I AC 439(1) TOTTENHAM Borough of Tottenham. ANNUAL REPORT of the MEDICAL OFFICER OF HEALTH 1940 BOROUGH OP TOTTENHAM. Annual Report of the Medical Officer of Health, 1940. STAFF. Public Health Department. Medical Officer of Health: G. Hamilton Hogbon. Deputy Medical Officer of Health: J. Landon. Chief Sanitary Inspector: J. B. Smith. Sanitary Inspectors: W.P. West J.A. Shillito E.S. Glegg J. Goodfellow; L.J. Kerridge E.T. Jenkins R.H.T. Chappell W.L. Morris C.J. Cattell Shops Acts Inspector - F.T.G. Lock Assistant Shops Acts Inspector - A.A. Senda11. Nurses for Infectious Disease. S. Swaffield. W. Mathias. Clerical Staff: Chief Clerk - R. Garvey. H.R. Gilbert W. Potter A.W. Lawrence (H.LI. Forces) L.R. Perry H. Thomas (H.M. Forces) W.P. Kent D.J. Legge, H.F. Smith (Since Aug. 1940) Miss M.R. Erwood (Since Oct.1940) - 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 1940, which, owing to the exigencies of the war, must again this year appear in an abridged form. In spite of heavy additional duties placed on the various Departments, the Health Services of the Borough generally were carried on at their pre-war level. No serious outbreak of Infectious Disease occurred during the year. The Death Rate of 14.26 includes the deaths due to enemy action and cannot therefore be compared with previous years. The Infantile Mortality Rate and Maternal Mortality Rate again remained lower than pre-war years, being 41.05 and 2.48 respectively. I very sincerely thank the Members of the Town Council for their encouragement and support during a busy and difficult year, and again record my admiration for the excellent work carried out by my colleagues in the Health Services. I have the honour to be Your obedient Servant, Medical Officer of Health. Town Hall, Tottenham, N.15. 1st December, 1941. - 2 - statistical summary, etc. Area of the District in acres 3,014 Ragistrar-General1 s estii ate of civilian population, mid-year 1940 119,400 Rateable Value £991,973 Sum represented by a penny rate £3,830 Births and Deaths. Registered live births:- Total Hales Females. Legitimate 1,595 799 796 Illegitimate 71 39 32 1,666 858 828 Birth Rate per 1,000 estimated population 13.95 Total live births for calculation of Infant Mortality Rate, etc. Total Males Females. Legitimate 1,491 743 748 Illegitimate 68 38 30 1,559 781 778 Still Births (a) Registered 59 28 31 (b) Total Still Births for calculating Still 56 27 29 Birth Rate. Stillbirth Rate per 1,000 total (live and still) births. (a)34.20 (b) 34.67 Deaths (Males 858 (Females 845 Total 1,703 Death Rate per 1,000 estimated Civilian population 14.26 Mote:- Deaths arising out of war operations have been included in the figure of total deaths for the year. The death rate cannot, therefore, be compared with previous years. Maternal Deaths:- Rate per 1,000 total Deaths (live and still)blrths. Puerperal sepsis Other puerperal 4 2.48 causes. 2.48 Death Rate of Infants under one year of age:- All infants per 1,000 live births 41.05 Legitimate infants per 1,000 legitimate live births. 40.24 Illegitimate infants per 1,000 illegitimate live births. 58.82 Deaths from - Cancer (all ages) 225 Measles (all ages) Whooping Cough (all ages) 1 Diarrhoea (under 2 years) 7 - 3 - Table of Deaths during the Year 1940 in the Borough of Tottenham, classified according to Diseases. Cause of Death Males Females Totals Typhoid & paratyphoid fevers. - 1 1 Measles. - — — Scarlet Fever _ — — Whooping Cough — 1 1 Diphtheria - 1 1 Influenza 11 11 22 Encephalitis Lethargica — — — Cerebro-Spinal Fever 1 3 4 Tuberculosis of Respiratory 66 38 104 System Other Tuberculous Diseases 4 1 5 Syphilis 8 2 10 General Paralysis of the Insane - - — Tabes Dorsalis Cancer, Malignant Disease 114 111 225 Diabetes 4 10 14 Cerebral Haemorrhage, etc. 43 63 106 Heart Disease 214 241 455 Aneurysm - - - Other Circulatory Diseases 18 20 38 Bronchitis 74 68 142 Pneumonia (all forms) 56 59 115 Other respiratory diseases 14 8 22 Peptic Ulcer 21 7 28 Diarrhoea (under 2 years) 4 3 7 Appendicitis 4 2 6 Other Digestive Diseases 18 17 35 Acute and Chronic Nephritis 11 12 23 Puerperal Sepsis - - - Other Puerperal Causes — 4 4 Congenital Debility, Premature Birth, Malformations. 13 19 32 Road traffic accidents 16 2 18 Other violent causes 92 102 194 Suicide 8 4 12 All other causes 44 35 79 858 845 1,703 - 4 - Infantile Deaths in Ages and Sexes during the year 1940. Cause of Death. Under 1 week 1-2 weeks 2-3 weeks 3-4 weeks Total under 4 weeks 1-3 months 3-6 months 6-9 months 9-12 months Total deaths under 1 year Males Females Whooping Cough - - - - - - - - - - - - Meningitis - - - - - - - - - - - Bronchitis - - - - - 2 1 2 1 6 4 2 Pneumonia - - - - - 5 2 4 3 14 7 7 Diarrhoea & enteritis - - - - - 6 1 - - 7 4 3 Asphyxia 1 - - - 1 - - - - 1 1 - Premature Births, congenital malformation, etc. 19 - - - 19 2 2 - - 23 11 12 War, Operat ions - - - - - 1 - - - 1 1 - Other Causes. 5 3 - 1 9 1 - 1 1 12 6 6 Totals 25 3 - 1 29 17 6 7 5 64 34 30 -6- Table of cases of Infectious Disease coming to the knowledge of the Medical Officer of Health during the year 1940 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 cases removed to Isolation Hospital by Council. Scarlet Fever 48 55 1 1 7 5 8 43 10 11 14 2 1 - 52 Diphtheria 15 13 - 1 3 4 2 4 5 6 2 1 - - 27 Pneumonia 60 27 2 1 1 1 2 4 3 7 18 7 27 14 - Erysipelas 14 18 1 - 1 - - - - - 3 9 15 3 10 Puerperal Pyrexia — 20 - - - - - - - - 17 3 - - 2 Dysentery 1 - - - - - - 1 - - - - - - Ophthalmia Neonatorum 2 - 2 - - - - - - - - - - - — Cerebro-Spinal Meningitis 7 10 3 3 2 - - - - 4 3 2 - 6 Poliomyelitis - 1 - - - - - 1 - - - - - - - Typhoid 2 3 - - - - - - - 1 2 1 1 - 1 Food Poisoning 3 5 - 1 - - - - - - 5 1 1 - - Whooping Cough 12 9 3 5 1 4 1 7 - - - - - - 4 Measles 128 108 13 17 21 12 19 94 13 19 20 8 - - 36 Pulmonary Tuberculosis 116 62 - 1 - 1 - 2 4 30 74 21 41 4 - Other forms of Tuberculosis . 10 9 - - — - 3 2 2 1 9 1 1 - - Totals 418 340 25 30 36 27 35 157 38 79 167 54 89 21 138 GENERAL PROVISIONS OF HEALTH SERVICES. LABORATORY FACILITIES. The following is a statement of the examinations made during the year:- Swabs examined for Diphtheria:- Positive 13 Negative 581 Total 594 Specimens of Sputa examined for Tuberculosis:- Positive 13 Negative 127 Total 140 Stools examined for Dysentery. 2 (Negative) Swabs " " " 4 (1 Pos., 3 Nog.) Swab " " Anthrax 1 (Negative) Faeces " " Typhoid 4 (1 Pos., 3 Neg.) Blood " " Typhoid 2 (Positive) Urine " " T.B. 1 (Positive) AMBULANCE FACILITIES. The Council possess five motor embulances which are used for accident and non-infectious cases, end two buses for conveying children to special schools. The Ambulances were also used for conveying meals to the various school Feeding Centres. Total mileage for the year 48,154 Number of accident and hospital cases etc. conveyed during the year. 5,240 Number of occasions on which the oxygen resuscitator was used. 2 The Ambulance Service is now controlled by the Public health Department. SANITARY CIRCUMSTANCES. WATER SUPPLY. Tho Borough water supply, controlled by the Metropolitan Water Board, has been satisfactory in all respects. SANITARY CONDITIONS. Inspections carried out by the Sanitary Inspectors are summarised below. Number of houses inspected after Infectious Disease 269 " " " " under the Housing Act 64 " " " " on complaint 1,324 -7- Drains examined and tested 253 Drains reconstructed 32 Drains repaired 127 Drains found stopped 144 Soil pipes repaired or renewed 37 Gullies renewed 27 Fresh-air-inlets renewed 15 Rain-water-pipes, wastes, etc. repaired or renewed 191 Roofs repaired or renewed 302 Gutters repaired or renewed 135 Drinking water cisterns repaired or renewed 33 Number of houses whore water was provided from the main 20 W.C. cisterns and pans repaired or renewed 204 Yard paving repaired or renewed 63 Sinks repaired or renewed 37 Floors (wood and concrete) repaired or renewed 121 Floors ventilated 30 Window frames and sashes repaired or renewed 191 Window frame s and sashes painted 18 Coppers repaired or renewed 34 Fireplaces, stoves and ovens repaired or renewed 175 Number of houses where walls and cellings were cleansed 770 Accumulations of refuse removed 62 Miscellaneous defects remedied 377 Lamp proof courscs were inserted in 62 houses, 58 houses wore pointed, and 123 houses wore rendered externally. 26 food stores were provided or repaired. Re inspections totalled 4,703. Other inspections were:- Inspections of Common Lodging Houses 12 " of Stables and Mews 16 " of School Lavatories 6 " of Pawn Shops 4 " of Public-House Urinals 57 " of Brooks 15 " of Knackers' Yards 8 Interviews with owners and builders 408 Rooms inspected after disinfection 191 Miscellaneous inspections 458 Staircases lighted 3 Periodical visits were also paid to A.R.P. Depots and Public Shelters. Repair of Houses by the Council. In 18 instances, repairs etc. were executed at properties, after service of notices under the Public Health and Housing Acts, and the total cost of this work amounted to £31. 17.. 11. Infectious Disease. 238 visits wore made by the Sanitary Inspectors to houses where infectious cases had been notified. 9,809 articles were disinfected at the steam disinfector. 148 articles were destroyed at the request of owners. - 8 - Terminal disinfection of rooms: carried out with the Formalin Spray- 112 rooms disinfected after Searlot Fever. 41 " " " Diphtheria 92 " " " Tuberculosis 96 " " " verminous and miscellaneous cases. 10 Wards or School Rooms wore disinfected. 89 Library Books were disinfected with Formaldehyde Gas . The baths at the disinfecting station were used on 20 occasions by persons suffering from Scabies. In addition, the blankets, pillows, etc. used by A.R.P. personnel were disinfected periodically, end there were 11,474 such articles disinfected during the year. SHOPS ACTS, 1912-1938 The Shops Acts are administered by two whole-time officers. By means of systematic visitation of shops throughout the borough, effective administrat ion of the shops Acts is secured, and the necessary information obtained for the purpose of keeping un to date a register of all shops in the borough. Regular visits on the weekly half holiday, and in the evening, are made to ensure that the provisions of the Shops Acts and the various closing orders made thereunder are complied with. In the administration of the Acts and closing orders, 3183 inspections have been made. Most of the offences have been minor irregularities and the non-exhibition of statutory notices in respect of which 179 verbal warnings and notices were issued. It is pleasing to be able to state that the conditions relating to the employment of assistants on Sundays and the compensatory holidays in lieu of Sunday work are being complied with. During the year, it has been found necessary to devote considerable time to the Act dealing with the hours of employment of young persons, and to the provisions relating to the health and comfort of all shop workers. Conditions generally were found to be satisfactory. It is gratifying to record that with the co-operation of shopkeepers, the Acts generally have been well observed. During 1940, 14 first warning notices and 5 final warning notices were issued in respect of contraventions of the above Acts. Legal proceedings were taken in 5 instances. Fines were inflicted in each case. INSPECTION OF FACTORIES. Inspections of factories and workplaces totalled 222. 168 visits were paid to Outworkers' premises. - 9 - HOUSING. Number of houses erected during the year - By private enterprise - 1 house 4 flats. By Tottenham Borough Council - 6 houses (completion of Scotland Green Estate) Routine housing work was largely in abeyance throughout the year, curing the first few months, most of the Sanitary Inspectors were occupied with the administration and supervision of the A.R.P. Ambulance repots, and the Chief Sanitary Inspector acted as ambulance Officer until May. Subsequently, the repair of war damage became the responsibility of the Public Health Department, and during the last 4 nonths of the year, the Sanitary Inspectors and clerical staff were almost wholly engaged in this work. Nevertheless, every effort was made to ensure that dwelling houses in the Borough were maintained in a sanitary condition. Informal notices served numbered 1,173, and Statutory Notices under the Public Health and Housing Acts numbered 231. 66 premises included in Clearance Areas were reported demolished during the year. The buildings demolished now total 385, causing the displacement of 1,673 persons. All the families in confirmed Clearance Area Schemes have been rehoused. INSPECTION AND SUPERVISION OF FOOD. MILK SUPPLIES. There are no farms or cowsheds in the district, but 128 visits were paid to premises retailing milk supplies. MILK (SPECIAL DESIGNATIONS) ORDERS, 1936 and 1938. These designations may only be used under licence from the local authority. In 1940, the following licences were granted:- Tuberculin Tested Milk Licences; Bottlers' Licences 2 Dealers' Licences 11 Supplementary Licences 3 Accredited Milk Licences: Bottlers' Licence 1 Pasteurised Milk Licences: Pasteurisers' Licences 3 Dealers' Licences 14 Supplementary Licences 4 - 10 - MEAT AND OTHER FOODS. There are 5 licensed slaughterhouses in the district, but these are not now used for slaughtering. One of the slaughterhouses has been converted into a food canning factory. 191 visits wore paid to Butchers' Shops. 108 " " " 11 Fish Shops. 127 " " " " Fruiterers' Shops. 92 " " " " Ice Cream Shops & Factory. 56 " " " " Bakehouses. There are 4 basement bakehouses in the District. During 1939, it was decided to give the occupiers of three of these promises notice that the Certificates issued under the Factory and Workshop Act, 1901, would cease to have effect in July, 1940, but this action has been postponed for the time being. Miscellaneous Unsound Foodstuffs dealt with. 82¾ lbs. Ham; 34cwts ,21qrs . 12½ lbs .14ozs. Bacon; 246¾ lbs. Beef; 13qrs.41bs.8ozs, tinned ham; 3 lbs.cooked meat; 250 meat pies; 12 lbs. beef sausages; 32 lbs. tinned shoulder; 2½ lbs.meat roll; 4oz.pressed ham; 3 tins ham & beef roll (3 lb. tins); 10 tins chicken & ham roll (3 lb.tins); 14ozs. brawn; 5½lbs, galantine; 2 legs pork (16 lbs,); 4 smo.Danish sides; 4 lbs. calves sweat-breads; 37 lbs.shoulder; 1 carcase - lamb (17½lbs.); 1 .carcase - calf (50 lbs.); 1 tin jellied veal (6 lbs); 1 mesentery; 2 pigs heads; 3 boxes kippers;. 1 tin pilchards; 1 tin salmon; 42 lbs. herrings; 8 stone rock eel; 3 gals .winkles; 5 stone haddocks fillets; 5 tins sardines; 2 tins herrings; 5 stone whiting; 4 stone box skate wing; 33 lbs. skate wing; 14 lbs. hard roe; 1 tin mice mackerel (½ lb,); 2 tins plums; 3 tins fruit salad; 8 tins peas; 2 tins pears; 2 tins peaches; 4 tins beans; 2 tins apricots; 20 baskets of cherries; 6 jellies; 205 small cakes; 1 lb. lard; 18½ lbs, margarine; 8.lbs. jam; 29 lbs. tomatoes.; 1½ lbs. butter; 12¾ lbs. mixed fruits; 7 lbs. sago; 4 lbs. custard powder; 51 lbs. rice; 10 lbs. tapioca; 8 lbs. sultanas; 3 lbs. wafer oats; 4¼ lbs. blancmange; ¼ lb. suet; ¼ lb. tea; 5 pkts.rusks; 3¼ lbs. soda; 7 lbs. biscuits; 72 lbs. flour; 42 bars chocolate; 1 lb. tomatoes; 12 boxes apples and 16 cases apples; 16 bottles pickled onions; 2 jars sandwich paste; 2 tins oranges; 412 lbs. butterbeans; 41 cabbages; 1 tin condensed milk (2 pints). PREVALENCE OF, AND CONTROL OVER, INFECTIOUS AND OTHER DISEASES. Scarlet Fever. The number of cases notified was 103, compared with 335 in 1939 and 186 in 1938. 52 cases were removed to Isolation Hospital. Diphtheria. The number of cases notified was 28, compared with 60 in 1939 and 221 in 1938. 1 death occured from this disease. Immunisation is carried out by two doses of alum precipitated toxoid, 0.2 c.c., followed three weeks later by 0.5 c.c. Total attendances 812 Schick Tests 196 Cases completed during the year. 171 - 11 - DIABETES. With the approval of the Ministry of Health, Insulin was supplied to 7 patients suffering from Diabetes. The number of Units amounted to 55,506, and the cost was £14. 13. 11. TUBERCULOSIS. The County Council are responsible for the treatment of Tuberculosis. 197 notifications were received during 1940 - Pulmonary, 178; other than Pulmonary, 19. Cases remaining on the register at the end of the year were: Pulmonary, 553; Non-Pulmonary, 154. 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. Age Periods. New Cases Deaths. Pulmonary Non-Pulmonary Pulmonary Non-Pulmonary Males Females Males Females Males Fernales Males Females Under 1 year. - - - - _ - _ _ 1 to 5 years. 2 - 2 1 - - 1 - 5 to 15 " 4 2 1 3 - 1 - - 15 to 25 " 25 34 4 3 4 14 1 1 25 to 35 " 31 14 2 1 6 12 - - 35 to 45 " 15 6 - 1 16 4 1 - 45 to 55 „ 17 3 1 - 19 3 - — 55 to 65 " 19 2 - - 17 3 - - 65 years & upwards. 3 1 — - 4 1 1 — Totals 116 62 10 9 66 38 4 1 Organs affected (New Cases):- Males Females. Lung 116 62 Glands 2 4 Spine 1 Intestines 1 1 Bladder - 1 Knee 1 2 Hip 1 Elbow 1 Generative Organs 3 1 126 71 The deaths represent a death rato of 0.91 per 1,000 population. In 5% 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. - 12 - BOROUGH OF TOTTENHAM EDUCATION COMMITTEE 0O0 THE THIRTYFIRST ANNUAL REPORT of the SCHOOL MEDICAL SERVICE 1940 1. 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. Deputy Medical Officer of Health J.LANDON, 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. (joined H.M.Forces) MISS B.H.JOHNSON, L.D.S. (Eng.), (also M. & C.W.) Specialist Medical Officers (Part-time) Ophthalmic Surgeon, T.W.LETCHWORTH, F.R.C.S. Aur1st, F.P.M.CLARKE, B.A., B.Sc., L.R.C.P., L.R.C.S. Orthopaedic Surgeon, J.A.CHOLMELEY, 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 B.WHITAKER, S.R.N., S.C.M., H.V.Certificate MISS R.BENTLEY-CORNER, S.R.N., S.C.M. MRS. K.SANDLE, S.R.N. MISS E.CONNOR, S.R.N., S.C.M., H.V.Certificate MISS E.E.WATTERSON, S.R.N., S.G.M., H.V.Certificate Dental Attendants MRS.L.HOWE, S.R.N. MISS N.A.BESTALL MISS M.KEOGH Masseuse (Part-time). MRS. M.W.YORKE, C.S.M.M.G. Clerical Staff. Chief Clerk - V.GODDAM). T.E.COWAN, F.C.I.S. MISS O.W.NEWSON H.J.DUNHAM (Joined H.M.Forces) R.E.TUSON (to 10.8.40) MISS G.KINGSTON (from 10.8.10) 2. Any changes (whether additions, depletions or replacements) in the staff of the Service, Owing to illness, Dr. Stalker, Senior Assistant Medical Officer, was absent from duty from the 24th.September, 1940, and was still incapacitated at the end of the year. Dr. Nora Webster was therefore appointed in a temporary capacity, on a part-time sessional basis, to carry out the duties of an Assistant School Medical Officer. Mr. A.E.Fisher, one of the Dental Surgeons, obtained a commission in the Dental Branch of the R.A.F.V.R., and temporarily relinguished his dental duties in Tottenham on November 15th., 1940. In view of the reduced school population owing to evacuation, it was considered unnecessary to fill this vacancy, and the remaining two Dental Surgeons have been able to deal adequately with the dental supervision and treatment of the existing school population. There have also been changes in the clerical staff owing to liability to military service and secondment to Civil Defence work. Any changes in the arrangements for medical, dental and cleanliness Inspections. During the year under review, efforts were made to maintain as complete a service as possible, and the general arrangements for medical, dental and cleanliness inspections approximated closely to those of a normal year. Owing to evacuation of a proportion of the school population, however, there was a reduction in the number of children inspected, compared with previous years. The following table gives a summary of the inspections carried outs:- A. Routine Medical Inspections. Entrants 747 Second Age Group 592 Third Age Group 661 Total - 2,000 Other Routine Inspections 274 Grand Total - 2.274 B. Special Inspections + Re-inspections - 19,346 In addition to routine medical inspections, the directions outlined in the Board of Education Circular 1523, have been followed. Rapid medical surveys of school children have been carried out with particular regard to the state of nutrition and the cleanliness of the children concerned. Those found to be suffering from any degree of malnutrition were at once recommended for supplementary nourishment, e.g., school meals, and/or free milk. Whenever necessary, children were referred to the Nutrition Clinic where they obtained treatment, and were also kept under observation. Medicinal foods, such as Cod Liver Oil & Malt, were supplied in those cases recommended by the Medical Officer, SPECIAL SURVEY OF NUTRITION OF SCHOOL CHILDREN Total Examined A B C D 3,156 518 2,311 298 29 (16.4%) (73.2%) (9.5%) (0.9%) Contd. 3. Special attention was also given to the detection, prevention and treatment of uncleanliness and verminous conditions. The School Nurse concerned attended these surveys with a Medical Offioer, and every child was examined for signs of these conditions. Those discovered to be in a verminous condition were followed-up by the School Nurse both in the School and in their homes. Where, owing to adverse home circumstances, cleansing facilities were not available, the children were treated at the Clinics. A table showing the number of children found to be unclean, and the action taken, is given later in the report. Special Wartime duties of School Nurses. In the summer of 1940, there was a large influx into Tottenham of French and Belgian refugees. The Jewish Hospital in the High Road, Tottenham, was utilised as the main cleansing station for the whole of Middlesex, and as many of the refugees were badly infested, this entailed a considerable amount of work. The services of all available nursing staff were enlisted and the School Nurses, working on a rota, rendered useful service. School Nurses have also helped in the Central Information Bureau for Homeless Persons, and have regularly visited school children whose families have had to be rehoused as a result of enemy action. Any additions to or curtailment of the arrangements for the various forms of treatment or the provision of solid meals or milk. (a) Dental Treatment - As a result of the re-opening of schools in the Spring of 1940, and of the return to the system of compulsory school attendance, dental clinic attendance showed a marked improvement. With the commencement of intensive aerial attack in September, 1940, however, accompanied by numerous daylight "alerts", there was a further falling-off in attendances, as ohildren were uAable to keep their Clinic appointments. There was an improvement, again, towards the end of the year when a diminution in the number of daylight raids occurred# The provision of adequate air raid shelter no doubt contributed to the return to something approaching normal conditions. A table is given later in this report In regard to Dental Inspection and Treatment. (b) The Ear, Nose & Throat Clinic - This service was well maintained during the year and there was an extension of the facilities for the conservative treatment of Ear, Nose & Throat conditions on the lines set out in my reports for 1938 and 1939. Owing to evacuation, the number of sessions was reduced from two to one,but attendance at this Clinic was very good. In the beginning of January, 1940, the Clinic was removed from the Lordship Lane Medical Centre to the Park Lane Medical Centre, where more adequate accommodation had been provided. Attendances increased steadily and it was found necessary to resume the Ear, Nose & Throat Treatment Clinics which are carried out by specially trained Sohool Nurses under the supervision of the Ear, Nose & Throat Specialist. During the year, the new Peters Suction method for diseased tonsils was adopted, A sufficient number of cases have now been treated, to make it clear that in this method lies a valuable therapeutic measure for the cure of these conditional During the year, 70 children, who in previous years would have been referred for tonsillectomy, were successfully treated by suction. It is found that parents readily co-operate In this treatment, and this may be attributed to the fact that the beneficial effects become apparent at an early stage in the treatment. The number of cases of enlarged or diseased tonsils referred for operation has been reduced to an absolute minimum. Contd. 4 Chronic otorrhoea, at one time the commonest and most intractable condition among children attending the Aural Clinic, has now practically disappeared from the Tottenham school population. Less than 20 cases were reported during the year. This is, in the main, due to efficient treatment by zinc ionization, as well as the prompt treatment of acute otitis media and such predisposing factors as nasal catarrh, sinus infection and unhealthy tonsils, etc. The Clinic services are now available, also, for the treatment of children of pre-school age. Nasal diastolisation has been continued during the year and high frequency treatment has been added in accordance with the methods practiced by its French exponents. The system of Tables and Returns introduced in the 1938 Report has been retained, and full information has been collected for this purpose, (c) Orthopaedic Clinic - At the outbreak of the War the Orthopaedic Clinic had, unfortunately, to be discontinued, but at the beginning of 1940 it was resumed. Although the number of patients was less than in peace time, the resumption of this Clinic was amply justified by the number of attendances of new and old patients. Owing to evacuation some of the patients drifted backwards and forwards between London and the reception areas corresponding with the raiding conditions obtaining at the time. Others, who were attending London hospitals, came to the Clinic for continuation of their treatment. Very few pases of rachitic deformity were seen during the year. This is no doubt due to the fact rickets can be controlled by giving adequate doses of Vitamin Di Surgical appliances were supplied and repairs and replacements effected in 85 instances. (d) Provision of solid Meals & Milk - On the outbreak of War and as a result of evacuation, the school population fell considerably. Compulsory school instruction was temporarily in abeyance, and was replaced for a time by Home Service Classes. There was a gradual re-opening of schools which commenced in December 1939, but full-time school attendance for every child Of school age was not completely restored until early in March 1940, The meals centres, however, were opened, with the approval of the Board of Education, immediately after evacuation in September 1939, and continued to function even though the schools themselves were closed. The Nutrition Clinics were resumed twice weekly, a fortnight after the outbreak of War, and a constant survey of the school population for evidence of malnutrition has been maintained during 1940. In February 1940, the reconstruction of the Page Green Central Kitchens was authorised by the Board of Education, and the facilities for the provision of meals were greatly increased. However, the number of children having free meals in August, fell to 425, as against 1750 in July 1939. In August 1940, a centralised scheme for the cooking and distribution of meals was put into operation. Numerous difficulties were encountered however. Heavy raiding occurred about this time, and the average attendances at school fell steeply. Many parents and children were rendered homeless, and were housed and fed temporarily in Rest Centres. The machinery of the Local Education Committee for the provision of school meals, was used for this purpose, and 1000 meals a day for homeless persons had, on certain occasions, to be provided. However, feeding of necessitous children in school continued without interruption. Contd 5. Owing to early blackout and frequent "alerts" the period of school attendance was reduced to one session a day from 9.30 a.m. to 1.30 p.m. Some of the children who were having school meals had to go to a neighbouring school for this purpose at the end of the school session. Owing, unfortunately, to the frequent and sustained "alerts" children were often in their air raid shelters at 1.30 p.m., and the feeding scheme had to be redrafted so that meals could be provided and served at all the schools. Meals were often taken in the shelters themselves. On December 17th, 1940, an Enlarged Scheme for the provision of meals was introduced, open to all children whether necessitous or not, on a sliding scale of income. The maximum charge per meal was 4d., the cost of the food only, and meals were also provided at part cost or free according to income. The number of children partaking cf school meals rose considerably, On the first day of the new scheme, 1228 had school meals, and a fortnight later this number was increased to 1862, i.e., by 56%. As will be seen from the table given below, by far the majority of children paid for their meals, whereas previously nearly all the meals provided were given free. The explanation of this is threefold:- 1. The evacuation of children who had previously had free meals. 2. The introduction of a sliding scale of payment for meals for all children whether necessitous or not. 3. An increase in remunerative employment in the district, so that fewer children came within the 'free' portion of the scale. The number of school meals taken has continued to Increase during 1941. (See table below) (e) Provision of Milk - The provision of milk both free and on payment continued, apart from minor interruptions, throughout the year, but provision was not resumed during the school holidays. The number of children having milk on payment increased 'pari passu' with those having meals on payment, no doubt for the same reason as given in (3) above.. MONTH FREE MEALS PAID MEALS April 577 50 May 663 50 June 640 50 September 528 72 December 241 1670 January 1841 302 1986 * Commencement of Enlarged Scheme 6. Health of School Children under Bombardment In the early part of 1941, a survey was made to ascertain the effect on children of heavy bombing and other factors arising from the War. Head Teachers and their Staffs were interviewed by the Medical Officer and the matter was freely discussed. It was found that only 1% of the children were frequenting Public Shelters and that a further 1% were sleeping in outdoor Anderson Shelters. The remainder were sleeping in their own homes, although not necessarily in their own beds. The ground floors were naturally preferred to upper storeys, and some form of blast protection had in most cases been provided. As far as could be ascertained, the children showed few signs of mental or physical stress or psychological disturbance, except, of course, in the case of children who had sustained some personal loss. On the sounding of an "alert" while the children were in school, there was not the least suggestion of fear. Indeed, it became a routine matter on such occasions for the children to file in orderly fashion into the air raid shelter, and there to continue their lessons until the "all clear". In spite of the increased cost of living, nutrition among school children has shown no deterioration. In fact, as the figures for the provision of meals on payment show, there is now more remunerative employment in this district as a result of war work. The Incidence of Pediculosis and Scabies An attempt was made, in the early part of 1941, to ascertain the trend of lice infestation in the Borough and a questionnaire was sent out to all the Council's Health Officers, including School Medical Officers and Nurses who are in a good position to express an opinion on this matter. The conclusions arrived at, were that there appears to have been no gross increase in lice infestation among the school population. In fact, 74% of the returns pointed either to the position being unchanged or to an actual decrease in this condition. In spite of this favourable indication, however, a cautious attitude has been maintained. It is obvious that shelter life and lowered habits of cleanliness and personal hygiene resulting from air raids, all favour an increase in lice infestation. Further* many mothers are now going out to work and it is likely that many school children may not be getting their customary care and attention. From a consideration of these facts, it would be prudent to assume that there probably has been a slight increase in verminous cases among school children in this district since the outbreak of the War. The Local Authority are taking all possible preventive and curative action possible in dealing in the lice infestation. During 1940 there was a definite increase in the incidence of scabies, the increase being more marked at the beginning than at the end of the year. The condition was noted in many cases among children who have returned from Reception Areas. The spread of this condition is also favoured by the lowered standard of cleanliness and the gregariousness engendered by air raid conditions. Children suffering from scabies were referred to Minor Ailments Clinics both for diagnosis and treatment, in most cases, by the benzyl benzoate method. Following-up of such cases was in every case carried out, both in school and in the home, to ensure, as far as possible, that all members of an affected household obtained treatment. 7. School Medical Staff and Evacuation. Throughout the year a number of children were examined by the School Medical Officers and Nurses to determine and ensure their fitness for evacuation prior to their departure. Certified Special Schools. 1. Suntrap Open-air School. This School operated normally until August 10th., 1940, when, owing to frequent air raids in the neighbourhood, the school was closed down and a dispersal of the children was carried out. A school party of 25 Tottenham children was evacuated, with the consent of parents, to Gillingham, in Dorset, The remaining Tottenham children were brought back to Tottenham, and children maintained by other Authorities at Suntrap were returned to the districts of these Authorities. The Staff also were dispersed. The buildings remained empty until taken over by the Admiralty at the end of 1940. 2. Vale Road School for P.P.Children. In November, 1959, the pupils and Staff of this school, who had been evacuated to the Civil Service Camp at Corton, near Lowestoft, and to Golden Sands Camp and to Horsley Green Camp, Stokenchurch, Bucks, were redrafted as follows:- 30 children were merged with L.C.C, units at Horsley Green and Hambleton Manor. The remaining 43 children were returned to Tottenham under the supervision of the Head Teacher, where the P.D. School was resumed at Downhills School in March, 1940, and transferred to West Green Road School in May, 1940. 3. School for the Deaf. The pupils and Staff of this school who had been evacuated at the outbreak of War to Gorleston Camp, Barry, S. Wales, were transferred to Allangate, Rustington, where a large house had been taken over for this purpose. The premises consist of a fine modern house and annexe standing in a spacious garden. Excellent heating and hot water systems are installed, and there are several luxurious bathrooms, good domestic offices, and large classrooms and dining rooms. For the training of the deaf children remaining in Tottenham, the School for the Deaf was set up at West Green Road School, in Tottenham. 4. Lordship Lane School for Partially Sighted Children. As in previous years, Tottenham pupils have attended this School which is in the administrative district of Wood Green. 5. Oak Lodge Special School. Throughout 1940, mentally defective educablechildren were sent to Oak Lodge Special School as in previous years. This School is under the management of a Joint Board consisting Of representatives of Finchley, Wood Green and Hornsey. Unfortunately, it was found necessary by the Finchley Council to utilise part of the premises as a depot for Civil Defence personnel, which caused serious loss to the school of vital accommodation, One of the results of this displacement has been that occupational training has been brought practically to a standstill, and Contd. 8. the school is existing in quarters which are quite inadequate for the purpose. This matter has already been brought fully to the notice of the Board of Education who are, therefore, aware of all the circumstances. 6. Vale Road Nursery School - This school continued to be housed, during 1940, at Elveden Hall, West Suffolk. The health of the children on the whole, was very good, but there was a small outbreak of whooping cough in October, 1940. A School Nurse was sent to Elveden Hall to assist in the care of the children. The school was regularly visited by the School Medical and Dental Officers, and whenever required, by the visiting Doctor, who is a local medical practitioner. In January 1940, immunisation against diphtheria of all the children was completed, and a proportion of the Staff were also treated. The children appear to be benefiting from their stay in the country and show evidence of the beneficial effects of the fresh air, good food and ordered routine available in their present environment. Infectious Diseases Considerable loss of school attendance occurrs annually, 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. Comparative figures of infectious disease occurring during the last three years are not given owing to the pressure of work during 1940 as a result of the War. Diphtheria Immunisation. During the year under review, immunisation clinics were continued without interruption, although, owing to evacuation and, in the latter part of the year, to the incidence of repeated daylight "alerts",attendances were not comparable with those of a normal year, In the last two months, however, attendances improved and the number of clinic sessions was Increased from two to four per week. Early in 1941, a special appeal to parents was made to have their children immunised. Arrangements were made for a doctor to attend at each school to give the necessary .treatment in a mobile immunisation clinic, which consisted of a Civil Defence Mobile Unit fitted with a water supply heated by calor gas, and full sterilisation equipment. The response has been excellent, and 2500 new acceptances have so far been received. A further report on this matter will be forthcoming In due course. Bacteriological Examinations. The results of examinations of throat and nose swabs for diphtheria will be found in the Health section of the report. ELEMENTARY SCHOOLS TABLE I.- Number of children inspected 1st January to 31st December,1940 A. - ROUTINE MEDICAL INSPECTIONS No. of Inspections in the prescribed Groups:- Entrants 747 Second Age Group 592 Third Age Group 661 Total 2,000 No. of other Routine Inspections 274 Grand Total 2,274 B. - OTHER INSPECTIONS No. of Special Inspections & Re-Inspections 19,346 TABLE II.- Classification of the Nutrition of Children during the year in the routine age groups Age Groups Number of Children Inspected A (Excellent) B (Normal) c (Slightly Sub-normal D (Bad) No. % No. % No. % No. % Entrants 747 106 14.1 528 70. 99 13.2 14 1.8 Second Age Grp: 592 96 16.2 410 69.0 79 13.3 7 1.2 Third Age Group 661 137 20.7 469 70.9 54 8.2 1 .2 Other Routine Inspections 274 73 26.6 144 52.5 49 17.8 8 2.8 Total 2,274 412 18.1 1,551 68.2 281 12.3 30 1.3 GROUP.I - TREATMENT OF MINOR AILMENTS (Excluding Uncleanliness) Total Number of Defects treated or under treatment during the year under the Authority's scheme 1,171 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) 515 12 527 Other defect or disease of the eyes, (excluding those recorded in Group I.) 6 4 10 Total 521 16 537 No. of Children for whom spectacles Under the Authority's Scheme Otherwise Total were (a) Prescribed 417 12 429 (b) Obtained 416 12 428 GROUP. III - TREATMENT OF DEFECTS OF 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 70 33 106 209 TABLE.IV - DENTAL INSPECTION & TREATMENT (1) 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 Numbers 2,294 1,205 1,374 1,600 1,484 1,315 1,208 1,065 342 75 11,960 (b) Specials 886 (c) TOTAL (Routine & Specials) 12,846 (2) Number found to reqaire treatment 9,292 (3) Number actually treated 3,417 (4) Attendance made by children for treatment 7,168 (5) Half-days devoted to:- (7) Extractions:- Inspection 79 permanent Teeth 1,128 Temporary Teeth 4,881 Treatment 905 Total 6,009 Total 984 (8) Administrations of general anaesthetics for extractions 138 (6) Filling&r- Permanent Teeth 2,819 (9) Other Operations:- Temporary Teeth 641 Permanent Teeth 259 Temporary Teeth 247 Total 3,460 Total 506 TABLE.V - VERMINOUS CONDITIONS (i) Average number of visits per school made during the year by the School Nurses 17.3 (ii) Total number of examinations of children in the Schools by School Nurses 79,441 (iii) Number of individual children found unclean 821 (iv) Number of children cleansed under arrangements made by the Local Education Authority 59 In addition, 197 were cleansed prior to evacuation (v) Number of cases in which legal proceedings were taken:- ) (a) Under the Education Act, 1921 - (b) Under School Attendance Byelaws - BOROUGH OF TOTTENHAM MATERNITY AND CHILD WELFARE COMMITTEE ANNUAL REPORT OF THE MEDICAL OFFICER 1940. MATERNITY AND CHILD WELFARE DEPARTMENT - STAFF. Executive Officer and Supervisor of Midwives: G.HAMILTON HOGBEN, M.R.C.S.(Eng.) D.P.H. Medical Officer of Health. Deputy Medical Officer: JOHN LANDON, M.R.C.S.(Eng.) D.P.H. Part-time Medical Officers: Infant Welfare Centres: C. Alice King, M.D.,M.R.C.P.,D.P.H. Ante and Post-Natal Clinics: Esther Rickards,M.S.,F.R,C.S. Superintendent Health Visitor and Assistant Supv.Midwives: Mrs.J.Kent Parsons, M.B.E.,S.I.Ex.Board, S.C.M.,II.V.Certificate. Assistant Superintendent Health Visitor: Miss M. Blanchard, S.R.N.,S.C.M. ,H.V.Certificate. Health Visitors Miss G. M. Hockin, S.R.N.,S.C.M. ,H.V.Certificate. " E. Dunn, " " " (to 21st March,1940) " N.A.Lennon, " " " " K.Goodwin, " " " " M. Oldfield, " " " " M. Suiapner, " " " " B .H.T.Townsend, " " "(seconded to Ministry of Labour) " H. Haworth, " " "(to November 30th,1940) " H.E. Clynes, " " "(to May 24th, 1940) " K.B. Drage, " " " " S.G.Briggs, " " " " M.P.Jones, " " " " E. Beattie, " " " " K.Parslow, " " " " E.Mallory Smith," " " " D.M. Cox, " " " " 0.M.B race, " " "(from August 6th,1940) " Mellett, " " "(from Sept.24th to Dec.13th) Municipal Midwives:Miss 0. Durie, S.C.M.,60,Compton Crescent,N.17. T0T.2301. Mrs. H.A.C.Jones,S.C.M.,32,Strode Road, N.17. TOT.31O3. Miss D. Nyman, S.C.M.,74, Greenfield Road,N.15. STA.6166. Miss E. S. Lloyd,S.R.N.,S.C.M.,408, Lordship TOT.2987. Lane,N.17. Miss F. J. Trethewy,S.C.M.,184,St.Ann's Rd.,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. Mrs. M. Latchford, S.C.M.,103,Broadwater Rd.N.17.T0T.4l80. District Nursing Association,The Superintendent, Queen's Nurses' Home, Bruce Grove, N.17. T0T.4087. DAY NURSERY. PARK LANE. N.17. MATRON-IN-CHARGE, Miss J. Pearse, S.R.C.N. DAY NURSERY. 227. WEST GREEN ROAD. N.l5. (evacuated to Alcoribury, 1st Sept.1939 and subsequently to Bengeo House, Bengeo, Hertford.) MATRON: Miss G.E.Moody,S.R.O.N. WAR-TIME DAY NURSERY(VALE ROAD). ACTING MATRON: Miss V.W.Moss (from 15th April 1941) Clerk to the Committee - Miss M. F. Davidson. CLERICAL STAFF Senior Clerk - Miss E. Horton Mr. E. E. Fisher. Miss G.A.Elliott. Miss N.L.Petty. Mrs.D.Martin(nee,Miss Osbourne) Miss D. II. Ball. Miss T. Dillistone. MATERNITY CHILD WELFFARE DEPARTMENT. ANNUAL, REPORT 1940. MATERNITY HOSPITAL SERVICES Arrangements for maternity cases; have been made, as in previous years, in respect of patient, able to pay the whole or part of the fee, with the Mothers Hospital, Clapton, and the North Middlesex County Hospital., 355 confinements of Tottenham residents took place in these institutions compared with 523 in the previous year. THE HEALTH VISITORS DEPARTMENT At the beginning of 1940, the department had fully adjusted itself to war conditions and was once again working normally. During the year, 33,975 borne visits were made compared with 41,909 during 1939. As in the previous year, it was found that the war imposed additional duties on this service. Health Visitors continued to accompany expectant mothers to reception areas. In June, 1940, following the invasion of the Low Countries, there, was a large influx of Belgian and French refugees into this country. Many of these were found to be in a verminous condition and the Jewish Hospital in Tottenham was made the central cleansing station for the whole of Middlesex. All available nursing assistance was employed and the Health Visitors, working in a rota, rendered useful service. After air raids, during which Tottenham received heavy damage, Health Visitors attended bombed families, either in their homes, or at Rest Centres and bathed and fed the children. At the Harringay Arena, then the main Rest Centre, Health Visitors paid daily visits to attend sick children and adults. Further sup rvision of young children was also made necessary by the increase in scabies and to a lesser extent in lice infestation, due to a relaxation of peace time standards of cleanliness and the crowding together of persons in air-raid shelters. The emergency shelters for lost children which had been provided were not used as children invariably found their way to Rest Centres. ANTENATAL AND POST-NATAL CLINICS. During 1940 , the work of these clinics showed little variation in spite of day and night raids find the. consequent evacuation of an increased number of expectant mothers. Two sessions were held weekly at each of the three clinics. At the Chestnuts. Clinic, happily restored to its normal use during the year, 705 patients were attended of whom 124 were post-natal; at Lordship Lane Clinic, 447 of whom 122 were post-natal and at Park Lane 275 of whom 51 were post-natal. The slight falling off in attendances at the Post-Natal clinics was probably due to the continued residence in the country of patients evacuated for their confinements. As in previous years, the closest co -operation was maintained with, the Maternity Hospitals in the district. The fullest use has been made of the many welfare services and this is especially true of the dental services. During the year 458 expectant, mothers and 103 nursing mothers have received treatment and 160 dentures have been supplied. Great appreciation has been expressed of this service by the mothers. (cond.) - 2 - INFANT WELFARE CENTRES. During 1940, the Infant and Child Welfare clinics continued to operate satisfactorily and all the customary services were available for mothers, infants and toddlers. The Chestnuts clinic, which in the early part of the war was utilised for Civil Defence purposes, reverted to its normal use from the 23rd September 1940, which relieved the congestion occasioned by the use of emergency premises at 227 West Green Road. Although, owing to evacuation, attendances were somewhat reduced in the first half of the year, the numbers improved considerably in the latter half in spite of air raid conditions. The number of infants examined by the Medical Officer during the year was 4774 compared with 5885 during 1939. New cases numbered 800 against 1,503 in 1939. The amount of rickets detected amongst children attending the clinics was practically negligible and their nutrition and general health, on the whole, remained good. No increased tendency to anaemia was noticed. Where children had returned to Tottenham from reception areas, the beneficial effect of their stay in the country was much in evidence. The increasing demand for the services of the special clinics, especially the dental clinic, testifies to the good work done by the health visitors staff. BREAST FEEDING. As the result of the Health Visitors' enquiries, it was ascertained that 1396 infants have been fed as follows:- Breast fed 932 Part breast-fed, plus milk, dried milk or condensed milk 322 Bottle feeding - cow's milk 56 dried milk 54 Other artificial foods 3 Feedings unknown 29 Total 1,396 CHILD LIFE PROTECTION. As a result of the evacuation of a proportion of the child population, the number of foster mothers has been correspondingly reduced. Also, women seem to prefer to undertake factory work instead of registering as foster mothers as in pre-war years. 131 home visits were paid to foster parents during the year, compared with 158 during 1939. The number of foster mothers registered at the end of 1940 was 21 as compared with 28 in the preceding year. CONVALESCENT TREATMENT FOR YOUNG CHILDREN. Owing to war conditions there was a great reduction in the number of children under five years of age sent away during the year 1940. Many were already evacuated and the parents of those that remained at home were unwilling to evacuate them. (contd). - 3 - However, 12 children were sent to Convalescent Hones through the Invalid Children's Aid Association during this period. MUNICIPAL MEDICAL CENTRE AND DAY NURSERY,PARK LANE. This building, a full report of the planning and construction of which was given in my report for 1938, was officially opened on March 9th 1940. From the first, this centre has fulfilled all expectations and has provided an important addition to the health services of the Borough. Apart from the day nursery, which occupies one entire wing of the building, the services provided include Infant Welfare, Ante and Post Natal and Toddlers' Clinics, Artificial Sunlight, Ear, Nose and Throat, Dental, Minor Ailment and Diphtheria Immunisation Clinics. Lectures are given to mothers in the maintenance of health in war-time supplemented by practical demonstrations of war-time cookery. Adequate air-raid shelter accomodation is provided and proved of great value in the difficult days of intensive bombing. 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 2051 as compared with 2028 during 1939. DAY NURSERIES. (1) The West Green Day Nursery. As previously reported, this Nursery was evacuated, en bloc, to Alconbury House, near Huntingdon, on September 1st 1939. On the 24th June 1940, the nursery was transferred to temporary quarters at Ashendene, Bayford, Herts, pending the completion of arrangements for the more permanent housing of the nursery at Bengeo House, near Hertford which was effected on July 22nd 1940. Bengeo House. This is a large house of Queen Anne design, erected about 30 years ago and standing in its own grounds of which 8 aeres are available to the nursery. It is centrally heated and has independent hot-water supply, main drainage, gas and:electric lighting and company's water supply. There is good accommodation for 38 children and the staff, and the nursery is fully residential. Administrative control is in the hands of the Tottenham Maternity and Child Welfare Committee. A local medical practitioner visits this nursery whenever necessary and frequent visits are paid by the Committee's Medical and Dental Officers. All the children have been immunised against diphtheria. A number of places have been reserved at this Nursery for the children of expectant mothers who are to be evacuated and this facility is greatly appreciated by the mothers who face their confinements happy in the knowledge that their children are being well cared for. (2) Park Lane Day Nursery. This nursery which forms part of the new Municipal Centre (contd.) - 4 - in Park Lane, before mentioned, opened on April 10th 1940 with 19 children. Dy May 20th, 50 children were on the register. At this nursery the children enjoy conditions which are widely felt to be almost ideal. During the year, the land made available by the demolition of 129, Park Lane was acquired for the nursery and further space for recreation and kitchen gardens was provided. One of the special amenities of this nursery is that the medical and clinic services available at the centre are immediately available for the children and this facilitates the provision of dental, ophthalmic and other services. Particular mention should be made of the use that has been made of the sunlight clinic. During the winter of 1940/41 all the children were regularly given graduated doses of artificial sunlight. This was reflected in the general well being of the children and their satisfactory resistance to intercurrent ailments. Routine medical inspection was regularly carried out and all the children have been immunised against diphtheria. There is at present a large waiting list for the two nurseries before mentioned. (3) War-time Day Nurseries. On the 25th September, 1940, a letter was received from the Ministry of Health stressing the importance of taking all necessary steps to facilitate the employment of female labour in munition and other factories essential to the war effort by the provision of one or more day nurseries for the children of mothers so employed. An investigation into the need for such wartime nurseries in Tottenham had shown that the matter was one of urgency and immediate steps were taken to implement the instructions received from the Ministry. The authority of the Local Education Committee was, therefore, obtained for the use of the premises in Vale Road, Tottenham, of the evacuated Nursery School, for this purpose. By the end of the year, the task of providing the necessary equipment and staff was well advanced. An adequate air raid shelter was erected and the nursery was opened early in 1941. T0DDLERS CLINICS. These were continued throughout 1940. In all, 52 medical sessions were held as compared with 51 in 1939 and attendances numbered 486, as against 700 in 1939. A number of toddlers were referred to the Eye Specialist, following routine refraction examination. (contd.) - 5 - MIDWIFERY SERVICE: MIDWIVES ACT, 1936. During 1940 the Municipal Midwifery Service consolidated its position as an integral part of the Maternity and Child welfare Service. Many of our Municipal Midwives accompanied expectant mothers to their destinations in reception areas and several were loaned to Maternity Homes at which the mothers wrare confined. During the intensive night bombing in the latter part of the year, the midwives showed great devotion to duty under extremely difficult conditions:- Record of Work. By Municipal Midwives. By the Maternity Nursing Association. By the District Nursing Association. Total Number of deliveries. 666 81 5 755 Number of cases attended as Maternity Nurse 79 14 - 93 Primipara 241 34 1 276 Multipara 504 64 4 572 Number of ante-natal visits 1540) 297) 40) 1877) Number of nursings. 11428) 2360) 86) 13874) Total home visits. 12968 2657 126 15751 Number of deaths of mothers - at home - - - - Patients admitted to hospitals - - (a) during pregnancy 42 1 - 43 (b) during labour 6 1 - 7 (c) during puerperium. 11 1 - 12 Ante Natal Clinics: attendances included in clinic figures. 805 17 822 — 6 — EVACUATION OF EXPECTANT MOTHERS. The Borough of Tottenham is part of the ExtraMetropolitan Evacuable Area and provisions are made, under the Government Evacuation Scheme, for the evacuation of expectant mothers. During the year, 99 expectant mothers were evacuated. The mothers assenble at the Town Hall every Friday and are conveyed in coaches, accompanied by a certified midwife to reception areas; On arrival most of the mothers go into billets until the commencement of labour, when they are taken to Government Emergency Maternity or Nursing Homes. The average period of absence from home is six weeks. During 1940, one of our greatest problems was the care of children under 5 years whose mothers were expectant and required evacuation. To meet this difficulty, a number of places were reserved at the residential day nursery at Bengeo House; Hertford for such children. This arrangement has proved very satisfactory and, furthermore, the stay in the country has invariably had a beneficial effect on the children themselves. DENTAL_TREATMENT_FOR MOTHERS AND CHILDREN. Throughout the year, steady progress was made in the Dental Treatment of expectant and nursing mothers and children under five years in spite of the difficulties occasioned by evacuation and the incidence of daylight air raids. The number of nursing and expectant mothers who received treatment during the year was 458 of- which 355 were ante-natal cases and 103 were nursing mothers. In addition, 160 of these were provided with dentures, 99 of which were free of cost and 6l at part-cost. 400 consultations and 486 treatments were given to children under five years of age. ASSISTED MILK_SUPPLY. On July 1st, 1940, a National Scheme for the supply of milk, either free or cheaply, to all expectant and nursing mothers and children under five years of age came into operation under the Ministry of Food. Under the Scheme, one pint of liquid milk (or in special circumstances for children under 1 year of age, an equivalent amount of dried milk) is supplied daily to each member of these classes on whose behalf a proper application is made. The price normally paid is twopence per pint irrespective of income scale, although there are provisions for a free supply in certain cases of economic necessity. This scheme entirely superseded the arrangement made by the Milk Marketing Board and approved by the Minister of Agriculture and Fisheries on 26th July, 1939 set out in Circular 1840 of August, 1939. The powers of the Welfare Authorities were, however, in no way affected by the new scheme, and where necessary, independent arrangements were made to supplement the provision of milk under the scheme, where such a course appeared desirable on medical grounds.