AC 439 (1) TOTTENHAM LIBRARY TOT 21Middy Borough of Tottenham Annual Report ON THE HEALTH OF THE BOROUGH FOR THE YEAR 1946 G. Hamilton Hogben Medical Officer of Health and School Medical Officer MEMBERS OF THE TOWN COUNCIL His Worshipful the Mayor (Councillor G. H. Ottaway, J.P.) The Deputy Mayor (Councillor A. E. Johnson.) Alderman E. J. Field, J.P. Councillor „ A. E. Harvey. „ Mrs. W. A. Kent. „ Mrs. A. Kitchener. „ Mrs. J. D. Lynch. „ J. H. Morrell, J.P. „ The Rt. Hon. The Lord Morrison, J.P. „ A. Reed, A. C.I. I., J.P. „ A. R. Turner. „ R. H. Warren. Councillor S. Booley. „ Mrs. F. E. Boyton. „ K. H. Brill. „ J. W. H. Brown. „ E. W. Bunker. „ A. Clark. „ A. Davies. „ T. J. Dickinson. „ R. W. H. Ford. „ C. H. Gill. „ K. A. E. Gregg. Mrs. L. R. Harrington. „ W. S. Herbert. „ J. W. Hollingsworth. „ Mrs. M. C. Irving, J.P. „ Mrs. Q. V. Jacobs. „ A. E. Johnson. „ F. A. F. Keay, J.P. „ E. P. Kent. „ L, A. Le Vor, M.I.M.I. „ Mrs. A. E. Lyons. „ Mrs. E. M. A. Morrell. „ The Lady Morrison. „ G. H. Ottaway, J.P. „ A. E. Pawson. „ Mrs. A. F. Remington. „ W. T. Richards. „ H. C. Scapens. „ E. Small. „ Mrs. M. E. Soall. „ A. E. C. Taylor. „ H. W. Turner. „ Mrs. G. Wilson. THE HEALTH and HOUSING COMMITTEE (as at 31st December, 1946). Chairman: Alderman R. H. Warren Members: (Ex-Officio) His Worshipful the Mayor (Councillor G. H. Ottaway, J.P.) (Ex-Officio) The Deputy Mayor (Councillor A. E. Johnson.) Alderman Mrs. W. A. Kent. Councillor K. H. Brill. „ Mrs. A. Kitchener „ A. J. Davies. „ J. H. Morrell, J.P. ,, T. J. Dickinson „ A. Reed, A.C.I.I.,J.P. „ R. W. H. Ford. „ A. R. Turner. „ Mrs. A. E. Lyons. Councillor The Lady Morrison. ,, T. W. Richards. „ Mrs. G. Wilson. Council's Representative on the Metropolitan Water Board. Alderman The Rt. Hon. The Lord Morrison, J.P. Town Clerk: Eric Townson, LL. B. 3 Public Health Department, Town Hall, N.15. 1st November, 1947. His Worship the Mayor, Aldermen and Councillors of the Borough of Tottenham. Mb. Mayor, My Lord, My Lady, Ladies and Gentlemen, I have the honour to submit this my tenth Annual Report on the health of the Borough for the year ending the 31st December, 1946. Delay in submission of this Report is due to an exceptional number of retirements and resignations of key personnel during the year. Resignations have been partly due to a general feeling of uneasiness caused by the transfer of so many important health functions away from the Borough under the provisions of the Education Act, 1944, and the National Health Service Act, 1946. Vital Statistics. The population, though still below the pre-war figure of 144,000, shows a rise of 14,230 over the previous year and is now estimated to be 124,830. The birth rate was 20.7, the highest for over 20 years, and the number of registered live births 2,580. Special satisfaction must be expressed in recording the lowest infantile death rate in the history of Tottenham of 34.1, compared with that of 43 for the whole country. The maternal death rate was 1.49, and the general death rate 11.9. Housing. Every effort possible has been made during the year to ease the unfavourable housing situation, aggravated by six years at war. Progress made and the difficulties met with by the Public Health Department are set out in some detail on pages 21 to 29 of this Report. Infectious Diseases. There was no serious outbreak of infectious disease during the year. The number of cases of diphtheria, 83, was one of the lowest recorded, and no death occurred during the year from this disease. An increase in the incidence of tuberculosis, 222 new cases being recorded as compared with 155 in the previous year, With the Compliments of the Medical Officer of Health. Health Department. Town Health Tottenham, N.15. 4 indicates the importance of a more intensive drive to improve the housing conditions of many of our people, and the relief of overcrowding. The greater facilities for early diagnosis and improved methods of treatment, is reflected in the fact that the death rate from this disease was lower than in previous years. Scabies, which is still compulsorily notifiable in this area, that shown a further decline. I wish to acknowledge the support and encouragement accorded to me by the Chairmen and Members of Committees, and my indebtedness to the loyal and efficient staff of the Corporation's Health Services. I have the honour to be; Your obedient Servant, G. Hamilton Hogben, Medical Officer of Health. 5 STATISTICAL SUMMARY. Year ended 31st December, 1946. Area of the District in acres 3.014 Pre-War Population 144,400 Registrar-General's estimate of the Civilian Population Mid-year 1946 124,830 Rateable Value £989,811 Sum represented by a penny rate £3,913 Births and Deaths. Registered live births:— Total. Males. Females. Legitimate 2,467 1,276 1,191 Illegitimate 113 61 52 2,580 1.337 1,243 Birth Rate (per 1,000 estimated population) 20.7 Stillbirths Total. Males. Females. Legitimate 83 41 42 Illegitimate 5 — 5 88 41 47 Stillbirth Rate per 1.000 total (live and still) births 32 98 Deaths Males 808 Females 683 Total 1,491 Death Rate (per 1,000 estimated Population 11.94 Deaths from Cancer—Males 142: Femals 124 266 Deaths from Diphtheria — Deaths from Measles 2 Deaths from Whooping Cough 4 Deaths from Diarrhoea (under 2 years) 6 6 Maternal Deaths:— Puerperal Sepsis 1 Other Puerperal Causes 3 Total 4 Maternal Death Rate (per 1,000 total live and still births) 1.49 Deaths of Infants under 1 year of Are: Total. Males. Females. Legitimate 81 45 36 Illegitimate 7 5 2 88 50 38 Infantile Death Rate (all infants per 1,000 live births) 34.1 Legitimate Infants per 1,000 legitimate live births 32.8 Illegitimate Infants per 1,000 illegitimate live births 61.9 The population which, in 1938, was 144,400, shows an increase of 14,230 over the figure of 110,600 for 1945. The birth-rate 20.67 compared with 17.97 in 1945 and 13.1 in 1938. Registered live births totalled 2,580, compared with 1,988 in 1945, the proportion of males to females being 1,337 boys and 1,243 girls. The infantile death-rate of 34.11 was lower than the rate for 1945—39.24. Deaths in the first 4 weeks of life caused a neo-natal mortality of 20.93 per 1,000 live births. The maternal death-rate was 1.499, as compared with 0.494 in 1945. The general death rate of the whole population showed a reduction over the previous year—11.94 compared with 12.40. 7 Table 1 STATISTICS OF TOTTENHAM FOR THE LAST TWENTY YEARS. Number of Cases. Year Population Deaths Death Rate Births Birth Rate Infantile Deaths Infant Death Rate Puerperal Fever and Puerperal Pyrexia Scarlet Fever Diphtheria Typhoid Fever SmallPox 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 1031 159,300 1,621 10.2 2,345 14.7 124 52.9 19 571 220 6 7 1932 156,800 1,591 10.1 2,214 14.2 114 51.4 37 452 149 4 5 1933 154,700 1,618 10.5 2,138 13.8 118 55.2 35 551 194 5 4 1934 152,694 1,572 10.3 2,091 13.7 108 51.6 34 628 300 1 — 1935 150,310 1,456 9.7 1,969 13.1 108 54.8 41 577 286 3 — 1936 148,600 1,600 10.8 1,931 13.0 100 51.8 37 430 227 5 — 1937 146,200 1,617 11.1 1,973 13.5 126 63.9 36 306 236 7 — 1938 144,400 1,512 10.5 1,893 13.1 89 47.0 23 186 221 — — 1939 142,400* 1,406 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 — — 1944 108,180 1,356 12.53 2,066 19.09 87 42.11 13 206 44 — — 1945 110,600 1,371 12.40 1,988 17.97 78 39.24 14 214 47 — — 1946 124,830 1,491 11.94 2,580 20.67 88 34.11 13 323 83 - - *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. 8 Table 11 Deaths during the year 1946 in the Borough of Tottenha m classified according to Diseases. Cause of Death Males Females Totals Typhoid and Paratyphoid Fevers — — — Measles 2 — 2 Scarlet Fever 1 — 1 Whooping Cough 3 1 4 Diphtheria — — — Influenza 10 10 20 Encephalitis Lethargica — 1 1 Cerebro-Spinal Fever — — — Tuberculosis of Respiratory System 55 20 75 Other Tuberculous Diseases 5 5 10 Syphilis 2 3 5 General Paralysis of the Insane Tabes Dorsalis - - - Cancer, Malignant Disease 142 124 266 Diabetes 4 9 13 Cerebral Haemorrhage, etc. 53 68 121 Heart Diseases 177 180 357 Other Circulatory Diseases 38 24 62 Bronchitis 71 48 119 Pneumonia (all forms) 44 50 94 Other Respiratory Diseases 13 2 15 Peptic Ulcer 22 4 26 Diarrhoea (under 2 years) 2 4 6 Appendicitis 1 4 5 Other Digestive Diseases 16 12 28 Acute and Chronic Nephritis 17 12 29 Puerperal Sepsis — 1 1 Other Puerperal Causes — 3 3 Congenital Debility, Premature Birth, malformations 32 24 56 Road Traffic Accidents 9 4 13 Other Violent Causes 13 11 24 Suicide 14 6 20 All other Causes 62 53 115 808 683 1,491 9 Table 111 Infantile Deaths in Ages and Sexes during the year 1946. 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 — — — — — 4 3 1 - 8 4 4 Diarrhoea and Enteritis — 2 — — 2 3 2 — — 7 5 2 Measles — — — — — — — — — — — — Pneumonia 2 1 1 — 4 4 1 2 — 11 7 4 Premature Births,Congenital Malformations, etc. 35 7 4 — 46 8 — 2 — 56 32 21 Miliary Tuberculosis — — — — — — — — — — — — T.B. Meningitis — — — — — — — — — — — — Whooping Cough — — — — — — — — 1 1 1 - Other Causes 1 — — 1 2 — 3 — — 5 1 4 Totals 38 10 5 1 54 19 9 5 1 88 50 38 10 GENERAL PROVISIONS OF HEALTH SERVICES. Hospitals. General hospital services are provided at the Prince of Wales's General Hospital, which is centrally situated within the borough and to which the Council contribute annually an amount equal to a ½d. rate. Provision is also made at the North Middlesex County Hospital, in the adjoining Borough of Edmonton, and a short distance beyond the Northern boundary of Tottenham. The Teaching and Special Hospitals of London are within easy access. Diabetes. Insulin is supplied to necessitous persons suffering from Diabetes, in accordance with the authority contained in Ministry of Health Circular 2734 (1943). Number of cases supplied during the year 29 Cost to local authority £140 13s. 10d. Nursing in the Home. The District Nursing Association provides a most valuable home nursing service in the Borough, and the local authority continues to make an annual grant in respect of non-infectious cases nursed by them. The Home Help Service for general duties is incorporated in the Maternity and Child Welfare Committee's scheme. Domiciliary treatment was arranged for approximately 50 per cent. of the Scarlet Fever cases notified during the year, and in necessitous cases, the local authority paid the fees of the medical practitioner in attendance. The home nursing of infectious cases is facilitated by the services of a whole-time public health nurse, who also assists at the immunisation clinics. Ambulance Facilities. The Borough Ambulance Service has remained under the control of the Public Health Department, and notwithstanding the difficulties arising from the deterioration of pre-war vehicles and the difficulty of early replacements, the service has been able to cope with the increasing demands of the Borough. Five vehicles 11 each manned by a driver and attendant, are available during the day period. From 5 p.m. until 8 a.m. a reduced staff of four men are on duty for accident, maternity, and urgent hospital cases. The increase in the number of maternity calls at night time has been considerable, but it has not yet been necessary to expand the night service. Mutual aid with adjoining Boroughs has worked smoothly and well. Ambulance Charges. The following pre-war scale of charges for the service of ambulance and attendants still obtains, namely:— Tottenham Residents: To and from Prince of Wales's Hospital Free. To any Hospital or Nursing Home in the Metropolitan Police Area Free. From any of the foregoing (excluding the North Middlesex County Hospital) 5s. From the North Middlesex County Hospital 2s. 6d. To or from any Railway Station in the Metropolitan Police Area 5s. House to House removal 5s. Outside Metropolitan Police Area 1s. 6d. per mile. Non-Tottenham Residents. 7 a.m. to 10 p.m.—15s. per hour for the first hour or any part thereof, and subsequently at the rate of 15s. per hour. 10 p.m. to 7 a.m.—Substitute 20s. for 15s. as above. Two school buses for conveying children to four Day Special Schools: Oak Lodge School, Finchley, Vale Road School for Physically Handicapped Children, the School for Partially Sighted Children, Walthamstow, and Tottenham School for the Deaf, Philip Lane, are attached to the Ambulance Service, and two utility vans are maintained for transporting school meals. 12 Ambulance Statistics. Month. Mileage Ambulances Mileage School Buses Total. January 3,490 1,670 5,160 February 2,846 1,654 4,500 March 3,838 1,897 5,735 April 3,210 1,016 4,226 May 4,032 2,075 6,107 June 3,888 1,429 5,317 July 3,981 1,839 5,820 August 2,803 — 2,803 September 3,920 1,413 5,333 October 4,286 2,095 6,381 November 4,458 1,776 6,234 December 3,848 1,252 5,100 Totals 44,600 18,116 62,716 Accident and Hospital cases conveyed 6,443 Maternity cases conveyed 450 Special School Journeys 1,613 The oxygen resuscitator was used on 8 occasions for the following cases:— Collapse 1 Apoplexy 1 Cerebral Haemorrhage 1 Gas Poisoning 5 8 CONTROL OF INFECTIOUS DISEASE. Notifiable Diseases (other than Tuberculosis). The number of notifications of infectious disease, excluding Tuberculosis, was 1,930 (see Table IV). Infectious Diseases Hospitals. The Agreement with the Southgate Borough Council, made in January, 1934, in respect of the maintenance of Tottenham cases of infectious disease in the Southgate Isolation Hospital, was terminated on the 31st December, 1946, when the hospital was taken over by the Middlesex County Council for auxiliary maternity bed accommodation. 13 An arrangement has now been entered into with the Finchley, Hornsey, Wood Green, and Friern Barnet Joint Hospital Committee, for the provision of accommodation for cases of infectious disease occurring in Tottenham, on the following terms:— (i) that the charge be at the rate of £1 1s. 0d. per patient per day, plus specialists fees (if any); (ii) that proper ambulance charges in regard to the conveyance of patients be reimbursed; (iii) that the above charges be subject to review at the expiration of one year. Laboratory Facilities. Since 1903 the examination of bacteriological specimens has been undertaken mainly in the laboratory situated at the Town Hall. With the establishment of a National Laboratory Service this arrangement came to an end on the 28th January, 1946. The new service first came into being as an emergency organisation at the beginning of the war, and was set up by the Medical Research Council, at the request of the Government, to provide for certain parts of the Country which had no satisfactory facilities for Public Health bacteriology. The service is now being continued on a permanent basis in the building occupied by the Government Lymph Establishment at Colindale, Hendon, with the Medical Research Council responsible for its direction at least during an initial period of five years. The intention is that the service shall undertake work required by Medical Officers of Health in relation to the diagnosis, prevention and control of infectious disease, and the following details are submitted of the examinations carried out during the period February to December, 1946:— *Throat/Nose Swabs.—Diphtheria Bacilli, 62; Haemolytic Streptococci, 385; Vincent's Angina, 24; Negative, 1,104: Total, 1,537. Faeces.—Shigella, 1; Salmonella, Nil; Protozoa, Nil; Negative, 8: Total, 9. Sputum.—T.B. Smear, 6; Other Organisms, 1; Negative, 59: Total, 66. Pertussis.—Cough Plate, 2; Postnasal Swab, 1; Negative, 10: Total, 13. Milk.—Pasteurized, 3; Other, 4; Ice Cream, 3: Total, 10. 14 Water.—Domestic Supplies, etc., 1; Swimming Pools, Nil. Miscellaneous, 7. Total Examinations, 1,643. * Note:—Certain specimens may be positive for more than one pathogen, which is the reason why the numbers of examinations add up to more than the total given. Disinfection. A Public Cleansing Station is maintained by the Health Department in Markfield Road, which includes a steam disinfector for disinfection of clothing and bedding after infectious disease; and additional facilities are provided for mothers and children at the two principle Municipal Health Centres in Lordship Lane and Park Lane, Tottenham. Disinfection Work. Rooms disinfected after Diphtheria, Scarlet Fever, Tuberculosis, etc. 593 Number of houses where bedding was disinfected after the occurrence of infectious disease 646 Wards and/or school rooms disinfected 48 Verminous rooms cleansed (including disinfestation process) Private houses 435 Council houses 52 487 During the first month of the year, the following examinations were made in the Council's laboratory:— Diphtheria Swabs 104 Negative 3 Positive Total 107 Pulmonary Tuberculosis Sputum Tests 11 Negative 2 Positive Total 13 15 Library books disinfected 44 Bedding dried 23 Temporary Houses:— Furniture and bedding disinfected and removed to temporary houses in 179 cases. Diphtheria. The number of cases notified during the year was 83, of which 60 occurred among children under 15 years of age. Hospital treatment was afforded in every case, and there was no death from this disease. IMMUNISATION. Four immunisation clinics are held weekly, and the treatment given consists of two doses of alum precipitated toxoid, the first 0.2 c.c. followed three weeks later by 0.5 c.c. Notwithstanding intensive propaganda by poster displays, the distribution of leaflets, personal advice by medical officers and health visitors; and national publicity on public hoardings and by films in cinemas, the percentage of children immunised remains comparatively low. The percentage figures being 50.79 of the under five children and 64.1 of children of school age. Centres. Total Attendances. Number of Schick Tests. Number of individual cases completed. 0—4 yrs. 4—15 yrs. Chestnuts 2,329 546 546 104 Town Hall 1,900 477 431 53 Lordship Lane 1,986 460 453 76 Park Lane 1,413 328 357 32 Nurseries 104 26 23 3 7,732 1,837 1,810 268 2,078 Medical practitioners are supplied with the prophylactic material on application at the Health Department, but the number of children immunised in this way has been very small. 16 Immunisation in Relation to Child Population. Number of Children who had completed a full course of Immunisation at any time up to 31st December, 1946. Age at 31.12.46 i.e., Born in Year. Under 1 1946 1 1945 2 1944 3 1943 4 1942 5 to 9 1937-41 10 to 14 1932-36 Total Under 15 Number Immunised 4 1,054 1,418 1,090 1.295 5,511 4,574 14,946 Estimated mid-year Population 1946. 9.570 15,730 Percentage of Children Immunised 50.79% 64.11% Diphtheria Notifications and Deaths Notifications. Deaths. Age at date of Notification Number of Cases Notified Age at date of Death. Number of Deaths. Under 1 1 Under 1 Nil. 1 1 1 Nil. 2 3 2 Nil. 3 3 3 Nil. 4 6 4 Nil. 5 to 9 28 5 to 9 Nil. 10 to 14 18 10 to 14 Nil. Totals 60 Totals Nil. Scarlet Fever. There has been no change in the Council's policy of isolating Scarlet Fever cases at home, where conditions for this are satisfactory and of the 323 cases notified during the year, only 166. were removed to Isolation Hospital. No difficulty was experienced in treating the remaining cases at home, this being made possible by the ready co-operation of doctors in attendance, which allowed the Public 17 Health Department to exercise adequate control in the prevention of spread of infection. The one death recorded from this disease was a man, aged 63 years, who was an in-patient at the North Middlesex Hospital, the cause of death being:— (1) Confestive Heart Failure. (2) Scarlet Fever. Measles. The incidence of Measles was much less than in 1945, 592 cases being notified as compared with 1,088 in the previous year. 31 were admitted to isolation hospital, and there were two fatal cases. Whooping Cough. There were 181 cases notified, 26 occurring under the age of one year. Four deaths were recorded; and 10 cases with complications were removed to hospital. PREVENTION OF WHOOPING COUGH. Whooping Cough Vaccine Trials. Since the latter part of the year the Health Department has co-operated with the Medical Research Council in a special investigation being undertaken to assess the preventive value of an American pertussis vaccine (Sauer's vaccine). The purpose of the investigation is to compare the incidence of whooping cough in two comparable series of children, one series receiving Sauer's vaccine and the other a control—anti-catarrhal vaccine—which contains no H. pertussis. A large number of children between six months and one year of age have been inoculated, and they will be kept under close observation over the next two years, so that a comparison may be made of the incidence and severity of the disease occurring in both groups. Full details of the scheme have been explained to the parents of these children, and it is known that only half the entrants into the scheme receive the Whooping Cough vaccine. But the parents also know that each child taking part in the trials will have the advantage of being visited monthly by a Health Visitor, who will note all coughs and colds the infant gets and will immediately investigate any suspicion of whooping cough. By this means, not only will 18 information on the value of whooping cough and anti-catarrh vaccines be obtained, but each mother can be assured that if the disease does spread into the home, a very early diagnosis can be made and the family doctor informed. No. of Consent Forms Received. No. of Inoculations. First Second Third. 288 278 270 266 It is gratifying to note from the above table that the number of defaulters has been small. Scabies. For the first time since December, 1943, when Scabies was made compulsorily notifiable in the Borough, there has been a marked decrease in the cases notified. During 1946, 591 cases were notified or otherwise brought to the notice of the department. The figures for 1945 and 1944 were 709 and 697 respectively. Cases were visited by the Infectious Disease Nurse, and treatment arranged at the Public Cleansing Station in Markfield Road or at the Municipal Health Centres in the district. No action was necessary under the Scabies Order, 1940. Age and sex distribution Males Females Total Under 15 years of age 132 154 286 Over 15 years of age 132 173 305 Totals 264 327 591 Tuberculosis. There was an increase in the incidence of Tuberculosis, 222 new cases being recorded as compared with 155 in the previous year. Notification of pulmonary cases totalled 198, and non-pulmonary 24. This increase in the number of notified cases of pulmonary tuberculosis is associated with increased facilities during the year for early diagnosis by mass radiography. There were 865 cases of tuberculosis on the department's register on the 31st December, 1946, 707 being pulmonary and 158 nonpulmonary. 19 Death from pulmonary tuberculosis occurred in 75 cases, in the proportion of 55 males to 20 females; and in the case of nonpulmonary tuberculosis, 10 deaths were notified, five being males and five females. The death rate from all forms of tuberculosis was 0.68 per 1,000 population, which is slightly lower than the corresponding figure of 0.79 for 1945. Summary of Tuberculosis Cases. Age Periods New Cases. Deaths. Pulmonary. NonPulmonary. Pulmonary. NonPulmonary. Males Females Males Females Males Females Males Females Under 1 year — 1 — — — — — — 1 to 5 years 12 3 — 1 — — 1 — 5 to 15 „ 4 4 1 4 — — — 2 15 to 25 „ 26 32 — 4 10 10 3 2 25 to 35 „ 29 23 5 5 9 3 — — 35 to 45 „ 14 11 3 — 10 3 — — 45 to 55 „ 9 5 — — 10 2 1 — 55 to 65 „ 14 3 — — 10 1 — 1 65 years and upwards 6 2 1 — 6 1 — — Totals 114 84 10 14 55 20 5 5 Non-pulmonary cases affecting— Male. Female. Total. Genito-urinary system 2 3 5 Spine 4 2 6 Hip joint — 2 2 Knee joint 1 — 1 Foot — 1 1 6 Cervical glands 1 5 Meninges — 1 1 Wrist Joint 2 — 2 10 14 24 '20 Table IV Table of Cases of Infectious Disease coming to the knowledge of the Medical Officer of Health during the gear 1946 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 159 164 1 6 23 23 28 148 67 14 6 7 1 - 166 Diphtheria 44 39 1 1 3 3 6 28 18 4 15 1 3 - 83 Pneumonia 39 32 1 1 2 2 2 2 1 2 9 8 25 16 - Erysipelas 13 22 1 — — — — 2 1 1 7 5 16 2 14 Puerperal Pyrexia — 13 - - - - - - - 1 11 1 — — 3 Dysentery 4 5 1 1 — 1 1 — — — — 2 3 — 8 Ophthalmia Neonatorum 8 6 14 - - - - - - - - - - - 2 Meningitis 3 6 1 1 — 1 1 2 — 1 1 — 1 — 3 Malaria — — — — — — — — — — — — — — — Scabies 264 327 9 10 13 12 16 129 97 57 164 39 36 9 1 Enteritis 5 2 4 - — — — —. — 1 - 1 1 - 3 Food Poisoning - — - — — — — — — — — - - — - Whooping Cough 84 97 26 35 30 24 22 38 3 1 1 1 — - 10 Measles 270 322 19 74 87 92 116 185 11 1 5 1 — 1 31 Pulmonary Tuberculosis 114 84 1 4 8 1 2 4 4 12 98 25 31 8 — Other forms of Tuberculosis 10 14 — — - — 1 2 3 3 11 3 — 1 — Poliomyelitis 2 - - - - - - 1 - 1 - - - - 1 Totals 1,019 1,133 79 133 166 159 195 541 205 99 327 94 117 37 325 21 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. Drainage and Sewerage. Soil sewage is taken into the London County Council system and surface water discharges into the River Lee. The Moselle Brook continues to be a source of complaint by residents in the adjacent areas, and the necessity for culverting this open water course is again stressed. Closet Accommodation. Closet accommodation in the Borough is on the water carriage system. The severe conditions of last winter, with the consequent "freezing up'' of flushing apparatus, emphasises the necessity for greater publicity to be given to the provisions of Section 51, Public Health Act, 1936. This section requires that the occupier of every building shall cause the flushing apparatus to be kept supplied with sufficient water. Many tenants fail to take the most elementary precautions to prevent frozen pipes, and appear to regard this as the sole responsibility of the landlord. HOUSING. Attention is directed to the necessity for a review of policy in relation to slum clearance procedure. This problem is assuming greater importance each succeeding year, and gives rise to grave concern. The question of securing a reasonable standard of living accommodation in houses which are fit only for condemnation is almost impossible of solution. Owners of such properties give expression to this when notices requiring urgent repairs are served upon them by replying that the dwellings are past repair, and they are prepared to refuse to collect the rents. The policy of patching up old and worn out property cannot continue indefinitely. Housing Act, 1936, Section 11. During the year 1946, Demolition Orders were made with respect to the following dwelling-houses, namely:— Nos. 50, 52, and 54, Tewkesbury Road. Nos. 13, 15, 17, 19, 21, and 23, Chalgrove Road. 22 The operation of this section of the Housing Act at this time is complicated by the question of alternative accommodation for the tenants of occupied houses, but whilst there is no legal obligation on the local authority to provide alternative accommodation for these families, it has generally been possible to rehouse them in requisitioned property, when necessary. Housing Act, 1936, Sections 9 and 10. There has been no relaxation in the operation of Sections 9 and 10 of the Housing Act, 1936, whereby repairs to insanitary houses are secured; but considerable difficulty has been experienced in carrying out the requirements of the notices issued, chiefly on account of restrictions on the availability of building materials. It will be recalled that in January, 1946, the Ministry of Works announced the continuance of licensing, limiting unlicensed work to the value of £10, plus a further amount of £2 per month. The effect of this was to curtail very considerably the normal maintenance work carried out by owners. The position was aggravated by a further announcement in April, 1946, of a priority scheme for the allocation of building materials. In this scheme, priority was given to work which made additional housing accommodation available. The immediate effect was to stop repair work completely, although this was partly rectified by Ministry of Health Circular 100/46 which provided for certificates in respect of the following:— Sanitary breakdown: Repairs to avoid collapse: Work required by Statutory Notice. This list was extended by Circular 138/46, in June, to include Repair of gas and other fittings: Repair of drains and sewers. In September, 1946, local authorities received Ministry of Health Circular 171/46, which stated (inter alia) that "the Minister is aware that there is a huge pent-up demand for repairs and improvements in existing dwellings. But this demand in the immediate future can be met only at the expense of seriously impeding the construction of new houses. The policy is clear that new houses must come first. Repairs to existing houses, badly needed though it be, must be deferred." Nevertheless it became necessary to apply more extensively than in any other year, the Corporation's powers to carry out work in owners' default, and reference to the housing statistics included in 23 this report will give clear indication of the immensity of this section of the department's activities. Public Health Act, 1936, Section 94. Having regard to representations made by the Corporation to the Minister of Town and Country Planning, that certain areas should be scheduled as "Declaratory Areas," it was thought advisable to deal with certain properties under the nuisance section of the Public Health Act, rather than as insanitary houses capable of repair at reasonable cost. Inspections Carried out by the Sanitary Inspectors, and Defects, etc., Remedied. House-to-House Inspections Nil Infectious Disease 490 Complaints investigated 6,164 Re-inspections 7,081 Factories 252 Workplaces 48 Dairies, etc. 92 Slaughter-houses 16 Bakehouses 81 Public House Urinals 97 Stables and Mews 52 Fruiterers, etc. 87 Fish Shops 89 Butchers Shops 180 Other Food Premises 405 Drains Tested 351 Drains Defective 240 Small Dwellings Acquisition Acts 15 Appointments and Interviews, 833 Other visits 1,979 Drains reconstructed 49 Drains repaired 267 Drains cleared 224 W. C. Cisterns repaired or renewed 336 W. C. Pans renewed 287 W. C. Pans cleansed 71 Waste Pipes repaired or renewed 288 24 Rain-water Pipes repaired or renewed 538 Roofs repaired or renewed 1,884 Eaves Gutters repaired or renewed 921 Drinking Water Cisterns renewed 63 Drinking Water Cisterns covered 14 Water Service Pipes repaired 146 Water Supply reinstated 55 Yards repaired or reconstructed 181 Sinks renewed or provided 143 Floors repaired or renewed 957 Floors ventilated 370 Dampness remedied— by insertion of damp-proof courses 311 by pointing of brickwork 150 by internal rendering 713 by miscellaneous remedies 44-1,218 Window Frames and Sashes repaired or renewed, or repainted 1,064 Coppers repaired or renewed, or provided 101 Fireplaces, Stoves and Ovens repaired or renewed 750 Flues and Chimney Stacks repaired 252 Brickwork of Walls repaired and Walls rebuilt 200 Ventilated Food Stores provided 17 Rooms cleansed 3,306 Staircases, Passages and Landings cleansed 395 Stairs, Balconies and Steps repaired or renewed 156 Noxious Accumulations removed 33 Nuisances arising from Animals abated 9 Miscellaneous Defects remedied 1,469 Wall Plaster repaired 791 Ceiling Plaster repaired 647 25 Notices Served. Informal 4,111 Statutory— Housing Act, 1936, Section 9 969 Public Health Art, 1936:— Section 39 63 Section 24 15 Section 94 45 Section 45 9 Section 83 4 Section 84 1 Section 56 1 Section 79 5 Tottenham Urban District Council Act, 1900, Section 48 1 Total 1,113 Repair of Houses by the Council. £ s. d. Work carried out in default and by agreement in respect of orders given to builders in 1946:— Section 9, Housing Act,* 1936—152 premises 7,329 16 8 Section 39, Public Health Act, 1936—37 premises 902 4 5 Section 94, Public Health Act, 1936—32 premises 877 11 11 Section 56, Public Health Act, 1936—1 premises 7 4 10 Section 79, Public Health Act, 1936—5 premises 1 18 2 Section 275, Public Health Act, 1936—5 premises 65 18 8 Work carried out for maintenance of Public Sewers (Section 24, Public Health Act, 1936) —17 premises 313 12 8 £9,498 7 4 Housing Lettings. The investigation and allocation of all housing applications continued to be the responsibility of the Public Health Department. 26 Temporary Houses. The Council's programme of 315 temporary houses was completed during the year, and a full report of the method of investigation and the scheme of allocation was included in my report for 1945. Permanent Houses. Work commenced on the Asplins Road and Allington House permanent housing sites, and it therefore became necessary to consider the arrangements for allocating permanent houses. In framing a points scheme to assist them in allocating these dwellings, the Housing Committee had before them the following classification of the types of applicants on the housing application list:— (1) Families in houses scheduled for action under Sections 25 and 26, Housing Act, 1936, i.e., slum clearance. (2) Families rendered homeless by enemy action, including those temporarily rehoused in requisitioned properties; also evacuees from bombed houses. (Note:—Many of these families claimed a right to be permanently rehoused on the sites of their former homes.) (3) Families of war-time marriages, never having had homes of their own and. living with friends or relatives. (4) Families evacuated under Government schemes, who relinquished accommodation in Tottenham, and have been unable to find accommodation which would enable them to return to the district. (5) Families in rooms, living in overcrowded conditions. The Council decided that no special allowance should be made in a points scheme for applications from persons living in Slum Clearance areas under conditions which were not overcrowded. Such persons to be dealt with under the normal housing procedure in relation to slum clearance. Likewise the Council agreed that no special points allowance should be made in respect of applications from families living under satisfactory conditions in requisitioned properties, merely because they had lost their former homes through enemy bombing attacks. 27 The housing difficulties confronting families of war-time marriages were fully appreciated, . but it was remembered that special consideration had been given these applicants when the temporary houses were allocated. The Council decided that no special allowances could be made in the points scheme for these cases. With regard to families evacuated under Government Schemes, the Council were of opinion that considerable distress was being experienced by these families as a result of the separation of the husband from his wife and family, and they directed that a special points allowance should be made in such cases. Overcrowding was deemed to be the over-riding factor in assessing the merits of applicants for rehousing, and it was agreed to allocate points in accordance with the scheme for temporary houses. The Council finally decided on the following revised points scheme:— Max. points. Period of Residence 1 point per 2 years 5 Date of Application 1 point per year 10 Cleanliness 10 Rent Book 5 Present Accommodation No. of rooms 0 1 2 3 4 30 Points 30 24 18 6 0 Persons in Family (excl. husband and wife) Each person over 10 years 6 Each person under 10 years 3 Evacuation Points for families separated by reason of Government Evacuation Scheme 10 Service in H.M. Forces 1 point per completed year of service 6 Overcrowding Points to be assessed after visiting; taking into consideration physical incapacity, illness, and psychological difficulties 30 28 In October, 1946, a careful examination of all housing applications was made by the department, and applicants were placed in categories according to the type of accommodation required. The following summary shows the housing needs of the borough at that time:— Families. Category A.—(Married couples only) Two-bedroomed house rerequired 1,569 Category B.—(Married couples with not more than 2 children). Two-bedroomed house required 3,157 Category C.—(Married couples with 2*, 3, or 4 children). Three-bedroomed house required 757 (*=children of opposite sexes.) Category D.—(Families with 4 or more children). Four-bedroomed house required 173 Category X.—(Old age pensioners). One-bedroomed flat required 63 Applicants not complying with the residential qualification 1,405 Applications still under consideration 600 Total 7,724 The Council then had to decide which particular category should be dealt with first, and in considering this question they were bound to take cognizance of the fact that the accommodation to be provided in the first local housing schemes consisted mainly of dwellings of not less than three bedrooms, apart from the onebedroomed flats for old age pensioners. It was accordingly agreed to apply the points scheme in the first instance to families in Categories (C) and (D), and investigations and interviews by the Lettings Committee commenced in the last quarter of the year. Requisitioned Properties and Vacancies occurring on the existing housing estates. The limited number of requisitioned properties becoming available during the year, and a few re-lets on the existing housing estates, were also dealt with by the Public Health Department. In selecting tenants for requisitioned properties, special consideration in a few instances was given to families evicted from their present 29 accommodation as a result of County Court Orders, usually on account of the owner requiring the house for his own occupation and proving greater hardship. These cases, however, became so numerous, that eventually nothing more than temporary "half-way house" accommodation could be offered; and this quickly filled up, leaving a considerable number of families left to their own devices to find shelter wherever they could—generally with a sympathetic friend or relative. Disinfestation in connection with Housing. The policy of the Corporation to arrange for the disinfestation treatment of household articles before removal to new premises, has been maintained. In the early part of the year this work was carried out by a private firm of fumigators, using hydrocyanic acid gas, at a local hall requisitioned by the Council for the purpose of storing furniture belonging to families rendered homeless during the war. The complete household goods and furniture were collected by the Council's vans and deposited in an air-tight room at the hall for fumigation the same day, several "lots" being treated at one operation. Delivery to the new house was arranged the following day, together with beds and bedding which had previously been disinfected in the steam disinfector at the Council's Cleansing Station. This procedure proved satisfactory, but eventually the hall in question was de-requisitioned and other arrangements had to be made. Accordingly an agreement was reached with the Hackney Borough Council for the disinfestation treatment to be carried out in the cyanide chamber at the disinfesting station in their Borough, the Tottenham Council providing the necessary transport, and this arrangement continues. It would be, however, more convenient if these facilities were available within the borough, and it is the Council's intention to provide a Cleansing Station adequate for this purpose as soon as circumstances permit. Disinfestation of dwelling-houses is carried out by the use of D.D.T., and the results justify the hopes expressed in last years annual report. Rodent Control. Considerable advance in rodent control was accomplished during the year by the implementation of Ministry of Food Circular N. S. 12, dealing with a special scheme for the treatment of private dwellings. 30 In this Circular, the Ministry stated that they were prepared to make a grant of 60 per cent. of the cost of rodent control at private dwellings, where certain conditions of operation were observed. The Council agreed to participate in this scheme, and a detailed plan for the systematic treatment of the entire district, using the poisoning and baiting methods recommended by the Ministry, was immediately submitted to them for approval. The Council's proposals were accepted by the Ministry, and the treatment which commenced in October, was carried out by operators in teams of two, under the supervision of selected sanitary inspectors. The Borough was divided into small workable areas, which could be covered in the period of a week; a full week being necessary for pre-baiting, poison baiting, and the reading of poison baits. All types of premises were treated—private dwellings, shops and factories—but in the case of business premises, a charge was made. Operation. Before treatment was commenced in any area, a letter-questionnaire was delivered to the houses. This was collected two days after delivery, and any necessary treatment commenced the following week. In this way the campaign was based on actual information provided. The "points" baited included drains or sewers serving the houses (this being distinct from the main sewers in the roadways), and is known as block control. A maintenance treatment of the public sewers was also carried out in conjunction with the block control system. Results. The area covered up to the end of the year commenced with the London, Midland and Scottish Railway at South Tottenham, and extended northwards as far as the Edmonton boundary and eastwards from the High Road to the London and North Eastern Railway. From thence southwards to Lordship Lane and bounded on the east by the High Road, and on the west progressively by the Council's Housing Estate, Tottenham Cemetery and Bruce Castle Park. In this area, a total of 7,398 houses were circularised, and rats were indicated in 1,002 instances. Total Number of Baiting Points. Dwelling-houses 1,843 points. Factories, etc. 769 points. Total 2,612 Estimated Rats Killed. Dwelling-houses 5,620 Factories, etc. 4,920 Total 10,540 31 As an example of what has been done, I quote the case of a Knacker's Yard, and also the railway embankment surrounding these premises. Here, 92 points were poison baited on the Knacker's Yard premises, with an estimated kill of 1,485 rats. The operators were in fact shovelling the dead rats into sacks. 240 points were also poison baited on the railway embankment, and a kill of 1,590 was estimated. In addition to the block control scheme, two further maintenance treatments of the Corporation sewers were also carried out, making the fourth and fifth since the first treatment in 1943; the 5th treatment running concurrently with the block control scheme as previously stated. Table Showing Number of Treatments. Fourth Treatment. Fifth Treatment. Number of manholes with small poison takes 139 272 Number of manholes with good poison takes 100 196 Number of manholes with complete poison takes 152 2 Number of manholes with no poison take 327 559 Number of manholes not poison-baited 395 84 Totals 1,113 1,113 Estimated number of rats killed 3,926 2,580 Dwelling-houses and Business Premises. Number of dwelling-houses treated, apart from the special scheme 554 Number of business premises treated, where a charge was made (including special scheme) 53 Total charges for business premises £37 6s. 4d. Food Premises. The inspection and control of food premises used for the purpose of sale and manufacture, etc., of foodstuffs, has been carried out with the utmost diligence. There are now numerous small cafes and restaurants in the Borough, and it must be admitted that many of them are not in all respects suitable for this purpose. Regular inspections are an important feature in the control of these premises, and a large measure of improvement in conditions has been brought about by informal action. The shortage of building labour and materials is having its effect on the work of the department in dealing with Dairies. It is realised that the resources of the building industry are fully engaged in its many phases of providing additional housing accommodation, and therefore we must needs curb our impatience before any large scale improvements can be carried out to bring dairy premises up to the desired state of perfection. 32 The Middlesex County Council continue to be the responsible authority for dealing with adulteration, etc., and their sampling officers are actively engaged in this work; but it is a matter of regret for purpose of continuity, that these duties are not made the responsibility of the Corporation. One prosecution for selling milk in dirty bottles was taken by the Corporation, without success, and this has served to strengthen the view that amendments in existing legislation are necessary. Milk (Special Designations) Orders, 1936 and 1938. Licences granted:— Pasteurised Milk:— Pasteurisers' Licences 4 Dealers' Licences 17 Supplementary Licences 3 Tuberculin Tested Milk:— Bottlers' Licences 1 Dealers' Licences 11 Supplementary Licences 3 SHOPS ACTS, 1912-1938. In the administration of the Shops Acts, 4,229 inspections were made by the Shops Inspectors. Most contraventions reported have been minor defaults such as non-exhibition of statutory notices and records of young persons hours of employment, in respect of which 142 verbal warnings and notices have been issued. By means of systematic visitation of shops throughout the Borough, effective administration is secured, and the necessary information obtained for the purpose of keeping up-to-date a register of all shops in the Borough. 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, subject to the alternative day (Saturday) in all cases. 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 early closing orders made thereunder are duly complied with. In connection with half-holiday closing 230 visits were made 33 Half Holiday for Shop Assistants. Every shop assistant in every class of shop must be allowed a half-holiday once a week commencing not later than 1.30 p.m. The rule applies whether a shop is required to be closed for a weekly half-holiday or not. Meal Times. Dinner.— If the hours of employment include the hours from 11.30 a.m. to 2.30 p.m., each assistant must be allowed an interval of three-quarters of an hour within that time if the meal is taken on the premises, or an interval of a full hour within that time if the meal is taken off the premises. Tea.—If the hours of employment include the hours from 4 p.m. to 7 p.m., each assistant must be allowed an interval of half-an-hour within that time. No assistant shall be employed for more than six hours (five hours if under 18) without an interval of at least 20 minutes being allowed during the course thereof. Shops Act, 1934, and Young Persons Employment Act, 1936. Regular investigations and inspections were made in connection with these Acts, and it has been ascertained that the conditions of employment have improved, both as to hours of employment of young persons, and the arrangements made for the health and comfort of shop workers generally. Many complaints were received of assistants suffering severely from cold during the restrictions on heating of shops last winter, which caused a good deal of absenteeism. 462 special visits were made in connection with the enforcement of these Acts. Shops (Sunday Trading Restriction) Act, 1936. The provisions of this Act are effectively carried out by means of systematic investigations and observations. It is satisfactory to note that shopkeepers appreciate having a day's rest each week, and very few shops now open on Sundays in Tottenham. 34 THE EDUCATION COMMITTEE. Chairman: Alderman J. H. Morrell, J. P. Members: Alderman E. J. Field, J. P. Councillor C. H. Gill. „ Mrs. M. C. Irving, J. P. „ Mrs. A. Kitchener. „ Mrs. J. D. Lynch. „ A. Reed, A.C.I.I.,J.P. Councillor S. Booley. „ A. Clark. „ A. J. Davies. „ T. J. Dickenson. „ R. W. H. Ford (Chairman Special and Social Service Sub-Committee). Mrs. J. Brill. Mr. F. Marshall. Mr. M. A. Amias. Mr. A. L. Youngs, B.Sc. County Councillor Mrs. A. L. Hollingsworth, J.P. „ Mrs. Q. V. Jacobs. „ F. A. F. Keay, J.P. „ Mrs. A. E. Lyons. „ Mrs. E. M. A. Morrell. „ The Lady Morrison. „ A. A. Pawson. „ Mrs. A. F. Remington. „ W. T. Richards. Borough Education Officer: C. F. Strong, M.A., Ph.D. School Medical Officer: G. Hamilton Hogben. M.R.C.S.. D P H SCHOOL HEALTH SERVICE CLINICS Clinic. Address. Monday. Tuesday. Wednesday. Thursday. Friday. Saturday. † 1. Minor Ailments Lordship Lane 1.30 p.m. - 1.30 p.m. - 1.30 p.m. — Park Lane - 9.0 a. m. - 9.0 a.m. — 9.0 a.m. Cornwall Road 1.30 p.m. — 1.30 p.m. — 1.30 p.m. — * 2. Dental (A= anaesthetic Sessions). Lordship Lane 9-12 noon. 9-12 noon. 9-12 noon. 9-12 noon. 9-12 noon. - Park Lane Chestnuts (St. Ann's Road). 2-4.30 p.m. 2-4.30 p.m. 2-4.30 p.m. 2-4.30 p.m. 2-4.30 p.m. - Town Hall * 3. Ophthalmic Lordship Lane - 9 a. m. and 1.30 p.m. Alternate Tuesdays. 9 a.m. and 1.30 p.m. — — — * 4. Aural Park Lane — — 2.0 p.m. — 9.0 a.m. — * 5. Orthopaedic Lordship Lane Once monthly. 10.0 a. m. — — — — — * 6. Remedial Exercises Lordship Lane 9 a. m. and 2 p. m. 9 a. m. and 2.0 p.m. 9 a.m. and 9 a.m Vale Road 2 p.m. 9 a. m. 2 p. m. 9 a.m. 2 p.m. - * 7. Speech Therapy Lordship Lane 2.0 p.m. 9.30 a.m. — 9.30 a.m. and 2.0 p.m. — — Park Lane 9.30 a.m. - - 2.0 p.m. — Cornwall Road — 2.0 p.m. — — 9.30 a. m. — * 8. Rheumatism Lordship Lane — 2.0 p.m. monthly. — — — * 9. Nutrition Lordship Lane as necessary by appointment. Park Lane 10. Immunisation Lordship Lane - - 2.0 p.m. - - - ParkLane - - - - - - Cornwall Road 2.0 p.m. - - - - - Town Hall - 2.0 p.m. - - — — * Attendance at the Specialist Clinics is by appointment only. † For attendance at the Minor Ailments Clinics children must obtain a clinic card from the Head Teacher, Attendance Officer or Health Visitor. The Minor Ailments Clinics are open throughout the school holidays. 35 SCHOOL MEDICAL AND DENTAL STAFF. Table VII.—School Medical and Dental Staff. Proportion of whole time devoted to Name of Officer. School Medical Service. Public Health. School Medical Officer:— trative - Dr. G. Hamilton Hogben Deputy School Medical Officer:— Dr. B. Broadbent l/6th 5/6ths Senior Assistant Medical Officer:— Dr. S. Leff Whole time — Assistant School Medical Officers:— Dr. Nora A. M. Webster Whole time Senior Dentist:—V. Sainty, L. D.S. Dentists:— A. E. Fisher, B.D.S. Miss C. M. Dixon, L. D. S. Miss E. M. McRaith, L.D.S, Note.—2/3rds of the services of one Dental Unit is apportioned to The Maternity and Child Welfare Committee. 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. 36 ROUTINE MEDICAL INSPECTION. Table I.—Medical Inspections of Children attending Primary and Secondary Schools—Year ended 31st December, 1946. A.—Routine Medical Inspections. (1) No. of routine Inspections aocording to age groups:— Entrants 2,342 Second Age Group 1,979 Third Age Group 1,264 Total 5,585 (2) No. of other Routine Inspections (leavers) 817 Grand Total 6,402 B.—Other Inspections. No. of "Specials" and Re-Inspections 26,039. 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 5,624 Group II.—Treatment of Defective Vision and Squint. Under the Authority's Scheme. Errors of Refraction (including Squint) 1,096 Other defects or diseases of the eyes (excluding those recorded in Group I) 23 Total 1,119 No. of Children for whom spectacles were: Under the Authority's Scheme. (a) Prescribed 796 (b) Obtained 791 Table II.—Classification of the Nutrition of Children Inspected during the year under review in the routine age groups . Inspections. A. (Excellent). B. (Normal). C. (Slightly Sub-Normal). D. (Bad). No. % No. % No. % No. % 5,585 307 5.5 4,918 88.0 351 6.3 9 0.2 37 Group III.—Treatment of Defects of Nose and Throat. Under the Authority's Scheme. Received Operative Treatment 89 Received other forms of treatment 553 Total number treated 642 Table IV.—Dental Inspection and Treatment. (1) No. of children inspected by Dentist:— (a) Routine Age Groups 14.935 (b) Specials 1,166 (c) Total (Routine and Specials) 16,101 (2) No. found to require treatment 9,501 (3) No. actually treated 5,675 (4) Attendances made by Children for treatment 9,972 (5) Half days devoted to:— Inspection 87 Treatment 1,235 Total 1,322 (6) Fillings:— Permanent Teeth 3,248 Temporary Teeth 1,524 Total 4,772 (7) Extractions:— Permanent Teeth 806 Temporary Teeth 5,104 Total. 5,910 (8) Administrations of general Anaesthetics for Extractions 726 (9) Other Operations:— Permanent Teeth 1,051 Temporary Teeth 1,669 Total 2,720 Table V.—Verminous Conditions. (1) Total number of examinations of children in the Schools by School Nurses or other authorised persons 45,052 (2) No. of individual children found unclean 1,734 38 SCHOOL HEALTH SERVICE. Co-ordination. The aim has been to secure, within the bounds of existing administrative machinery, a continuity in care of children from birth to school leaving age. Co-ordination of effort has been made possible in recent years by interchangeability of staff in the school health and maternity and child welfare services. Associated public and voluntary agencies have co-operated well with the Department, as also teachers and parents. Special mention must be made of the close co-operation between the School Health Service and the Invalid Children's Aid Association providing convalescent treatment for handicapped pupils; and to the National Society for the Prevention of Cruelty to Children in dealing with the problem families. A close link has been maintained with the Juvenile Employment Officer in the task of placing school leavers in suitable occupations. Nutrition. It is significant that again this year I am able to report no evidence of adverse nutritional standards of children examined at routine medical inspections. A factor contributing to this is the increasing use made by parents for their children of mid-day meals and milk in schools. Figures showing the number of children participating are shown elsewhere in this Report. A Table is appended showing the nutritional standard of children revealed by routine medical inspection, and representing a crosssection of the school population:— Standards of Nutrition.—See page 36, Table II. 39 School Meals and Milk. I am indebted to the Borough Education Officer for the following details with respect to meals and milk supplied in school:— Report on School Meals and Milk for the Year ended 31st December, 1946. During the twelve months 1st January, 1946 to 31st December, 1946, 1,332.304 school meals were served, an increase of 265,707 meals over the previous year. The Education Committee have now two additional Nursery Schools, formerly used for War-time Day Nurseries, Rowland Hill and Pembury House, housed in pre-fabricated buildings taken over from the Maternity and Child Welfare Committee, and some 65 children are catered for in each nursery daily. In September the first complete pre-fabricated kitchen-dining room was opened at St. Ignatius' College. This was designed to feed 375 boys, but has, from its opening date, fed 550 per day. In December the High Cross British Restaurant closed and the School for the Deaf has now regained possession of the school hall, which is also used for dining, and has its own small self-contained kitchen as before the war. Since August, 1946, milk became free to all children, but at the present time only one-third of a pint per child is allowed each day and this has had the following effect: In October, 1945, there were present in Secondary School 4,998 children, of whom 2,414 had milk (48.5%), but of these 596 had two-thirds of a pint. In the same month there were present in Primary Schools, 9,169 children, of whom 7,376 had milk (80.0%) but of these 5,649 had two-thirds of a pint. In October, 1946, there were present in Secondary Schools 5,542 children, of whom 4,968 had milk (89.7%), but none of these had two-thirds of a pint. In the same month there were present in Primary Schools 9,236 children, of whom 9,006 had milk (97.5%), but none of these had two-thirds of a pint. In other words, more children are now taking milk, but for approximately 6,300 children the amount of milk consumed daily has been reduced from two-thirds to one-third of a pint. 40 The most recent return to the Ministry of Education shows that dinner in school is taken by 65.7% of the children in secondary schools. 49.2% of the children in primary schools. 100% of the children in nursery schools. 100% of the children in special schools. and milk in school is taken by 89.6% of the children in secondary schools. 97.5% of the children in primary schools. 100% of the children in nursery schools. 100% of the children in special schools. Physical Education in Schools. I am indebted also to the Borough Education Officer for the following particulars of progress made in the Department of Physical Education. Organisation. In spite of the many post-war restrictions on reconstruction and re-planning, it is re-assuring to be able to record signs of improvement in the development of Physical Education during the year. Most of the teachers under the Authority who served in H.M. Forces have now returned to its service. In addition there have been several new appointments of qualified women to the Secondary Modern Schools, resulting in improved work in those schools. The appointment of ex-service men and women, newly trained under the emergency training scheme, has raised the staffing strength of the Primary Schools, though not all of these new teachers have had as much training in this branch of teaching as we might hope. The Secondary Grammar and Modern Schools, with their fully equipped gymnasia and suitably qualified teachers, have made progress and in some cases experimental work is being carried out. Unfortunately the gymnasia at Crowland and Down Lane are still out of use owing to War Damage, but it is hoped that this position will be remedied in the near future. Equipment and Clothing. There has been a continued improvement in the supply of small apparatus. The supply of gymnastic shoes, though still subject to coupon restrictions, has also improved, with the result that the Secondary Schools are now fully supplied, while the Primary Schools have received some supplies and it is hoped to bring their allocation up to 100% during the coming year. 41 The question of storage of shoes on the school premises is an urgent problem and it is hoped to supply cabinets of wire cages for this purpose in the near future. Because of the shortage of textiles, it has not been possible to supply physical training and games clothing this year, but arrangements have been made to receive first supplies early in 1947. The lack of towels also is still a serious handicap in making full use of the shower baths, and because of the prevailing conditions it is unlikely to show any immediate change. Swimming. It is pleasing to record increased enthusiasm for swimming. This is due in some measure to the inauguration of a scheme of transport for the children of those schools most distant from the Central Baths. It is hoped further to develop this service and so to obtain an increased attendance at the Lido during the summer months. It is still impossible, however, to accommodate more than a small percentage of school children at the Baths, and the need for increased facilities for instruction is vital to the full development of this important branch of the work. The year 1946 has seen the introduction of Middlesex Swimming Certificates. These are of three grades, elementary, intermediate and advanced, and together cover all branches of swimming, diving and life-saving. A very high standard in correctness of style and consequent ease of performance is demanded by the Examiners and possession of these certificates indicates real merit. Similar county certificates have been prepared for members of youth clubs. Organised Games. Organised Games are still seriously curtailed through lack of suitable playing space, the only fields available during the year being those at Queen Street, at Lordship Lane, at the Marshes, and the High School. This amounts in all to no more than 30 acres for a school population of about 16,000. Hence only a small proportion of children can play on grass, and consequently the grass space available is seriously overworked. Girls' games in particular have suffered, as most of the available space is marked and maintained for football and cricket. Nevertheless, the Parks Department is doing its utmost to bring back to normal use those parks and recreation grounds which have 42 been used for growing food, but it will clearly be some considerable time yet before they are fit for regular use as school games pitches. School playgrounds have also suffered heavily. Lack of manpower and materials for repair have resulted in very poor surfaces but in spite of this serious drawback, netball has been continued in the Secondary Schools and, indeed, started in most of the Primary Schools. It is hoped to arrange for the girls in the Secondary Modern Schools to play tennis in the near future, and with this in view it is proposed to support a coaching scheme sponsored by the Lawn Tennis Association. Classes will be held for teachers in the coaching and teaching of lawn tennis, at various Centres in the County. Recreative Physical Training. Classes in Gymnastics, Keep-Fit, Dancing, Boxing, Weightlifting, Life-saving and Games Training have been maintained in Youth Centres and Clubs, and at the Technical College. A Youth Netball League was completed despite much inclement weather, as were the Youth Cricket and Football Competitions. Two rehabilitation Keep-Fit Classes for older women have had considerable success and it would appear that there is a growing demand for this type of class, those already in existence being much appreciated by the members. A recreative class for men and women of the Tottenham Blind Society is under consideration. A renewed interest in Dancing has been a feature of 1946. Courses of training for teachers in European National Dancing have been held and it is hoped during the coming year to encourage still further the interest shown in Dancing. Special Day Schools for Handicapped Children. (a) Oak Lodge School, Finchley. This school continues to provide accommodation for Mentally Defective Children on the certificate of the School Medical Officer. The number of children on the register in 1946 was 64 (41 boys and 23 girls). 8 boys and 8 girls were admitted, and 5 boys and 7 girls left during the year. (b) Vale Road School for Physically Handicapped Children. The number of pupils in attendance at this school during 1946 was 87 (45 boys and 42 girls), their ages ranging from 5 to 16 years. 43 During the year 14 boys and 13 girls were admitted. Of these 11 came from neighbouring boroughs. (c) School for Partially-Sighted Children, Walthamstow. The number of pupils in attendance during 1946 was 13. During the year 4 pupils were admitted and 2 left. (d) Tottenham School for the Deaf. The Tottenham School for the Deaf serves all parts of Middlesex as well as parts of Hertfordshire and Essex. Arrangements are made for certain groups to travel in charge of guides, other pupils being brought to school by ambulance. In certain cases, older children travel independently. The number of pupils registered at December 31st, 1945 was 59. During the year 1946 13 new pupils were registered and 4 left. Residential Special Schools. Children certified by the School Medical Officer as in need of special educational treatment in residential schools have been registered at the following schools: Mentally Defective—Nil. Blind—Nil. Deaf—Nil. Epileptic—Lingfield Epileptic Colony: 2 boys. Physically Handicapped. Boys. Girls. R. N. Orthopaedic Hospital, Stanmore 9 1 St. John's Open Air School, Woodford Bridge 9 — St. John's Home, Brighton — 1 St. Dominic's Home, Godalming 1 — Collington Manor, Bexhill-on-Sea 1 — Children's Heart Home, Lancing 2 1 Children's Heart Home, West Wickham 1 — St. Patrick's Open Air School, Hayling — 3 Oak Bank, Sevenoaks — 1 St. Vincent's Open Air School, St. Leonards — 2 Victoria Home, Margate — 3 Queen Mary's Hospital, Carshalton — 1 Halliwick Cripples Home, Winchmore Hill — 1 — — Totals 23 14 - - 44 Convalescent Camp Schools. The number of children recommended by the School Medical Officer as in need of short-term treatment during the year 1946 totalled 48, and arrangements were made for 32 of these children as follows:— Boys. Girls. West Mark School, Petersfield, Hants 12 8 Lords Field School, Overton, Hants 7 5 - - Totals 19 13 - - Invalid Children's Aid Association. The Association arranged during the year 1946, for 54 boys and 78 girls to receive Convalescent Home treatment. Mental Deficiency Act (Statutory Notification). During the year 1946, 3 boys and 7 girls have been notified to the Statutory Authority under the Mental Deficiency Act. Transport. At all Special Day Schools transport is provided and the children are in charge of a guide. Artificial Sunlight. Treatment by mercury vapour lamps at two health centres in the district is popular among parents. Suitable cases for this form of treatment are carefully selected and afterwards supervised by the school health service staff. As a therapeutic measure the value of ultra-violet light treatment is difficult to assess accurately. Immunisation. In the Public Health section of this Report reference is made to the increasing effort made during the past year to ensure that children are protected against diphtheria before and during school age. The co-operation of parents and teachers has been willingly given. While no decision has yet been reached as to the comparable value of immunisation against whooping cough, controlled experiment with voluntary co-operation of parents has been undertaken during the year in association with the Medical Research Council. 45 Ear, Nose, and Throat Clinic. I am indebted to Dr. F. P. M. Clarke for the following report on the work of the Ear, Nose and Throat Department:— During the year 1946, the usual two ear, nose and throat sessions per week were held at the Municipal Medical Centre, Park Lane. The usual smooth-working conditions of the clinic as operated in pre-war years, and to an unavoidable extent interrupted and disorganised during the war years, were steadily being restored. The regular attendance for treatment was improved, as the normal working of the schools, which considerably influences attendances, was able to resume its former regular routine. The resumption of the usual pre-war regular school medical inspections was also a very important factor in locating any defects or diseases of the ear, nose and throat in the school population, and directing these for examination and treatment to the Aural Clinic. The total number of new cases seen during the year was 853. Of these 756 were school children and 97 pre-school. Of the total, a certain number, as is customary, did not require any special clinic treatment after examination. These cases are set out in the Table of Returns, "D". The attendance of 97 pre-school children—the great majority of whom required treatment for various ear, nose and throat conditions is very satisfactory, because this is a very important age-group in which to correct any ear, nose and throat defects. The correction of such conditions in this age-group materially affects the number of similar conditions to be found later in the early school-age classes. As we have noted in previous years, the majority of children seen at the clinic during the year were referred for "unhealthy" conditions of the nose and throat. The number of "ear"' cases in comparison was less than one to three; and the number of chronic discharging ears, which formerly constituted the main bulk of the clinic numbers, was exceedingly small for the population of this Borough. The early treatment of acute otorrhoea. (running ear), and nasal defects in particular, in the pre-school children, and the efficient treatment of the acute discharging ear in the school child, has materially reduced the "chronic running ear" amongst school children here. The quick and successful treatment of the acute "running" ear is so vitally important that we wish to emphasize again the success we have had with ear "suction" and Schering's Albucid solution, carried out at the clinic, always with the addition of 46 any nasal treatment required. Home treatment is unsatisfactory. It is rarely ever correctly done and this leads quickly to the condition of chronic otorrhoea which is the one important thing to avoid in effecting a speedy cure, with no lasting disability. The French method of Diastolisation has been extensively employed in various nasal conditions, and cases of deafness arising from nasal defects, with the success which we have been accustomed to expect of this interesting procedure. As in previous years we regularly employed zinc ionisation for treating chronic discharging ears, and we are able to say, from a wide experience over some years in dealing with these intractable cases, that there is no other method, so far, which can supersede or equal ionisation—given the correct technique—in rapidly and successfully curing chronic otorrhoea. Also the saving in time for both the patient and the clinic is very considerable. A very large number of children were found to have varying degrees of infection of the nasal sinuses. We have greatly extended the use of Proetz nasal "displacement'' in dealing with these nasal conditions and we find it a most valuable method. Again, the correct technique is most important, and we have found the more recent modifications, such as the Le Mee and Parkinson positions, a considerable improvement in suitable cases. We have used with much success a 5 to 10 per cent solution of Schering's Albucidasa ' 'replacement'' medium to wash out the sinuses. A number of children with "enlarged" or "unhealthy" tonsil were treated by "tonsil suction"—using a 5 to 10 per cent, solution of Albucid to cleanse the tonsil crypts. There is a considerable field of usefulness for this method. Special ear, nose and throat examinations were held at the School for the Deaf during the year and any cases found requiring clinic treatment were referred to the treatment clinics for their prescribed courses. Certain treatments, such as diastolisation, were carried out at the school by the clinic nurse who also attends to treatments at the Deaf School. Audiometer tests were carried out for the children suffering from hearing defects, attending the clinic. It was not possible to carry out a complete audiometric survey of all the school children, as has been done in pre-war years; for such a "survey'' to be correctly and usefully done entails a very considerable call on staff time, and in the existing circumstances, with the staff at its minimum, this 47 "total survey" must be temporarily postponed. Meanwhile, the audiometer testing of any children found with, or suspected of defective hearing, is being done and this in itself is a very considerable help. The general health and nutrition of the children seen at the clinics during the year was very satisfactory. The provision of school meals, milk, tonics, etc., has been a very valuable factor in maintaining the good general health of the school population. A classified Table of Returns is appended, setting out the various conditions found (with any accompanying-complications), the nature of the treatment given, and the results. We find such a comprehensive Table useful in comparing the different years' working of the clinics. Ophthalmic Clinic. Mr. T. W. Letchworth, M.D., F.R.C.S., reports as follows:— 1,978 children and young people were seen. Of this number 178 had left school, but were under the age of nineteen. Most of these were myopes. It will be possible henceforth to keep any who may desire it, under observation, with the help of the National Ophthalmic Treatment Board scheme, a centre for which is being established at Tottenham. 292 of the children were suffering from strabismus, and it is satisfactory that we can get these children early, before the school age, as the earlier we can treat them the more hope there is of cure. There is, unfortunately, one circumstance. The children are not taught the letters of the alphabet and many cannot name them till they are seven. This makes the recognition of amblyopia much more difficult, and results in many more eyes remaining amblyopic than would otherwise be the case. Another cause of this failure is the frequent neglect of the parents to attend when requested, or to carry out the instructions given. I believe under the new Act there will be increased difficulty in enforcing attendance when it is necessary. 48 In 110 less than 127 cases no defect was discovered or a defect so small as not to require correction. This was in some cases due to children being sent on account of headaches not caused by ocular defects, and in others to the difficulty of distinguishing a real squint from what was only an apparent one. In many young children there are conditions which cause an appearance of a squint, notably epicanthal folds, when the eyes are really straight. One can recognise a true convergent squint by getting the child to fix and then cover the good eye. The squinting eye will then turn inwards. In a child too young to co-operate one can only go by the light reflex on the cornea as seen through the retinoscopy mirror. In the squinting eye the position of this reflex will be displaced to the temporal side. One must again remember that many squints start as being only occasional. Therefore it is better that all children, in whom there is only a suspicion of a squint, should be seen. Cases suitable for orthoptic treatment are referred to the Prince of Wales's Hospital. Of the children seen 1,069 had errors of refraction. In 796 glasses were ordered and in 791 obtained. In the other cases glasses previously ordered were still satisfactory. Other conditions were:- Conjunctivitis 14 Tear of conjunctival Naevus 1 Cataract 2 Corneal nebulae 1 Detached retina 1 Ptosis 3 Corneal abrasion 1 Hordeola 3 Spring Catarrh . 1 Fitting or attention to artificial eye 5 Blepharitis 6 Optic Atrophy . 1 I saw no phlyctenular ulcers of the cornea which in 1912 caused so much damage to eyes and sight. No trachoma. Nor have I seen a case of xerosis of the conjunctiva with night blindness for about twenty-five years. All this testifies to the better nutrition of the children! 49 Dental Service. Mr. V. Sainty, L.D.S., Senior Dental Officer, reports:— "The Dental Service has been greatly improved by the opening in May of a new Dental Unit in the Annexe at the Town Hall, thus giving greater convenience to people living in the central part of the Borough. With four dental centres in daily operation and consequent reduction in the number of schools under the care of each dental officer, a more frequent routine inspection of the children's teeth is possible. In view of the raising of the school leaving age to fifteen, the reduction in the number of schools per dental officer will offset the effects of this larger school population, and it should be possible with existing staff to inspect all children at least once a year, unless there is an immediate extension of priority classes other than school children. Dental treatment extended to adolescents, coupled with extended provision for priority classes, will necessitate an increase in the number of dental officers and centres required in the future. There has been a noticeable improvement in the condition of pre-school and infants' teeth during the last few years, the numbers requiring multiple extraction of deciduous teeth being far less than some years ago. Whether this is due to a better balanced diet with increased milk consumption, or to the more controlled consumption of sweets due to rationing is a matter of opinion; probably it is due to both, plus a definite increase in the number of parents who realise the importance of regular dental treatment, thus ensuring the preservation of the temporary dentition for its full time, and subsequent avoidance of malocclusion caused by the early loss of the first teeth. Some years ago, owing to dental neglect and refusal to have conservative treatment, it was necessary to remove a large number of first permanent molars, very often all four from one mouth; now, what is known as extraction of ' 'four sixes'' is very rare indeed. A comparison between 1921 and 1946 is interesting:—In 1921, as the only dental officer in the Borough, I extracted 10,504 teeth; in 1946 the number of teeth removed by three dental officers was 5,000; the number of gas administrations was also down by more than half; whilst the number of fillings inserted in 1946 was more than three times the number in 1921 per dental officer. These figures show what a great improvement has been brought about in the 50 condition of the children's teeth during the last 25 years, by the regular apd increasing dental service provided in Tottenham." Orthopaedic Clinic. Attendances— Number of new cases dealt with during the year 206 Total number of children treated during the year 141 Total number of treatments during the year 1,665 Total number of children examined by Orthopaedic Surgeon this year 237 Schedule of New Defects. Congenital defects 31 Birth injuries 1 Rickety deformities 2 Knock-knees (non-rickety) 32 Postural defects of the spine 15 Structural curvature of the spine 13 Flat feet, footstrain, etc. 74 Infantile paralysis 1 Sequelae of acute fevers — Fractures and other injuries 4 T. B. Joints 2 Other bone or joint diseases (Non-T.B.) 1 Osteomyelitis — Other conditions including postural in-toeing 8 Non-Orthopaedic 10 N.A.D 18 Provision of Surgical Instruments. Surgical appliances were supplied and repairs and replacements effected in 45 instances. It is an encouraging sign that there is an increasing number of children with minor defects now being referred to the Orthopaedic Clinic, so that defects can be treated at an early and remediable stage. 51 I am indebted to Mr. J. A. Cholmeley, F.R.C.S., for the following report on the work of the Orthopaedic Clinic:— During the past year there have been certain changes and difficulties at the Orthopaedic Clinic. Mrs. Yorke, who had been the physiotherapist for several years, left, as she had an opportunity to do similar work nearer her home and for some while it was found impossible to get anyone to replace her. In the early part of the year a considerable increase in the number of surgeon's sessions at the orthopaedic clinic and the opening of additional clinics over the County made it quite impossible for me to carry out increased clinic work so that I had to discontinue my attendances at Tottenham and my work was taken over by Mr. J. I. P. James, M.S., F.R.C.S., in September. Examining the returns of the Clinic for the past five years it will be noted that apart from 1945 there has been a steady increase in the number of new cases examined each year; however, in 1946 there has been a decrease in the number of cases treated and the number of treatments given, almost certainly due to the time when there was no physiotherapist available. The detailed schedule of new defects shows an almost steady number of congenital abnormalities each year, but the number of cases of Flat Feet and Knock Knees has increased steadily. In the case of the former this is certainly in part at least due to the poor type of shoes, available for children, but in the case of the latter the increased number is probably due to the tendency when a specialist clinic is well established for minor degrees of deformity which will correct spontaneously to be referred for advice or treatment; the majority of these cases of Knock Knee are developmental, occur between the ages of 3 and 6 years and are non-rachitic. I am glad to note that the number of cases of postural defects of the spine has decreased, and this reflects the improvement in the physical training given in the schools. Ideally, the general school physical training should be supervised or carried out by teachers with a physical training diploma and such should be available in both the Primary and Secondary schools. 52 The Analysis of Orthopaedic Statistics for the past five years ie as follows:— ORTHOPAEDIC CLINIC. New Cases dealt with at Clinic during year. Total No. of children treated during year. Total No. of treatments during year. . Schedule of New Defects. * 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 N A D 1942. 136 235 2,945 25 — 4 16 14 3 56 3 — — 1 5 — 4 2 9 1943. 153 196 2,811 24 3 — 12 23 2 53 2 — 3 — 3 5 2 — 21 1944. 190 228 3,057 36 — 5 13 40 1 72 1 — 3 2 1 1 1 1 19 1945. 159 184 2,926 39 — 1 11 28 13 48 1 1 3 — — 2 1 5 12 1946. 206 141 1,665 31 1 2 32 15 13 74 1 — 4 2 1 — 8 10 18 *R.N.O.H. Code of defects. 53 Hospital Treatment. Tottenham is particularly well served with regard to Hospital treatment, having within its boundaries the Prince of Wales's General Hospital, and being within easy access of all main London teaching and specialist hospitals. Under the National Health Service Act, 1946, Tottenham will look to the North East Regional Hospital Board for the future provision of its hospital and specialist services. Speech Therapy. I am indebted to Mrs. R. L. Heineman, for the following report on the work of the Speech Therapy service during the year:— During the past year the Speech Therapist has been able to give considerable time to explaining the work of the clinics. The Speech Therapist had the opportunity of addressing the Head Teachers' Association, at a meeting which was open to assistant heads, and at which a lively discussion took place. Informal gatherings of teachers were also held during school hours. By addressing meetings of parents and teachers, it has been possible to gain the interest and understanding of a wider circle of parents than those whose children's speech is defective. An invitation was extended to all teachers to visit the Speech Clinic, and see how cases were treated. The greatest response to this was from teachers in Infants Schools, which, of course, have a relatively high proportion of children with Speech Defects. Attendance during the holidays naturally tends to be poor. To avoid this during the summer holidays a number of outings, such as picnics and visits to the Science Museum were arranged, and proved most successful. 54 Apart from the educational value to the children, the Speech Therapist found these outings of real assistance in learning more about the children, and gained valuable insight into their personal problems. Defect Total Cases dealt with Discharged. Still under treatment Cured Improved Non-Cooperation of parents Dyslalia 47 17 3 6 21 Lisp 23 11 — 6 6 Stammer 62 7 7 2 46 Cleft Palate 5 2 9 1 - Aphasia 1 — - — 1 Dysarthria 2 — — - 2 Totals 140 37 12 15 76 Children who failed to commence treatment:— (a) Non co-operation of parents 15 (ft) Domestic difficulties, i.e., too young to attend alone, and parents unable to accompany children 4 Reasons for "discharged improved": either leaving school or leaving the district. Minor Ailments Clinics. These sessions have become even more populous and popular than before, and have been run from three of our Municipal Medical Centres in such a way that at least one clinic has been in action on every weekday throughout the year (Bank Holidays excepted). Penicillin cream and tablets continued to show their value, but were not used to the exclusion of older remedies, nor as a panacea. Scabies notification, and treatment of families as a unit, have undoubtedly contributed towards the continued reduction in the numbers of new cases, but there continues to remain a doubt on the question of whether the re-infestations are not due to young factory workers who remain by far the most difficult section of our community to get and keep under control. However, the co-operation of health staff, and school teacher has ensured that none of the young children have reached a stage of severe secondary infection before receiving treatment, and it has not been found necessary to invoke the aid of the Scabies Order, 1940. Continued effort is made to take advantage of new developments in treatment for minor ailments, having Regard to the great wastage in time, which occurs from children suffering from minor ailments having to attend treatment centres. Development in the use of 55 penicillin, the sulphonamides, and D.D.T. continues and every effort is made by the use of these and other methods to hasten the recovery of children suffering from minor ailments, and so lessen the general economic burden which minor disabilities impose. Infectious Diseases. There was no serious outbreak of infectious disease during the year, and the co-operation of the teachers by notification of absenteeism due to non-notifiable infectious diseases, continues not only to be valuable, but to be an essential part of the control measures adopted with regard to infectious diseases. Rheumatism Clinic, 1946. Total attendances at Rheumatism Clinic 181 Number of new cases examined 71 Number of cases brought forward from 1945 17 Statistics relating to 71 new cases examined:— Tonsillectomy performed in 28 cases. Throat affection in 5 cases. Environmental Conditions Number of cases sharing a bed 18 Dampness in bedroom 12 Dampness elsewhere in house 26 Classification of Cases:— Albuminuria 1 Anaemia and Debility 3 Chorea 6 ? Congenital Heart 1 Functional Heart 5 Growing Pains 15 Mitral Stenosis 1 No specific defect 5 Post-chorea 3 Post-Rheumatic Fever 1 Rheumatic Heart 3 Rheumatism 5 Sub-acute Rheumatism 22 71 56 Treatment of Cases. School for Physically Handicapped Pupils 3 Convalescence 7 Admitted to Hospital at Clinic's request 1 Ultra-Violet Light Treatment 10 Medicinal Treatment 46 Referred to Sanitary Inspector 11 Referred to Dental Surgeon 4 Referred to Orthopaedic Clinic 2 Referred to E.N.T. Department 2 Referred to Housing Department 1 43 children were having dinners at school. 61 children were having milk at school. As can be seen from the above figures, this clinic has continued to do useful work in the course of the year in improving the prospects of children examined. Unfortunately it has had to remain an extra session for the Assistant School Medical Officer, and could not be as fully supervisory as we would have wished; but we have become even more convinced that if this could become a regular session, in charge of a Paediatrician, there is scope for a great increase in the help possible for such children. TOTTENHAM—E.N.T. CLINIC—1946; table "a" acute otitis media. SCHOOL CHILDREN. Diagnosis. Total (Ears). Tonsils and Adenoids. Treatment. Results. Zinc Ionisation. Antiseptic Treatment. Tonsils & Adenoids Treatment: Nasal Treatment, etc. Tonsils & Adenoids Operation. Cured. Improved. Still under Treatment or Observation. Left School or Treatment Lapsed. Referred to Hospital for Operation. Did not Attend or Declined Treatment. a b c d e f g H i j k l Acute Non-Suppurative Otitis Media 6 2 Operation before Clinic — 2 1 — 2 — — — - — 4 No Operation — 4 - - 4 — — — - — Acute Non-Suppurative Otitis Media with Nasal Conditions: Enlarged Tonsils and Adenoids. 13 1 Operation before Clinic — 1 1 — 1 — — — - — 12 No Operation — 11 6 - 11 — — — - 1 Acute Suppurative Otitis Media 41 (5) 12 Operation before Clinic 1 12 1 - 8 — — 2 2 — 29 No Operation 7 29 2 - 26 — 1 2 — — Acute Suppurative Otitis Media with Nasal conditions : Enlarged Tonsils and Adenoids 12 1 Operation before Clinic — 1 1 - - - - - - 1 11 No Operation — 11 7 1 10 — — 1 — 4 Totals 72 8 71 19 1 62 — 1 5 2 2 PRE-SCHOOL CHILDREN. Acute Non-Suppurative Otitis Media 1 (5) — Operation before Clinic - - - - - - - - - - 1 No Operation — 1 — - 1 — — — - — Acute Suppurative Otitis Media 13 1 Operation before Clinic — 1 — - — — 1 — - — 12 No Operation — 12 — — 12 — — — — — Acute Suppurative Otitis Media with Nasal Conditions : Enlarged Tonsils and Adenoids 2 — Operation before Clinic - - - - - - - — - - 2 No Operation — 2 2 - 1 — — 1 — — Totals 16 — 16 2 - 14 — 1 1 — — Grand Totals 88 8 87 21 1 76 - 2 6 2 2 *The figures in brackets indicate the number of cases with Bi-lateral Otorrhoea. TOTTENHAM—E.N.T. CLINIC—1946. TABLE "B" CHRONIC SUPPURATIVE OTITIS MEDIA. SCHOOLCHILDREN. Diagnosis. Totals (Ears). Diagnosis. Tonsils and Adenoids. Treatment. Results. Chronic Tympanic Sepsis, Complicated by:— Granulations: Simple Rolypi. Mastoid Disease. Enlarged Tonsils and Adenoids. Nasal Catarrh: Rhinitis: Sinusitis. External Otitis, Eczema. Primary (Ear). Collateral (Nose and Throat). Cured. Improved. Still under Treatment: Observation. Left School or Treatment Lapsed. Referred to Hospital for Operation. Did not attend or Declined Treatment. Old Operation. No Operation. Ionisation. Antiseptic Treatment. Cautery, etc. Mastoid Operation. Tonsils/Adenoids. Conservative Treatment. Nasal Treatm. Tonsils and Adenoids Operation. SCHOOL. A Granulations: Simple Polypi 6 (1) a B c d e f g h I J k l m n o p — — — — 1 - Operation before Clinic 1 1 - - - - - 1 - - - 3 2 — — — — No Operation 3 3 — - — 1 - - - 2 2 B Mastoid Disease 6 — 4 - — — — Operation before Clinic 3 4 — - — 3 - - - 1 — — 1 1 - — — No Operation 2 2 — - — 1 — - - 1 — C Enlarged Tonsils and Adenoids 1 - - - - - - Operation before Clinic - - - - - - - - - - - — — — 1 - — No Operation 1 — — 1 — 1 - - - — — D Nasal Catarrh: Rhinitis: Sinusitis 9 (1) — — — — 1 — Operation before Clinic 1 - - - - 1 - - - - - — — — — 8 — No Operation 6 1 — 6 — 6 — - 1 — 1 E External Otitis: Eczema — - - - - - - Operation before Clinic - - - - - - - - - - - - - - - - - No Operation - - - - - - - - - - - Chronic Suppurative Otitis Media, solely 37 (7) - - - - - 9 Operation before Clinic 7 2 — — — 8 — - - — 1 - - - - - 28 No Operation 25 2 — — — 24 — - 3 — 1 Totals (School) 59 3 7 1 1 10 - 49 15 — 7 — 45 — 1 4 4 5 PRE-SCHOOL CHILDREN. PRESCHOOL. Chronic Suppurative Otitis Media, solely. . 4 - - - - - — Operation before Clinic - - - - - - - - - - - - - - - - 4 No Operation 1 3 - — — 2 — 1 — — 1 Chronic Suppurative Otitis Media, with Nasal Conditions: Tonsils/Adenoids 3 - - - - - Operation before Clinic - - - - - - - - - - - — — — — 3 - No Operation — 3 — 3 — 2 — 1 — — — Totals 7 — — — — 3 — 1 6 — 3 — 4 — 2 — — 1 Grand Totals 66 3 7 1 1 13 - 50 21 — 10 — 49 — 3 4 4 | 6 *Figures in Brackets—Cases of Bi-Lateral Otorrhoea or Mastoid. TOTTENHAM—E.N.T. CLINIC—1946. TABLE "C" NOSE AND THROAT CONDITIONS. SCHOOL CHILDREN. Diagnosis. Totals. Tonsils and Adenoids. Secondary Conditions. Treatment. Results. Otitis Media. Deafness. Nasal Catarrh, etc. Enlarged Tonsils and Adenoids. Diastolisation. Antiseptic Treatment. Proetz Displacement. Tonsils and Adenoids. Cured. Improved. Still under Treatment or Observation. Left school or Treatment Lapsed. Referred Hospital for Operation. Did not attend or Declined Treatment. Conservative Treatment. Operative Treatment. Primary Conditions. a b c d e f g h i j K l m n o p q r Sinusitis: Rhinitis 54 Operation before Clinic 14 - 1 - — 7 14 12 - — 11 1 1 1 — — No Operation 40 1 2 - 8 10 20 31 7 — 19 6 7 6 1 1 Nasal Obstruction: Rhinitis 168 Operation before Clinic 23 - 1 - 1 17 6 2 — — 12 4 - 2 — 5 No Operation 145 7 10 - 23 74 63 2 14 — 79 7 1 23 1 34 Nasal Catarrh 192 Operation before Clinic 32 1 10 - — 25 4 — — — 29 — — 1 — 2 No Operation 160 2 20 - 16 93 48 — 7 — 96 10 — 22 1 31 Enlarged Tonsils and Adenoids 87 Operation before Clinic - - - - - - - - - - - - - - - - No Operation 87 1 4 12 — 2 10 — 46 — 19 3 2 19 33 11 Totals (school) 501 12 48 12 50 228 165 47 74 — 265 31 11 74 36 84 PRE-SCHOOL CHILDREN. Nasal Conditions: Sinusitis: Rhinitis. 45 Operation before Clinic 2 - - - - - 2 - - - 2 - - - - - No Operation 43 1 3 — 6 4 41 — 6 — 23 9 — 10 — 1 Enlarged Tonsils and Adenoids 12 Operation before Clinic - - - - - - - - - - - - - - - - No Operation 12 - - - - - - - 7 — 3 1 — 3 4 1 Enlarged Tonsils and Adenoids with Nasal Conditions Operation before Clinic - - - - - - - - - - - - - — — — No Operation 2 — — 2 - — 2 — 1 — 1 — - — — 1 Totals (Pre-school) 59 1 3 2 6 4 45 — 14 — 29 10 — 13 4 3 Grand Totals 560 13 51 14 56 232 210 — 88 — 294 41 11 87 40 87 TOTTENHAM—E.N.T. CLINIC—1946. TABLE "D"- MISCELLANEOUS. Examined for:— Affections of the ear, nose and throat: special cases of deafness for admission to special classes, or Deaf School: re-examination, observation of cases treated last year: colds and other conditions 118 Advised: recommendations and reports made. Clinic treatment not required. Epistaxis 6 Treated. Wax in the ear 5 Removed. Hay Fever 2 Zinc ionisation. Foreign Body in ear 1 Referred to hospital. Furuncle (boil in ear) 1 Treated. Boil in nostril 2 Treated. Eczema of the ear 1 Treated. Acute tonsillitis 3 Treated. Total 139 Of the above :— Tonsils and adenoids removed before attending clinic 23 Pre-school children 15 SUMMARY. Total number of cases seen in 1946 853 School 756 Pre-school 97 "A" "B" Ear Cases. School 131 Pre-school 23 "C" Nose and Throat. School 501 Pre-school 59 "D" Miscellaneous. School 124 Pre-school 15 MATERNITY AND CHILD WELFARE (December 31st, 1946). Committee: Chairman: Alderman Mrs. W. A. Kent. Vice-Chairman: Councillor Mrs. E. M. A. Morrell. Members: Alderman J. H. Morrell, J. P. Councillor F. A. F. Keay, J.P ,, A. Reed, A.C.I.I.,J.P. ,, Mrs. A. E. Lyons. ,, A. R. Turner. ,, W. T. Richards. Councillor T. J. Dickinson. ,, Mrs. A. F. Remington. ,, Mrs. L. R. Harrington. ,, Mrs. M. E. Soall. ,, Mrs. Q. V. Jacobs. ,, Mrs. G. Wilson. Executive Officer: G. Hamilton Hogben, M.R.C.S., D.P.H. Medical Officer of Health. 58 MATERNITY AND CHILD WELFARE SERVICE. Centre. Address. Monday. Tuesday. Wednesday. Thursday. Friday. Saturday. *1. Ante-Natal and Post-Natal. The Chestnuts, The Chestnuts Park, St. Ann's Road, N. 15. 9 a. m. and 2 p. m. — 9 a.m. and 2 p.m. 9 a.m. - — Lordship Lane Municipal Health Centre, N. 17. 9 a.m. and 2 p.m. 9 a.m. and 2 p.m. Park Lane Municipal Health Centre, N. 17 2 p .m. 2 p.m. 2 p.m. — *2. Gynaecological Park Lane Municipal Health Centre, N. 17 9 a.m. — — 3. Infant Welfare: D = Doctor.. W = Weighing only. The Chestnuts Centre — 2 p.m.—W 2 p. m.—W 2 p.m.—D 9 a. m.—D 2 p.m.—D — Lordship Lane Centre. 2 p. m.—D — 9 a. m.—D 2 p. m.—W 9 a. m.—W 2 p.m.—W — - Park Lane Centre - 2 p.m.—D 2 p.m.—D - — — Town Hall - — 2 p.m.—W - — - *4. Toddler The Chestnuts - - 9 a.m. - - - Lordship Lane - — — 2 p.m. — -— Park Lane - 9 a.m. - — — -— 5. Immunization. Town Hall - 2 p.m. - - - - Lordship Lane - - 2 p. m. - — — The Chestnuts 2 p.m. — — — — Park Lane — — - 2 p.m. — — 6. Sunlight. Park Lane 9 a.m. - - — 9 a.m. — *By appointment. N. B.—All specialist clinics of the School Health Service equally available to children under five years of age. Dental clinics of School Health Service available also to expectant and nursing mothers. Vitamins sold at the Infant Welfare Centres to holders of R.B.2 ration books, and at the Town Hall. Vitamins sold to expectant mothers only at the ante-natal clinics. 59 STATISTICAL INFORMATION. The population of the Borough as estimated by the RegistrarGeneral is 124,830 as compared with the pre-war estimated population of 144,400. Number of Registered Live Births:—Male 1,337 Female 1,243 2,580 Birth Rate (per 1,000 population) 20.67 Number of deaths under one year of age 88 Number of still births registered 88 Infantile Death Rate (per 1,000 live births) 34.11 Number of maternal deaths 4 Maternal Death Rate (per 1,000 total births) 1.499 CO-ORDINATION. The policy to co-ordinate as far as possible the work of the Maternity and Child Welfare Department with that of the Public Health and School Health Service has been well maintained. All the nursing staff, with the exception of the midwives is under the supervision of the Superintendent Health Visitor. Specialist clinics under the school health services are equally available to children under five years of age. The Dental Service makes full provision for the treatment of expectant and nursing mothers, including the provision, where necessary, of artificial dentures, and for children under five years of age, at each of the four municipal health centres. All records made in connection with the supervision of young children are transferred on reaching school age and incorporated in a common envelope with the school health records. During 1946 three Health Visitors of the Maternity and Child Welfare Committee transferred temporarily to the School Nursing Service for periods varying from 3 to 6 months to gain experience in that department. 60 HEALTH VISITORS. The Superintendent Health Visitor, Miss Blanchard, reports as follows:— At the beginning of the year there were seventeen Health Visitors and a Superintendent. During the year some Health Visitors left and others were appointed, the number at the end of the year remaining at 17. In April, 1946, Miss H. Townsend who had been seconded to the Ministry of Labour from August, 1940, returned to the department. Miss K. Drage, seconded to the Ministry of Health in January, 1942, was permanently appointed by the Ministry from May 1st, 1946, and left the service of this Borough. The Health visiting duties continued to be mainly concerned with the general care of nursing and expectant mothers, and children up to five years, including home visiting and clinic duties, and visiting of foster children and homes of applicants for adoption orders. Student Health Visitors of the National Health Society have continued to attend for practical training during the year, and many visits have been paid by pre and post-certificate students from the Royal College of Nursing. Women Public Health Officers Association, Hospital Almoners, and midwifery students have also come for instruction, as well as a large number of visitors from this and other countries. In April of 1946 the Health Visitors took part in a special enquiry undertaken by the Royal College of Obstetricians and Gynaecologists and Population Investigation Committee to enquire into certain social and economic aspects of motherhood in Britain. All mothers who had babies between March 3rd and 9th were asked to co-operate and to answer certain questions designed by the Committee of Enquiry. The number of enquiries was approximately 50 and all but two of the mothers were most helpful. This enquiry entailed a lot of work and took a good deal of the health visitors' time, but we hope that when the report is published it will be found that some useful information has been collected and that it will be helpful to the community. The department received, as always, very active assistance from Inspector Martin of the National Society for the Prevention of Cruelty to Children, the Invalid Children's Aid Association, and Almoners of various Hospitals. 61 Gifts of milk powder and chocolate-flavoured milk powder were received during the year from the Kinsmen's Clubs of Canada, being distributed by the W.V.S., to day and residential nurseries in this district. 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. 2,327 2,500 2,295 6,692 12,357 26,171 Other visits:—Infantile Deaths 37 Still Births 111 Ophthalmia Neonatorum 31 Pneumonia 42 Infectious Diseases 779 Public Health Act, 1936: Infant Life Protection 145 Adoption of Children (Regulation) Act, 1939 116 Special visits: Mothers 1,121 Children 299 Total 28,852 Dockets for Sheets—2,215 were given to expectant mothers. 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 live births for the year, i.e., 2,504. Breast fed 1,234 Part Breast fed, plus milk, dried milk or condensed milk 768 Bottle feeding— Cow's milk 20 Dried milk 305 Other Artificial Feeding 4 Feedings unknown: i.e., removals, evacuations and deaths 173 Total 2,504 62 Care of Illegitimate Children (Circular 2866). The co-operation between the Maternity and Child Welfare Department and the moral welfare worker has continued, and the number of mothers referred to her was 18. Babies who remained with the mother 40 Babies who were adopted 9 Babies who were fostered 4 Babies who died 3 Babies who were still-born 1 Unknown, as mother had left the district 2 Total 59 Referred to Moral Welfare Officer 18 Referred to other organisations 7 Other arrangements made 34 Total 59 Child Life Protection. The health visitors paid 145 visits as Infant Life Protection Visitors during the year to 35 foster mothers in respect of 36 foster children. The number remaining on the register at the end of the year was 18 foster mothers in respect of 19 foster children,, 9 under 5 years of age and 10 over 5 years of age. Adoption of Children (Regulation) Act, 1939 (Sec. 7). 116 visits were paid by Health Visitors and 48 adoptions were completed. Number under supervision at the end of the year, 16 children. INFANT WELFARE CENTRES. At the end of July the Maternity and Child Welfare service suffered the loss by retirement of Dr. C. A. King, who had been Infant Welfare Clinician for many years. Dr. U. Jerram was appointed whole-time senior Maternity and Child Welfare Officer to replace Dr. King, and the number of medical sessions was increased from 6 to 8. 63 The following table shows the attendances of infants and children under five years of age at the Municipal Health Centres:— Centre. Sessions. Weighings. Infant Attendances . New Cases. Weighings . Over 1 year Attendances . New Cases. Examined by Doctor. lordship Lane Municipal Health Centre 256 6,626 644 1,666 46 1,618 The Chestnuts, St. Ann's Road 255 6,963 750 1,624 80 2,180 Park Lane Municipal Health Centre 146 4,934 398 1,157 19 1,133 Town Hall 51 1,004 135 439 17 — Totals—1946 . . 708 19,427 1,927 4,886 162 4,931 Totals—1945 .. 654 16,984 1,667 4,622 68 4,098 TODDLER SESSIONS. This type of routine medical inspection continues to be popular and has been generally accepted by the parents as a welcome and valued service. When appointments cannot be kept the parents invariably send a letter of explanation and ask for another appointment to be made—this kind of co-operation we value very highly. The routine examination of children between the ages of two and five years is one of the most satisfying of all sessions to the Medical Officer in charge, especially when seeing any individual child for the second time. Few of these children are completely free from any defect on their first visit (though Vitamin deficiencies are now almost unknown). By remedying slight errors before they have time to produce permanent damage, the doctor has the satisfaction of seeing, three to six months later, not only an improvement in the general condition of the child concerned, but also of observing the improvement in other associated disorders which were merely threatening to become defects at a later date, if neglected. A perhaps minor, yet frequent, example is the filling of a tooth, with the apparently consequent 64 improvement in the appearance of tonsils and neck glands by the time the next visit comes round. It is also gratifying to have an early squint remedied in time, so that the child becomes completely reconciled to the wearing of glasses before having to make daily contact with the teasing schoolchild. After contact with the friendly atmosphere of these sessions, very few even of the "don't believe in it" mothers, fail to take their children for immunisation against diphtheria. During this particular year the Toddlers' Session has been a valuable means of ensuring that children immunised as babies receive their "booster" dose of A. P. T. before starting school. Thus the mother, being forewarned, ensures that her child is forearmed against the stresses of early schooldays. Table of Attendances at Toddler Clinics. Health Centre. Sessions held. Appointments made. Actual Attends mces. New. Reexams . Total. Lordship Lane 44 872 193 478 671 The Chestnuts 38 751 214 297 511 Park Lane 46 1,003 240 457 697 Totals 128 2,626 647 1,232 1,879 Attendances at Specialist Clinics. The arrangement with the School Health Service for children under five to attend the special clinics has continued during the year. Consultations and treatment were as follows:— Clinics. No. of Consultations. No. of Treatments. Minor Ailments 64 63 Dental 348 524 Orthopaedic 81 247 Ear, Nose and Throat 94 108 Ophthalmic 140 3 65 ARTIFICIAL SUNLIGHT. This service continued to be of value to the mothers andchildren for whom it was prescribed by the ante-natal and infant welfare clinicians. Number of children treated at Park Lane Centre 529 Treatments 2,356 IMMUNISATIONS. Number of children immunised 1,787 Shick Tests 1,544 ANTE-NATAL CLINICS. Miss Esther Rickards, M.S., F.R.C.S., has continued in the ante-natal services of the Borough. Owing to the increased number of ante-natal cases a second specialist was appointed to take over the Park Lane ante-natal sessions, and Mr. Wynn Williams, M.B., F.R.C.S., commenced duty at that Centre on the 12th August, 1946. An additional antenatal clinic was commenced at Lordship Lane Centre from the 13th August, making 4 sessions per week at that Centre, and an additional session at The Chestnuts ante-natal clinic, making 5 sessions per week from the 12th August. Attendances at Ante-Natal Sessions. Centre. Sessions. Attendances. Cases. PostNatal. The Chestnuts 218 4,445 1,205 97 Lordship Lane 177 3,802 1.028 80 Park Lane 123 2,678 716 42 Total—1946 518 10,925 2,949 219 Total—1945 449 8,164 2,230 471 66 MATERNITY SERVICE. Hospital Provision. This continues to be a major problem—shortage of available beds at the Mother's Hospital and the North Middlesex Hospital compelled many women to have a home confinement who should have been admitted to hospital for confinement. The following table shows the various institutions in which the confinements took place:— The Mothers' Hospital, Clapton— Under the Council's scheme 115 Own arrangements 23 The North Middlesex County Hospital 319 Other outside institutions 337 Evacuations: Under the L.C.C. scheme 30 Only 30 mothers were sent out of London area from Tottenham for confinement during the year, due not to unwillingness on the part of the mothers to leave home, but to the shortage of available places. Record of Municipal Midwifery Cases. Number of deliveries 1,392 Number attended as maternity nurses 146 Primipara cases 430 Multipara cases 1,108 Ante-natal visits 2,317 Nursing visits 20,075 Deliveries by mid wives in private practice, 33 HOME HELP SERVICE. There was still an acute shortage of suitable women willing to act as Home Helps. Financial aid was allowed in 211 necessitous cases, of which 87 were in need of free assistance. PUERPERAL PYREXIA. The following table shows the final results in each of the 13 cases of Puerperal Pyrexia notified during the year:— Domiciliary Confinements. Occurred in Institutions outside District. Total. Final Results. Recovered Died. 5 8 13 12 1 67 MATERNAL MORTALITY. Puerperal sepsis 1 Other puerperal causes 3 Total 4 The maternal mortality rate was 1.49. OPHTHALMIA NEONATORUM. The number of notifications of this disease was 14. Three cases removed from the district before result was known. 11 made a satisfactory recovery. There were 10 Domiciliary confinements and 4 Institutional confinements. PREMATURE INFANTS. Born at Home. Number of premature infants notified born at home 70 Nursed at home 61 Died during the first 24 hours 5 Number who survived (at the end of the first month) 55 Number alive and thriving at the end of December 48 MUNICIPAL MIDWIFERY SERVICE. The Non-Medical Supervisor of Midwives, MissF. E. Curtis, S.R.N., S.C.M., H.V. Certificate, reports:— During 1946 four midwives were appointed to the services, making in all 14 full-time midwives. One midwife who had recently retired continued throughout the year in a part-time capacity. The number of women delivered in their own homes by the midwives was 1,392, a great increase on the 1945 figure of 804. The provision of a car for use of the Non-medical Supervisor has greatly facilitated the smooth running of the service. 68 Nine midwives in all are now qualified to administer gas and analgaesia and of this number 6 received their training during the first part of the year. During the year the gas and air analgaesia was made available for all mothers on request. One apparatus is permanently installed at the ante-natal clinics so that mothers may have its purpose explained to them, and at the same time become familiar with its use. Sterilised maternity outfits were supplied on request. 659 were supplied at cost price, 43 at part cost, free of charge 27, making a total of 729. GENERAL HOSPITAL TREATMENT FOR CHILDREN UNDER FIVE YEARS. Twelve children were referred to the Prince of Wales's Hospital or the North Middlesex Hospital for operative treatment of enlarged tonsils and adenoids. Orthopaedic surgical appliances were supplied to 8 children by arrangements with the National Orthopaedic Hospital, Stanmore, Middlesex. Convalescent Home Treatment. The Invalid Children's Aid Association has co-operated with the department in placing 19 children in convalescent homes for children under five years of age. Number of children who stayed for 1—10 weeks 9 Number of children who stayed for 11—20 weeks 8 Number of children who stayed over 20 weeks 2 19 Of this number five cases were free, the other fourteen paying varying amounts weekly towards the cost. In addition six children were already away on the 1st January, 1946, and stayed during the year from 10 to 20 weeks. 69 Nature of Defects for which Convalescent Treatment was advised. Mastoid 1 Post-Measles 1 Malnutrition 2 Adenitis 1 Debility & underweight 3 Otitis Media 1 Post-pneumonia 4 Post-Tonsils & Adenoids Op. 1 Bronchitis 3 Nephritis 1 Post-Whooping Cough — Dislocated Hip 1 MATERNITY AND NURSING HOMES. 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 Nil (excluding exemptions) DENTAL REPORT. This service continues to expand, and the opening of a fourth dental clinic at the Town Hall in May, 1946, has made attendance for dental treatment much easier for those patients who live in the central Tottenham district. Comparative figures show that 772 expectant and nursing mothers attended as against 531 in 1945, an increase of nearly 50%. Three hundred and ninety-seven attendances were made by children under five years of age who had been referred to the dental clinics from Toddler clinics or had been dentally inspected at the day nurseries. The main categories of treatment were:— Extractions 1,539 Fillings 1,071 Scalings 243 Dentures supplied 157 70 NURSERY PROVISION. On September 30th Pembury House and Rowland Hill Day Nurseries were handed over to the Local Education Authority, and have been continued as nursery schools. The remaining three day nurseries continue to be full and active, and each has a long waiting list. The children have maintained a good standard of health and the nurseries have remained very free from infection. Student training has been continued in conjunction with the Tottenham Technical College. For attendances at day nurseries—see page 71. BENGEO HOUSE NURSERY. The Residental Nursery at Bengeo House continued its function of releasing under-5's from the stresses of their "normal" home life, and had proved itself of as high value in peace as it did in war in this aim. The benefit of a period of Nursery life under country conditions has been marked in every case, and will stand these children in good stead for many years to come. Staffing difficulties at this nursery have been very great, and at no time during the year have we had a full staff. We have again been able'to help many mothers over periods of domestic difficulty by admitting their children temporarily to Bengeo, and all have greatly benefited, the parents appreciating this service also. 71 NURSERIES. Nurseries. Attendances, 1946 (Whole days). Total. Days Open. Av. Daily Attendance January to March. April to June. July to September. October to December. Total. Under 2 Over 2 Day Nurseries. Park Lane: Under 2 years 714 892 807 815 3,228 9,848 254 38.77 Over 2 years 1,573 1,558 1,610 1,879 6,620 Lordship Lane: Under 2 years 762 612 682 773 2,829 8,809 254 34.68 Over 2 years 1,544 1,281 1,449 1.706 5,980 Plevna Crescent: Under 2 years 701 968 899 1,060 3,628 10,839 254 42.67 Over 2 years 1,757 1,844 1,847 1,763 7,211 *Pembury House: Under 2 years 828 684 386 — 1,898 7,265 190 38.24 Over 2 years 1,792 1,789 1,786 — 5,367 *Rowland Hill: Under 2 years 818 669 540 — 2..027 5,336 190 28.08 Over 2 years 1,127 1,106 1,076 3,309 Total: Under 2 3,823 3,825 3,314 2,648 13,610 42,097 __ Over 2 7,793 7,578 7,768 5,348 28,487 Residential— BENGEO HOUSE, HERTFORD. In residence 29.12.45 26. Admitted during 1946 22.=48 Discharged 29. In residence 31.12.46 19. *Transferred to Local Education Authority as Nursery Schools 1.10.46. 72 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:— 26,434 bottles of Cod Liver Oil. 156,013 bottles of Orange Juice. 52,446 tins of National Dried Milk. 6,313 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:— 684 bottles of Cod Liver Oil 4,032 bottles of Orange Juice 786 tins of National Dried Milk To health Centres. 1,014 bottles of Cod Liver Oil. To Day 3,276 bottles of Orange Juice Nurseries. 1,920 bottles of Cod Liver Oil. To Day 6,141 bottles of Orange Juice Schools. CRDSHA & SON, LTD., Tottenham, Enfield, Wood Green and soothqate.