AC 439(1) to ttenham TOT11 Borough of Tottenham. Annual Report of the MEDICAL OFFICER OF HEALTH 1937. Borough of Tottenham. Annual Report of the MEDICAL OFFICER OF HEALTH 1937. Crusha & Son, Ltd. Tottenham, Enfield, Wood Green and Palmers Green. 2 HEALTH AND HOUSING COMMITTEE (as at 31st December, 1937). Chairman: Alderman R. H. Warren. Members: (Ex.Officio) His Worship the Mayor (Alderman F. W. Cox, J.P.). (Ex.Officio) The Deputy Mayor (Councillor A. Reed, A.C.T.I., J.P.). Alderman C. D. Grant. ,, Mrs. A. Kitchener. ,, Major Sir P. B. Malone, J.P. ,, J. H. Morrell, J.P. Councillor G. A. Armfield. ,, Mrs. A. M. Ellis. ,, R. W. H. Ford. ,, F. A. F. Keay. ,, Mrs. J. D. Lynch, M.C.C. ,, Mrs. A. E. Lyons. ,, Mrs, G. E. Morrison. ,, S. Timms. ,, A. R. Turner. Council's Representative on the Metropolitan Water Board under the. Metropolis Water Act, 1902: Alderman R. C. Morrison, M.P., J.P. 3 STAFF. Health Department. Medical Officer of Health: G. Hamilton Hogben, M.R.C.S.Eng., L.R.C.P.Lond., D.P.H. Chief Sanitary Inspector— J. B. Smith (1), (2), (4). Sanitary Inspectors— W. P. West (1), (4). J. Goodfellow (3), (4), (5), (6). J. A. Shillito (1), (4). L. J. Kerridge (3), (4). P. W. T. Bennett (1), (4). E. T. Jenkins (3), (4), (5). E. S. Glegg (3), (4). R. H. T. Chappell B.Sc., (3). W. L. Morris (3), (4), (6). Shops Acts Inspector.—Lock, F. T. G. Assistant Shops Acts Inspector.—Sf.ndall, A. A. Nurses for Infections Disease. S. Swaffield, S.R.N., C.M.B., Fever Training Certificate. W. Mathias (Part time), C.M.B., Fever Training Certificate. Medical Officer—Gynecological Clinic. (Part time). Gladys H. Dodds, M.D., F.R.C.S.Ed. Clerical Staff. Chief Clerk—R. Garvey (1). H. R. Gilbbrt. L. R. Perry. W. Potteh. A. W. Lawrence (3). H. Thomas (3). W. P. Kent. (1) Certificate of the Royal Sanitary Institute. (2) Certificate—Sanitary inspector's Examination Board. (3) Certificate—R.S.I, and S.I. Examination Joint Board. (4) Meat Inspector's Certificate. (5) Smoke Inspector's Certificate. (6) R.S.I. Certificate in Sanitary Science. 4 Health Department, Town Hall, Tottenham, N.15. June, 1938. To the Mayor, Aldermen and Councillors of the Borough of Tottenham. Mr. Mayor, Ladies and Gentlemen, I have the honour to present the Report upon the Health of the Borough and the work of the Council's Medical Services for the year ended the 31st December, 1937. During the year, the Authority suffered the loss, by retirement, of my predecessor, Dr. David C. Kirkhope, who for twenty.four years laboured unceasingly in the interests of the health of the public in Tottenham. It came as a great shock to all those who were engaged with him in the Public Health Service, that, within only three months of his retirement from the position of Medical Officer of Health, his death should occur. The Report I now place before you is mainly statistical, and the information is supplied in strict accordance with the requirements of the Ministry of Health and the Board of Education. Vital Statistics. The last census of 1931 showed the population of the Borough of Tottenham to be 157,772 persons. The Registrar.General's estimate of the population for 1937 was 146,200. The number of births registered during 1937 was 1,973, the Birth Rate per thousand of the population being 13.5. The deaths of Tottenham residents certified during the year numbered 1,617, giving a general Death Rate of 11.1 per thousand of the population, compared with 1,600 deaths and a rate of 10.8 in the previous year. 5 Housing. In the matter of better housing, considerable progress has been mad© during the year. Seven Clearance Areas, involving 147 houses and the displacement of 711 persons, were represented for demolition and subsequently confirmed by the Minister of Health. The number of families rehoused during the year at the Weir Hall Estate was 54. In connection with the overcrowding provisions of the Housing Act, 1936, a review was made during the year of the 1,322 families previously reported as overcrowded, together with 1,483 families previously found to be just outside the overcrowding standard. It was found that as many as 743 of the original 1,322 overcrowded families, or more than 50 percent. had ceased to be overcrowded. The number of new overcrowded families recorded was 86. Infectious Diseases. The number of cases of Scarlet Fever notified was 306, the lowest for 20 years: one death occurred from this disease. The number of Diphtheria cases was 236, compared with 227 in the previous year, and 10 deaths occurred, compared with 9 in 1936. No deaths from Measles occurred during the year. Maternity and Child Welfare. The number of deaths in infants under one year of age was 126, and the Infantile Death Rate 63.9, which compares unfavourably with that of 51.8 in 1936. During the year, 1,349 infants under one year attended the Welfare Centres, the total attendances being 16,208 for this age period, with a total of 29,126 of all children under 5. The year was notable for the inauguration of the Municipal Midwifery Service under the provisions of the Midwives Act, 1936. School Medical Service. The comprehensive facilities for the medical inspection and treatment of school children, and the special schools established for the 6 ment of the physically defective child, have worked to full capacity during the year. The much improved accommodation provided at the Municipal Medical Centre, Lordship Lane, officially opened by His Worship the Mayor on October 30th, 1937, has further enhanced the Service. Following a special report made by me in June, 1937, a Nutrition Clinic was established by the Education Committee during the latter part of the year. This clinic is closely associated with the scheme for the provision of meals and milk in school, and is evidence that more than lip.service is given to the problem of malnutrition in this area. In conclusion, I wish to acknowledge the support and encouragement accorded to me by the members of the Council, and the interest shown by the Chairmen and Members of the Committees concerned with the work of the Health Services. To the loyal and efficient staff of the Health Services I am particularly indebted during my first year of office. I have the honour to be Your obedient Servant, G. Hamilton Hogbein, Medical Officer of Health. 7 LIST OF CONTENTS. PAGE Section I. Statistical Summary, etc. 9 ,, II. General Provision of Health Services 17 ,, III. Sanitary Circumstances 22 ,, IV. Housing 30 ,, V. Inspection and Supervision of Food 38 ,, VI. Infectious Diseases 43 SECTION I. STATISTICAL SUMMARY, Etc. 9 STATISTICAL SUMMARY, ETC. Area of the District in acres 3,014 Population (Registrar.General's estimate, Midsummer, 1937) 146,200 Number of inhabited houses (end of 1937) according to Rate Books 30,801 Rateable value £968,332 Sum represented by a penny rate £3,874 Social Conditions, including the Chief Industries carried on in the area. The Annual Report for 1935 contains particulars of the social conditions of the district; these have not altered. 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, December, 1937, was 4,430. In addition, 196 persons were registered as temporarily stopped. There were also registered as unemployed 88 men who normally are engaged in casual employment, making a grand total registered of 4,714. Births and Deaths. Registered live births:. Total. Males. Females. Legitimate 1,910 983 927 Illegitimate 63 38 25 1,973 1,021 952 Birth Rate per 1,000 estimated population 13.5 Stillbirths {Males 31 {Females 33 Total 64 Stillbirth Rate per 1,000 total (live and still) births 31.4 10 Deaths{Males 830 {Females 787 Total 1,617 Death Rate per 1,000 estimated population 11.1 Maternal deaths:— Deaths. Rate per 1,000 total (live and still) births. Puerperal sepsis 3 1.47 Other puerperal causes 6 2.95 Total 9 4.42 Death Rate of Infants under one year of age:— All infants per 1,000 live births 63.9 Legitimate infants per 1,000 legitimate live births 62.3 Illegitimate infants, per 1000 illegitimate live births 111.1 Deaths from Cancer (all ages) 237 ,, Measles (all ages) Nil ,, Whooping Cough (all ages) 4 ,, Diarrhoea (under 2 years of age) 25 11 STATISTICS OF TOTTENHAM FOR THE LAST 20 YEARS. Year. Population. Deaths. Death Rate. Births. Birth Rate. Infantile Deaths. Infant Death Rate. Number of Cases. Puerperal Fever and Puerperal Pyrexia. Scarlet Fever. Diphtheria. Typhoid Fever. Smallpox. 1918 152,304 2,060 13.5 2,432 15.9 206 84.7 . 222 264 3 . 1919 152,508 1,564 10.2 2,711 17.7 180 66.4 . 483 334 7 . 1920 156,020 1,465 9.3 4,064 26.0 248 61.0 8 596 492 1 . 1921 149,200 1,553 10.4 3,402 22.8 231 67.9 5 1,062 561 4 . 1922 152,000 1,703 11.2 3,167 20.8 203 64.0 6 919 400 6 . 1923 154,300 1,408 9.1 3,093 20.0 180 58.1 3 385 194 2 — 1924 156,000 1,559 9.9 2,853 18.2 176 61.6 5 367 227 6 . 1925 156,700 1,596 10.1 2,756 17.6 150 54.4 6 427 252 2 . 1926 159,500 1,545 9.6 2,601 16.3 147 56.5 4 481 495 7 . 1927 162,000 1,664 10.2 2,388 14.7 154 64.4 2 466 398 3 . 1928 165,000 1,540 9.3 2,478 15.0 133 53.7 19 594 328 1 . 1929 168,000 1,839 10.9 2,561 15.2 162 63.2 19 536 562 5 6 1930 170,000 1,569 9.2 2,510 14.8 137 54.6 22 574 541 6 131 1931 159,300 1,621 10.2 2,345 14.7 124 52.9 19 571 220 6 7 1932 156,800 1,591 10.1 2,214 14.2 114 51.4 37 452 149 4 5 1933 154,700 1,618 10.5 2,138 13.8 118 55.2 35 551 194 5 4 1934 152,694 1,572 10.3 2,091 13.7 108 51.6 34 628 300 1 . 1935 150,310 1,456 9.7 1,969 13.1 108 54.8 41 577 286 3 . 1936 148,600 1,600 10.8 1,931 13.0 100 51.8 37 430 227 5 . 1937 146,200 1,617 11.1 1,973 13.5 126 63.9 36 306 236 7 — 12 Table showing the Population, Birth and Death Rates, in Wards, during 1937. Ward. Population. No. of Births. Birth.rate. No. of Deaths. Death.rate. No. of Deaths Under 1 Year. Infant Mortality per 1,000 Births. Bruce Grove & Central 13,454 184 13.7 135 10.0 6 32.6 Chestnuts 11,023 125 11.3 124 11.2 10 80.0 Coleraine 10,561 143 13.5 101 9.6 12 83.9 Green Lanes 13,964 178 12.7 184 13.2 18 1011 High Cross 11,515 175 15.2 137 11.9 8 45.7 Park 13,857 202 14.6 163 11.8 19 94.1 Seven Sisters 13,954 201 14.4 147 10.5 11 54.7 Stamford Hill 10,459 168 16.1 136 13.0 4 23.8 Town Hall 15,219 211 13.9 192 12.6 15 71.1 West Green 17,959 189 10.5 161 9.0 7 37.0 White Hart Lane 14,235 197 13.8 137 9.6 16 81.2 Totals 146,200 1,973 13.5 1,617 11.1 126 63.9 13 Birlh-Rates, Death-Rates, Analysis of Mortality, Maternal Death-Rates, and Case-Rates for certain Infectious Diseases in the Year 1937. England and Wales. 125 County Boroughs and Great Towns, including London. 148 Smaller Towns (Resident populations 25,000 to 50,000 at 1931 Census. London. Tottenham. Rates per 1,000 Population. Births:— Live 14.9 14.9 15.3 13.3 13.5 Still 0.60 0.67 0.64 0.54 0.44 Deaths All causes 12.4 12.5 11.9 12.3 11.1 Typhoid and Paratyphoid Fevers 0.00 0.01 0.00 0.00 0.01 Smallpox — — — — — Measles 0.02 0.03 0.02 0.01 - Scarlet Fever 0.01 0.01 0.01 0.01 0.01 Whooping Cough 0.04 0.04 0.03 0.06 0.03 Diphtheria 0.07 0.08 0.05 0.05 0.07 Influenza 0.45 0.39 0.42 0.38 0.22 Violence 0.54 0.45 0.42 0.51 0.46 Notifications:— Smallpox 0.00 — 0.00 — — Scarlet Fever 2.33 2.56 2.42 2.09 2.09 Diphtheria 1.49 1.81 1.38 1.93 1.61 Enteric Fever 0.05 0.06 0.04 0.05 0.05 Erysipelas 0.37 0.43 0.34 0.44 0.45 Pneumonia 1.36 1.58 1.20 1.18 0.95 Rates per 1,000 Live Births. Deaths under 1 year of age 58 62 55 60 63 Deaths from Diarrhoea and Enteritis under 2 years of age 5.8 7.9 3.2 12.0 12.7 Maternal Mortality:— Puerperal Sepsis 0.97 Not available. 1.52 Others 2.26 3.04 Total 3.23 4.56 Rates per 1,000 Total Births (i. e., Live and Still). Maternal Mortality:— Puerperal Sepsis 0.94 Not available. 1.47 Others 2.17 2.95 Total 3.11 4.42 Notifications:— Puerperal Fever 13.93 17.59 11.52 4.15 17.67 Puerperal Pyrexia 14.34 14 TABLE OF DEATHS during the Year 1937 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. All Ages. Under 1 year. 1 and under 2. 2 and under 5. 5 and under 15. 15 and under 25. 25 and under 35. 35 and under 45. 45 and under 55. 55 and under 65. 65 and under 75. 75 and under 85. 85 and upwards. Bruce Grove & Central. Chestnuts. Coleraine. Green Lanes. High Cross. Park. Seven Sisters. Stamford Hill. Town Hall. West Green. W bite Hart Lane. Typhoid and Paratyphoid Fevers 1 - - - - - - - - - - - - - - - - - - - - - - - Measles - - - - - - - -- - - - - -- - - - - - - - - - - - Scarlet Fever 1 - - - - - - - - - - - - - - - - - - - - - - - Whooping Cough 4 1 2 1 — — — - — — - - - - - - - - 1 1 - 1 - 1 Diphtheria 10 1 — 2 6 — — — — 1 — — - - 1 1 - - l 1 2 1 1 2 Influenza 32 - - - - 2 3 7 4 10 3 3 4 6 1 - 2 2 3 2 3 2 3 Encephalitis Lethargica 1 — — — — — 1 - — - — - - - - 1 - - - -- - - Cerebro-Spinal Fever 2 2 — — — — — — — — — — — — 1 — i - - - - - - — Tuberculosis of Respiratory System 97 — — 1 1 20 19 14 21 16 3 2 — 8 3 7 16 7 11 7 7 11 9 11 Other Tuberculous Diseases 8 — — 1 2 2 — — 2 1 — — — — — — - 1 1 1 — — 3 2 Syphilis — — — — — — — — — — — — — - - - - - - - - - - - General Paralysis of the Insane, Tabes Dorsal is 3 - - - - - 1 - 1 1 — — — — — — — — 1 — 1 — — 1 Cancer, Malignant Disease 237 — — 1 — 1 4 13 30 72 68 41 7 23 16 12 27 q 22 23 19 23 32 25 15 Diabetes 23 — — — 1 2 1 1 1 1 9 7 — 1 2 1 3 1 2 2 3 3 3 2 Cerebral Haemorrhage, etc. 103 4 — 3 1 1 1 4 22 27 33 5 8 11 2 19 13 7 12 5 12 8 6 Heart Disease 429 - - 1 4 8 6 22 32 63 107 144 42 37 32 26 49 32 34 43 46 51 43 36 Aneurysm - — — - - - - - - - - — - — — — - — — — — — — Other Circulatory Diseases 96 - - - - - - - 2 17 34 29 14 15 7 8 12 7 11 6 7 12 9 2 Bronchitis 73 3 — — — - - 6 9 17 19 17 2 9 5 6 7 8 6 6 4 10 8 4 Pneumonia (all forms) 114 34 4 2 2 2 4 6 13 16 17 7 7 7 9 9 7 10 17 11 9 11 10 14 Other Respiratory Diseases 14 1 — — — — 1 1 2 5 2 1 1 1 1 2 1 2 1 1 - 4 1 — Peptic Ulcer 11 - - - - - 2 3 3 3 — — — — 1 — - 2 1 2 1 2 1 1 Diarrhoea, etc. 28 20 5 — — — 1 — 1 — 1 — — 2 — 1 2 3 2 6 1 5 3 3 Appendicitis 3 — — — 1 1 — 1 — - - - - - - - 1 - 1 - - 2 1 - Cirrhosis of Liver 3 — — — — — — — 1 — 2 — - - - 1 1 - - l - - 1 - Other Diseases of Liver, etc. 3 — — — — — — — — — 3 — — 3 3 2 5 3 5 4 6 7 5 6 Other Digestive Diseases 49 2 1 1 1 2 6 6 10 11 4 5 — 4 6 3 2 7 4 5 3 5 7 3 Acute and Chronic Nephritis 49 1 — — 2 5 3 3 3 11 11 9 1 4 6 3 2 7 ~ ~~ 1 0 1 Puerperal Sepsis 3 — — — — 1 2 — — — —— — —— — — — — — —— —— — 1 Other Puerperal Causes 6 — — — — 1 4 1 — — — — — — — — 1 — 1 — 1 1 — 2 Congenital Debility, Premature Birth, Malformations 43 43 — — —— — — — — — — — — 2 4 3 7 3 8 2 2 3 3 6 Senility 16 — — — — — — — — — — 11 5 1 3 — 1 1 3 1 l 1 3 1 Suicide 16 — — — 1 2 2 4 3 2 2 — — 3 2 5 2 6 3 1 — 1 5 7 Other Violence 51 2 — 1 3 5 4 5 3 4 9 13 2 3 2 7 5 6 7 2 5 5 5 — Other Defined Diseases 81 11 1 1 5 5 5 6 9 9 12 17 — 6 5 7 11 5 10 8 7 8 6 8 Causes Ill-defined or Unknown 7 1 — — — — — — 1 1 2 2 — — 3 — — 2 — — — —— 2 — Totals 1617 126 13 15 32 58 70 96 158 277 342 341 89 135 124 101 184 137 163 147 136 192 161 137 15 Table of cases of Infectious Disease coming to the knowledge of the Medical Officer of Health during the year 1937 in the Borough of Tottenham, classified according to Diseases, Ages and Localities. notifiable disease At all Ages number of Casus Notified. Total Cases Notified in Each Locality Total Cases Removed to Isolation Hospital Bruce Grove & Central. Chestnuts Coleraine. Green Lanes High Cross. Park. Seven Sisters. Stamford Hill Town Hall West Green White Hart Lane Under 1 1 to 2 2 to 3 3 to 4 4 to 5 5 to 10 10 to 15 15 to 20 20 to 35 35 to 45 45 to 65 65 and over Scarlet Fever 306 2 10 18 33 16 133 46 18 24 4 2 — 37 11 15 23 20 24 28 46 34 30 38 123 Diphtheria 236 2 3 11 21 19 113 32 12 19 2 2 — 14 23 16 7 19 26 20 19 41 15 36 230 Pneumonia 139 9 5 9 2 6 19 3 10 16 13 35 12 14 21 5 26 6 5 16 11 5 12 18 — Erysipelas 66 — 2 — — — 4 2 2 6 6 32 12 3 7 4 6 4 4 9 5 6 7 11 33 Puerperal Fever 4 — — — — — — — — 3 1 — — 1 — 1 — — 1 1 — — — — 2 Puerperal Pyrexia 32 - - - - - - - 2 26 4 — — 2 2 2 3 2 3 5 2 4 2 5 5 Typhoid Fever 7 — — — — — 2 — — 3 — 2 — — 1 1 2 — — — — 1 1 1 3 Dysentery 26 — 1 — 1 1 9 1 2 5 2 3 1 1 1 3 1 2 3 3 1 1 1 9 1 Ophthalmia Neonatorum 10 10 — — — — — — — — — — — — — 1 1 — — 3 1 — 1 3 5 Cerebro-Spinal Meningitis 4 1 1 — 1 — 1 — — — — — — 1 1 — 1 — 1 — — — — — 1 Poliomyelitis 6 1 — — — — 4 1 — — — — — — — — 2 — — 2 — 1 — 1 2 Continued Fever - - - - - - - - - - - - - - - - - - - - - - - - — Malaria - - - - - - - - - - - - - - - -- - - - - - - - - — Pulmonary Tuberculosis 178 — — — 1 1 7 9 20 63 35 39 3 12 20 10 26 7 23 13 9 10 23 25 — Otherforms of Tuberculosis 34 — 1 2 2 — 12 3 4 8 — 1 1 1 4 5 2 — 2 8 3 2 4 3 — Totals 1048 25 23 40 61 43 304 97 70 173 67 116 29 86 91 63 100 60 92 108 97 105 96 150 405 SECTION II. GENERAL PROVISION OF HEALTH SERVICES. 17 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 Laboratory undertakes for the Council Wassermann tests, Virulence tests, examinations 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, 201; Negative, 2,563. Specimens of Sputa examined for Tuberculosis:—Positive, 19; Negative, 183. Virulence tests, Diphtheria:—Positive, 4; Negative, 0. Blood examined for Typhoid group:—Positive, 0; Negative, 3. Hairs examined for Ringworm:—Positive, 2; Negative, 2. Stools examined for Dysentery:—Positive, 12; Negative, 7. Stools examined for Typhoid:—1 (Negative). Rectal swabs examined for Dysentery:—Positive, 15; Negative, 21. Urine examined for Tuberculosis:—1 (Negative). Ambulance Facilities. The Council possess five motor ambulances 'one utilized as a "standby") which are used for accident and non-infectious cases, and two buses for conveying children to special schools. The service is ample for the needs of the area, and is under the supervision of the Chief Officer of the Fire Brigade, who has furnished me with the following table:— 18 Tottenham Motor Ambulance Service, 1937. Month. No. of Cases. Total Mileage. Receipts. Surgical. School Children. (Attendances. ) T.E.C. Paying Cases. £ s. d. £ s. d. January 708 1,802 4,157 7 7 6 February 674 2,604 5,393 6 15 0 March 681 2,440 5,274 697 15 6 5 12 6 April 701 2,578 5,512 3 5 0 May 733 1,647 4,486 7 1 3 June 700 3,054 6,001 724 18 7 8 7 6 July 875 2,740 5,724 6 10 0 August 779 133 2,216 3 12 6 September 832 3,080 5,970 584 9 9 4 7 6 October 785 2,996 5,584 3 15 0 November 801 2,668 5,353 2 12 6 December 875 2,186 4,900 745 7 1 3 12 6 9,144 27,928 60,570 £2,752 10 11 £62 18 9 £2,815 9 8 Total mileage to date 1,026,774 Number of street accidents and illnesses for the year 474 The oxygen resuscitator was used on 7 occasions. Nursing in the Home. The Council employ a whole-time nurse and the part-time services of a second to treat at home Scarlet Fever cases that it is considered expedient not to send to hospital. A subsidy is paid to the Tottenham District Nursing Association for the services of their nurses in tending the sick in their own homes whilst suffering from certain types of illness. Clinics and Treatment Centres. The Clinics and Treatment Centres are staffed by the School Medical Department and the Maternity and Child Welfare Department. During the year a Municipal Medical Centre was built to replace that formerly at Bruce Castle. The Gynaecological Clinic established by the Council in ] 936 is held at the new Centre. 19 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 London County Council Infectious Diseases Hospitals, is situated in Tottenham. The Home and Hospital for Jewish Incurables is also located in this area. 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. 922 £13,176 0s. 3d. 2,849 £67,885 19s. l0d. Institutional Relief—North Middlesex Hospital. No. of cases admitted from Tottenham during 1937 4,530 No. of days In-Maintenance of these patients during 1937 108,720 Health Propaganda. In connection with the "National Campaign to encourage the wider use of the Health Services "a Health Exhibition was held in the Municipal Hall from November 29th to December 3rd. The Exhibition was composed of 32 stalls, and drew attention especially to the Health Services provided by the Local Authority. Subjects such as The Control of Infectious Diseases, Sanitation, Housing, Maternity and Child Welfare and School Medical Work were dealt with, and great interest was 20 shown by the general public. Officers of the various departments were in attendance for the purpose of demonstrating exhibits and answering enquiries. Films dealing with Disinfestation, House Refuse Collection, etc., were shown, and proved a popular feature. During the last three months of the year the Health Services were advertised by the display of posters find the distribution of folders, bookmarks, etc., supplied to the Council, this period being the first half of the National Campaign. Medical Examinations. In 1937, 58 examinations were made of persons entering the permanent service of the Council, the Education Committee and the Maternity and Child Welfare Committee. SECTION III. SANITARY CIRCUMSTANCES. 22 SANITARY CIRCUMSTANCES OF THE AREA. At the end of the year there were on the Staff of the Sanitary Section of the Department, 1 Chief Sanitary Inspector and 9 male Inspectors. Water Supply. The water supply of the Borough is under the control of the Metropolitan Water Board. No complaints were received as to the quality of the water supplied during the year. Drainage and Sewerage. The District is drained on the dual system of soil and surface water. The soil sewage is pumped into the London County Council system from the sewage works at the South-East end of the district. The surface water flows into various streams and then to the River Lee. During the summer months there were two exceptionally heavy downfalls of rain and some flooding occurred in certain parts of the district. Public Cleansing. House refuse is collected weekly by direct labour and disposed of at the Refuse Disposal Works by burning, after certain materials are salvaged. This work is under the control of the Cleansing Committee of the Council and the Cleansing Superintendent. Sanitary Inspections. The nature and extent of the work done by the Sanitary Inspectors is shown in the following statement:— No. of houses inspected 5,632 Drains examined and tested 820 ,, reconstructed 133 ,, repaired 193 ,, found stopped 351 23 Defective soil pipes 260 ,, fresh air inlets 143 ,, rain water pipes, wastes, etc. 756 ,, dustbins 560 ,, roofs 1,117 ,, gutters 640 ,, drinking water cisterns 144 No. of houses where water was provided from the main 129 Defective W.C. cistern and pans 608 ,, yard paving 710 ,, sinks 412 ,, floors (wood and concrete) 752 ,, window frames and sashes 1,390 ,, coppers 255 ,, fireplaces 910 ,, and damp walls 966 No. of dirty walls and ceilings 3,182 No. of houses where damp-proof courses were inserted 97 Miscellaneous defects 1,581 Small Dwellings Acquisition Acts. Under the above Acts, the Local Authority cannot advance any money unless they are satisfied that the premises are in good repair. During the year the Sanitary Inspectors have reported on the condition of 37 properties of which the owners have made application for mortgages. Other Inspections, etc. In addition to the inspections mentioned in the preceding paragraphs, the following inspections have been made:— Inspections of Common Lodging Houses 86 ,, Stables 319 ,, School Lavatories 17 ,, PawnShops 4 ,, Public-house Urinals 295 ,, Brooks 14 ,, Knackers' Yards 25 Interviews with builders and owners 1,762 Miscellaneous Inspections 2,339 24 At the commencement of the year there were two common lodging houses in the district. One was regarded as unsatisfactory as regards repair and cleanliness, and the Licence was withdrawn. Repair of Houses by the Council in Default. In 20 instances repairs were executed at properties owing to owners making default, the amount involved being £433 18s. 8d. Shops Acts. The Shops Acts are administered by two whole-time officers. Hereunder are indicated the provisions of the viarious Orders., the observance of which is required. Shops Acts, 1912 to 1936. Half-Holidays. Harringay Area. Tottenham Remainder Area. * Butchers Monday, 1p.m. Monday, lp.m. (or alternatively Saturday, 1 p.m.) (or alternatively Saturday, 1 p.m.) Bakers .. Wednesday, 2 p.m. Thursday, 2 p.m. (or alternatively Saturday, 2 p.m.) (or alternatively Saturday, 2 p.m.) f Other Shops . . Wednesday, lp.m. Thursday, lp.m. (non-exempted (or alternatively (or alternatively Saturday, lp.m.) trades) Saturday, 1 p.m.) Half-Holiday for Shop Assistants. Every shop assistant in every class of shop must be allowed a halfholiday once a week commencing not later than 1.30 p.m. The rule applies whether a shop is required to be closed for a weekly half-holiday or not. 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. 25 Evening Closing Hours. * Butchers Monday, Tuesday, Wednesday and Thursday 7 p.m. Friday and Saturday 8 p. m. (Subject to Weekly Half-holiday Order.) Confectioners Sunday, Monday, Tuesday, Wednesday, Thursday and Friday 9.30 p.m. Saturday 10 p.m. †Other Shops Monday, Tuesday, Wednesday, Thursday and Friday 8 p. 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.). A Jewish Hairdresser and Barber may open his premises on Sunday until 2 p.m., provided he 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 1937, 65 first or warning notices and 15 final notices were 26 issued in respect of contraventions of the Acts. Legal proceedings were taken in 5 instances and fines inflicted. The shops in the district have been kept under observation with regard to the ventilation, temperature and sanitary conveniences. During the year, special exemption was granted in two cases where sanitary conveniences and washing facilities were not on the premises but were within a reasonable distance of the shop. Smoke Abatement. 159 observations of chimneys have been made during the year and 20 preliminary notices have been served requiring the owners to cease the discharge of excessive smoke or grit. No legal proceedings have been taken. Most of the black smoke discharged in this district is from factories where wood is the principal combustible material used for raising steam. Pressure has been brought to bear on two factories with regard to the discharge of grit, and an improvement has been obtained by an extension of the boiler capacity. Swimming Baths. The Council possess two indoor swimming baths and one outdoor swimming pool. The swimming pool was opened on the 5th June and was closed on the 2nd October. During that period 130,616 persons took advantage of the facilities offered. Samples of water taken during the year proved that the filtration plant was working satisfactorily and that the water was of a high standard. Eradication of the Bed Bug. The number of houses disinfested on the Council's Housing Estate, which comprises 815 houses, was 96. The number of houses and the effects of the occupiers disinfested prior to removal to the Council's Housing Estate was 80; 25 ordinary lettings and 55 from Clearance Areas. The number of houses in the district which were disinfested at the request of the owner or as a result of Sanitary Inspection was 290. 192 lots of verminous bedding were dealt with at the steam disinfector and 445 articles were destroyed at the request of the householders. The method employed in disinfesting houses and their contents is as follows:— 27 First Bay:— Bedding, rugs, mats, cushions, curtains, wearing apparel and all loose material is removed from the house and taken to the disinfecting station for steam disinfection. Bedsteads are dismantled, drawers removed from furniture, and all loose paper removed from back of pictures. All removable woodwork—skirtings, architraves, etc.—is taken down and flamed with the blow lamp. The blow lamp is also applied to holes and cracks in the plaster. The rooms are then disinfected by burning sulphur (1 lb. for every 200 cubic feet), and is left thoroughly sealed until the next day. (All brass is smeared with vaseline before disinfection). Second Day:— The floor and furniture are thoroughly brushed and dusted, the contents of the room, the ceiling and walls are sprayed with disinfesting solution, care being taken to get the fluid into every crack. The work is carried out by direct labour and the premises are visited at the expiration of ten days after disinfestation. If the premises appear to be free from bugs the owner is instructed to replace skirtings, etc., and distemper walls and whiten ceiling. The premises are revisited at the expiration of one month and again after three months. During the year 178 houses, which have been erected in connection with Clearance Areas, and to which slum tenants were moved after their effects were disinfested, were inspected and in 5 cases only slight re-infestation was found and dealt with. Infectious Disease. 1,490 visits were made by the Sanitary Inspectors to houses where infectious cases had been notified. 797 rooms and 51 Hospital Wards and School rooms have been treated with Formalin Sprav. 9,644 articles were disinfected at the steam disinfector and 390 library books were disinfected with Formalin Vapour. The Disinfecting Station is provided with two baths which were used 118 times for the treatment of Scabies cases. 28 Factories, Workshops and Workplaces. 1.—Inspection of Premises. Number of Inspections. Written Notices. Prosecutions. Factories (including Factory Laundries) 322 27 — Workshops (including Workshop Laundries) 366 19 — Workplaces (other than Outworkers' premises) 346 9 — 1,034 55 2.—Defects Found. Number of Defects Found. Remedied. Referred to H.M. Inspector. Nuisances under Public Health Acts:— Want of Cleanliness 45 45 — Want of Ventilation 3 3 — Overcrowding — — — Want of Drainage of Floors 2 2 — Other Nuisances 3 3 — Sanitary Accommodation:— Insufficient 2 2 — Unsuitable or Defective 12 12 — Not separate for Sexes — — — Offences under the Factory and Workshop Acts 2 2 — 69 69 3.—Outwork in Unwholesome Premises. Nature of Work. Instances. Notices Served. Prosecutions. Wearing Apparel (Making) 27 10 - Curtains and Furniture Hangings 7 1 - 34 11 - SECTION IV. HOUSING. 30 HOUSING. House Inspection. During the year under review, 1,986 houses were visited under the house-to-house survey in the following roads:—Albany Road, Alexandra Road, Antill Road, Arnold Road, Ascot Road, Avondale Road, Beaoonsfield Road, Bedford Road, Bernard Road, Birkbeck Road, Birstall Road, Blackboy Lane, Burlington Road, Clarendon Road, Clinton Road, Cornwall Road, Cranleigh Road, Culross Road, Cunningham Road, Dongola Road, Edith Road, Elizabeth Road, Fairbourne Road, Falconer Road, Falmer Road, Forster Road, Foyle Road, Glenwood Road, Gloucester Road, Gorleston Road, Gourley Place, Gourley Street, Grand Parade, Gretton Road, Grove Road, Halef Gardens, Handsworth Road, Hanover Road, Harringay Road, Hartington Road, Henry Road, Hermitage Road, Heybourne Road, High Cross Road, Kings Parade, Lansdowne Road, Lincoln Road, Lothair Road, Moreton Road, Mount Pleasant Road, Newton Road, North Grove, Park Avenue Road, Park Road, Penrith Road, Philip Lane, Rangemoor Road, Roslyn Road, Rowley Road, St. John's Road, St. Loy's Road, Salisbury Mansions. Seaford Road, Selwyn Road, Sirdar Road, Southey Road, South Grove, Stanley Road, Station Crescent, Stonebridge Road, Suffolk Road, Sutton Road, Templeton Road, Terront Road, Tewkesbury Road, Townsend Road, Victoria Crescent, Weir Hall Road, Welbourne Road, Westerfield Road, West Green Road, Willoughby Lane, Winchelsea Road and Woodlands Park Road. HOUSING STATISTICS. Number of Houses erected during the Year. By private enterprise—48 houses, 11 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) 5,632 (b) Number of inspections made for the purpose 16,598 31 (2) (a) Number of dwelling-houses (included under head (1) above) which were inspected and recorded under the Housing Consolidated Regulations, 1925 1,986 (b) Number of inspections made for the purpose 10,074 (3) Number of dwelling-houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation *150 * 147 of these were dealt with under Part 1, Housing Act, 1936, and 3 were dealt with as individual houses or tenements. (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 2,934 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 2,464 Action under Statutory Powers during the Year. (A) Proceedings under Sections 9, 10 and 16 of the Housing Act, 1936: (1) Number of dwelling-houses in respect of which notices were served requiring repairs 432 (2) Number of dwelling-houses which were dered fit after service of formal notices:— (a.) By owners †344 (b) By local authority in default of owners 12 †Including premises in respect of which notices were served in 1936. 32 (B) Proceedings under Public Health Acts: (1) Number of dwelling-houses in respect of which notices were served requiring defects to be remedied *127 (2) Number of dwelling-houses in which defects were remedied after service of formal notices:— (a) By owners †l30 (b) By local authority in default of owners 3 (c) By local authority at request of owners 1 * Included in this figure are 14 houses in respect of which notices were also served under Section 9 of the Housing Act, 1936. In 3 instances notices under 2 different sections of the Public Health Acts were served on the same premises. †Including premises in respect of which notices were served in 1936. (C) Proceedings under the Tottenham Local Bo&rd Act : (1) Number of dwelling-houses in respect of which notices were served requiring defects to be remedied *4 (2) Number of dwelling-houses in which defects were remedied after service of formal notices :— (a) By owners 3 (b) By local authority in default of owners 1 * Included in this figure are 3 houses in respect of which notices were also served under Section 9 of the Housing Act, 1936. (D) Proceedings under Sections 11 and 13 of the Housing Act, 1936: Demolition Orders were considered with respect to 2 premises and Undertakings that the buildings would not be used for human habitation were accepted. 33 (E) Proceedings under Section 12 of the Housing Act, 1936: (1) Number of separate tenements or underground rooms in respect of which Closing Orders were made 1 (2) Number of separate tenements or underground rooms in respect of which Closing Orders were determined, the tenement or room having been rendered fit — (F) Housing Act, 1925: Three dwelling-houses, in respect of which Demolition Orders were served under the Housing Act, 1925, were demolished. Housing Act, 1936.—Part IV—Overcrowding. (a) (i) Number of dwellings overcrowded at the end of the year 665 (ii) Number of families dwelling therein 665 (iii) Number of persons dwelling therein 4,472 (b) Number of new cases of overcrowding reported during the year 86 (c) (i) Number of oases of overcrowding relieved during the year 655 (ii) Number of persons concerned in such cases 4,062 Overcrowding Survey. In the Survey carried out in 1935, 1,322 families or 3.2 percent. of the 40,644 families surveyed were found to be overcrowded and 1,483 were just above the overcrowding standard. In the closing months of 1937 a review was made of the 1,322 overcrowded families and the 1,483 that were just outside the overcrowding standard, when it was found that 743 of the 1,322 oases had 34 ceased to be overcrowded as a result of removal or other causes, and 86 new oases were recorded. The present distribution of overcrowding in the various wards compared with the figures for 1935 is as follows: — Ward. Percentage 1935. Overcrowded. 1937. Bruce Grove and Central 1.4 .62 Chestnuts 3.2 1.66 Coleraine 2.8 1.09 Green Lanes 1.77 .75 High Cross and Stoneleigh 3.16 1.58 Park 3.9 2.20 Seven Sisters 6.07 3.42 Stamford Hill 1.77 .87 Town Hall 3.7 1.90 West Green 1.33 .56 White Hart Lane 6.58 3.24 In connection with the overcrowding provisions of the Housing Act, 1936, the year has been one of consolidating the work commenced in 1935. There were in March, 1937, 28,892 houses in the district, 6,860 being owned by the occupiers. In connection with the remaining 22,032 houses, 12,988 certificates as to the permitted number of occupiers have been furnished to the owners. Clearance Areas. Official representations were made during the year with respect to seven areas, comprising, in all, 147 premises, namely:— Alexandra Road.—Nos. 1, 3, 5, 7, & 9. South Grove.—Nos. 33, 35, & 37. 35 Brook Street.—Nos. 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, & 23. Brook Street.—Nos. 39, 40, & 41. Cornwall Road.—Nos. 112, 114, 116, 118, 120, 122, 124, 126, & 128. Cornwall Road.—Nos. 34, 34a, 36, 38, 40, 42, 44, 46, 48, 50, 52, 54, 56, 58, 60, 62, 66, 68, 70, 72, 74, 76, 78, 80, 82, & 84. Nos. 23, 25, 27, 29, 31, 33, 35, 37, 39, 41, 43, 45, 47, 49, 51, 53, 55, 57, 59, 61, 63, 65, 67, 69, 71, 73, 75, 77, 79, 81, 83, 85, 87, 89, 91, 93, 95, 97, 99, & 101. Falconer Road.—Nos. 6, 8, 10, 12, 22, 24, 26, 28. Nos. 1, 3, 5, 7, 9, 11, 13, 15, 19, 21, 23, 25, 27, 29, 31, 33, 35, 37, 39, 41, 43, 45, 47, 49, 51, & 53. White Hart Lane (Tottenham. Terrace).—Nos. 176, 178, 180, 182, 184, 186, 188, 190, 192, 194, 196, & 198. In one area (Tottenham Terrace) comprising 12 houses the Council decided to proceed by Compulsory Purchase Order as the land on which the houses stood adjoined that recently acquired by the Corporation for housing purposes and included in the Order a house adjoining the Clearance Area. The Minister of Health confirmed this Order, excluding one house from the Clearance Area. The house excluded remained in the Compulsory Purchase Order to be purchased by the Corporation under Section 27 of the Act. The Inquiry with respect to the other areas was held in January, 1938. The maps on the following pages show the Cornwall Road Area and also the Tottenham Terrace Area—with the land adjoining—which the Council have acquired for housing purposes. 54 families from Clearance Areas and individual houses have been re-housed at the Weir Hall Estate. Premises Demolished. During the year a total of 131 houses were reported to have been demolished as follows:— Borough Of Tottenham Housing Act 1936 Cornwall Road Clearance Area No 1 BOROUGH OF TOTTENHAM ALLINCTON HOUSE ESTATE 36 Clearance Areas.—Nos. 2, 3, 4, 5, 6, 7, 8, 9, 10, 11 and 12, Hope Place, Nos. 3, 5, 7, 9, 11, 13, 15, 17, 19, 62, 64, 66, 68, 70, 72, 74, 76, 78, 80, 82, 84, 86, 88, 90, 92 and 94, Scotland Green, Nos. 1 and 2, Brewer's Cottages, Scotland Green, Nos. 1, 2, 3, 4, 5, 6, 7, 8, 9 and 10, Willow Terrace, Scotland Green, Nos. 1, 2 and 3, Tubby's Alley, Scotland Green, Nos. 1, 2, 3, 4, 5 and 6, Fountain Square, Nos. 1, 2 and 3, Fountain Place, Nos. 7, 8, 11, 11a. and 12, Queen Street, Nos. 902, 904, 906 and 908, High Road, Nos. 1, 2, 3, 4, 5, 6 and 13, Union Row (East Side), No. 1, Union Row (West Side), Nos. 1, 2, 3 and 4, Union Square, Nos. 1, 2, 3 and 4, Pond's Cottages, Waggon Lane, Nos. 1, 2, 3 and 4, Trulock Cottages, Waggon Lane, Nos. 1 and 2, Young's Cottages, Waggon Lane, Young's Cottage, Waggon Lane, Nos. 1, 3, 5, 7, 9, 11, 13, 15, 17, 2, 4 and 52, Love Lane, Nos. 1, 2, 3, 4, 5 and 6, Waterloo Place, Nos. 1, 2, 3, 4, 5 and 6, Vine Road, Nos. 4 and 6, Church Road, and Nos. 1, 2, 3, 4, 5, 6, 7, 8, 37 and 38, Brook Street. Demolition Orders.—Nos. 2, 3 and 4, Union Row (West side). SECTION V. INSPECTION AND SUPERVISION OF FOOD. 38 INSPECTION AND SUPERVISION OF FOOD. Milk Supply. There are no farms or cowsheds in the district. The number of persons registered as retail purveyors of milk during the year was 29 and there are now on the Register 185. During the year 318 visits were paid to these milk shops and 5 samples of milk were submitted to the Counties Public Health Laboratories for bacteriological examination; in each case the sample was of a satisfactory standard. Milk (Special Designations) Order, 1936. This Order, which came into operation on the 1st January, 1937, revoked the Milk (Special Designations) Orders of 1923 and 1934, and prescribed the following special designations for milk:— (a) Tuberculin Tested; (b) Accredited; and (c) Pasteurised. Milk designated under this Order may be shortly described as follows:— Tuberculin Tested Milk oomes from cows that have passed the Tuberculin Test for freedom from Tuberculosis. Tuberculin Tested Milk (Pasteurised) is Tuberculin Tested Milk which has also been pasteurised. Tuberculin Tested Milk (Certified) is Tuberculin Tested Milk which is bottled on the Farm. Accredited Milk comes from cows which have passed veterinary examinations but have not been submitted to the Tuberculin Tests for Tuberculosis. Pasteurised Milk is milk which has been heated to a temperature of 145-150 degrees F., and maintained at that temperature for 30 minutes. 39 These designations may only be used under a licence from the local authority. In 1937 the following licences were granted: — Tuberculin Tested Milk Licences: — Bottlers' Licences 2 Dealers' Licences 12 Supplementary Licences 5 Accredited Milk Licences: — Bottler's Licence 1 Pasteurised Milk Licences: — Pasteurisers' Licences 3 Dealers' Licences 15 Supplementary Licences 6 Ice Cream. Premises for the sale of ice cream in this district do not require to be registered, but the premises are visited for general cleanliness and 59 such visits were made during the year. Bread. 222 visits were made to the 52 bakehouses. The premises were found to be well maintained. Meat, Fish and Fruit. There are 3 Registered Slaughterhouses and 6 Licensed Slaughterhouses in the Borough; also 122 butchers' shops, 157 Fruiterers, and 80 fish shops. 1,091 visits were paid to the slaughterhouses. 418 ,, ,, ,, butchers' shops. 303 ,, ,, ,, fish shops. 242 ,, ,, ,, fruit shops. 40 The following table gives particulars of the carcases examined at the slaughterhouses: — Cattle, excluding Cows. Cows. Calves. Sheep and Lambs. Pigs. Number killed 560 104 1,223 12,809 19,834 Number inspected 560 104 1,218 8,533 19,834 All Diseases except Tuberculosis: Whole carcases condemned — — — — 13 Carcases of which some part or organ was condemned 16 10 — 190 384 Percentage of the number inspected affected with diseases other than Tuberculosis 2.9% 9.6% - 2.2% 2.0% Tuberculosis only: Whole carcases condemned — — — — 29 Carcases of which some part or organ was condemned 28 42 — — 725 Percentage of the number inspected affected with Tuberculosis 5.0% 20.0% — — 3.8% Summary of Diseased Meat Found. Bovine.—14 lbs. Beef, 21 Lungs, 26 Livers, 2 Mesenteries, 7 Heads, 3 Tongues, anjl 1 Skirt. Sheep.—166 Lungs, and 187 Livers. Swine.—42 Carcases, 213 Lungs, 246 Livers, 178 Mesenteries, 529 Heads, 3 Spleens, and 1 Collar. Miscellaneous Foodstuffs Condemned. 14 Fowls, 3 stone Skate, 4 tins Pork, 6 tins Baked Beans, 1 tin Soup, 84 boxes Soup Powder, and 6 tins Fruit. Legal Proceedings. There was one prosecution during the year for exposing for sale fowls which were unsound, and the defendant was fined 40s. 41 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:— List of Samples taken in Tottenham for the year:— Name of Article. Samples. Taken. Found Adulterated. Milk 218 4 Milk, New 4 4 Milk, Sterilised 10 — Butter 8 — Calf's Liver 4 2 Cream 1 — Gin 3 — Haddock 1 — Hake 2 — Lamb's Liver 2 1 Margarine 1 — Rum 1 — Sheep's Liver 10 5 Vinegar 2 — Whisky 22 2 Totals 289 18 Number of Prosecutions 12 Number of Convictions 12 Artificial Cream Act, 1929, and Public Health (Condensed and Dried MUlc) Regulations, 1923.—Inspections were made under the above in order to see that the requirements with respect to labelling were complied with, but no infringements were discovered. SECTION VI. INFECTIOUS DISEASES. 43 PREVALENCE OF, AND CONTROL OVER, INFECTIOUS AND OTHER DISEASES. Scarlet Fever. The number of notified cases was 306 and the lowest recorded in the Borough for twenty years. Of this number, 123 were admitted to Southgate Isolation Hospital, and 183 were nursed at home. One death occurred from this disease. Cases of Scarlet Fever treated in 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). 113 24.9 10 16.8 — — Cases wrongly diagnosed were reclassified as follows:—Noninfectious Rash, 2; Tonsillitis, 3; Tonsillitis and Septic Rash, 2; Measles, 1; Septicaemia, 1; and Heat Stroke, 1. Diphtheria. The number of notified cases was 236, compared with 227 in 1936. The number of cases admitted to hospital was 230. 10 deaths occurred from this disease. Immunisation against diphtheria has continued to gain popularity during the year, and two sessions a week, with an average attendance of 40 per session, have been regularly held throughout the year. Cases of Diphtheria treated in hospital:— 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 159 67.0 *16 11.1 7 81 Hornsey 19 55.6 1 21.0 — L.C.C. 13 77.7 2 48.0 1 13.0 London Fever 11 83.5 1 32.0 — — * One case proved fatal. Cause of death: Septic Scarlet Fever. 44 Others wrongly diagnosed were reclassified as follows:—Tonsillitis, 13; Pneumonia, 2; Septic Tonsils, 1; Bronchitis, 1; Scarlet Fever, 1; Otorrhoea, 1. Small-pox. No cases of this disease occurred in 1937. I am indebted to the Vaccination Officer for the following information :— Number of successful vaccinations 394 Number of conscientious objections to vaccination 679 Non-notifiable Infectious Diseases. A small epidemic of Measles of a generally mild type occurred during the early part of the year. No deaths were recorded. Admission to hospital of non-notifiable infectious disease cases associated with complications :— Measles 6 German Measles 1 Whooping Cough 8 Chicken Pox 4 Mumps 1 Diabetes and Anaemia. With the approval of the Ministry of Health, Insulin was supplied to 6 patients suffering from Diabetes. The number of units amounted to 124,780 and the cost was £24: 19s. 9d. 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 Anæmia was supplied with Ventraemon Powder at a cost of £3 lis. 0d. Tuberculosis. The County Council are responsible for the treatment of Tuberculosis. 212 notifications were received during 1937—Pulmonary, 178; other than Pulmonary, 34. 45 Cases remaining on the register at the end of the year were: Pulmonary, 557; Non-Pulmonary, 137. 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 oases referred to him. Age Periods. New Cases. Deaths. Pulmonary. NonPulmonary. Pulmonary. NonPulmonary. Males Females Males Females Males Females Males Females Under 1 year — — — —— — — — — 1 to 5 years 2 — 3 2 1 — — 1 5 to 15 9 7 6 9 1 — 1 1 15 to 25 25 25 4 6 9 11 1 1 25 to 35 17 16 — 2 7 12 — — 35 to 45 21 14 — — 9 5 — — 45 to 55 17 4 — — 17 4 1 1 55 to 65 14 4 — 1 14 2 1 — 65 years and upwards 1 2 1 — 5 — — — Totals 106 72 14 20 63 34 4 4 46 Organs affected (New Cases):— Males. Females. Lung 106 72 Glands 2 9 Spine 3 1 Men inges — 3 Peritoneum 4 3 Hip 3 2 Thigh 1 — Arm 1 — Kidney — 1 Skin — 1 120 92 The deaths represent a death rate of 0.72 per 1,000 population. In 20.95 percent. of the fatal oases 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 The Twenty-Eighth ANNUAL REPORT of the SCHOOL MEDICAL SERVICE For the Year 1937 2 Borough of Tottenham EDUCATION COMMITTEE (As at 31st December, 1937.) Chairman: Councillor A. J. Lynch, J. P. Vice -Chairman: Alderman Mrs. W. A. Kent. Members: Alderman E. J. Field. Councillor R. W. H. Ford. Alderman C. D. Grant. Councillor A. E. Harvey. Alderman A. E. Jay. Councillor D. Jordan. Alderman Mrs. A. Kitchener. Councillor Mrs. J. D. Lynch, M.C.C. Alderman Major Sir Patrick Malone, J. P. Councillor Mrs. A. E. Lyons. Alderman J. H. Morrell, J. P. Councillor M. J. O'Gara. Alderman R. H. Warren. Councillor H. W. Pearce. Councillor Miss R. F. Cox. Councillor A. Reed, A.G.I.I., J.P. Councillor Mrs. A. M. Ellis. Councillor H. W. Turner. Director of Education: Medical Officer: C. F. Strong, G. Hamilton Hogben, M.A., Ph.D. M.R.C.S., D.P.H. 3 Staff of the School Medical Service Medical Officer (also Medical Officer of Health): G. Hamilton Hogben, M.R.C.S., L.R.C.P., D.P.H. Senior Assistant Medical Officer: Alice Stalker, M.B., Ch.B., D.P.H. Assistant Medical Officer: R. H. Smythe, M.C., L.R.C.S., L.R.C.P. Dental Surgeons: V. Sainty, L.D.S. (Eng.). A. E. Fisher, B.D.S. Specialist Medical Officers (Part-time): Ophthalmic Surgeon: T. W. Letchworth, F.R.C.S. Aurist: A. R. Friel, M.A., M.D., F.R.C.S.I. (retired 31st December, 1937.) F. P. M. Clarke, B.A., B.Sc., L.R.C.P., L.R.C.S. (from January, 1938.) Orthopaedic Surgeon-. H. J. Seddon, F.R.C.S. School Nurses: Miss E. M. Johns, S.R.N., S.C.M. Mrs. L. H. J. Hawkey, S.R.N., S.C.M. Mrs. C. Vine, S.R.N. Miss L. Rogers, S.R.N., S.C.M. Mrs. E. Barratt, Fever Trained. Miss B. Whitaker, S.R.N., S.C.M., H.V.Dip. Miss R. Bentley-Corner, S.R.N., S.C.M. Mrs. K. Sandle, S.R.N. Masseuse (Part -time): Miss Y. Folkes, C.S.M.M.G. Clerical Staff: Chief Clerk: V. Goddard. T. E. Cowan, F.C.I.S. Miss O. W. Newson. H. J. Dunham. R. E. Tuson. 4 GENERAL INFORMATION. The population of the Borough of Tottenham as estimated by the Medical Officer of Health on the 31st December, 1937, was 146,200. The Elementary School population as recorded on the 31st December, 1937, was 18,542, which includes 546 children under 5 years of age. The following figures have been kindly supplied by the Borough Treasurer:— £ s. d. Gross expenditure of School Medical Service 10,510 9 3 Less Receipts 822 13 4 Net Cost of Service £9,687 15 11 In terms of rate in the £ after taking into consideration Government grant 1.25 pence NUMBER OF SCHOOLS AND CHILDREN ON THE ROLL. Elementary Schools:— Provided Departments 53 .. On Roll 15,023 Non-Provided Departments 12 ,, 2,087 Central Departments 3 ,, 1,148 Nursery School 1 ,, 70 Special Day Schools 3 ,, 144 72 18,472 Special Day Schools in other districts 2 ,, 70 74 „ 18,542 Boys. Girls. Infants. Mixed. Central. Special. Totals. Number on roll at 20.12.37 4,705 4,700 4,997 2,778 1,148 144 18,472 Average Attendance for year 1937 4,408 4,356 4,533 2,302 1,020 125 16,744 Secondary and Technical Schools On Roll 2,212 Private Schools ,, 246 5 MUNICIPAL MEDICAL CENTRE. This Centre was formally opened by the Mayor of Tottenham on October 30th, 1937. The Centre has been jointly built by the Education Committee and Maternity and Child Welfare Committee of the Borough to replace and enlarge the accommodation hitherto available at Bruce Castle. The building is a permanent brick structure of the single-storey type, situated in Lordship Lane, and is easily accessible from most parts of the district. The premises have cost £9,657 to construct and £618 to equip. All departments may be approached from a main entrance, but the School Medical Department and Maternity and Child Welfare Centre have each, also, separate departmental entrances. Every room is well lighted and correctly orientated for its purpose, and the building is central heated throughout by low pressure hot water radiators. The internal decorations have been carried out in such a manner as to achieve an effect which is both hygienic and decorative. In that part of the building which is devoted to the School Medical Services the walls are distempered cream and the woodwork is painted in a pleasing shade of blue. The furnishings harmonise with this decoration scheme. The following departments of the School Medical Services are accommodated at the Centre:— (а) Minor Ailments Clinic.—This unit consists of a large waiting room, a treatment room, a consulting room and isolation room. Two bathrooms with sitz and shower-baths and ample washing and lavatory accommodation are provided and in the basement a steam disinfector has been installed. (б) Dental Clinic.—A well-lighted surgery equipped with modern dental appliances is the main feature of the dental department which also includes a waiting room and recovery room. In the latter is a rinsing trough fitted with a series of "bubbling-fountains." 6 (c) Orthopaedic Clinic.—This contains appliances necessary for the performance of remedial exercises, massage, electrical and light treatment. (d) Ophthalmic Clinic. (e) Ear, Nose and Throat Clinic. (/) Waiting Room.—For accommodation of patients attending the three last-named Clinics. (g) Offices for Nursing Staff. (h) Offices for Clerical Staff. (i) Offices for Medical Staff. (j) Five Garages. The improvement in the conditions under which the duties of the medical and clerical staff are now carried out will, without doubt, enhance the value of the work undertaken. The excellent accommodation and equipment is not only appreciated by the Committee's staff, but also by the parents, many of whom have expressed their admiration for the new Clinic premises. SCHOOL HYGIENE. In addition to the provision of a new nursery school, further steps have been taken during the year towards the improvement and reorganisation of the older schools in the district, and the foundations laid for the building of a new senior boys' school to be known as the Rowland Hill School. No year passes without leaving a record of improvements to schools by which the conditions under which children receive their education are assisted towards the high level which present-day standards demand. 7 CO-ORDINATION. The greatest possible degree of co-ordination exists between the School Medical Service and the Public Health and Maternity and Child Welfare Departments. The administration of the service is controlled by the Education Committee's Medical Officer who is also Medical Officer of Health and Medical Officer to the Maternity and Child Welfare Committee. The main object always to be kept in view is the unification of the various health services made available by the Local Authority, and, as far as possible, to supervise child life from the ante-natal stage to the termination of school days and (by passing on the medical records obtained under the scheme for National Health Insurance and Factory Service) until late adolescence. The propaganda of recent years has resulted in a steady increase in the attendances at the ante-natal clinics and appreciation of the infant welfare centres and day nursery by the mothers of the district, thus contributing as part of the scheme for ensuring a healthier school entrant. The attainment of this end is further assisted in Tottenham by the establishment in 1937 of a nursery school and further development of nursery class provision, in the schools, for children under the age of five years. The School Medical Service continues to work in close co-operation with the local Ministry of Labour Employment Exchange by means of the Juvenile Employment Central Bureau, thus helping to ensure that school leavers are placed in occupations for which they are at least physically suited. 8 CLINIC SERVICES. Clinic. Address. Mon. Tues. Wed. Thurs. Fri. Sat. 1†Minor Ailments Municipal Med. Centre, Lordship Lane, N. 17 (Dr. Stalker) 9 a. m. - 9 a. m. - 9 a. m. - Town Hall, N. 15 (Dr. Smythe) 9 a. m. 9 a. m. — 9 a.m. — — 2 *Dental Municipal Med. Centre, Lordship Lane, N. 17 (Mr. Sainty) 9-12 noon 2-4.30 p.m. 9-12 noon 2-4.30 p. m. 9-12 noon 2-4.30 p. m. 9-12 noon 2-4.30 p. m. 9-12 noon 2-4.30 p.m. — Chestnuts Centre, St. Ann's Road, N. 15 (Mr. Fisher) 9-12 noon 2-4.30 p.m. 9-12 noon 2-4.30 p. m. 9-12 noon 2-4.30 p.m. 9-12 noon 2-4.30 p. m. 9-12 noon 2-4.30 p.m. - 3 *Ophthalmic Municipal Med. Centre, Lordship Lane, N. 17 (Mr. Letchworth) - - 9 a. m. and 1.30 p. m. - - - 4 *Aural Municipal Med. Centre, Lordship Lane, N. 17 (Mr. Clarke) — 9 a. m. — — 9 a. m. - 5 *Orthopaedic Municipal Med. Centre, Lordship Lane, N. 17 (Mr. Seddon) Once m'thly 2 p.m. - - - - - 6 *Remedial Exercises Municipal Med. Centre, Lordship Lane, N.17 (Miss Folkes) — 2 p.m. — 9 a. m. and 2 p. m. — 9 a.m. Vale Road School (Miss Folkes) 9 a. m. — 2 p.m. — — — 7 *Nutrition Municipal Med. Centre, Lordship Lane, N. 17 (Dr. Stalker) — — — — 2 p. m. - Town Hall, N. 15 (Dr. Smythe) - - - - - 9 a.m. * Attendance at the Specialist Clinics is by appointment only. † For attendance at the Minor Ailments Clinics children must obtain a clinic card from the Head Teacher, Attendance Officer or School Nurse. The Minor Ailments Clinics are open throughout the school holidays. 9 MEDICAL INSPECTION. Routine.—The routine medical inspection of school children is confined to the following three groups, and no exception was made during the year 1937 :— (i) The entrants, or those not previously examined since their admission to school. (ii) The intermediates, or those who have attained the age of 8 years. (iii) The leavers, or those who are 12 years of age and have not been examined since reaching that age. Parents were in all cases notified of the proposed inspection and invited to be present. The response to these invitations has been good, particularly in the case of infant departments, in which it has not been unusual to have at least 90 per cent. of parents. The examination of children, with the exception of Culvert, Crowland Road and Devonshire Hill Schools (where accommodation is set apart for this purpose), is undertaken in classrooms, teachers' rooms and school halls, under conditions which are mostly unfavourable to the privacy and silence required for the performance of medical examinations. At several schools there is no accommodation available for medical inspection and in such cases the children and their parents attend at the school clinic premises. The inspecting medical officer is accompanied by a school nurse who weighs and measures the children, carries out cleanliness examinations and tests distant vision. All defects found are notified to the parents who at the same time are advised as to treatment, and all children found to have defects are re-examined during the course of the year. Table II A (Appendix) shows the number of defects found during the year and number requiring treatment. Special.—Besides the routine age-groups, 8,511 special cases were examined, including all boys and girls who were about to leave school and whose final routine examination disclosed defects rendering them unsuitable for certain types of work. A special card was completed for each case and forwarded to the Juvenile Employment Officer in accordance with the suggestion contained in the Board of Education Memorandum 10 No. 137. By this procedure co-operation between the School Medical Service and Juvenile Employment and Advisory Committee was rendered more complete. FINDINGS AND TREATMENT OF MEDICAL INSPECTION. Nutrition.—As the result of a report made by the Medical Officer to the Education Committee in June, 1937, a Nutrition Clinic was set up at which all children of subnormal nutrition and those already in receipt of school meals and/or milk, might be referred. The object of the clinic in addition to selection of children for meals has been:— (a) To medically re-examine each child (on the basis laid down in the Board's Administrative Memorandum 124) at specified intervals, for example, once per term; and to record the findings, re-classify nutritional standard and re-authorise supply of meals or milk as occasion demands. (b) To offer advice to parents as to suitable diet, importance of sleep and fresh air. (c) To estimate the fitness of such children for physical training proportionate to the physical capacity of the individual child (Board of Education Circular 1445). (d) To recommend, as required, admission of suitable cases to the Committee's Residential Open Air School, Hayling Island, Hants. Children found at the routine medical inspections to be suffering from malnutrition numbered 564, or 10 per cent. of the children inspected. For classification of the nutrition of children inspected during the year in the routine age-groups, see Table B, page 47. Children specially examined in school by the medical officers and found to be undernourished numbered 181. Of the 5,240 children who attended the Minor Ailments clinics, 256, or 4.9 per cent., were found to be suffering from varying degrees of malnutrition. 11 By the end of the year two weekly nutrition clinics were being conducted, one at the Municipal Medical Centre and another at the Town Hall Clinic premises. All children referred to these clinics were weighed and measured, particulars concerning their previous health and home conditions, etc., ascertained and entered upon appropriate cards, and wherever extra nourishment was indicated, school meals and/or free milk were prescribed by the medical officers. The following statement gives the result of the investigations undertaken in connection with nutrition:— Number of children who attended Nutrition Clinics .. 754 Nutrition excellent (A) 70 Nutrition normal (B) 212 Nutrition slightly subnormal (C) 388 Nutrition bad (D) 84 Recommended for free milk in school on nutritional or medical grounds 300 Recommended for free milk and school meals on nutritional or medical grounds 228 Recommended for assessment on economic grounds 165 Uncleanliness.—The total number of examinations of children at the cleanliness surveys in the schools conducted by the school nurses was 114,867. In 1,108 cases pediculi or nits were detected. At the school clinics 240 children were dealt with and 22 children were cleansed by the school nurses. Minor Ailments and Diseases of the Skin.—Mild bronchial affections, sore throats, impetigo and minor injuries formed the highest percentage of the cases coming under this heading. During the winter months many children are afflicted with severe chilblains which give rise to distressing symptoms. All such cases are ordered extra milk and cod-liver oil and malt, and various medicaments are prescribed. In a number of cases this method of treatment has been successfully supplemented by the local use of Faradism. The affected portion of the limb is submerged in water as hot as can be borne by the patient 12 and a Faradic current is then passed through the water. Treatment is continued for 15 minutes and is administered twice weekly until the symptoms subside. Scabies.—There was an increase in the incidence of scabies. In 1937 the number of cases dealt with was 108 compared with 94 in 1936. Scabies and verminous cases can now be more satisfactorily treated owing to the provision of two slipper and shower baths and a disinfector at the Municipal Medical Centre. The availability of in-patient hospital treatment for scabies is, however, highly desirable, and would materially shorten the protracted periods of absence from school caused by this disease. Cleansing of verminous children is undertaken by the school nurses. Ringworm of the scalp has become a comparatively rare disease among Tottenham school children owing to early detection and treatment by X-rays. Visual Defects and External Eye Diseases.—The number of children found to have visual defects was 840. In 720 cases spectacles were prescribed, and in every instance these were obtained. Many cases of blepharitis were exceedingly chronic in nature. In numerous instances this was due to irregularity in attending at the clinics for treatment and to lack of care and cleanliness in the home. Untreated cases of squint are more rarely met with among school children than was formerly the case. This is due to the fact that treatment is obtained before the child attains school age. Nose and Throat Defects.—The number of children for whom treatment for enlarged tonsils and adenoids was advised was 644. Operative treatment was carried out in 469 instances, certain of these cases having been carried over from the previous year. The number awaiting operation had assumed considerable proportions by the end of the year owing to the non-existence of an agreement with the Middlesex County Council for the admission of Tottenham cases to their hospital. An agreement was subsequently made and the admission of cases to the North Middlesex Hospital was resumed on December 1st. A similar 13 agreement has also been entered into with the Prince of Wales's Hospital. The patients are retained in hospital for a minimum stay of two nights. The question of handkerchief drill in the schools is one which is worthy of consideration in connection with nasal defects. Ear Disease and Defective Hearing.—During the course of routine medical inspection 60 cases of ear disease and defective hearing were encountered. A further 230 cases were discovered at the clinics and as a result of special inspections. Dr. Friel, Consulting Aural Surgeon, has submitted the following figures with regard to the defects treated at the Aural Clinic together with his comments thereon Cause of Suppuration. Total Ears. Cured. Lost sight of. Still under treatment. Needing Hospital. Acute Inflammation of the Middle Ear 89 81 2 5 1 Chronic Inflammation of the Middle Ear, due to— I. (a) Tympanic sepsis 30 26 2 2 — (b) T.S. and Granulations 3 3 — — - (c) T.S. and Polypi 2 2 — II. Tympanic sepsis and Rhinitis 2 — 1 1 — III. Tympanic sepsis and— (a) Attic Disease 3 1 — 1 1 (b) Mastoid Disease 13 2 — 8 3 Inflammation of the External Auditory Canal 22 18 1 3 — Not Diagnosed 2 1 — 1 — Totals 166 134 6* 21 5 N.B.—* The children "Lost sight of" left the district before treatment was completed. 14 "The above table is similar to that which has been published annually for several years past. In the first column an analysis of the conditions present is shown, while in the second column the number of cases under each of these conditions appears. The two largest groups are the acute and the chronic suppurations. The word 'chronic' in this connection needs elaboration. Formerly, the term 'Chronic Suppuration' was applied to cases in which the suppuration has lasted a long time, e.g., 3 months. Duration was the criterion, but that has never been the criterion used in these reports. It is an arbitrary one and it is much more illuminating to take as a criterion the bacteriological field. In the acute condition it is presumed that micro-organisms (usually one variety only) have invaded the tissues. Gradually the tissue cells and the body fluids gain the upper hand and the micro-organisms are banished to the discharge which also diminishes. So long as one variety of microorganism is present in this, the body can deal with it and it quickly becomes scanty. But if it does not entirely cease, owing to its small amount it lies in the ear and is liable to become a culture medium for additional micro-organisms derived from the skin, or introduced from outside. If this happens the fluid becomes irritating to the tissues, and they continue to suppurate. Chronicity begins, and it is plain that this begins early. "Treatment is brought into line with the changing conditions. During the acute stage instillations of glycerine and carbolic acid 1 per cent. are used. When the discharge becomes scanty these are left off and boracic powder is blown into the ear. This is the normal ending. Sometimes the patient does not attend the Clinic till it may be assumed that the chronic stage has begun. If this is only recent, careful cleansing and boracic powder are usually sufficient to cause the discharge to cease, but if the trouble has lasted a long time, and there is much swelling and congestion of the tissues, a careful examination must be made as to whether the septic area is accessible in its whole extent, or as to whether the mastoid is the main source of purulent discharge. If the latter is the case, an operation in Hospital is necessary. If, on the other hand, the septic area is accessible, and there are no granulations, or polypi, etc., active antiseptic treatment is given. This consists in zinc ionisation. This method has the unique advantage of being efficiently antiseptic and non-irritating to the tissues. "As acute inflammation in the middle ear so often follows inflammation in the nose, it is necessary to deal with this at the same time. 15 Diastolisation has proved to be most useful for treating the blocking of the nose due to a severe cold. The inflammation in the ear does not always go on to suppuration, but the hearing is diminished and there is often some pain. These cases are just as important to treat as the suppurating ears on account of the liability to slight deafness becoming permanent. The principal difficulty lies in detecting them. Without the audiometer and the Cowan picture frame many more would be missed. Diastolisation is our mainstay in treating catarrh and inflammatory obstruction of the nose in young children. As our knowledge has increased, both as to the cause of catarrhal deafness as well as to the age at which the onset takes place, we are in a position to know when to suspect it, how to prevent it, and how to treat it. There is at present an enormous amount of slight or moderate deafness in adults, the greater part of which should in future be preventible." Dental Defects.—The number of children examined during the year reached a total of 12,219. The number found to require treatment was 8,068. The number actually treated was 3,753, or 46.5 per cent. This apparent low percentage of acceptances has been a matter for consideration by the Committee during the year and it was felt that this was due in large measure to the absence of a satisfactory scheme for the following-up in the home of cases of unexplained refusal. This was due to the fact that the dental nurses' time was wholly occupied by the routine clinic and dental inspection work. To re-establish an efficient "following-up" system the Education Committee has decided to appoint female dental attendants to assist in the routine clinic work and thus release the fully trained school nurse for the important educative work associated with home visiting. By arrangement with the Maternity and Child Welfare Committee it has been decided to recommend the early establishment of an additional dental clinic to deal with the treatment of expectant and nursing mothers and children under school age. I am indebted to Mr. Sainty, the Committee's Dental Surgeon, for the following report:— "The work of the dental clinics has continued on lines similar to those of recent years. In the area served by the Lordship Lane Clinic all children, including nursery school children, are inspected annually in the schools and treatment is offered to all those who require it; this 16 applies also to the secondary schools by arrangement with the Middlesex County Council. ' 'Owing to changes of staff and consequent unsettled conditions at the Chesnuts dental clinic, it has not yet been found possible to include all the age-groups for inspection in the schools in that area, but with the permanent appointment made last Spring these conditions should soon be remedied. A certain amount of dental treatment has been given to babies referred from the Welfare Clinics as in previous years, but under present conditions only a small number of such cases can be dealt with. By the proposed additional dental clinic it will be possible to deal conservatively with the teeth of pre-school children and thus obviate some of the bad dental condition which is so prevalent in infants when they first join school. It is of especial importance that whenever possible, the second temporary molars should be preserved for their full natural life, not only on account of masticatory value, but as an aid to the normal eruption of the first permanent molars; early loss of the second deciduous molar almost always results in a movement forward of the upper and a tilting of the lower first permanent molars, with consequent contraction of the arches and crowding of pre-molars and sometimes anterior teeth. This brings me to the question of orthodontics in the school dental service; it has been the practice in Tottenham for some years to correct irregularities in suitable cases with removable appliances; difficulties of cost and lack of facilities have prevented treatment by fixed appliances being carried out; also it is doubtful if many of the cases are of a type to benefit by this method. Cases which specially call for treatment by fixed appliances are referred to the Eastman Dental Clinic, but this only very rarely occurs. "Finally, last year saw a big step forward in the opening of the well-equipped Lordship Lane Centre.'' Orthopaedic and Postural Defects.—The routine and special inspections revealed 197 children needing treatment for some form of crippling defect. Surgical appliances were supplied and repairs and replacements effected in 208 instances. The orthopaedic surgeon pays periodic visits to Tottenham for the examination of children referred to him on account of these defects, 17 and a masseuse attends daily for the purpose of carrying out treatment and remedial exercises or other measures advised. The report of Mr. Seddon, F.R.C.S., Orthopaedic Surgeon of the Royal National Orthopaedic Hospital, is as follows:— "The work at the Orthopaedic Clinic is now running smoothly and is carried out under ideal conditions. "I am not, perhaps, competent to pass an opinion on the new Health Centre as a whole, but I am satisfied that the orthopaedic department leaves nothing to be desired. The arrangement of the rooms is excellent, the equipment is sufficient for our present needs, and the provision of paved ground outside will be much appreciated during the summer months by children who attend the remedial exercise classes. "On the assumption that the statistics cover most of the children in Tottenham (there may still be a number attending hospitals in the neighbourhood), the present position is satisfactory. Deformity due to rickets has almost vanished, and with one exception there has been a remarkable absence of severe crippling disease. The exception is infantile paralysis. During the summer of 1937 there was an unusual outbreak of this disease —hardly amounting to an epidemic, but sufficient to call for frequent comment in the medical journals. More cases of this disease have been admitted to Stanmore than ever before. Three came from Tottenham, two with mild paralysis that is recovering rapidly, the third with extensive involvement of both lower limbs. It is almost certain that the last child will not make a complete recovery, and he may have to wear some form of apparatus for the rest of his life. This is the curse of this disease. It afflicts previously healthy children. It is rarely fatal, at any rate in this country, and it may leave a child with permanent disability that is a grave burden to himself and to society. Fortunately, modern orthopaedic treatment can do much to hasten recovery, but until we know more about the cause and prevention of this devastating disease, it will continue to be a serious problem, both medically and economically." 18 TABULATED DIAGNOSES OF NEW CASES DEALT WITH DURING 1937. (1) Congenital Defects— Metatarsal varus 2 Pes arcuatus 1 Irregular toes 4 Congenital flat foot 2 Spastic paralysis 1 Congenital kypho-scoliosis 1 Congenital equino valgus 1 Pes cavus 1 Spastic monoplegia 1 Congenital synostosis 1 Other conditions 5 (2) Birth Injuries— Torticollis 1 Other Conditions 1 (3) Rickety Deformities— Bow legs 3 Other conditions 3 (4) Knock knees 5 (5) Postural defects of the spine 62 (6) Structural curvature of spine 6 (7) Foot strain 5 (8) Pes cavus 1 (9) Hallux valgus 3 10) Flat foot 10 (11) Infantile paralysis 9 (12) Sequelae of acute fevers— Post Diphtheritic weakness 1 (13) Fractures 1 (141 Other bone diseases— Apophysitis of the os calcis 2 (15) Other conditions, including postural intoeing. 10 (16) Non-orthopaedic 8 Total 151 Number of individual cases dealt with in 1937 293 Total number of attendances for treatment 4,919 19 Nervous Disease.—Nervous affections were again found to be on the increase. Several cases of chorea so severe as to necessitate immediate admission to hospital, came under observation. Habit spasm and night-terrors were other manifestations frequently encountered. The growing incidence of such nervous ailments is attributed to the stress and excitement attendant upon present-day conditions of life. Speech Defects.—The classes for speech defects were discontinued in September, 1933, owing to an insufficiency of pupils, and cases in need of treatment were sent to speech clinics at various hospitals. By the end of 1937 the investigations of the school medical officers had brought to light sufficient cases to warrant the formation of a speech training class at the School for the Deaf. Heart Disease and Rheumatism.—The number of children found to be suffering from organic heart disease was 68. The cause of this disease is in the majority of cases rheumatism. A large proportion of these children attend the Committee's School for Physically Defective Children at Vale Road. Tuberculosis.—Eight children were diagnosed as definitely to be suffering from pulmonary tuberculosis, in each case the diagnosis being confirmed by X-ray and bacteriological investigation at the instance of the Tuberculosis Officer for the area. Tuberculosis of glands, bones, joints and other organs was noted in 11 further instances. Hospital Treatment.—Such patients as cannot be adequately treated at a school clinic are referred to private practitioners or to the two local hospitals and various London hospitals. Of these the Hospital for Sick Children, Great Ormond Street, is perhaps of the greatest assistance to Tottenham children, and the willing co-operation of the medical staff is a most valuable asset to the work of the education authority's medical officers. A large number of children suffering from rheumatism and resulting carditis are treated annually at the Rheumatic Clinic of this hospital and subsequently transferred to the Lancing Heart Home which is conducted under the auspices of the same hospital. 20 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:— Children found at routine medical inspection to have defects are re-inspected periodically by the assistant school medical officers. The school nurses visit the homes of the children referred to hospitals, school clinics and private practitioners in order to ascertain whether treatment has been obtained, and to stimulate the parents, when necessary, to carry out the medical officers' instructions. Children excluded from school on the recommendation of the school medical officers are likewise visited at their homes by the school nurses when regular attendance at the appropriate clinics is interrupted. Weekly returns from the schools are received by the School Medical Officer, giving the names of children absent on account of illness. The school nurses follow-up in the homes the children thus notified. A list of children, who on medical grounds have not attended school for lengthened periods, is furnished at the commencement of each calendar year by the attendance officers, and all such cases are visited in their homes by one of the medical officers. The attendance officers also inform the medical department of absences from school for apparently inadequate reasons, and suitable measures are taken. From hospitals, information is received of school children who are out-patients or about to be discharged from hospital, together with suggestions as to further treatment. The school medical officers and nurses keep all such cases under observation in order that the instructions received from the hospitals shall be carried out. All children who wear surgical appliances, towards the cost of which the Education Committee have contributed, are examined periodically by one of the school medical officers. Defective children attending the various special schools are medically examined every six months. 21 The work undertaken by the school nurses, in addition to followingup at the homes of scholars, includes attendance with doctors at medical inspections and clinics, general cleanliness inspections in the schools, bathing scabies cases and cleansing verminous children. In connection with these duties 3,664 homes were visited, 786 attendances were made at clinics, and 1,492 school attendances were made for the purpose of medical inspection and cleanliness surveys. INFECTIOUS DISEASES. Considerable loss of school attendance annually occurs, especially in the infants' departments, owing to measles, whooping cough, chicken-pox and mumps, and in order to keep a check upon the incidence of these conditions in school children, an arrangement exists by which the head teachers are able to keep the Health Department informed of the weekly absences due to infectious diseases. The information supplied by the head teachers includes the names and addresses of the children, thus enabling the nursing staff to visit the homes. When it is considered advisable or necessary, a general survey is made of all the scholars attending particular classes with a view to discovering newly attacked or missed cases. The table below gives the numbers of infectious diseases found in school children during the past three years:— Notifiable Infectious Diseases. 1935. 1936. 1937. Scarlet Fever 353 265 179 Diphtheria 180 138 145 Typhoid Fever — — 2 Erysipelas 3 4 6 Pneumonia 27 9 22 Dysentery — — 10 Cerebro-Spinal Meningitis — — 1 Poliomyelitis 3 1 5 Tuberculosis—Pulmonary 14 22 16 Non-pulmonary 3 12 15 Totals 583 451 401 22 N on-notifiable Infectious Diseases. 1935. 1936. 1937. Measles 243 1453 198 Mumps 816 344 192 Whooping Cough 568 247 226 Chicken-pox 701 518 342 Scabies 19 26 25 Totals 2347 2588 983 Children excluded as contacts 490 621 339 In respect of the following school a low attendance certificate was issued during 1937. St. Francis of Sales' Infants' School, for 1 week. Diphtheria Immunisation.—The demand for immunisation against diphtheria has steadily increased during the year and the attendances at the Clinic on two sessions a week, including children under 5 years of age, have averaged 40 per session. Microscopical Examinations.—Four specimens of hairs were examined, two of which were found to contain ringworm spores. Bacteriological Examinations.—The results of examinations of throat and nose swabs for diphtheria will be found in the Health section of the report. OPEN-AIR EDUCATION. I am indebted to the Director of Education for the information supplied under the following headings:— (a) Open-Air Classrooms. The Open-Air Classes which have been conducted for several years, for boys at Orchard House (all the year round) and for girls at the Bandstand, Downhills Park (May to October), have been continued. 23 (b) School Journeys and Camps. For the year 1937, 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, particulars of which are given below:— School. No. of Children and Duration of Visit. No. of Teachers in Charge. Place of Visit. Total Cost. Amount of Grant. Belmont Sr. Boys 21 (10 days) 2 Swanage £ 70 £ 35 Crowland Boys 47 (2 weeks) 2 Niton. Isle of Wight 141 47 Downhills Sr. Girls 40 (10 days) 2 Folkestone 110 40 Down Lane Central Girls 100 (1 week) 4 Sandown 190 70 Earlsmead Jr. Boys 30 (2 weeks) 2 Shanklin 110 35 Earlsmead Jr. Girls 20 (10 days) 2 Heme Bay 55 20 St. Katharine's Sr. Girls 30 (2 weeks) 2 Seaford 95 45 (c) Physical Training. (1) Organisation of Physical Education.—The most important development in physical training during the year 1937 is to be found in the proposals to form a Joint Scheme of the County and Part III Authorities for the Organisation of Physical Education. This scheme came into force on January 1st, 1938. The Organisers, who previously spent only part of their time in the Borough and were concerned only with the elementary schools, will now be concerned exclusively with Tottenham and will be responsible for organising the physical education of pupils in all types of schools and for promoting facilities for the physical education of persons who have left school. 24 (2) Provision of Gymnasia.—The Education Committee have adopted a large programme of extension and reconstruction of schools for the period 1938-1940, which, when it is completed, will provide gymnasia in the senior schools and will afford opportunities for evening classes in gymnasia in every part of the Borough. Suitable arrangements for the storage of physical training kit are being made, and the provision of shoes and clothing mentioned in the Report of 1936 has been temporarily deferred until proper facilities for storage can be provided. (3) Summer Play Centres.—This year, following a course in Recreative Physical Training held in conjunction with the J.O.C. and the National Council of Recreative Physical Training, two Summer Play Centres were successfully launched in May, and continued till September. These were held in Lordship Lane Recreation Ground and Chestnuts Park, and wereopen to all school children on three evenings per week from 6.30 p. m. to 8.30 p. m. Leaders and Helpers were appointed by the Education Committee, in conjunction with the J.O.C., and suitable apparatus was provided. (4) Physical Training and the J.O.C.—As a result of close cooperation between the Education Authorities and the J.O.C., a steadily increasing number of "Keep-Fit" classes were arranged during the year. (5) Swimming Instruction.—Swimming instruction has continued throughout the year at the Indoor Bath at the Town Hall, and during the Summer Season at the Lido, Lordship Lane. The number of awards of certificates for swimming various distances continues to be highly gratifying. 1,922 such certificates were gained by pupils during the year ended 31st March, 1937. The Education Committee have agreed to appoint two Swimming Instructors (one man and one woman) for school children, and these appointments are shortly to be made. (d) Provision of Meals. The arrangements for the feeding of necessitous children have remained unchanged during the year. The Education Committee, however, have under consideration two major changes which are necessitated by the increasing number of children who are recommended for meals. 25 This increase follows naturally upon the establishment in July of the principle of selecting children on a nutrition basis. The Education Committee propose, during the year 1938— (a) to centralise the arrangements for the cooking and distribution of dinners and to increase the accommodation in meals centres; (b) to adopt a sliding scale in assessing the income of parents, so that the principle of part-payment for meals may be introduced. In October the Education Committee appointed a Woman Social Services Officer, part of whose duty is to advise on matters relating to the provision of meals. During the year ended 31st December, 1937, 293,211 dinners were provided to children in the schools. Of these, 288,112 were provided to children of necessitous parents and 5,099 on payment, to children in Central Schools. The average number of children receiving milk daily during the year was 10,737 on payment, under the voluntary schemes organised by the Head Teachers, and 1,391 free, on the recommendation of the School Medical Officer. CO-OPERATION OF PARENTS, TEACHERS, SCHOOL ATTENDANCE OFFICERS AND VOLUNTARY BODIES. Parents are informed of the time and place at which their children will be inspected and are invited to attend. The parents of infants take advantage of the invitation and are mostly present. With the older children the attendance of parents is less usual. By means of the invitation form, parents, if they are not able to be present at the inspection, are asked to state what illnesses their children have suffered from and thus the personal history of each child can be ascertained and recorded. Intimation is given or sent to parents of defects noted at the inspections and suitable directions are given. 26 The interest that the parents take in the examination of their children is very gratifying, and no opportunity is lost in making each parent feel that his or her co-operation in the safeguarding of the health of the child is essential to the efficiency of the School Medical Service. Without the cordial co-operation of the Teaching Staff, especially in the matter of cleanliness, the benefits of the School Medical Service would be much reduced. Their acquaintance and good relations with the parents generally enables many obstacles to be overcome, to the benefit of the children. By the teachers' vigilance, also, early treatment is obtained, illness curtailed and suffering avoided, and their knowledge of family circumstances is often helpful in determining the line of conduct in particular cases. The help of the teachers also is invaluable in securing regular attendance of the children under treatment at the clinics. Their assistance at the medical and dental inspections is freely given and much appreciated; and although in some cases they are placed in difficulties by the lack of accommodation in their schools, the inspections are carried out in the smoothest possible manner. Attendance Officers and members of the medical staff are mutually helpful in securing the regular attendance of children at school or treatment centre. Two Voluntary Organisations have given useful service to the School Medical Department, namely, the Invalid Children's Aid Association and the National Society for the Prevention of Cruelty to Children. The Invalid Children's Aid Association have arranged for convalescent treatment for school children at homes or institutions other than at Suntrap Residential Open-Air School; for the regular attendance at hospital of cripple children, and for the supply of surgical instruments. 27 As in previous years, the co-operation of the National Society for the Prevention of Cruelty to Children proved particularly helpful to the School Medical Service. When other measures fail a visit from the officer of that Society usually suffices to create in a recalcitrant parent a sense of his responsibility towards his own children. BLIND, DEAF, DEFECTIVE AND EPILEPTIC CHILDREN. The model regulations of the Board of Education for the detection of these children are in operation and work satisfactorily. A summary of the children coming under this heading is given in Table III of the Appendix. Information concerning these children is received from parents, attendance officers, teachers, school nurses, health visitors, from other authorities where there has been change of address, and also from hospitals and institutions. This method of obtaining information is so comprehensive that there are practically no exceptional children in the district who have not come under the observation of the School Medical Department. Blind Children. At the end of the year 1937 there were 2 blind and 15 partially children, and these were accommodated at:— East London School for the Blind 2 Lordship Lane Day School for the Partially Blind 15 17 The Committee's Ophthalmic Surgeon has all children with defective vision under his care and supervision. Deaf Children. There were 20 cases of children too deaf to be taught at an elementary school and these were accommodated at:— 28 Tottenham School for the Deaf 18 London County Council Deaf School, Anerley 1 East Anglian Deaf School, Yarmouth 1 20 Mentally Defective Children. Children who were certified by the Medical Officers as mentally defective have been accommodated as follows:—- Oak Lodge Special Day School, Finchley 58 All Souls' Special School, Hillingdon 3 61 Tottenham low-grade mental defectives attend two occupation centres' maintained by the Middlesex County Council. One of these is situated in the Borough and the other is in that portion of Wood Green which is adjacent to Tottenham. By arrangement with the County the same provisions for medical inspection and treatment as apply to elementary school children are available for children attending the Tottenham centre. If a child under the age of 7 years is examined and it appears probable that on reaching that age the case will become notifiable to the Local Authority under the Mental Deficiency Act, information is sent, as soon as the diagnosis has been made, to the medical officer appointed under that Act in order that he may deal with the case without loss of time. Epileptic Children. One girl is receiving institutional treatment at Lingfield Home and School, one boy is waiting for suitable accommodation, and one girl is receiving hospital treatment. Physically Defective Children. There were at the end of the year 69 children in attendance at the Committee's School for Physically Defective Children, Vale Road. 29 Owing to additional accommodation having become available at this School, application was made to the Board of Education to increase the number of school places to 96, and by the end of the year the Board's assent to this proposal had been received. The accommodation now provided allows for the attendance at a special school of all the children whose physical condition renders undesirable their retention at an ordinary elementary school. At the end of the year delicate children requiring residential treatment were accommodated as follows:— Suntrap Residential Open-Air School, Hayling Island 38 Royal Sea Bathing Hospital, Margate 2 St. John's Institution, Woodford 1 St. John's, Brighton 1 Brookfield Orthopaedic Hospital 1 Lord Mayor Treloar's Cripple Hospital, Alton 2 Royal National Orthopaedic Hospital, Stanmore 6 St. Dominic's School 2 The Heart Hospital, Lancing, Sussex 4 Total 57 All Tottenham children resident in institutions are periodically visited and examined by the School Medical Officer with a view to ascertaining their progress. In the case of mentally defective children approaching the age of 16 years special attention is given to their possible need for further supervision and training under the County Council's Scheme. special schools. The following is a review of the arrangements made for the supervision and care of children in Special Schools, information for which has been supplied generally by the Head Teachers:— 30 SUNTRAP RESIDENTIAL OPEN-AIR SCHOOL, HAYLING ISLAND. Matron -in -Charge: Miss O. P. E. Hann, S.R.N., D.N. Visiting Medical Officer: A. J. May, B.A., M.B. Hon. Consulting Surgeon: Sir Henry Gauvain, M.D., F.R.C.S. Nursing Staff: Miss D. Weetman, Sister. 10 Probationary Nurses. During the course of the year this Residential Open-Air School has been reconstructed and extended, and now provides accommodation for 120 children. Situated on the sea front facing the Solent at Hayling Island, in a mild yet bracing climate, the School is peculiarly suitable for the treatment of the majority of the maladies which commonly affect school children, and in particular those resulting from adverse conditions of living in densely populated urban districts. Cases of debility after acute or prolonged illnesses, malnutrition and respiratory affections such as bronchial catarrh and asthma respond well to a period of residence at the School. The duration of stay is determined in each instance by the child's progress towards recovery, and varies from six weeks to several months. The children are admitted to the School between the ages of five and sixteen years by one of the following methods:— (a) Children selected by the medical officers of the Tottenham Education Authority; (b) Children recommended for admission by medical officers of other Education Authorities; (c) Children referred for open-air or convalescent treatment by members of the medical staff of hospitals. 31 The health of the children is under the constant supervision of the Matron-in-Charge, assisted by a Sister and ten probationer nurses. The medical staff comprises the Honorary Consulting Orthopaedic Surgeon, the visiting Medical Officer, who is also engaged in private practice on the Island, and the Medical Officer of the Tottenham Education Committee who visits the School at frequent intervals. Treatment is based upon "open-air" principles, and all dormitories, classrooms and recreation rooms are so constructed as to ensure continuous access of fresh air and sunlight. Games are played on the beach, and during the summer months bathing and swimming are encouraged. Modern hospital and isolation accommodation are provided including X-ray, Artificial Sunlight, massage and remedial exercise treatment. All children receive in addition to a liberal and varied diet, one and a half pints of Tuberculin-Tested milk daily. The benefit derived from hygienic surroundings, good food and a regular mode of life, including lengthy rest periods, is evidenced by the gain in weight of the children and by their healthy appearance on returning home. During the year the total number of children admitted was 234. Of this number 202 were children attending the Tottenham schools and the remaining 32 were children for whom application for admission was made by outside Authorities. During the summer school recess 46 children, selected by the school medical officers, were also sent to Suntrap Open-Air School for a fortnight's holiday. In addition to the children sent to Suntrap School many others have obtained convalescent treatment under the auspices of the Invalid Children's Aid Association and the King Edward VII Memorial Seaside Hostel, Bexhill-on-Sea. The School for the Deaf. This School accommodates 80 children. Boys and girls from nine rateable areas attend the School for the Deaf. Certain groups are brought by ambulance, others are accompanied by guides, and some pupils travel independently. The scholars remain 32 at school during the mid-day interval. Arrangement of classes and methods of tuition Lave been continued on the same lines as described in previous reports. During the year the premises have been improved by reconditioning and additional building. A kitchen has been made from part of the former dinner hut. This new kitchen has been well equipped and contains twin gas cookers, twin sinks and a steaming oven. A well-proportioned hall has been built in which the pupils now have their mid-day meal and also some of their physical training lessons. The hall is connected with the new kitchen by a door and a hatchway. The larger part of the former dining hut has been converted into a manual workroom and contains benches of modern type. The lighting is excellent. A covered way has been made to connect the classrooms with the line of buildings at the end of the playgrounds. Hot water is now provided in the cloakrooms, which adds to the comfort of the pupils and staff. Vale Road School for Physically Defective Children. Arrangements and routine at this school do not differ materially from those of the preceding year. Further manual training for the older boys has been secured by their attendance at carpentry classes at Stamford Hill Boys' School. Open-air instruction is given in the field adjoining the school whenever weather conditions are favourable. The ages of the pupils in attendance range from 5 to 16 years. During 1937 the number on the roll was 72. Twenty-five children were admitted and 26 left. Records are kept and checked annually of the after-careers of former scholars. Particulars of those leaving during the year under review are as follows:— 33 Removed from district 10 Returned to elementary schools 4 Employed at commercial work 1 Employed at draughtsmanship 1 Employed at tailoring 1 Employed at dental work 1 Employed at factories 3 Employed at needlework 3 Unemployed 2 Oak Lodge School for Mentally Defective Children. During the year 1937, 75 children attended the above school from the Tottenham area. Of this number, 22 were girls and 53 boys. Five girls and 13 boys left in the same period. Of these 9 were excluded by the School Medical Officer as unsuitable, 2 entered institutions, 3 left the district and 4 left at the age of 16. Of the leavers, one remained at home, helping her mother, one girl is employed making soft toys in a factory, one boy is at a cabinet makers and another boy at a bakery. Fifty-seven children are provided with free dinners and three pay half-price. In addition 53 are given free milk. The majority of the children are bathed at school under the supervision of the school nurse. All the senior boys are capable of repairing their own shoes and receive instruction in woodwork, whilst the senior girls have a complete course of domestic science and are able to make their own dresses; the majority of the girls can also weave the material. Lordship Lane Partially Sighted School. During 1937 sixteen pupils from Tottenham have attended here. There were 14 on roll in January and three of these left during the year. Two other children were admitted, so that by December, 1937, there were 13 Tottenham children in attendance. 34 General Welfare.—All are conveyed to and from school by ambulance, and, with one exception, stay through the dinner period, when a cooked meal is supplied (free to necessitous cases and for a payment of 6d. per day to others). Milk is available for all at each of the recreation periods and many of the children have two bottles a day. During the year all have been medically examined and also have had a dental inspection followed by treatment where necessary. Those needing special eye care and new glasses, etc., attend at the Tottenham School Clinic for inspection by the Ophthalmic Surgeon. Progress.—Physical progress has been very satisfactory. The children have gained in weight and increased in height—some remarkably so. Fewer restrictions in physical training and games have been a helpful factor, and there is an increasing interest shown by the children in outdoor activities. Educationally, average progress has been made except in the case of a delicate boy who attends intermittently and another with very defective sight and perhaps retarded mentality (his admission to a school for blind might be considered). All follow the curriculum of the elementary school-child, but special methods are used which aim at conserving vision. Differentiation is made between myopes and those suffering from other eye defects. Wireless lessons, nature study and games in the parks, and many types of handwork all help to educate these children without undue eye-strain. Instruction in domestic science is provided for girls of 10 years and over and boys of that age are taught woodwork. After-Care.—The Juvenile Employment Bureau at Tottenham gives assistance in finding suitable work for the pupils on leaving school. Orchard House Open-Air Centre. During the year there were 23 boys on the school roll and the ages varied from 9 to 14 years. 35 Six boys left during the year and these found employment as follows:— Electric work 2 Motor engineering 2 Cardboard case maker 1 Woodwork 1 The boys received one-third pint of milk and half-ounce of cod-liver oil and malt daily. In addition, several pupils were provided with school meals. There has been a very distinct improvement in physical development and an average increase in weight of 8½-lbs. Carefully modified physical training exercises were taken, otherwise the ordinary school curriculum was followed, except for the time given to lessons in gardening. On leaving, the boys were noted for After-Care and the County Tuberculosis Officer, Dr. Davies, kept in touch with the boys previously referred to him. Downhills Park Open-Air Class. This Class, which is accommodated at the bandstand in Downhills Park during the summer months, was opened on May 25th and closed on October 29th. The number on roll was 22, and the girls were admitted from the following schools:— Downhills Senior Girls 12 Culvert Senior Girls 5 Bruce Grove Girls 1 West Green Junior Mixed 4 The children were provided daily with milk and cod-liver oil and malt. The Class has been conducted on lines similar to those of last year. Once again much use has been made of the Park; nature study was much enjoyed and dramatic work in the open air is delightful. One of the girls secured entrance to a secondary school and another to a central school. 36 Nursery School. Tottenham's first Nursery School was opened in a newly-constructed and well-planned building in Yale Road on August 31st. During the first week 25 children from 2 to 5 years of age were admitted, and by the end of the year 70 children were in attendance. Every child was examined by one of the Committee's medical officers who visited the school at fortnightly intervals for the purpose of performing routine medical inspections. The children were weighed each week and minor injuries, etc., were treated by one of the school nurses. Nursery Classes. At Lancasterian Infants' School there are now three nursery classes (two approved by the Board of Education), with 114 children on roll. In two classes the ages of the children are from 3 to 4 years and the third class consists of children from 4 to 4¾ years old. Attendance in the nursery classes is excellent. Throughout the winter it has attained a higher percentage than that of the remaining classes in the Infants' Department and exceptional immunity from infectious disease has been experienced. All nursery class infants partake of one-third pint of milk during the morning session, and another one-third pint is supplied during the afternoon to 75 per cent. of the pupils. Special attention is given to hygiene. Tooth-brush drill and nasal hygiene form part of the daily curriculum and every child possesses its own toilet accessories and sleeping-blanket. A school nurse visits the school twice per week to dress minor injuries and sores and to carry out general cleanliness inspections. When weather conditions are favourable the children are taken into Bruce Castle Park for games and during cold weather care is taken to ensure that they are warmly clad for their outdoor exercise. The afternoon session is devoted almost entirely to resting, when the majority of the children enjoy one and a half hour's sound sleep. 37 At other Infants' Schools classrooms have been suitably adapted for nursery classes to which children are admitted at the age of 4 years. Excellent work is being carried out in these classes. SECONDARY SCHOOLS AND OTHER INSTITUTIONS OF HIGHER EDUCATION. Statement of the work of the School Medical Service in connection with pupils attending secondary schools and other institutions of higher education, showing the provision made for medical inspection and treatment. I.—Medical and Dental Inspection:— Schools provided by the Middlesex County Council and numbers on the register of each:— Boys. Girls. Totals. County School 299 277 576 High School — 436 436 Grammar School 442 — 442 Junior Commercial School 12 67 79 Junior Technical School 162 — 162 St. Ignatius' College 517 — 517 Totals 1,432 780 2,212 Pupils attending the secondary schools are inspected and treated by the medical and dental officers of the Tottenham Education Authority by arrangement with the County Council. Full medical inspection is made of all pupils in secondary schools as follows:— (i) During the first term following their entrance. (ii) Between 13 and 14 years of age. (iii) Between 15 and 16 years of age. 38 The actual arrangements in connection with medical inspection are identical with those adopted at elementary schools. During 1937 there were inspected 664 boys and 460 girls. Special examinations of selected scholars are carried out by the medical officers at the request of the Head Teachers. The work of medical inspection in the secondary schools has, in some instances, been carried out under conditions not conducive to accuracy of diagnosis, owing to lack of accommodation suitable for the performance of medical examinations. An annual dental inspection is made of all pupils in attendance at secondary schools. II.—Following-up and Medical Treatment:— Following-up is undertaken by the Head Teachers, who submit reports to the School Medical Officer. Ophthalmic and dental treatment are given at the school clinics on the production of a receipt from the Head Teacher, who collects from the scholars the payments in respect of such treatment. In all other instances scholars found to have defects are referred to their family medical advisers or to hospitals. On pages 43-44 will be found a record of the treatment given. PARENTS' PAYMENTS. Minor Ailments and Dental Clinics. Voluntary contribution boxes are placed in conspicuous positions in the Clinics, and parents are asked to contribute as liberally as their means allow. 39 The following arrangements obtain with respect to other treatment, etc.:— Dental Plates.—Cost price is charged and payments may be made by instalments. Spectacles.—Cost price is charged and payments may be made by instalments. Operative Treatment of Tonsils and Adenoids.—5s. per case. X-Ray Treatment.—5s. per case. Drugs and Medicinal Foods.—Cost price. Where the family income does not exceed that of the scale adopted by the Education Committee and approved by the Board of Education, treatment is given at less than cost price, or free. EXAMINATIONS BY THE MEDICAL OFFICERS. All entrants to the Education Committee's permanent service are examined by the Medical Officers. Children taking part in stage performances are also medically examined and 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 1,315 lbs. Parrish's Food 402 lbs. Cod Liver Oil 362 ozs. Syrupus Ferri Iodidi 1,901 ozs. Syrupus Calcii Lactophosphatis 1,813 ozs. 40 CHILD GUIDANCE. During the year under review a number of children presenting difficulties associated with educational progress and behaviour were referred to the London Child Guidance Clinic, Canonbury, N. Financial responsibility for the fees attendant upon such examination is accepted by the Education Committee. Towards the close of the year a whole-time psychologist was appointed by the Committee for a period of six months to undertake the investigation of retarded and maladjusted children in order to determine whether there was any ground for the establishment of a Child Guidance Clinic in the area. HEALTH PROPAGANDA. In connection with the "National Campaign to Encourage the wider use of the Health Services'' an Exhibition was held at the Municipal Hall, Tottenham, from 29th November to 3rd December. The School Medical Service was well represented and exhibits descriptive of the provision made for safeguarding the health of the school child were portrayed on various stalls. With the co-operation of the Director of Education parties of senior school children visited the Exhibition at the morning and afternoon sessions, the exhibits being explained to them by members of the School Medical Staff. Films illustrating the various Health Services including a local film of the work of House Refuse Collection were shown at each session. The interest in the Exhibition was manifest by the many and varied questions put to the demonstrators by the children during their visits. 41 SECONDARY SCHOOLS. Table I.—Number of Pupils Inspected 1st January, 1937, to 31st December, 1937. Routine Inspections. Total. Ages. 10 11 12 13 14 15 16 Boys .. — 138 150 126 78 106 2 600 Girls •• 2 106 111 65 87 48 1 420 Totals •• 2 244 261 191 165 154 3 1,020 TECHNICAL SCHOOLS. Table I.—Number of Pupils Inspected 1st January, 1937, to 31st December, 1937. Routine Inspections. Total. Ages. 13 14 15 16 17 Boys 37 11 8 6 2 64 Girls - — 29 11 — 40 Totals 37 11 37 17 2 104 42 SECONDARY AND TECHNICAL SCHOOLS (contd.). Table II.—Return of Defects Found in the Course of Medical Inspection in 1937. 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) 20 - Eye Blepharitis — - Conjunctivitis — - Keratitis — - Corneal Opacities — - Defective Vision 108 1 Squint — - Other Conditions 3 - Ear Defective Hearing 2 - Otitis Media 5 - Other Ear Diseases — - Nose and Throat Chronic Tonsillitis 13 2 Adenoids — 1 Chronic Tonsillitis and Adenoids 2 — Other Conditions 9 — Enl. Cervical Glands (Non-Tubercular) — — Defective Speech 1 — Heart Disease:— Heart and Circulation Organic — 3 Functional 1 2 Anaemia 4 — Lungs Bronchitis and Bronchial Catarrh 7 — Other Non-Tubercular Diseases 4 — Pulmonary:— Tuberculosis Definite — — Suspected — — Non-Pulmonary Glands — — Spine — — Hip — — Other Bones and Joints — — Skin — — Other Forms — — Nervous System Epilepsy — — Chorea — — Other Conditions 1 — Deformities Rickets 1 — Spinal Curvature 6 — Other Forms 30 — Other Defects and Diseases 31 2 Teeth—Dental Diseases 40 — Table III. relates to "Exceptional Children" and is not required in connection with Secondary Schools 43 SECONDARY AND TECHNICAL 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.) 10 2 - 2 - - 11 244 49 150 38 7 12 261 63 160 36 2 13 228 65 139 20 4 14 176 68 94 14 — 15 191 76 107 8 — 16 20 10 10 — — 17 2 - 2 - - Totals 1,124 331 664 116 13 Per cent — 29.5 59.1 10.3 1.1 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 Otherwise. Total. (1) (2) (3) (4) (5) Errors of Refraction (including Squint) 143 2 - 145 Other Defect or Disease of the Eyes (excluding those recorded in Group I) 2 - — 2 Total 145 2 — 147 Total number of Pupils for whom spectacles were prescribed:— (а) Under the Authority's Scheme 132 (b) Otherwise 2 Total number of Pupils who obtained or received spectacles:— (a) Under the Authority's Scheme 105 (b) Otherwise 28 44 SECONDARY AND TECHNICAL 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 15 16 17 18 TOTAL Number 11 21 175 234 213 237 163 78 13 — 1,145 (b) Specials 60 (c) Total (Routine and Specials) 1,205 (2) Found to require treatment 753 • (3) Actually treated 494 (4) Attendances made by children for treatment 969 (5) Half-days devoted to:— (7) Extractions:— Inspection 9 Permanent Teeth 228 Temporary Teeth 65 Total 293 (8) Administrations of general anaesthetics for extractions 16 (6) Fillings:— (9) Other operations:— Permanent Teeth 650 Permanent Teeth 68 Temporary Teeth 44 Temporary Teeth 1 Total 694 Total 69 45 ELEMENTARY SCHOOLS. C.—Children Found to Require Treatment. Group. For defective vision (excluding squint). For all other conditions recorded in Table IIa. Total. Entrants 3 299 302 Second Age Group 94 152 246 Third Age Group 138 117 255 Total 235 568 803 Table I.—Number of Children Inspected 1st January to 31st December, 1937. A.—Routine Medical Inspections. Number of Code Group Inspections:— Entrants 2,051 Second Age Group 1,759 Third Age Group 1,795 Total 5,605 Number of other Routine Inspections — B.—Other Inspections. Number of Special Inspections 8,511 Number of Re-Inspections 11,479 Total 19,990 46 Table II. A.—Return of Defects found by Medical Inspection in the Year ended 31st December, 1937. Defect or Disease. Routine Inspections. Special Inspections. No. of Defects No. of Defects. Requiring Treatment. Requiring to be kept under observation, but not requiring Treatment. Requiring Treatment. Requiring to be kept under observation, but not requiring Treatment. (1) (2) (3) (4) (5) Skin Ringworm:— Scalp — — 3 — Body — — 9 — Scabies 1 — 107 — Impetigo 3 - 255 - Other Diseases (Non-Tuberculous) 12 - 393 2 Eye Blepharitis 8 — 50 - Conjunctivitis 3 - 104 - Keratitis - - 4 - Corneal Opacities - - - - Other Conditions (excluding Defective Vision and Squint) 2 - 66 - Defective Vision (excluding Squint) 235 22 478 - Squint 20 1 107 — Bar Defective Hearing 15 - 9 — Otitis Media 11 — 166 — Other Ear Diseases 34 - 55 — Nose and Throat Chronic Tonsillitis only 143 148 321 2 Adenoids only 2 7 6 — Chronic Tonsillitis and Adenoids 110 11 62 - Other Conditions 44 5 216 1 Enlarged Cervical Glands (Non-Tuberculous) 4 2 50 — Defective Speech 2 6 7 — Heart and Circulation Heart Disease:— Organic 7 22 36 3 Functional 3 25 6 3 Anaemia 8 2 178 — Lungs Bronchitis 25 35 393 — Other Non-Tuberculous Diseases 8 6 50 — Tuberculosis Pulmonary:— Definite — — 8 — Suspected 1 — 10 — Non-Pulmonary:— Glands 2 - 7 — Bones and Joints - - - — Skin — — — — Other Forms - - 2 — Nervous System Epilepsy 1 — 12 4 Chorea 5 2 56 — Other Conditions 10 5 78 3 mities Rickets 4 1 9 — Spinal Curvature 19 — 11 — Other Forms 50 4 104 — Other defects and diseases 54 17 2327 21 Grand Total 846 321 5695 39 47 B.—Classification op 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 2051 218 10.6 1625 79.2 173 8.4 35 1.7 Second Age Group 1759 221 12.6 1316 74.8 183 10.4 39 2.2 Third Age Group 1795 533 29.7 1128 62.8 116 6.4 18 10 Other Routine Inspections Total 5605 972 17.3 4069 72.6 472 8.4 92 1.7 Table III.—RETURN OF ALL EXCEPTIONAL CHILDREN IN THE AREA. BLIND CHILDREN. Certified Schools for the Blind. At Public Elementary Schools. At Other Institutions. At no School or Institution. Total. 2 — -- 1 3 PARTIALLY BLIND CHILDREN. At Certified Schools for the Blind. At Certified Schools for the Partially Blind. At Public Elementary Schools. At Other Institutions. At no School or Institution. Total. — 15 — — 1 16 DEAF CHILDREN. At Certified Schools for the Deaf. At Public Elementary Schools. At Other Institutions. At no School or Institution. Total. 15 — — — 15 48 PARTIALLY DEAF CHILDREN. At Certified Schools for the Deaf. At Certified Schools for the Partially Deaf. At Public Elementary Schools. At Other Institutions. At no School or Institution. Total. 5 — — — — 5 In addition 2 boys and 1 girl suffering from Aphasia attend the School for the Deaf. MENTALLY DEFECTIVE CHILDREN. Feeble-minded Children. At Certified Schools for Mentally Defective Children. At Public Elementary Schools. At Other Institutions. At no School or Institution. Total. 64 51 — 2 117 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-thoracio glands.) At Certified Special Schools. At Public Elementary Schools. At Other Institutions. At no School or Institution. Total. 11 — 1 3 15 49 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 3 3 16 D.—Children with Heart Disease. At Certified Special Schools. At Public Elementary Schools. At other Institutions. At no School or Institution. Total. 44 25 — 2 71 B.—Delicate Children. At Certified Special Schools. At Public Elementary Schools. At Other Institutions. At no School or Institution. Total. *59 267 37 5 368 * Of the 59 children at Certified Schools, 38 are at Suntrap Residential Open-Air School, Hayling.for a period of not less than 6 weeks, for convalescent treatment. C—Crippled Children. At Certified Special Schools. At Public Elementary Schools. At Other Institutions. At no School or Institution. Total. 42 8 — 4 54 50 CHILDREN SUFFERING FROM MULTIPLE DEFECTS. Combination of Defect. At Certified Special Schools. At Public Elementary Schools. At other Institutions. At no School or Institution. Total. Feeble-minded and Crippled.. 2 - - - 2 Heart and Epileptic — — — 1 1 Crippled and Deaf J — — 1 2 Tuberculosis and Heart 1 - — - 1 Table III.—Continued. Statement op the Number of Children Notified during the Year ended 31st December, 1937, by the Local Education Authority to the Local Mental Deficiency Authority. Total number of children notified, 19. Analysis of the Above Total. Diagnosis. Boys. Girls. (1) (i) Children incapable of receiving benefit or further benefit from instruction in a Special School:— (a) Idiots — — (b) Imbeciles 1 1 (c) Others 10 2 (ii) Children unable to be instructed in a Special School without detriment to the interests of other children:—- (a) Moral Defectives — - (b) Others — — (2) Feeble-minded children notified on leaving a Special School on or before attaining the age of 16 2 3 (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 13 6 In addition, 2 boys and 1 girl under seven years of age, who came under our notice, have been intimated, at his request, to the Officer under the Mental Deficiency Act. 51 Table IV.—Return or Defects Treated during the Ybab ended 31st December, 1937. TREATMENT TABLE. Group I.—Minor Ailments (excluding Uncleanliness, for which see Table VI). Disease or Defect. Number of Defects treated or under treatment during the year. Under the Authority's Scheme. Otherwise. Total. (1) (2) (3) (4) Skin:— Ringworm—Scalp (treated by X-Rays) 1 1 2 ,, ,, (other treatment) - 1 1 Ringworm—Body 8 1 9 Scabies 109 - 109 Impetigo 256 2 258 Other Skin Disease 359 42 401 Minor Eye Defects (External and other, but excluding cases falling in Group II) 218 5 223 Minor Ear Defects 230 21 251 Miscellaneous (e.g., minor injuries, bruises, sores, chilblains, etc.) 961 23 984 Total 2,142 96 2,238 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) (1) Under the Authority's Scheme. (11) Otherwise. (1) Under the Authority's Scheme. (11) Otherwise. (1) (2) (3) (4) Errors of Refraction (including squint) 810 19 829 Other Defect or Disease of the Eyes (excluding those recorded in Group I) 6 7 13 720 19 720 19 Total 816 26 842 52 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 Total. (1) (2) (3) (4) (5) (i) (ii) (iii) (iv) (i) (ii) (iii) (iv) (i) (ii) (iii) (iv) 260 729 — — 144 — — — 325 — — — 409 — (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. (i) Residential treatment without education. (ii) Nonresidential treatment at an orthopaedic clinic. (iii) Residential treatment with education. (i) Residential treatment without education. (ii) Nonresidential treatment at an orthopaedic clinic. (iii) Number of children treated 10 - 293 - - 48 351 53 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 984 1,351 1,104 769 843 1,606 1,115 850 1,048 120 9,790 (b) Specials 2,429 (c) Total (Routine and Specials) 12,219 (2) Found to require treatment 8,068 (3) Actually treated 3,753 (4) Attendances made by children for treatment 5,933 (5) Half-days devoted to:— (7) Extractions:— Inspection 45 Permanent Teeth 1,211 Treatment 716 Temporary Teeth 5,780 Total 6,991 Total 761 (8) Administrations of general anaesthetics for extractions 203 (6) Fillings:— (9) Other operations:— Permanent Teeth 1,162 Permanent Teeth 282 Temporary Teeth 155 Temporary Teeth 10 Total 292 Total 1,317 Regulation cases 27 Table VI.—Uncleanliness and verminous conditions. (i) Average number of visits per school made during the year by the School Nurses 21.9 (ii) Total number of examinations of children in the Schools by School Nurses 114,867 (iii) Number of individual children found unclean 1,108 (iv) Number of children cleansed under arrangements made by the Local Education Authority 22 (v) Number of cases in which legal proceedings were taken:- (a) Under the Education Act, 1921 27 (b) Under School Attendance Byelaws - BOROUGH OF TOTTENHAM WELFARE AUTHORITY. MATERNITY AND CHILD WELFARE COMMITTEE. ANNUAL REPORT OF THE MEDICAL OFFICER FOR THE YEAR 1 937. 2 Borough of Tottenham MATERNITY AND CHILD WELFARE COMMITTEE (as at 31st December, 1937). Chairman: Councillor Mrs. A. E. Lyons. Vice-Chairman: Councillor Mrs. A. M. Ellis. Members: Alderman J. H. Morrell, J.P. ,, Mrs. W. A. Kent. ,, Major Sir Patrick Malone, J.P. ,, Mrs. A. Kitchener. Councillor G. A. Armfield. A. Reed, A.C.I.I., J.P. ,, Mrs. E. M. Coles. ,, Miss R. F. Cos. ,, M. Doran. ,, F. A. F. Keay. ,, M. J. O'Gara. ,, A. R Turner. Clerk to the Committee: Miss M. F. Davidson. Medical Officer: G. Hamilton Hogben. 3 MATERNITY AND CHILD WELFARE CENTRES. INFANT WELFARE CLINICS. Address. Day and Hour of Attendance. Municipal Medical Centre, *Monday, Tuesday and Thursday, 2.0 p.m., Lordship Lane and * Wednesday and * Thursday, 9.30 a. m# The Chestnuts, St. Ann's Tuesday, * Wednesday, * Thursday and Road *Friday, 2.0 p.m., and Wednesday, 9.30 a.m. Town Hall Wednesday, 2.0 p.m. * Lady Doctor in attendance. All consultant and clinic services existing for the benefit of the school child are available for the child under school age. ANTE- AND POST-NATAL CLINICS. Municipal Medical Centre, Tuesday, 9.30 a.m., and Wednesday and Lordship Lane Friday, 2.0 p.m. The Chestnuts, St. Ann's Monday, 2.0 p.m., and Wednesday and Road Friday, 9.30 a.m. MUNICIPAL MIDWIFERY SERVICE. The Corporation lias provided a whole-time service of Municipal Midwives to attend in the homes, full particulars of which may be obtained from the Maternity and Child Welfare Department, Town Hall. GYNAECOLOGICAL CLINIC. (By special appointment only.) Municipal Medical Centre, Friday, 9.30 a.m. Lordship Lane DAY NURSERY. 227, West Green Road .. Monday to Friday, 8.30 a.m. to 5.30 p.m. 4 Maternity and Child Welfare Department. STAFF. Medical Officer and Supervisor of Midwives: 6. Hamilton Hogben, M.R.C.S. (Eng.), D.P.H. Part-time Medical Officers: Infant Welfare Centres.— C. Alice King, M.D., M.R.C.P. Ante and Post-Patal Clinics.— Esther Rickards, M.S., F.R.C.S. Superintendent Health Visitor and Asst. Supv. Midwives : Mrs. J. Kent-Parsons, M.B.E., S.I. Ex. Board, S.C.M., H.V. Certif. Health Visitors: Miss M. Blanchard, S.R.N., S.C.M., H.V. Certif. „ G. M. Hockin, S.R.N., S.C.M., H.V. Certif. ,, E. M. Dunn, S.R.N., S.C.M., H.V. Certif. ,, M. Timlin, S.R.N., S.C.M. ,. N. A. Lennon, S.R.N., S.C.M., H.V. Certif. .. K. Goodwin, S.R.N., S.C.M., H.V. Certif. ,, M. Oldfield, S.R.N., S.C.M., H.V. Certif. „ M. Sumpner, S.R.N., S.C.M., H.V. Certif. „ B. H. T. Townsend, S.R.N., S.C.M., H.V. Certif. ,, H. Haworth, S.R.N., S.C.M., H.V. Certif. „ H. E. Clynes, S.R.N., S.C.M., H.V. Certif. „ K. B. Drage, S.R.N., S.C.M., H.V. Certif. ,, A. Ear,li, S.R.N., S.C.M., H.V. Certif. (appointed March, 1938). „ S. G. Briggs, S.R.N., S.C.M., H.V. Certif. (appointed April, 1938). ,, M. P. Jones, S.R.N., S.C.M., H.V. Certif. (appointed April, 1938.) 5 Municipal Midwives: Miss 0. Durie, S.C.M., 60, Compton Crescent, N.17. TOT. 2301. Mrs. H. A. C. Jones, S.C.M., 50, St. Loy's Road, N.17. TOT. 3103. Miss E. S. Lloyd, S.R.N., S.C.M., 408, Lordship Lane, N.17. TOT. 2987. Miss F. J. Trethewy, S.C.M., 184, St. Ann's Road, N.15. STA. 3782, Mrs. E. M. Watkins, S.C.M., 314, Philip Lane, N.15. TOT. 2553. Mrs. A. A. Willis, S.C.M., 30, Seymour Avenue, N.17. TOT. 3425. Midwives supplied' by arrangement with Voluntary Organisations : Miss N. King, S.R.N., S.C.M. (Sister-in-charge), 34, Howard Road, N.15. STA. 2625. Maternity Nursing Association (Royal Northern Hospital). Day Nursery: Matron-in-chiirge.— Miss F. E. Trewinnard. Nursing Staff.— Miss E. Evans, Creche Trained Kindergarten Certif. Miss A. Powell, Creche Trained. Miss M. B. Ireson, Creche Trained. Miss E. E. Martin, Creche Trained— Appointed July, 1938, Clerical Staff : Miss E. Horton (Senior Clerk). Mr. E. E. Fisher. Miss G. A. Elliott. Miss N. L. Petty. Miss D. Osborne. Miss D. H. Ball. 6 STATISTICAL INFORMATION. The population of the Borough of Tottenham as estimated by the Registrar-General is 146,200. Number of births : Male 1,021 Female 952 1,973 Birth Rate (per 1,000 population) 13.5 Deaths under one year of age 126.0 Number of Still-Births notified 62.0 Infantile Death Rate 63.9 Number of Maternal Deaths 9.0 Maternal Death Rate 4.42 Cost of Maternity and Child Welfare Services. The following figures have been kindly supplied by the Borough Treasurer:— £ Total Cost of Maternity and Child Welfare Services 13,868 Total Receipts 1,084 Government "block" Grant ... ... ... ... 4,606 £8,178 Cost of Maternity and Child Welfare Services in terms of rate in the £1, 2.18 pence. CO-ORDINATION. The scheme for the care of the mother and child in this district provides for ante-natal and post-natal care of the mother, and a comprehensive scheme exists for the welfare of infants and young children under the age of five years. 7 The Specialist Clinics of the School Medical Service for, the diagnosis and treatment of affections! of the eye, ear, nose and throat, and crippling defects ar© available for the child under school age. Maternity Hospital Service. 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 52 Own arrangements 183 The North Middlesex (County) Hospital 448 Other Outside Institutions 279 Total 962 The retmainder were confined within the District. HOME VISITING BY THE HEALTH VISITORS. Expectant Mothers. Children under 1 year. Over 1 year. Totals. First Visit. Re-visits. First Visit. Re-visits. Re-visits. 900 2,138 1,8?3 9,497 20,223 34,651 Other visits:- Infantile deaths 50 Still-Births 81 Ophthalmia Neonatorum 119 Pneumonia 28 Infectious Diseases 108 Special visits: Mothers 1,282 Children 625 Total 36,944 The Committee employs 16 fully trained health visitors, who devote their whole time to Maternity and Child Welfare work, and upon their efficiency the success of the service very largely depends. The mothers rely upon the health visitor for information on every aspect of child- 8 rearing, and to a very real extent the health visitor is an immediate bulwark between the mother and adverse conditions. In addition to home visiting, which in 1937 represented 36,944 visits, the staffing of the Infant Welfare Centres, Ante- and Post-Natal Clinics, and Gynaecological Clinic are undertaken by the health visitor in rota. BREAST FEEDING. As the result of the Health Visitors' enquiries, it was ascertained that 1,913 infants have been fed as follows :— Breastfed 1,412 Part Breast-fed, plus milk, dried milk or condensed milk 357 Bottle feeding—Cow's milk 51 Dried milk 68 Other artificial foods 20 Feedings unknown 5 1,913 ANTE-NATAL CLINICS. Centre. Sessions. Number of Attendances. Mothers. New Cases. Post-Natal. Municipal Medical Centre, Lordship Lane 112 2,146 468 100 The Chestnuts, St. Ann's Road 150 2,275 509 129 Totals 262 4,421 977 229 The figures of attendances at the new Lordship Lane Centre, and the Chestnuts, St. Ann's Road, are given in the above table. I am indebted to Miss Esther Rickards, M.S., F.R.C.S . Medical Officer in charge of the Committee's ante-natal work, for the following report :— During the first nine months of 1937, 5 sessions a week were held: 3 at The Chestnuts Centre, St. Ann's Road, and 2 at Bruce Castle. 9 From October 8th, a third session was held at Bruce Castle. This third session was justified by the very great increase in the number of oases at that centre, where, during 1937 an average of 20.05 cases were seen per session, whilst 16.03 per session were seen at The Chestnuts. On the 25th October The Bruce Castle Clinic was transferred to the new Lordship Lane Centre. In total there were seen at the ante-natal clinics during the year 1,144 ante-natal patients. To obtain an idea of the growth of the work of these clinics, comparison may be made to the year 1927, when at The Chestnuts 329 cases were seen, with an average of 9.9 per session, and, at Bruce Castle, 231 cases, with an average of 7.6 per session; or, in other words, 41.1 per cent, of the maternal population of the Borough attended the clinics in 1937 compared with 22.8 per cent, in 1927. It is important that the numbers attending at each session should be kept under 20 in order that ample time may be given for the complete physical examination of each case, and for the discussion of the health needs of each mother, and for education work. We attempt at the clinics to advise mothers how to keep fit, how to avoid fatigue and how to remove all possibilities of complications in the later months of pregnancy and during the confinement. Each mother presents a different psychological problem and time must be allowed to obtain the maximum response to one's.efforts, therefore, the maximum of 20 per session must be adhered to; and no more than eight of these should be new cases. During the past year, especially at Bruce Castle, before the additional session was sanctioned, the numbers attending were greater than could be dealt with adequately. At the clinics the mothers are told of the health services which are available for them and their children. If any abnormality is found the patients are referred to their own doctors with a letter, or are sent to hospital for treatment. Minor ailments can be dealt with, and such articles as bandages, tonics, cod liver oil and malt, etc., are sold to them at cost price. Patients are welcomed as early as possible in pregnancy and their arrangements for the confinement are fixed up speedily, so that anxiety is allayed should the event happen before the appointed day. 10 In the earlier part of the year, before the introduction of the new midwifery scheme, patients were referred to independent midwives, and those wishing to go into hospital were referred by letter to the North Middlesex Hospital, or the Mothers' Hospital, Clapton. Many patients oome to the clinics having made their own arrangements, and these were referred by the independent midwives and by private practitioners, with many of whom we work in close co-operation. On the 1st February, 1937, the North Middlesex Hospital started a scheme of co-operation for the supervision of the patients booking to go into hospital. Patients were referred back to the clinics until the 8th month, and were then referred back to the hospital clinics for the last 4 weeks of supervision. This scheme has continued to work successfully, has brought more mothers to the clinic, and has provided the means of contact with many young mothers who would not have been seen until after the birth of their babies. Mothers booking to go into the Mothers' Hospital, Clapton, have had this form of shared supervision working for many years. It has been continued during the present year. By a scheme of note-taking between the clinics and the central office at the Town Hall abnormalities arising in any patients are notified to the health visiting staff, who, in following up the patients and visiting them in their own homes can find if the advice given has been followed out, and whether it is producing the required result. If this is not so, arrangements can be made for the patients to go back to the clinio at an earlier date than the one given, and it is possible with the ambulance service (which has been available for many years in Tottenham, free of charge) to fetch patients to the clinic who are unable to walk. Every facility is given to the patients to lessen the difficulty of meeting expense at the confinement. If they wish they can bring weekly sums for their midwife's fee, for the Clapton Hospital fee, for the sterilised outfit, or they can join the Mothers' Bank and save money for any other purpose. Many patients make use of this service and many also join the mothers' classes, where sewing, knitting, preparation of garments and other social activities are undertaken. 11 Patients suffering from financial distress have been assisted in many ways permitted by the Council, but special mention must be made of the grant which enables butter to be given to certain undernourished mothers. There has been a remarkable improvement in every case so helped. To complete the supervision of pregnancy a post-natal examination should be made six weeks after delivery. Patients are urged to return for this final visit, and to make it easy for them, and less alarming, they are told to return to their usual ante-natal clinic. Unfortunately in 1937 there has been a decline in the number of postnatal cases, only 129 attending at The Chestnuts and 100 at Bruce Castle. This was undoubtedly due to the overcrowding in the earlier months at the clinics. Complete as these services appear to be, there are still ways in which they can be further improved. Doctors and patients are eagerly awaiting the long overdue dentist for the mothers. A very high percentage of the patients need this attention, and it is to be hoped by careful supervision and timely treatment the young mothers will be saved much that their older sisters have suffered in pain and loss. Another way in which material help could be given to the mothers suffering in health through disease, or debilitated by child-bearing is in the provision of home helps before the actual confinements. The last few weeks of pregnanc-v drains the vitality of such patients and causes profound morbidity, which could be prevented. Yet another way in which morbidity could be reduced would be to permit the Municipal midwives to continue the nursing of patients discharged early from hospital. The midwives must now nurse their patients for 14 days, whereas many patients are discharged from hospital on the 10th, 9th, or even the 8th day. If these mothers could be given the services of the Council's midwives much debility could be prevented. Gynaecological Clinic. I am indebted to Miss Gladys A. Dodds, M.B., M.C.O.G., F.R.C.S.Edinburgh, Medical Officer in charge of the Clinic for the following report on the year's work:— 12 The complaints from which the patients attending the Gynaecological Clinic suffered may be summarised in the following way:— Menstrual Irregularities.— 49 patients reported at the Clinic on this account. 16 were found to be pregnant and were transferred to the Ante-natal Clinio; 6 had fibroids, 1 had' an ovarian cyst, and 1 had carcinoma of the uterus. All these patients were transferred to hospital for further treatment. Of the remaining 25 patients 5 were recommended to hospital for artificial termination of menstruation and 20 were treated at the Clinio. Displacement of the U terms.— 9 patients had retroversion. All were treated at the Clinic. 21 patients had prolapse. 12 were transferred to hospital for operation and the remaining 9 were treated at the Clinic. Inflammation of the Uterms and Appendages.— 35 patients with cervicitis were treated at the Clinic, and 3 were transferred to hospital for further investigations and treatment. 6 patients with general pelvic inflammation were recommended to hospital for treatment. Disorders of Menstruation.— 4 patients were referred to the Clinic for investigation of sterility and 3 patients for investigation of dysmenor rhoea. Minor Disabilities of the Menopause.— 16 patients complained of headaches, "flushings," giddiness, depression, etc. All were treated at the Clinic. Backache.— 19 patients had this symptom and no gynajcological cause was found to account for it. 3 were recommended to hospital for manipulation, and the remainder were either recommended to wear a suitable corset or to attend " Keep fit " classes. Hyperpiesia.— 6 patients with varying symptoms, but with only this one sign, were kept under observation at the Clinic. In some it appeared to be only of a temporary nature associated with the sudden cessation of menstruation. Breasts.— 4 patients came complaining of pain in the breasts. 2 of these had chronic mastitis, 1 had an early and 1 an advanced carcinoma. 13 Rheumatism.— A large number of patients complained of pains in joints and muscles. They were either treated at the clinio or transferred to a rheumatism clinio. Intestines.— 21 patients had symptoms referable to the intestine. 3 had symptoms of carcinoma and were transferred to hospital. The majority of the remainder were recommended to attend their own doctor for further treatment. Miscellaneous Group.— The remainder of the patients suffered from a variety of conditions such as diabetes, heart disease, varicose ulcers, fractures, anaemia, obesity and debility. The majority were transferred to their own doctor or to hospitals for treatment. INFANT WELFARE CENTRES. Centre. Sessions. Number of Attendances. Examined by Doctor. Infants Weighed. New Cases. Over 1 year. New Cases. Municipal Medical Centre, Lordship Lane 252 7,208 598 5,573 155 3,549 The Chestnuts, St. Ann's Road 255 7,897 673 6,501 129 3,589 The Town Hall 47 1,103 78 844 28 — Totals 554 16,208 1,349 12,918 312 7,138 I am indebted to Dr. Alice King, M.D., M.R.C.P., Medical Officer in charge of the Committee's Infant Welfare Centres for the following report:— The opening of the Municipal Centre in Lordship Lane in October was a happy event in the Tottenham Child Welfare world. That District now has a self-contained home of its own there and I think these structural conditions are conducive to a more intimate and friendly atmosphere than was always possible in the old quarters at Bruce Castle. 14 The "special" departments are next door to us and it is a great advantage for children with eye, ear, orthopedic or dental defectsto be given an appointment on the spot for these clinics. Mothers from both Lordship Lane and St. Ann's Road are saved journeys to hospitals and the consequent, often lengthy, waits in out-patients' rooms. As regards dental treatment, facilities for more conservative treatment among young children would be a great advantage. The parents of children requiring treatmant for enlarged tonsils and/or adenoids are practically always ready to take advantage of the existing arrangements for such cases with the Prince of Wales's and North Middlesex Hospitals. Where the services of a children's hospital for more general diseases are indicated, I am generally able to obtain such, both for in- and outpatients, at the Queen's Hospital for Children. Advantage, too, is taken of the facilities for admitting nursing mothers with their infants at the Queen's Hospital when the latter require in-patient treatment. The increase in the Health Visiting Staff has already resulted in the attendance at the clinics of a certain number of " toddlers " who have not been re-examined for lengthy periods and in the near future it is hoped that there will be facilities for reviewing this age-period at regular intervals. At both Centres there are now facilities to show, to greater advantage, the various displays of model clothing, specimen meals, etc., arranged by the health visitors. The Invalid Children's Aid Association, through its active local secretary, Miss Johnson, continues to give valuable aid to the department by arranging convalescence for a number of young children. 68 children were sent away for varying periods. 15 Defects Discovered at Infant Welfare Centre. Asthma 4 Bronchitis and Bronchial Catarrh 164 Post-Influenza 2 Whooping Cough 7 Post-Whooping Cough 6 Post-Measles 6 Broncho-Pneumonia 4 Post-Pneumonia 4 Congenital Heart Disease 5 Anaemia 45 Sub-normal Nutrition 83 Threadworms 36 Enuresis 38 Phimosis 165 Sub-acute Rheumatism 3 Umbilical and other Hernia 41 Dental Defects 84 Skin Naevus 22 Urticaria 99 Seborrhoea 101 Impetigo 21 Eczema 26 Dermatitis 12 Herpes 11 Boils 6 Septic Spots 64 Rash 53 Scabies 15 Eyes Conjunctivitis 28 Strabismus 20 Sticky Eye 51 Blepharitis 29 Coloboma 2 Meibromiam Cyst 10 Epiphora 1 16 Nose and Throat Nasal Catarrh 161 Otorrhoea 62 Enlarged Tonsils 164 Tonsillitis 27 Otitis Media 1 Enlarged Adenoids 36 Cervical Adenitis 10 Enlarged Glands 40 Gastric Disorders Diarrhoea 98 Stomatitis 52 Gingivitis 24 Anorexia 28 Intussusception 2 Deformities Genu Valgum 14 Bilateral Talipes 1 Rickets 14 Congenital Deformities 4 Contracted Tendons 1 Fractured Clavicle 1 Dislocated Jaw .. 1 Miscellaneous 150 Total 2,159 CHILD LIFE PROTECTION. During the year the Health Visitors in their capacity of Child Life Protection Visitors regularly supervised the registered foster mothers. In addition to the Home Visits the foster mothers with children under school age are encouraged to bring their charges to the Welfare Centres. The Medical Officer of Health and Health Visitors are thus kept in constant touch with the mothers and children. Number of Home Visits paid to Foster Mothers 218 Number of Foster Mothers registered 54 Number of Foster Children 64 17 SPECIAL CLINICS— CHILDREN UNDER 5. Clinic. Number of Consultations. Treatments. Minor Ailments 251 488 Dental 113 119 Orthopaedic 105 711 Ophthalmic 43 43 Ear, Nose and Throat 75 283 Artificial Sunlight 0 — Immunisation Schick Tests. Ill Immunized. 127 Total 698 1771 CONVALESCENT HOME TREATMENT. During 1937 the number of children under five admitted to Convalescent Homes through the medium of the Invalid Children's Aid Association was 68, and by arrangement with other Organisations 13. During the year 14 mothers participated in the Committee's scheme for the provision of Convalescent Home Treatment. HOSPITAL TREATMENT FOR CHILDREN UNDER 5 YEARS OF AGE. The arrangement with the Prince of Wales's General Hospital, Tottenham, for children referred from the Welfare Centres for consultation and treatment of Tonsils and Adenoids was continued during the year, and a new agreement has now been entered into with that hospital and the North Middlesex (County) Hospital for the treatment of such cases. A number of cases requiring urgent hospital treatment have been referred by Dr. Alice King from the Welfare Centres to the Queen's Hospital for Children and the Prince of Wales's Hospital, rhe parents making their own arrangements with the hospitals for treatment. 18 The following table sets out the number of cases referred for special hospital treatment under the Authority's scheme: — Tonsils and Adenoids Cases. Other Cases. Total. Prince of Wales's General Hospital. The North Middlesex (County) Hospital. Orthopaedic Hospitals. Eye Hospitals. Special Dietetic Treatment. Artificial Sunlight Treatment. 35 — *6 2 †1 5 49 * Still in residence, January, 1938—2. † Mother and infant. 19 INFANTILE DEATHS in Ages, Sexes and Localities, during the year 1937. CAUSE OF DEATH. Under 1 week. 1—2 weeks. 2—3 weeks. 3—4 weeks 1 Total under 4 we^ks. 1—3 months. 3—6 months. 6—9 months. 0—12 months Total Deaths under 1 year. Males. Females. Bruce Grove & Central. Chestnuts. Colcra ine. Qreen Lanes. High Cross. Park. Seven Sisters. Stamford Hill. Town Hall. West Green. White Hart Lane. Whooping Cough - - - - - - - 1 - 1 1 - - - - - - - - - 1 - - Diphtheria — — — — — 1 — — — 1 1 - - - - - - - - 1 - - - Bronchitis — — — — — 2 1 — — 3 1 2 1 - - - - - - - - 1 1 Pneumonia 4 2 2 6 14 6 5 8 1 34 26 8 - 3 4 2 3 7 2 - 5 2 6 Diarrhoea and Enteritis — — 1 1 2 7 5 4 2 20 10 10 2 - 1 2 - 1 5 1 5 1 2 Atelectasis 4 1 — 1 6 — - — — 6 4 2 - - 1 - 3 1 - - - 1 - Congenital Malformation 2 — 2 — 4 2 — — — 6 4 2 1 - - - - 1 - 1 1 2 - Premature Births 20 1 3 — 24 1 — — — 25 12 13 1 3 1 5 - 5 2 1 1 - 6 Atrophy, Debility and Marasmus 1 - - 1 2 1 2 1 - 6 5 1 - 1 1 2 - 1 - - 1 - - Other Causes 8 - - 2 10 3 8 3 - 24 17 7 1 3 4 7 2 3 2 — 1 — 1 Totals 39 4 8 11 62 23 21 17 3 126 81 45 6 10 12 18 8 19 11 4 15 7 16 20 DAY NURSERY. There is at present one Day Nursery situated in South Tottenham, but a second is shortly to be built for the benefit of mothers in the Northern part of the district. " Daily minding " of children under school age, whose mothers must go out to work is a problem in an area such as Tottenham. Very young children at the most important period of their life are all too often left with obliging neighbours with little or no supervision and deprived of sufficient fresh air, rest, exercise and suitable food. The Day Nursery accommodates 40 children, and is open between the hours of 8.30 a.m. and 5.30 p.m. from Monday to Friday. Number of children admitted: — Under 3 years (when admitted) 119 Over 3 years ,, 21 140 Average daily attendance 35.7 Number of days on which the Day Nursery was opened, 236; half days, 10. Quarter. Attendances under 3 years of Age. Attendances over 3 years of Age. Total. Whole-day Attendances. January to March 1,556 455 2,011 April to June 1,685 653 2,338 July to September 1,362 336 1,698 October to December 1,717 682 2,399 6,320 2,126 8,446* * In addition to this number there were 68 half-day attendances. 21 Midwifery Service— Midwives Act, 1936. Tottenham Maternity and Child Welfare Committee, being the Local Supervising Authority for the midwives in its area was called upon to provide an adequate midwifery service to meet the needs of women requiring the services of midwives or maternity nurses. In accordance with the terms of the Act, six whole-time Municipal Midwives wTere appointed in Tottenham as from August, 1937. In addition to these midwives employed directly by the Committee, the Maternity Nursing Association, in conjunction with the Royal Northern Hospital, accepts responsibility for 200 midwifery cases per year. The District Nursing Association has also expressed a desire to be included in the midwifery service. The district is divided into areas with a Municipal Midwife living in each. As far as possible every mother is given free choice of midwife. Each midwife has a partner who is responsible for the dual districts when her colleague is off duty or engaged elsewhere. Fees payable for the Municipal Midwifery Service are the same as for the private midwife. Fees are reduced only in necessitous cases. Post-Graduate Lectures. All the midwives avail themselves of the opportunity to attend a course of post-graduate lectures and demonstrations arranged at various teaching hospitals. Midwives' Duties. Every patient booked by a Municipal Midwife is advised to attend one of the ante-natal clinics or her own doctor for ante-natal supervision. A Municipal Midwife visits her patient in her own home during the ante-natal period and supervises the preparation for the coming confinement. 22 In normal cases after the birth of the baby each mother is visited twice daily for the first three days and once daily for the next eleven days. Ante-Natal Clinic. Every midwife in turn attends the Ante- and Post-natal Clinics. This procedure, enables her to meet her patients with the obstetrician in charge of the clinio and also keeps her up to date in all ante- and post-natal work. Post-Natal Examination. Every mother is invited to attend the Post-natal Clinic 6 weeks after the birth of the baby. The mother is supervised by a clinician until quite fit. Uniform. The grey uniform worn by the Tottenham Municipal Midwife is both distinctive and attractive. Supervision of Midwives by the Medical Officer of Health. The midwives, when on duty, attend at the Town Hall daily, in the afternoon, for the purpose of keeping records, booking of oases, etc. This enables the Medical Officer of Health and his staff to keep in close touch with them. That this service is appreciated and popular is shown by the following table:— From August 1st to December 31st, 1937— Number of deliveries by Municipal Midwives 165 Number of cases attended as Maternity Nurse 21 Number of nursings 2,617 Number of ante-natal visits 535 23 Conditions for which medical aid was sought: — Reason for Call. Number of Calls made. Total. Municipal Midwives. Maternity Nursing Assn. District Nursing Assn. Private Midwives. For Mother:— Obstructed labour 5 2 — 20 27 Uterine inertia — — — 1 1 Retained placenta, etc. 2 1 - 5 8 Placenta previa — — — — — Ante-partum haem. 2 1 — — 3 Post-partum haem. — — 1 1 Pyrexia 3 — — 2 5 Torn perineum 9 1 — 29 39 Abortion 2 — — 5 7 Ante-natal treatment — — — 1 1 Various 4 2 — 21 27 For Child:— Prematurity — 1 — 4 5 Ophthalmia 3 2 — 35 40 Skin eruptions — — — — — Convulsions — — — 1 1 Malformations — — — 2 2 Various 2 3 — 14 19 Total 186 Difficult Labour. Four consultants are available in cases of obstetric difficulty occurring in the home, upon the request of a medical practitioner. PUERPERAL PYREXIA. Four consultants are available for consultation required in the home at the request of the medical practitioner in charge of the case. A Special Consultant's Fee was paid in 1 cases. Hospital Treatment is also arranged for in suitable cases. 36 cases were notified, and the following table shows the final result in each case: — 24 PUERPERAL PYREXIA. In attendance at the Confinement. Total. Final Result. Doctors' Cases. Midwives' Cases. Occurred in Hospitals outside the District. Recovered. Died. 3 8 25 36 34 2 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 in attendance upon the mother. Maternal Deaths.—The Registrar-General's records show that 9 deaths were attributed to Tottenham. The Death Rate per 1,000 live and still births was :— From Puerperal Sepsis 1.47 From other Puerperal Causes 2.95 Total 4.42 MATERNITY AND NURSING HOMES. The number of Nursing Homes on the register at the beginning of the year was 1. (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 2 (viii){Closed voluntarily nil {Closed owing to removal from district nil (ix) Carried forward from previous year nil * Hospitals exempt for registration:— The Prince of Wales's General Hospital. The Home and Hospital for Jewish Incurables. 25 HOME HELPS. Assistance towards the services of Home Helps was granted in 56 cases. The time is not far distant when the Home Help will only be what the name implies, and not, as often happened in the past, assistant midwife. A trained Home Help is invaluable in the home. She cares for the house and family thus relieving the mother from household worry. At the Town Hall a list of suitable women who act in this capacity is supplied to expectant mothers and in necessitous cases the Maternity and Child Welfare Committee may pay for their services. 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 OPHTHALMIA NEONATORUM. 48 cases of Discharging Eye occurred during the year, 10 of which were notified as Ophthalmia Neonatorum. The following table shows the final result in each case: — In attendance at Confinement. Final Result. Doctors' Cases. Mid- wives' Cases. Occurred in Hospitals outside the District. Eyes Clear. Died. Removed. Unable to trace. Notified as Ophthalmia Neonatorum 10 2 5 3 8 1 1 Discharging Eye 38 — 35 3 38 — — Total 48 2 40 6 46 1 1 26 When necessary, provision is made for the admission of mother and infant to various hospitals, including St. Margaret's Hospital, Kentish Town. Arrangements with the District Nursing Association has been made for the home nursing of Ophthalmia Neonatorum: Exhibits connected with mothercraft are arranged at the Town Hall and the Centres. They included ideal clothing and food for expectant and nursing mothers, babies, toddlers and school children; dental and personal hygiene, model family diets. A health visitor is always in attendance to give helpful advice and listen with sympathy to a worried or anxious parent. SEWING CLASSES AND CLUBS. These are held at The Chestnuts and Lordship Lane Centres every week during the winter months. One session every month is of a purely social character. All sessions have been well attended during 1937. The members pride themselves on the general excellence of their work and take great delight in creating " something new from something old." The health visitor in charge usually gives a collective talk and demonstration followed by what is often a keen discussion. During these meetings the children are in another room, where they are minded by a paid helper. This arrangement is much appreciated as it gives the mothers a rest from the children and an opportunity for a chat and a cup of tea in comfort. A Health Exhibition was held in the Town Hall from November 29th to December 3rd, 1937, details of which appear in another section of the Report. "KEEP FIT'' CLASS FOR MOTHERS. The leader of the class is a trained certificated teacher, and holds the Physical Training Certificate (Reading University, 1921). The system of exercises follows the modern interpretation of the Swedish system and is used as a basis for recreative physical training. The work is recreative in character with a bias towards postural training. 27 For a number of reasons postural defects are most noticeable in women such as one gets from: — (i) General health disability (overwork in the home). (ii) Pre or post-maternity reasons. (iii) Post-operative. (iv) Lack of knowledge of body mechanics. With the close co-operation of the Child Welfare and Maternity Services in Tottenham, defects and ailments are known to the "Keep Fit" leader, who is in an excellent position to arrange and adapt the work accordingly. The class is held at the Central Library Hall, High Road, Tottenham, N.17, one afternoon per week : Wednesday, 2.45—3.45. The attendances average about 40 mothers per week The number of mothers on the register for 1937 was 105, and there was an average attendance of 40.8 The class is supervised by the Organiser for Physical Training for the Borough of Tottenham, who has affiliated all these classes to the Central Council of Recreative Physical Training. ASSISTED MILK SUPPLY. Assistance in the supply of milk is given to expectant and nursing mothers, and children under 5 years of age, where the income of the family is within the scale recognised by the Committee as a basis for the supply of milk free, or at less than cost price. The progress of recipients of the milk is noted at the Centres. 1,081 families were assisted during the year. The amount of milk distributed was 29,806 gallons of "Tuberculin Tested" pasteurised cow's milk and 367 lbs. of dried milk. ASSISTED MILK SUPPLY. Cow's Milk. Dried Milk. Cost. Average per day. Comparison with 1936. 1935. Average per day. Average per day. gallons. lbs. £ s. d. gallons. gallons. gallons. 29,806 367 2,846 3 7 82.5 82.1 84.5 28 INDIVIDUAL FAMILIES ASSISTED. Free. At HalfCost. Total Families. New Cases. Renewals from previous years. Monthly Renewals during 1938. Total Orders. 1,035 46 1,081 395 686 4,007 5,088 Participants. Expectant Mothers 278 Nursing Mothers 406 Children under 5 years 1,052 Other Foods to Expectant and Nursing Mothers. Mothers 102 Assistance given 366 lbs. of butter DENTAL SERVICE. There has been no adequate provision in the past for dental treatment of expectant and nursing mothers as an integral part of the Maternity and Child Welfare Services in Tottenham. During the year a few individual cases have been referred to the School Dental Clinics but where multiple extractions have been performed there has been no provision for supply of artificial dentures in necessitous cases. In the case of young children under the age of five years there is ample scope both for actual conservative treatment of the teeth find what is perhaps of even greater importance the need for acquiring early habits of regular inspection and dental hygiene through the propaganda methods of a preventive dental service. As the result of a report made to the Committee by the Medical Officer in July, 1937, a scheme for an adequate dental service has been approved to include :— (1) Co-ordination with the School Dental Service by contributing two-thirds of the salary of an additional full-time Dental Surgeon and by arrangement with the Education Committee to 29 undertake the inspection and treatment of young children referred from the Welfare Centres, Day Nursery, Nursery Classes and Nursery Schools and to reserve certain sessions solely for the treatment of expectant and nursing mothers at each of the school dental clinics. (2) The appointment of a part-time specialist anæsthetist on a sessional basis. (3) To provide for and equip a new Dental Clinic at the Committee's combined Day Nursery and Maternity and Child Welfare Centre shortly to be built on the site of Orchard House. (4) To supply artificial dentures in necessitous cases where so authorised by the Committee on the undermentioned approved scale of income. No. in Family. Free. Net income after deducting rent. Parents to Contribute:— ¼ cost when the income is above previous column and below:— ½ cost when the income is above previous column and below:— ¾ cost when the income is above previous column and below:— 1 16/- 21/- 26/- 31/- 2 30/- 35/- 40/- 45/- 3 42/- 47/- 52/- 57/- 4 52/- 57/- 62/- 67/- 5 60/- 65/- 70/- 75/- 6 or over 66/- 71/- 76/- 81/- (a) Only mothers in need of dentures whose family income comes within this scale will be permitted to benefit by the scheme. (b) The circumstances of mothers to be determined, and the amount of liability ascertained, before extraction of teeth is undertaken, 30 (c) Mothers coming within the scheme to be given the tunity of paying any contribution due from them by instalments, such instalments to be commenced at any time after the Committee has intimated its intention to provide dentures and to be completed before the dentures are actually supplied. (d) The necessary certificates of Dental Surgeon certified by the Medical Officer to be completed before artificial dentures can be supplied. GIFTS TO THE CENTRES AND DAY NURSERY. The Committee is indebted to the following donors for gifts during the year :— From The Tottenham League of Service for the Unemployed— £10 towards the provision of butter to expectant mothers whose husbands were unemployed, and £20 towards The Tired Mothers' Holiday Fund. The Mothers' Welfare Club also contributed £3 and The Coronation Fund £50 towards this fund. Gifts of Clothing or Toys have been received from the following: — From the Mayoress, Mrs. F. W. Cox; Alderman J. H. Morrell, J.P., and Mrs. Morrell; Alderman Mrs. W. A. Kent; Councillor Mrs. E. W. Coles. Generous gifts of infants' clothing have again been received as in former years from The Dorcas Society of the High School for Girls; Mrs. F. King (Seaford); The Rev. A. T. Morgan, M.C., M.A., Vicar of St. Ann's Church; and from The Knitting Guild through the Hon. Secretary, the Honourable Mrs. D'Arcy Hart. From Miss M. Y. S. Ward the gift of a shawl. INDEX. PART I.—Health Department. A PAGE Adulteration, etc 41 Ambulance Service 17 B Bacteriological Laboratory 17 Bakehouses 39 Births 9 Bread 39 C Cleansing 22 Clearance Areas 34 Clinics 18 D Deaths 10 Demolition of Premises 35 Diabetes 44 Diphtheria 43 Disinfection and Disinfes- tation 26 Drainage and Sewerage 22 F Factory and Workshop Act 28 Food and Drugs Act 41 Food. Unsound 40 H Health Services 17 Hospitals 19 Housing 30 I Ice Cream 39 Infant Mortality 10, etc. Infectious Diseases 15 & 43 L Laboratory 17 M PAGE Milk Supply 38 N Non-notifiable Infectious Diseases 44 North Middlesex Hospital 19 Nursing in the Home 18 0 Overcrowding 33 P Population 9 Propaganda 19 R Rateable Value 9 S Sanitary Circumstances of the Area 22 Scarlet Fever 43 Shops Acts 24 Slaughter-Houses 39 Small Dwellings Acquisition Act 23 Smallpox 44 Smoke Abatement 26 Social Conditions 9 Staff 3 Swimming Baths 26 T Treatment Centres 18 Tuberculosis 44 U Unsound Food 40 W Water 22 PART II.—School Medical Department. A PAGE Attendance Officers 25 Aural Clinic 13-15 B Baths, School 24 Blind Children 27, 48 C Child Guidance 40 Clinics 8 Convalescent Home Treatment 26 Co-ordination of Services 7 D Deaf, School for 31-32 Deafness 13-15, 47 Dental Defects 15-16, 46, 47, 53 E Ear Diseases 13 Epileptic Children 28,48 Examinations by Medical Officers 39 Exceptional Children 47-49 External Eye Diseases 12 F Findings of Medical Inspection 10 Following-up 20 Food Accessories and Drugs 39 H Hayling Island 30 Hearing 13 Heart Disease 19 Hygiene, School 6 I Immunisation 22 Infectious Diseases 21 Institutional Treatment 27 Invalid Children's Aid Association 26 M Malnutrition 10,47 Meals, Provision of 24-25 Mentally Defective Children 28, 33, 48 Milk Supplied 25 Minor Ailments 11,46 Myopic School 33 N PAGE Nervous Disease 19 Nose and Throat 12 Nursery School and Classes 36 Nutrition 10,47 0 Oak Lodge Special School 32 Occupation Centre 28 Open-Air Centre 34 Open-Air Class 35 Open-Air Education 22 Orthopaedics 16, 52 Otorrhoea 13 P Parents, Co-operation of 25 Parents' Payments 38 Physically Defective School 32 Physical Training 23 Play Centres 24 Population, School 4 Postural Defects 16,52 Propaganda 40 R Remedial Exercises 17 Residential Schools 27-29 Rheumatism 19 Ringworm 12, 22 S Scabies 12 School Journeys and Camps 23 Secondary Schools 37-38,41 Skin Diseases 11, 46 Speech Defects 19 Special Schools 29 Staff 3 Statistics 41-53 Sun Trap School 30 Swimming 24 T Teachers, Co-operation of Tonsils and Adenoids Tuberculosis 19, 48 V Verminous Conditions 11, 53 Vision 12, 51 Voluntary Bodies 25 PART III. Maternity and Child Welfare. A PAGE Ante-Natal Clinics 3,8-11 Assisted Milk Supply 27, 28 Attendances—Centres 8, 13. 15-17 Accouchement Bags 25 B Births 6, 7 Breast Feeding 8 C Chairman 2 Centres 3 Centres—Attendances 8, 13, 15-17 Clerk of Committee 2 Clerical Staff 5 Child Life Protection 16 Convalescent Home Treatment 17 Committee 2 Co-ordination 6 Chestnuts, The 3, 8-13 Cost, Maternity & Child Welfare Services 6 D Day Nursery 3,5,20 Defects—Schedule 15 Dental Service 17,28 E Ear, Nose, Throat 17 F Foster Mothers—Registrations 16 G Gifts 30 Gynaecological Clinic 3,11 H Hospital Treatment 17, 18 Home Visits 7 Health Visitors 4,7 Home Helps 25 I PAGE Infant Welfare Centres— Attendances 3 Infant Welfare Centres— Schedule Infant Defects 15 Infantile Deaths 19 Invalid Children's Aid Association 14,17 Immunisation 17 K Keep Fit Class 26 L Lectures to Mid wives 21 Lordship Lane Municipal Medical Centre 3,8-13 M Maternal Mortality 24 Maternity and Midwifery Services 21, 22 Maternity Hospital Service 7 Medical Sessions 3, 8, 13 Medical Aid 23 Medical Officer 2,4 Mothercraft Classes 26 Municipal Midwives 3-5 Midwives' Fees 21 Minor Ailments 17 N North Middlesex Hospital 7,17 Nursing Homes 24 0 Ophthalmia Neonatorum 25 Orthopaedic 17 P Puerperal Pyrexia 23, 24 Post-Natal Cases 8, 22 S Special Clinics 17 Sewing Class 26 Staff 4,5 Still Births 6 Statistical Information 6 Schedule 15 Supervision of Midwives 4, 21, 22 T Town Hall Centre 3, 13 V Voluntary Association— Midwives 5 Vice-Chairman 2 W Welfare Centres—List of 3