AC439(1) Borough of Tottenham Annual Report ON THE HEALTH OF THE BOROUGH FOR THE YEAR 1944 G. Hamilton Hogben Medical Officer of Health and School Medical Officer THE HEALTH AND HOUSING COMMITTEE (as at 31st December, 1944). Chairman: Alderman R. H. Warren. Members: (Ex-Officio) His Worshipful the Mayor (Alderman E. J. Field. J.P.). (Ex-Officio) The Deputy Mayor (Councillor Mrs. M C Irving\ Alderman Mrs. W. A. Kent. Councillor Mrs. M. Berry. Mrs. A. Kitchener. ,, Miss R. F. Cox. J. H. Morrell, J.P. ,. R. W. H. Ford. ,, A. Reed, A. C.I.I.,J.P. ,, Mrs. A. E. Lyons. A. R. Turner. ,, Mrs. G. E. Morrison. Councillor H. W. Pearce. ,, W. T. Richards. ,, J. Wallace. Council's Representative on the Metropolitan Water Board under the Metropolis Water Act, 1902: Alderman R. C. Morrison, M.P., J. P. Town Clerk: Eric Townson, Esq. LL. B. 4 STATISTICAL SUMMARY. Year ended 31st December, 1944. Area of the District in acres 3,014 Registrar-General's estimate of the Civilian Population Mid-year 1944 108,180 Rateable Value £974,781 Sum represented by a penny rate £3,875 Births and Deaths. Registered live births:— Total. Males. Females. Legitimate 1,961 1,022 939 Illegitimate 105 51 54 2,066 1,073 993 Birth Rate (per 1,000 estimated population) 19.09 Stillbirths Total. Males. Females. Legitimate 47 29 18 Illegitimate 7 4 3 54 33 21 Stillbirth Rate per 1,000 total (live and still) births 25 47 Deaths Males 721 Females 635 Total 1,356 Death Rate (per 1,000 estimated population) 12.53 Deaths from Cancer—Males 127 : Females 109 236 Deaths from Diphtheria 3 Deaths from Measles 1 Deaths from Whooping Cough 3 Deaths from Diarrhoea (under 2 years) 12 5 Maternal Deaths:— Puerperal Sepsis 1 Other Puerperal Causes 2 Total 3 Maternal Death Rate (per 1,000 total live and still births) 1.41 Deaths of Infants under 1 year of Age: Total. Males. Females Legitimate 83 40 43 Illegitimate 4 1 3 87 41 46 Infantile Death Rate (all infants per 1,000 live births) 42 11 Legitimate Infants per 1,000 legitimate live births 42.32 Illegitimate Infants per 1,000 illegitimate live births 38.09 The population which, in 1938, was 144,400, shows a decrease of 2,170 over the figure of 110,350 for the previous year. The birth-rate continues to rise—19.09 compared with 17.85 in 1943 and 13.1 in 1938. Registered live births totalled 2,066, compared with 1,970 in 1943, the proportion of males to females being 1,073 boys and 993 girls. The infantile death-rate of 42.11 was lower than the rate for 1943—43.65. Deaths in the first 4 weeks of life caused a neo-natal mortality of 22.26 per 1,000 live births, a further reduction on previous years. The maternal death-rate was 1.41, as compared with 2.94 in 1943. The general death rate of the whole population showed a reduction over the previous year—12.53 compared with 13.71. Deaths from cancer showed a slight increase, but there were fewer deaths from diseases of the lungs. 6 STATISTICS OF TOTTENHAM FOR THE LAST TWENTY YEARS. Year Population Deaths Death Rate Births Birth Rate Infantile Deaths Infant Death Rate Number of Cases. Puerreral Fever and Puerperal Pyrexia Scarlet Fever Diphtheria Typhoid Fever SmallPox 1924 156,000 1,559 9.9 2,853 18.2 176 61.6 5 367 227 6 - ] 925 156,700 1,596 10.1 2,756 17.6 150 54.4 6 427 252 2 - 1926 159,500 1,545 9.6 2,601 16.3 147 56.5 4 481 495 7 - 1927 162,000 1,664 10.2 2,388 14.7 154 64.4 2 466 398 3 - 1928 165,000 1,540 9.3 2,478 15.0 133 53.7 19 594 328 1 - 1929 168,000 1,839 10.9 2,561 15.2 162 63.2 19 536 562 5 6 1930 170,000 1,569 9.2 2,510 14.8 137 54.6 22 574 541 6 131 1931 151 ,300 1,621 10.2 2.345 14.7 124 52.9 19 571 220 6 7 1932 156,800 1,591 10.1 2,214 14.2 114 51.4 37 452 149 4 5 1933 154,700 1,618 10.5 2,138 13.8 118 55.2 35 551 194 5 4 1934 152,694 1,572 10.3 2,091 13.7 108 51.6 34 628 300 1 - 1935 150,310 1,456 9.7 1,969 13.1 108 54.8 41 577 286 3 - 1936 148,600 1,600 10.8 1,931 13.0 100 51.8 37 430 227 5 - 1937 146,200 1,617 11.1 1 ,973 13.5 126 63.9 36 306 236 7 - 1938 144,400 1,512 10.5 1,893 13.1 89 47.0 23 186 221 - - 1939 142,400* | 1,400 10.3 1,776* 12.5 66 37.95 15 335 60 - - 136,000 1,739 1940 119,400 1,703 14.26 1,666* 13.95 64 41.05 20 103 28 5 - 1,559 1941 105,620 1,418 13.43 1,560* 14.77 61 46.35 13 103 73 4 - (1,316 1942 110,100 1,349 12.25 1,819 16.52 79 43.43 12 295 75 1 - 1943 110,350 1,513 13.71 1 .970 17.85 86 43.65 9 340 107 - - *For the years 1939—1941 alternative birth figures were given by the Registrar-General:— (а) for calculation of birth rates; and (b) for calculation of death rates or the incidence of notifiable diseases. Likewise for the year 1939 only, two population figures were given:— (a) for calculation of birth rates; and (b) for calculation of death rates, etc. 7 Table of Deaths during the year 1944 in the Borough of Tottenham, classified according to Diseases. Cause of Death Males Females Totals Typhoid and Paratyphoid Fevers - - - Measles 1 - 1 Scarlet Fever 1 - 1 Whooping Cough - 3 3 Diphtheria 2 1 3 Influenza .. 6 4 10 Encephalitis Lethargica - - - Cerebro-Spinal Fever 1 - 1 Tuberculosis of Respiratory System 36 27 63 Other Tuberculous Diseases 9 3 12 Syphilis 3 2 5 General Paralysis of the Insane Tabes Dorsalis Cancer, Malignant Disease 127 109 236 Diabetes 4 11 15 Cerebral Haemorrhage, etc. 45 60 105 Heart Disease 145 161 306 Other Circulatory Diseases 44 26 70 Bronchitis 52 30 82 Pneumonia (all forms) 53 41 94 Other Respiratory Diseases 6 7 13 Peptic Ulcer 14 3 17 Diarrhoea (under 2 years) 7 5 12 Appendicitis 4 2 6 Other Digestive Diseases 17 22 39 Acute and Chronic Nephritis 20 10 30 Puerperal Sepsis - 1 1 Other Puerperal Causes - 2 2 Congenital Debility, Premature Birth, Malformations 21 30 51 Road Traffic Accidents 8 5 13 Other Violent Causes 42 26 68 Suicide 3 2 5 All other Causes 50 42 92 721 635 1,356 8 Infantile Deaths in Ages and Hexes during the year 1944. 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. Bronchitis - - - - - 2 4 1 1 8 6 2 Diarrhoea and Enteritis - - 1 - 1 3 6 2 1 13 9 4 Measles - - - - - - - - - - - - Pneumonia - - 1 - 1 3 2 1 3 10 3 7 Premature Births,Congenital Malformations, etc. 33 8 1 - 42 2 - - 3 47 19 28 Miliary Tuberculosis - - - - - - - - - - - - T.B. Meningitis - - - - - - 2 - - 2 2 - Whooping Cough - - - - - - - - 1 1 - 1 Other Causes 1 - - 1 2 - 2 1 1 6 2 4 Totals 3 8 3 1 46 10 16 5 10 87 41 46 9 Table of Cases of Infectious Disease coming to the knowledge of the Medical Officer of Health during the year 1944 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 95 111 1 4 7 8 18 96 44 12 9 7 - - 117 Diphtheria 22 22 1 2 2 - 10 15 9 4 1 - - - 44 Pneumonia 50 35 1 3 5 3 1 4 - 5 15 11 20 17 3 Ery3ipelas 18 25 1 - - - - - 1 3 9 6 18 5 13 Puerperal Pyrexia - 13 - - - - - - - - 10 3 - - 2 Dysentery 11 6 2 1 3 - 3 - 3 - 2 1 1 1 8 Ophthalmia Neonatorum 2 1 3 - - - - - - - - - - - 1 Meningitis 3 - - - - - - 1 - - 2 - - - 2 Malaria 2 - - - - - - - - - 2 - - - - Scabies 243 454 12 18 15 7 18 47 45 125 249 77 66 18 - Enteritis 2 - - - - 1 - - - - - - 1 - 2 Food Poisoning 5 6 - - 1 - - - - 1 3 3 3 - - Whooping Cough 170 164 30 57 54 40 51 86 6 4 2 1 3 - 13 Measles 152 145 7 24 29 33 38 120 29 10 5 - 2 - 19 Pulmonary Tuberculosis 101 68 1 1 - 2 - 5 4 24 76 21 30 5 - Other forms of Tuberculosis 13 7 1 2 - - - 3 3 3 3 4 1 - - Totals 889 1,057 60 112 116 94 139 377 144 191 388 134 145 46 224 10 INFECTIOUS AND OTHER DISEASES. Scarlet Fever. 206 cases of Scarlet Fever were notified during the year, compared with 340 in 1943, 295 in 1942, 103 in 1941, 103 in 1940 and 335 in 1939. Less than 57 per cent., namely 117 of these cases, were removed to Isolation Hospital. Diphtheria. The number of cases notified was 44, compared with 107 in 1943, 75 in 1942, 73 in 1941, 28 in 1940, 60 in 1939 and 221 in 1938. There were 3 deaths from this disease. Immunisation has been carried out at 4 afternoon sessions each week, and the method used has been two doses of alum precipitated toxoid; 0. 2 c. c., followed 3 weeks later by 0.5 c. c. Total attendances at Immunisation Clinics5,341 Schick Tests1,348 Cases completed during the year:- Over 5 years of age, 1,096. Under 5 years of age, 1,095—Total 2,191. Estimated percentage of child population immunised at the 31st December, 1944 :— Aged under 5 years, 70 per cent. Between 5 and 15 years, 68 per cent. Diabetes. Necessitous persons suffering from Diabetes were supplied with Insulin, in accordance with the general authority contained in Ministry of Health Circular 2734, of January, 1943. The number of cases seeking this assistance continued to increase. Number of Cases supplied, 28. Cost, £147 7s. 4d. 11 Scabies. The compulsory notification of Scabies enabled the Council to exercise close control over this disease. It is interesting to note that, as in 1943, the larger number of cases occurred in adult females. Medical Practitioners in the Borough co-operated with the Council in securing treatment for this disease, with the result that there was no difficulty in arranging for those affected to accept the facilities offered at the Council's Cleansing Station. Number of Cases Notified. Age Groups Males Females Total Under 15 years of age 78 84 162 Over 15 years of age 165 370 535 Totals 243 454 697 Laboratory Facilities. The following examinations were made during the year in the Council's laboratory:- Swabs (Throat and Nasal). Negative. Positive. Total. Referred by the Health Department:- Diphtheria Contacts, Discharged Cases, Convalescent Home Cases, etc. 705 10 715 Medical Practitioners 369 18 387 C.S. Meningitis 10 1 11 Totals 1,084 29 1,113 Specimens of Sputa examined for Tuberculosis:- Negative 90 Positive 8 Total 98 12 Negative. Positive. Total. Stools examined for Typhoid 2 - 2 Faeces examined for Paratyphoid 2 - 2 Faeces examined for Dysentery 9 2 11 Faeces examined for Colitis 1 - 1 Tuberculosis. The County Council are responsible for the treatment of Tuberculosis. 189 notifications were received under regulations during 1944. Pulmonary, 169, other than Pulmonary, 20. Cases remaining on the register at the end of the year were— Pulmonary, 584; Non-Pulmonary, 155. 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. .. 12 noon. (also from May to September, first and third Thursdays 6—7 p.m.). Age Periods. New Cases. Deaths. Pulmonary. NonPulmonary. Pulmonary. NonPulmonary. Males Females Males Females Males Females Males Females Under 1 year 1 - 1 - - - 2 - 1 to 5 years 1 2 2 - - - - - 5 to 15 ,, 6 3 4 2 2 - - - 15 to 25 ,, 36 29 2 3 3 8 1 1 25 to 35 ,, 19 16 - - 4 6 2 1 35 to 45 ,, 14 7 3 2 7 7 - 1 45 to 55 ,, 13 5 - - 9 1 1 - 55 to 65 ,, 8 4 1 - 8 3 3 - 65 years and upwards 3 2 - - 3 2 - - Totals 101 68 13 7 36 27 9 3 13 Organs affected (New Cases) Males. Females. Lung 101 68 Glands 4 1 Neck 1 - Rib - - Hip - 1 Peritoneum 1 2 Meninges 3 - Spine 1 - Genito-urinary system 3 3 The deaths represent a death rate of 0.69 per 1,000 population, and in 13.33 per cent. 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. It is satisfactory to note that the incidence of Tuberculosis, as indicated by the number of notifications received, has not shown any appreciable increase during the war years. SANITARY CIRCUMSTANCES OF THE AREA. Water Supply. The Borough water supply is obtained from the Metropolitan Water Board, and has been satisfactory in all respects. Adequate arrangements were made for maintaining and purifying the supply in the event of an emergency due to enemy action. Drainage and Sewerage. Soil sewerage is taken into the L.C.C. system, and the surface water drainage passes into the River Lee. Closet Accommodation. There has been no variation in the form of closet accommodation, but arrangements exist for the provision of emergency sanitation should the need arise. Housing. The general standard of housing in the Borough continued to deteriorate, and the difficulties of the housing situation were 14 fied as a result of the renewal of air attacks on this Country. During the second half of the year the housing section of the public health department was fully occupied in arranging and supervising repairs to war-damaged properties, whilst the rehousing section was equally extended in providing accommodation for the large number of families rendered homeless during that period. Throughout these six months, repairs to properties requisitioned for the inadequately housed were of necessity discontinued, and properties previously repaired were transferred to the "homeless persons" pool. War Damage Repairs. The flying bomb attacks first affected the Borough about the middle of June, and the department was hard pressed to deal with the damage caused by large incidents during this period of enemy attack. The difficulty experienced by builders in obtaining essential materials, owing to the introduction of controls at this time, made it necessary for the department to set up a stores department for the supply of all building materials required for war damage repairs. This was a departure from the practice employed since the commencement of the war, whereby contractors supplied materials from their own stocks; and it necessitated a great deal of emergency organisation. The services of all contractors—large and small—were utilised, and the success of the emergency arrangements was evident by the fact that at no time were repairs held up through lack of supplies. In this period, some £60,000 worth of building material passed through the department's stores. One unfortunate fact must be recorded, namely, the necessity at that time of introducing substitute materials of temporary lasting value for reinstating walls and ceilings. Shortage of building labour was always an acute problem, but the Government later in the year placed war-damage repair work under the Essential Works Order. REHOUSING STATISTICS. (Position at 31.12.44.) Total number of houses and flats requisitioned1,050 Total number of persons rehoused 4,231 Total number of persons billeted 9,602 15 Local Town Planning Exhibition. Despite the difficulties of the war situation, the Council organised a Town-Planning Exhibition during the year. This was well-attended by the public, and an extension of time was necessary. A local Sessional Meeting of the Royal Sanitary Institute was held during the Exhibition week, and the Borough Engineer and Surveyor, the Medical Officer of Health, and the Chief Sanitary Inspector submitted papers on planning and housing matters. At this meeting, the difficulty of dealing with unfit houses in unhealthy areas was stressed, and it was suggested by the meeting that the most effective solution to the problem would be the immediate acquisition of these areas. The local authority would then be able to give adequate maintenance to the properties until permitted to proceed with Clearance Schemes. Establishments for Massage and Special Treatment. The Council adopted part VII of the Middlesex County Council Act, 1934, and sought permission to make byelaws for controlling these establishments. This was withheld, but the Council have exercised their powers and have licensed only those persons whose names appear on the register of the Board of Registration of Medical Auxiliaries. Persons not so qualified are being allowed to continue in practice for a period of two years, during which time they must obtain the required qualification. Licences are subject to the condition that ultra-violet ray treatment shall be administered only in accordance with the directions given by a registered medical practitioner with reference to each person to whom such treatment is given and only by such persons as may be approved in that regard by the Council. The fee for a licence is £2 2s., and for a renewal licence £1 Is. Inspections Carried out by the Sanitary Inspectors, and Defects, etc., Remedied. House-to-House Inspections Nil Infectious Disease 372 Complaints 2,991 Re-Inspections 3,439 Factories 160 Workplaces 23 Dairies, etc. 86 Slaughter-houses 34 Bakehouses 48 16 Public House Urinals 51 Stables and Mews 21 Food Premises 418 Appointments and Interviews 784 Other Visits 2,276 Massage Establishments 7 Visits in connection with the supervision of repairs to war-damaged residential property 25,387 Visits to requisitioned houses (for homeless persons) in connection with the general maintenance of these properties 2,950 Drains reconstructed 41 Drains repaired 101 Drains cleared 133 W. C. Cisterns repaired or renewed 121 W. C. Pans renewed 46 W. C. Pans cleansed 87 Waste Pipes repaired or renewed 249 Rain-water Pipes repaired or renewed 93 Roofs repaired or renewed 534 Eaves Gutters repaired or renewed 324 Drinking Water Cisterns renewed 23 Drinking Water Cisterns covered 5 Water Service Pipes repaired 398 Water Supply reinstated 39 Yards repaired or reconstructed 28 Sinks renewed or provided 18 Floors repaired or renewed 241 Floors ventilated 30 Dampness remedied— by insertion of damp-proof courses 15 by pointing of brickwork 12 by internal rendering 89 by miscellaneous remedies 13 Window Frames and Sashes repaired or renewed, or painted 98 Coppers repaired or renewed, or provided 13 Fireplaces, Stoves and Ovens repaired or renewed 251 Flues and Chimney Stacks repaired 20 Brickwork of Walls repaired and Walls rebuilt 9 Ventilated Food Stores provided 3 17 Rooms cleansed 638 Staircases, Passages and Landings cleansed 411 Staircases, Balconies and Steps repaired or renewed 38 Noxious Accumulations removed 12 Nuisances arising from Animals abated 3 Miscellaneous Defects remedied 239 Notices Served. Informal 1,851 Statutory- Housing Act, 1936, Section 9 304 Public Health. Act, 1936:- Section 24 62 Section 39 58 Section 83 16 Section 9421 Section 45 - Section 44 - Total 461 Repair of Houses by the Council. £ s. d. Work carried out in default:- Section 9, Housing Act, 1936. 45 premises: 1,026 6 9 Public Health Act, 1936:- Section 39, 24 premises 475 2 2 Work carried out for maintenance of public sewers, 46 premises 802 14 1 Disinfection Work. Private firms in the Borough continued to use the Health Department's Disinfection Service to a considerable extent, as also the Civil Defence Services. Rooms disinfected after Diphtheria, Scarlet Fever, Tuberculosis, etc. 325 18 Number of houses where bedding was disinfected after the occurrence of infectious disease 407 Wards or School Rooms disinfected 10 Verminous Rooms (including disinfestation process) 347 Miscellaneous rooms 87 Bedding and Blankets:— Other Blankets. Pillows. Overlays. Articles. Private Firms 9,073 1,206 1,146 150 Civil Defence, Fire Watchers, etc 3,618 747 713 949 Houses disinfested on the Council's Estates—27 houses (61 rooms). Milk (Special Designations) Orders, 1936 and 1938. These designations may only be used under licence from the local authority. In 1944 the following licences were granted:— Pasteurised Milk:— Pasteurisers' Licences 4 Dealers' Licences 15 Supplementary Licences 3 Tuberculin Tested Milk:- Bottlers' Licences 1 Dealers' Licences 9 Supplementary Licences 2 Rodent Control. As from the 1st April, 1944, the Local Authority accepted Delegation of Powers under the Rats and Mice (Destruction) Act, 1919. Both private dwelling-houses and business premises were treated by a system of "baiting," and in addition, a second treatment of the sewers in the Borough was also carried out. Full details of this treatment were reported to the Health Committee and published in the Council's Minutes. No charge is made for the work undertaken in respect of private dwelling-houses, but in the case of business premises a charge is made on a time and material basis. Number of dwelling-houses treated 426 Number of business premises treated 24 Total charges made for business premises £33 12s. 7d. 19 Second Treatment of Sewers:- Manholes baited 1,111 Estimated number of rats destroyed 4,483 (The estimated number of rats destroyed as a result of the first treatment carried out in 1943 totalled 10,898). Shops Acts, 1912-1938. Effective administration of the Shops Acts has been secured by the systematic visitation of shops throughout the Borough, and an up-to-date register of shop premises has been maintained. Shops in the Tottenham (Remainder) Area are closed for the weekly half holiday at 1 p.m. on Thursday, and in the Harringay Area on Wednesday at 1 p.m., with the exception of butchers, who close on Monday at 1 p.m., throughout the Borough. Visits in connection with the half holiday closing totalled 191. Regular visits and investigations are made on the days of the weekly half holiday, and in the evening, to ensure that the provisions of the Acts and the various closing orders made thereunder are duly complied with. In the general administration of the Shops Acts, 3,698 inspections were made during the year. The majority of contraventions reported have been minor infringements of the Shops Acts, such as non-exhibition of statutory notices, in respect of which 292 verbal warnings and notices were issued. Shops Act, 1934 and Young Persons Employment Act, 1938. The pr visions of these Acts relating to the employment of shop workers have been effectively applied, and routine visitation has revealed the fact that conditions of employment have improved both with respect to hours of employment of young persons and the arrangements for the health and comfort of shop workers generally. 284 special visits were made in connection with the enforcement of these Acts. Shops (Sunday Trading Restriction) Act, 1936. The conditions relating to the employment of assistants on Sunday, and the compensatory holiday in lieu thereof, are being complied with, but very few shops now open on Sundays. The provisions of the Shops Acts generally have been well observed. THE EDUCATION COMMITTEE. Chairman : Alderman J. H. Morrell, J. P. Members : Alderman E. J. Field. Councillor G. A. Armfield. ,, C. D. Grant. ,, Miss R. F. Cox. ,, A. E Harvey. ,, E. W. Cox. Mrs. W. A. Kent. ,, R. W. H. Cox. ,, Mrs. A. Kitchener. ,, F. A. F. Keay, J. P. ,, A. J. Lynch, J. P. ,, Mrs. J. Lynch. ,, A. Reed, A C I I . J.P. ,, Mrs. A. E. Lyons (Vice-Chairman). Councillor Mrs. E. M. A. Morrell. ,, Mrs. G. E. Morrison. ,, M J. 0 Gar a. ,, H. W. Pearce. ,, H. W. Turner. Director of Education: C F. Strong, M A , Ph.D. 21 SCHOOL HEALTH SERVICE. Staff. Table VII gives particulars of medical, dental and nursingstaff. Dr. B. Broadbent, Deputy School Medical Officer, is still on service with H. M. Forces. There have otherwise been no staff changes. Co-ordination. Co-operation of parents is generously obtained in this area, without which the effectiveness of our work would be destroyed. Their interest in the efforts which are made to maintain high standards of health and hygiene among the school population is probably the most, vital factor in the success which the School Health Service has achieved. The co-ordination of the Maternity and Child Welfare and School Health Departments has been brought a stage nearer in that the Committees concerned are considering the appointment of a superintendent to co-ordinate the work of the nursing staffs of both departments. This, coupled with the provisions of the Education Act, 1944, that in future all the nursing staff should have the qualification of health visitor, brings very much nearer the day when complete interchangeability of staff will be accomplished. The Juvenile Employment Bureau, by the very nature of its work, must maintain close contact with the School Health Service. It is only because of the availability of the records in both departments that correct placing in appropriate types of employment can. be gained. The Invalid Children's Aid Association and the National Society for the Prevention of Cruelty to Children continue to give valuable help, as has always been the case, and the co-operation of these bodies is much appreciated. PHYSICAL WELFARE IN WAR-TIME. Nutrition. A remarkably high nutritional standard among school children, in spite of the vicissitudes of six years of war, has been maintained; and the official statements which have been made publicly are positively confirmed by the results of medical inspection in this 22 area. It would not have been surprising if nutritional standards had fallen considerably, but the fact that it is otherwise is evidence of wise planning that those who have suffered least of all from the limitations of a war-time diet are the children of the country. It is necessary to repeat that a very important factor in the maintenance of these high standards has been the provision of milk and meals in school. Nutrition Clinic. It is inevitable, even in the best circumstances, that there will be found a number of children whose standard of nutrition is subnormal, and these oases are referred to nutrition clinics for further examination and observation; and to enable the medical officers to ensure that where supplemental feeding is necessary, no effort is spared to secure this. A further, and most important, point is the prevention of deterioration in the physical welfare of children whose nutrition standard is normal, but whose home circumstances militate against the maintenance of healthy standards. Nutrition clinics have been held regularly throughout the year, at two Municipal Health Centres. Number of individual cases seen: 447. Vitamin Supplements for Children under Five. The provision of orange-juice and cod-liver oil has continued for children under 5 attending school. There has been some difficulty in getting parents to obtain supplies of orange-juice, but generally overcome. It cannot be said, however, that the position is entirely satisfactory, and it is one which might well be taken up on a national scale, and an intensive health propaganda campaign instituted so that a true "balanced diet" should be taken advantage of by the parents. Rest. The arrangements for special periods of rest for all children under 5 years of age in infant departments has continued. There is no question that the disturbance of sleep which occurred during the year as a result of enemy attacks has been minimised by this wise provision. 23 Clothing. It would be unreasonable to say that after five years of clothes rationing the standard of clothes and shoes has been entirely satisfactory. There have been numerous complaints during the year that the workmanship of children's shoes has deteriorated, as also the quality. The Board of Trade have been alive to this, and are doing all they can to maintain an improved standard, but the general situation is such that particular attention has had to be paid to the question of clothing and footgear during routine surveys made during the year. Where the standard of footgear is low because of economic circumstances, cases are referred to the Education Committee for their consideration. It is fair to say that, generally, any lowering of standards has not been as a result of parental neglect, but rather of short supply: a circumstance which is common to all. The arrangements reported last year of a "pool" supply of plimsolls in each school for the use of all children have continued, and the same precautions have been taken to minimise the risk of contagion by careful attention to cleanliness of feet and by the use of a disinfecting dusting-powder. That this has been effective is shown by the fact that there has been no apparent increase in plantar warts or other contagious conditions of the feet. Artificial Sunlight. The artificial sunlight treatment has continued at Lordship Lane and Park Lane Health Centres. The vitality of children so treated has increased, a fact of particular importance during 1944, when so many conditions were likely to cause a deleterious effect on appetite, energy and sleep of the children. 385 children were treated, and the total number of treatments given was 4,837. Immunisation. Immunisation against diphtheria is now being accepted by a great majority of parents as a routine. The reason for this is not entirely due to propaganda, but is a result of experience of the immunity given and the simplicity of the procedure. This work is carried out in conjunction with the Public Health Department, and the total number of children over 5 immunised during the year was 1,096. The percentage of school children now immunised is over 60 per cent. 24 Nursery Classes. Nursery Classes continue to fill an important part of the social life of the community. They relieve mothers of much of the drudgery of domestic life, and at the same time by allowing the mother to work, give opportunities of economic independence. By this nursery provision children are accommodated in surroundings where no effort has been spared, within the limits of war-time supplies, to secure a happy and healthy atmosphere. The children are under regular inspection by the school nurse, who visits daily, and they are provided with milk twice a day and a substantial midday meal is provided on the premises. The Committee's Nursery School and two classes have continued as a temporary measure as war-time Day Nurseries under the administration of the local Welfare Authority. Ophthalmic Clinic. Refraction work and ophthalmic treatment have for many years been an established service in this area, from time to time extending the scope as circumstances altered. Any child from birth up to the age of 19 years can now be treated at the clinics. Where treatment other than the provision of spectacles is indicated, this is arranged either at hospital, where operative treatment is necessary, or at the clinic when treatment by drugs or medicaments can be given. Treatment for squint can by this means be obtained at a very early age by close co-operation with the Infant Welfare and Toddler Clinics. Treatment is continuous after leaving school by continuation of supervision up to the age of 19. The total number of refraction cases, including cases suffering from squint, was 562. Total number of cases provided with glasses, 517. Dental Clinic. Mr. V. Sainty, L.D.S., Senior Dental Officer, reports as follows:— "The results as shown in Table IV, pages 30 and 32, are very satisfactory. In spite of flying bomb attacks, which caused fresh evacuation of children and also interfered with the routine appointments made at the dental clinics, there were 300 more attendances for treatment than in the previous year; namely, in 1943, 7,580; 1944, 7,900." 25 Orthopaedic Clinic. The Orthopædio Clinic has now resumed its pre-war activities, the number of treatment sessions each week being five. A full statement on the work of this clinic was presented in my last report by Mr. J. A. Cholmeley, M.B., F.R.C.S., which at this stage does not necessitate supplement. The statistical analysis of the work carried out at the clinic is as follows:— Attendances. No. of new cases dealt with during the year 190 Total number of children treated during the year 228 Total number of treatments during the year 3,057 Total number of children examined by Orthopaedic Surgeon this year 327 Schedule of New Defects. 1. Congenital defects 36 2. Birth injuries — 3. Rickety deformities 5 4. Knock-knees (non-rickety) 13 5. Postural defects of the spine 40 6. Structural curvature of the spine 1 7. Flat feet, footstrain, etc. 72 8. Infantile paralysis 1 9. Sequalae of acute fevers — 10. Fractures and other injuries 3 11. T. B. joints 2 12. Other bone or joint diseases (Non-T.B.) 1 13. Osteomyelitis 1 14. Other conditions including postural in- toeing 1 15. Non-Orthopaedic 1 16. N.A.D. 19 Provision of Surgical Instruments. Surgical appliances were supplied and repairs and replacements effected in 21 instances. 26 It has been found during the year that the impact of war has had its effect upon this phase of the work. It is, unfortunately, true that as a result of limitation of supplies, there is a delay in the provision of surgical appliances. Every effort is made to overcome this difficulty, and the indications now are that the period of waiting will in future be considerably lessened. Nervous Disorders. The Education Act, 1944, lays particular emphasis on the need for the provision of a child guidance clinic service by local authorities, and an increasing number of children are being referred for psychological examination and treatment. The arrangements which have obtained for some time continued during the year by the reference of cases to:— Tavistock Clinic. The London Child Guidance Training Centre. Guy's Hospital. There are indications that this work will have to be developed very considerably, and at an appropriate time it is my intention to submit to the Education Committee a comprehensive plan for the furtherance of this work locally. Hospital Treatment. Arrangements with voluntary hospitals have continued to be most cordial, and I acknowledge with gratitude the help which has been freely given by the hospital staffs in the vicinity, and particularly that of the Almoners. The North Middlesex Hospital has again undertaken the operative treatment for enlarged tonsils and adenoids. Convalescent Home Treatment. The continued co-operation and help of the Invalid Children's Aid Association is much appreciated. Convalescent treatment was arranged through the local education authority for children recommended by the school health service. These children were placed in suitable recognised homes. It should be said, however, that the service sorely misses the facilities available before the war at the Suntrap Residential Open-Air 27 School, Hayling Island, and it is hoped that the day is not far distant when this Open-Air School will again be available for the reception of children needing convalescent treatment. The School Medical Officer has visited various convalescent homes and residential special schools wherein are maintained children for whom the Committee is responsible, and found generally that the conditions were satisfactory. These contacts made with outside authorities are most valuable in formulating policy and in understanding the particular problems which from time to time concern those with whom we are fortunate enough to be in close co-operation. Infectious Diseases. A constant supervision over cases of notifiable infectious diseases is exercised by the school health visitors, and the source of their information continued to be a weekly return submitted by the Head Teachers. There has been no serious outbreak of infectious disease during the year, and it is right to claim that some of the credit for this is due to the close supervision exercised by the staff generally. Scarlet Fever 140 Diphtheria 24 Measles 149 Scabies 92 Scabies. The number of cases of scabies continued to fall, which, having in mind the experience of the war of 1914-18, is remarkable. It is true to say that a good deal of responsibility for this difference can be attributed to modern methods of treatment and the consciousness in the minds of the general public of the advantages of preventive measures. During the year the School Medical Officer took the opportunity of arranging, through the Ministry of Information, for the showing of a most instructive film on scabies, issued by that Ministry. There were present at the showing of this film general practitioners of the area, the health visitors and school health visitors, and all concerned in public health and hygiene in the Borough. While such a display quite obviously cannot of itself prevent the incidence of scabies, it is clear that the stimulation of interest in curative 28 measures must have in the long run an important effect upon the approach to social problems of this character with a resultant diminution of incidence of disease. Emphasis has been laid upon the question of scabies by the fact that during 1944 this disease was included among the notifiable diseases. Number of Cases of Scabies Treated by the School Health Service. Lordship Lane Health Centre 139 Park Lane Health Centre 103 Markfield Road Baths for Downhills School Clinic 132 Total 374 School for the Deaf. This school has consolidated its work since its return to its own premises in Philip Lane. There is great need at this school for the modernisation of the hearing aid equipment. The limitations of supplies during the war have prevented this, but it is a matter which should receive prompt consideration as soon as supplies are available, particularly having in mind the great developments in sound research which have taken place during the war. At the end of the year there were 55 deaf and partially deaf children on the roll. In addition there were 20 children with severe speech defects continuing their ordinary education while receiving remedial instruction. (In 1945 a whole-time speech therapist was appointed as a member of the school health service.) School for Physically Defectives. The School for Physically Defective Children is still housed in the unsatisfactory temporary premises at West- Green School. It is hoped that they may soon return to the more suitable and commodious premises at Vale Road, where the benefits which they receive from special instruction will be considerably augmented. The school health visitor visits daily at this school, and the children are under constant medical supervision by one of the Committee's medical officers. It cannot be said that the present arrangement is satisfactory, but it must be claimed that the best has been made of what is 29 sarily a war-time expedient. The field for development in this school is wide, and every opportunity should, and will, be taken of the opportunities offered as soon as an approach to normality in the general position is possible. Oak Lodge Special School. The progress of the children has been satisfactory, and there has been a good standard of health throughout the year. Regular visits have been made by the School Medical Officer. The number of children attending at the end of 1944 was, 54. School for Blind and Partially Sighted Children. It is still, unfortunately, necessary to send children requiring this type of special school accommodation to the school maintained by the Borough of Walthamstow, at Hale End Myopic School. The number on roll at the school at the end of the year from Tottenham totalled 8, and during the year 10 children were in attendance. Progress made by these children has been satisfactory. Examinations by Medical Officers. All entrants to the Education Committee's permanent service are examined by medical officers for superannuation purposes, and in addition the staff returning from national service are submitted to examination before reinstatement. 30 ELEMENTARY SCHOOLS. Table I.— Medical Inspections of Children attending Public Elementary Schools—Year ended 31st December, 1944. a.— Routine Medical Inspections. (1) No. of Inspections in the prescribed Groups:— Entrants 1,355 Second Age Group 1,035 Third Age Group 853 Total 3,243 (2) No. of other Routine Inspections 733 Grand Total 3,976 B.— Other Inspections. No. of Special Inspections and Re-Inspections 20,018. Table II.— Classification of the Nutrition of Children Inspected during the year in the routine age groups. No. of Children Inspected. A. (Excellent). B. (Normal). C. (Slightly Sub-Normal). D. (Bad). No. % No. % No. % No. % 3,976 431 10.84 3144 79.07 386 9.7 15 0.37 Table III. Group I.— Treatment of Minor Ailments (excluding Uncleanliness.) Total number of defects treated or under treatment during the year under the Authority's Scheme 4,187 Group II.— Treatment of Defective Vision and Squint. Under the Authority's Scheme. Errors of Refraction (including Squint) 562 Other defects or diseases of the eyes (excluding those recorded in Group I) 4 Total 566 Under the Authority's Scheme. No. of Children for whom spectacles were: (a) Prescribed 524 (b) Obtained 517 31 Group III.— Treatment of Defects of Nose and Throat. Under the Authority's Scheme. Received Operative Treatment 72 Received other forms of treatment 301 Total number treated 373 Table IV.— Dental Inspection and Treatment. (1) No. of children inspected by Dentist:— (a) Routine Age Groups 8,965 (b) Specials 973 (c) Total (Routine and Specials) 9,938 (2) No. found to require treatment 6,364 (3) No. actually treated 3,408 (4) Attendances made by Children for treatment 6,068 (5) Half days devoted to:— Inspection 49 Treatment 930 Total 979 (6) Fillings:— Permanent Teeth 1,950 Temporary Teeth 899 Total 2,849 (7) Extractions:— Permanent Teeth 648 Temporary Teeth 4,135 Total 4,783 (8) Administrations of general Anaesthetics for Extractions 394 (9) Other Operations:— Permanent Teeth 454 Temporary Teeth 763 Total 1,217 (10) Attendances for Orthodontic Treatment 592 Table V.— Verminous Conditions. (1) Average No. of visits per school made during the year by the School Nurses or other authorised persons 14 (2) Total number of examinations of children in the Schools by School Nurses or other authorised persons 65,402 (3) No. of individual children found unclean 1,553 (4) No. of individual children cleansed under Section 87 (2) and (3) of the Education Act, 1921 13 (5) No. of cases in which legal proceedings were taken:— (a) Under the Education Act, 1921 21 (b) Under School Attendance Byelaws — 32 SECONDARY SCHOOLS. Number of Pupils Inspected 1st January, 1944, to 31st December, 1944. Routine Medical Inspection. Total. Age 9 10 1 1 12 13 14 15 16 17 Boys — — 46 171 143 33 116 32 — 541 Girls — — 87 125 77 5 1 1 — 296 Totals — — 133 296 220 38 117 33 — 837 TECHNICAL SCHOOLS. Number of Pupils Inspected 1st January, 1944, to 31st December, 1944. Routine Medical Inspection. Total. Age 12 13 14 15 16 17 Boys — 87 110 40 39 1 277 Girls — 27 94 71 7 4 203 Totals — 114 204 111 46 5 480 Table II. Classification of the Nutrition of Children Inspected during the Year in the Routine Age Groups—Secondary and Technical Schools. Number of Children Inspected. A B C D No. % No. % No. % No. % 1,317 213 16.17 1,051 79.8 53 4.02 — — 33 Table III.—(Group II.) Under the Authority's Scheme. Treatment of Defective Vision and Squint:— Errors of Refraction (including Squint) 160 Other defects or disease of the eyes 1 Total 161 No. of Children for whom Spectacles were:— (a) Prescribed 157 (b) Obtained 157 Table IV.— Dental Inspection and Treatment. (1) No. of Children Inspected by the Dentist— (a) Routine Age Groups— Age 9 10 11 12 13 14 15 16 17 18 Total Number 13 61 181 266 432 464 343 255 172 83 2,270 (b) Specials 2 (c) Total (Routine and Specials) 2,272 (2) Number found to require treatment 1,318 (3) Number actually treated 851 (4) Attendances made by children for treatment 1,832 (5) Half-days devoted to:— Inspection 17 Treatment 220 Total 237 (6) Fillings:— Permanent Teeth 1,418 Temporary Teeth — Total 1,418 (7) Extractions:— Permanent Teeth 242 Temporary Teeth 93 Total 335 (8) Administrations of general anaesthetics for extractions 22 (9) Other Operations:— Permanent Teeth 335 Temporary Teeth 3 Total 338 (10) Attendance for Orthodontic treatment 106 34 SCHOOL MEDICAL AND DENTAL STAFF. Table VII.— School Medical and Dental Staff. Name of Officer. Proportion of whole time devoted to School Medical Service. Public Health. School Medical Officer:— Dr. G. Hamilton Hogben Administrative — Deputy School Medical Officer:— Dr. B. Broadbent (On Military Service) 1 /6th 5/6th Senior Assistant Medical Officer— Dr. Joyce E. Marshall (Temporary) l/3rd 2/3rds Assistant School Medical Officers:— Dr. R. H. Smythe Whole time — Dr. Nora A. M. Webster (Temporary) 2/3rds. l/3rd Senior Dentist:— V. Sainty, L.D.S. Dentists:— A. E. Fisher, B.D.S., joined dental branch R.A.F.V.R. (November, 1940). Miss C. M. Dixon, L.D.S. Miss E. M. McRaith, L.D.S. (Temporary appointment.) Note.— 2/3rds of the services of one Dental Unit is apportioned to the Maternity and Child Welfare Committee. The whole of the school medical and dental inspection and treatment of secondary school children is undertaken for the Higher Education Authority. School Nursing Staff. (Excluding Specialist Nurses such as Orthopaedic Nurses). Number of Officers Aggregate of time given to S.M.S. work in terms of whole time Officers. School Nurses 8 Whole time. District Nurses — — Nursing Assistants* — — Dental Attendants 3 See Note above under Dentists. *This term refers to untrained assistants described in paragraph 3 of Circular 1604. MATERNITY AND CHILD WELFARE (December 31st, 1944). Committee: Chairman: Alderman Mrs. A. Kitchener. Vice-Chairman: Councillor Mrs. A. E. Lyons. Members: Alderman Mrs. W. A. Kent. Councillor Mrs. M. Berry. ,, J. H. Morrell, J. P. ,, Miss R. F. Cox. ,, A. Reed, A.C.I.I., J.P. „ T. J. Dickinson. ,, A. R. Turner. ,, R. W. H. Ford. ,, R. H. Warren. ,, F. A. F. Keay, J.P. Councillor Mrs. E. M. A. Morrell. ,, W. T. Richards. Executive Officer Dr. G. Hamilton Hogben. Superintendent Mrs. J. Kent Parsons, M.B.E. 36 STATISTICAL INFORMATION. The population of the Borough as estimated by the RegistrarGeneral is 108,180 as compared with the pre-war estimated population of 144,400. Number of Registered Live Births:—Male 1,073 Female 993 2,066 Birth Rate (per 1,000 population) 19.09 Number of deaths under one year of age 87 Number of still births registered 54 Infantile Death Rate (per 1,000 live births) 42.11 Number of maternal deaths 3 Maternal Death Rate (per 1,000 total births) 1.41 CO-ORDINATION. The Health Services of the Borough are within the same administration, and the organisation is such that a ready co-operation is obtained in all branches of the work. The Department is indebted to many organisations whose work is related to Maternity and Child Welfare, and who have generously assisted wherever required. The Almoner services of the Prince of Wales and North Middlesex Hospitals, the Invalid Children's Aid Association, the N.S.P.C.C., and the Women's Voluntary Service have been particularly helpful. Good contact has been maintained with the services of the Middlesex County Council in this area, especially for the treatment of Tuberculosis and Venereal Diseases. HEALTH VISITORS. The year began with a staff of 16 Health Visitors and a Superintendent and an Assistant Superintendent Health Visitor. During the year members of the staff left the service for various reasons, and because of the shortage of trained personnel in securing replacements, the work of the department was carried out under difficulties, and, in fact, for the greater part of the year with a depleted staff. 37 In March, Miss S. Briggs, one of the health visitors, was seconded to be superintendent of the war-time nurseries, but after eight months' service was appointed to be Superintendent Health Visitor in an adjacent borough. The supervision of the nurseries then reverted to the Superintendent Health Visitor. In July, 1944, the health visitors were called upon to assist with the examination and despatch to the provinces of about 2,400 mothers and children of all ages, including about 50 expectant mothers under the Government Evacuation Scheme. The customary duties of home visitation of expectant and nursing mothers, children under five years, and all cases of children in the care of foster parents and adopters, was carried out by the health visitors. These duties also included attendance at all clinic services, ante-natal, infant welfare, artificial sunlight, dental and toddlers' sessions. The health visitors also visited and made final arrangements for the departure of evacuating expectant mothers, and sometimes accompanied the mothers to their destinations. Talks to the mothers attending the various clinics, together with the issue of Government vitamins at the distribution centres, were continued as in previous years. Close co-operation was maintained with members of staffs of other services under the Authority, with the N.S.P.C.C., the I.C.A.A., W.V.S., and the Soldiers', Sailors' and Airmen's Families Association, probationer officers, factory welfare officers and hospitals in and outside the district which serve Tottenham residents. During 1944 sixteen students of the National Health Society's Health Visitors' Course received their practical training in the Borough. Arrangements were made with the Borough of Islington for their training in the Tuberculosis service. The sewing classes and the Mothers' Clubs at the Chestnuts and the Lordship Lane Municipal Health Centres were reopened, and proved as popular as ever. The mothers seemed to be very grateful for the opportunity of resuming their contacts with the staff and with each other. Several parties of post-graduate medical officers and student health visitors from the Royal College of Nursing and the National Health Society visited the Municipal Health Centres and other services in the Borough, and several parties of women from the 38 Services were given talks and shown the work of the Borough. Many visitors from abroad and others going abroad to undertake relief work in Europe visited us during the year. DETAILS OF HOME VISITING BY HEALTH VISITORS. Expectant Mothers. Children under 1 year. Over 1 yr. Totals. First Visits. Re-visits. First Visits. Re-visits. Re-visits. 1,694 2,575 1,979 7,190 14,283 27,721 Other visits:—Infantile Deaths 47 Still Births 72 Ophthalmia Neonatorum 8 Pneumonia 55 Infectious Diseases 471 Special visits: Mothers 1,295 Children 372 Total 30,041 BREAST FEEDING. The following table shows the types of infant feeding and their incidence in the total infant population of the Borough. The information is obtained by the Health Visitors when the child has reached six months, and is based on the total notified births for the year, i. e., 2,046:— Breast fed 1,003 Part Breast fed, plus milk, dried milk or condensed milk 677 Bottle feeding—Cow's milk 24 Dried milk 150 Other Artificial Feeding 5 Feedings unknown: i.e., removals, evacuations and deaths 187 Total 2,046 Care of Illegitimate Children (Circular 2866). The present scheme of co-operation between the Maternity and Child Welfare Department and the Moral Welfare Worker of the Tottenham Deanery Board continued to work well. During the year the number of oases referred by the health visitors to the 39 moral welfare worker was 40, 35 of whom were confined during the year and five early in 1945. Five of the confinements took place at home and 28 were in institutions. Seven were evacuated under the expectant mothers' scheme. Eight adoptions were arranged, two foster mothers obtained, and four of the children were retained in homes. Fourteen of the mothers returned home after their confinements. There were two still births and one infantile death. Child Life Protection. The health visitors paid 128 visits as Infant Life Protection Officers during the year to 24 foster mothers in respect of 25 foster children. The number remaining on the register at the end of the year was 17 foster mothers in respect of 17 foster children; namely, 9 children under 5 years of age and 8 children over 5 years. Adoption of Children. The number of persons who gave notice of their wish to adopt children during the year was 30 in respect of 30 children. The total number of children under supervision at the end of the year was 42 and the number of visits paid 204. INFANT WELFARE CENTRES. The following table shows the attendances of infants and children under five at the Municipal Health Centres:— Centre. Sessions. Weighings . Infant Attendances . New Cases. Weighings Over 1 year Attendances . New Cases. Infant Welfare— Examined by Doctor. Lordship Lane Municipal Health Centre 255 6,078 511 1,484 218 1,397 The Chestnuts, St. Ann's Road 253 6,009 626 1,543 173 1,932 Park Lane Municipal Health Centre 103 3,541 323 720 251 913 Town Hall 52 722 74 156 1 — Totals—1944 663 16,350 1,534 3,903 643 4,242 Totals—1943 670 19,247 1,568 5,966 185 4,633 40 I am indebted to Miss C. Alice King, M.D., M.R.C.P., for the following report on the Infant Welfare Centres:— The work of the Infant Welfare Clinics during the greater part of 1944 was spasmodically affected by the "flying bomb" and, later, "rocket" phases of the war; but the clinics continued to function, and were, I think, all the more appreciated by those mothers who attended. The numbers of these were at times much reduced, but after evacuation of the older children had taken place, infants and those toddlers who remained at home were brought fairly regularly for weighing and inspection. The total number of new cases seen at the clinics during this disturbed year was, however, little less than during the previous year. The average size and state of nutrition of the infants were good, and the percentage of congenital defects or abnormalities small. There were few instances where breast feeding was not desired by the mother, though the wish or necessity to augment the family income by part-time work sometimes interfered with its completion. The continued provision of National Dried Milk has been of great value. Housing conditions and the necessity of sharing domestic amenities were also a. handicap to some young mothers. The Invalid Children's Aid Association was most helpful in securing convalescence for a number of the older children of the "under five" group, while the Tottenham Residential Nursery at Hertford afforded a home for younger members, especially in cases of temporary disablement of the mother of the family. The services of the health visiting staff were, as always, of great value in ensuring that advice given at the centres was, as far as possible, carried out at home. There is still a considerable number of parents who do not take advantage of the help offered at the Infant Welfare Centres, but this proportion is, I believe, gradually decreasing. TODDLERS' CLINICS. Clinics for children between two and five years of age were held regularly throughout the year, their object being to secure 41 routine medical inspection of children under five not regularly attending the infant welfare centres, nurseries, or nursery classes. The attendances were well maintained, in spite of evacuation; 585 new oases were seen, and there were 881 re-examinations, making a total of 1,466 examinations during the year, an increase of 93 over last year's figures. The majority attended once during the year, 26 per cent. twice, and 13 per cent. three or more times. The children were seen by appointment, and it would seem that there is considerable value in the fact that the clinics are held regularly every week, because, even though it is unnecessary for any one child to be seen frequently, the parents appreciate the knowledge that they can request help from the clinic whenever they need it, which often gives them more confidence in their own ability to deal with their children during the rather difficult period of rapid growth and development. Many mothers have mentioned this, and it is perhaps) more important in war-time when mothers have to shoulder so much responsibility during the father's absence. The percentage of children found to be immunised was 83. Of the non-immunised children the majority came for immunisation after one or two attendances at the Toddlers' Clinic, where there was the opportunity to remind them of the importance of this measure and of the time and places of the immunisation clinics held. The standard of development and nutrition was found to be good. The distribution and frequency of the minor defects found was almost the same as for 1943. In most cases the defects found were of recent origin, and not serious in nature. Some cleared up spontaneously, and in other oases prompt early treatment—e.g., for squint or otitis media—cured the condition before it had become well established. Attendances. Centre. Sessions. Number Notified. New Cases. Re- exams. Total. Lordship Lane 47 924 208 345 553 The Chestnuts 21 481 131 105 236 Park Lane 47 1,139 246 431 677 Total | 115 2,544 585 881 1,466 42 Nature of defects found. Infections of the Ear, Nose, Throat. Signs of Emotional Disturbances. Dental. Vision. Nutrition C. Debility after Infectious Disease. T.B. Family History. 10% 20% 10% 3% 6% 5% 3% The number of children under five who attended the special clinics by arrangement with the School Medical Service was as follows:— Clinics. No. of Consultations. Treatments. Minor Ailments 29 18 Dental 390 513 Orthopaedic 82 435 Ophthalmic 203 13 Ear, Nose and Throat 82 65 Artificial Sunlight — 3,388 Immunisations:— Final Schick Teats 883 1,026 I am indebted to Miss Esther Richards, M.S., F.R.C.S., for the followin report on the ante-and Post-Natal work:— Ante and Post Natal Care. The volume of work undertaken at the clinics, though slightly less than in the previous year, due no doubt to the renewal of air raids and evacuation, still stretched the services to full capacity. The work undertaken in these difficult circumstances was only made possible by the excellent co-operation of the health visitors, midwives and domestic staff at the clinics. With a rising birth rate, 19.09 as compared with 17.85 in 1943, it is gratifying to find the number of still births reduced from 70 to 54 and the maternal death rate reduced 2.94 to 1.41. The health of the mothers has been well maintained, and the babies reflect the value of good nutrition and special dieting in pregnancy. 43 Close co-operation has continued with our two principal hospitals: the Mothers' Hospital, Clapton, and the North Middlesex Hospital, and with others admitting mothers from Tottenham. ANTE-NATAL CLINICS. Centre. Sessions. Attendances . Cases. PostNatal. The Chestnuts 199 3,598 1,048 188 Lordship Lane 155 2.784 767 170 Park Lane 103 1,970 513 144 Total—1944 457 8,352 2,328 508 Total—1943 459 8,721 2,322 585 MATERNITY SERVICE. Hospital Provision. The scheme for the provision of beds for hospital cases at the Mothers' Hospital again worked satisfactorily, as also with the North Middlesex Hospital. The general shortage of maternity bed accommodation in this area is nevertheless a major problem, temporarily relieved by the Government facilities for evacuation. The following table shows the various institutions in which the confinements took place:— The Mothers' Hospital Clapton— Under the Council's scheme 85 Own arrangements 12 The North Middlesex County Hospital 218 Other outside institutions 214 Evacuations: Under the L.C.C. scheme— Arranged by the Borough 399 Education Department, Government scheme 53 Others 78 MUNICIPAL MIDWIFERY SERVICE. During 1944 the midwives again did yeoman service under blackout and housing difficulties. There were 12 Municipal Midwives, and the number of deliveries by them was 862. Cases attended as maternity nurses increased from 28 to 115. Ante-natal visits increased from 1,699 to 2,363. 44 The midwives were again permitted to use the ambulance service for very distant or emergency cases during the blackout hours. This privilege was much appreciated by the midwives, and was used only where really necessary. Six calls were made on the service during the year. The co-operation between the health visitors and the midwives continued to be very close, and was of great benefit to both the staffs and to the mothers. Sterilised packages of dressings were still very popular, the number supplied during the year being 705. Post-certificate courses were again arranged for our midwives under the scheme provided by the London Cbunty Council. Record of Cases. Number of deliveries 862 Number attended as maternity nurse 115 Primipara cases 468 Multipara cases 509 Ante-natal visits 2,364 Nursing visits 14,599 Deaths of mothers at home - HOME HELP SERVICE There was still an acute shortage of suitable women willing to act as Home Helps, and it will be a relief when conditions permit the enrolment of more helpers. Financial aid was allowed in 192 necessitous oases, of which 75 received free help. PUERPERAL PYREXIA. The following table shows the final results in each of the 13 cases of Puerperal Pyrexia notified during the year:— Doctors' Cases. Midwives' Cases. Occurred in Hospitals outside District. Total. Final Results. Recovered Died. 6 — 7 13 12 1 45 OPHTHALMIA NEONATORUM. Only three cases were notified, one of which was removed to hospital. All three cases made a satisfactory recovery. MATERNAL MORTALITY. Deaths from Puerperal Sepsis 1 From other Puerperal Causes 2 Total 3 Maternal death rate (per 1,000 live and still births) 1.41 GOVERNMENT SCHEME FOR EVACUATION OF EXPECTANT MOTHERS, L.C.C. The number of patients who took advantage of the scheme to evacuate for their confinement during 1944 was 399, due no doubt to the prevalence of flying bombs and V2 rockets. Many patients also left London during the middle of the year under the supplementary scheme. Many children under five were again sent away to " short stay" homes by the W.V.S.., and others went to our residential nursery at Hertford during the period of their mother's absence from London. In November, 1944, the Board of Trade issued priority dockets for bed sheets to be given to expectant mothers. This duty devolved upon the Maternity and Child Welfare Department, and proved a very popular scheme. PREMATURE INFANTS. Born at Home. Number of premature infants notified born at home 55 (includes 9 sets of twins, oi whom 14 were under 5½ lbs.) Nursed at home 55 Died during the first 24 hours 8 Died within the first week 4 Died within the first month 2 Total 14 Number survived a.t the end of the first month 41 Number alive and thriving at the end of December, 1944 41 40 Born in hospitals outside the District but resident in Tottenham. Notified 42 (includes 3 sets of twins) Died during the first 24 hours 4 Died during the first week 1 Died within the first month 5 Total 10 Number survived at the end of the first month 32 Number alive and thriving at the end of December, 1944 32 Total premature births born at home and in hospitals outside the district was 97, of which 24 died within the first month of life, a figure calling for intensified action in the provision made for the care of the premature child. GENERAL HOSPITAL TREATMENT FOR CHILDREN UNDER FIVE YEARS. Fourteen children were referred to the North Middlesex Hospital for consultation and treatment of tonsils and adenoids, where operation was probably required. Orthopoedio surgical appliances have been supplied to three children by arrangement with the National Orthopaedic Hospital, Stanmore, Middlesex. Convalescent Home Treatment. The Invalid Children's Aid Association have co-operated with the department in placing 32 children in convalescent homes for children under five years of age. Number of children who stayed for 1—10 weeks 22 Number of children who stayed for 11—20 weeks 7 Number of children who stayed for 21—30 weeks 2 Number of children who stayed for 31—40 weeks 1 Total 32 Of this number one case was free, the other 31 paying varying amounts weekly towards the cost. 47 Nature of Defects for which convalescent treatment advised. Malnutrition and Rickets 9 Debility 7 Post Pneumonia 6 Anaemia and Catarrh 1 Post Diphtheria 1 Post Measles and Bronchitis 1 Post Tonsils and Adenoid Op. 1 Asthma 2 Post Whooping Cough 1 Post Mastoid 3 GOVERNMENT EVACUATION SCHEME. The evacation of expectant mothers within four weeks of term for their confinement continued again throughout the year. Particulars of the scheme are set out in the report on the work of the midwifery service. Children under five were evacuated to our Residential Nursery at Bengeo House, Hertford, and by arrangement with the W.V.S., as in 1943. In accordance with the Ministry of Health circular 78/44 of the 1st July, authorising the organised evacuation of unaccompanied school children, the medical examination of these children was instituted on July 3th. On July 10th began the evacuation of mothers with children under five and of expectant mothers (G.E.S. 94 M. of H.). All persons evacuated under the recommended organised evacuation scheme were medically examined, and received a cleanliness inspection on the day before travelling, the result being recorded on the medical record cards provided by the Ministry. Those who were found to require it were treated immediately by cleansing, and the appropriate treatment for nits, vermin and scabies. The medical examinations were carried out at the Health Centres, where the health visitors, who knew the majority of the evacuees, assisted the medical staff and carried out local treatment and baths where necessary. The School Medical and Maternity and Child Welfare record cards of the children were available at the examinations, so that the medical history could be recorded on duplicate cards for the information of the medical officers; of the reception centres. 48 The escorts of each evacuation party were present at the centres during the examinations, where they became acquainted with the members of their party, and were informed when necessary of the medical condition. Large numbers of mothers and children applied for evacuation when the scheme was put into operation. 532 were examined on July 10th, and a total of 2,502 in the first eleven days, July 5th to 16th inclusive. Although the arrangements undertaken for medical examination and the transmission of records involved a considerable amount of additional work, it was found to be well worth the time and labour involved. All members of the Corporation's medical and nursing staffs voluntarily co-operated in this urgent work. I am indebted to the Borough Education Officer for the following information:— 1. Number of evacuations under Plan V (Unaccompanied Children) from July 5th to September 8th, 19-14 (inclusive). 2. Number of evacuations under Plan VII (Mothers with children over and under 5 years) from July 11th to September 8th, 1944 (inclusive). 3. Private arrangements scheme, June 26th to September 8th, 1944 (inclusive). 4. Other categories to September 8th, 1944 (excepting Aged and Infirm Persons, which are taken to date September 22nd, 1944). 5. Homeless persons. Children. Category. Mothers. Under 5. Over 6. 1. Unaccompanied Children — — — Handicapped Children 2. Mothers and children—over 5 and under 5 881 979 652 3. Private arrangement scheme (a) Mothers with children 2,261 1,662 1,660 (b) Unaccompanied children — 62 1,153 4. Homeless Persons (children) — — 2 Totals 3,142 2,703 3,467 49 Total Mothers and Children over and under 5 years and other Categories Evacuated:— (a) Mothers 3,142 (b) Children under 5 2,703 (c) Children over 5 4,995 10,840 Other Categories:— (a) Aged Persons 574 (b) Invalid Persons 174 (c) Blind Persons 6 (d) Expectant Mothers 53 (e) Homeless Persons 28 835 Total 11,675 Total number of Cheap Travel Vouchers to visit Evacuees in the Reception Areas from 1st July to 22nd September, 1944 1,479 MATERNITY AND NURSING HOMES. The number of Nursing Homes on the register at the beginning of the year was one. Number of applications for registration Nil Hospitals exempt from registration 1 (i.e., the Prince of Wales's General Hospital) Number on the register at the end of the year 1 DENTAL TREATMENT FOR MOTHERS AND CHILDREN. The number of expectant and nursing mothers who have received dental treatment during the year was 526. Of these 428 were ante-natal and 98 post-natal cases, all of whom were rendered dentally fit by fillings where preservation was possible; and otherwise, by extraction under local or general anaesthesia. 50 125 mothers were supplied with artificial dentures, 17 of whom were in the scale for free dentures and 108. contributed part of the cost. Treatment of children under 5 continued as in previous years and 220 consultations with 513 treatments were made. The dental service for mothers and young children is undertaken by the dental officers appointed by the Education Committee, one-third of the cost of a dentist "unit" being contributed by the Maternity and Child Welfare Committee. The growth in recent years of the number of young children requiring conservative treatment and the increasing popularity of this service raises the question of adequacy in the number of dental officers, now numbering three, appointed by the Local Authority. In the post-war review of this service, a strong case can be made for the appointment of an additional dental officer for maternity and child welfare work alone. War-Time Nurseries Service. No new nurseries were opened in 1944, the total number remaining at nine, one of which is a residential nursery at Bengeo House, Hertford. The standard of work in the nurseries has been maintained at a high level throughout the year. The nurseries have been consistently well maintained, and have had many additional improvements!, such as the repainting of the tables and chairs as these became shabby, new nursery friezes and pictures. A happy atmosphere has been evident throughout, and the parents have been friendly and co-operative, thus reflecting the care and interest shown by the staff in their work. During the year parents' meetings, held in most oases monthly, were well attended, and have been found to be of great value in the smooth running of this service. Measures were provided in a Ministry of Health circular issued in February, 1944, to meet the difficulties of maintaining an adequate staff by giving permission for the appointment of a certain number of additional untrained and partly trained staff, and for the appointment of additional nursery nurses where untrained workers were unobtainable. 51 Attendances for the first quarter of the year in all the nurseries were considerably above those for the same period in 1943. The numbers then began to decline as air raids increased, and, first, privately arranged, and, later, Government evacuation took many children out of London. During the last quarter of the year the attendances had reached the figures for the same period of 1943 in only two of the nurseries. In August 1944, at the request of the Ministry of Health, a survey of the attendances of children at the nurseries was carried out to find out whether any nursery could be closed and the staff spared for work in reception areas. A number of the staff volunteered for evacuation work, but at no time were the attendances sufficiently low to justify closure of any of the nurseries. In addition to the effects of air raids and evacuation on the work of the nurseries, the supply of toys was also affected. The civil defence depots and school woodwork classes were unable to continue their valuable help. The initial toy allowance per child was also reduced, in accordance with a circular of the Ministry of Health. The formation of the London Toy- Committee provided material for making and repairing toys, and the nursery teachers were able to avail themselves of this, as a woodwork room and tools were provided for their use in one of the schools, by cooperation with the Director of Education. Health of Children in Nurseries. The majority of children attending the nurseries improved noticeably in general health after the first- four to eight weeks of attendance. A good standard of health has been maintained throughout the year. This would seem to be closely related to the provision of suitable surroundings designed to provide the optimum environment for large groups of young children. No reconverted premises have been used. The value of adequate space, warmth, light and sanitation is increased at the present time because of the overcrowded, unsatisfactory conditions in the homes of many of the children who attend the nurseries. The danger from spread of infection does not appear to be greater than that for children of the same age group in the district generally. At no time has it been considered necessary to close a nursery for an outbreak of infection. 52 The time spent in the shelters did not noticeably alter the incidence of infection except in two cases, where measles and mumps were respectively introduced into two nursery shelters and the spread was apparently due to the close proximity of the children. Fatigue was evident during the flying bomb raids, and the nurseries served a useful purpose by providing facilities for rest for the children who had spent disturbed nights at home. Where cases of diarrhoea have occurred (22 cases among the nursery population of 380 children), they were mild, and in no instance was a child absent with this complaint for more than two weeks; in most cases the duration was two or three days. There was only one case of Sonne dysentery found. At the Residential Nursery there was an outbreak of mild diarrhoea in August, when practically all the children were affected. The advice of the E.M.S. Pathology Service was obtained. No infective organisms were found, although the possible sources of infection were explored- The following figures show the incidence of infectious disease among the children attending the nine nurseries during the year. The number of places remained at 380 throughout the year, and the total number of daily attendances was 68,755:— Dysentery (Sonne)—1 case. (No diarrhoea at this nursery.) Mild Diarrhoea or Gastro-enteritis—22 cases. 1 nursery had 9 oases: 1 in January, March, May, June, 3 in August and September. 1 nursery had 9 cases : 2 in February, 4 in March, 2 in May, and 1 in December. 1 nursery had 2 cases. 2 nurseries had 1 case each. 1 nursery (residential) had 3 cases in April and May and all children in August. Measles—45 cases (epidemics in three nurseries). 1 nursery, July and August, 20 cases. 1 nursery, May, 15 oases. 1 nursery, March, 10 cases. 53 Whooping Cough—18 cases. 1 nursery, April, 8 cases. 1 nursery, May, 6 oases. 1 nursery, April, 4 cases. Rubella. Occurred in three nurseries; total number unknown as diagnosis was uncertain, and in one nursery it occurred with measles. About 6 cases in each nursery. Mumps—6 cases. All in one nursery, July and August. Scarlet Fever—1 case. (This was the primary case at the Residential Nursery.) Jaundice.—Nil. Medical Supervision. As in previous years, the children were examined at regular intervals, and the nurseries were visited regularly by a Medical Officer. Routine dental inspections were carried out and treatment arranged where necessary. There were 54 completed immunisations and 69 Schick tests carried out in the nurseries. Artificial sunlight treatment was provided for all the children in the four nurseries which are situated near Municipal Health Centres, and in cases of special need from the other nurseries. Health of Staff at Nurseries. The standard of health of the staff has been maintained at a high level. The students especially have improved in health. In accordance with Circular 111/44, Ministry of Health, received in August, arrangements were made for the junior staff to receive a special examination to exclude tuberculosis where necessary. 54 In respect of the staff averaging approximately 82 throughout the year, the most common causes of sick leave have been mild infections of the upper respiratory tract and tonsillitis. The incidence of infectious illness has been as follows: — Rubella—10 cases. All in Tottenham. Scarlet Fever—7 cases. 4 in Tottenham, 3 at Bengeo House. Gastroenteritis-—7 cases. All in Tottenham. Jaundice—2 cases. 1 in Tottenham, 1 at Bengeo House. Training of Students. In the spring of 1944 a course of training for the Diploma of the National Society of Children's Nurseries; was commenced at the Technical College, which provided theoretical teaching for the student probationers of Tottenham and of adjacent Boroughs. Four Boroughs sent their students to this course, and 60 students, including 14 from our own nurseries, attended. The students received their training in practical work in their own nurseries. The Principal of the Technical College provided a tutor for the course, and lecturers in cookery and needlework. The teaching for the major part of the course was given by an Assistant Medical Officer, the Deputy Superintendent Health Visitor, the Supervising Matron of the War Nurseries, and by Matrons and Teachers: of the Tottenham Nursery staff. A visit to the Municipal Health Centre, Park Lane, was arranged to demonstrate the facilities afforded by a Public Health Service. Infant and Toddlers Clinics, Minor Ailment and Specialist Clinics were seen, also the work of health education carried out by the health visitors. The advantages to' the students of centralised training are mainly two; firstly, that they are provided with surroundings more conducive to study than can generally be provided on nursery premises, and, secondly, that their training is brought into relation with other branches of education, so that they have the opportunity 55 of meeting and working with students from other districts, and such facilities as a library, gymnasium and canteen are available to them. The training authority can maintain the standard of work more easily in this way than in a number of separate nurseries. The major part of the training, however, is still carried out in the day to day routine of the nurseries, where the quality of the work is determined by the individual matrons and their staff. Examination Successes. The practical examination for the N.S.C.N. Diploma was held twice in Tottenham nurseries during the year. Five probationers were successful in obtaining the N.S.C.N. Diploma. One obtained a distinction. Students who are trained under the new scheme at the Technical College enter for the examination in 1945 and 1946. The Work of the Nursery Staff. One of the senior health visitors was seconded to the post of Supervising Matron of the War Nurseries in 1944, and began this work in March. Her experience in teaching was of considerable value in carrying out the training for the N.S.C.N. Diploma. She left the Borough on October 31st, 1944, on her appointment elsewhere as Superintendent Health Visitor. Six of the staff (five nursery nurses and one student) left the service in order to take the general training in hospital. Leave of absence was given to members of the staff for the following:— The "stepping up" course for Deputy Matrons, held at the Sick Children's Hospital, Gt. Ormond Street—one nursery nurse. The Child Care Reserve Supplementary Course—one warden. The Child Care Reserve Senior Course—one nursery nurse. The Matron of Park Lane Nursery left on her appointment as a Supervisor to the Nurseries of the Save the Children Fund. For table of attendances see over. 56 WAR-TIME NURSERIES. Nurseries. Children; Places. Opened Attendances, 1944. Total. Days Open. Av. Daily Attendance January to March. April to June. July to September. October to December. Total. Under 2 Over 2 Municipal Day Nursery Park Lane equipped for: Under 2 yrs. of age 20 Over 2 yrs. of age 30 50 1940 April 10 1,404 1,665 815 1,863 537 1,570 695 1,847 3,451 6,945 10,396 254 40.9 War-time Lay Nurseries: Vale Road School for: Under 2 yrs. of age 30 Over 2 yrs. of age 30 60 1941 April 28 1,047 1 ,998 949 1,734 544 1,400 766 1,991 3,306 7,123 10,429 25??? 41.1 Lordship Lane for: Under 2 yrs. of age 15 Over 2 yrs. of age 25 40 1942 Sept. 28 835 1,318 679 1,339 641 993 726 1,256 2,881 4,906 7,787 254 30.6 Downhills School for: Over 2 yrs. of age 40 1942 Aug.10 — 2,282 — 1,944 — 1 ,463 — 2,267 — 7,962 7,962 254 31.3 Parkhurst School for: Over 2 yrs. of age 40 1942 Aug. 10 — 1,965 — 2,299 — 1,412 — 1,933 — 7,609 7,609 254 29.9 Plevna Crescent for: Under 2 yrs. of age 25 Over 2 yrs. of age 25 50 1943 Dec. 1 915 892 985 1,476 818 1,419 1,199 1,494 3,917 5,281 9,198 254 36.2 Pembury House for: Under 2 yrs. of age 25 Over 2 yrs. of age 25 50 1943 Nov. 15 1,012 1,153 1,376 1,233 1,009 886 1,299 1,055 4,696 4,327 9,023 254 35.3 Rowland Hill for: Under 2 yrs. of age 25 Over 2 yrs. of age 25 50 1943 Nov. 15 626 1,027 633 774 563 825 913 990 2,735 3,616 6,361 254 25.0 Total under 2,140 Over 2, 240 380 Total =418 — 5,839 12,300 5,437 12,66 4,112 9,974 5,598 12,833 20,986 47,769 68,755 — — Residential Nursery, Hertford: 38 Bengeo In residence 31.12.43 28 House Admitted during 1944 42=70. Discharged 32, in residence 31.12.44 = 38. 57 Health Education in Maternity and Child Welfare Work. The conditions necessary for healthy living are brought to the notice of all who attend the centres, and a large section of the population is reached in this way, particularly of mothers. Talks by the health visitors on many aspects of hygiene and parentcraft have been given throughout the year to groups of mothers at the centres. Individual explanations and discussions with mothers are given day by day at the baby-weighing sessions, at the ante-natal clinics, and during the sale of dried milk and vitamins by the health visitors. This is the most effective and valuable means of education. It has been interesting to see the large number of letters sent by our evacuated families to health visitors during last year's evacuation, asking for advice on a variety of problems concerned with health and child management. The demonstrations arranged by means of materials in showcases, poster-frames and on blackboards in the centres have been an effective method of education. Isotype has been employed in the demonstration of the importance of diphtheria immunisation and clean milk. The posters and leaflets of the Ministry of Food have been of exceptional interest and value, not in the least because of the design and colour they contribute. Officers of Rangers and Girl Guide Companies and school teachers have applied for permission for their girls to gain experience in their spare time as voluntary helpers in the war nurseries1. A rota of such helpers has been maintained throughout the year. The routine work and the layout of the nurseries affords an important demonstration of healthy living. A course of lectures on hygiene and maternity and child welfare work was given during the year at the Park Lane Municipal Health Centre to members of the A.T.S. stationed on gun sites in this area. The education on healthy living carried out throughout the war among members of H.M. Forces is one of the many factors which have served to increase the consciousness of health in the community during the last few years. Measures to secure and maintain the high standard of health are increasingly appreciated, and it seems that the educational work of the Public Health service will increase as the public demand more information and guidance. 58 Distribution of Fruit Juices and Cod Liver Oil. I am indebted to the Local Food Office for the following information of supplies of Cod Liver Oil and Vitamin Foods distributed in the area during the year under review:— 15,437 bottles of Cod Liver Oil. 127,595 bottles of Orange Juice. 38,757 tins of National Dried Milk. 3,504 packets of Cod Liver Oil Capsules. Of this quantity 60 per cent. was issued by the Local Food Office, and the remaining 40 per cent. was issued through the four Welfare Centres. In addition to the above numbers, the following were issued to The Medical Officer of Health:— 616 bottles of Cod Liver Oil To Health Centres. To War-time Nurseries. To Day Schools. 4,536 bottles of Orange Juice 1,267 tins of National Dried Milk 992 bottles of Cod Liver Oil 2,921 bottles of Orange Juice 965 bottles of Cod Liver Oil 3,688 bottles of Orange Juice