AC 439 (1) TOTTENHAM BOROUGH OF TOTTENHAM ANNUAL REPORT of the MEDICAL OFFICER OF HEALTH FOR THE YEAR -1936- DAVID C. KIRKHOPE, m.d, ch.m., d.p.h., barhister-at-law, TOT 10 Borough of Tottenham. report ON THE health of tottenham FOR THE YEAR 1936. Crusha & Son, Ltd. Tottenham, Enfield, Wood Green and Palmers Green. 2 SUMMARY OF STATISTICS FOR 1935 and 1936. 1935. 1936. Area 3,014 acres 3,014 acres Population 150,310 148,600 Births 1,969 1,931 Birth-rate (per 1,000 of population) 13.1 13.0 Deaths 1,456 1,600 Death-rate (per 1,000 of population) 9.7 10.8 Deaths under 1 year of age 108 100 Infant Death-rate (per 1,000 births) 54.8 51.8 Phthisis Death-rate (per 1,000 of population) 0.76 0.78 Rateable Value £954,241 £960,995 (at 1st April) (at 1st April) Amount produced by 1d. Rate £3,850 £3,852 3 HEALTH AND HOUSING COMMITTEE (as at 31st December, 1936). Chairman: Councillor R. H. Warren. Members: (Ex-Officio) His Worship the Mayor (Alderman J. H. Morrell, J.P.). (Ex-Officio) The Deputy Mayor (Alderman F. W. Cox). Alderman C. D. Grant. ,, 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. A. E. Lyons. ,, 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 Metropolis Water Act, 1902: Alderman Major Sir P. B. Malone, J.P. 4 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. Medical Officer Gynaecological Clinic (part-time)— Gladys H. Dodds, M.D., F.R.C.S.Ed., M.G.O.C. Chief Sanitary Inspector— *Smith, J. R. (1), (2), (4). Male Sanitary Inspectors— * West, W. P. (1), (4) *Shillito, J. A. (]), (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) (to July 6th). *Jenkins, E. T. (3), (4), (5) (from 1st June). *Chappell, R. H. T. (3), (7) (from 1st August). *Morris, W. L. (3), (4) (from 21st September). Shops Acts Inspector.—Look, F. T. G. Assistant Shops Acts Inspector.—Sendall, A. A. (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. (7) B.Sc. (London). *Contribution to salary from Exchequer Funds. 5 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. (to July). Thomas, H. do. Perry, L. R., do. Lawrence, A. W. do. (from November). Kent, W. P. Junior Clerk. Disinfecting and Disinfesting Staff— F. Dowse (Fumigating houses). S. Reid (Disinfesting houses). J. Wilson (Clothing). J. Collin ,, E. Mannell (Driver, Disinfecting Vans). Dram Testers, Etc. H. Bysouth (to 9th May). W. Jackson. D. M. Hunter (from 6th May). R. C. Wilson (from 10th May). F. J. Dowse (from 25th June). 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, 32, White Hart Lane. West Tottenham: Mr. C. H. Dunicley, 135, West Green Road. Public Assistance Officials— Area Officer: Mr. L. A. Franklin. Relieving Officers'. 5, Lansdowne Road: Mr. Axford, Mr. Burchali Mr. Gibson, Mr. Heafield and Mr. Lister. "Dorset Hall," Dorset Road: Mr. Lee, Mr. Mister and Mr. Williams Public Vaccinators— Dr. M. J. Cronin, 8. High Road. Dr. F. L. Cattle, 326, Philip Lane. Dr. A. Wilson, 707, High Road. Dr. J. Devine, 629, High Road. Dr. E. C. Wallace, 52, Salisbury Road. Vaccination Officer— Mr. L. J. Atherton, 32, White Hart Lane. Coroner's Officer— P.O. Jones, 94, Gloucester Road. 7 Health Department, Town Hall, Tottenham. May, 1937. To The Mayor, Aldermen and Councillors of the Borough of Tottenham. Mr. Mayor, Ladies and Gentlemen, I have pleasure in presenting the Annual Report on the Health and Social Conditions of the Borough for 1936. This is my twenty-fourth and last. The report is mainly statistical, the requirements of the Ministry of Health being, however, strictly complied with. The present outstanding problem is that of housing the people adequately. It has now assumed a double aspect. The first is the provision of proper housing accommodation for those persons and families living in dwellings unfit for human habitation. The second is the provision of proper accommodation for persons and families living under conditions of overcrowding. The Housing Act, 1930, required that a five-year programme should be formulated indicating what measures your Council proposed to adopt to meet the first-mentioned aspect of the housing problem, and that was done. But, before the five-year period had elapsed, it was found necessary to relax in some measure the vigorous action that was being taken to have old and otherwise decayed property condemned and demolished, for it was easier and speedier to have such property pulled down than to have new property erected to take its place. To add to that difficulty, there is the equally or even more serious one—that there is little available suitable vacant land in Tottenham for housing development. 8 The Housing Act of 1935 requiring a census to be taken of the people of Tottenham and the conditions under which they were living led them to believe that their overcrowded condition would receive immediate consideration. The situation is an embarrassing one, for the public expeot from the Council what the latter cannot provide—at any rate within a measurable period of time. I am led to make this statement in order that the difficulties of the Council may receive public recognition. The Council have done their utmost to meet the demands made upon them and I am confident they would be happy to find such a solution as would satisfy all proper claimants. I cannot sever my connection with the Council without making my acknowledgment of the great satisfaction it has given me in serving them during these past 24 years. I have received from them the utmost courtesy and encouragement and many unforgettable kindnesses. My colleagues in other departments have collaborated with me in the spirit of mutual friendly helpfulness and my staff have given the Council and me their devotion and their loyalty, all of which has been reflected in the harmonious and efficient working of a department whose importance to the community cannot be measured. I am. Mr. Mayor, Ladies and Gentlemen, Your obedient Servant. David C Kirkhope. 9 POPULATION. The population of Tottenham at the 1931 Census was 157,772. ,, ,, at mid-year 1936 (Registrar-General's estimate) was 148,600. HOUSES. According to the rate-Books, the number of houses at the end of 1936 was 30,871. RATEABLE VALUE. The rateable value of the Borough at 1st April, 1936, was £960,995. A Penny Rate produced £3,852. SOCIAL CONDITIONS, INCLUDING THE CHIEF INDUSTRIES CARRIED ON IN THE AREA. The social conditions during 1936 have not differed from those prevailing in the previous year, details of which are contained in the 1935 report. THE EXTENT OF UNEMPLOYMENT. The state of unemployment may be gauged from the following figures, supplied from the local Labour Exchange:— The total number of persons normally in regular employment who were registered at Tottenham Employment Exchange as wholly unemployed on 14th December, 1936, was 3,649. In addition, 136 persons were registered as temporarily stopped. There were also registered as unemployed 96 men who normally are engaged in casual employment, making a grand total registered of 3,881. STATISTICS. BIRTHS. Live Births Registered:—Males 993 Females 938 Total 1,931 10 Live Births of Tottenham "Residents" occurring in the district 1,126 ,, ,, ,, ,, outside the district 805 Total 1,931 Of these there were 86 born out of wedlock:— 46 males. 40 females. =4.4% illegitimate. Birth Rate, 13.0 per 1,000 of the population. Number of Stillbirths 77 Stillbirth Rate per 1,000 total births (live births and stillbirths) 38.3 DEATHS. The tables showing the number of deaths from different causes, and according to age groups and Ward distribution, are set out on pages 13 and 16. Epitomised, it will be seen that— The total number of deaths registered in Tottenham was 933 Number of Non-residents dying in the district 271 712 Deaths of residents occurring in the district 712 ,, ,, ,, elsewhere 888 Deaths of residents—Total 1,600 Deaths of children under 1 year occurring in the district 34 ,, ,, ,, ,, outside the district 66 Total of deaths under 1 year 100 11 Death Rate of Infants under one year of age:— All infants per 1,000 live births 51.8 Legitimate infants per 1,000 legitimate live births 50.4 Illegitimate infants per 1,000 illegitimate live births 81.4 Total deaths distributed according to age groups:— Deaths under 1 year 100 Deaths from 1 to 5 years 49 Deaths from 5 to 15 years 26 Deaths from 15 to 25 years 58 Deaths from 25 to 65 years 604 Deaths, 65 and upwards 763 The excess of births over deaths, or natural increase of population, was 331. The death-rate equalled 10.8 per 1,000 of the population. Deaths from puerperal causes:— Rate per 1,000 Deaths. total (live and still) births. Puerperal sepsis 2 0.99 Other puerperal causes 1 0.49 Total 3 1.49 12 COMPARISON OF DEATH INCIDENCE—YEARS 1935 & 1930. Cause of Death. 1935. 1936. Difference. Typhoid and Paratyphoid Fevers — 1 +1 Measles 2 21 +19 Scarlet Fever 3 — —3 Whooping Cough 5 5 .. Diphtheria 14 9 —5 Influenza 6 2 —4 Encephalitis Lethargica 4 1 -3 Cerebro-Spinal Fever 1 — -1 Tuberculosis of Respiratory System 114 116 +2 Other Tuberculous Diseases 9 12 +3 Syphilis 1 2 +1 General Paralysis of the Insane, Tabes Dorsalis 11 8 -3 Cancer, Malignant Disease 211 222 +11 Diabetes 6 20 +14 Cerebral Haemorrhage, etc. 68 79 +11 Heart Disease 383 481 +98 Aneurysm 1 3 +2 Other Circulatory Diseases 64 75 +11 Bronchitis 85 103 +18 Pneumonia (all forms) 119 117 —2 Other Respiratory Diseases 20 18 —2 Peptic Ulcer 15 10 —5 Diarrhoea, etc. 20 14 —6 Appendicitis 3 4 +1 Cirrhosis of Liver 3 3 .. Other Diseases of Liver, etc. 4 3 -1 Other Digestive Diseases 27 32 +5 Acute and Chronic Nephritis 51 45 —8 Puerperal Sepsis 1 2 +1 Other Puerperal Causes 5 1 —4 Congenital Debility, Premature Birth, Malformations, etc. 47 53 +6 Senility 16 13 —3 Suicide 17 21 +4 Other Violence 38 45 +7 Other Defined Diseases 80 58 —22 Causes Ill-defined or Unknown 2 1 —1 Totals 1456 1600 +215—71 =net+144 13 Table thowing the Population, Birth and Death Rates, tn Wards, during 1936. 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. Brace Grove & Central 180 139 13,674 13.2 10.2 6 0.4 33.3 Chestnuts 163 126 11,203 14.5 11.2 4 0.3 24.5 Coleraine 118 98 10,733 11.0 9.1 7 0.6 59.3 Green Lanes 182 154 14,225 12.8 10.8 7 0.5 38.5 High Cross 144 121 11,703 12.3 10.3 15 1.3 104.2 Park 184 176 14,083 13.1 12.5 8 0.6 43.5 Seven Sisters 193 172 14,182 13.6 12.1 7 0.5 36.3 Stamford Hill 140 132 10,619 13.2 12.4 7 0.6 50.0 Town Hall 205 186 15,468 13.2 12.0 13 0.8 63.4 West Green 214 176 18,243 11.7 9.6 14 0.8 65.4 White Hart Lane 208 120 14,467 14.4 8.3 12 0.8 57.7 Totals 1,931 1,600 148,600 13.0 10.8 100 0.7 51.8 14 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. Number. Rate. 1931 159,300 1,639 2,345 14.7 1,098 6.9 259 782 124 52.9 1,621 10.2 1932 156,800 1,487 2,214 14.2 1,153 7.3 347 785 114 51.4 1,591 10.1 1933 154,700 1,397 2,138 13.8 1,060 6.9 275 833 118 55.2 1,618 10.5 1934 152,694 1,262 2,091 13.7 1,129 7.4 311 754 108 51.6 1,572 10.3 1935 150,310 1,162 1,969 13.1 833 5.5 189 812 108 54.8 1,456 9.7 1936 148,600 1,126 1,931 13.0 983 6.6 271 888 100 51.8 1 ,600 10.8 Table of cases of Infectious Disease coming to the knowledge of the Medical Officer of Health during the year 1936 in the Borough of Tottenham, classified according to Diseases, Ages and Localities. NOTIFIABLE DISEASE At all Ages Number or Casks Notified. Total Casks Notified in Each Locality Total Cases Removed to Isolation Hospital Bruce Grove & Central. Chestnuts Coleralne. 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 430 1 9 26 31 31 184 81 25 33 6 3 — 33 1 32 30 37 38 33 37 38 37 62 53 139 Diphtheria 227 3 3 7 12 21 102 36 13 21 2 7 — 11 29 13 27 12 21 26 13 36 12 27 204 Pneumonia 107 2 5 2 1 4 7 2 6 29 11 25 13 6 14 5 10 9 5 11 10 16 17 4 — Erysipelas 62 1 2 — 1 — 1 3 3 9 16 20 6 6 4 3 8 6 2 4 5 11 3 10 25 Puerperal Fever 10 — — _ — — — — — 10 — - — 1 2 — — 1 1 2 1 1 1 - 5 Puerperal Pyrexia 27 — — — — — — — — 24 3 — 3 2 — 1 1 3 4 3 7 2 1 3 Typhoid Fever 5 — - — — — — 1 — 3 — 1 — — 1 1 — — — — 1 — 1 1 4 Dysentery 1 — 1 - - - - - - - - - - - - - - - - - - - - - - Ophthalmia Neonatorum 14 14 — — — — — — — — — — — 1 — 1 1 — — 3 3 1 — 4 2 Cerebro-Spinal Meningitis 2 2 - - - - - - - - - - - - - - - - - - 1 1 — — — Poliomyelitis 1 - - - - - 1 - - - - - - - - - - - - - - - - - - Continued Fever 1 - - - - - - - - - - - - - - - - - - - - - - - 1 Malaria 2 — — — — — — — — 1 — 1 — 1 — — — — — 1 — — - — — Pulmonary Tuberculosis 222 - - - - - 14 8 35 83 28 46 8 21 10 10 31 16 21 25 19 17 19 33 — Other forms of Tuberculosis 30 — - — 1 2 6 6 3 8 2 2 — 3 3 1 2 1 6 2 1 5 2 4 — Totals 1,141 23 20 35 46 58 316 137 85 221 68 105 27 86 97 64 117 84 92 115 96 133 120 137 383 15 16 TABLE OF DEATHS during the Year 1936 in the Borough of Tottenham, classified according to Diseases. Ages and Localities Cause of Death. Deaths at the subjoined ages of "Residents" whether occurring in or beyond the District. Deaths at all ages of "Residents" belonging to Localities, whether occurring in or beyond the District. Total Deaths, whether of "Residents'' or "nonResidents" in Institutions in the District. All Ages. Under 1 year. 1 and under 2. 2 and under 5. 5 and under 15. 15 and under 25. 25 and under 35. 35 and under 45. 45 and under 55. 55 and under 65. 65 and under 75. j 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 1 - - - 1 — — - — - - - - — — 1 — - — — — — — — — Measles 21 1 10 7 1 2 - - - - - - - 3 4 1 2 — 2 2 3 — — 4 53 6 Scarlet Fever — — — — — — — — — — — — — — — — — — — — — — — Whooping Cough 5 4 - - - - - - - - - - - - - — — 1 - 2 — 1 — 1 10 Diphtheria 9 - — 2 7 — — — — — — — — 1 — — 1 - 3 - - 3 — 1 23 Influenza 2 - - - - - - - - - - - - - - - - - - - - - - - - Encephalitis Lethargica 1 - - - - - - - - 1 - - - - - - - 1 - - — - - - 1 Cerebro-Spinal Fever - - - - - - - - - - - - - - - — — - — — — — — — - Tuberculosis of Respiratory System 116 — — — — 26 26 22 22 15 4 1 — 10 7 6 9 16 14 12 10 13 9 10 5 Other Tuberculous Diseases 12 1 1 3 1 1 2 1 1 1 — — — 3 1 2 2 — - 1 — 1 — 2 2 Syphilis 2 — — — — — — — — 1 1 — — — — — — — — 1 — 1 — — — General Paralysis of the Insane, Tabes Dorsal is 8 - - - - - - - 3 3 1 1 - - 1 1 1 - 1 2 — 1 - 1 2 Cancer, Malignant Disease 222 — — — — 2 6 15 37 62 53 42 5 10 19 16 31 22 20 30 15 24 20 15 46 Diabetes 20 — — — — 2 1 — 2 5 6 4 — — 1 2 — 1 3 1 4 2 3 3 3 Cerebral Haemorrhage, etc. 79 — — — — 2 — 3 4 18 20 26 6 4 3 7 10 6 12 11 3 10 9 4 11 Heart Disease 481 — 2 1 5 5 14 11 33 84 132 142 52 46 43 21 32 29 54 53 40 67 64 32 46 Aneurysm 3 - - - - - - - 1 2 — — — — - — — — — — 2 — 1 — — Other Circulatory Diseases 75 — 1 — — — — — 3 13 21 22 15 8 3 3 14 7 9 6 4 10 7 4 12 Bronchitis 103 1 — — — — — 1 4 16 30 39 12 18 7 5 13 6 13 6 7 12 11 5 4 Pneumonia (all forms) 117 18 12 4 2 1 9 5 10 17 22 11 6 5 10 9 9 9 12 18 12 8 13 12 15 Other Respiratory Diseases 18 — — — 1 — 1 2 3 5 2 4 — 1 2 — 1 1 3 1 2 3 1 3 5 Peptic Ulcer 10 - - - - - 1 2 5 1 1 — — — 2 — 2 — 4 1 — — 1 — 1 Diarrhoea, etc. 14 11 1 — 1 - - - - - - - 1 1 1 — 1 3 1 1 1 1 — 4 8 Appendicitis 4 — — — — — — 1 2 — 1 — — — — — 2 — — — — — 1 1 1 Cirrhosis of Liver 3 - - - - - - - - 2 - - - - - 1 1 1 - - - - - - 2 Other Diseases of Liver, etc. 3 - - - - - - - 1 1 1 — — — — 1 1 - — — — — — 1 — Other Digestive Diseases 32 1 — — — 2 — 3 7 9 6 4 — 3 4 3 2 3 1 3 3 3 4 3 17 Acute and Chronic Nephritis 45 1 — — — — 2 2 7 12 11 10 — 5 1 5 3 4 4 5 9 5 3 1 13 Puerperal Sepsis 2 - - - - 2 - - - - - - - - - - - - - 1 - - 1 - - Other Puerperal Causes 1 - - - - - 1 - - - - - - - - - - - - - - - - - - Congenital Debility, Premature Birth, Malformations 53 53 - - - - - - - - - - - 3 2 4 6 7 3 2 5 7 10 4 — Senility 13 - - - - - - - - - 2 5 6 4 1 2 - - 1 2 2 - 1 - 1 Suicide 21 — — — — 1 4 2 7 4 2 1 - 3 3 1 — — 1 1 4 3 5 — 3 Other Violence 45 1 - 1 3 9 6 - 5 6 6 4 4 4 - 4 4 2 9 1 1 3 4 6 21 Other Defined Diseases 58 8 2 1 4 2 6 7 6 5 _9 3 5 6 4 3 6 2 6 7 5 8 8 3 27 Causes Ill-defined or Unknown 1 — — - — — — — — — - — 1 1 — — — — - - — — - — — Totals 1600 100 30 19 26 58 79 78 164 283 331 319 113 139 126 98 154 121 176 172 132 186 176 120 338 17 INFANTILE DEATHS in Ages, Sexes and Localities, during the year 1936. cause of DEATH. Under 1 week. 1—2 weeks. 2—3 weeks. 3—4 weeks Total under 4 weeks. 1—3 months. 3—6 months. 6—9 months. 9—12 months. Total Deaths under 1 year. Males. Females. Brace Grove A Central. Chestnuts. Coleralne. Green Lanes. High Crouse. Park. Seven Sisters. Stamford Hill. Town Hall. West Green. White Hart Lane. Measles - - - - - - - 1 - 1 1 - - - 1 - - - - - - - - Whooping Cough - - - - - 1 1 1 1 4 2 2 — — — — 1 — 1 — 1 — 1 Meningitis (not Tuberculous) - - - - - - - 1 - 1 1 - 1 - - — - — — — — — — Pneumonia 1 1 3 — 5 5 3 3 2 18 9 9 — 1 1 — 3 4 2 — 2 2 3 Bronchitis - - - - - 1 — — — 1 — 1 — — — — 1 — — — — — — Diarrhoea and Enteritis - - 1 — 1 6 2 1 1 11 8 3 1 — 1 1 2 — 2 1 1 — 2 Suffocation 1 - - - 1 - - - - 1 - 1 - - - - - 1 - - - - - Injury at birth 1 - - - 1 - - - - 1 1 - - - - - - - - - 1 - - Atelectasis 1 — — — 1 — — — — 1 — 1 — — — — — — — 1 — — — Congenital Malformations 4 1 — — 5 — — — — 5 4 1 — 1 — — — 1 — — 1 1 1 Premature Birth 26 2 2 1 31 4 1 — 1 37 19 18 3 1 3 6 4 2 1 2 4 8 3 Atrophy, Debility and Marasmus 1 1 - 1 3 3 2 2 - 10 5 5 - - 1 — 3 — 1 2 2 — 1 Tuberculous Meningitis — — — — — — — 1 — 1 1 — — — — — 1 — - — - - - Other Causes 2 - - 1 3 3 1 - 1 8 7 1 1 1 - - - - - 1 1 3 1 Totals 37 5 6 3 51 23 10 10 6 100 58 42 6 4 7 7 15 8 7 7 13 14 12 18 DEATHS FROM VIOLENCE. There were 66 deaths from Violence. 21 were suicidal. Deaths resulting from motor accidents numbered 19. Males. Females. Falls 1 8 Knocked down by motor car 2 — ,, ,, ,, lorry 2 1 ,, ,, ,, tri-car — 1 ,, ,, auto train 1 — ,, ,, steam train 1 — ,, ,, a dog — 1 ,, ,, runaway pony and van 1 — Collision between motor car and motor cycle 1 — ,, ,, ,, ,, ,, pedal cycle 1 — ,, ,, ,, lorry and pedal cycle 2 — ,, ,, ,, lorry and motor cycle 1 — ,, ,, ,, coach and motor cycle . — 1 ,, ,, ,, cycle and motor cycle 1 — ,, ,, tram car and barrow 1 — Run over by motor lorry 2 — ,, ,, hearse 1 — Thrown from motor cycle 1 2 Suffocated in bed 1 1 Coal gas poisoning ] — Shooting 1 — Drowning 2 — Burning — 2 Fall from chair — 1 ,, moving tram car 1 — ,, plank 1 — Injury to hand working power press 1 — 27 18 SUICIDES. Coal gas poisoning 5 6 Corrosive poisoning 1 3 Drowning 1 2 Cut throat 2 — Abortion self-induced — 1 9 12 19 MALIGNANT DISEASES. The deaths from Malignant Diseases in 1936 numbered 222 or 11 more than in 1935. The organs affected and the sex distribution were as indicated, viz.:— Males. Females. Digestive System:— Mouth 1 — Tongue 1 — Oesophagus 8 3 Stomach 27 17 Bowels (large and small intestines) 4 4 Rectum 7 12 Liver and Gall Bladder 7 11 Pancreas 5 3 Colon 9 12 Genito-urinary:— Kidney 3 2 Bladder 2 1 Breast. — 20 Uterus — 14 Ovary — 7 Cervix — 2 Male Reproductive Organs 2 — Respiratory:— Lung 11 3 Larynx 3 2 Pharynx — 1 Bronchus 3 1 Antrum 1 1 Various:— Glands 3 3 Throat 1 — Spine — 1 Hip 1 — Pelvis — 1 Nose — 1 Pace 1 — 100 122 20 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, 180; Negative, 2,648. Specimens of Sputa examined for Tuberculosis :—Positive, 26; Negative, 221. Virulence tests, Diphtheria:—Positive, 3; Negative, 3. Blood examined for Typhoid group:—Positive, 1; Negative, 3. Hairs examined for Ringworm:—Positive, 2; Negative, 2. Swabs examined for HHemolytic Streptococci:—3 (negative). AMBULANCE FACILITIES. There are no alterations in the ambulance facilities for the district since 1935; they appear to be ample for all the needs of the area. The ambulance service is under the supervision of the Chief Officer of the Fire Brigade, who has furnished me with the following table, which relates to non-infectious cases only:— Tottenham Motor Ambulance Service, 1936. Month. No. of Cases. Total Mileage. Receipts. Surgical. School Children. (Attendances. ) T.E.C. Paying Cases. £ s. d. £ s. d. January 704 2,070 4,766 3 0 0 February 634 2,357 4,755 4 0 0 March 642 2,557 5,291 796 16 3 8 10 0 April 551 1,769 4,157 6 0 0 May 589 2,679 5,190 5 0 0 June 556 2,671 4,519 673 1 6 6 12 6 July 675 2,580 5,306 4 17 6 August 673 — 1,955 5 6 3 September 593 2,895 5,377 574 16 7 5 2 6 October 747 2.815 5,941 7 7 6 November 806 2,674 5,762 4 12 6 December 724 2,158 4,974 787 14 2 6 0 0 7,894 27,225 57,993 £2,832 8 6 £66 8 9 £2,898 17 3 21 Total mileage to date 966,204 Number of street accidents and illnesses for the year 528 The oxygen resuscitator was used on 10 occasions. NURSING IN THE HOME. The same conditions prevailed in 1936 as in 1935, and a statement thereupon will be found on page 20 of the 1935 report. CLINICS AND TREATMENT CENTRES. Clinics and Treatment Centres have been established by the School Medical Department and the Maternity and Child Welfare Department, and at the time of writing a new centre is being erected in Lordship Lane to replace the combined centre at Bruce Castle. A Gynecological Clinic was established at Bruce Castle on June 12th, and a short statement of the work done there is appended:— Number of attendances of patients 264 (first visits 143, re-appointments 121) Number of sessions held 38 Average attendance per session 7 Number of patients referred to hospital 46 Number of patients referred to own doctor 8 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. The North-Eastern Hospital, one of the infectious hospitals of the London County Council, is situated in Tottenham. Extensive alterations and improvements were made to this hospital during the year. The Home and Hospital for Jewish Incurables is also located in Tottenham. 22 POOR LAW RELIEF. The following information has been kindly supplied by the Public Assistance Area Officer and the Steward of the North Middlesex Hospital:— Out-Door Relief: Unemployed : Ordinary: No. of cases. Amount. No. of cases. Amount. 1,730 £29,320 18s. 6d. 2,751 £63,995 19s. 7d. Institutional Relief—North Middlesex Hospital. No. of cases admitted from Tottenham during 1936 4,308 No. of days In-Maintenance of these patients during 1936 88,710 HEALTH WEEK Health Week (October 4th to 10th) was observed in the usual way; leaflets were distributed to children in the schools, and through them to the parents. Matters relating to health contained in the booklets were made the subject of an essay competition and prizes were give, to the successful competitors at a public meeting where the children gave an entertainment including music and dancing. MEDICAL EXAMINATIONS. In 1936. 72 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 AREA. WATER. The Metropolitan Water Board's mains provide the district's water supply, which is abundant and of good quality. DRAINAGE AND SEWERAGE. The drainage of the district is mainly on the dual system. It has been your Council's policy to convert to the dual system such drains and sewers taking soil and surface water as are brought to light during inspection or otherwise, a certain sum of money being earmarked annually for that purpose. 23 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. Instances of pollution are notified to them. CLOSET ACCOMMODATION. The provision of closet accommodation is as reported in 1935. PUBLIC CLEANSING. There is a weekly collection of house refuse. Trade refuse is collected by agreement with traders. The Cleansing Department deals with the collection and disposal of refuse. During the year ended 31st March, 1937, 31,246 tons of refuse were dealt with at the Refuse Disposal Works and 440 tons were dealt with at the Council's Shoot, White Hart Lane. SANITARY ADMINISTRATION OF THE BOROUGH. STAFF. During the year, Mr. H. V. Cass, Sanitary Inspector, left the Borough, having been appointed Chief Sanitary Inspector to the County Borough of Bolton. The Committee decided to increase the inspectorial staff by two, in addition to filling the vacancy created by the resignation of Mr. Cass. The three Inspectors appointed were: E. T. Jenkins, who had previously served at Barry and Rowley Regis; R. H. T. Chappell, B.So., who had been in the Health Department for several years; and W. L. Morris, who had had experience at Littlehampton and the City of Westminster. CLEARANCE AREAS. During the year 110 families were rehoused on the Weir Hall Estate, making a total of 144 since rehousing commenced in 1935. The year 1936 marked the commencement of the general demolition of houses included in Clearance Area Schemes, and by the 31st December 59 houses had been demolished. 24 Official representations were made with respect to three small areas, viz.:—The High Cross Road Area (No. 1), The Scotland Green Area (No. 3), and the Scotland Green Area (No. 4). The number of houses included in these areas is 29, and the persons to be displaced number 100. DEMOLITION OF INDIVIDUAL HOUSES. Three houses that had been the subject of demolition orders were demolished during the year. CLOSING ORDERS. Two underground rooms were closed during the year. HOUSE INSPECTION. The number of houses Inspected during 1936 was 4,737, including 1,526 in routine house-to-house inspections, 2,343 during inspections made on complaints received, and 868 consequent upon the occurrence of cases of infectious disease. Defects necessitating the service of preliminary notices were discovered at 2,895 premises, and failing compliance therewith, 430 statutory notices were served requiring the owners to remedy defective conditions. In 20 instances the work was carried out by the Council, in owners' default, and this work cost the sum of £566 12s. 3d., which has been recovered from the owners. The 1,526 houses inspected in the systematic "house-to-house" survey were in the following roads:—Braemar Road, Crown Road, Catherine Road, Cornwall Road, Culvert Road, Elmar Road, Frinton Road, Foyle Road, High Cross Road, Herbert Road, Kent Road, Laura Road, Melton Road, Richmond Road, Russell Road, Roslyn Road, Southey Road, Stonebridge Road, Thorpe Road, Victoria Road, Winchelsea Road, Willow Walk. The drains at 810 houses were tested with smoke, and defects were discovered in 312 instances. In 112 cases entire reconstruction was necessary. 25 The following table shows the principal defects discovered, apart from structurally defective drains and defects in houses within clearance areas:— 251 drains found stopped. 449 defective W.C. cisterns and pans. 411 ,, rain-water pipes, gutters and waste-pipes. 133 ,, soil pipes and vents. 876 ,, roofs. 256 ,, sinks. 939 ,, window frames. 552 ,, floors. 811 ,, coppers and fireplaces. 699 ,, dustbins. 267 ,, staircases. 2,342 houses with dirty walls and ceilings. 337 ,, defective yard paving. 623 ,, damp walls. 83 ,, defective drinking water cisterns. 574 miscellaneous defects. Owners were induced to provide 120 houses with water supplies direct from the mains in substitution for supplies from storage cisterns. Damp-proof courses were inserted in 183 premises to remedy dampness in walls. OVERCROWDING. The Census in connection with the Overcrowding Survey was completed in the early part of the year, and was mentioned in the Annual Report for 1935. 40.644 families were enumerated and of these 1,322 were found to be overcrowded. The Council elected that the Appointed Day under the Act should be the 1st January, 1937, and the necessary steps were taken accordingly. Information respecting the permitted number of persons allowed to occupy a dwelling has been supplied to all agents and owners who have made application for the information. 23 On the Council's Housing Estates 78 families were found to be overcrowded. The Lettings Committee are endeavouring to abate this overcrowding by transfer to more commodious premises, and 33 such transfers were arranged during the year. One of the overcrowded families left the Estate, and 3 ceased to be overcrowded, owing to the marriage of children. At the end of the year there were 41 families remaining to be dealt with. On the L.C.C. Estate there were 109 cases of overcrowding, and the L.C.C. have undertaken to abate this by transfer and re-arrangement. At the end of the year, 21 cases had been dealt with. Accommodation was found on the Counoil's Housing Estates for 30 overcrowded families from other parts of the district. The figures above show that 88 cases of overcrowding have been dealt with. It would, therefore, appear that there are still 1,234 overcrowded families, but many changes have occurred since the census was taken, and the latter figure may be inaccurate. HOUSING ESTATES. During the year a house to house inspection was made of the 816 houses on the Council's Housing Estates. Taken as a whole, the tenants are good, and appear to appreciate the amenities provided by the Council, but 10 per cent, are careless. The tenants appear to appreciate their baths; only in five instances could it be stated definitely that the baths were not used. DISINFESTATION. To prevent the conveyance of vermin, and to avoid misunderstanding, the furniture of all new tenants of the Council's houses is examined and suitably dealt with before removal. This applies not only to the tenants from clearance areas, but to all new tenants on the Council's Estates. In addition to the work on the Housing Estate, disinfestation has been carried out at 2'47 houses in the Borough, at the request of the owners of the properties. The procedure adopted is as followsAll removable woodwork (beading, skirting-boards, arohitraves, etc.) is taken down and treated with the blow lamp. All papers are stripped from the walls and ceilings, and all holes) in the walls are subjected to the flame of the blow lamp. 27 Bedding is disinfested by steam, the rooms are fumigated with sulphur and subsequently sprayed with an insecticide prepared in the department, while the bedsteads and springs are flamed with the blow lamp. Re-inspections are made after three months, and these visits have proved that the system adopted is efficient. SMOKE ABATEMENT. During 1936, 150 observations were made of the emission of smoke from factory chimneys, these observations varying from 30 to 60 minutes. In 15 instances preliminary notices were served for contravention of the byelaws; 6 of these notices were concerned with the discharge of grit which comes under the definition of "Smoke." In one instance a Statutory Notice was necessary in connection with the grit nuisance, and work is now in hand which, it is hoped, will effect a remedy. The discharge of black smoke is a waste of fuel, as well as being injurious to health. It is usually due to careless stoking, and preliminary notices drawing attention to the evil invariably bring about improvements both in methods of stoking and appliances. INFECTIOUS CASES. In connection with infectious cases, 936 visits were made by the sanitary inspectors. During the year 1936 the following disinfection was carried out:— 11,683 articles were disinfected in the steam disinfector; 966 rooms were disinfected with the formalin spray, namely:— 226 after diphtheria; 426 after scarlet fever; 132 in cases of tuberculosis; 82 after miscellaneous diseases; 100 wards and rooms in institutions and schools; 672 library books were disinfected and returned to the libraries; 1,044 articles of clothing and bedding, etc., were destroyed at the request of the owners; 215 lots of bedding from verminous houses, and 33 lots of Bedding from houses where scabies was present, were treated in the steam disinfector. 28 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 34 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 257 ,, stables 304 ,, common lodging houses and sublet houses 49 ,, pawnbrokers' premises 11 ,, brooks 32 ,, schools 7 882 appointments have been kept with owners, builders, etc., relative to notices. SHOPS ACTS. The Shops Acts are administered by two whole-time officers. Hereunder are indicated the provisions of the various Orders, the observance of which is required. Shops Acts, 1912 to 1934. Half-Holidays. Harrinqay Area. *Butchers Monday, 1 p.m. (or alternatively Saturday, 1 p.m.) Bakers Wednesday, 2 p.m. (or alternatively Saturday, 2 p.m.) †Other Shops Wednesday, 1 p.m. (non -exempted (or alternatively trades) Saturday, 1 p.m.) Tottenham Remainder Area. Monday, 1 p.m. (or alternatively Saturday, 1 p.m.) Thursday, 2 p.m. (or alternatively Saturday, 2 p.m.) Thursday, 1 p.m. (or alternatively Saturday, 1 p.m.) 29 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. 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 three-quarters 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 Monday, Tuesday, Wednesday, Thursday and Friday 8p.m. Saturday 9 p.m. (subject to Weekly Half-holiday Order.) Note:—Shops wholly exempt from the provisions of the Shops (Sunday Trading Restriction) Act, 1936—Sunday, 8 p.m. (with the exception of confectioners, whose closing hour on Sunday is 9.30 p.m.). 30 A Jewish Hairdresser and Barber may open his premises on Sunday until 2 p.m., provided lie is registered in accordance with the Shops (Sunday Trading Restriction) Act, 1936, and that all premises occupied by him are closed for the whole of Saturday. 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. The Shops Act, 1936, brings lending libraries (with certain exceptions) within the scope of the Shops Acts. The Retail Meat Dealers (Sunday Closing) Act, 1936, requires that butchers' shops shall be closed on Sunday. Exemption is permitted for Jewish butchers selling kosher meat, provided the shop is closed for the whole of Saturday. The Shops (Sunday Trading Restriction) Act, 1936, restricts the opening of shops and trading on Sunday. Partial exemption orders may be made for certain trades, and there are special provisions for persons observing the Jewish Sabbath. Provision is also made for assistants employed on Sundays to receive holidays in lieu thereof on week-days. During 1936, 46 first or warning notices and 24 final notices were issued in respect of contraventions of the Acts. Legal proceedings were taken in 3 instances and fines inflicted as follows:— Date. Name. Nature of Case. Result. July Ernest Young, 116a, West Green Road Serving after the closing hour Fined 10s. or seven days. July Edward Martin. 63, Range more Road ,, ,, ,, ,, October Leslie G. Hussey, 45, Broad Lane ,, ,, Fined 20s. or fourteen days (10s. each in respect of two offences). 31 During 1936, 5 premises were exempted from the provision of sanitary conveniences and washing facilities, suitable and easily accessible accommodation being available; 3 premises were exempted from the provision of sanitary conveniences only. SWIMMING BATHS AND POOLS. The Council has two public swimming baths situated in the centre of the town. Water was taken from the baths in the busy summer season and under the most unfavourable conditions and submitted to bacteriological examination. The analysis showed that the water was satisfactory for bathing purposes. An open air swimming bath on the Lordship Recreation Ground was in course of erection in the latter part of 1936. It is built and equipped on up-to-date lines and will be opened in June, 1937, and available to the public after that date. 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 1936. HOUSING STATISTICS. Number of Houses erected during the Year. By private builders (no State assistance)—30 houses, 24 flats, 11 shops and 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) 4,737 (h) Number of inspections made for the purpose 15,849 32 (2) (a) Number of dwelling-houses (included under head (1) above) which were inspected and recorded under the Housing Consolidated Regulations, 1925 1,526 (b) Number of inspections made for the purpose 5,661 (3) Number of dwelling-houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation *30 *29 of these were dealt with under Part 1, Housing Act, 1930, and 1 was demolished voluntarily by the owners. (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 2,895 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 2,475 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 262 (2) Number of dwelling-houses which were dered fit after service of formal notices:— (a) By owners 1233 (b) By local authority in default of owners 18 33 (B) Proceedings under Public Health Acts: (1) Number of dwelling-houses in respect of which notices were served requiring defects to be remedied *168 (2) Number of dwelling-houses in which defects were remedied after service of formal notices:— (a) By owners †172 (b) By local authority in default of owners 2 †Including premises in respect of which notices were served in 1935. *Included in this figure are 5 houses in respect of which notices were also served under Section 17 of the Housing Act, 1930. In 2 instances notices under 2 different sections of the Public Health Acts were served on the same premises. (C) Proceedings under sections 19, 20 and 21 of the Housing Act, 1930: Two dwelling-houses were demolished in pursuance of Demolition Orders and two Closing Orders were made in respect of underground rooms. (D) Proceedings under the Housing Act, 1925: One house in respect of which a Closing Order under the Housing Act, 1925, was served in 1929 was demolished in 1936. 34 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. Faotories (including Factory Laun dries) 302 25 - Workshops (including Workshop Laundries) 311 22 — Workplaces (other than outworkers' premises included in Part 3 of this Report).. 202 13 — Total 815 60 — 2.—Defects Found. Particulars. Number of Defects. Numbei of Prosecutions. Found. Remedied. Referred to H.M. Inspector. Nuisances under the Public Health Acts*— Want of cleanliness 41 42f — — Want of ventilation 3 3 — — Overcrowding — — — Want of drainage of floors 1 1 - — Other nuisances 19 17 — — Sanitary ???ccommodation insufficient - — - — unsuitable or defective 11 11 - — not separate for sexes — — — — Offences under the Factory & Workshop Act Illegal occupation of underground bakehouses (s. 101) — -- — — Other offences (excluding offences relating to outwork which are included in Part 3 of this Report) — Total 75 74 — — *Including those specified in sections 2, 3, 7 and 8, of the Factory and Workshop Act as remediable under the Public Health Acts, †Including one notice served in 1935. 35 3.—Home Work. OUTWORKERS' LISTS, SECTION 107. Number of Inspections of Outworkers' Premises. Outwork in Unwholesome Premises, Section 108. Outwork in Infected Premises, Sections 109, 110. Nature of Work. Lists received from Employers. Number of Addresses of Outworkers received from other Councils. Number of Addresses of Outworkers forwarded to other Counoils 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 (Seos. 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 22 213 5 17 150 100 - - 367 - - — — — — Boots and Shoes 4 31 2 5 6 21 - — 21 — — — — — — Stationery 2 16 1 1 — 7 — — 12 — — — — — — Cardboard, etc., Boxes 2 17 — — — 7 — — 14 — — — — — — Brushes - - - - - - - - 2 - - - - - - Furs — — — — 5 — — — 8 — — — — — — Fancy Goods 2 250 — — 11 109 — — 152 — — — — — — Artificial Flowers — — — - 2 — — — 2 — — — — — — Lace Paper & Xmas Crackers 4 20 — - 2 5 — — 18 — — — — — — Leather Goods - - - - 4 - - - 4 - - - - - - Needlework - - - - 4 - - - 4 - - - - - - Toys — — — - 2 — — — 2 — — — — — — Paper Goods 2 23 1 2 1 5 — — 21 — — — — — — Totals 38 570 9 25 188 254 — — 627 — — — — — — 36 4.—Workshops, Laundries and Bakehouses on the Register at the end of the Year. Number. Workshops 238 Laundries 18 Bakehouses 61 Total 307 5.—Other Matters. Class. Number. Matters notified to H.M. Inspector of Factories:— Failure to affix Abstract of the Factory and Workshop Act (Seo. 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 (a. 5), Notified by H.M. Inspector 9 Reports (of action taken) sent to H.M. Inspector 9 Other — Underground Bakehouses (s. 101):— Certificates granted during the year — In use at the end of the year 3 Note.—The Factory and Workshop Act, 1901 (s. 132) requires the Medical Officer of Health, in his Annual Report to the Council, to report specifically on the administration of that Act in workshops and workplaces, and to send n copy of his Annual Report, or so much of it as deals with this subject, to the Secretary of State (Home Office). 37 INSPECTION AND SUPERVISION OF FOOD. MILK 7 persons were registered as retail purveyors of milk during the year. There are now 166 purveyors of milk on the register and during the year 298 visits were made to their premises. There are no cowsheds in the district. In 1936, licences under the Milk (Special Designations) Order, 1923, were granted as follows: — For the sale of Grade A (Tuberculin Tested) Milk 21 (including 5 supplementary licences). For the sale of Pasteurised Milk 24 ,, 4 ,, ,, For the sale of Certified Milk 7 ,, 4 For the sale of Grade A Pasteurised Milk 5 ,, 3 ,, ,, For the sale of Grade A Milk 1 BREAD. There are 51 bakehouses in the district and during the year 197 visits were made to these premises by your inspectors. MEAT, FISH AND FRUIT. There are now 3 registered and 5 licensed slaughterhouses in the Borough, a reduction of one licensed slaughterhouse. One slaughterhouse carries on a wholesale trade. There are 117 butchers shops, 145 fruiterers' and greengrocers' shops and 80 fish shops in the district. 38 During the year, 1,029 visits were made to slaughterhouses, 590 to butchers' shops, 340 to fruiterers' and greengrocers' shops, and 280 to fish shops. 32 licences to slaughter animals were issued in 1936. During the year the following animals were inspected:—Bovines, 1,776; Sheep, 12,197; Swine, 15,696. Disease was found to exist in 29 per cent, of the Bovines, 2.4 per cent, of the Sheep and 5.8 per cent, of the Swine. The following is a summary of the diseased meat found: — Bovines.—1 whole carcase; 21 sets lungs; 14 livers and 16 lbs. liver; 4 heads and tongues; 4 heads; 3 tongues; 3 mesenteries; 1 skirt; 1 heart; 80 stones of beef. Sheep.—182 livers; 129 sets lungs; 7 stones of mutton; 4 stones of New Zealand lamb. Swine.—27 whole carcases; 413 heads; 163 livers; 147 mesenteries; 115 sets lungs; 14 hearts; 6 bellies; 4 spleens; 3 loins; 3 legs; 2 kidneys; 1 neok; 1 hand and spring; 14 stones of pork. MISCELLANEOUS FO'ODSTUFFS 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 oondemned and destroyed:— 10 cases Peaches. 23 lbs. Skate. 2 boxes Apples. 13 Turkeys. 50 lbs. Strawberries. 11 lbs. Sausages, cwt. and 4 bags Potatoes. 1 Rabbit. 2 boxes Cod Fillets. 1 Chicken. 3 stones Herrings. 1 tin Corned Beef. 1 box Fish Knobs. 1 tin Condensed Milk. 39 ADULTERATION, ETC. I am indebted to the Middlesex County Council (the Authority for administering the provisions of the Food and Drugs (Adulteration) Act) for the following information respecting samples taken in this district: — Name of Article. Samples Taken. Found Adulterated. Milk 273 4 Milk, separated 1 - Butter 5 — Citron Peel 1 1 Gin 5 2 Hake 2 — Lard 3 — Lemon Sole 5 1 Meat 6 2 Meats, cooked 4 —■ Minced Beef 1 — Mustard 2 — Paste, Meat and Fish 2 — Pepper 1 — Sausages 16 6 Vinegar 3 — Whisky 6 1 336 17 Number of Prosecutions 7 Number of Convictions 2 (4 cases pending) PREVALENCE OF, AND CONTROL OVER, INFECTIOUS AND OTHER DISEASES. Compared with 1935 there were in 1936 147 fewer notified oases of Scarlet Fever, and there were no deaths. Of the 430 notified cases, 139 were removed to Hospital—about one third. These figures would indicate that the system of retaining at home where possible all mild cases of Scarlet Fever is justifiable. 40 The practice adopted in Tottenham in relation to Scarlet Fever made available hospital beds for the accommodation of complicated cases of Measles. There was a considerable outbreak of Measles in the early part of the year of a severe type so that there were 21 deaths—19 more than in the preceding year. Of the 221 oases of Diphtheria notified in 1936, 204 were removed to hospital. Nine died. The age group of greatest incidence of Scarlet Fever and Diphtheria was from 5 to 10 years—early school life. Immunisation against Diphtheria is gaining in popularity but not to such a degree as to give promise of early suppression of the disease. Upon notification of a case of a school child being received, the parents of all the ohildren attending the same class are, by letter, invited to seek for their immunisation. This frequently results in all the children of the family being either Schick tested or immunised without preliminary Sohick testing, depending upon the age of the children. Schick testing is employed in all children 8 years of age or over. Children under that age are immunised without preliminary Sohick testing. Hereunder is set out in tabular 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 oases. 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 120 23.7 *9 12.7 — — Hornsey 6 32.2 - — †1 56.0 L.C.C 1 61.0 — — — — London Fever 2 42.5 — — — — Enfield & Edmonton — — — — — — *One case proved fatal—cause of death, septicaemia †Actual cause of death was Pulmonary and Abdominal Tuberculosis. 41 Other wrongly diagnosed oases were re-olassified as follows:—Not Soarlet Fever, 1; Urticaria, 3; German Measles, 1; Tonsillitis, 1; Impetigo, 1; Dermatitis, 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 58.8 *12 15.9 7 19.1 HornBey 21 54.5 1 35.0 2 3.5 L.C.C 5 59.8 1 24.0 — — London Fever 3 60.0 — — — — Enfield & Edmonton 8 75.6 — — — — *One oase proved fatal—-cause of death. Measles and Pneumonia. Other wrongly diagnosed cases were re-olassified as follows:—Not Diphtheria, 2; Tonsillitis, 10; Suppurated Adenitis, 1. CASES OF NON-NOTIFIABLE INFECTIOUS DISEASE REMOVED TO HOSPITAL. 109 Measles and Pneumonia. 16 ,, ,, Bronchitis. 5 ,, ,, Otitis Media. 3 ,, ,, suspected Meningitis. 2 ,, ,, Epistaxis. 1 ,, ,, Eye Trouble. 1 ,, ,, Abdominal Trouble. 1 ,, ,, Heart Disease. 1 ,, ,, Whooping Cough. 1 ,, ,, ,, ,, and Impetigo. 1 ,, ,, ,, ,, ,, Bronchitis. 1 ,, ,, Osteomyelitis. 1 ,, ,, Mastoid. 42 1 Measles and Laryngitis. 1 ,, ,, Otorrhoea. 1 ,, ,, Tracheotomy. 1 ,, ,, Septic Scalds and Convulsions. 1 ,, ,, Peritonitis. 1 ,, ,, Severe Aneuritis. 1 ,, ,, Cervical Adenitis. 4 Whooping Cough and Pneumonia. 2 ,, ,, ,, Bronchitis. 1 ,, ,, ,, Otitis Media. 1 ,, ,, ,, Marasmus. 1 ,, ,, ,, Otorrhoea. 1 ,, ,, ,, Mumps and Nephritis. 3 Chicken Pox and Bronchitis. 2 ,, ,, ,, Mastoiditis. 1 ,, ,, ,, Otitis Media. 1 ,, ,, ,, Pneumonia. SMALLPOX. There were no cases of Smallpox during 1936. I am obliged to the Vaccination Officer for the following information:—Number of successful vaccinations during 1936, 448; number of declarations of conscientious objection to vaccination, 629. DIABETES AND ANAEMIA. With the approval of the Ministry of Health, Insulin was supplied to 7 patients suffering from Diabetes. The number of units amounted to 95,424 and the cost was £26 7s. l£d. Reports upon the progress of the cases were furnished to the Ministry according to their requirements. With the Ministry's sanction, one patient suffering from Anaemia was supplied with Liver Extract and Ventraemon Powder at a cost of £8 5s. Od. TUBERCULOSIS. The County Council are responsible for the treatment of Tuberculosis. 252 notifications were received during 1936—Pulmonary, 222; other than Pulmonary, 30. 43 Cases remaining on the register at the end of the year were: Pulmonary, 542; Non-Pulmonary, 133. 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 — 1 to 5 years — — 3 — — 1 3 5 to 16 ,, 10 12 5 8 — — 1 15 to 25 ,, 21 37 3 3 7 19 I — 25 to 35 ,, 35 30 1 3 16 10 1 4 35 to 45 ,, 15 13 — 2 13 9 1 — 46 to 55 ,, 22 4 1 1 15 7 1 — 56 to 65 ,, 16 4 — — 11 4 1 — 65 years and upwards 7 1 — — 5 — — — Totals 121 101 10 20 67 49 7 5 44 Males. Females. Organs affected (New Cases):— Lung 121 101 Glands 7 10 Spine 1 3 Meninges 1 1 Peritoneum — 3 Rib — 1 Abdomen — 1 Knee 1 — Pelvis — 1 131 121 The deaths represent a death rate of 0.86 per 1,000 population. In 11.72 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 1936. MEMBERS OF THE COMMITTEE. (As at 31st December, 1936.) Councillor A. J. LYNCH, J.P. (Chairman). Alderman Mrs. W. A. KENT (Vice-Chairman). Alderman E. J. FIELD. Alderman C. D. GRANT. Alderman A. E. JAY, J.P. Alderman Major Sir P. B. MALONE, J.P. His Worship the Mayor (Alderman J. H. MORRELL, J.P.). Councillor Miss R. F. COX. Councillor M. DOR AN. Councillor Mrs. A. M. ELLIS. Councillor A. E. HARVEY. Councillor W. H. HEALING. Councillor D. JORDON. Councillor Mrs. A. KITCHENER. Councillor Mrs. J. D. LYNCH. Councillor Mrs. A. E. LYONS. Councillor H. W. PEARCE. Councillor A. REED, A.C.I.I., J.P. Councillor H. W. TURNER. Councillor R. H. WARREN. 2 School flDctncal Department. School Medical Officer : David C. Kirkhope, M.D., Ch.M., D.P.H., of Gray's Inn and Middle Temple, Barrister-at-Law. Senior Assistant Medical Officer: Alice Stalker, M.B., Ch.B., D.P.H. Assistant Medical Officer: R. Hastings Smythe, L.R.C.P. and S.I. Ophthalmic Surgeon: T. W. Letchworth, F.R.C.S. Aurist: A. R. Friel, M.A., M.D., F.R.C.S.I. Orthopaedic Surgeon: H. J. Seddon, F.R.C.S. Dental Surgeons: V. Sainty, L.D.S., R.C.S. (Eng.). L. S. Pilbeam, L.D.S., R.C.S. (Eng.) (to 29th September). A. G. Brown, L.D.S., R.C.S. (Eng.) (temporary from let October). School Nurses: *†E. Johns. *†W. Barnes. *‡C. Vine. *†L. Rogers. ‡E. Barhatt. *†H. McMath. *†§°B. Whitakhr. *†‡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. Masseuse: Miss Y. Folkes, C.S.M.M.G. (Part-time). Clerical Staff: V. Goddard (Chief Clerk). T. E. Cowan, F.C.I.S. D. Osborne. R. E. Tuson. H. J. Dunham. (and at Laboratory). 3 SUNTRAP SPECIAL SCHOOL. Hayling Island. MEDICAL STAFF. Medical Officer (Part-time) A. J. Mat, B.A., M.B. Honorary Consulting Surgeon: Sir Henry Gauvain, M.A., M.D., F.R.C.S. Matron-in-Charge: Miss 0. P. E. Hann, S.R.N., D.N. Miss D. Weetman. Sister. 10 Probationary Nurses. GENERAL INFORMATION. Total School Population. Number of Scholars on Roll. Elementary Schools:— Provided Departments 51 On Roll 16,417 Non-Provided Departments 12 ,, 2,227 Central Departments 3 ,, 1,074 Special Day Schools 3 ,, 165 69 ,, 19,883 Special Day Schools in other Districts 2 ,, 70 71 ,, 19,953 Secondary and Technical Schools 6 ,, 2,104 Private Schools 10 ,, 350 87 ,, 22,407 Boys. Girls. Infants. Mixed. Central. Special. Totals. Number on Roll 5,268 5,180 5,799 2.397 1,074 165 19,883 Average Attendance 4,800 4,666 4,847 2,142 1,004 146 17,605 Percentage of Average Attendance 91.1 90.1 83.6 89.3 93.5 88.5 88.5 4 INTRODUCTION. School Medical Department, Town Hall, Tottenham. March, 1937. To the Chairman and other Members of the Tottenham Education Committee. Ladies and Gentlemen, The report for 1936, which will be the last that I shall have the pleasure to compile, gives a digest of the medical services in behalf of the school children during that year. Twenty-four years ago, when I was entrusted with the supervision of the School Medical Services, the only clinic in being was the Eye Clinic, then as now, in the competent hands of Mr. Letchworth. The most recent additions are the Aural Clinic and the Orthopaedic Clinic, and both are proving as valuable to the health of the younger members of the community as are the others. The growth of the School Medical Services to their present dimensions and the manner of their development would have been impossible but for the fostering care and encouragement of the Education Committee during all these years, and the hearty goodwill of my co-workers in the department, for all of which I tender my grateful thanks. I am, Ladies and Gentlemen, Yours faithfully, David C. Kirkhope 5 CO-ORDINATION. Arrangements for the co-ordination of the work of the School Medical Service with that of other Health Services. There are 110 alterations under this heading. The same conditions prevail to-day as outlined in the report for 1935. THE SCHOOL MEDICAL SERVICE IN RELATION TO PUBLIC ELEMENTARY SCHOOLS. School Hygiene.—-I am indebted to your Committee's Surveyor for the following schedule of repairs, alterations and improvements to schools during 1936. It will be observed that effective measures are being employed to modernise—so far as that is practicable—the older schools. Belmont School. Modernisation and improvement works, comprising new ranges of children's offices, wash bowls with hot and cold water supplies, heated clothes racks, and the provision of Nursery Classrooms, etc. Installation of electric lighting. Removal of stoppings (nine rooms) and forming level floors. Provision of exhibition panels and sliding blackboards (five rooms). Provision of 120 tables and 240 chairs. Bruce Grove School. Removal of steppings and forming level floors in one classroom, and the provision of exhibition panelling and sliding blackboards. Provision of 40 tables and 80 chairs. External re-decorations. Installation of six modern bubble-jet drinking fountains. Coleraine Park School. Removal of steppings and forming level floors in two classrooms. Installation of six modern drinking fountains. Crowland School. Installation of electric lighting. Installation of modern drinking fountains. Culvert School. Installation of six modern drinking fountains. Removal of steppings and forming level floors in five classrooms. Provision of 60 tables and 120 chairs. Relaying of corridor floor in Infants' Department. 6 Downhills School. Installation of electric lighting. Removal of steppings and forming level floor in one classroom. Provision of exhibition panels and sliding blackboard. Provision of 20 tables and 40 chairs. Improvements to playground area. Installation of six modern drinking fountains. External re-decorations. Downhills (Central) School. Installation of four modern drinking fountains. External redecorations. Erection of new premises to provide Handicraft Room for boys and Practical Workroom for girls, together with physical training hall for elementary junior children. Provision of a housewifery suite for Domestic Subjects Room. Down Lane (Central) School. Installation of six modern drinking fountains. Earlsmead School. Modernisation and improvement works, comprising new ranges of children's offices, wash bowls with hot and cold water, heated clothes racks and the provision of a Nursery Classroom and Staff Room, etc. Removal of steppings, and forming level floors to 12 classrooms. Fitting-out six classrooms with exhibition panels and sliding blackboards. Provision of 120 tables and 240 chairs. Parkhurst School. Installation of electric lighting. Re-tanking of boiler pit and reerection of heating boilers at a higher level. Erection of new Handicraft Room for boys and Domestic Subjects Room for girls, with housewifery suite attached. Risley Avenue School. Provision of six modern drinking fountains. Relaying of corridor floor in Junior Mixed Department. Removal of steppings and forming level floors in two classrooms. Provision of 60 tables and 120 chairs. Improvements to playground surface. 7 Seven Sisters School. Modernisation and improvement works, comprising alterations to children's offices, new wash bowls with hot and cold water, heated clothes racks, widening of corridors, new flooring throughout, and the provision of Nursery Classrooms, etc. Provision of 160 tables and 320 chairs, and classroom cupboards, Stamford Hill School. Relaying of corridor in Infants' Department with "Granwood" composite flooring. Installation of six modern drinking fountains. Provision of 40 tables and 80 chairs. Woodlands School. Removal of steppings and forming level floors in 12 classrooms. Fitting-out 12 classrooms with exhibition panels and sliding blackboards. Provision of 120 tables and 320 chairs. General. In addition to the general maintenance and upkeep of school premises a considerable number of blackboards, desks, tables, cupboards, and other items of school furniture have been renovated and repaired, or replaced by new. Teachers' obsolete classroom desks are being replaced by modern tables, and general improvements in the Staff Rooms are being constantly carried out. MEDICAL INSPECTION. Description of arrangements made and methods adopted for the medical inspection of children :— The age-groups examined were those prescribed by the Board of Education. See statistical tables, page 41. The arrangements made and methods adopted for the medical inspection of the children were described in the Annual Report for 1935. 8 FINDINGS OF MEDICAL INSPECTION. Malnutrition.— Children found at the routine medical inspections to lie suffering from malnutrition, in any degree, numbered 595, or 10 per cent. of the children inspected. See Table B, page 43. About 20 per cent. of these children received free milk. In the remainder it was deemed sufficient to advise parents with regard to the diet of their children. Such children are periodically re-examined to ascertain their progress. Children specially examined in school by the medical officers and found to be undernourished numbered 197. At the school clinics 577 children were judged to have nutritional and kindred defects. For the children from all sources found to be suffering from malnutrition, the following provision was made :— Free Milk 697 Free Milk and Medicinal Foods 28 Medicinal Foods 96 Convalescent Treatment and Medicinal Foods 24 Convalescent Treatment 36 Referred to Hospital or Private Doctor 6 Uncleanliness.—1,060 children were unclean at the time of examination, equal to 6 per cent. of the children in average attendance at school. This number corresponds almost exactly with those of 1935. Minor Ailments and Diseases of the Skin.—In 1935 these accounted for the ailments of 3.38 per cent. of the children in average attendance. In 1936 the percentage was 4.13. Visual Defects and External Eye Diseases.—Whereas in 1935, 1,253 children were found upon medical inspection to suffer from defects within this category, in 1936 the number was 1,310. Of 795 spectacles prescribed, 793 were obtained. 9 Nose and Throat Defects.—There was a reduction in the number of these defects noted in the routine and special inspections in 1936. The number was 1,040 ; in 1935 it was 1,094. The number of children for whom treatment for enlarged tonsils and adenoids was advised was 647. Children who received operative treatment during the year numberd 596. Certain arrears of treatment are carried forward from year to year and the number awaiting attention approximates to 250. Serious difficulties are experienced in having the tonsils and adenoid cases treated, as no arrangement has yet been made with the County Council for the admission of Tottenham cases to their hospital. Ear Disease and Defective Hearing.—Compared with the returns for 1935, there has been a reduction by 20 of children found in the 1936 routine inspections to suffer from defects of this character, but there has been an increase by 30 of children submitted for special examination. The major portion of these latter suffered from otitis media. Dental Defects.—12,248 dental inspections were made. The number found to require treatment was 8,887. The number actually treated was 5,283, being 59 per cent. The percentage in 1935 was 53. Orthopsedic and Postural Defects.—Inspections in 1936 revealed 204 children to be subjects of deformities, and these were referred to the Orthopædic Surgeon for examination and appropriate treatment. In 1935 the number of cases brought to light was 325. I am reluctant to claim that the remarkable reduction in numbers reflects a corresponding improvement in the physique of the school children. It is probably accounted for, in part, by change of method in ascertainment. It is claimed, however, that no child requiring skilled orthopaedic treatment is missed. The Orthopsedic Surgeon's report is to be found on page 16. Heart Disease and Rheumatism.—The general observations made in the 1935 Report are still applicable. There has been the insignificant reduction by 12 during 1936 of diseases of the heart discovered on inspection. 10 Ttuberculosis.—6 children were diagnosed definitely to lie suffering from tuberculosis of the lungs, and 25 others were suspected to be so suffering, Glands, bones and joints accounted for 15 other tuberculous cases, discovered on medical inspection. The County Council is the Authority responsible for the treatment of tuberculosis, and the collaboration of their local Tuberculosis Officer, Dr. Davies, is of incalculable advantage to your Committee's Medical Officers. FOLLOWING-UP. Review of the arrangements for the following-up of children suffering from the various defects, including a summary of the work undertaken by the School Nurses :— The general arrangements for the following-up of school children absentees from school were outlined in the 1935 report. In addition to the statement therein, the school doctors re-examine periodically in school, children who at routine and special inspections have been found defective in some particular. These children are kept under scrutiny until the defects are remedied, nothing further can be done for them, or they have reached the school leaving age. From hospitals information is frequently received of school children in attendance at out-patient departments who are to be discharged. The value of following-up these cases is recognised at the hospitals and occasionally valuable suggestions respecting treatment that can be given locally are made, and acted upon. The home visitation of hospital cases by school nurses ensures attendance at hospital, as required, being more regular than it might otherwise be. The work undertaken by the school nurses in addition to following-up in the homes of scholars, includes attendance with doctors at inspections and clinics, regular visitation at schools for the purpose of cleanliness survey, cleansing of scabies cases and occasionally of verminous oases where distressing domestic circumstances indicate that this is desirable. 11 In connection with the above, 5,345 homes were visited, 753 attendances were made at clinics, 1,342 school attendances were made for the purpose of medical inspection and cleanliness surveys, and 147 baths were given to 57 children suffering from scabies. Table VI, page 49, outlines the work of the school nurses in schools. MEDICAL TREATMENT. Review of the methods of treatment employed, or available, for 'he treatment of defects. Malnutrition.—School dinners are provided for children of necessitous parents and children recommended for school meals by the school medical officers. .Milk is also provided in schools for children recommended therefor by the school doctors. See in this connection the statement of the Director of Education, page 24. Uncleanliness.—At the Council's disinfesting station unclean children may have their garments disinfested whilst they are bathed in the slipper baths adjacent. Cleansing of the hair is assisted by the school nurses in the case of those children who are not old enough to be expected to look after themselves and whose parents show willingness to co-operate in a thorough cleansing of their children. The nurses are willing to demonstrate to mothers how cleansing should be effected, or they will themselves cleanse children of mothers who are suffering from some incapacitating condition. Minor Ailments and Diseases of the Skin.—There are Minor Ailment Clinics at the Town Hall and Bruce Castle, the sessions being as follows :— Town Hall.—Monday, Tuesday, Thursday and Saturday mornings. Bruce Castle.—Monday, Wednesday and Friday mornings. At the Town Hall there is a spray bath for the treatment of scabies. Ringworm is usually treated by X-Rays at the North Middlesex Hospital and a payment is made by the Committee to the County Council in respect of such treatment. 12 A record of the work done at the Minor Ailments Clinics during 1936 will be found tabulated in Table IV, page 47. For many years Bruce Castle has been the main centre of the School Medical Department. It has been the aim of the Council to appropriate the Castle to other purposes, and premises were sought for, more appropriate to the needs and importance of the department. The Council's scheme to provide a building for the School Medical Services and the Maternity and Child Welfare Centres is likely to mature during 1937. Visual Defects and External Eye Diseases.—At the Eye Clinic at Bruce Castle sessions are held on Wednesday mornings and afternoons. Children are treated there for errors of refraction and other eye defects not dealt with at the Minor Ailments Clinics. Certain cases of inveterate external eye complaints are sent to Institutions, in particular the White Oak Institution, Swanley. Myopic children attend the Wood Green Special School and children blind within the meaning of the Education Act are placed in suitable Institutions. Nose and Throat Defects are treated principally at the Prince of Wales's Hospital and the North Middlesex Hospital. See Table IV, Group III, page 48. In cases of dulness of hearing associated with adenoid conditions, treatment is given at the Ear Clinic. Dental Defects.—The Committee employ two whole-time dentists at Clinics, one at Bruce Castle and another at the Chestnuts. The work accomplished by them is summarised in tabular form on page 49, Table V. Ear Diseases and Hearing.— AURAL REPORT. / am indebted to Dr. Friel for the following statement:— The success of this clinic has been due in large measure to the co-operation of the mothers. 13 By a system of appointment making and keeping, the time spent by mothers at the clinic is reduced to a minimum. The system is akin to that employed at factories called "clockingon. It has been so worked out in detail that absences are at once detected and punctuality of attendance is registered by the patient himself. The treatment given is usually by one or more of the following methods :— (1) Diastolisation.—A means of freeing the passages of the nose by stimulating to healthy activity the lining membrane of the nostrils. (2) Insufflation of medicated vapour to destroy infecting germs. (3) Displacement.—A method of mechanically sucking the fluid content from the cavities (sinuses) communicating with the nose and substituting therefor medicated solutions. Good results usually follow this latter method of treatment when the displaced sinus content is of mucoid character. If it is of a purulent, character, more radical methods of treatment are required. The Audiometer has been regularly used in the schools to detect impairment of hearing in one or both ears. Attention is focussed on the younger children as it was found that in them benefit by treatment was more likely to follow. In the older children the changes in the tissues had already consolidated. If examination and treatment could be carried out on the young they would, when they passed into the senior classes, be able to hear unless the inflammation causing deafness had been so severe as to disorganise the ear. It is interesting to see in a tabular form the results of testing a large number of children of all ages. This testing was spread over the years 1932/36. Total children tested 10,171 Total children passed 9,272 or 91.2 per cent. Total children failed 899 or 8.8 per cent. 14 Total ears tested 20,342 Total ears passed 19,100 or 93.9 per cent. Total ears failed 1,242 or 61 per cent. Total Tested. Found with Defect. Defect in:— One ear. Both ears. Boys 4,782 415 168 247 Girls 5,389 484 175 309 Totals 10,171 899 343 556 ANALYSIS OF DEFECTS FOUND. Total defective ears. Number of ears showing hearing loss in units of hearing, as follows:— 9 12 15 18 21 24 27 30 Boys 583 166 169 129 64 24 14 4 13 Girls 659 227 192 102 59 38 15 13 13 Totals 1,242 393 361 231 123 62 29 17 26 The following tables show the degree of defect and the results of treatment in children examined in 1936. Number of ears with their loss before treatment. Loss reduced after treatment to:— 6 units or less. 9 12 15 18 21 24 27 30 21 ears had 9 units loss 20 1 - - - - - - - 33 „ 12 „ 30 3 - - - - - - - 14 „ 15 „ 13 — 1 — — — — — - 3 „ 18 „ 2 — — 1 — — — — - 4 „ 21 „ 2 1 — — — 1 — — - 4 „ 24 „ — — 2 2 — — — — - 3 „ 27 „ 1 - - - - - 2 — - 3 „ 30 „ — 2 — 1 — — — — - 85 ears had loss of 9 to 30 units 68 7 3 4 — 1 2 — - 15 Defects in hearing power of children under 7 years of age, with result of treatment. Number of ears with their loss before treatment. Loss reduced after treatment to:— 0 units 0+ units 6 units 9+ units 21+ units 30+ units 73 ears had 9+ units loss 9 41 16 7 - - 30 „ 21+ „ 7 8 7 7 1 - 18 „ 30+ „ 3 6 3 4 1 1 121 „ hearing loss 19 55 26 18 2 1 The next table shows the importance of testing being carried out in a quiet room. The records are standardised for words spoken in a quiet room and if the examination is made when noise is present a true result is not obtained. At the request of the Head Teacher of Page Green Girls' School, a test was carried out to determine what hearing loss is sustained by children, working in classrooms adjoining the main road. Six girls of between 13 and 14 years of age were tested in the quietest room in the school. They were immediately afterwards tested in what is regarded by the school staff as a noisy classroom. The resultant tests were then averaged, with the following result:— Average hearing loss in quiet room—minus 3 units, i.e., acute hearing. Average hearing loss in noisy room—plus 3 units. Average additional loss as a result of tests being conducted in a noisy classroom—plus 6 units. A table (page 16) is also given analysing the conditions found in discharging ears and summarising the results of treatment. Many of these patients were subsequently tested by the Audiometer to ascertain if the hearing was normal; if not, treatment was given for the defect in hearing. Examination is devoted (1) to ascertain the condition in the ear and (2) to decide what is keeping up the discharge. When these questions are answered the line of treatment is clear. 16 Otorrhoea. Cause of Suppuration. Total Ears. Cured. Lost sight of. Still under treatment. Needing Hospital. Acute Suppuration of the Middle Ear 55 42 4 9 — Chronic Suppuration of the Middle Ear, due to— Tympanic Sepsis 22 17 3 2 — T.S. and Granulations 6 5 — 1 — T.S. and Polypus 2 1 — 1 — Attic Disease 6 1 — 2 3 Mastoid Disease 9 — - 3 6 External Otitis 13 11 - 2 — Not Diagnosed 5 2 1 1 1 Totals 118 79 8** 21 10 **The 8 cases "lost sight of," left the district, before treatment was completed. Orthopaedic and Postural Defects.— An arrangement with the Royal National Orthopaedic Hospital authority was entered into towards the end of 1935. An orthopaedic surgeon pays periodic visits to Tottenham for the examination of children referred to him on account of these defects, the appropriate remedy is prescribed by him and a masseuse from the hospital carries out the exercises or other measures advised. Mr. Seddon, of the Royal National Orthopædic Hospital, has kindly furnished the following statement and record of the nature and amount of the work done at the Centres at Bruce Castle and Vale Road during 1936:— The Orthopædic Clinic has completed the first full year of its existence, and a brief review of its activities is therefore called for. The accommodation at Vale Road is excellent, and the equipment there is almost complete. The room at Bruce Castle, though in many ways unsatisfactory, is serving its purpose well, pending the completion of the new clinic. 17 The organisation of the department follows closely that employed at other clinics working in conjunction with the Royal National Orthopaedic Hospital. The actual cards and letters used are based on those in use at Hendon, and we are grateful to Dr. A. Fairgrieve Adamson, Medical Officer of Health for Hendon, for his generous help. Within a remarkably short time the clerical staff and the masseuse had mastered the organisation of the clinic, with the result that the work has been carried out efficiently almost from the first. A list of the conditions dealt with appears below. It is by no means indicative of the extent of crippling conditions in the child population of Tottenham. Many children with orthopaedic defects had already been taken to the Prince of Wales's Hospital, Tottenham, or to the Hospital for Sick Children, Great Ormond Street, or to the Royal National Orthopaedic Hospital, Great Portland Street. In such cases parents were informed that it was not necessary for them to bring their children to the orthopaedic clinic, and at the same time the importance of regular attendance at Hospital was emphasised. It is fairly certain that in the course of time more and more orthopaedic cases will find their way to the clinic, and the advantages of a unified service will become increasingly apparent. The forty-five children with postural defects of the spine represent, in the main, the residuum from the group that had been dealt with in remedial exercise classes before the clinic started. This work is now being done entirely by the orthopaedic masseuse. Five cases have been admitted to the Country Branch of the Royal National Orthopædic Hospital. In each case, progress has been satisfactory. TABULATED DIAGNOSES OF NEW CASES DEALT WITH DURING 1936. (1) Congenital Defects— Club Foot 3 Metatarsal Varus 1 Hammer Toes 1 18 Irregular Toes 5 Congenital Flat Foot 2 Spastic Paralysis 3 Other Conditions 3 (2) Birth Injuries— Torticollis 2 Other Conditions 1 (3) Rickety Deformities— Bowed Tibiæ 4 Other Conditions 3 (4) Knock Knees—Non-Rickety 7 (5) Postural Defects of the Spine incl. Flat Chest 45 (6) Structural Curvature of the Spine 7 (7) Feet- Foot Strain 4 Flat Foot 12 Pes Cavus 1 Hallux Valgus 1 Hallux Rigidus 1 (8) Infantile Paralysis 1 (9) Sequelæ of Acute Fevers 1 (10) Scarring Due to a Burn 1 19 (11) Tuberculous Joints 1 (12) Other Bone Diseases—Non-Tuberculous— Epiphysitis of Spine 2 (13) Other Conditions 4 Total 116 Number of individual children dealt with during 1936 206 During 1936 the total number of attendances at the Orthopædic Clinic for treatment was 3,194. Treatment sessions are held as follows:— Bruce Castle.— Tuesday afternoon, Thursday morning and afternoon. Vale Road School.— Monday morning and Wednesday afternoon. INFECTIOUS DISEASES. Review of the action taken to detect and prevent the spread of infectious diseases:— The measures employed for the detection and prevention of the spread of infectious diseases have not varied for many years. The Report for 1935 sets out generally these measures. In respect of the following schools and for the periods stated, certificates for depleted attendances on account of the prevalence of infectious diseases were granted. Woodlands Park Infants' School 5 weeks Crowland Road „ „ 5 „ Holy Trinity „ „ 3 „ Lancasterian „ „ 2 „ Stamford Hill „ „ 1 week Bruce Grove „ „ 1 „ 20 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 265 Diphtheria 138 Erysipelas 4 Pneumonia 9 Poliomyelitis 1 Tuberculosis—pulmonary 22 „ non-pulmonary 12 Voluntary Notifications. Teachers, attendance officers and others gave intimation of the occurrence, amongst school children, of the following diseases with the stated incidence:— Measles 1432 Sore Throat 27 German Measles 21 Influenza 31 Mumps 344 Eye Disease 3 Whooping Cough 247 Sores and Impetigo 58 Chickenpox 518 Rheumatism 2 Scarlet Fever 271 Other Diseases 39 Diphtheria 92 Children excluded owing Scabies 26 to Infectious Disease in Tonsillitis 8 house 621 Bronchitis 11 Immunisation against diphtheria is gaining greater favour and the numbers of school children attending at the Town Hall on Wednesday and Friday forenoons have greatly increased. Upon notification of a case of diphtheria in a school child, the parents of all the children attending the same class are circularised and invited to give their consent to the immunisation of their children. The response has been gratifying. Microscopical Examinations. Four specimens of hairs were examined, two of which were found to contain ringworm spores. 21 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:— (а) 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 33 and 34. (b) School Journeys and Camps. For the year 1936, expenditure on School Journeys, not exceeding £300, was agreed to by the Education Committee and approved by the Board of Education. Seven schools organised Journeys, and, in addition, 40 children were sent for a fortnight to the Hostel of the Shaftesbury Society at Whitstable, on a free maintenance basis. 22 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. Boys 22 (10 days) 2 Swanage 70 35 Crowland Boys 32 (2 weeks) 2 Niton. Isle of Wight 96 32 Downhills Sr. Girls 40 (10 days) 2 Shanklin 110 45 Down Lane Central Girls 100 (1 week) 4 Sandown 215 70 Earlsmead Jr. Boys 24 (2 weeks) 2 Shanklin 110 35 Earlsmead Jr. Girls 25 (9 days) 2 Sandown 87 15 Deaf 30 (2 weeks) 3 Lyme Regis 80 27 Shaftesbury Society 40 2 Whitstable — 25 (These 40 children were carefully selected from among the poor children of the district. The children were accepted by the Society free of maintenance charge). (c) Physical Training. Physical training in the schools during the year 1936 continued to make steady progress. Training of Teachers.— In the Spring of 1936, courses extending over a month were held for Teachers of Senior Children, while in the Autumn Term courses extending over ten weeks were held for those Infant and Junior Teachers who had not attended a more intensive course held earlier. Demonstrations with classes of children throughout both courses were given. Provision of Equipment.— Portable gymnastic apparatus is now in all the Senior Schools, and it is hoped that the training now being received by the senior children will be of a more advanced kind. 23 The Education Committee have given consideration to the Board of Education's Circular 1450 concerning the provision of shoes and cloth:ng for Physical Training, and much is expected to be done in this way during the next financial year. Education Week, May, 1936.—This week provided many opportunities for patents and others to see what schools are doing in Physical Training. Massed demonstrations of physical exercises, dancing and swimming galas, as well as ordinary physical training lessons daily in the schools, attracted wide interest. Recreative Physical Training for the Post-School Child and Adults. Demonstrations of this type of Physical Training were given during Education Week. The formation of several classes for young people and one for mothers resulted, the latter in connection with the Maternity and Child Welfare Centres. It is hoped that this aspect of Physical Training will attract still wider interest. Swimming Instruction.—Swimming instruction has continued throughout the year at the Indoor Hath 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. 1,836 such certificates were gained by pupils during the year (ended 31st March, 1936). A pamphlet on the teaching of swimming for girls has been prepared, which will be in the hands of the teachers before the summer swimming season begins. 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. 24 During the year ended 31st December, 1936, 259,290 dinners were provided to children in the schools. Of these, 251,289 were provided free to children of necessitous parents, and 8,001 on payment, to children in Central Schools. The average number of children receiving milk daily during the year was 10,536—9,811 on payment, under the voluntary schemes organised by the Head Teachers, and 725 free, on the recommendation of the School Medical Officer. CO-OPERATION OF PARENTS, TEACHERS, SCHOOL ATTENDANCE OFFICERS AND VOLUNTARY BODIES. The report for 1935 gives in explicit terms the measures employed to enlist the co-operation of those interested persons and bodies. CONVALESCENT HOME TREATMENT. 305 children suffering from debility, inanition, bronchitis, bronchial catarrh, etc., were sent to Hayling Island for six weeks or more. 46 took advantage of the summer holiday arrangements at the same place. The Invalid Children's Aid Association sent 210 children to various convalescent homes, and 8 were received in residence at the King Edward VII Memorial Seaside Hostel, Bexhill-on-Sea. PROVISION OF SURGICAL INSTRUMENTS. Surgical appliances were supplied, and repairs and replacements effected in 203 instances. These were in respect of 65 children who were suffering from the following defects:— Infantile and other forms Flat-foot 24 of Paralysis 13 Talipes 3 Tuberculosis— Other forms of Deformed Hip 1 Feet 8 Spine 1 Other Cases 14 Bones and Joints 1 25 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. Children suffering from defects under this heading are promptly brought to the notice of the department by parents, attendance officers, health visitors and school nurses, by the medical officers at school inspections, by other Authorities where there has been a change of address, and from hospitals and institutions. With such means of information available to the Authority it would be difficult for any child to escape detection for any length of time. Defective children who are supposed to come within Part V are referred, in the case of visual and hearing defects, to the Committee's Eye Specialist and Aurist respectively, who advise as to the institution to which each child should be sent. 18 children with visual defects have been accommodated at :— Lordship Lane Day School for Partially Blind 15 children East London School for the Blind 2 „ White Oak Hospital School, Swanley, Kent 1 child There are 20 deaf or partially deaf children at:— Tottenham School for the Deaf 18 children L.C.C. Deaf School, Anerley 1 child East Anglian Deaf School, Yarmouth 1 „ Physically Defective Children attend the Vale Road Physically Defective Centre and at the end of the year 77 children were in attendance. Accommodation for children requiring residential treatment has been provided as follows:— Heart Hospital School, Lancing 5 children St. John's Institution, Woodford 2 „ Royal Sea Bathing Hospital, Margate 2 „ 26 St. John's, Brighton 2 children Brookfield Orthopædic Hospital 1 child Lord Mayor Treloar's Cripple Hospital, Alton 1 „ Children who have been certified by the School Medical Officers as mentally defective have been accommodated as follows:— Oak Lodge Special Day School, Finchley 59 children All Soul's Special School, Hillingdon 2 „ Low grade defectives are referred to the County Authority. For epilepsy, one girl is receiving institutional treatment at Lingfield Home and School, and one boy and one girl 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. (b) 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. 27 The School for the Deaf. The following report has been submitted by the Head Mistress of this tchool:— The School for the Deaf serves the rateable areas of Tottenham, Edmonton, Enfield, Wood Green and Hornsey. Pupils also attend from parts of Middlesex, Herts and Essex. Arrangements are made for certain groups to travel in charge of responsible guides. Other groups are brought to school by ambulance. The elder Tottenham scholars and a few scholars from other areas travel independently. The boys and girls remain at school during the mid-day recess, and at 12.30 a two-course hot dinner is served. This meal for which a charge of 3d. is made, is prepared on the premises. Advantage is taken of the Milk-in-Schools Scheme, and hot milk is served during the morning session. Some of the scholars make an early start and this refreshment is appreciated. One result of congenital deafness is the failure to acquire speech and language naturally. Therefore, the pupils and teachers work together to build up a knowledge of English, so that the children may communicate with others. Those pupils who have become deaf, or whose deafness is partial, enter the school with their speech and language in stages of attainment varying with the age at which they became deaf, the degree of their deafness and intelligence. When a sufficient groundwork of English is gained, geography, citizenship, hygiene, etc., take their place on the time-table. The boys have a visiting master for woodwork. They also learn book-binding and cardboard modelling. The girls take cookery and needlework. Both boys and girls learn country dancing. During the year nine boys left school to take up work. Three were placed with a firm of furniture makers, one whose hearing had been normal till he reached the age of 10½ years entered upon an engineering course, and three obtained work in studios for commercial art. The parents of two wished to act independently in placing their children. 28 Four girls left school to take up work during 1936. One began to learn ladies' tailoring, another entered the baby linen workroom of an old-established firm in London. A girl, whose home is in Essex, became a sewing maid at a large public educational institution, and another entered domestic service at a college for women students. The experiment was tried of fixing a later period in the year than was usual for the school journey, and so in the beginning of September a party of senior scholars in charge of three mistresses went to Lyme Regis in Dorsetshire, where they stayed for two weeks. Oak Lodge School for Mentally Defective Children. The Head Mistress has submitted, the following statement :— During the year 1936 the Tottenham Education Authority has sent 70 children to this Special School. Of this number five girls and fourteen boys were new admissions, and four girls and seven boys left. Of the leavers six children were excluded by the School Medical Officer as unsuitable for further attendance, four reached the leaving age of 16 years and one left the district. Reports about the children who have left during the past three years show that the following are doing well:— 7 children are employed in factories; 3 children are employed in laundries; 1 boy is apprenticed to a carpenter. Eleven children were excluded as unsuitable and the majority of these are either in institutions or attending the Occupation Centre. Reports from those who left over three years ago show that a fair number are doing excellently, several having kept their situations for over five years. These report regularly to the school and correspond frequently. The types of situations are as follows, viz., lorry driver, housekeeper, machinists, factory hands, laundry hands, etc. 29 It might be of interest to know that one of the present pupils, a Tottenham child, won First Prize for Spinning in a recent All England Competition open to all classes of schools. Vale Road School for Physically Defective Children. The following report is based upon information supplied by the, Head Mistress. The school is a self-contained one-storey building with a large field and school garden attached. The accommodation includes three class-rooms, a spacious hall and an orthopaedic centre. Here treatment is carried out by an Orthopaedic Surgeon and a Masseuse, who is also a qualified instructress in remedial exercises. The hall is utilised for educational work and serves also as a dining-room. When weather conditions are favourable instruction is given in the open air. Specially constructed furniture has been provided. This includes desks of varying height, chairs with foot-rests, and couches for recumbent cases and for those children who have to rest during the day. The pupils are conveyed to and from school by ambulance. A hot two-course meal is provided at mid-day. Each child is given one-third pint of milk during the morning interval, and a further one-third pint is supplied during the afternoon, in selected cases, on the recommendation of the School Medical Officer. Chemical food and cod liver oil and malt are also administered when medically prescribed. The morning educational time-table resembles that of an ordinary elementary school. The afternoon sessions are devoted to art and craft work. During the year under review one scholar was awarded a secondary school scholarship. Many specimens of craft-work, executed by the children, were submitted for the exhibitions organised in connection with Tottenham's first Education Week. 30 A trained nurse is in constant attendance during school hours. Her duties include those of feeding and attending to the needs of helpless scholars and the supervision of children during rest periods. The ages of the pupils on the register range from 5 to 16 years. During 1936 the number on roll was 79. There were 21 new admissions and 18 children left the school. A record is kept of the after-careers of former scholars, and this register is checked annually. A brief summary is appended:— Clerical Duties 6 Factory Work 22 Shop Assistants 8 Hairdressing 1 Dressmaking 9 Tailoring 6 Decorating 1 Cabinet-making 2 Sign writing 1 Poultry Farming 2 Hawking 3 Domestic Work 6 Attending Adult Occupational Centre for Cripples 6 Unemployed on account of Disability 15 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 20 Muscular Paralysis 1 Amputation of Leg 2 Amputation of Hands 1 Injury to Head 1 Hydrocephalus 2 Tuberculosis— Hip 6 Knee 3 Heart Disease 38 Chorea 2 Talipes 1 31 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.— Sixteen children have attended during the year. Of these 8 attended prior to 1936, 3 were re-admitted after periods spent in hospitals and sanatoria, 3 were transferred (because of defective vision) from elementary schools and 2 young children with poor sight came at the ages of 4 and 5 years, not having attended school previously. Two boys left during the year, one of whom is working in a bakehouse. At the end of the year there were 14 children in attendance. Reasons for attending.— Myopia chiefly, often with secondary defect, and also hypermetropia, cataract, nystagmus, astigmatism, strabismus, blepharitis, conjunctivitis, aphakia, corneal nebulae, coloboma of iris (one case only). Trachoma was suspected in one case, that of a boy, who was excluded from September to December. He was re-admitted on the 18th January, 1937, on medical recommendation. Because of this variety, and frequent multiple defects, it has been found necessary to treat sections by differing educational and hygienic methods:— Myopes—Conservation of vision. Cataracts, coloboma and certain hypermetropes—School work within the scope of their defective vision. Blepharitis, conjunctivitis—Special health treatment. Health.—Health generally needs and receives special attention. Out-door periods and lessons in the park are enjoyed. Simple "talks on eye hygiene are given, besides the usual attention to teeth, hair, nails and cleanliness generally. Milk is taken by most children once or twice daily and increasing numbers are now taking the cooked dinner supplied. Necessitous cases receive both free, but payment is accepted from such as can afford it. At the annual medical inspection each child is seen by Dr. Manson, School Medical Officer, Wood Green. The parents attend well and are glad to be advised. The children receive special treatment from the Ophthalmic Surgeon at the Bruce Castle Clinic or attend privately at Moorfields Hospital. 32 The school has special lighting and ventilation and the installation of four new roller blackboards has allowed of better and larger work permitting of good posture. Musical exercises (Ann Driver's broadcast) are engaged in and music is also employed to assist relaxation and for the treatment of nervous cases and speech defects. Special desks, are to be replaced by a newer type adjustable for each child so as to allow correct postures for all. Experiments with a magnifying lens (in addition to the correcting glasses worn) have proved that ordinary type books can be used without danger and a supply of lenses is to be obtained shortly. Meantime wireless lessons help to teach by ear. Progress.—Progress in educational subjects has been maintained and increased particularly with the younger children. The youngest two (admitted at 4 and 5 years) show development in intelligence above the normal. The three children re-admitted after long absences for poor health have not attended very regularly and are retarded, the girl being especially backward, the boy suspected of Trachoma is now progressing a little and the third child is likely to make more rapid progress as his health improves. Transit.—Transit by ambulance means that the children arrive warm, dry and happy, and return home quickly. In addition the cause of absence is always ascertained and messages between teacher and home are made possible. Visitors.—Parents are welcomed at school any Thursday from 3.30—4 p.m. Other people interested in education or health, such as councillors and travellers, have paid visits of observation and are induced if possible to address the children so as to establish contacts with minds other than those of the two teachers. Entertainments, etc.—A visit was paid to a Horticultural Display at Downhills Park. 33 At Christmas the children printed invitations to their Christmas Tree Party and Concert, decorated the rooms, chose songs and carols and produced a play which they prepared and presented to an audience of parents, members of the Wood Green Education Committee and friends. The Mayor and Mayoress of Wood Green were present. The girls gave voluntary help with domestic tasks on the day of the entertainment and the next. Presents and cards to be given to members of their families were made at school by the children. Co-operation with normal schools.—The girls attend for Geography lessons in three different classes of the Lordship Lane School. They also have Domestic Science lessons from the specialist teacher there, whilst the boys are included in a class for woodwork lessons at the usual centre. Orchard House Open-Air Centre. During the year there were 34 boys on the school roll. The age range was 8—14 years with an average age of 11-6 years. Six boys were admitted during the year and eleven left. Of the eleven withdrawn, one returned to his school and the other 10 found employment as follows:— Carting 2 Clerical work 1 Woodwork 2 Shoemaking 1 Casemaking 2 Gardening 1 In Electrical Trade 1 The scholars have been provided with one-third pint of milk and A oz. cod-liver oil and malt daily. In addition, 12 boys received dinners daily. There has been a distinct improvement in physical development and an average increase in weight of 6 lbs. Except for the gardening lessons and a modified form of physical training, the ordinary school curriculum is followed. 34 Scholars were admitted from the following schools Lancasterian. Parkhurst. Devonshire Hill. Bruce Grove. Risley Avenue. Those selected for admission were suffering from the following defects:— Malnutrition. Anaemia. Habit Spasm. Tuberculosis. Rheumatism. Mastoid Disease. Functional heart affection. Eczema. Asthma. Downhills Park Open-Air Class. This class of girls met in the bandstalid from May 18th until October 29th. The cases selected for admission were suffering from various defects including quiescent and suspected pulmonary tuberculosis, bronchial catarrh, anaemia and malnutrition. The number of pupils on roll was 25 and was recruited from the following schools Downhills Senior Girls 13 West Green Junior Mixed 6 Downhills Junior Mixed 3 Culvert Senior Girls 2 Bruce Grove Girls 1 The ages of the scholars ranged from 10 to 14 years, thus necessitating a considerable amount of individual tuition. The work was conducted on lines similar to those adopted in previous years, and once again extensive use of the park was made for the purposes of naturestudy and physical training. 35 The children were provided with milk and cod-liver oil daily and there was evidence of both physical and mental improvement when the girls were examined prior to the closure of the class. Full-time Courses of Higher Education for Blind, Deaf, Defective and Epileptic Students:— These cases are dealt with by the County Authority. Suntrap Home, Hayling Island. Suntrap Home is undergoing extensive alterations and reconstruction and will be available, towards the end of 1937, for the accommodation of the full complement of children. During the alterations and reconstruction accommodation has been somewhat restricted. At the beginning of 1936— 78 children were in residence; 412 were admitted in 1936 ; 414 were discharged; 76 remained at the beginning of 1937. NURSERY SCHOOLS. Statement of the work of the School Medical Service in connection with Nursery Schools, including results of medical inspection and treatment. A Nursery School, to accommodate 100 children, is in the course of erection at Vale Road. It is hoped that the school will be opened this Summer (1937). Nursery Classes are held at Lancasterian School and the circumstances obtaining with respect to them are as stated in the report for 1935. 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. 36 I.— Medical Inspection:— Schools provided by the County Authority and numbers on the register of each:— Boys. Girls. Totals. County School 297 265 562 High School — 435 435 Grammar School 398 — 398 Junior Commercial School 8 76 84 Junior Technical School 109 — 109 St. Ignatius' College 516 — 516 1,328 776 2,104 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 1936 there were inspected 668 boys and 484 girls. 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 39-40 will be found a record of the treatment given. 37 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 1088 lbs. Parrish's Food 325 lbs. Cod Liver Oil 238 ozs. Syrupus Ferri Iodidi 1,768 ozs. Syrupus Calcii Lactophosphatis 1,751 ozs. SECONDARY SCHOOLS. Table I.—Number oe Pupils Inspected 1st January, 1936, to 31st December, 1936. Routine Inspections. Total. Ages. 9 10 11 12 13 14 15 16 17 Boys 11 7 118 153 133 117 106 21 2 668 Girls — 3 110 108 77 88 85 13 — 484 Totals 11 10 228 261 210 205 191 34 2 1,152 38 SECONDARY SCHOOLS (contd.). Table II.— Return of Defects Found in the Course of Medical Inspection in 1936. Defect or Disease. Routine Inspections. Number referred for Treatment. Number requiring to be kept under Observation, but not referred for Treatment. (1) (2) (3) Skin Ringworm:— Head — - Body — - Scabies — - Impetigo — - Other Diseases (Non-Tubercular) 11 - Eye Blepharitis 1 - Conjunctivitis 1 - Keratitis — - Corneal Opacities — - Defective Vision 91 2 Squint 5 — Other Conditions 2 — Ear Defective Hearing 3 — Otitis Media 1 — Other Ear Diseases 10 — Nose and Throat Chronic Tonsillitis 13 4 Adenoids — 1 Chronic Tonsillitis and Adenoids 2 — Other Conditions 7 — Enl. Cervical Glands (Non-Tubercular) 1 — Defective Speech — — Heart and Circulation Heart Disease:— Organic — 6 Functional — 3 Anaemia 2 — Lungs Bronchitis and Bronchial Catarrh 7 — Other Non-Tubercular Diseases 1 — Pulmonary:— Definite — — Tuberculosis Suspected — — Non-Pulmonary:— Glands 1 — Spine — — Hip — — Other Bones and Joints — — Skin — — Other Forms — — Nervous System Epilepsy — — Chorea 1 — Other Conditions 1 — Deformities Rickets — — Spinal Curvature 10 — Other Forms 24 — Other Defects and Diseases 24 3 Teeth—Dental Diseases 24 — Table III. relates to "Exceptional Children" and is not required in connection with Secondary Schools 39 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 11 2 8 1 - 10 10 3 5 1 1 11 228 41 160 25 2 12 261 56 181 24 - 13 210 38 159 13 - 14 205 57 137 11 - 15 191 60 127 4 - 16 34 7 27 - - 17 2 2 — — — Totals 1,152 266 804 79 3 Per cent — 23.1 69.8 6.8 .3 Defective Vision and Squint. 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) 149 9 - 158 Other Defect or Disease of the Eves (excluding those recorded in Group I) 2 - - 2 Total 151 9 - 160 Total number of Pupils for whom spectacles were prescribed:— (а) Under the Authority's Scheme 138 (b) Otherwise 8 Total number of Pupils who obtained or received spectacles:— (a) Under the Authority's Scheme 138 (b) Otherwise 8 40 SECONDARY SCHOOLS (contd.). Group III.— Table V.— Dental Defects. (1) Number of Children Inspected by the Dentist— (a) Routine Age Groups— AGE 9 10 11 12 13 14 16 16 17 18 TOTAL Number 8 20 301 363 354 402 321 103 15 — 1,887 (b) Specials 34 (c) Total (Routine and Specials) 1,921 (2) Found to require treatment 1,095 (3) Actually treated 421 4) Attendances made by children for treatment 1,003 (6) Half-days devoted to:— (7) Extractions:— Inspection 13 Permanent Teeth 234 Temporary Teeth 24 Total 258 (6) Fillings:— (8) Administrations of general anaesthetics for extractions 26 Permanent Teeth 719 (9) Other operations:— Permanent Teeth 97 Temporary Teeth 33 Temporary Teeth — Total 152 Total 97 41 ELEMENTARY SCHOOLS. Table I.— Number of Children Inspected 1st January to 31st December, 1936. A.— Routine Medical Inspections. Number of Code Group Inspections:— Entrants 2,189 Second Age Group 1,779 Third Age Group 1,947 Total 5,915 Number of other Routine Inspections — B.— Other Inspections. Number of Special Inspections 6,308 Number of Re-Inspections 14,861 Total 21,169 C.— Children Found to Require Treatment. Group. For defective vision (excluding squint) For all other conditions recorded in Table IIa. Total. Entrants 4 299 303 Second Age Group 110 156 251 Third Age Group 152 124 266 Total 266 579 820 42 Table 11. A.— Return of Defects found by Medical Inspection in the Year ended 31st December, 1936. Defect or Disease. Routine Inspections. Especial 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 — — 11 — Body — — 21 — Scabies* 6 — 88 — Impetigo 1 — 230 — Other Diseases (Non-Tuberculous) 6 364 1 Eye Blepharitis 8 — 67 — Conjunctivitis 4 — 141 — Keratitis — — 4 — Corneal Opacities 1 — — — Other Conditions (excluding fective Vision and Squint 2 - 71 1 Defective Vision (excluding Squint) 266 31 565 - Squint 19 — 130 — Ear Defective Hearing 24 1 10 — Otitis Media 15 — 88 — Other Ear Diseases 3 — 81 1 Nose and Throat Chronic Tonsillitis only 141 131 309 13 Adenoids only 1 3 4 — Chronic Tonsillitis and Adenoids 112 9 80 3 Other Conditions 29 2 188 15 Enlarged Cervical Glands (Non-Tuberculous) 4 1 43 4 Defective Speech 1 3 11 6 Heart and Circulation Heart Disease:— Organic 3 18 38 7 Functional 1 36 4 3 Anaemia 17 2 158 — Lungs Bronchitis 24 43 422 — Other Non-Tuberculous Diseases 5 3 34 — Tuberculosis Pulmonary:— Definite — — 6 — Suspected 2 8 15 — Non-Pulmonary:— Glands 1 — 8 1 Bones and Joints 1 — 4 — Skin — — — — Other Forms — — — Nervous System Epilepsy 1 2 3 4 Chorea 8 4 61 1 Other Conditions 7 3 40 7 Deformities Rickets 1 — 7 — Spinal Curvature 8 — 7 — Other Forms 59 3 119 — Other defects and diseases 49 32 2351 15 Grand Total 830 335 5783 82 43 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 2189 332 15.0 1662 76.3 179 8.0 16 0.7 Second Age Group 1779 275 15.4 1254 70.5 225 12.7 25 1.4 Third Age Group 1947 510 26.2 1287 66.1 137 7.0 13 0.7 Other Routine Inspections - - - - - - - - - Total 5915 1117 19.0 4203 71.0 541 9.1 54 0.9 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. 2 — — — 2 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. — 16 — — 2 18 DEAF CHILDREN. At Certified Schools for the Deaf. At Public Elementary Schools. At Other Institutions. At no School or Institution. Total. 15 — — — 15 44 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 — — — — 6 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. 62 59 — 2 123 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. 14 — 2 6 22 45 II.— Children Suffering from Non-pulmonary Tuberculosis. At Certified Special Schools. At Public Elementary Schools. At Other Institutions. At no School or Institution. Total. 10 — — 9 16 * Of the 69 children at Certified Schools, 38 are at Suntrap Speoial School, Hayling, for a period of not lees 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. 30 23 — 3 56 D.— Children with Heart Disease. At Certified Special Schools. At Public Elementary Schools. At other institutions. At no School or Institution. Total. 45 35 — 6 86 B.— Delicate Children. At Certified Special Schools. At Public Elementary Schools. At Other Institutions. At no School or Institution. Total. *69 289 39 8 405 46 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 3 - - - 3 Feeble-minded 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, 1936, by the Local Education Authority to the Local Mental Deficiency Authority. Total number of children notified, 29. Analysis of the Above Total. Diagnosis. Boys. Girls. (1) (i) Children incapable of receiving benefit or further benefit from instruction in a Special School:— (a) Idiots 1 - (b) Imbeciles 1 2 (c) Others 13 7 (ii) Children unable to be instructed in a Special School without detriment to the interests of other children:— (a) Moral Defectives 1 — (b) 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 18 11 In addition, 4 boys under seven years of age, who came under our notice, have been intimated, at his request, to the Officer under the Mental Deficiency Act. 47 Table IV.— Return or Defects Treated during the Year ended 31st December, 1936. TREATMENT TABLE. Group I.— Minor Ailments (excluding Uncleanliness, for whioh 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) 4 5 9 „ „ (other treatment) 2 — 2 Ringworm—Body 21 — 21 Scabies 95 1 96 Impetigo 228 3 231 Other Skin Disease 346 26 372 Minor Eye Defects (External and other, but excluding cases falling in Group II) 292 6 298 Minor Ear Defects 207 13 220 Miscellaneous (e.g., minor injuries, bruises, sores, chilblains, etc.) 1,040 31 1,071 Total 2,235 85 2,320 Group 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) (ii) (i) (ii) Under the Authority's Scheme. Otherwise. Under the Authority's Scheme. Otherwise. (1) (2) (3) (4) Errors of Refraction (including squint) 947 21 908 774 21 772 21 Other Defect or Disease of the Eyes (excluding those recorded in Group I) 7 8 16 Total 954 29 983 48 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) — — 74 — - — 522 — — — 596 — 217 813 (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 7 - 206 - - 66 272 49 Table V.— Dental Defects. (1) Number of Children Inspected by the Dentist— (a) Routine Age Groups— AGE 5 6 7 8 9 10 11 12 13 14 TOTAL Number 1,119 960 1,228 1,073 1,151 1,143 1,438 659 588 310 9,669 (b) Specials 2,579 (c) Total (Routine and Specials) 12,248 (2) Found to require treatment 8,887 (3) Actually treated 5,283 (4) Attendances made by children for treatment 8,103 (5) Half-days devoted to:— (7) Extractions:— Inspection 40 Permanent Teeth 1,608 Treatment 784 Temporary Teeth 4,807 Total 824 Total 6,415 (6) Fillings:— (8) Administrations of general anaasthetics for extractions 554 (9) Other operations:— Permanent Teeth 1,616 Permanent Teeth 262 Temporary Teeth 328 Temporary Teeth 1 Total 1,944 Total 263 Regulation cases 16 Table VI.— Uncleanliness and verminous conditions. (i) Average number of visits per school made during the year by the School Nurses 20.3 (ii) Total number of examinations of children in the Schools by School Nurses 121,735 (iii) Number of individual children found unclean 1,060 (iv) Number of children cleansed under arrangements made by the Local Education Authority 44 (v) Number of cases in which legal proceedings were taken:— (a) Under the Education Act, 1921 24 (b) Under School Attendance Byelaws — Cottenham Maternity and Child Welfare Committee. ANNUAL REPORT FOR THE YEAR 1936. 2 MATERNITY AND CHILD WELFARE COMMITTEE. As at the 31st December, 1936. The Mayor (Alderman J. H. Morrell, J.P). Alderman Mrs. W. A. Kent. Alderman Major Sir Patrick B. Malone, J.P. Councillor G. A. Armfield. Councillor Mrs. E. M. Coles. Councillor Miss R. F. Cox. Councillor M. Doran. Councillor Mrs. A. M. Ellis (Vice-chairman). Councillor F. A. F. Keay. Councillor Mrs. A. Kitchener. Councillor Mrs. A. E. Lyons (Chairman). Councillor M. J. O'Gara. Councillor A. Reeh, A.C.I.I., J.P. Councillor A. R. Turner. 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: ||†aB. Wallace. *‡afB. H. T. Townsend. *†§aM. Blanchard. *†§«H. Ha worth. *†abG. M. Hockin. *†adH. E. Clynes *†abcE. M. Dunn. (from 1st March, 1937). *†cM. Timlin. *‡aK. B. Drage *†§cN. A. Lennon. (from 1st March, 1937). *†§K. Goodwin. *†§M. Sumpner. *†§M. Oldfield. * General Training Cert. a R.S.I. Health Vis. Cert. †C.M.B. Cert. b Eye Hosp. Cert. (Moorfields). †San. Insp. Exam. Bd. Cert. c Fever Cert. § Health Visitor's Diploma. d Tubeiculosis Cert. ||R.S.I. San. Insp. Cert. e Ultra-Violet Light Cert. f Orthopaedic Creche: Matron—F. E. Trewinnard (Creche Trained) Nat. Soc. of Day Nurseries. Nursing Stuff. Miss E. Evans (Creche Trained, Welgarth Nursery Training Cert.) (Kindergarten Cert., Gipsy H 11 Training College.) Miss M. B. Ireson (Preliminary, Elementary and Advanced Cert. Nat. Soc. Day Nurseries). Miss D. Powell (Preliminary and Elementary Cert. Nat. Soc. Day Nurseries). Clerical Staff: E. Horton (C.I.S. Inter.). E. E. Fisher. G. A. Elliott. N. L. Petty. D. H. Ball. 4 Infant 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 5.30 p.m. In addition to the above Clinics, a Sewing Class for Mothers who attend the Centres, is held on Wednesday afternoon, 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, 1937. Madam Chairman, Ladies and Gentlemen, The Annual Report for 1936 is required to state, in addition to matters of statistical importance, only those alterations of and additions to the Maternity and Child Welfare services as have occurred during the year. In the Health Section of the report it will be noted that a gynaecological clinic has been established. Although this clinic is under the auspices of the Council it is so closely linked with the work in which your Committee is directly interested that it was considered convenient that the services of health visitors should be enlisted to assist the clinician at the gynaecological clinic. The new combined centre in Lordship Lane for Maternity and Child Welfare and School Medioal purposes is in process of erection at the time of writing this report. It is to replace the existing centre at Bruce Castle. "Keep Fit" classes for mothers commenced at Bruce Castle in the month of May. Miss S. P. Beale, the organiser of physical training, is in charge of the movement, which is very popular and gives promise of growing to considerable dimensions. Circular 1550 of the Ministry of Health recommending more systematic scrutiny of children between the ages of 18 months and 5 years has received your Committee's favourable consideration. In order that effect may be given to the Minister's representations you have approved the appointment of four additional health visitors, of whom two, at the moment of writing, have taken up their duties. On account of the expansion of the Maternity and Child Welfare services generally your Committee approved the appointment of an additional health visitor to augment the staff, so that there are now the Superintendent Health Visitor, and 13 health visitors in your employment. 6 The Midwives Act, 1936, came into operation on the 31st July, 1936. The purpose of the Act is, by setting up a Municipal Midwifery Service, to improve the status of midwives, to give them opportunity to attend post certificate courses, to abolish midwifery practice by unqualified and incompetent persons, and by these and other means, reduce maternal mortality and morbidity. In accordance with the requirements of the Act, your Committee have approved a draft scheme for giving; effect thereto, which has teen submitted to the Ministry of Health. Representatives of the Ministry of Health have visited Tottenham, officially, on two occasions; once in relation to Maternity and Child Welfare services generally, and once in relation to Infant Life Protection. Arising thereout the recommendations of the Ministry have been laid before your Committee. One, the equipment of a dental centre for mothers and children under 5 years of age, has long engaged your Committee's consideration, and the erection of a new centre is awaited whereat a dental clinic may be set up. The only other recommendation was the provision of sterilised outfits, which has already been complied with. Your Committee suffered the loss by death of one of its members in May—Councillor A. W. Lock. Mr. W. Mallinson, the Clerk of the committee, from its inception in 1919 until the date of his retirement in 1931, died also in May, 1936. Mrs. G. Mason, one of the health visitors, retired on account of illhealth on the 1st of June, 1936. As this is the last report that it will be my privilege to submit I desire to express the great pleasure I have had in serving your Committee, and I thank all the staff who have so loyally and faithfully co-operated with me in the duties entrusted to us. I am, Madam Chairman, Ladies and Gentlemen, Your obedient Servant, Darvid G. kirkhone. Medical Officer of Health. 7 Births, 1936. LIVE BIRTHS. Registrar-General's Figures— M. 993 F. 938 *1,931 Local Information:— Total Births notified—2,030 (less 8 transfers to other Districts) 2,022 Still Births 75 Live Births 1,947 *The Registrar's and the local figures do not agree because they relate to different periods. The local notifications are those of children horn within the year; the Registrar's, of those children registered within the year. MATERNITY SERVICES. Arrangements for Maternity Cases have been made, in respect of patients able to pay the whole or part of the fee, with the Mothers' Hospital, Clapton; for others, at the North Middlesex County Hospital. The following table shows the various institutions in which the confinements of Tottenham residents took place, and the numbers in each: — The Mothers' Hospital, Clapton :— Under the Council's Scheme 57 Own arrangements 157 214 The North Middlesex (County) Hospital 407 Other Outside Institutions 273 894 The remainder were confined within the District. 8 BREAST FEEDING As the result of the Health Visitors' enquiries, it was ascertained that 1,953 infants have been fed as follows:— Breast fed 1,494 Part Breast fed—plus milk, dried milk or condensed milk 298 Bottle feeding—Cow's milk 57 Dried milk 62 Other artificial foods 20 Feedings unknown 22 *1,953 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 1,937 8,567 20,431 30,935 Still Births 69 42 — 111 Total 2,006 8,609 20,431 31,046 Other visits to Children in respect of:— Deaths 60 Ophthalmia Neonatorum and Discharging Eye 81 * Other Infectious Diseases 593 †Other visits to Children 488 Total 1,222 * 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. Visits were made to children between 1 and 5 years of age under the Notification of Births' Acts totalling 20,431. 9 HOME VISITS TO MOTHERS. The following Ante-Natal Visits were made to Mothers:— First visits, 761; Re-visits, 1,162; total, 1,923. Mothers specially visited post-natally mere as follows:— First visits, 127; Re-visits, 120; Total, 247. HOME VISITS—PUERPERAL FEVER AND PYREXIA. 37 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. One mother was not traced, as she did not return from hospital to the address given. (For table see page 15.) Other visits to mothers totalled 590, and included visits in respect of complaints of neglect, inspection of premises, visits in respect of assistance in the supply of milk, and applications for registration as Foster Mothers. Unsuccessful visits to mothers and children totalled 5,377. INFANT WELFARE CLINICS. Centres. 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) 7,835 6,095 13,930 686 141 827 53 206 17.6 63.4 Bruce Castle 6,420 5,446 11,866 489 173 662 106 149 31.8 56.9 Town Hall 1,020 888 1,908 83 21 104 — 53 — 36.0 Total 15,275 12,429 27,704 *1,258 335 1,593 159 407 — — * Percentage of Notified Live Births represented by the above figure 64.54 10 NUMBER OF CHILDREN ON THE REGISTERS. Centres. 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). Became 5 during the year. Total. (on 1st attendance.) The Chestnuts (St. Ann's) 952 736 1,688 581 1,037 70 1,688 Bruce Castle 732 713 1,445 423 958 64 1,445 Town Hall 166 113 279 62 211 6 279 Total 1,850 1,562 3,412 1,066 2,206 140 3,412 Infant Mortality of Infants Attending the Infant Welfare Centres during 1936. Centres. No. on Register. (Under 1 year.) Deaths of Infants Infantile Death-rate The Chestnuts (St. Ann's) 952 6 6.30 Bruce Castle 732 7 9.56 Town Hall 166 0 0.00 Total 1,850 13 7.02 Infant Mortality rate for whole area 51.8 per thousand births. Medical Examinations. Total N umber. New Cases Number of Sessions. Average per Session The Chestnuts (St. Ann's) 3,769 798 154 24.47 Bruce Castle 3,581 620 153 23.42 Town Hall — - — — Total 7,353 1,418 307 — Children attending the Town Hall Centre are referred to The Chestnuts or Bruce Castle, for medical advice. 11 ANTE AND POST-NATAL CLINICS. Medical Examinations Ante Natal. PostNatal. Total. Number of Sessions. Average per Session. The Chestnuts (St, Ann's) 1,892 154 2,046 151 13.55 Bruce Castle 1,645 105 1,750 102 17.15 3,537 269 3,796 263 — Ante Natal Cases. Number of Mothers on the Registers. At the beginning of the year. New Cases. Total. The Chestnuts (St. Ann's) 104 421 525 Bruce Castle 62 357 419 Total 166 778 944 "Keep Fit " classes—date commenced, May 6th—for 1 session per week. Instructress— Mrs. Robson. No. of Mothers on the Register. No. of Sessions. Attendances. Average Attendance per Session. 99 25 743 30 12 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. 856 families were assisted during the year. The amount of milk distributed (Grade A, Tuberculin tested, and dried milk) was, Cow's Milk, 29,713 gallons, Dried Milk, 302 lbs. MIDWIFERY 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. 12 19 31 727 48 776 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. 150 calls were made by Midwives for Medical Aid, under the following headings:— 13 Medical Aid for Mothers. 106 calls were made on behalf of 100 mothers, as follows:— Hemorrahage. Labour trouble. Perinneal tear. Temperatures:— Miscarriages and Abortions. Miscellaneous. Total. Puerperal Fever & Pyrexia. Other causes. Antenatal. Postnatal. 10 28 36 9 2 1 7 13 106 Medical Aid for Infants. 44 calls were made on behalf of infants, as follows:— Dead, Feeble or Stillborn. Eye Cases. Total. Inflammation of or Discharging Eyes. Notified as Ophthalmia. 20 14 10 44 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 oases: — cases Authorisation of attendance in necessitous cases 27 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 10 14 Compensation for loss of practice was given to one Midwife who was in contact with an infections disease and debarred from attending other patients, a substitute being employed 1 Total 38 HOME HELPS. Assistance towards the services of Home Helps was granted in 35 cases. ACCOUCHEMENT BAGS, AND MATERNITY OUTFITS. Accouchement Bags are available at the Centres and are loaned to the mothers in suitable cases. Necessitous cases are given appropriate consideration in the matter of payment, and Maternity Outfits are provided and may be had at cost price. CASES OF DISCHARGING EYE AND NOTIFIED OPHTHALMIA NEONATORUM. 28 cases of Discharging Eye occurred during the year, 14 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. 14 14 28 0 24 0 4 28 28 Two cases were removed from home to hospital. 15 PUERPERAL FEVER AND PUERPERAL PYREXIA. The Council provides consultants and arranges for pathological or bacteriological examinations in cases of puerperal fever or pyrexia, and other cases, at the request of the medical practitioner in attendance. A special Consultant's Fee was paid in 3 cases. Hospital treatment is also arranged for in suitable cases. The following table shows the final result of the oases on the register at the end of the year: — PUERPERAL FEVER AND PYREXIA. In attendance at Confinement. Final Result. Removed (unable to trace). Doctors' cases. wives' cases. Occurred in Hospitals outside the District. Total. Recovered. Died. Puerperal Pyrexia 27 5 5 17 27 25 1 1 Puerperal Fever 10 2 4 4 10 9 1 — Total 37 7 9 21 37 34 2 1* * This case occurred in hospital, and did not return to Tottenham. 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 is based on the result of the enquiries made of every nurse, midwife, or doctor who has been in attendance upon the mother. 3 deaths were so reported. 16 Maternal Deaths.— The Registrar General's records show that 3 deaths were attributed to Tottenham. The Death Rate per 1,000 live and still births was:— From Puerperal Sepsis 0.99 From Other Puerperal Causes 0.49 Total 1.49 MATERNITY AND NURSING HOMES. The number of Nursing Homes on the register at the beginning of the year was 3. (i) Application for registration nil (ii) Registered during the year nil (iii) Orders made refusing or cancelling registration nil (iv) Appeals against such orders nil (v) Number confirmed on appeal nil (vi) Applications for exemption 2 *(vii) Application for exemption granted Closed voluntarily 1 (viii){ Closed owing to removal from district 1 (ix) Carried forward from previous year 1 * Hospitals exempt for registration:— The Prince of Wales's General Hospital. The Home and Hospital for Jewish Incurables. 17 The Creche.— The Creche, situated at 227, West Green Road, has had the following attendances:— Number of' days on which the Creche was opened, 242. Half days, 9. Quarter. Attendances under 3 years of Age. Attendances over 3 years of Age. Total. Whole-day Attendances. January to March 1,184 521 1,705 April to June 996 412 1,408 July to September 1,218 289 1,507 October to December 1,781 378 2,159 5,179 1,600 6,779* * In addition to this number there were 66 half-day attendances. Number of children admitted:— Under 3 years (when admitted) 108 Over 3 years „ 33 141 Average daily attendance, 27.44 CONVALESCENT HOME TREATMENT. The arrangement with the Invalid Children's Aid Association for the maintenance of children at Convalescent Homes has been continued during 1936 as follows:— 94 children were sent away for varying periods. 13 The periods of convalescence were as follows:— Number of weeks 1 2 3 4 5 6 7 8 9 10 11 12 Number of Children 2 12 10 24 10 17 4 3 1 3 1 2 Number of weeks 13 14 15 16 17 18 19 20 21 22 23 24 Number of Children 1 3 1 - - - - - - - - - 5 mothers with infants were sent away for two to three weeks' convalescent home treatment, and 6 mothers without infants. 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. The following table sets out the number of oases referred to hospital under the Local Authority's Scheme:— Tonsils and Adenoids Cases. Other Cases. Artificial Sunlight Treatment. Total. Prince of Wales's Hospital. North Middlesex Hospital. Orthopaedic Hospitals. Eye Hospitals. 36 - *1 1 3 41 * Special instruments also supplied. HEALTH VISITORS. Three additional Health Visitors have been appointed. 19 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 Infant Life Protection Officers under Part I of the Children Act, 1908, as amended by the Children and Young Persons Act, 1932. 265 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 64 (б) At the end of the year 60 Number of children on the Register:— (a) At the beginning of the year 78 (b) At the end of the year 71 (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 4 oases 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. 20 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 1936 the following homes have afforded hospitality to Tottenham cases: — Beacon Lodge, East Finchley. St. Helena's, Cricklewood. Enfield Hostel. Royal Free Hostel, Highbury Quadrant. St. Agatha s, Hampstead. St. Mary's, Stamford Hill. Main Memorial Home, N.W.3. Dalston Hostel. Rokeby, Streatham. MOTHERCRAFT CLASSES—WELFARE CENTRES. 379 pupils from the Senior Girls Departments of the undermentioned schools have attended demonstrations at one or other of the Child Welfare Centres: — Downhills Senior Girls'. Culvert Road Senior Girls'. Parkhurst Girls'. Risley Avenue Girls'. Bedford College sent 36 winter school students for lectures on Maternity and Child Welfare Work. 21 PUPIL MIDWIVES. Under an arrangement with the North Middlesex Hospital, Nurses from that hospital made 65 attendances at The Centre. GIFTS TO CENTRES. The Committee is again indebted to the Dorcas Society of the High School for Girls and to Mrs. F. King for generous gifts of infants' clothing; to Mr. W. J. Saul for a parcel of new boots and shoes for children, and to Mrs. T. W. Harby for a cot. Gifts to the Creche have also been received from certain local organisations and friends. INDEX. PART I.— Health Department. A PAGE Adulteration, etc. 39 Ambulance Service 20 Anæmia 42 B Bacteriological Laboratory 20 Bakehouses 37 Births 9 C Cancer 19 Cleansing 23 Clearance Areas 23 Clinics 21 Closet Accommodation 23 D Dairies, etc. 37 Deaths 10 Diabetes 42 Diphtheria 41 Disinfection and tation 26 & 27 Drainage and Sewerage 22 F Factory and Workshop Act 34 Food and Drugs Act 39 Food Unsound 38 H Health Services 20 Health Week 22 Hospitals 21 House Inspection 24 Housing 31 I Infantile Mortality 17, etc. Infectious Diseases 15 & 39 L Laboratory 20 M PAGE Malignant Diseases 19 Milk Supply 37 N Non-notifiable Infectious Diseases 41 North Middlesex Hospital 22 Nursing in the Home 21 O Overcrowding 25 P Population 9 R Rateable Value 9 Rivers and Streams 23 S Sanitary Administration of the Borough 23 Scarlet Fever 40 Shops Acts 28 Slaughter-Houses 37 Small Dwellings Acquisition Act 28 Smallpox 42 Smoke Abatement 27 Social Conditions 9 Staff 4 Swimming Baths 31 T Treatment Centres 21 Tuberculosis 42 U Unsound Food 38 V Violent Deaths 18 W Water 22 PART II.— School Medical Department. A page Attendance Officers 24 Aural Clinic 12-16 B Bacteriological Examinations 21 Baths, School 23 Blind Children 25, 43 C Clinics 11 Convalescent Home Treatment 24 Co-ordination of Services 5 D Deaf, School for 25-27 Deafness 9, 12-16, 43 Dental Defects 9, 12, 49 E Ear Diseases 9, 12 Education Week 23 Epileptic Children 26, 44 Exceptional Children 43-45 External Eye Diseases 8, 12,47 F Findings of Medical Inspection 8 Following-up 10 Food Accessories and Drugs 37 H Hayling Island 24, 35 Hearing 9, 12-16 Heart Disease 9 Hygiene, School 5 I Immunisation 20 Infectious Diseases 19 Institutional Treatment 25 Introduction 4 Invalid Children's Aid Association 24 M page Malnutrition 8 11,43 Meals, Provision of 23 Mentally Defective Children 25, 26, 44 Microscopical Examinations 20 Milk Supplied 24 Minor Ailments 8, 11,47 Myopic School 31-33 N Nursery Schools 35 Nutrition 8, 11,43 O Oak Lodge Special School 28 Occupation Centre 26 Open-Air Centre 33 Open-Air Classes 21, 34 Open-Air Education 21 Orthopaedics 9, 16, 48 Otorrhoea 16 P Parents, Co-operation of 24 Parents' Payments 37 Physically Defective School 29-30 Physical Training 22, 23 Population, School 3 Postural Defects 9, 16, 48 R Remedial Exercises 16 Residential Schools 25, 26 Rheumatism 9 S School Journeys and Camps 21-22 Secondary Schools 35,36, 37 Skin Diseases 8, 11, 47 Staff 2-3 Statistics 37-49 Surgical Instruments 24 Sun Trap Home 3, 24, 35 Swimming 23 T Teachers, Co-operation of 24 Tonsils and Adenoids 12, 48 Tuberculosis 10, 44 V Verminous Conditions 8, 11, 49 Vision 8, 12, 47 Voluntary Bodies 24 PART III.— Maternity and Child Welfare Department. a page Ante-Natal Clinics 11 Assisted Milk Supply 12 Attendances—Centres 9, 10 & 11 Accouchement Bags 14 B Bruce Castle 4, 9, 10 & 11 Births (and page 9 Health Department portion) 7 Breast Feeding 8 C Chestnuts (The) 4, 9, 10, 11 Creche 17 Centres, List 4, 9, 10, 11 „ Attendances 9. 10, 11 Convalescent Home Treatment (I.C.A.A.) 17 Committee—Members of 2 Children Act, 1908/1932 19 D District Nursing Association, Home Visits 21 (Health Dept. portion) F Foster Children—Registrations 19 G Gifts 21 H Hospital Treatment 18 Home Visits 8 & 9 Home Nursing 14 Health Visitors 3 Home Helps 14 I Introduction 5 Infant Mortality 10 (and pages 17. etc. of Health Dept. portion) Illegitimate Infants, institutional provision for 20 Infant Life Protection 19 K page Keep Fit Classes 11 L Lectures to Midwives 13 M Maternal Mortality 15 & 16 Maternity and Midwifery Services 12 Medical Examinations 10 Midwives' Fees 13 Midwives 11 Medical Aid 12 & 13 Mothercraft Classes 20 Mothers' Hospital 7 N North Middlesex Hospital 7 Notification of Births Acts —Visits 7 Nursing Homes 16 O Ophthalmia Neonatorum— Visits 14 Orthopaedic Treatment 18 P Puerperal Fever and Puerperal Pyrexia 15 (and page 15 of Health Department portion) Pupil Midwives 21 S Staff 3 Still Births 7 T Town Hall Centre 4 & 9 V Visitors to Centres 20 W Welfare Centres (list of) 4