BORUUGH OF TOTTI® KAM AC 439(1) TOTTENHAM TOT15 Annual Report of the Medical Officer of Health for 1941. BOROUGH OP TOTTENHAM. Annual Report of the Medical Officer of Health. 1941. PUBLIC HEALTH DEPARTMENT HEALTH AND HOUSING COMMITTEE. (As at 31st December, 1941) Chairman: Alderman R.H. Warren (Deputy Mayor) Members: (Ex-officio) His Worship the Mayor (Councillor Mrs. A.E. Lyons, J.P.) Alderman C.D. Grant " Mrs. W.A. Kent, J.P. " Mrs. A. Kitchener. " J.H. Morrell, J.P. " A. Reed, A.C.I.I., J.P. " A.R. Turner. Councillor G. A. Armfield. " Mrs. M. Berry. " A. Clark. " Miss R.F. Cox. " R.W.H. Ford. " Mrs. G.E. Morrison. " H.W. Pearce. " J. Wallace. STAFF. PUBLIC HEALTH DEPARTMENT. Medical Officer of Health: G. Hamilton Hogben. Deputy Medical Officer of Health: J. Landon (until Nov. 3Oth, 1941). B. Broadbent (from December 8th, 1941). Chief Sanitary Inspector: J.B. Smith. Sanitary Inspectors. W.P. West J.A. Shilllto L.J. Kerridge E.T. Jenkins W.L. Morris C.J. Cattell F.J. Parsons (from 3.11.41) (until 13.11.41) E.S. Glegg. R.H.T. Chappell A.S. Munoey (from 31.3.41) R. Garvey. Shops Acts Inspector - F.T.G. Lock. Assist. Shops Acts Inspector - A.A. Sendall. Nurses for Infectious Disease. S. Swaffield W. Mathias. Clerical Staff. Acting Chief Clerk - W. Potter. H.R. Gilbert H. Thomas (H.M.Forces) H.F. Smith A.W. Lawrence (H.M. Forces) W.P. Kent Miss J. Cadd Miss B.M. Miller (since- 28.7.41.) L.R. Perry (Seoonded to Rehousing Dept. ) D.J. Legge (H.M, Forces, since 31.7.41) Miss M.R. Erwood. - 1 - STATISTICAL SUMMARY. ETC. Area of the District in acres. 3,014 Regiatrar-General's estimate of civilian population, mid-year 1941. 105,620 Rateable Value. £972,770 Sum represented by a penny rate. £3,880 Births and Deaths. Registered live births:- Total Males Females. Legitimate 1,490 743 747 Illegitimate 70 37 33 1,560 780 780 Birth Rate per 1,000 estimated population 14.77 Total live births for calculation of Infant Mortality Rate, Total Males Eto:Females Legitimate 1,248 622 626 Illegitimate 68 36 32 1,316 658 658 Still Births. (a) Registered Total Males Females . Legitimate 50 30 20 Illegitimate 1 1 - 51 31 20 (b) Total Still Births for calculating Still Birth Rate. Total Males Females Legitimate 46 27 19 Illegitimate 1 1 - 47 28 19 Still Birth Rate per 1,000 total (live and still) births. (a) 31.66 Deaths. Males 732 (b) 34.48 Females 686 Total 1,418. Death Rate per 1,000 estimated civilian population.13.43. Maternal Deaths. Deaths. Rate per 1,000 total (Live and still) births. Puerperal sepsis. 2 1.47 Other puerperal causes 1 0.73 3 2.20 Death Rate of Infants under one year of age:- All infanta per 1,000 live births 46.35 Legitimate infants per 1,000 legitimate live births 44.87 Illegitimate infants per 1,000 illegitimate live births 73.53 Deaths from - Canoer (all ages) 194 Measles (all ages) 4 Whooping Cough (all ages).. 8 Diarrhoea (under 2 years).. 8 Table of Deaths during the year 1941 in the Borough of Tottenham, classified aocording to Diseases. Cause of Death. Males Females Totals. Typhoid & paratyphoid fevers. - - - Measles 1 3 4 Scarlet Fever - — - Whooping Cough 3 5 8 Diphtheria 3 2 5 Influenza 7 9 16 Encephalitis Lethargica - 1 1 Cerebro-Spinal Pever 1 - 1 Tuberculosis of Respiratory System. 68 38 106 Other Tuberculous Diseases 6 8 14 Syphilis 6 3 9 General Paralysis of the Insane Tabes Dorsal is - - - Cancer, Malignant Disease 96 98 194 Diabetes 2 12 14 Cerebral Haemorrhage, etc. 40 74 114 Heart Disease 170 174 344 Other Circulatory Diseases 16 15 31 Bronchitis 63 53 116 Pneumonia (all forms) 54 50 104 Other respiratory diseases 6 5 11 Peptic Ulcer 21 2 23 Diarrhoea (under 2 years) 4 4 8 Appendicitis 7 5 12 Other Digestive Diseases 13 7 20 Acute and Chronic Nephritis 17 15 32 Puerperal Sepsis — 2 2 Other Puerperal Causes - 1 1 Congenital Debility, Premature Birth, Malformations. 16 14 30 Road traffic accidents. 7 4 11 Other violent causes 38 34 72 Suicide 7 5 12 All other causes. 60 43 103 732 686 1,418 - 3 - Infantile Deaths in Ages and Sexes during the year 1941. 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 Measles - - - - - - - - 1 1 - 1 Whooping Cough 1 - - - 1 1 1 - - 3 - 3 Meningitis - - - 1 1 - - - 3 4 1 3 Bronchitis - - - - - 2 2 1 - 5 3 2 Pneumonia - - - - 2 - 2 - 4 2 2 Diarrhoea & enteritis - - - 1 1 2 3 2 - 8 5 3 Premature Births, congenital malformation, etc. 23 3 - - 26 1 2 1 - 30 16 14 Other causes. - - - - - 2 2 1 1 6 6 - Totals - 24 3 - 2 29 10 10 7 5 61 33 28 - 4 - -5 - Table of cases of Infectious Disease coining to the knowledge of the Medical Officer of Health during the year 1941 in the Borough of Tottenham, classified according to Diseases & 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 Coursci1. Scarlet Fever 41 62 1 - 5 11 6 41 18 7 11 2 1 — 59 Diphtheria 30 43 - 1 7 6 8 18 16 8 7 1 1 - 67 Pneumonia 60 38 8 5 5 7 1 7 1 6 9 12 27 10 - Erysipelas 12 12 - - - - - - - 1 5 4 12 2 5 Puerperal,Pyrexia - 13 - - - - - - - - 12 1 - - 3 Dysentery - 2 - - - - - - - - 1 - 1 - 1 Ophthalmia Neonatorum 1 1 2 - - - - - - - - - - - - Cerebro-Spinal Meningitis 11 11 - 2 2 1 1 3 1 4 4 2 1 1 9 Poliomyelitis 1 1 - - - - 1 1 - - - - - — — Typhoid 2 2 - - - - - - 2 1 - — 1 - 1 Pood Poisoning 3 4 - - - - 1 - - 1 1 1 3 - - Whooping Cough 240 225 35 60 57 56 75 169 7 3 2 - 1 - 41 Measles 539 505 18 92 111 110 129 542 23 12 7 - - - 65 Pulmonary Tuberculosis 98 63 - - - 1 1 3 1 22 75 20 35 3 - Other forms of Tuberculosis. 11 17 - 1 1 - - 6 1 4 10 1 3 1 - 1,049 999 64 161 188 192 223 790 70 69 144 44 86 17 251 GENERAL PROVISIONS OF HEALTH SERVICES. LABORATORY FACILITIES. The following is a statement of the examinations made during the year:- Swabs. Negative Positive Total. Diphtheria contacts, discharged cases, Convalescent Home cases, etc. 311 24 335 Medical Practitioners 238 28 266 Totals. 549 52 601 Specimens of Sputa examined Positive 8 for Tuberculosis:- Negative 76 84 Faeces examined for Typhoid & Dysentery 2 (negative) " " " Typhoid. 1 (positive) Stool examined for Food Poisoning. 1 (negative) AMBULANCE FACILITIES. The Borough Ambulance Service continues to be controlled by the Public Health Department. Five motor ambulances are available for accident and non-infectious cases, and there are two buses for conveying children to Special Schools. The buses are also used for transporting meals to the various School Feeding Centres, and this branch of the service was augmented early in the year by an additional vehicle-a Utility Van-provided by the Tottenham Education Committee. The Education Committee also pay for a driver for this vehicle. Total mileage for the year - Ambulance Vehicles and buses. 40,866 Total mileage for the year - Utility Van 4,463 Number of accident and hospital cases, etc. conveyed during the year 4,139 Number of occasions on which the oxygen resuscitator was used 7 SANITARY CIRCUMSTANCES. WATER SUPPLY. The Borough water supply, controlled by the Metropolitan Water Board, has been satisfactory in all respects, SANITARY CONDITIONS AND HOUSING. During the whole of the year, the Sanitary Inspectors were engaged on the repair of war damage. - 6 - These duties included the inspection of properties immediately after an incident occurred; classification of properties in category 'A', 'B', or 'C; arrangement for the carrying out of first aid repairs (roofs, windows, doors, etc) & supervision of this work; detailed surveys to ascertain more permanent repairs required, and arrangement and supervision of this work; and checking of Builders' accounts. This work claimed the greater part of the Inspectors time, and their normal statutory duties were of necessity curtailed. No details can at present be given, regarding the repair of war damage, but other inspections are summarised below. Number of houses inspected after Infectious Disease .201 " " „ „ under the Housing Act - " " on complaint. 942 1,145 Informal notices served numbered 1,179, and Statutory Notices under the Public Health and Housing Acts 177. Drains examined and tested 121 Drains reconstructed and repaired 92 Drains found stopped 109 Soil pipes repaired or renewed 28 Gullies renewed 26 Fresh air inlets renewed 14 W.C. cisterns and pans repaired or renewed 185 Waste pipes repaired or renewed 68 Rain-water-pipes repaired or renewed 123 Roofs repaired or renewed 215 Gutters repaired or renewed 109 Drinking water cisterns repaired or renewed 11 Number of houses where water was provided from the main. 5 Yard paving repaired or renewed 37 Sinks repaired or renewed 28 Floors repaired or renewed 58 Floors ventilated 14 Window frames & sashes repaired or renewed. 94 Coppers repaired or renewed. 17 Fireplaces, stoves, etc. repaired or renewed 87 Number of houses where walls and ceilings were cleansed.225 Miscellaneous defects remedied. 272 Damp proof courses were inserted in 15 houses, 16 houses were rendered externally, and 7 houses were pointed. Reinspections totalled 2,036 Other inspections were:- Inspections of Stables and Mews 15 „ " Schools 4 „ „ Pawnbrokers' premises 4 " „ Public House Urinals 36 " " Knackers' Yards 10 There is only one Common Lodging House in the district, and this was visited monthly. The Moselle Brook gave cause for complaint during the summer months. The surface water sewers from Wood Green and Tottenham discharge into this open brook, and examinations of samples of the effluent showed that there was some sewage pollution. Further investigations are proceeding. - 7 - Repair of Houses by the Council. Work carried out in default - Section 9. Housing Act, 1936 - 19 premises; cost £319. 7. 0, Section 39, Public Health Act, 1936 - 2 promises; cost £14. 9. 1. Work carried out for maintenance of public sewers - Section 24, Public Health Act, 1936 - 34 premises; cost £470. 2. 7. Housing Act. 1936; Section 11. Demolition orders with respect to 2 dwelling houses were made under this Section. Infectious Disease. Disinfection Work. In addition to the normal terminal disinfection of rooms carried out with the Formalin Spray, an increasing amount of disinfection work has been undertaken at the Steam Disinfector. Blankets, pillows, etc. used by the firewatchers of private firms, A.R.P. personnel, etc., have been disinfected regularly at the Markfield Road Disinfecting Station, and the Baths there have been used for cleansing persons suffering from Scabies. The complete renovation of these baths, in order to render them more suitable for the increasing number of cases required to be dealt with, was arranged in the last month of the year, and the work was completed early in 1942. The accommodation here cannot, however, be regarded as providing permanent cleansing facilities. Full details of the Disinfection work carried out, are set out below. Rooms disinfected after Scarlet Fever, Diphtheria, and Tuberculosis. 258 Bedding, etc. from 484 houses (Infectious Disease - incl. Scabies) Wards or School Rooms, 19 Verminous rooms (incl. disinfestation process) and mis cellaneous. 324 Blankets. Pillows. Overlays. Other articles„ Private Firms in the district. 2,120 102 66 18 Civil Defence and Fire Watchers, 3,144 76 127 18 206 Library Books were disinfected with Formaldehyde Gas. Disinfestation of 60 houses on the Council's Housing Estates was also completed during the year. - 8 - SHOPS ACTS. 1912-1938. The Shops Acta are administered by two Whole-tine offIcers. By means of systomatic visitation of shops throughout the borough, effective administration of the Shops Acts is secured, and the necessary information obtained for the purpose of keeping up to date a rogister of all shops in the borough. During the year a complete survey of shops was made. In the various roads visited, it was noted that there are:- 21 shops empty (damaged by enemy action) .6%)of total shops 599 shops empty (other reasons) 20.00%)in Tottenham. 71 shops demolished (62 by enemy action, 2.06%) (Approx. 9 for road improvements, etc. .3% ) 3,000) Percentage of total number of shops empty and demolished for various reasons - 23,0% It is interesting to note the small percentage demolished or empty due to enemy action. 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 compiled with. Many shopkeepers are desirous of having the earlier evening closing hours imposed under the Defence Regulations, made permanent by legislation after the war. In the administration of the Acts and closing orders, 3,881 inspections have been made. Most of the offences have been minor Irregularities and the non-exhibition of statutory notices in respect of which 252 verbal warnings and notices were issued. Shops (Sunday Trading Restriction) Act, 1936. In spite of the opportunities for Sunday Trading, due to exemptions, exceptions and High Court decisions, it is pleasing to be able to state that very few shops open on Sunday in Tottenham. The conditions relating to the employment of assistants on Sunday, and the compensatory holidays in lieu of Sunday employment are being complied with. Shops Act, 1934 & Young Persons Employment Act.1938 The provisions of the Acts relating to the employment of shop workers have been effectually applied during the course of routine visitation of shops, and it has been ascertained that the conditions of employment have improved as a result, in respect both of the hours of employment of young persons, and the arrangements for the health and comfort of shop workers. Shopkeepers generally are desirous of taking reasonable measures to comply with the requirements of the Act, and are ready to obtain and act upon the advice given by the Shop Inspector. Owing to so many older shop assistants being engaged on work in connection with the war, the number of young persons employed at present is above the normal. It is gratifying to record that with the co-operation of shopkeepers, the Acts generally have been well observed. During 1941, 7 first warning notices were issued in respect of contraventions of the above Acts. - 9 - INSPECTION OF FACTORIES. Inspections of factories and workplaces totalled 140. 48 visits were paid to Outworkers' premises. INSPECTION AND SUPERVISION OF FOOD. MILK SUPPLIES. There are no Farms or Cowsheds in the District, but 83 visits were paid to premises retailing milk supplies. MILK (SPECIAL DESIGNATIONS) ORDERS. 1956 and 1938. These designations may only be used under licence from the local authority. In 1941, the following licences were granted. Tuberculin Tested Milk Licences: Bottlers' Licences 2 Dealers' Licences 10 Supplementary Licences 3 Accredited Milk Licences - Pasteurised Milk Licences: Pasteurisers' Licences 2 Dealers' Licences 16 Supplementary Licences 4 MEAT AND OTHER FOODS. None of the Slaughter Houses in the District are in use. 97 visits were paid to Butchers' Shops. 32 " " " " Fish Shop3 30 " " " " Fruiterers' Shops 43 " " " „ Bakehouses. Miscellaneous Unsound Foodstuffs dealt with. 1,346 tins milk; 47 tins peas; 18 tins baked beans; 16 tins stewed steak; 2 tins chopped ham; 3 tins sausage meat; 22 lbs. luncheon sausage; 1½ lbs. sausage meat; 4 tins luncheon meat; 6 lbs. luncheon meat; 1 tin canned meat; 1 tin emergency meal; 15 tins salmon; 5 tins pilchards; 3 tins sardines; 3 tins herrings; 34- tins fruit; 151 cases dried apricots; 10 tins carrots; 1 tin and 50 lbs. brawn; 15 tins spaghetti; 8 tins soup; 3 bottles pickled onions; 3 bottles pickles; 1 jar pickles; 32 tins jam; 20 jellies; 2 cwt . sweets; 2½ cwt, biscuits; 108 lbs. slab cake; 26 lbs. cake; 2 jars sandwich paste; 2 jars fish paste; 1,758 eggs; 164 duck's eggs; 22 lbs. cheese; 1 box cheese; 2 cwt. potatoes; 61 lbs. onions; 202 oranges; 112 lbs. pears; 5 boxes apples; 9 lbs. ox liver; 5 stone cod roes; 6 stone coley; 2 qurs. skate wings; 3 stone skate; 5 boxes kippers; 8 stone witches; 6 stones lemon soles; 5 stone cod fillets; 7 stone rock eel; 2 bags rice; 38 lbs. 11 oz. bacon; 4 hind qrs. beef; 2 fore ends beef; 12 .lbs. 4 oz. fore end; 1 chicken; 2¼ lbs. chicken; 3 qrs. 10 lbs. butter; 41 rabbits; 19 qrs. 18 lbs. rabbits; 1 pig's head. - 10 - PREVALENCE OF, AND CONTROL OVER, INFECTIOUS AND OTHER DISEASES. Scarlet Fever. The number of cases notified wa3 103, compared with 103 in 1940, 335 in 1939, and 186 in 1938. 59 cases were removed to Isolation Hospital. Diphtheria. The number of cases notified was 73, compared with 28 in 1940, 60 in 1939, and 221 in 1938. There were 5 deaths from this disease. Immunisation is carried out by two doses alum precipitated toxoid; 0.2 c.c., followed 3 weeks later by 0.5 c.c. Total attendances 12,367 Schick Tests 3,829 Cases completed during the year. 2,739 DIABETES. With the approval of the Ministry of Health, Insulin was supplied to 10 patients suffering from Diabetes. The number of units amounted 10 138,536, and the cost was £49. 2. 8. - 11 - TUBERCULOSIS. The County Council are responsible for the treatment of Tuberculosis. 189 notifications were received during 1941 Pulmonary, 161: other than Pulmonary, 28. Cases remaining on the register at the end of the year were - Pulmonary, 516: 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:- Monday to Saturday - 10 a.m. Age Periods New Cases. Deaths. Pulmonary Non-Pulmonary Pulmonary Non-Pulmonary Males Females Males Females Males Females Males Females Under 1 year. - - - - - - 1 2 1 to 5 years. 1 1 - 2 - - 1 - 5 to 15 4 - 4 3 - 1 1 1 15 to 25 26 30 4 6 6 11 - 2 25 to 35 21 20 - 4 12 15 - 3 35 to 45 13 7 1 - 8 5 1 — 45 to 55 19 4 1 1 20 4 1 - 55 to 65 11 1 — 1 18 2 1 - 65 years & 3 - 1 - 4 - - - upwards. Totals - 98 63 11 17 68 38 6 8 Organs affected (New Cases):- Males Females. Lung 98 65 Glands 2 3 Spine 2 5 Intestines - 4 Kidney 1 2 Knee 1 - Hip 2 1 Groin 1 - Ankle 1 - Meninges 1 1 Face - 1 The deaths represent a deathrate of 1.14 per 1,000 population. In 22.5% 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 - An examination of Vital Statistics for the Years 1935/41, with special reference to the Mortality Rate among illegitimate infants. Press publicity has been given recently to tho illegitimate birth rate generally, and particular reference has been made to specific sections of the community. The [inference to be drawn from the various statements which have been made is that the illegitimate birth rate among civilian women has increased in recent times, and because of this inference the relevant statistics relating to this area have been carefully examined to determine the position locally. The statistics for the years 1935/41, so far is they affect the Borough of Tottenham, are set out in tabular and graphic form herewith. It will be seen on examination that in fact while the birth rate is by no means constant the number of illegitimate children born since 1938 has steadily reduced, and there is no close relation between the general birth rate and the illegitimate birth rate. Generally, it can bo stated quite definitely that any suggestion that there has been an increase is without factual foundation. Examination of the figures, however, discloses that the death rate of illegitimate children is alarmingly high as compared with legitimate children. This,merits special examination. For example, in 1937 the infant mortality rate of legitimate children under. 1 year was 62.3 per 1,000, while that of illegitimate children was 111.1 per 1,000. In 1938, the infant mortality rate among legitimate children had fallen to 43.7 per 1,OO0, while the illegitimate mortality rate had risen to 116.3 per 1,000. There are, several inferences to be drawn from this disclosure, but two questions are postulated as being worthy of special enquiry in the immediate future. (Cont.) (2) They are:- (1) Do unsuccessful attempts at abortion have a material effoct upon the chances-of survival of the infant? and (2) Has the lack of ante-natal care in the case of unmarried mothers a material effect upon the chances of survival of the infant? It is recognised that in order to obtain any reliable information on such matters, very careful and tactful approach on the part of those conducting any enquiry will be required. It may be daid, however, that these statistics indicate that illegitimate children suffer, not only from economic and social handicaps, but from a materially lower basic health standard than do legitimate infants. The enquiry can be extended to include an examination of the incidence of Illegitimacy among those children who later in life are found to have been mentally defective or feeble-minded, and would seem to indicate that in the wider plan for the education of the public in Citizenship and Positive Health, consideration should be given to the problem of the unmarried mother not alone from the point of view of the care of the mother but additionally from the point of view of the care of the child. Detailed examination of the Registrar Generals figures shows that the greater proportion, probably 60%, of illegitimate infants are born away from home, e.g. in Institutions, etc., so that it would seem that this is an added reason for supposing that the lack of antenatal care is responsible for this high mortality rate. The trends indicated by the statistics herein examined have been compared with the relevant national statistics and sufficient evidence has been thus obtained to indicate that these local Implications have national significance. Infant Mortality BIRTHS under 1 year per 1000 Legitimate Illegitimate Legitimate Illegitimate 1935 1892 77 54.4 64.9 19 36 18145 86 50.4 81.4 1937 1910 65 62.3 111.1 1938 1807 86 13.7 116.3 1939 1660 79 30.1 75.95 1940 1491 68 40.21 58.82 1941 1248 68 44.87 73.53 • _ r • r Public Health Department; Town Hall, N.15 November, 1942. A Survey of the incidence of Tuberculosis in Tottenham during the past ten years. Since the war there has been a marked increase in Tuberculosis figures for the Country as a whole, and for this reason the position in Tottenham has boon examined and the relevant statistics collated. The statistical Table beneath shows the pulmonary and nonpulmonary cases notified and the mortality figures in Tottenham for 19pl and the following. ten years. Year Total cases on Register Now Cases Pulmonary Pulmonary Deaths % of,fatal cases to Total Deaths. 1931 392 280 235 45 151 9.3 1952 897 262 227 35 116 7.3 1935 874 224 202 22 136 8.4 1934 804 207 181 26 133 8.3 1935 819 235 203 32 - 123 8.4 1936 675 252 222 30 128 8.0 1937 694 212 178 34 105 6.5 1938 712 216 178 38 103 6.8 1939 712 212 182 30 100 7.1 1940 707 197 178 19 109 6.4 1941 670 189 161 28 120 8.4 From this Table and the appended graphs it will be seen that the number of Deaths bears no strict relation to the number of new cases. The importance of early diagnosis has recently boon emphasised by the Minister of Health in launching a new campaign for mass miniature radiography. Early diagnosis, while statistically overloading the number of now cases, should by inference and in fact produce a corresponding reduction in the number of deaths. The peak of new cases shown in 1931 has never since been reached and this- is supported by the statistical curve showing the total cases on the Register, which has progressively fallen. -2- with regard to the war years the position in Tottenham is that the number of now eases, the total number of cases on the Register and the number of deaths., with the exception of 1941, have fallen. Two significant facts are, however, revealed from a study of the graphs which demand special consideration:- (1) In 1941 the number of deaths rose while the number of now cases notified actually fell. By inference it would seem that unchecked this movement might continue until both lines met (always a signpost of danger) and the number of deaths equal the number of now cases. (2) In 1941 the percentage of deaths from tuberculosis among the total deaths from all causes has risen. Many factors contribute to the possible explanation of these increased rates among which ares- lessoned .facilities for early treatment, dictctic and nutritional deficiencies, defective ventilation under blackout conditions at home and- at work', mental stress and physical strain of war-time conditions. The position then in Tottenham is not such as to cause alarm, but the statistical information shown in'1941 requires careful watching; and close co-operation is necessary with the. County Council, who is responsible for the control and treatment of tuberculosis throughout Middlesex. In conclusion I wish to acknowledge my indebtedness to Mr.T.E. Cowan, Rohousing Officer in the Homeless Persons section of my Department, for the preparation and helpful interpretation of the statistical information and graphs produced in this. report. -Yv8£#C O l-os / 5" /n "To "T f l£ tMh H t*J ■ I$3/ - (J&i m* BOROUGH OF TOTTENHAM EDUCATION COMMITTEE. Town Hall, Tottenham,.N.15. August, 1942. To the Chairman & Members of the Education Committee. Ladies and Gentlemen, I herewith submit in abridged form the Annual Report of the School Medical Service for the year ending 31st December, 1941. Staff. In December, 1941, Dr. J. Landon resigned his position as Deputy Medical Officer to take up the post of Medical Officer of Health and School Medical Officer at Stockton-onTees. Dr. B. Broadbent, late Assistant Medical Officer at Willesden was appointed in his. place and commenced duty on the 8th December, 1941. Owing to the increase of work entailed by the return of children from reception areas, the part-time post of temporary Assistant Medical Officer held by Dr". Nora Webster became a whole-time position as from February, 1942. No-further changes occurred in the staff during 1941. Medical Inspection. At the commencement of the year the majority of the children evacuated still remained in the Reception Areas, but as the year progressed and the danger from air-raids became less evident, a large number of the children began gradually to return to their homes in Tottenham. Routine Medical Inspection of all "Entrants" and the majority of the children in the "Intermediate" and "Leavers" age-groups was carried out, the number examined being slightly in excess of that of the previous year. The following table gives a summary of these inspections and the number of special inspections and re-inspections:- A. Routine Medical Inspection. Entrants. 1,209. Second Age Group. 651. Third Age Group. 525. Total. 2,385. Other routine Inspections. 327. 2,712. B. Special Inspections and Re-Inspections. 13,762. - 2 - In addition to routine medical inspections, rapid medical surveys of school children have been continued by the medical and nursing staffs, with particular regard to th state of nutrition and the cleanliness of the children concerned. As in previous years, those children found to be of sub-standard nutrition were referred to the Nutrition Clinic and given supplementary cod liver oil, iron, etc. according to their needs, and thus lifted to higher nutritional grades. Nutrition - School Meals, etc. The School Medical Officers are provided with many opportunities at the routine and special medical, inspections of forming an opinion of the general effect of the war on the physical and mental welfare of the children. On the whole it can be said that the health of the children has been well maintained. As far as can be ascertained very few children show signs of any physical or mental deterioration as the result of war conditions, and in a great number of cases the physical and nutritional standard has been found to be much improved. . This is probably largely due to the special facilities provided for the provision of school meals .at the meals centres and for the supply of milk in school (especially now that, by local arrangement, the milk is delivered at the schools by 9.30 a.m., thus ensuring that appetites have returned in time for the midday meal). Provision of Solid Meals. During the year the new scheme for the Provision of School Meals, referred to in last year's Report - i.e. on a sliding scale of payment, not exceeding 4d per meal continued with ever increasing success, as proved by the following table, in which the daily average is shown month by month. Month. Free. On Payment. January. 288 1904. February. 327. 1975. March. 372. 1996. April. 403. 1992. May. 357. 2071. June. 413. 2233. July. 420. 2228. August. 420. 2055. * September. 441. 2068. * October. 464. 2147. November. 460. 2294. December. 445. 2464. * *Months during which school holidays occurred. At the end of the year, according to figures prepared by the Board of Education, Tottenham had a larger proportion of school children receiving a daily hot meal in school than any other area in the country, . An interesting development was the introduction, jointly with the School Meals Scheme, of the British Restaurants, which, in conjunction with the Ministry of Food, was undertaken, at the request of the Council, by the Education Committee under a scheme prepared and controlled by the Director of Education. The already existing organisation and equipment of the School Meals Scheme made possible this expansion to the larger purposes of general Community Feeding, and the successful association of the preparation of meals for adults with that of meals for children. - 3 - The growth of British Restaurant's also made it possible, through that Service, to provide children, from the latter part of the year, with meals both free and on payment, during school holidays. Provision of Milk. The provision of milk, both free and on payment, continued throughout the year in spite of the difficulty caused by lack of bottles, which resulted from the "Blitz". In December the Education Committee, in accordance with suggestions made in Board of Education Circular 1569, introduced a much enlarged provision of help and equipment, and by the end of the year the proportion of children taking milk in school had reached 80 per cent. Uncleanliness. Special attention has been given by the School Nurses, both at the clinics and at the school cleanliness inspection's, to the detection, prevention and treatment of uncleanliness and verminous conditions. The school nurses visit the schools at frequent intervals and the children are submitted to a thorough examination to detect any sign of uncleanliness. Those children discovered to be in a verminous condition are followed up by the School Nurses both at school and in their homes. In those cases, where, owing to special circumstances, there was a difficulty in the cleansing being effected at home, the children were cleansed by the School Nurses at the Clinics, and in this connection 140 children were cleansed during the year. Every child evacuated during the year was thoroughly examined with regard to his or her state of cleanliness and every precaution,was taken to ensure that at the time of evacuation each child was in a clean condition. Those children found to be in a verminous condition were either cleaned by their parents or by the school nurses, and again inspected prior to their departure. Table V (Appendix) shows the number of children found to be unclean end the action taken. Scabies. During 1941, efforts were redoubled to get as many as possible of the infested persons diagnosed and treated, A. valuable contribution, resulting from the Board of Education Circular, 1575 led to the co-operation of Head Teachers, by a daily inspection of hands and wrists of all children, with direct reference to the School Medical Officers of all doubtful cases. In each case diagnosed, home visits followed, and pressure was brought to bear on other members of the family to come for treatment at the various centres. The diffimilty of contacting members working away from home has recently been diminished by the employer allowing the worker to attend for diagnosis and treatment. Thus, in considering the relative figures as between 1940 and 1941, the fact must be remembered that there are not only fewer missed cases in school children, but more treatment of their relatives, as well as a considerably increased local population resulting from the steady return to the London area. - 4 - Ophthalmic Clinic. During the year there was a total of 486 errors of refraction, including 58 children suffering from squint. In 349 instances spectacles were prescribed, and in every case these were obtained. The' difficulty usually experienced in causing a sensitive school child to wear spectacles was minimised by a periodic checking on the part of the school nurses, and by ensuring through the medium of Toddler Clinics, that treatment was instituted before the child actually commenced attendance at school, In many instances, a potential squint was treated before the actual development of asymmetry, thus forestalling all risk of amblyopia at a later date. Aural Clinic. The Visiting Aural Surgeon, Dr. Clarke, reports that "The Aural Clinic has been carried or without interruption during the year 1941 at the Municipal Medical Centre, Park Lane. For the greater part of the year there was one session weekly-(a wartime measure)- but as the numbers increased towards the latter end of the year It was decided to revert to the original two sessions weekly. One of these, once a fortnight, is now devoted to the special treatment of tonsils by Tonsil Suction. For the first five months of the year there was a rather large number of absentees from the Treatment Clinics, no doubt largely due to the continued air raids and evacuation during this period. As conditions quietened down during the latter half of the year, the attendances noticeably improved. As a fixed objective, for some time, special attention has been given to the sorting out, and detection of predisposing causes' of aural and nasal troubles in pre-school children. In 1941, 42 pre-school children were ' examined and prescribed for at the Clinic fcr nasal defects, alone. This is an increase of 40 over the normal pre-war year of .1938. Whether it is just a coincidence or not, a parallel fall has occurred in the number of similar group children seen for Acute Otitis (middle ear inflammation), There were 4 in 1941 as against 28 in 1938. There is no doubt that the best way of "treating" Otitis or ear inflammation in children is by prevention, and as practically all acute ear troubles in young children arise through predisposing farters in the nasal mechanism, the early detection and efficient treatment of these nasal factors is the method of choice towards prevention. There has been r steady decline in the number of cases of Chronic Otorrhoea, The total number seen at the Clinic for the year was only 29, and of these 11 were cases where a radical mastoid operation had been done, in some cases, years previously. The tendency to chronicity in this type of case is well known. Zinc Ionisation has been the main method of treatment and its results in our experience, far outweigh that of any other known to us. We wish again to emphasise the great importance of including infants and pre-school children in the scheme of approved aural and nasal treatment. - 5 - The other methods of treatment which we mi, r,ht now describe as standard at the Clinic, have been fully availed of. Proetz "Displacement" has proved invaluable in the many cases in which it was used. Also, Diastolisaticn, with its complementary Oscillator-Vibration has been extensively used, and its effects in cases of deafness in children has been quite remarkable. We might add a word here of recommendation for a rather new method of aural douching which we have used for the last year with gratifying results. It is done by a special type of aural douche (known as Fowler's Douche, U.S.A.) - Bell-shaped arrangement of either glass or rubber (we prefer the rubber)-which fits tightly round and includes the aural canal and pinna, with a long lead-in rubber tube, fitted with stopcock from a douche can at a height of about 6 or 7 feet and a lead-away tube to the sink. The effect- is a mild suction which thoroughly cleanses the ear without any risk of injury or discomfort. Using from one to two pints of a warm solution, this affords great relief of pain in cases of acute otitis, as well as providing free drainage which is so important. It is by far the most satisfactory method of treating infants. With one or two applications of this douche, followed by daily applications of suitable "antiseptic drops", with due attention to nasal factors where indicated, the vast majority of cases of acute otitis clear up rapidly. Since 1938 the subject of the most suitable treatment for enlarged tonsils, as met with in a general school population-has received special attention. The Medical Officer of Health has been of the opinion judging from the end results he has observed that far too many cases of "tonsils" have been subjected to operation-done en a kind of "hit or miss" system - and that full due clinical and pathological consideration, with due regard to any associated defects, has not always been taken into account before cases are referred for operation. In t his opinion he is supported by other. Medical Officers of Health, many leading Laryngologists and Clinicians. In 1938 at his suggestion, that some recognised,, satisfactory conservative method should receive a thorough trial and investigation, we decided with the advice and recommendation of Mr, E, A. Peters, F.R.C.S. to try out the newer method of Tonsil Suction as practised by Mr. Peters, The general outline end technique of this method has been referred to in previous Reports. We started with a small number of selected cases in 1938 and the results were most satisfactory, In 1939 and 1940 we were able to increase the numbers, but unfortunately the dislocation caused by the outbreak of hostilities considerably disorganised cur scheme, However, we were able to carry on and steadily increase the numbers. In 1941, in all, 84 cases cf "enlarged tonsils", which in the ordinary sense would be referred for operation, were seen at the clinic and we did a full course of Tonsil Suction In 70 cf these, who continued attendance, as required. We cannot do more than refer briefly, in this Report to the general results obtained. We consider that we have done now, a sufficient number of various types cf cases as met with in school children, to allow us to come tofairly definite conclusions as to the value of this line of treatment. We can fully recommend this method as the most suitable . for t he majority of cases cf "Enlarged" or "unhealthy" tonsils amongst school children. We are careful not to allow the pendulum to swing too far in one side and regard sucticn as a panacea for "all and sundry" types of "diseased" tonsils. In the course cf the year we referred 21 cases for operation. - 6 - One great advantage of this method is that a child can have a course of suction without any risk, discomfort or expense, end if at the end of this we are satisfied that the tonsils are still "diseased" or septic, or the conditions for which it was undertaken are not showing signs of relief, we can always have recourse to operation. The method is diagnostic as well as curative. The presence of pus in the tonsil crypts is easily demonstrated. It is well tolerated by children as young as four or five years of age. As it is repeated at only fortnightly intervals for six to twelve sessions, there is no great loss of time from school, or much inconvenience in attendance and there is no "in-between" treatment. One very well worked effect that we have noticed is the reduction in what the parents describe as "the constant tendency tc colds". We wish to point cut here that in nearly all the tonsil suction cases, we also do, as a routine, Proetz "Displacement" This is in accordance with the theory that nearly all cases of "diseased tonsils" arise from infections in the nasal sinuses. If after one displacement we find the sinus "clear", we discontinue, but it will be surprising in how many cases (otherwise unsuspected)-mucc-pus will be found in the nasal sinuses. Treatment is continued until this Is cleared up, roughly about half a dozen applications, concurrently with the tonsil treatment. One thing to be kept constantly in mind in order to get the best results, is, not to regard the ear, the nose or the throat as separate entities. They are all interrelated and each, as influencing the other, must receive appropriate attention, even when the physical signs and symptoms point only towards the one. We have not been able to make a complete audiometric survey of all the schools as we had hoped, but a large number have been done and a special session is set aside, once a month for all cases attending the aural clinic with any special cases referred from the schools or other clinics. The majority of the parents are grateful and appreciative of what is being, done, and the teachers are also very helpful in getting the children tc attend for their treatment." The following are the tables of class ification:MISCELLANEOUS. CONDITION. TOTAL. TREATMENT. RESULT. 1. Wax in the ear. 15 Removed. Cured. 2. Epistaxis (nose bleeding). 5 Cauterised. do. 5. Furuncle, (boil in the ear). 6 Treated. do. 4. Referred for examination. 12 No treatment required. - 5. Foreign body in 2. Removed. do. 6. Foreign body in the nose. 3. do do. ; 7. Nasal Polypii. l. do. do. Total. 44. TABLE A. ACUTE OTITIS MEDIA (1) Children over 5. Diagnosis. Total (Ears) Tonsils & Adenoids. Zinc Ionisation. TREATMENT RESULT. xintiseptic Treatment. Tonsils & Adenoids Conservative: Nasal Diastolisaticn Tonsils & Adenoids Operation. Cured, Improved, Still under treatment or observation. Left or treatment lapsed. Referred to Hospital for Operation. Did not attend for or declined treatment. Acute non-suppurative Otitis Media. 10 (3) 3 Operation before Clinic. - 3 - - 3 - - - - - 7 No Operation - 7 - - 7 - - - - - Acute non-suppurative otitis media with 9 2 Operation before Clinic. - 2 - - 2 - - - - - Nasal conditions: Enlarged Tonsils & Adenoids. (2) 7 No Operation • 7 4 - 7 - - - - - Acute Suppurative Otitis Media. 20 (3) 5 Operation before Clinic. - 4 - - 4 - - - 1 - 15 No Operation. - 15 - - 13 - - - 2 - Acute suppurative Otitis Media with Nasal conditions: 16 (3) 1 Operation before Clinic. - 1 1 - 1 - - - - - Enlarged Tonsils & Adenoids. 15 No Operation 3 14 13 - 12 - - 3 - - TOTALS. (11) 55 3 53 18 - 49 - - 3 3 - The figures in brackets Indicate the number of cases with Bi-lateral Otorrhoea. TABLE A. ACUTE OTITIS MEDIA. (ii) Children under 5. Total (Ears) Tonsils and Adenoids. TR,ATMENti RESULT. Zinc Ionisation. Antiscptic Treatment. Tonsils & adenoids Conservative: Nasal Diast: iTonsils & Adenoids I Operation. Cured. Improved. Still under treatment or observation Left or treatment lapsed. Referred to Hosp. for operation. Did not attend for or declined treatment. Acute non-suppurative Otitis Media. - - Operation before Clinic. - - - - - - - - - - - No Operation. - - - - - - - - - - Acute suppurative Otitis Media. 2 *(1) Operation before Clinic. - - - - - - - - - - 2 No Operation. - 2 - - 1 - - 1 - — Acute Suppurative Otitis Media with Nasal conditions; Enlarged 2 - Operation before Clinic. - - - - - - - - - - Tonsils and adenoids. - 2 No Operation. - 2 - - 2 - - - — - Totals. 4 *(1) - 4 - - 3 - - 1 - - The figures in brackets indicate the number of cases with Bi-lateral Otorrhoea. TABLE B-CHRONIC SUPPURATIVE OTITIS MEDIA. DIAGNOSIS. Totals (Ears) DI^iGNOS ib. TONSILS AND ADENOIDS. TREATMENT RESULT. Children over 5 Chronic Tympanic Sepsis. Complicated by:- Granulations: Simple Polypii. Mastoid Disease Enlarge a Tonsils and Adenoids, . Nasal Catarrh: Rhinitis: Sinusitis External Otitis Eczema, Primary (Ear) Collateral (Nose and Throat) Cured. Improve d. Still under treat ment or observ: Left or lapsed treatment. Refd. to Hospital for operation. Did not attend for or declined treatment. Old Operatic No Operatior Zinc Ionisation Antiseptic Treatment or Cautery. Tonsils & Adenoids. Conservative Nasal: Diastolisation. Tonsils & Ads.Operatio] j Granulations: ; Simple Polypi. 1 - 1 - - - - Operation before Clinic. 1 1 - - - - 1 - - - - - - - - - No operation - - - - - - - - - - Mastoid Disease. 10 - 6 - - - - Operation . before Clinic. 6 1 - - 4 l - - 1 - - 4 - - - - ...No operation. 2 3 - - 4 - - - - - Enlarged Tonsils and Adenoids. 2 - - - - - - Operation before Clinic - - - - - - - - - (i) - - - 2 - - No operation. 2 — — - - - - - 2 - Nasal Catarrh: 5 - - - - 2 - Operation before Clinic. 2 - 2 - 2 - - - - - Rhinitis: Smusitis: (11) - - - - 3 - No Operation 3 - 2 — 3 - - - - - Fxternal Otitis: - - - - - - - Operation., before Clinic - - - - - - - - - - Eczema. - - - - - - No operation. - - - - - - - - - — TOTALS 18 - 11 - 2 5 - 16 5 4 - 13 1 1 - 3 - Chronic Suppurative Otitis Media Solely. (1)11 Children over' 5 years.; 5 Operation befor Clinic 5 - - - 5 - - - - - 6 No Operation. 6 - - - 6 - - - - - Chronic Suppurative Otitis Media Solely (1) 5 Children under 5 years. - Operation before Clinic. - ~ - - - - - - - - 5 No operation. 2 3 - - 3 - - 2 , - Chronic Suppurative Ot: (1) Children under 5 years. - Op. before C1. - - - - - . Media with Nasal Conditions. Tons. & Ads. 1 1 No' operation. - 1 - - l - - - - - GRAND TOTALS. 35. 17 29 9 4 - 28 1 1 2 3 - The figures in brackets indicate the number of cases with Birlateral Otorrhoea, with the exception of Mastoid Disease:- Mastoid Disease - Bi-lateral Otorrhoea. (a) Post-operation ... 3. (b) No Operation ... Nil. TABLE C. NOSE AND THROAT CONDITIONS, (i) Children over 5. Diagnosis. Primary. Totals Tonsils and Adenoids. Secondary Conditions. Treatment. Result. Deafness. Nasal Catarrh. Enlarged Tonsils & Adenoids, Diastolisation. Antiseptic Treatment. Proetz Displacement, Tonsils & Adenoids. Cured Improved. Still under treatment or observation. Left or treatment lapsed. Referred to . Hospital for Operation. Declined or did not attend for treatment. Conservative Treatment Operative Treatment. Sinusitis: 22 Operation before Clinic. 10 6 - 5 7 7 - - 5 — 1 1 1 2 Fhinitis. No operation. 12 - 6 4 5 8 8 3 — 8 — — - 1 3 Nasal Obstruction: 28 Operation before Clinic. 8 1 - - 8 6 - - - 8 - - - - - • Rhinitis. No operation. 20 1 - 4 17 11 - 3 1 10 2 3 2 1 2 Nasal Catarrh 59 Operation before Clinic. 16 4 - 13 2 - - - 10 - - 1 - 3 No operation. 43 6 - 11 29 7 ~ 4 1 20 3 4 2 1 13 Enlarged Tonsils and Adenoids. 84 Operation before Clinic. - - - - - - - - - - - - - - - No Operation 84 - 36 - 25 9 15 54 45 - 5 6 9 19 TOTALS. 193 12 43 19 102 50 30 64 21 106 7 13 12 13 42 (ii) PRE-SCHOOL (under 5) Nasal Conditions:Sinus Rhinitis. 12 Operation before Clinic. - - - - - - - - - - - - - - - No operation. 12 - - - 7 6 - - - 6 1 — — — 5 Enlarged Tonsils & Adenoids. 26 Operation before Clinic. - - - - - - - - - - - - - - - No Operation. 26 - - - 1 - — 6 _ 3 3 - 1 9 10 Enlarged Tonsils & Ads. with nasal condition 4 Operation before Clinic - - - - - - - - - - - - - - - No. Operation 4 - - - 3 2 - 1 - 1 - - 1 1 1 GRAND TOTALS. 235 235 12 48 19 113 58 30 78 21 116 11 13 14 23 58 - 7 - Dental Treatment, Elementary and Secondary School Children. Comparison with 1940 is not possible in the same way, as it would be between two years under peace-time conditions, During 1941 two dental surgeons have carried out the work as against three during 1939 and 1940, and owing to a steady flow of children back to Tottenham from reception areas, giving a school populations of some twelve thousand by the end of the year, it will be realised that the two clinics have been kept as busy as under normal conditions. The third Dental Clinic at Park Lane Centre (normally run solely by a dental surgeon now on Military Service) has been open for treatment on four sessions per week, both dentists paying two visits, and all patients, adult and children, living in that area, have received treatment at that Clinic. Owing to the reduction in staff, the total number of children treated in 1941 is, of course, somewhat less than in 1940 - actually averaging 80% of the 1940 figure. During the year under review, there has been a noteworthy increase in the percentage of acceptances of treatment, and in the numbers submitting the uselves to orthodontic treatment. Details giving statistics of the various forms of dental inspections and treatment will be seen on Tables IV. By arrangements with the Maternity and Child Welfare Committee facilities are provided at the School Dental Clinic for the treatment of expectant and nursing mothers and children under school age. This latter provision is much appreciated and ensures that the dental and general physical condition oi entrants to the schools is at as high a level as possible. Orthopaedic Clinic. During the past year there has been a 30% increase in the attendance at the Orthopaedic Clinic, though the number of treatments given is about l/3rd of that in the last full pre-war year. An analysis of the new cases examined shows that there were very few cases of rickets, and none of those referred were severe; this is especially commendable in these days of food restrictions. Five new cases of infantile paralysis were examined, some of them having received treatment in Stanmcre. In no case was the paralysis very extensive. There was a surprising increase in the number of new cases of congenital deformities - nearly 100%, This may possibly be due tc the number of patients now attending the clinic who in normal times visited children's hospitals in Inner London. Arrangements have now been made for secondary school children to be eligible tc attend the clinic; this is a great advance, as foot and back defects, in particular, often first develop or become definitely ncticcable between the age of 14 and 16 years, and early recognition and treatment may save much disability in later life. Surgical appliances were supplied and repairs and replacements effected in 62 Instances. - 8 - Infectious Disease. Measles, Whooping Cough, Chicken Pox and .Mumps cause a considerable loss of school attendance, especially in Infant Departments, and in order to keep a check upon the incidence of these complaints in school children, the Head Teachers supply the Medical Department with a weekly list of absences due to infectious diseases. This enables the nursing staff to visit the homes and give appropriate advice in each case. When considered necessary, the school nurse makes a general survey of all the scholars attending any particular class affected, with a view to discovering any newly attacked or missed cases. In the case of diphtheria, swabs are taken from the throats and noses of any suspected children. If the examinations give a positive result the children are excluded until either the swabs prove negative or the diphtheria bacilli are shown to be avirulent. Diphtheria Immunisation, Throughout the year the ordinary sessions were held at the Immunisation Clinics. Every opportunity was taken of impressing upon the parents the advisability of having their children immunised against diphtheria as early as possible. Much headway has been made in this crusade of educating the parents to realise the vital necessity of immunisation, and increasing numbers took advantage of the facilities offered. Early in the year an intensive effort was made to secure the immunisation of as many school children as possible, and to this end a scheme was put in hand for a mobile clinic, complete with Calor gas sterilisation plant, to visit each individual school. A special form of consent was sent, with the full co-operation of the Head Teacher': and their staffs, to the parents of all school children, informing them that one of the School Medical Officers would attend each school in the near future to carry out immunisation, and asking for their consent as soon as possible. The steps taken as outlined above proved to be a great success, and a large number of children were speedily inncculated. In the course of the year 2.739 children were immunised either at the Special Clinics or at the Schools themselves. Bacteriological Examinations„ Examinations of swabs (after culture) are carried out daily in the Council's Laboratory, and three negative swabs . for diphtheria are always insisted upon before contacts or Hospitalised patients are allowed to return to school - thus minimising the carrier'' population. Despite this care an unsuspected carrier has caused an occasional small outbreak of the disease, but the above measures, together with the increased percentage of immunised children, have not yet allowed a local epidemic to affect as many as 20 children (and none of these had been immunised). - 9 Vale Read Nursery School. This Nursery School was evacuated at the commencement of the war to Elvedon Hall, but, as these premises were required by the military authorities, similar suitable accommodation was found at Braunsten Manor, Near Oakham, the children being transferred there in October, 1941. Medical attention and treatment for the children is carried cut by a Visiting Medical Officer, appointed for this purpose, and periodical visits are made by the Committee's School Medical and Dental Officers. All new entrants to the school are submitted to special medical and dental inspection before evacuation, and immunisation against diphtheria is carried cut as far as possible prior to their departure. An outbreak of measles occurred in the early part of the year while the children were at Elvedon Hall. One of the Medical Officers visited the school and all the children were given an injection of immune globin with a view to controlling the spread of infection, with beneficial results. A School Nurse was sent from Tottenham to assist with the nursing of the children. Later in the year there were a few cases of mumps, but apart from this and the outbreak of measles, the children appeared to derive much benefit from their country surroundings and regularised lives. School for the Deaf. As reported last year the deaf children evacuated from this district are accommodated at suitable premises at Rustington, Sussex. The deaf children remaining in Tottenham are receiving instruction and training in temporary quarters at West Green School. Speech training sessions for both stammerers and other defects of speech are held at this school, but shortage of staff renders impossible the ideal of having a full-time school for these children. Oak Ledge Special School. Mentally defective children who are educable, attend the Special Day School at Oak Lodge Finchley. This school is under the management of a Joint Board consisting of representatives of Finchley, Wood Green and Hornsey, and still remains limited in its scope, owing to partial occupation by Fire Service personnel. Special Day School for Partially Sighted Children. These Tottenham children certified by the Committee's Ophthalmic Surgeon as requiring education for the partially blind attend the White Hart Lane Special Day School which is situated in the administrative district of Wood Green. Special School for Physically Defective Children. Children found to be physically defective attend the Special Day School which is now accommodated temporarily at West Green School. G. HAMILTON HOGBEN. School Medical Officer. •» ELEMENTARY SCHOOLS. TABLE 1. Medical Inspections of Children attending Public Elementary Schools - Year ended 31st December, 1941. A. ROUTINE MEDICAL INSPECTIONS. (1) No. of Inspections in the prescribed Groups: Entrants 1,209 Second Age Group 651 Third Age Group 525 Total 2,385. (2) No. of other Routine Inspections 327. Grand Total 2,712. 3. OTHER INSPECTIONS. No. of Special .Inspections. and Re-Inspections 13,762. TABLE 11. Classification of the Nutrition of Children Inspected during the year in the Routine Age Groups. No. of Children Inspe cted. A (Excellent) B (Normal) C (Slightly Sub-Normal). D. (Bad). No. % No. % No. % NO. % 2712. 450. 16.5. | 1949. 71.9. 295. 10.9, ! ; ! 18. j .7 . TABLE 111. GROUP 1. Treatment of Minor Ailments (excluding uncleanliness) Total number of defects treated or under treatment during the year under the Authority' s Scheme 3198. GROUP 11. Treatment of Defective Vision and Souint. Errors of Refraction (including Squint) Under the Authority's Scheme. 486. Other defects or diseases of the eyes (excluding those recorded in Group 1) 11. Total 497. No. of' Children for whom spectacles were Under the Authority's Scheme. (a) Prescribed 349. (b) Obtained 349. GROUP 111. Treatment of Defects of Nose and Throat. Received Operative Treatment 89. Received other forms of treatment 392. Total number treated 481. TABLE IV. DENTAL INSPECTION AND TREATMENT. (1) No, of children inspected by Dentist. (a) Routine Age Groups. AGE. 5 6 7 8 9 10 11 12 13 14 TOTAL. Number 1220 820 894 i 958 859 1053 884 826 878 293 8685. (b) Specifls 814. (c) Total (Routine & Specials) 9,499, (2) No. found to require treatment 7,074. (3) No. actually treated 2,860. (4) Attendances made by children for treatment 6,291. (5) Half days devoted to:- Inspection 62. Treatment 605. Total 667. (6) Fillings:- Permanent Teeth 1,444. Temporary Teeth 728. Total 2,172. (7) Extractions:- Permanent Teeth 1,141. Temporary Teeth 5,288. Total 6,429. (8) Administrations of general anaesthetics for extractions 491. (9) Other operations Permanent Teeth 421. Temporary Teeth 437. Total 858. TABLE V. VERMINOUS CONDITIONS. (1) Average No. of visits per school made during the year by the School Nurses or other authorised persons 18.7. (2) Total number of examinations of children in the Schools by School Nurses or other authorised persons 82,320. (3) No. of individual children found unclean 991. TABLE V (contd.) VERMINOUS CONDITIONS.(Contd.) (4) No. of individual children cleansed under Section 87 (2) and (3) of the Education Act, 1921. 140. (5) No. of cases in which legal proceedings were taken:- (a) Under the Education Act, 1921 27. (b) Under School Attendance Bye laws. - SECONDARY SCHOOLS. No. of pupils inspected - 1st January, 1941 to 31st December, 1941. ROUTINE MEDICAL INSPECTION. Age. 10. 11. 12. 13. 14. 15. 16. 17. Total. Boys. 3. 65. 121. 57. 43. 75. 5. 1. 370. Girls. 1. 79. 111. 54. 38. 29. 2. - 314. Total. 4. 144. 232. 111. 81. 104. 7. 1. 684. TECHNICAL SCHOOLS. No. of pupils inspected - 1st January, 1941 to 31st December, 1941. ROUTINE MEDICAL INSPECTION. Age. 12. 13. 14. 15. 16. Total. Boys. 16. 49. 24. 21. 110. Girls. 1. 13. 27. 1. — 42. Total. 1. 29. 76. 25. 21 . 152. TABLE 11. Classification of the Nutrition of Children Inspected during the year in the routine age groups - Secondary and Technical Schools. No. of children Inspected. A. B. C. D. No. % No. % No. % No. % 988. 250. 25.2. 662. 67.0. 72. 7.2. 4. .4. TABLE 111 (Group) Treatment of Defective Vision and Squint. Errors of Refraction (including squint. Under the Authority's Scheme. 171. Other defect or disease of the eyes. 2 Total. 173. No. of children for whom spectacles were:- (a) Pre scribed 128. (b) Obtained 93. TABLE IV. DENTAL INSPECTION AND TREATMENT. (1) No. of children Inspected by the Dentist. (a) Routine Age Groups. AGE. 12 13 14 15 16 17 Total. Number. 190 200 ' 235 ' 168 105 30. 928. (b)Specials. 41. (c) Total (Routine & Specials.) 969. (2) No. found to require treatment. 644. (3) No. actually treated. 424. (4) Attendances made by children for treatment. 1,383. (5) Half-days devoted tor:- Inspection. 9. Treatment. 97. Total. 106. (6) Fillings Permanent Teeth. 952 . Temporary Teeth. 2. Total. 954. (7) Extractions:- Permanent Teeth. 191. Temporary Teeth. 60. Total. 251. (8) Administrations of general anaesthetics for extractions. 11. (9) Other Operations:- Permanent Teeth, 237. Temporary Teeth. — Total. 237. MATERNITY AND CHILD WELFARE DEPARTMENT. ANNUAL REPORT 1941. STATISTICAL INFORMATION. Number of Births: Male 780 Female 780 1560 Birth Rate(per 1,000 population) 14,77 Number of Deaths under one year of age. 6l Number of Still Births registered 51 Infantile Death Rate per 1,000 live births 46.35 Number of Maternal Deaths 3 Maternal Death Rate per 1,000 total births 2.2 Cost of Maternity & Child Welfare Services:- Gross Cost(to 31st March 1942) £ 32,276. 9s. 9d. Total receipts including specific Govt. Grants 11,021. 0s. 11d. Net Cost: £21,255. 8s. 10d. Cost in terms of rate in the £1-net 5.6 pence. CO-ORDINATION. The interweaving of the Maternity and Child Welfare Service with the School Medical Service has continued during the year under review, in the same smooth manner as previously, in that all Specialist and Dental Sessions have catered for both departments and thus ensured the maximum possible supervision even during the periods of aerial attacks as in the earlier part of the year. The co-operation of all hospitals as well as Social Service Associations in the area has remained a constant source of help. MATERNITY HOSPITAL SERVICE. For patients desiring or requiring hospitalisation the facilities provided by the Mothers' Hospital,Clapton, and the North Middlesex County Hospital have proved adequate as in former years. These were distributed as follows:- The Mothers' Hospital, Clapton:- Under the Council's Scheme 44 Own arrangements 12 The North Middlesex County Hospital 113 Other Outside Institutions 60 229 M& C.W./2. THE HEALTH VISITORS' DEPARTMENT. The Health. Visitors were kept fully occupied throughout the year,-not only with the clinics for infant welfare, ante and post natal, toddlers and dental,-but also with evacuation, hone visiting,(as Child protection Officers as well as nurses) following up and supervising all clinic patients, birth notifications etc. As their duties associated with air raids diminished during the latter half of the year, so they became more occupied with propaganda, day nursery supervision and the complexities of coupons. DETAILS OF HOME VISITING BY HEALTH VISITORS. Expectant Mothers Children under 1 year. Children Over 1 year. TOTALS. First visits Revisits First visits Revisits. visits 1195 2855 1284 6335 16175 27,844 Other visits:- infantile deaths 28 Still Births 72 Ophthalmia Neonatorum 4 Pneumonia 5 Infectious diseases 1142 Special visits-mothers 1437 children 307 2,995 30,832 ANTE-NATAL CLINICS. Centre. Sessions. Attendances Mothers. New Cases. PostNatal. Lordship Lane Municipal Medical Cent. 104 1943 468 128 The Chestnuts Centre St.Ann's Road. 129 2363 616 140 Park Lane Municipal Medical Centre 103 1683 352 81 1941 Totals: 336 5989 1436 349 1940 Totals: 314 5210 901 297 I an indebted to Dr.Rickards for the following report on the Maternity Clinics:- "During 1941, the work undertaken at the Ante Natal Clinics has shown a marked increase at each centre. At the Chestnuts, the new patients increased from 572 in 1940 to 6l6 in 1941; at Park Lane from 207 to 352, and at Lordship Lane from 122 to 468. This shows an increase of over 500 new patients during the year; and of course this increase in patients is continued in the repeat visits and post natal visits. The number of sessions was only Increased by 22 (336 as compared with 314) and therefore the service has been strained to the utmost. The evacuation scheme continues to be widely used and is ouch appreciated by the mothers, and the hospitals in the neighbourhood work in close co-operation with the clinics and assist materially in taking patients developing abnormalities." Continued. M.& C.W./3 INFANT WELFARE CENTRES. Centre. Sessions. Attendances Infants weighed. New Cases. Over 1 yr. New Cases Examined by Dr. Lordship Lane Mun. Med. Centre. 246 3614 373 2323 112 1582 The Chestnuts Cen. St.Ann's Road. 257 4493 553 2623 175 2396 1 Park Lane Mun. Med.Centre. 103 2175 227 1161 81 875 Town Hall. 52 466 54 202 13 - 1941 Totals: 658 10748 1207 6309 381 4853 1940 Totals: 649 12423 1132 7356 800 4774. I am indebted to Dr.King for the following report on the Infant Welfare Clinics:- "The numbers attending the Welfare Centres during 1041 showed a steady increase on the previous year. This may not be altogether a matter for congratulation, as it indicates the return to the London area of large numbers of mothers and children. Some of the former have commented upon the paucity or lack of welfare facilities in rural districts and a few have returned to London for short spells, at intervals, partly to seek advice and help. War conditions have created various domestic problems which the Health Visitors have been able to solve or ease and the Invalid Children's Aid Association, as always, has invariably responded to appeals for children needing convalescence. Courses of ultra-violet light and medicinal iron, in addition to the Government-supplied fruit juices and vitaminized oil, have been administered where indicated, to keep the general standard of health as good as possible. Mothercraft classes for "leavers" at School, also sewing and Social Classes have been revived during the year." CHILD LIFE PROTECTION. The Health Visitors. in their role of Child Life Protection Officers,have,during the year,paid 173 visits to the 22 foster-mothers in the area, who have co- operate d in maintaining the health of these children by attending the Welfare Centres. The 22 children concerned maintained their health despite the rigours of war. SPECIAL CLINICS FOR CHILDREN UNDER FIVE. Attendances were well maintained, especially in the Immunisation Clinics, where the numbers were multiplied many times. Clinic. No. of consultations. No. of treatments. Minor Ailments 36 39 Dental 332 430 Orthopaedic 77 264 Ophthalmic 117 38 Ear,nose & throat 60 132 Artificial Sunlight No. of Children. 195 2173 Immunisation Final Schick Tests 566(93 in 1940) Immunised. 883( 107 in 1940). P.T.O. M.& C.W./4. Most of these clinics are held at more than one centre in the Borough, so that parents are thereby more likely to avail themselves of then during these days of the war-working mother. The various centres are at (l) The Municipal Medical Centre, Park Lane; (2) The Municipal Centre at Lordship Lane; (3) The Chestnuts Centre, St.Ann's Road; and (4) The Town Hall; each being in a separate quarter of the Borough. HOSPITAL TREATMENT FOR CHILDREN UNDER FIVE YEARS. For children requiring urgent hospital treatment the agreement already existing with the Prince of Wales' Hospital has continued; and occasionally the aid of the Queen's Hospital for Children has been sought through the medium of Dr.Alice King at the Infant Welfare Centres. The prior arrangement with the Prince of Wales' Hospital and the North Middlesex County Hospital for consultation and treatment of tonsils and adenoids, (especially where operation is required), has continued to work effectively through the Welfare Centres. BREAST FEEDING. As the result of the health visitors' enquiries, it was ascertained that l2o4infants have been fed as follows:- Breast fed 784 Part Breast-fed plus milk,dried mi'k,or condensed milk 393 Bottle feeding - cow's milk 32 dried milk 50 Other artificial foods .. .. 5_ -1264 Feedings unknown 87 * Total 1351 * These, refer to notified births and not registered births DAY NURSERIES. During the year under review, Tottenham's largest day nursery (for 60 children) was opened; and all three nurseries not only remained full to capacity, but, as the year advanced so their waiting lists swelled. Facilities for the opening of more wartime day nurseries were eagerly sought, but were difficult to find. However., before the end of the year,plans were submitted for the erection of a modified hutted nursery behind the Municipal Medical Centre in Lordship Lane; and it is certain that at least two more wartime day nurseries will be opened during 1942. Continued. M.& C.W./5. TOTTENHAM DAY NURSERY (evacuated to Bengeo House,Bengeo.Hertford) This evacuated day nursery continues to be a source of health as well as nursery nurture to Tottenham children requiring residential as opposed to day nursery attention. The quota is made up largely of children requiring constant supervision,either because of a further confinement of the mother or because of debility in the child. The benefit derived from a period of country air and regular hours is almost miraculous,especially in these times of complete blackout at night. The register shows that the number of children in residence rose from 32 in January to 37 in Deceit*er during which period 40 fresh children were admitted; while 35 (including 10 who had reached school age), were discharged. Of the 37 remaining at the end of the year, there were none under the age of one year; with four under 2; thirteen under 3; twelve under 4; and eight under five years of age - thus maintaining the tradition that the place for a breast-fed child is with its mother. PARK LANE MUNICIPAL DAY NURSERY. Though not recognised as a wartime day nursery, this building has been constantly filled to capacity, almost exclusively with the children of war-working mothers; and the fees have been brought into line with those of wartime nurseries. The health of the children was maintained at a high level throughout the year, and the physical and mental development of each child progressed at rates well above the average for the area. The average daily attendance throughout the year was 37.85 which reflects the keenness of all concerned. VALE ROAD WARTIME DAY NURSERY. This nursery, opened on the 28th April,1941,is the largest the Tottenham area, and caters for 60 children, all of whose Others are engaged in vital war work. Being in the midst of a district in which factories aro more abundant, its entrants tend to be of a lower physical standard than at the Park Lane Nursery, so that an average daily attendance of 40 children for the whole of 1941 may be considered extremely good. The improvement in the health of each child after a short period in the nursery has been remarkable, and,apart from mild catarrhal conditions the sickness rate has remained very low. TODDLERS' CLINICS. Clinics for the supervision of children not in regular attendance at the infant welfare sessions were held weekly at the Park Lane Municipal Medical Centre, and bi-weekly at the Lordship Lane and the Chestnuts Centres, with a view to ensuring that, when these Children attain school age, their general resistance and physical condition shall be at an optimum. Out of a total of 275 attendances since April 1941, 124 of these toddlers were found have defects requiring treatment. P.T.O. M,& C.W./6. MIDWIFERY SERVICE (Midwives Act 1936) During 1941 one 8 Municipal Midwives continued their onerous work with undiminished vigour despite all wartime difficulties, and participated in 670 confinements without the loss of a mother,as well as accompanying expectant mothers each Friday to evacuation areas. RECORD OF WORK. (not including work in reception areas) Cases. Attended by Municipal Midwives. Attended by The District Nursing Assoc. Total. Deliveries. 603 2 605 Attended as Maternity Nurse 67 6 73 Primipara 212 5 217 Multipara 458 3 461 Ante natal visits 1692 47 1739 Nursings 10457 116 10573 Total home visits 12149 163 12312 No.of Deaths of Mothers at home - - - Patients admitted to hospital: - - a) during pregnancy 25 - 25 (b) during labour 7 - 7 (c) during puerperium 2 — 2 Ante Natal Clinic included in clinic figures 22 22 Attendances (in October,1940, the Tottenham Branch of the Maternity Nursing Association was posted to an Emergency Maternity Hospital in the Midlands.) PUERPERAL PYREXIA. The following table shows the final result in each of the 13 cases of Puerperal Pyrexia mentioned below:- In attendance at the confinement. Total. Final Results. Doctors Cases Midwives Cases. Occurred in hospitals outside the district. Recovered. Died. 3 - 10 13 13 - M,& C.W./7. MATERNAL MORTALITY. A Special Report is forwanded to the Ministry of Health of each death of a mother,directly or indirectly connected with childbirth. This report is based on the result of the enquiries made of every nurse, midwife or doctor in attendance upon the mother. Maternal Deaths. The Registrar General's records show that three deaths were attributed to Tottenham. The Death Rate per 1,000 live and still births was:- From Puerperal Sepsis 1.47 From Other Puerperal Causes 0.73 Total 2.20 MATERNITY AND NURSING HOMES. The number of Nursing Homes on the register at the beginning of the year was 1. (1) Application for registration- nil. (2) Registered during the year- nil. (3) Orders made refusing or cancelling registration -nil. (4) Appeals against such orders- nil. (5) Number confirmed on appeal-nil. (6) Application,for exemption- nil(new cases) (7) Application for exemption granted-nil (8) Closed voluntarily; or owing to removal from district- nil. (9) Carried forward from previous year -as above.. x. Hospital exempt from registration The Prince of Wales's General Hospital. HOME HELPS. Assistance towards the services of heme helps was granted to 132 mothers. At the Town Hall a list of suitable women who are prepared to act in this capacity is supplied to expectant mothers and in necessitous cases the cost of a home help may be defrayed by the Maternity and Child Welfare Committee. ACCOUCHEMENT BAGS. AND MATERNITY OUTFITS. Accouchement bags are available at the centres and are loaned to the mothers in suitable cases. Necessitous cases are given appropriate consideration in the matter of payment, and maternity outfits are provided and may be had at cost price. M.& C.W./8. OPHTHALMIA NEONATORUM AND CASES OF DISCHARGING EYE. Three, cases of Discharging Eye occurred during. the year,, of which two were notified as Ophthalmia Neonatorum. Hospital treatment, whenonever necessary. is provided at various hospitals, including St.Margaret's Hospital,Kentish Town, and whenever possible, mother and child are admitted together. Hone nursing of these cases is undertaken by arrangement with the District Nursing Association. During the year under.review, however, no hospital treatment was. required. The following table shows the final result in the cases above enumerated: Notifications. In attendance at th confinement, Eyes clear Died Removed No trace. Doctors Cases. Midwives Cases. Occurred in hospitals outside the district. Ophthalmia . Neonatorum. 1 1 - 2 - - Discharging Eye - 1 - 1 - - Total 1 2 - 3 - - EVACUATION OF EXPECTANT MOTICSRS. During 1941 this scheme was more successful than in 1940 when "blitz" conditions might have been expected to produce a greater response. 372 mothers were evacuated during the year at, opposed to 99 during the previous twelve months, with corresponding increases in the number of places reserved at the Bengeo House Residential Nursery for older children of these mothers. Continued. M.& C.W./9. DENTAL TREATMENT FOR MOTHERS AND CHILDREN. It is notable that the number of expectant and nursing mothers who have received dental treatment during 1941 was 676 as against 458 the previous year. Of these, 550 were ante-natal and 126 post-natal, all of whom were rendered dentally fit by fillings where preservation was possible, and otherwise, by extraction under local or general anaesthesia. Unfortunately a number of these patients were in a deplorable dental condition when they presented themselves for treatment, so that 156 dentures were supplied, of which 80 were given free and 76 at part-cost. Treatment of toddlers and Infant Welfare children has continued as in previous years, and led to 332 consultations with 430 treatments, ASSISTED MILK SUPPLY. The arrangements for the supply of milk at the homes of expectant and nursing mothers and children under 5 continued as in the latter half of 1940, and was supplemented by the "welfare Authority when indicated on medical grounds. DISTRBUTI0N 0F FRUIT JUICES AND COD LIVER OIL. Following the inception of this scheme by the Ministry of Health, depots were begun at the four infant welfare centres, and resulted in 9 busy sessions in the course of each week. V m