case for twin children):— Dead, Feeble or Stillborn. Eye Cases. Miscellaneous. Total. Inflammation of or Discharging Eyes. Notified as Ophthalmia. 17 10 12 8 47 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 the following cases:— 13 cases Authorisation of attendance in necessitous cases 28 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 12 Compensation for loss of practice was given to two Midwives where they were in contact with an infectious disease and debarred from attending other patients, a substitute being employed 15 Total 55 HOME HELPS. Assistance towards the services of Home Helps was granted in 26 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. 32 cases of Discharging Eye occurred during the year, 22 of which were notified as Ophthalmia Neonatorum. The following table shows the final result in each case:— Notified as Ophthalmia Neonatorum. Discharging Eye. Total. In Attendance at Confinement. Total. Final Result Doctors' Cases. Midwives' Cases. Occurred in Hospital. Occurred within 10 days. After the 10th day. Eyes clear. 22 10 32 2 22 3* 5 32 32 Two cases were removed from home to hospital. *Occurred after the midwife had ceased to visit. One case taken to hospital by the mother. Two cases—parents sought medical advice. 14 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. A Special Consultant's Fee was paid in one case. Hospital treatment is also arranged for in suitable cases. The following table shows the final result of the cases on the register at the end of the year:— PUERPERAL FEVER AND PYREXIA. In attendance at Confinement. Final Result. Doctors' cases. Midwives' cases. Occurred in Hospitals outside the District. Total. Recovered. Died. Removed (unable to trace). Puerperal Pyrexia 31 1 4 26 31 29 — 2 Puerperal Fever 10 1 2 7 10 10 — — Total 41 2 6 33 41 39 - 2* *These cases occurred in hospital, and did not return to Tottenham. In addition to the above notified cases, one maternal death in the City of London Hospital was stated as Puerperal Sepsis following Caesarian Section. Of the 6 cases notified attended by midwives, one occurred after the midwife had ceased to attend, and for which there was no medical aid. (For table see page 12.) MATERNAL MORTALITY. A Special Report is forwarded to the Ministry of each death of a mother, directly or indirectly connected with child-birth. This report 15 is based on the result of the enquiries made of every nurse, midwife, or doctor who has been in attendance upon or treatment of the mother. 8 deaths were so reported. Maternal Deaths.—The Registrar General's records show that 6 deaths only were attributed to Tottenham. The discrepancy of two is accounted for by one death being due to suicide and one to Rheumatic carditis. The Death Rate per 1,000 live and still births—based on the Registrar-General's figure, namely 2,036—was:— From Puerperal Sepsis 5 From Other Puerperal Causes 2.4 Total 2.9 MATERNITY AND NURSING HOMES. The number of NursiDg Homes on the register at the beginning of the year was 2; the number at the end of the year was 3. (i) Applications for registration 1 (ii) Registered during the year 1 (iii) Orders made refusing or cancelling registration nil (iv) Appeals against such orders nil (y) Number confirmed on appeal nil (vi) Applications for exemption 2 *(vii) Application for exemption granted 2 Of the 3 homes registered one is authorised to receive 3 maternity cases, and 6 chronic cases; one 3 maternity and 1 medical case; and 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. 16 The Creche.—The Creche, situated at 227, West Green Road, has had the following attendances:— Number of days on which the Creche was opened, 236. Quarter. Attendances under 3 years of Age. Attendances over 3 years of Age. Total. January to March 730 742 1,472 April to June 975 773 1,748 July to September 798 647 1 ,,445 October to December 1,339 788 2,127 3,842 2,950 6,792* *5 half-day attendances included. Number of children admitted:— Under 3 years (when admitted) 88 Over 3 years ,, 32 120 Average daily attendance, 28.78 - CONVALESCENT HOME TREATMENT. The arrangement with the Invalid Children's Aid Association for the maintenance of children at Convalescent Homes has been continued during 1935 as follows:— 48 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 — 2 10 5 10 1 10 1 1 — 3 Number of weeks 13 14 15 16 17 18 19 20 21 22 23 24 or Number of Children - 1 - - - - - - - - - over 2 17 7 mothers with infants were sent away for two to three weeks' convalescent home treatment, and 2 mothers, whose expenses were met from the Special Jubilee Celebration Fund. Surgical Instruments.—One child was 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, 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 I at Brookfields Orthopaedic Hospital during the year. 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. 18 — *2 — 20 *1 Continued from 1934; special instruments also supplied. HEALTH VISITORS. Two additional Health Visitors were appointed during the year. 18 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. 282 Home Visits have been paid by the Health Visitors under this Act. Number of foster parents on the Register:— (а) At the beginning of the year 70 (b) At the end of the year 64 Number of children on the Register:— (a) At the beginning of the year 80 (b) At the end of the year 78 (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 two 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. 19 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 1935 the following homes have afforded hospitality to Tottenham cases:— Beacon Lodge, East Finchley. St. Helenas, Cricklewood. Enfield Hostel. Royal Free Hostel, Highbury Quadrant. Devon Nook, Chiswick. St. Agatha's, Hampstead. St. Mary's, Stamford Hill. MOTHERCRAFT CLASSES—WELFARE CENTRES. 551 pupils from the Senior Girls' Departments of the under-mentioned schools have attended demonstrations at one or other of the Child Welfare Centres:— Downhills Senior Girls'. Culvert Road Senior Girls'. Page Green Girls'. Parkhurst Girls'. Risley Avenue Girls'. St. Katharine's College Students' Bedford College sent 24 winter school students for lectures on Maternity and Child Welfare Work. PUPIL MIDWIVES. Under an arrangement with the North Middlesex Hospital, Nurses from that hospital made 49 attendances at The Chestnuts. 20 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; and to the following donors of giftsThe Mayoress (Mrs. A. E. Jay), a treadle sewing machine; Mr. and Mrs. Reading, a sewing machine and push-chair; Mrs. J. H. Morrell, a pram; and garments from Miss H. Eyles, Mrs. F. King, Mrs. Kemp, Mrs. Peters, Mrs. Scharner, Miss E. Ward. Gifts have also been received from certain local organisations, and friends, to the Creche, and a special parcel of clothing from The National Society of Day Nurseries, through Mrs. Percival. INDEX. PART I.—Health Department. A page Adulteration, etc. 44 Ambulance Service 19 B Bacteriological Laboratory 19 Bakehouses 43 Births 9 Bread 43 C Cancer 18 Cleansing 23 Clearance Areas 26 Clinics 21 Closet Accommodation 23 D Dairies, etc. 43 Deaths 9 Diabetes 47 Diphtheria 46 Disinfection and tation 35 Drainage and Sewerage 22 F Factory and Workshop Act 40 Food and Drugs Act 44 Food, Unsound 44 H Health Services 19 Health Week 21 Hospitals 21 House Inspection 26 Housing 37 I Infantile Mortality 16, etc. Infectious Diseases 14 & 45 L Laboratory 19 M page Malignant Diseases 18 Milk Supply 43 N Non-notifiable Infectious Diseases 47 North Middlesex Hospital 21 Nursing in the Home 20 P Population 8 R Rateable Value 8 Rivers and Streams 22 S Sanitary Administration of the Borough 25 Scarlet Fever 46 Shops Acts 23 Slaughter-Houses 43 Small Dwellings Acquisition Act 36 Smallpox 47 Smoke Abatement 36 Social Conditions 8 Staff 4 Swimming Baths 36 T Treatment Centres 21 Tuberculosis 48 U Unsound Food 44 V Violent Deaths 17 W Water 22 PART II.—School Medical Department. A page Attendance Officers 22 Aural Clinic . 13-14-16 B Bacteriological Examinations 18 Baths, School 20 Blind Children 23, 29, 40 C Clinics 13 Convalescent Home Treatment 22 Co-ordination of Services.. 5 D Deaf, School for 25-26 Deafness 10, 14-16, 40 Dental Defects 10, 46, 47 E Ear Diseases 10, 14 Epileptic Children 24, 41 External Eye Diseases 9 Examinations by Medical Officers 34 Exceptional Children 40-42 F Findings of Medical Inspection 9 Following-up 12 Food Accessories and Drugs 34 H Hayling Island 22, 31 Hearing 10, 14 Heart Disease 11 Hygiene, School 5 I Infectious Diseases 16 Invalid Children's Aid Association 22 Introduction 4 Institutional Treatment 23 M PAGE Malnutrition 9, 40 Meals, Provision of 20 Mentally Defective Children 24, 26, 41 Microscopical Examinations 17 Milk Supplied 21 Minor Ailments 9, 44 Myopic School 29 N Nursery Schools 32 Nutrition 9, 40 O Oak Lodge Special School 26 Occupation Centre 25 Open-Air Centre 30 Open-Air Class 31 Open-Air Education 18 Orthopaedics 10, 45 Otorrhoea 14 P Parents, Co-operation of 21 Physically Defective School 27-28 Physical Training 19 Population, School 3 Parents' Payments 34 Postural Defects 10 ,45 R Remedial Exercises 45 Residential Schools 23, 24 Rheumatism 11 S School Journeys and Camps 18-19 Secondary Schools 33, 34 Skin Diseases 9, 44 Staff 2-3 Statistics 34-46 Surgical Instruments 23 Sun Trap Home 22, 31 Swimming 20 T Teachers, Co-operation of 21 Tonsils and Adenoids 45 Tuberculosis 11, 41, 44 V Verminous Conditions 9, 46 Vision 9, 44 Voluntary Bodies 21 PART III.—Maternity and Child Welfare Department. A page Ante-Natal Clinics 10 Assisted Milk Supply 11 Attendances—Centres 9 & 10 Accouchement Bags 13 B Bruce Castle 4, 9 & 10 Births (and page 9 Health Department portion) 6, 7 Breast Feeding 7 C Chestnuts (The) 4, 9, 10 Creche 16 Centres, List 4, 9 & 10 ,, Attendances 9 & 10 Convalescent Home Treatment (I. C. A. A.) 16 Committee-—Members of 2 Children Act, 1908/1932 18 D District Nursing Association, Home Visits 20 (Health Dept. portion) F Foster Children—Registrations 18 G Gifts 20 H Hospital Treatment 17 Home Visits 7 & 8 Home Nursing 13 Health Visitors 3 & 17 Home Helps 13 I Introduction 5 Infant Mortality 9 (and pages 16, etc of Health Dept. portion) Illegitimate Infants, institutional provision for .. 19 Infant Life Protection .. 18 L page Lectures to Midwives 2 M Maternal Mortality 14 & 15 Maternity and Midwifery Services 11 Medical Examinations 10 Midwives' Fees 12 Midwives 11 Medical Aid 11, 12 Mothercraft Classes 19 Mothers' Hospital 7 N North Middlesex Hospital 7 Notification of Births Acts —Visits 7 Nursing Homes 15 O Ophthalmia Neonatorum— Visits 13 Orthopaedic Treatment .5 & 17 P Puerperal Fever and Puerperal Pyrexia14 (and page 14 of Health Department portion) Pupil Midwives 19 S Staff 3 Still Births 6 T Town Hall Centre 9 V Visitors to Centres 19 W Welfare Centres (list of) 4