CI AC.439(1) TOTTENHAM PUBLIC Health Dept. REPORTSS COLLECTION COPY TOT 13 Borough of Tottenham ANNUAL REPORT of the MEDICAL OFFICER OF HEALTH 1939 BOROUGH OP TOTTENHAM Annual Report of the Medical Officer of Health. 1939. 1 To the Mayor, Aldermen and Councillors of the Borough of Tottenham. Mr. Mayor, Ladies and Gentlemen, I have the honour to submit to you my Annual Report upon the Health Services of the Borough for the year 1939, in a very abridged form owing to much additional pressure of work in connection with Civil Defence. The Ministry of Health have, in fact, directed that during the period of War, the Annual Reports of Medical Officers of Health should be curtailed as far as possible and confined to the presentation of essential material. The outbreak of the War in September, 1939, came at the end of a year marked by highly satisfactory conditions from a health point of view, with the lowest Infantile Mortality Rate in the Borough's history of 37.95, a General Death Rate of 10.3, and a year completely free from serious outbreak of infectious disease. After the first few weeks of necessary adjustment to War conditions, the Health Services of the Borough generally returned to their pre-war level, except for the cancellation of a Public Inquiry which was to be held in October concerning Clearance Orders under the Housing Acts with respect to 8 areas; and. the building of a new Municipal Medical Centre by the Education Committee' at Cornwall Road. The building of the New Municipal Day Nursery and Medical Centre at Park Lane was, however, well advanced, and since its official opening early in 1940, has proved to be a valuable asset to the Medical Services which have been extended rather than limited by War Conditions. No details can be given in this Report of additional duties in connection with the Casualty Services, war damage repair of residential property, Billeting. and Care of Per ons rendered homeless as the result of enemy action, the organisation for which took up.much time of the Department in the early months of the War. In conclusion, I wish to thank the members of the Borough Council for their support and encouragement, and to record my highest admiration of the excellent team spirit shown by my staff under extremely trying circumstances. I have the honour to be, Your obedient Servant, Gsaillani Aogham Medical Officer of Health. Town Hall, Tottenham, N.15. 1st March, 1941 2 STATISTICAL_SUMMARY. ETC. Area of the District in acres 3,014 Registrar-General's estimate of resident population, mid-year 1939, for calculation of:- (a) birth rates 142,400 (b) death rates or the incidence of notifiable diseases 136,000 Number of inhabited houses (end of 1939) according to Rate Books 30,816 Rateable value £991,496 Sum represented by a penny rate £ 3,975 * The large movement of population arising out of the. war situation and the calling-up of men for military service, made it necessary for the Registrar General to ma :o special arrangements for dealing with statistics relating to non-civilian deaths and transferable births and deaths. Accordingly, after the 30th September, 1939, deaths of persons temporarily residing away, from home were assigned to the area of temporary residence. Transferable Births were dealt with normally for purposes of birth rates, but for calculating infant and maternal mortality, a similar arrangement was made to that adopted for deaths. Populations are likewise given - (a) for calculation of birth rates. (b) " " " death rates or the incidence of notifiable diseases. Births and Deaths . Registered live births:- Total. Males . Females. Legitimate 1,696 849 847 Illegitimate 80 42 38 1,776 891 885 Birth Rate per 1,000 estimated population 12.5 Total live births for calculation of Infant Mortality rate, etc. 1,739 874 865 Still Births .59 28 31 Stillbirth Rate per 1,000 total (live and still) births. 32.2 Deaths (MaL es 716 (Females 690 Total 1,406 Death Rate per 1,000 estimated population 10.3 Maternal Deaths Deaths. Rate per 1,000 total (live and still) births. Puerperal sepsis 1 0.55 Other puerperal causes 3 1.67 4. 2.22 Death Rate of Infants under one year of age:- All infants per 1,000 live births 37.95 Legitimate infants per 1,000 legitimate live births 36.1 Illegitimate infants per 1,000 illegitimate live births 75.95 Deaths from Cancer (all ages) 209 Measles (all ages) Whooping Cough (all ages) 3 Diarrhoea (under 2 years of age) 3 3 Table of Deaths during the Year 1939 in the Borough of Tottenham, classified according to Diseases. Cause of Death. Males Females Totals Typhoid & paratyphoid fevers. Measles. — - - Scarlet Fever. - — - Whooping Cough.1 2 1 3 Diphtheria. ~ 1 1 Influenza. 6 6 12 Encephalitis Lethargica. - 1 1 Cerebro-Spinal Fever. - 1 1 Tuberculosis of Respiratory System. 55 36 91 Other Tuberculous Diseases. 6 3 9 Syphilis . 1 - 1 General Paralysis of the Insane Tabes Dorsalis 5 2 7 Cancer, Malignant Disease. 116 93 209 Diabetes. 4 6 10 Cerebral Haemorrhage, etc. 36 35 71 Heart Disease, 195 244 439 Aneurysm. Other Circulatory Diseases. 29 52 61 Bronchitis . : : 51 45 96 Pneumonia (all forms). 42 51 93 Other respiratory diseases. b 4 10 Peptic Ulcer. «■» - Diarrhoea, etc. 2 1 3 Appendicitis . - 2 2 Cirrhosis of Liver, etc. 1 1 2 Other Diseases of Liver etc. 2 1 3 Other Digestive Diseases. 24 19 43 Acute and Chronic Nephritis. 27 18 45 Puerperal Sepsis. — 1 1 Other Pue rpe ra 1 Caus es , - 3 3 Congenital Debility, Premature B irth, Ma 1 f o rma t ions . 19 15 34 Senility. 10 8 18 Suicide. . 10 7 17 Other Violence. 38 25 63 Other Defined Diseases. 29 28 57 Causes ill-defined or unknown. 716 690 1406. (4) Table of cases of Infectious Disease coming to the knowledge of the Medical Officer of Health during. the year 1939 in the Borough of Tottenham, classified according to Diseases and ages. Notifiable Disease. Males .Females. Under one . 1-2 2-3 3-4 4-5 5-10 10-15 15-20 20-35 35-45 45-65 65 & over. Total remove to Isolation Hospital by Council Scarlet Fever. 156 179 1 6 16 19 32 156 70 10 16 8 1 - 154 Diphtheria. 32 28 -- 2 2 6 6 25 5 5 9 - - - 54 Pneumonia. 55 31 - 2 2 2 1 10 3 7 11 12 28 8 - Erysipelas. 19 8 1 1 - - - - - 2 4 3 14 2 7 Puerperal Pyrexia. - 15 - - - - - - - - 14 1 - 4 Dysentery. 4 2 3 - - 1 1 - - 1 - - - - - Ophthalmia Neonatorum. 3 3 6 - - - - - - - - - - - - Cerebro-Spinal Meningitis 1. 3 - 1 - -- - - 1 - 1 1 - - 2 Poliomyelitis. - 1 ■ - - - - - 1 - - - - - - - Food Poisoning. 1 1 - - - - - -- - - - - ' 2 -- -- Whooping Cough. 1 1 - 2 - - - - - - ■ - - - - - Measles. 2 1. - 2 - 1 - - - - - - '• - - 1 Pulmonary Tuberculosis 102 80 o 1 - 1 4 3 24 75 30 39 2 - Other forms of Tuberculosis . 14 16 - - - 2 1 5 3 4 8 4 - 3 - - Totalst- 390 369 11 19 21 31 42 201 85 53 138 59 87 12 222 (5) . Infantile Deaths in Ages and Sexes during the year 1939. Cause of Death. Under 1 week. 1-2 , weeks •2-3 weeks . 3-4 weeks . Total , under 4 weeks 1-3 months 3-6 . months . 6-9 months 9-12 months . Total deaths under 1 yr Males. Females. Whooping Cough. - - - - - 2 1 — _ 3 2 1 Mening it is . - - : - - - 1- 1 - - 1 - 1 Bronchitis . - - - - - - 1 1 - 2 - 2 Pneumonia. 1 1 1 - 3 5 2 2 1 13 6 7 Diarrhoea & enteritis. • - - - - - 2 1 . - - 3 3 - Atelectasis. 1 - - - 1 - - - - 1 1 - Premature Births, congenital malformation, etc. 22 2 1 1 26 2 2 - -. 30 18 12 Other causes. 1! ' 9 ^ ; 1 - - 10 1 - - 2 13 7 6 33 4 2 1 40 12 8 3 3 66 37 29 6 GENERAL PROVISION OF HEALTH SERVICES. LABORATORY FACILITIES . The following is a statement of the examinations made during the year. Swabs examined for Diphtheria:- Positive, 50; Negative, 1,858. Specimens of Sputa examined for Tuberculosis;-Positive,18; Negative,142 Virulence tests, Diphtheria;- Positive,1; Negative, 2. Stools examined for Dysentery:- Positive, 1; Negative, 5. Swabs examined for Haemolytic Streptococci:- 2 (Negative) AMBULANCE FACILITIES. The Council possess five motor ambulances which are used for accident and non-infectious cases, and two busos for conveying children to special schools. Until September, the ambulance service was under the supervision of the Chief Officer of the Fire Brigade, but at the commencement of hostilities, the control of this service was transferred to the Medical Officer of Health. Total mileage to date 1,139,645 Number of street accidents and illnesses for the year 703 The oxygen resuscitator was used on 10 occasions. SANITARY CIRCUMSTANCES -. WATER SUPPLY. The Borough water supply, controlled by the Metropolitan Water Board, has been satisfactory in all respects. SANITARY INSPECTIONS. Houses inspected for defects under the Housing and Public Health Acts totalled 3,426, and of this number, 1,229 were inspected under the Housing Consolidated Regulations. No. of houses inspected 3,426 Drains examined and tested 494 reconstructed 92 „ repaired 144 found 3topped 180 Soil pipes repaired or renewed 179 Gullies renewed 97 Fresh air inlets renewed 72 Rain water pipes, wastes, etc., repaired or renewed.569 Roofs repaired or renewed 943 Gutters repaired or renewed 430 Drinking water cisterns repaired or renewed 76 No. of houses where water was provided from the main. 51 W.C. cisterns and pans repaired or renewed. 398 Yard paving repaired or renewed 295 Sinks repaired or renewed 178 7 SANITARY CIRCUMSTANCES (CONTD) Floors (wood and concrete) repaired or renewed 434 Floors (ventilated) 206 Window frames and sashe3 repaired or renewed 846 Window frames and sashes painted 134 Coppers repaired or renewed Ill Fireplaces, stoves and ovens repaired or renewed 478 No. of houses where walls and ceilings were cleansed.2685 Accumulations of refuse removed 66 Miscellaneous defects remedied 861 Reinspect ions in connection with the 3,426 houses inspected, totalled 9,889. During the year 51 complaints relative to the provision of dustbins were referred to the Cleansing Superintendent. Damp proof courses were inserted in 516 houses, 337 houses were pointed, 208 houses rendered externally, and 72 food stores were provided or repaired. Other inspections were:- Inspections of Gommon L0dging Houses 12 „ Stables and Mews 145 School Lavatories 15 11 Pawn Shops 11 Public-house Urinals 115 Brooks . 13 „ Knackers Yards 6 Interviews with builders and owners 993 Rooms inspected after disinfection 353 Miscellaneous Inspections 1221 Staircases lighted 9 Repair of Houses by the Council. In 83 instances repairs were executed at properties, the amount involved being £843. 4. 2. Smoke Abatement. 110 observations of chimneys have been made turing the year and 6 preliminary notices and 1 Statutory Notice wero served. Infectious Disease. 578 visits were made by the Sanitary Inspectors to houses where infectious cases had been notified. 6,953 articles were disinfected at the steam disinfector. 505 articles were destroyed at the request of the owners. Terminal disinfection of rooms is carried out with the Formalin Spray:- 343 rooms were disinfected after Scarlet Fever. 69 „ „ „ „ Diphtheria 145 „ !l „ „ Tuberculos is . 298 '' „ '' „ verminous & miscellaneous cases . 5 Wards or Schoolrooms were disinfected. 221 Library Books were disinfected with Forme,Idehyde Gas The Disinfecting Station is provided with two baths, which were used 50 times by patients suffering from Scabies. Bedding and clothing belonging to patients suffering from Scabies were treated in the steam disinfector. In addition, the blankets, pillows, etc., used by A.R.P. personnel wero disinfected from time to time., and there were 7,754 such articles disinfected during the year. 8 SHOPS ACTS; . The Shops Acts are administered by two whole-time officers. Attention is drawn to the „Young Persons (Employment) Act, 1938. „ This is an act to regulate the hours'of employment of persons under the age of.18 years employed in certain occupations which are not covered by the Act of 1934; to amend the Shops Act, 1934, with respect to the regulation of the hours of employment of persons under the age of 16 years, and with respect to the determination of the number of working hours of persons under the age of 18 years; and for purposes connected with the matters aforesaid. During 1939, 19 first or warning notices and 6 final notices were issued in respect of contraventions of the Acts. Legal proceedings, were taken, in 3 instances. Pines were inflicted in two cases, one was dismissed under the Probation of Offenders Act. INSPECTION OP FACTORIES., ETC . 1. Inspection of premises. Number of Inspections. Written Notices . Prosecutions Factories with mechanical 'power. 356 19 - Factories without mechanical power. 129 7 - Other premises under the Act 97 2 - 502 28 - 2. Defects. Found. Number of Defects. No.of defects Found. Remedied Referred to H.M. Inspector which Prosecutions were instituted Want of Cleanliness. 11 11 - - Overcrowding. - — — - Unreasonable Temperature — - — - Inadequate Ventilation. - — — - Ineffective Drainage of Floors. - - - - Sanitary Conveniences - Insufficient. - — Unsuitable or Defective 3 3 - Not Separate for Sexes . 2 2 - — Other Offences. 12 12 - - Total. 28 28 - - 3. Outwork In Unwholesome Premises. Nature of Work Instances Not ices served. Prosecutions. Wearing Apparel (Making.) 7 7 - Curtains and Furniture hangings. 11 11 - 18 18 - HOUSING. (9) Number of houses erected during the year:- By. private enterprise 28 houses, 46 flats. By Tottenham Council 26 houses. During the year Clearance Orders were prepared with respect to 8 areas, comprising 132 premises. The Public Inquiry in relation to these Orders, arranged by the Ministry of Health to take place in October, was subsequently cancelled owing to the outbreak of War. Further Clearance Orders involving 200 premises, were also In course of preparation. All these schemes are now in abeyance for the far period. The Council's Scotland Green Housing Estate, comprising 36 dwelling-houses, was completed (with the oxception of 6 houses) towards the end of the year, and occupiers of houses in Clearance Areas previously confirmed by the Ministry of Health wero rehoused on this estate. , In addition, the Council were about to accept a contract for the provision of 216 flats on the Allington Estate, but this contract is also in abeyance. The rehousing of tenants in confirmsd Clearance Areas was not affected by this position, as the Scotland Green Estate was sufficient to accommodat e-all outstanding cases. 45 promises in Clearance Areas were demolished during the year. Informal Notices served numbered 2.301, and Statutory Notices served under various sections of the Public Health and Housing Acts numbered 454. INSPECTION AND SUPERVISION OF FOOD. MILK SUPPLIES. There are no farms or cowsheds in the district. The number of persons registered as reatil purveyors of milk during the year was 13, 137 visits were paid to these premises. Two samples of milk were examined at the County Laboratories for bacteriological purity, and several samples were subjected to the methylene blue tost in our own laboratory. MILK (SPECIAL DESIGNATIONS) ORDERS, Z 36 and 1938. These designations may only be used under a licence from the local authority. In 1939, the following licences were granted Tuberculin Tested Milk Licences:- 3ottlers' Licences 2 Dealers' Licences 14 Supplementary Licences 3 Accredited Milk Licences Bottlers.' Licence 1 (10) Pasteurised Milk Licences:- Pasteurisers' Licences 3 Dealers' Licences 14 Supplementary Licences 5 MEAT AND OTHER FOODS. There are 6 licensed slaughterhouses in.,the district, and one of these carries on a large wholesale trade. 582 inspections were made, and the number of animals slaughtered was 13,768, made up as follows:- Bovines - 930. Sheep - 5,239 Swine - 7,599. Summary of Diseased Meat dealt with at Slaughterhouse os and Shops. Swine.- 25 Carcases; 239 Heads; 101 sets Lungs; 106 Livers 49 Mesenteries; 1 Spleen. Sheep.- 2 Carcases; 158 Livers; 111 sets Lungs; 2 Hearts. Bovine.- 8 Heads; 15 sets Lungs 10 Livers; 3 Tongues; 2 Mesenteries 334 visits wore paid to Butchers' Shops. 149 „ „ „ „ „ Fish Shops . 218 „ „ l! „ Fruiterers ' Shops 112 „ „ i! „ Ice Cream Shops & Factory. 131 „ 11 „ „ Bakehouses. ' There are 4 basement bakehouses in the district, and when reviewing these under Section 54 of the Factories Act, 1937, it was decided to give the occupiers of 3 of these premises notice that the Certificate issued under the Factory and Workshop Act, 1901, would cease to have effect in July, 1940. Miscellaneous Unsound Foodstuffs dealt with 219 lbs. beef; 21 tins corned beef; 17 tins ham; 19 lbs. pressed ham; 39½ lbs. gammon; 31 lbs. bacon; 5 tins chicken & ham roll; 2 tins jellied veal; 6½ stone cod; 1 box whiting (6 stone); 1 stone dog fish; 8 stone skate; 5 stone coley; 2 boxes lobsters; 1 box crabs; 4-1 galls, peas; 14 tins baked beans; 10 lbs. apple rings; 17 boxes tomatoes. Adulterat ion, etc . The County Medical Officer of Health regrets, that owing to depleted clerical staff and other difficulties associated with the war, he is not in a position to furnish the usual information regarding samples taken in Tottenham. PREVALENCE OF, AND CONTROL OVER, INFECTIOUS AND OTHER DISEASES. Scarlet Fever. The number of cases notified was 335. Of this number, 167 were removed to Isolation Hospital. Diphtheria. The number of notified cases was 60 Colidared with 221 in 1938. 1 Death occurred from this disease. (11) Immunisation is carricd out by two doses of alum precipitated toxoid, 0.1 cc. followed three wooks later by 0.5 cc. Total attendances 6,165 Schick tests. 1,701 Cases completed 1,379 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 73,908, and the cost was £18. 13. 6. Reports upon the progress of the cases were furnished to the Ministry according to their requirements. With the Ministry's sanction, one patient suffering from Anaemia was supplied with Ventraomon Powder at a cost of £5. 8s. Od. Tuberculosis. The County Council are responsible for the treatment of Tube rculosis. 212 notifications were received during 1939 - Pulmonary, 182; other than Pulmonary, 30. Cases remaining on the register at the end of the year were; Pulmonary, 562; Non-Pulmonary, 150. 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.; Wednesday, Women, 10 a.m.; Thursday, Children, 10 a.m. Friday, Men, 10 a.m. Cases who are working and unable to attend any other day - Saturday morning. TUBERCULOSIS . Age Periods. New Cases . Deaths. Pulmonary Non-Pulmonary. Pulmonary Non-Pulmonary Males Females Males Females Males Females Males Females Under 1 year, » „. 1 1 to 5 years 3 2 1 2 2 — 1 5 to 15 „ 5 2 3 5 2 1 1 1 15 to 25 „ 16 27 3 5 5 16 1 1 25 to 35 „ 34 22 2 2 10 8 1 35 to 45 „ 15 15 3 1 8 4 1 45 to 55 „ 21 6 1 11 4 55 to 65 „ 8 4 1 1 12 1 1 1 65 years & upwards. - 2 - - 5 1 - Totals 102 80 14 16 55 36 6 3 (12) Organs affected (New Cases ):- Males. Females. Lung. 102 80 Glands. 1 7 Spine. 1 1 Meninges. 1 - Peritoneum - 2 Intestines. 1 . 1 Kidney. 2 - Ankle. 1 - Knee . - 1 Hip. 2 1 Shoulder . 1 — Arm 1 Wrist. 1 1 Generative Organs 2 2 116 96 The deaths represent a death rate of 0.74 per 1,000 population. In 23% of the fatal cases no previous notification had been received. There was, however, no suggestion of wilful neglect or refusal to notify, and accordingly no proceedings were taken. BOROUGH OF TOTTENHAM Education COMMITTEE i THE THIRTIETH ANNUAL REPORT of the SCHOOL MEDICAL SERVICE 1939 1 Changes (whether additions, depletions, or replacements) in the staff of the service. „ The staff of medical and dental officers remained unchanged. It was however necessary for the medical officers to devote considerable time to Civil Defence duties. The School Medical Officer and his Deputy were responsible for the administrative portion of this work, and the Deputy and Assistant Medical Officers were engaged in training personnel of Ambulance Depots and FirstAid Posts. Each reception area containing Tottenham school children was visited by the Committee's medical officers and dental surgeons, and a number of these districts received repeated visits. Six nurses and a dental attendant on the staff of the Committee accompanied school children to the reception areas on September 1st and remained there in order to assist with treatment, nursing and medical inspection. They also carried out general cleanliness inspections, undertook cleansing of children, and visited them in their billets. The arrangements for medical, dental and cleanliness inspections in iorce since tne end or August. Routine medical Inspection of children who came within the prescribed age-groups and who were in attendance at the three reopened schools was carried out In December. All boys and girls due to leave school at Christmas were also examined and medical reports forwarded to the Juvenile Employment Bureau. Children attending all Home Service Classes and schools were Inspected by the school dental surgeons, and treatment was carried out whenever accepted. Every Home Service and school class was periodically visited by school nurses, who carried out frequent general cleanliness inspections and cleansed children In these few instances where this procedure was necessary. The nurses also continued with the work of followingup children in their homes. Any additions to or curtailment of the arrangements for the various forms of treatment or the provision of solid meals or milk! (1) Treatment. On the outbreak of war all clinic premises were commandeered lor civil defence purposes, but on September 12th the Lordship Lane Centre, which had been requisitioned as an ambulance and stretcher party depot, was vacated. The Minor Ailments and two Dental Clinics were then immediately re-opened at this Centre and continued to function without interruption. Owing to the continued occupation of the Chestnuts and Town Hall Centres by First-Aid personnel, clinic facilities were no longer available in the southern portion of the district. To meet this deficiency a temporary dental clinic was set up on September 27th in the vacant premises of the West Green Road Day Nursery. Work at Aural, Ophthalmic, Orthopaedic, and Remedial Exercises Clinics was resumed early in October and by the end of the year special clinic services were available as follows:- Ophthalmic Clinic - one session each fortnight (previously two sessions per week) Aural Clinic - One weekly ses£ion (previously two sessions per week) Orthopaedic Clinic - onee monthly. Remedial Exercises Clinic - three sessions per week (previously seven sessions per week) (2) Provision of solid meals and milk. Early In October four feeding centres were re-opened and here all necessitous children received a hot mid-day meal and two thirds of a pint of fresh milk daily. On the institution of Home Service Classes milk was supplied to all children in attendance, free of charge in necessitous cases. Similar arrangements were made for the pupils attending the re-opened schools. 2 The Director of Education reports that during the last year the numbers of children receiving meals and milk have fluctuated very widely and it is impossible to make an accurate generalisation over the period„ (a) Meals In July roughly 1610 free meals were served each day, and in the course of the month 300 meals were served, mostly on payment, in the special schools. The monthly average number of children receiving free dinners daily during the period of normal working, January to August, 1939 was 1768. From September to Christinas the average number of children In receipt of free meals was 250. With the re-opening of some schools in the new year that figure rose sharply to about 400. The total number of meals served during the year was 250,036, of which 248,516 were provided free. Plans were in readiness for the centralisation of the meals service after the summer holiday, but the operation of the scheme had to be postponed owing to the outbreak of war. (b) Milk r In the Christmas holiday 1938/39, the experiment was started of serving milk at the nine meals centres. This was continued in later holidays and at Whitsun centres were also established in four public parks. Through these facilities about 40% of the children normally receiving free milk wore supplied while the schools were closed, but only about 8% of the children who took milk oh payment in term time took advantage, of this plan to receive .it during the holidays. Under the emergency home service education scheme in November and December, approximately 1,500 children received milk daily on payment and 92 free of charge. Before the home service scheme the 250 children having dinners were also, having milk. Under the present scheme (March 1940) 5380 children are having milk on payment and 467 free, The' monthly average number of childrern receiving free milk during the period of normal working, January to August, 1939, was 1445, and the total number of bottles of free milk provided during the year was 274,101. Part played by the Medical Staff in the Evacuation arrangement. Prior to their departure for reception areas a number of children were examined by the school medical officers and nurses in order to determine their fitness or otherwise for evacuation. Certified Special Schools. Vale Road School for Physically Defectives, The pupils and staff of this school were evacuated to the Civil Service Camp, Gorton, Near Lowestoft. Later in the year the senior boys 7were transferred to Golden Sands Camp and senior girls and younger children were removed to Horsley's Green Camp, Stokenchurch. Bucks. School for the Deaf, The personnel and pupils of the School for the Deaf were evacuated to Kessingland Camp, Nr, Lowestoft, and subsequently transferred to Gilestone Camp, Barry, South Wales. Mental Defectives A number of Tottenham children attending Oak Lodge Special School accompanied a party from this institution to Hopton Camp, near Lowestoi All these d ay special schools were thus transformed into residential institutions. 3 Reconstruction of School Buildings. The Director of education reports that the extensive building programme of reconstruction would have allowed, but for the outbreak of war, the completion the re.organisation scheme on Hadow lines and provided complete modern facilities for all children from the nursery stage to the new school leaving age of 15. As it is, all but three of the buildings under construction or reconstruction have now been completed. The most careful attention has been given to the health of the children in this building programme. Both natural and artificial lighting has been greatly improved; the central heating has been modernised and a domestic hot water supply installed; the conveniences have been modernised and are connected with the school buildings by covered ways; medical rooms with waiting accommodation where possible have been provided and full modern facilities for the feeding of necessitous children have been included in the plan for each school concerned. Details of the construction of gymnasia, changing rooms and shower baths are given in the section of this report on physical training All these features have rendered possible the highest standards of cleanliness and health in the daily conduct of the school. In all the modernised or reconstructed school buildings, nursery classrooms have been incorporated. There are now nine schools with such Nursery Wings, planned, to provide all that is needed for the fullest physical and mental development of the child under five. They afford a maximum of light and air, and there is in five cases an outdoor playing space, distinct from the infants' playground, including a sand.pit, lawn and flower beds, and providing space for a climbing apparatus. In one case there is also a paddling pool. MEDICAL INSPECTION. Routine. Up to the end of July routine medical inspection of all statutory age.groups v. as carried out. At Vale Road Nursery School and Lancasterian Nursery Classes routine inspections took place each term in accordance with existing arrangements. On the resumption of education in the elementary schools early in December all children in attendance who came within the prescribed age.groups, together with the pupils due to leave at the end of the term, were examined. Special. Besides the routine age.groups 6670 special cases were examined. FINDINGS AND TREATMENT OF MEDICAL INSPECTION. Nutrition. 1,068 children have attended the Nutrition Clinics, which are held"on two sessions per week, Children whose nutrition was below standard or who were considered to require extra nourishment were referred to these clinics by medical officers, school nurses, teachers and attendance officers. The home circumstanoes of these children were carefully investigated and noted, and records of periodic weighing and mearuring have been kept. Instructions concerning diet and hygiene were given to parents, who were encouraged to take an interest in these matters. Feeding centres were visited by the School Medical Officers on 17 occasions, and dietaries have been submitted to the School Medical Officer throughout the year. As a result of close co.operation between this office and the Social Services Officer who is responsible for the dietaries it has been possible to add more variety to the menus than was formerly displayed, without detracting from the food..vs.lue of the meals served. Uncleanliness. The total number of examinations of children at the cleanlriidbo "scurvey conducted by the school nurses was 65,269. In 969 pediculior nits were detected. At the school clinics 261 children were dealt with and 48 verminous children were cleansed by the school nurse Clothing is generally suitable and clean. Footgear in a small number of cases was found to be unsatisfactory„ Minor Ailments. Except for the continuation of the high incidence of scabies there"was little variation from defects which have been noted in previous years, bronchial catarrh, debility, impetigo, and injuries forming the bulk of the cases dealt with. 4 Scabies, The incidence of scabies showed still further increase towards the 'end of the year under review, when a large number of children who had returned from the recention areas were found to have contracted this disease. The rilment was then passed on to adult members of the family who could not be inspected and who in many instances sought no treatment.. School children and younger members of the family known to be suffering from the disease by officials of the Maternity and Child Welfare Department received treatment' by bathing and the application of various medicaments at the School Clinic. As soon as a cure was effected personal clothing and bedding were disinfected, but re.infection was frequent and could often be traced to contact with affected adults in the home. r . Much of the labour expended in treating school children suffering from scabies is therefore wasted, and until means have been devised for the detection and treatment of affected adult members of the household, there appears to be ;.ut little prospect of obtaining good results from the remedies applied to the school population. Ringworm. Of the three cases of ringworm of the scalp dealt with, two received X.Eay treatment at the North Middlesex Hospital. Five cases of body ringworm were discovered and treated at the school clinics. The incidence of ringworm thus maintained its steady decline. Plantar Warts. The increase of children exhibiting this affection noted in 1938 has again been observed during the year under review. Girls suffer from plantar warts more frequently than boys, and the condition appears to be particularly prevalent in girls' secondary schools. Infants are rarely affected. These findings in Dare feet, together with the extension of swimming instruction to a larger proportion of older children,for that these wants are Visual Defects and External Eye Disease. Conjunctivitis and blepharitis were, as in former years, the most common external eye diseases. Corneal ulceration in a severe form has of late been rarely encountered, and the provision of milk in schools and well. balanced school meals has no doubt contributed materially to the decline of this disease. Nose and Throat Defects. Operative treatment of enlarged tonsils fiftd adOnOiaS was carried out in 383 cases. Of these operations. 167 were performed at the North Middlesex Hospital and 115 at the Prince of Wales's Hospital (282 in all) Treatment at both Hospitals is in accordance withagreements entered into by the Education Committee, and provides for the retention of patients in hospital for a minimum period of 48 hours. All tonsillectomy cases are visited immediately after their return home by the school nurses. Apart from the 282 cases which received treatment .under the Authority's scheme, a further 101 cases were operated upon by private practitioners or at hospitals outside the scope of the Authority's agreements. Orthopaedic and Postural Defects. The work in the orthopaedic department sulTered. temporary interruption during the early weeks of the war, but before the termination of the year orthopaedic and massage and remedial exercises clinics were resumed. Surgical appliances were supplied and repairs and replacements were effected in.149 instances. Dental Defects. Owing to the dislocation of the work caused during the, first few weeks of the war by evacuation and the temporary closing of schools, a comparison with 1938 is only made possible by referring to the pre.war part of 1939. During this period the following.up scheme which was initiated in the autumn of 1938 was put into full operation; all refusals of treatment were visited by the school nurses and thanks to their efforts a great many parents were persuaded to reconsider their previous objection to treatment for their children. 5 As a result cf this scheme the percentage of acceptances rose from 51.2 in 1938 to 59.9 this year. The secondary schools continued to receive complete annual inspection and treatment. Nervous Disease. Although a large number of nervous diseases were dealt with they were mostly of a mild but somewhat troublesome nature such as somnabulism, nervousness, and night terrors. These cases generally yielded to treatment.by a change of environment and routine at the Committee's Open.Air School or at a Convalescent Home. Speech Defects. The classes for speech defects at the School for the Deal' were continued until this school was transferred to Kessingland Camp. Heart Disease and Rheumatism. Mild cases of rheumatism were dealt with at the school clinics where also many children suffering from heart affections were kept under constant observation; Treatment for more severe cases has been available by the co.operation of various hospitals and in particular the Hospital for Sick Children, Great Ormond Street, where a number of Tottenham children have been'treated as in.patient and subsequently transferred to Lancing Heart Home for a prolonged stay. Tuberculosis. Scholars suspected to be suffering from pulomary tuberculosis were referred to the Tuberculosis Officer for examination and report Surgical tuberculosis was dealt with at the Orthopaedic Clinic Hospital Treatment. The majority of children requiring hospital treatment have attended the Prince of Wales's General Hospital, North Middlesex Hospital, and Hospital for Sick Children Great Ormond Street. There is close co.operation between most of the London Hospitals and the School Medical Department thus ensuring adequate treatment and observation of all patients. FOLLOWING . UP. No material changes have been effected in the methods adopted to ensure that all children suffering from defects receive treatment. 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 hy 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 necessaey, a general survey is made of all the scholars attending particular classes with a view to discovering newly attacked or missed' cases. Comparative figures cf infectious disease occuring during the last three years are not given:owing to the dislocation of work during 1939 as a result of the outbreak of war and the evacuation of school children.. Diphtheria. Immunisation. 1080 school children were immunised ahainst diphtheria and 5,125 attendances were made at the immunisation clinics. Details concerning diphtheria immunisation are included in the Medical Officer of Health's report. Microscopical Examinations. Two specimens cf hairs were examined, one cf which was found to contain ringworm spores. Bacteriological Examinations. The results of examinations of throa and nose swabs for diphtheria will be found in the Health section of the report. 6 OPEN AIR EDUCATION. I am indebted tc the Director of Education for the information supplied under the following headings Open.Air Classes. Until the end of the summer term the Open. Air Class was continued in the Annexe at Risley Avenue .School with an average attendance of 28, Early in the year arrangements were made for the children to have a midday rest under supervision, and the afternoon session was shortered to end at 4.0 pm. Measures to increase the beneficial results of the class were under active consideration during the summer term, and if schools had opened normally; at the em Of August^ there would then have been two classes cf juniors in special accommodation in the now Lancasterian School building. During the summer term a second Open.Air Class, with an average attendance of 22, was held in the bandstand in Downhills Park, School, Journeys. Journey other than to Suntrap School For the year 1939 expenditure on School Journey's not exceeding £445 was agreed to by the Education Committee and approved by the Board of Education. Twelve schools organised Journeys. Journeys to Suntrap School. The Committee approved a programme of six School Journeys to Suntrap School, organised on similar lines to those of 1938, and parties, each consisting of 20 pupils and two teachers, were sent for a fortnight. The children were selected by the Head Teachers concerned from the 13 . 14 age group on the basis of their ability to profit by such a Journey, The parents of each child selected were asked to contribute a sum of five shillings towards the cost, provided that no child was prevented from going through inability to pay. The Committee allocated, in respect cf each party undertaking the Journey, a sum of £25 to cover the cost of transport to and from the School, housing and feeding the children, and incidental expenses of the teachers in charge, and this was approved by the Board of Education. Physical Education. Continuance under war conditions. Although the outbreak of war has affected the work in physical education as in all other educational activities, it has been possible, by careful adaptation to the circumstances, tc continue to give some form of physical training tc all school children whether in the reception areas or in Tottenham. Provision of Gymnasia. The four gymnasia approaching completion on the outbreak of war have now been successfully completed and fully equipped. In the organisation and staffing of these school buildings now re.opened for full.time instruction, careful attention has been given to physical education and the gymnasia are in full.time use. With the exception of two schools where the building of gymnasia has been temporarily held up by the war, full gymnastic facilities, with kit stores, changing rooms, and shower baths, have been provieded for all senior children in the Borough. The provision of suitable shoes and clothing, in accordance with the terms of the Board of Education Circular 1450, is now proceeding. Courses for Teachers. In preparation for the use of gymnasia, suitable courses for teachers have been given by the Organisers of Physical Education, To overcome the serious difficulty caused by the call to the Forces of men teachers below the age of reservation, a course in gymnastic work has been planned for suitable men teachers over the age of reservation. During the summer term 1939, an outdoor course in organised games for women teachers was held. In addition several teachers have been assisted by the•Authority to attend either the Board's term Courses for Serving Teachers cr the third year course in physical training. 7 Keep Fit Classes and Recreative Physical Training. Fourteen classes "for girls ana women and sixteen for boys and men were established during 1938 and 1939. The training class for women leaders continued until the summer term. At the end of the summer term leaflets inviting school leavers to join a Keep Pit class were distributed to the Senior, Central and Secondary Schools. A very full programme of classes was planned for the autumn of 1939 but, owing to the outbreak of War, this had tc be abandoned. As in former years, much encouragement in all forms of Recreative Physical Training has been given by the Youth Organisations Committee. Summer Play Centres. The two Summer Play Centres as described in the report for 1938 were successfully continued this year. The average attendance at the Lordship Recreation Ground was 200 and at Chestnuts Park 150. Evacuation. Tottenham evacuated school parties were dispersed over a reception area covering eight counties. In the first days following evacuation, while more stable educational arrangements were being made, a great deal of useful outdoor physical activity was carried out, arrangements having already been made before evacuation for the dispatch from Tottenham of suitable equipment for this purpose. The Organisers visited the reception areas for a short time to give advice and assistance, and later sent out detailed advice to teachers concerning the planning of the work in restricted school accommodation. In connection with the temporary Home Service Centres established in Tottenham for children not evacuated, a scheme of organised games in the parks and of swimming at the public baths was successfully worked out. The reopening of the schools for normal instruction was begun in December, and proceeded through the spring term 1940, and by the middle of March compulsory full.time education for all children of school age was introduced. The normal curriculum in physical training has now been resumed. CO.OPERATION OF PARENTS, TEACHERS, SCHOOL ATTENDANCE OFFICERS, AND VOLUNTARY BODIES. Parents are notified of the time and place at which children are to be inspected and are invited to attend, A high percentage of these invitations are accepted and this fact diminishes greatly the necessity for correspondence and home visiting. The co.operation of the Teaching Staff has once again been proved of much value in assuring treatment for scholars and in effecting their cleanliness. Co.ordination between the Education Department and School Medical Services has been continually maintained in dealing with verminous and defective children Voluntary Organisations. The Invalid Children's Aid Association has been instrumental in the provision of convalescent treatment for school children who were not suitable cases for admission to Suntrap School and for the supply of surgical instruments to children other than those under the care of the Education Committee's orthopaedic surgeon. The National Society for the Prevention of Cruelty to Children has proved helpful in dealing with cases of neglect and in acquainting the School Medical Officers of any particular difficulties with which parents or children have had to contend. BLIND, DEAF, DEFECTIVE, AND EPILEPTIC CHILDREN. Except for the changes brought about by evacuation, the methods adopted for ascertaining and dealing with children who are defective within the meaning of Part V of the Education Act, 1927, have not deviated from those of previous years. 8 SPECIAL SCHOOLS. SUNTRAP RESIDENTIAL OPEN AIR SCHOOL, HAVING ISLAND. . ' This school now provides accommodation for 120 boys and girls from 5 to 16 years of age. Pupils are received both from Tottenham and other districts. Since the re.construction of the buildings in 1937, when large airy:,dormitories and a new hospital block were built, and day rooms, school rooms and administrative quarters were extended and modernised, the school has become an eminently suitable medium, for the treatment of children suffering from many Varieties of ill.health. The minium time of residence is six weeks and the duration of stay is determined in each instance by the visiting medical officer and may be prolonged to several months, During the summer months the accommodation at the school is occupied to its full capacity, but difficulty is experienced in obtaining consent for the admissior of children during the winter season. This is to be deplored, since'.the climatic conditions obtaining on this part cf the coast during the autumn and winter are particularly beneficial to patients suffering from respiratory affections, debility, and malnutrion. The School for the Deaf, Vale Road School for Physically Defective Children and Oak Lodge School for Mentally Defective Children, have been dealt with in an arlier section of the report. Lordship Lane Partially.Sighted School. As in previous years.Torrenhem pupils., have attended this school, which Is in.the'Administrative district of Wood,Green Vale Road Nursery School . The entire teaching staff and pupils, together with domestic staff and helpers were. evacuated to Elveden Hall, Suffolk, on the outbreak of war and a school nurse accompanied the party, Unfortunately Scarlet Fever broke out two days after evacuation and the epidemic which was of a mild..nature .;Was of short duration. Uncomplicated cases were at first nursed by three members of the Tottenham school nursing and Maternity and Child Welfare Staffs in an isolated portion of the premises, but during the latter weeks Of the epidemic all patients were removed to hospital. The Nursery Classes at Lancasterian Infants' School were .continued. as in and during the structural•alterations at this school additional classrooms and bathrooms were cobstructed for the use of these classes. Alterations, and additions at a number of other .schools have included the provision of nursery.class accommodation. ELEMENTARY SCHOOLS TABLE I. . No. of children inspected 1st January to 31st December, 1939 A. . ROUTINE MEDICAL INSPECTION No. of Inspections in the prescribed groups:. Entrants 946 Second Age Group 1,489 Third Age Group 701 Total 3,316 No, of other routine inspections 4 228 Grand Total 3,364 B. . OTHER INSPECTIONS No. of Special inspections & Re.inspections 15,782 TABLE . Classification of. the, Nutrition of Children during the year in the routine age' groups Age Groups Number of Children Inspected A B C D (Excellent) (Normal) (Slightly Sub.normal) (Bad) No. % No. % No. % No. % Entrants 946 145 15.3 667 70.5 119 32.6 15 1.6 Second Age Group 1489 281 18.9 1002 67.3 183 12.3 23 1.5 Third Age Group 701 166 23.7 483 68.9 50 7.1 2 .3 Other Routine Inspections 228 41 18.0 178 78.1 9 3.9 - - Total 3364 633 18.8 2320 69.3 361 3D .7 40 1.2 TABLE III. RETURN OP EXCEPTIONAL CHILDREN IN THE "(BLIND & DEAF) There are no children in these categories who are not receiving education suitable for their special needs. THE YEAR ENDED 31St DECEMBER 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) Skint- Ringworm - Scalp(treated by-X-Rays) 2 2 do do (other treatment) 1 - 1 Ringworm - Body 5 - 5 69 69 "89 •» 89 271 35 306 Minor Eye Defects , 109 14 123 (External & other, but excluding cases falling in Group II) 209 6 215 Miscellaneous (e.g.,minor injuries, bruises,sores, chilblains, etc.) 489 30 519 Total 1,224 85 1,329 GROUP. II. TREATMENT OF DEFECTIVE VISION & SQUINT" (Excluding Minor Eye,Defects treated as Minor Ailments . Group I). No. of Defects dealt with . Under the Authority's Scheme Otherwise. Total ERRORS OF REFRACTION(including squint) 14 640 Other defect OF disease of the eyes, (excluding those recorded in Group I) 6 7 13 Total . 632 21 653 No. of Children for whom spectacles Under the Authority Scheme Otherwise Total were (a) prescribed 525 14 539 (b) obtained 525 14 539 GROUP III. . TREATMENT OP PPPPOTS OP NOSE & THROAT NUMBER OF DEFECTS Received Operative Treatment: Received Other forms of Treatment. Total Number Treated Under the Authority's Scheme in Clinic or Hospital By Private Practitioner or Hospital,apart from the Authority's scheme 232 101 139 522 GROUP IV ORTHOPAEDIC & POSTURAL DEFECTS Under Authority's Scheme Otherwise Total Number Treated. Residential Treatment with ' Education Non. ' Residential Treatment at an Orthopaedic Clinic. Residential Treatment with Education Non. Residential Treatment at an Orthopaedic Clinic. Number of Children Treated 7 218 — 29 247 TABLE V. . DENTAL INSPECTION & TREATMENT (l) Number of children inspected by the Dentist:. (a) Routine age groups Age 5 and under 6 7 8 9 10 11 12 13 14 Total Number 844 656 997 1058 1106 1081 972 528 649 350 8268 (b) Specials 1482 (c) Total (Routine and Specials) 9750 DENTAL INSPECTION & TREATMENT ( Contd. ) (2) Found to require treatment 8032 (3) Actually treated 4926 (4) Attendances made by children for treatment 8962 (5) id .f.days devoted to:- Inspection 50 Treatment 890 Total 940 (6) Fillings:- Permanent Teeth 2837 Temporary Teeth 707 Total 3544 (7) Extractions:- Permanent Teeth 1579 Temporary Teeth 8166 Total 9745 (8) Administrations of general anaesthetics for extractions 297 (9) Other Operations:- Permanent Teeth 287 Temporary Teeth 278 Total 565 TABLE VI. UNCLEANLINESS & VERMINOUS CONDITIONS. (i) Average number of visits per school made during the year by the School Nurses 14.8 (ii) Total number of examinations of children in the Schools by the School Nurses ., 65,269 (iii) Number of individual children found unclean 969 (iv) Number of children cleansed under arrangements made by the Local Education Authority 48 (v) Number of cases in which legal proceedings were taken:- (a) Under the Education Act, 1921 12 (b) Under School Attendance Byelaws - borough of tottenham 1 maternity and child welfare committee anual report of the medical officer 1939 1 MATERNITY HOSPITAL SERVICES Arrangements for Maternity Cases have been made, as in previous years, in respect of patients able to pay the whole or part of the fee, with the Mothers' Hospital, Clapton, and the North Middlesex County Hospital. 847 Confinements of Tottenham residents took place in these institutions compared with 990 in the previous year. The work of this department continued normally until September 1939 when the exigencies of the war imposed additional duties on the Health Visitors. Many of them accompanied expectant mothers to reception areas while for a short time, several of them undertook duties in connection with Civil Defence. Every effort was made to ensure the continuity of the service and by the middle of October the Department was again working normally. During the year, 41,909 home visits were made, compared with 40,300 in 1938. During 1939, the work of the Maternity Clinics has been maintained and in spite of the interference made at the outbreak of war by the evacuation of mothers and children the number of new patients seen and the average at each clinic has been very little varied. Three sessions have been held per week at each centre and, at the outbreak of war, the clinic at ''The Chestnuts" was transferred to 227 West Green Road. At "The Chestnuts" Clinic, 140 sessions have been held, 2,200 attendances made and these include 496 new cases, 178 postnatal visits. At Lordship Lane, 151 sessions have been held, 2,100 attendances made of which 612 were new cases and 203 postnatal visits. The increase in post.natal examinations has been encouraging. The fullest use has been made of the many Welfare Services and this is especially true of the dental services. During the year, 283 expectant mothers and 71 nursing mothers have received treatment and 81 dentures have been supplied. Great appreciation has been expressed for this service by the mothers. The closest co.operation has been maintained between the Clinics and the two Maternity Hospitals . the North Middlesex and the Mothers' Hospital. The Infant and Child Welfare Clinics, except for the short interruption of services at the outbreak of war, have continued to function satisfactorily during the past 12 months. The attendances since last September have been unexpectedly good and a high percentage of first infants have been supervised. The temporary premises in West Green Road, used in place of "The Chestnuts'1, St. Ann's Foad, which was requisitioned for Civil Defence purposes, have proved generally inadequate, and application has been made for the early return of "The Chestnuts" for its peace.time functions. Dental patients, both mothers and children, have steadily increased in number to a very satisfactory extent. The amount of rickets detected among the children attending the Clinics has been practically negligible. The number of infants examined by the Medical Officer during the year was 5885 as compared with 6887 during 1938. New cases numbered 1503 against 1630 in 1938. It will be seen that in spite of the evacuation of mothers and children under five, attendances at Clinics have been maintained at very near their previous level. THE HEALTH VISITORS' DEPARTMENT ANTE.NATAL CLINICS INFANT WELFARE CENTRES P.T.O 2 CHILD LIFE PROTECTION. As a result of the war. several of the children were evacuated to reception areas under the Government Scheme. This correspondingly reduced the number of foster mothers on the register. 158 home visits were paid to foster mothers during the year, compared with 185 during 1938. The number of foster mothers on the register at the end of 1939 was 28 as compared with 47 in 1938. MUNICIPAL MEDICAL CENTRE AND DAY NURSERY, PARK LANE. A full report of the planning and construction of this building was given in my report for 1938. The work of construction continued steadily throughout the year and was, to some extent, held up by the outbreak of the war. However, by the end of the year, the work was practically completed, and the new buildings were officially opened on Saturday, March 9th 1940. SPECIAL CLINICS FOR CHILDREN UNDER FIVE YEARS. All the specialist clinics of the School Medical Service were available to these children and the attendances during the year were 2028 as compared with 2354 during 1938. In view of evacuation this figure is remarkably high and attendances at dental clinics were almost twice as many as during the previous year. DAY NURSERIES. On September 1st, 1939,the Day Nursery in West Green Road was evacuated, en bloc, to Alconbury House, near Huntingdon, which accommodated 36 children. The Nursery soon became acclimatised and the children benefited greatly by their stay in the country. General administrative control was retained by the Tottenham Maternity and Child Welfare Committee and medical attention was given by local practitioners and numerous visits were paid by the Committee's Medical Officers. All the children were immunised against diphtheria. The general health of the children has been very good. The new Day Nursery in Park Lane, Tottenham, will open early in 1940 and will provide accommodation for 50 children. Increased demands for these facilities are expected as a result of mothers having to undertake various kinds of war work. TODDLERS CLINICS. These were continued during 1939. In all,51 medical sessions were held as compared with 31 in 1938, and attendances numbered 700 against 294 in 1938.' The routine examination of toddlers for gross errors of refraction is now regularly undertaken, but sufficient data are not yet available for a full report in this work to be made. PROVISION OF REFUGE FOR CHILDREN LOST AS RESULT OF AIR RAIDS. MINISTRY OF HEALTH CIRCULAR 1900. In accordance with the above Circular, provisions have been made to receive children separated from their parents as the result of air raids. Rooms have been set aside at the Welfare Centres for this purpose, and stretcherbeds blankets, food and other necessities have been made available . On the occurrence of raids, Health Visitors will proceed to these centres, and will prepare them for the reception of such children who may require temporary refuge. It is not intended that children should remain at these refuges for an indefinite period and should it become necessary for them to be cared for, for a longer period, other measures will have to be taken. 3 EVACUATION CF EXPECTANT MOTHERS. The Borough of Tottenham is a part of the Extra-Metropolitan Evacuable Area and provisions were made, under the Government Evacuation Scheme, for the evacuation of expectant mothers. When was was declared the scheme for expectant mothers in Tottenham was ready to be put into operation. About 300 expectant mothers in the last month of pregnancy availed themselves of the opportunity of being removed to zones of comparative safety. The provision of transport and of suitable maternity homes was undertaken by .the London County Council. The mothers trsvollod in special coaches and were accompanied by Municipal Midwives, fully equipped for any emergency, to maternity homes in reception areas. . Whenever possible ante.natal record cards were sent with the mothers. After the birth of their babies some of the mothers returned to Tottenham,. while others were billeted out in adjacent reception areas. A few were transferred to other districts in which their children of school age were billeted. A further 160 expectant mothers, many with children under five years of age, were evacuated by 'train with non.school parties. These expectant mothers were accompanied by Health Visitors, (who are also trained midwives), equipped with first aid and midwifery bags, and were billeted in reception areas until nearly full term, when they were transferred to suitable maternity homes, or were attended by district midwive.s, During their waiting period all were kept under the supervision Of the Local Medical Officersof Health and their staffs of Health Visitors and district midwives. Additional evacuation arrangements were carried through without a hitch and registration has,continued steadily until the present time.. . . ' MIDWIFERY SERVICE MIDWIVES ACT, 1936. A full report was given in my Annual Report for 1938. During 1939, the Municipal Midwifery Service consolidated its position as an integral part of the Maternity and Child Welfare Services. On the outbreak of war, many of our Municipal Midwives accompanied expectant mothers to their destinations in reception areas, and several were loaned to Maternity Homes at which these mothers were confined. In spite of the evacuation of expectant mothers, 724 deliveries were carried out by the Municipal Midwifery Service in Tottenham compared with 642 in 1938. The Midwifery agreement for maternity cases with the District Nursing Association became operative on 1st January, 1939. MATERNAL MORTALITY. The figures relating to this are not yet available. DENTAL TREATMENT TO EXPECTANT & NURSING MOTHERS &_CHILI lEN UNDER FIVE YEARS . Figures for a complete year are available for the first time, as under Expectant Mothers treated 283 Nursing Mothers treated 71 Artificial Dentures Supplied; Free 53 At Part Cost 28 Children under 5 years of age; Consultations 214 Treatments 390 P.T.O. 4 ASSISTED MILK SUPPLY. The provision of milk to mothers and young children continued during the year, the total families receiving assistance being 1,329 in respect of 256 expectant mothers, 232 nursing mothers, andl(316 children under five years of age. In accordance with the Ministry of Health Circular 1840 of the 2nd of August, our scheme was extended, from 1st November, to provide pasteurised liquid milk from approved vendors to expectant and nursing mothers, and to children under five years of age, free, or at Id. or 2d. per pint,according to family circumstances. The average quantity distributed increased, under the new scheme.from 77.18 gallons to 88.78 gallons per day. Dried Milk was also distributed at the Centres in specially authorised cases. The net cost for the year for the distribution of pasteurised liquid milk and of dried milk was £3,091. 13s. 2d. as compared with £3,896. 6s. 5d. for the previous year after making allowances for the Rebate from the Milk Marketing Board under the Government Cheap Milk Scheme. (The above scheme has now been superseded for the wider one under administrative arrangements made by the Ministry of Pood),