AC 439 TOTTENHAM TOT 25 TOTTENHAM'S HEALTH 1950 The Annual Report of the Medical Officer of Health, Borough of Tottenham. 66059 TOTTENHAM'S HEALTH 1950 The Annual Report of the Medical Officer of Health, Borough of Tottenham. Health Department, Town Hall, Tottenham, N.15. The Worshipful the Mayor, Aldermen and Councillors of the Borough of Tottenham Mr Mayor, My Lord, My Lady, Ladies and Gentlemen, I have the honour to submit to you my Annual Report on certain aspects of the health of the Borough for the year ended the 3lst December, 1950. The record of health in Tottenham, as measured by vital statistics, continues to compare favourably with national figures. Positive health, however, cannot be enjoyed by many families who still live in overcrowded and bad housing conditions. Over 65% of living accommodation was built in the nineteenth century, and judged by minimum standards at least 2,500 houses in the district are worn out and should be demolished Others lack amenities now regarded as essential to healthy living. This problem of rehousing occupiers of insanitary and obsolescent houses, in addition to the pressing need of new families, has been the constant concern of the Health and Housing Committee and its officers On completion of the Tewkesbury estate a stage will be reached where it is impossible to contemplate further housing redevelopment within the Borough without increasing the density of persons to the acre and erecting multi-storied flats. The year 1950 marked the centenary of organised health services in this district Research into central and local records was undertaken by students of the History Study Group in Professor J.M. Mackintosh's Department (University of London), at the London School of Hygiene and Tropical Medicine. The whole survey was carried out under the expert guidance of Dr. Ian E McCracken of the School, who has collated and edited a review entitled "The First Phase from 1850-1873" which I am proud to include in an appendix to this report. Acknowledgment is made by the authors of the assistance given by my colleagues in the Borough service and to whom I wish to add my personal thanks. With the further co-operation of all concerned it is hoped to publish in next year's Annual Report the completed story of one hundred years of public health in Tottenham. I am, Your obedient Servant, G. HAMILTON HOGBEN, Medical Officer of Health. 1st October, 1951. 1 MEMBERS OF THE COUNCIL Alderman Mrs. A. Kitchener, J.P. MAYOR Councillor J. W. Holliagsworth DEPUTY MAYOR Alderman E. J. Field. Alderman G. H. Ottaway. „ Mrs. M. C. Irving. „ J. J. Pagin. „ Mrs. J. D. Lynch. „ A. Reed, A.C.I.I., J.P. „ J. H. Morrell, J.P. „ A. R. Turner. „ The Rt. Hon. The „ R. H. Warren. Lord Morrison, Councillor Mrs. Q. V. Jacobs. P.C., D. L., J.P. „ A. E. Johnson, J.P. Councillor H. E. Ashby. „ F. A. F. Keay, J.P. „ Mrs. M. Berry, J.P. „ H. Langer. „ F. G. Bohringer. „ L. A. LeVoi, M.I.M.I. „ Mrs. F. E. Boyton. „ The Lady Morrison. „ J. W. H. Brown. „ D. B. Moscou. „ E. J. J. Carter. „ A. A. Pawson. „ A. W. Catley. „ P. Readings. „ A. Clark. „ Mrs. A, F. Remington. „ C. H. Colyer. „ W. T. Richards. „ A. J. Davies. „ G. W. Rowley. „ R. W. H. Ford, J.P. „ A. E. Soall. „ K. A. E. Gregg. „ G. E. R. Stanley. „ W. S. Herbert. „ H. W. Turner. „ Mrs. M. W. Holland. „ Miss L. E. A. Whitworth. „ Mrs. F. C. Ilsley. „ C. Wise. Town Clerk: M. Lindsay Taylor, LL.B. 2 HEALTH AND HOUSING COMMITTEE Alderman R. H. Warren Chairman His Worshipful The Mayor, Alderman Mrs, A, Kitchener, J.P. The Deputy Mayor, Councillor J„ W. Hollingsworth. (Ex-officio members) Alderman J. H. Morrell, J.P. Alderman A. Reed, A.C.I.I., J.P. Alderman A. R. Turner. Councillor Mrs. M. Berry, J.P. Councillor The Lady Morrison. " F. G. Bohringer. " D. B. Moscou. " J. W. Ho Brown, " Mrs,, A. F. Remington, " K. A E, Greggo 11 G. W. Rowley. " ~ Mrs. M, W_ Holland, " A. E» Soallo METROPOLITAN WATER BOARD Council's Representative: Alderman E J Field. STAFF OF THE PUBLIC HEALTH DEPARTMENT Medical Officer of Health (Also Area Medical Officer, MoCoCo, and Medical Officer of Health, Hornsey.) Deputy Medical Officer of Health Chief Sanitary Inspector Go Hamilton Hogben, MoRoC.S., D.P.H. J. Cramond, M.B., D.P.H. (Resigned 30.9. 50) Eo T. Jenkins, M.S.I.A. Chief Clerk A* W. Lawrence, M.S.IoA. 3 Sanitary Inspectorial Staff Senior District Sanitary Inspector . E. S. Glegg (a) (b) (c) C. J. Cattell (a) (b). L. J. Kerridge (a) (b). A. E. Clarke (a) (b) (c) (d). B. J. H. Mercer (a) (b). (Resigned 31.12.50) G. A. Hagedorn (a) (b). A. S. Muncey (a) (b). (Resigned 25.9.50) (Resigned 24.7.50) W. P. Kent (a) (b). W. Openshaw (a). F. J. Parsons (a) (b). NOTE: (a) Certificate of the Royal Sanitary Institute and Sanitary Inspectors' Joint Examination Board. (b) Meat Inspectors' Certificate. (c) Institution of Sanitary Engineers' Certificate. (d) Sanitary Science Certificate. Shops Acts Inspectors F. To G. Lock. C. H. Goodwin (Assistant) (Resigned 15.4.50) Public Health Nurse Mrs. W. Mathias, S.R.N. Clerical Staff W. E. Lawson (Senior Clerk: General). D. J. Legge (Resigned 12.11.50) C. J. Lemon. C. S. Clark (Appointed 2.10.50) D. J. McLintic (Senior Clerk: Housing). Mrs. E K. Parker. Miss C. Bird. G. Barratt (Appointed 21.11.50) Outside Staff Foreman Disinfecting Van Driver Drain Testers S. H. Reid. E. E. Mannell. A. E. Crow. F. T. Dowse. I. A. Matthews R. E. Hobbs (Commenced 29.6.50) P. C. Moore. (Left 30.4.50) F. J. Slater. R. C. Wilson. Disinfectors: Apparatus Attendants Rodent Oper. at ives Labourer W. Butcher. A. Dowse. A. E. Moon. J. Lawrence. G. W. Percival. A. Ferridge. 4 GENERAL STATISTICS Area of District in Acres 3,01.3 Population: Estimate of Registrar General of Population- Mid-year, 1950 129,400 Pre-War Population 144,400 Approximate Number of Dwellings in District 30,327 Rateable Value of District £1,009,477 Sum Represented by Penny Rate £4,060 Live Births- Legitimate 1,641 1,727 Illegitimate 83 Birth rate (per 1,000 population) 13.35 Still Births 33 Deaths 1,382 Death rate (per 1,000 population) 10.68 Infantile death rate (per 1,000 live births) 23.74 Maternal death rate (per 1,000 live & still-births) 0.00 Comparability Factors- Deaths 1.07 Births 0.94 (note:- Detailed vital statistics appear on pages 51 to 59 in the Statistical Summary). 5 CONTENTS page Part i Infectious Diseases 6 „ II Food Control 17 „ III Sanitary Circumstances of the Area 26 „ IV Factories and Shops 43 " v General 47 " VI Statistical Summary 51 Appendix (i) Statistical Return of the work of the Local Area Health Committee No. 3 of the Middlesex County Council 60 (2) A Phase in the History of Public Health in Tottenham (facing page 77) - 1 6 PART INFECTIOUS DISEASES In reviewing progress made in prevention and treatment of infectious diseases, a valuable pointer can be obtained from a study of the mortality rates for the boroughs These are available for the past half century and their relation is shown in the charts printed on subsequent pages of this report. Overall figures demonstrate the substantial reduction in the number of deaths for all the principal infectious diseases; and may be said to reflect the advances made in recent years in measures for control. TUBERCULOSIS Although the death rate from this disease is falling, the number of notifications of pulmonary tuberculosis remains high, Pin-pointing the notified cases on a map of the district shows how widely and evenly dispersed these cases are over the whole area. Priority in re-housing on municipal estates-so popular a recommendation by all concerned with curative measures in the individual provides no answer to the community prohlem of prevention of spread of the disease. In a densely populated district such as Tottenham the means for widely introducing a scheme of voluntary B.C.G. Inoculation seems justified. At present this preventive measure is limited to "contact" cases at the local Chest Clinic and to a small experiment among children of school-leaving age, conducted during the past year under the auspices of the Medical Research Council. In the decline of notified cases of non-pulmonary tuberculosis the extension of pasteurisation to almost all the milk supplied to the Greater London Area, has been a most important factor. As from the 1st October 1951 no other than Designated Milk may be sold in the London Area. 7 The Public Health (Tuberculosis) Regulations, 1908, which came into force on the 1st January, 1909, first made tuberculosis notifiable, but the requirement was limited to pulmonary cases occurring among Poor Law patients Further regulations in 1911 made notification of all cases of pulmonary tuberculosis compulsory, and a year later this was extended to all forms of the disease. The chart below indicates the progress made in Tottenham during the past half century in reducing the mortality rate for both pulmonary and non pulmonary tuberculosis It would appear that prior to the issue of the 1908 regulations, many cases which are now classified as pulmonary, were included among those then described as "tuberculosis other than phthisis." 8 la 1950 there were 174- new cases of tuberculosis notified, a fall of 58 on the previous year. 161 of these notifications were in respect of cases of pulmonary tuberculosis. Deaths from pulmonary tuberculosis numbered 33 (22 males and 11 females), and non-pulmoaary tuberculosis caused 7 deaths (3 sales and 5 females). The death rate from all forms of tuberculosis was *399 per 1,000 population, the lowest ever recorded for the borough. The number of cases on the Department'3 register at 3lst December^ 1950, was 1,465 (1,285 pulmonary and 180 non-pulmonary tuberculosis). This was an increase of 12 on the previous year, Summary of Tuberculosis Cases. Age Periods New Cases Deaths Pulmonary Non-pulmonary Pulmonary Non-pulmonary Male Female Male Female Male Female Male Female Under 1 Year - - - - - - - - 1 to 4 Years - 4 - 3 - - - 1 5 to 14. " 4 4 - 1 - - - - 15 to 24 23 27 3 - - 1 - 3 25 to 34 " 24 19 - 2 4 4 2 1 35 to 44 " 15 8 1 2 1 1 - - 45 to 54 " 7 3 - - 6 - - - 55 to 64 " 14 - 1 - 7 2 - - 65 years & up 9 - - - 4 3 - - 96 65 5 8 22 11 2 5 Non-pulmonary cases affecting:- Male Female Total Genito-urinary system 1 0 1 Sacro iliac joint 1 0 1 Hip 1 1 2 Meninges 0 2 2 Spine 2 3 5 Breast 0 1 1 Saee 0 1 1 5 8 13 9 Cases of Tuberculosis on the Register at 31st December, 1950. Ward Male Female Total Pulmonary NonPulmonary Pulmonary NonPulmonary White Hart Lane 129 10 116 16 271 Park 53 16 53 11 133 Coleraine 40 6 39 2 87 West Green 84 9 64 12 169 Bruce Grove & Central 58 1 39 7 105 High Cross & Stoneleigh 52 14 38 8 112 Green Lanes 59 6 59 3 127 Chestnuts 50 4 33 12 99 Seven Sisters 72 8 36 5 121 Town Hall 73 7 54 14 148 Stamford Hill 53 4 31 5 93 723 85 562 95 1,465 Re-Housing in Relation to Tuberculosis The Council do not give special priority to tuberculosis cases, although some weighting is given on medical grounds, as is the case for other medical disabilities,: From an analysis of the applicants on the Council's housing lists, it has been found that 1.7% of the applications are from tuberculous families The incidence of tuberculosis in the borough is 1.13% so that it would appear that tuberculous families express a need for rehousing accommodation at a higher rate than the average family. Approximately 5% of the lettings made by the Council are to tuberculous families, which is about three times the rate at which the average applicant is rehoused. Diphtheria. There were 23 notifications of Diphtheria during the year, but in 20cases the diagnosis was corrected by the hospital authorities, so that the final corrected figure for Diphtheria was 3 cases. The other cases were amended to:- Glandular Fever, 3; Peritonsillar Abscess, 1; Pharyngitis, 1; Scarlet Fever, 1; Tonsillitis, 13; No Obvious Disease, 1. For the fifth year in succession no death has resulted from Diphtheria. 10 The three children who contracted the disease were aged 10 years, 6 years, and 3h years. The child aged 10 years is reported to have been immunised 8 years previously. The Area Health Office has compiled the following table showing the number of children at 31st December, 1950, who had completed a course of immunisation at any time before that date (i.e. at any time since 1st January, 1936). Immunisation in Relation to Child Population Age at 31.12.50 i. e. Born in Year Under 1 1950 1 1949 2 1948 3 1947 4 1946 5 to 9 1941 1945 10 to 14 1936 1940 Total under 15 Number Immunised 94 983 1463 1692 1633 6873 5845 18,583 5, 865 12,718 Estimated mid-year Child Population 1950. Children under five 10,720 Children 5 to 14 15,700 26,420 Percentage Immunised 54.7% 81.1% 70.3% The progress in the prevention and treatment of this disease is clearly demonstrated in the following chart shewing the average annual mortality rates over ten year periods for diphtheria in Tottenham during the past half century. In recent years the effects of the sustained campaigns for the immunisation of children in infancy, have been most marked, so that the occurrence now of a diphtheria case has become comparatively rare Parents thinking they need no longer fear the disease might attack their children, coupled with delay in operating the immunisation scheme as a general practitioner service, no doubt, accounts for some falling off during 1950 of the number of babies receiving immunising treatment. It is to be hoped that a decline in the acceptance rate will not continue as it is essential to maintain a high percentage of immunised children in the community if the disease is to continue to be held in check. 11 Scarlet Fever. There were 356cases of scarlet fever notified during 1950, an increase of 101 on the previous year's figure and the greatest number since 1936. 188 of these cases were treated in hospital, the remainder being nursed at home. However the disease continued to be of a mild character and again no deaths from the disease were recorded. The following are amended diagnoses of certain cases originally notified as scarlet fever Bronchitis, 1; Catarrhal Sore Throat, 2; Coryza, 2; Influenza, 1; Measles, 5; Mumps, 1; Otitis Media, 1; Pityriasis Rosea, 1; Tonsillitis, 16; Urinary Infection, 1; No Obvious Disease, 1. 12 Details of the cases treated in hospital are as follows:- Hospital Diagnosis Correct and Cases Treated to a Conclusion. Diagnosis Incorrect Number of Cases Average stay in Hospital (days) Number of Cases Average stay in Hospital (days) St. Ann's General 124 16,1 28 12.1 Other Hospitals 64 20.7 4 18.8 A survey of the vital statistics for the past half century shews that scarlet fever has caused less deaths than whooping cough or measles, and during the past 10years it has caused only two deaths in Tottenham. The following chart gives the average annual death rates per 100,000 population over 10 year periods since 1901 13 Whooping Cough. During the year there were -509 notifications of this disease, and death resulted in 1 case. 39 cases with complications were admitted to hospital. As with other infectious diseases, the mortality rate for whooping cough has dropped considerably over the past half century. Whooping Cough Vaccination. As reported in previous years, trials with whooping cough vaccines are in progress in this area under the aegis of the Medical Research Council, The early trials have shown that some whooping cough vaccines are effective, but on the other hand, considerable variations between them have been observed. No reason for these differences has been found and there is, as yet, no satisfactory laboratory test of the potency of new vaccines. It is thought, therefore, that the trials should continue, but that children in a wider age-range should now be eligible for inoculation, and that all those eligible should receive a whooping cough vaccine. There will, in other words, be no "control" uninoculated group as in some areas in the early trials. A supply of vaccines has been made available by the Medical Research "Council, sufficient to inoculate all children who are under 4 years of age in this area. As a specially selected proportion of such children must be followed up over a period to determine the value of the trial vaccines, inoculations will be given at Welfare Centres only. The selected children will be visited for 1-2 years after inoculation and if they develop symptons suggesting the disease nurse-investigators will take pernasal swabs in an effort to establish an immediate diagnosis, A medical officer will also visit cases if necessary. 14 15 Measles. There were 1,622 notification of this disease during 1950. This is the highest figure recorded since 1940when Measles notification was made compulsory, and is an increase of 655 on the previous year and 797 on 1949. The incidence of the disease was above the average throughout the year, and it rose to epidemic proportions at the end of the year and continued on into 1951. 87 cases, with some complications, were removed to hospital, but no deaths were caused by this disease. 16 Poliomyelitis. There was 110 epidemic of this disease in the borough. During the year 11 cases were confirmed; in four of these there was no paralysis associated with the illness. Typhoid Fever. For the third year in succession there were no notifications of this disease. In the nineteenth century the unsatisfactory sewerage and water supply arrangements gave rise to severe outbreaks of typhoid fever and Tottenham was among the most seriously affected areas, in outer London, but with modern water carriage sewerage systems and adequate supplies of properly treated water, the disease is restricted to the very rare outbreaks when contaminated food is the more common means of transmitting the disease. 17 Summary of Disinfection work during 1950. Rooms disinfected after occurrence of infectious disease 598 Bedding disinfected after occurrence of infectious disease or death 405 Library books disinfected 63 Articles disinfected for the Ambulance Service Blankets 704 White coats 446 Pillow slips 259 Hot water bottle covers 2 1,411 18 PART 11 FOOD CONTROL Food Hygiene. Efforts to promote a general interest in this important aspect of food control have continued throughout the year. The adoption of the Ministry of Food Model Byelaws was finally accomplished when ministerial approval was given in June. The byelaws came into operation in July. Some criticism has been made that the model byelaws are too vague and that the requirements are not sufficiently detailed or specific. We do not, however subscribe to this view. In theseearly stages it is a distinct advance to have resource to bye law standards, and experience alone can assess their true value. In order to make food handlers in the trade fully aware of the requirements, copies of the byelaws have been distributed and meetings have been held when the department has attempted to explain their scope and purpose. Milk and Dairies. The law on this subject has been consolidated in the Food and Drugs (Milk, Dairies and Artificial Cream) Act, 1950. No changes in the law are brought about by this Act. The Ministry of Food have intimated that a survey has been made of the Greater London area, and they are satisfied that the consumer demand for milk can be met by supplies of specially designated milk. It is intended, therefore, to lay before Parliament an Order to come into force on 1st October, 1951, specifying that all milk sold by retail within the area (which includes Tottenham) must be specially designated milk, that is, sterilised, pasteurised, tuberculin tested or accredited milk. Every milk dealer known to the Department holds a' licence to sell specially designated milk, and the following is a summary of such licences issued for 1950, namely:- 19 Milk (Special Designation) {Pasteurised & Sterilised Milk) Regulations, 1949. Dealers' Licences- "Pasteurised" 60 Dealers' Licences- "Sterilised" 129 Dealers' Supplementary Licences - "Pasteurised" 13 Dealers' Supplementary Licences - "Sterilised" 14 Milk (Special Designation) (Raw Milk) Regulations, 1949. Dealers' Licences - "Tuberculin Tested" 26 Dealers' Licences - "Accredited" 3 Dealers' Supplementary Licences - "Tuberculin Tested" 13 Dealers' Supplementary Licences - "Accredited" 1 During the year 38 applications for registration as milk distributors were dealt with, and 1 application was received in respect of a dairy. 28 persons, who ceased to carry on trade as milk distributors, and 2 premises, which ceased to be used as dairies, were removed from the register. The number of premises and distributors registered at 31st December, 1950, was as follows :- Number of Distributors registered 130 Number of Dairies registered 11 Ice Cream, Routine sampling and systematic inspection continues to be undertaken in the supervision of the production of ice cream. Regular visits are also made to premises where loose ice cream is sold, but increasing' numbers of dealers are switching over to the sale of pre-packed ice cream, where the risk of contamination is greatly reduced. The Department's insistence on proper hygienic methods in the manufacture and handling of this commodity has resulted in a considerable improvement in the bacteriological grading o:3 samples submitted for examination by the Public Health Laboratory Service. The following ice cream premises were registered during 1950, namely:- For the sale of Ice Cream 42 For the manufacture and sale of Ice Cream 4 Total 46 20 14 premises which ceased to be used for the sale of ice cream, were removed from the register. The total number of premises on the register in accordance with Section 14 of the Food and Drugs Act, 1938, at 31st December, 1950, was as follows:- Sale of Ice Cream 209 Manufacture and Sale of Ice Cream 37 Storage of Ice Cream 2 Total 218 Samples of Ice Cream Submitted for Bacteriological Examination Results Total Grade 1 Grade 2 Grade 3 Grade 4 Number of Samples taken where Ice Cream was produced in Tottenham 24 4 4 - 32 Number of Samples taken where Ice Cream was produced in districts other than Tottenham 8 4 1 - 13 Total 32 8 5 - 45 Catering Establishments and Canteens. Regular visits are made to all premises where meals are prepared, to ensure that proper standards of hygeine are maintained. The opportunity is taken to have informal talks with the food handlers and to impress upon them the need for the greatest care to avoid contamination of food. The new byelaws and the campaign which has accompanied their introduction have done much to rouse the interest of the public in the subject of food hygiene, and many restaurant proprietors are voluntarily carrying out improvements in their premises and in the general management in order to bring them into line with modern standards. Food Poisoning. During the year there were 20 notifications of food poisoning. These occurred as scattered cases, and there was no outbreak attributed to any particular food. 11 of the cases occurred in the third quarter of the year, 5 in the second quarter, and the remaining 4> in the last quarter. 21 The case rate per 1,000 population 0.15 compares favourably with the provisional figure for London, of 0.25. Slaughterhouses and Knackers' Yards. Five premises are licensed as slaughterhouses under Section 57 of the Food and Drugs Act, 1938. At only one of these premises is regular slaughtering carried on. This slaughterhouse deals mainly with horses. Another section of the premises is licensed as a knacker's yard. The number of horses slaughtered at this slaughterhouse during the past three years is as follows 1948 1949 1950 3,189 2,889 2,750 781 animals were slaughtered in the knacker's yard during 1950. Regular visits are made by the District Sanitary Inspectors to ensure compliance with the regulations and to carry out post-mortem examinations of the animals slaughtered. During the year 16 licences to slaughter were issued in accordance with the provisions of the Slaughter of Animals Act, 1933. Preserved Foods. 95 premises used in connection with the manufacture and/or preparation of preserved foods are registered under Section 14 of the Food and Drugs Act, 1938. During the year 3 new registrations were made - Manufacture of Sausages 1 Preparat ion of Preserved Foods 2 Middlesex County Council Act, 1944: Section 279 - Registration of Hawkers. The following is a summary of the registrations of hawkers anc their storage premises as at the 31st December, 1950:- Articles Number of Persons Registered for sale Number of Storage Premises Fruit & Vegetables 107 104 Shell Fish 12 8 Fish 9 9 128 121 22 Section 279 applies to hawkers of meat, fish, and fruit and vegetables only, but Section 11 of the Middlesex County Council Act, 1950, extends these provisions to hawkers of any type of food, unless packed in sealed containers. This new provision, which is adoptive, has been adopted by Tottenham, and comes into force on the 1st April, 1951. Food Condemned. The following tinned articles were condemned during the year, namely:- Anchovies 2 Figs 1 Pilchards 52 Apple Pulp 85 Frozen Eggs 1 Pineapple 10 Apple Puree 12 Fruit Salad 12 Pineapple Juice 2 Apples 64 Gherkins 2 Plums 1,246 Apricot Juice 2 Gooseberries 42 Pork 43 Apricot Puree 55 Goulash 1 Porkam 1 Apricots 14 Grapefruit Juice 31 Pork Loaf 8 Asparagus 1 Grapes 105 Potatoes 6 Baby Pood 20 Greengages 1 Potted Meat 3 Beans 569 Groats 1 Prunes & Orange 59 Beef and Pork Loaf 6 Ham 61 Prune & Orange Juice 180 Beetroot 20 Ham Loaf 1 Prune Puree 1 Blackberries 7 Herring Roes 3 Rabbit 5 Bournvita 1 Herrings 42 Raspberries 15 Brawn 14 Jam 284 Salmon 46 Brisket of Beef 1 Lobster 1 Sandwich Spread 880 Brislings 107 Luncheon Meat 371 Sardines 196 Broth 12 Macaroni 2 Sausages 21 Carrots 160 Macedoine 14 Shredded Coconut in Oil 2 Celery 1 Mackerel 3 Silds 12 Cherries 42 Marmalade 163 Snoek 1 Chicken 1 Meat and Gravy 23 6 Soup 435 Chile Con Carne 10 Meat & Vegetables 21 Spaghetti 32 Chinchards 1 Meat Roll 152 Spaghetti & Sausages 1 Christmas Pudding 31 Milk 3, 080 Stewed Steak 34 Cod Liver & Roe Spread 127 Mincemeat 3 Strawberries 6 Cod Roe Spread 325 Minced Beef Loaf 79 Tomatoes 194 Cod Roes 1 Mussels 1 Tomato Juice 43 Corned Beef 39 Orange Juice 8 Tomato Puree 45 Corned Mutton 5 Oranges, Sliced 84 Tongue 5 Crab 10 Peaches 109 Tunny Fish 4 Crab Paste 1 Peanut Butter 2 Veal 43 Crawfish 43 Pears 49 Veal Loaf 21 Crayfish 8 Peas 1,410 Veal & Ham Loaf 15 Custard Powder 2 Pease Pudding 12 Veal, Pork & Beef Loaf 1 Damsons 110 Mixed Vegetables 9 23 Other articles of food condemned were as follows Apricots ljar Marmalade 3 jars Bacon 166 lbs. Marzipan 56 lbs. Bananas 30 lbs. Meat Paste 1 jar Beef 5 57¾ lbs. Mincemeat 1 jar Biscuits 42 lbs. Mints 2 lbs. Bovril ljar Mixed Fruit 1 bottle Bread 1 loaf Mutton 84 lbs. Cake 2664 lbs. Nougat 1¼ lbs. Cheese 11¾lbs. Oats 4 packets Chocolate 6 lbs. Onions 1 jar Chocolate Caramel Candy 14 lbs. Orange Juice 18 bottles Chocolate Creams Pastry Mix 63 packets Cod 6 stone Pickles 18 jars Codling 8 stone Pork 10 lbs. Cooking Fat 1 lb . Prunes 38 lbs. Currants 199 lbs. Salami Sausage 7 tons 1 cwt. Dates 85 lbs. Salt 1 cwt. Desiccated Coconut 130 lbs. Sauce 26 bottles Dogfish 5 stone Sausage Rusk 1 cwt. Eggs 180 Sheep's Heads 358 lbs. Fish Roe 63 lbs. Skate 21 stone Flour 140 lbs. Smoked Herring Fillets 16 jars Fruit Cordial 152 bottles Sultanas 31 lbs. Ham 6 lbs. Tea 2½ lbs. Honey 1 jar Tomatoes 140 lbs. Jam 1 jar Tongue 4 lbs. 1 4oz Lamb 3lbs.14 oz. Turkish Delight 294 lbs. Lemon Squash 37 bottles Vinegar 6 bottles Liver 45¼lbs. Vita-Wheat 1 packet Margarine 2 lbs. Food Sampling. The Public Control Department of the Middlesex County Council has supplied the following information on food and drugs sampling in the borough during 1950:- 24 Milk 135 Milk, new 175 Adrenalin Cream 1 Apple Tart 1 Brawn 1 Cake Mixture 1 Cheese Cake 1 Chips 1 Chocolate Roll 1 Coffee & Chicory Essence 1 Cream Cakes, etc. 11 Crisp 1 Crunchy 1 Curry Powder 1 Drinking Chocolate 1 Dripping 1 Egg Square 1 Fancy Cakes 12 Fish Cake 1 Fish & Chips 1 Fish Paste Gelatine 1 Gin 5 Honey Fruit Lumps 1 Ice Cream 1 Jellies 2 Lemon Curds 3 Liquid Paraffin 1 Meat Products 9 Meringue 1 Mince Pie 1 Non-brewed Condiment 1 Pastry 1 Pressed Meats, various 5 Salami 1 Sausages & Sausage Meat 34 Salad Cream 1 Sausages, breakfast " Liver 1 " Luncheon 5 Sausage Roll 1 Sieved Apples & Sugar 1 Steak & Kidney Pie 2 Smoked Haddock 2 Synthetic Cream 1 Tinned Ham 1 Veal & Ham Pie 1 Vinegar, malt 1 Whisky 29 White Pepper 2 Total 467 25 Samples Incorrect. Milk 7 Milk, new 16 Chocolate Roll 1 Lemon Curd 1 Savoury Meat 1 Steak & Kidney Pie 2 White Pepper 1 Total 29 With respect to the samples found incorrect, an official caution was given to the manufacturer with regard to the chocolate roll which was found deficient of dry fat free cocoa material; an official caution was sent to the manufacturers of the lemon curd which was deficient in fat. The savoury meat, and steak and kidney pies, each had only traces of meat. No action was taken mainly because the manufacturer responsible was at the time prosecuted by the Middlesex County Council in respect of similar offences which occurred in the Borough of South gate and which supplied better evidence to support the prosecutions. This man was fined £20 with £6 6s ,0d. costs, and the Magistrate said "We consider this a serious case, so we are imposing the maximum penalty. You were passing off these articles of food to the prejudice of the purchasers, and we agree with the comment that this amounts to a common fraud." The manufacturer gave an assurance that he had given up making and dealing in this type of goods. An official caution was given in the case of the whitepepper, which contained black pepper. So far as the incorrect milks and new milks were concerned, three official cautions were given in cases of fat deficiency. In no case was adulteration of milk by the addition of water disclosed. Food & Drugs Act - Legal Proceedings. Case 1. Contaminated Bread* Defendant fined £25 and ordered to pay 10 guineas costs. Case 2. Sacking in Bread. defendant pleaded "Guilty" and was fined 10 guineas and ordered to pay £3.3s.0d. costs. 26 PART III SANITARY CIRCUMSTANCES OP THE AREA. Water supplied to the Borough continues to be of the high quality we now expect from the Metropolitan Water Board. The department continues to receive complaints about storage cisterns and it must be stressed that no power is available to the Local Authority to require a supply "off the mains", where storage cisterns are in use the tenant is under an obligation to keep the cistern covered and clean. I am indebted to the Director of Water Examination of the Metropolitan Water Board, for the following information The supply to the Tottenham area has been satisfactory both in quantity and quality during the year 1950. Details of the analytical results of the water passing into supply are given in the tables appended. The area is supplied from two sources (a) Water from the New River and treated at the Board's filtration works at Hornsey and Stoke Newington (b) River Thames water stored in Walton reservoir and treated at the Board's filtration works at Walton. Samples are collected on five days in every week, or more often if required, at each stage of the purification process and tests include physical, chemical and microbiological examination. All new and repaired mains are chlorinated before being restored to use and samples of water from them are tested bacteriologically to ensure that its quality is up to that normally supplied. The water supplied to this area is not plumbo-solvent. Drainage and Sewerage. The dual sewerage system continues in operation in Tottenham. Surface water is kept separate and discharged direct into the local watercourses and the soil sewage drains to the Tottenham and Wood Green Pumping Station at Markfield Road, where is raised and discharged into the London County Council's system. It appears that the Drainage Scheme for East Middlesex, which includes Tottenham, is 27 Results of the Chemical and Bacteriological Examinations of the Water Supplied to the Borough of Tottenham for the Year 1950. Parts per Million (Unless otherwise stated). Description of the Sample No. of Samples Ammoniacal Nitrogen Albuminoid Nitrogen Oxidised Nitrogen Chlorides as C1 Oxygen abs. from Permanganate 3hrs at 80°E Turbidity in Terms of Silica Colour, m.m. brown 2ft. Tube Burgess's Tintometer Hardness (Total) Hardness (Permanent) pH., Value Phosphate as P-o1114 Silica as Si02 Conductivity Nitrite Nitrate New River water filtered at Hornsey works. 242 0.037 0.071 8.1 51,6 0.67 0.2 8 315 91 7.7 0.82 15.0 575 New River water filtered at Stoke Newington works. 244 0.029 0.067 7.8 51,2 0.66 0.1 8 314 92 7.8 0.84 16.0 575 River Thames water filtered at Walton works. 244 0.018 0.097 3.1 27.6 1.32 0.3 17 260 81 7.8 0. 39 11.0 475 Bacteriological Results Description of Sample No. of Samples No. of microbes per ml. Colonies counted on agar after 20-24 hrs. at 37°C Bact. coli Test Percentage of samples negative to Bact. coli in 100 ml. Bact, coli per 100 ml. New River water filtered at Hornsey works 257 7.9 100.0 Nil New River water filtered at Stoke Newington works 257 12.2 100.0 Nil River Thames water filtered at Walton works 25 3 15.3 100.0 Nil 28 unlikely to be in operation for some years. The pollution of watercourses continues to receive the attention of the Department. Sanitary Inspectors have undertaken special investigations into sources of pollution. In a built up district like Tottenham, where the streams are culverted for most of their length, the tracing of sources of pollution is extremely difficult, and takes prolonged and careful observation to locate the cause. This is so particularly in the case of intermittent pollution. A scheme to improve the drainage of the Stonebridge watershed and so reduce flooding in the area is now being discussed by the local authorities concerned, and it is hoped that agreement will soon be reached. Closet Accommodation. The water carriage system operates throughout the Borough. There are no privies. Atmospheric Pollution. It is reasonable to assume that the reduction in pollution of the atmosphere by industrial undertaking has improved,, This is particularly so in the case of firms using the normal fuels. Anxiety continues in respect of firms who are using wood chips, off cuts or sawdust. In two cases the firms concerned committed themselves to schemes of prevention costing from £300 to £600, This sense of responsibility is encouraging although lapses still occur due to the personal element by lack of appreciation of the problem by individual stokers. The main source of pollution in this district is the domestic fire; this has reduced only by reason of the shortage of coal. Sanitary Administration. The year 1950 marked the centenary of public health in the Borough of Tottenham since it was in the year 1850 that the first inspector of nuisances was appointed. On the 27th April, 1850, a Mr* Thomas Tuck was appointed as Inspector of Nuisances and Roads Surveyor by the Tottenham Local Board of Health. He was selected from a number of applicants who were all "fit and proper persons" but whose technical qualifications are not recorded. 29 The evolution of the present day Sanitary Inspector as compared with his predecessors of 100 years ago provides an interesting study. As the functions and duties of the local authority have increased so too have the functions and duties of the Sanitary Inspector. Appointments of inspectors of nuisances were first authorised in Public Health Act, 1848, and appointments continued to be made under this title until the Public Health (and Housing) Act, 1921, which designated all such officers as Sanitary Inspectors. The duties of early Inspectors were however never very clearly defined - except in two instances:- (1) Reporting to the authority on the existence of nuisances. (2) Action to be taken for the examination of food. To-day, the duties are very clearly set out in the Sanitary Officers Order, 1926, and the Sanitary Officers (Outside London) Regulations, 1935-1950. These Orders likewise, prescribe the qualifications required, now known as the "Statutory Qualifications." It would be true to say that in no case of the local authority's activity, is the impact upon the public so evident, as that of the work carried out in the Public Health Department. The Sanitary Inspector is in intimate contact with members of the community in their homes and in their work. He must be reasonable in his outlook and understanding in his dealings with people whose attitudes are governed by their own immediate problems, since by the standard of his conduct the local authority is frequently judged. Housing Annual Reports which I have submitted since 1945 all stress the importance of housing. This report, no less than its predecessors, must reiterate the magnitude which this problem assumes year by year. An examination of the borough shows that:- 7% or 2,100 houses are more than 85 years old. 35% or 10,000 " " from 56 to 85 " " 35% or 10,000 " " " 36 to 55 " " 23% or 6,500 " " 35 years old or less, and of the last figure, approximately 40% are municipally owned houses. 30 If an analysis of the work done by the Sanitary Inspectors is made approximately 80% of their visits are in connection with housing. Since 1945 over 5,000 notices have been served under Section 9, Housing Act, 1936, and work to the value of £45,000 has been carried out and supervised by the Sanitary Inspectors, in owners defaulto In a borough of this character it will be agreed that this work is a substantial contribution to the housing problem; but is still not enough,, Experience shows that bad housing is a prime cause of physical and emotional distress, and people living under adverse housing conditions cannot derive full benefit from the advances that have been made through recent social legislation. A stage is being reached where it is impossible to contemplate further redevelopment; a deciding factor being lack of building land. Special attention must be drawn to the "age group" analysis of the houses in the Borough, where it is shown that over 12,000 houses are 56 years old or over. Judged by minimum standards at least 2,500 of them should be demolished The others all lack amenities which may now be regarded as necessities of every day life. Despite the urgency of the need of houses for new families, consideration must be given to the prospects of rehousing the occupiers of the insanitary and obsolescent houses. In this respect the Greater London plan calls for fixing the density in areas such as Tottenham. At the present rate of building and at this arbitrary density, slum clearance can never be carried out, resulting in an inevitable stalemate. The density of development in the Borough must therefore be increased if the problem of inadequate housing is to be solved; and permission sought to proceed with the immediate clearance of unhealthy areas. The type of development to be effective, is multiple storied flats whether of choice or expediency. Housing Act, 1949. Applications for assistance have been made to the Corporation under this Act, but it has been clear that not all applicants are 31 aware of the purpose of the Act. On investigation many applications prove to be for the purpose of neglected work of maintenance; and such cases are better dealt with under the provisions of Section 9, Housing Act, 1933. The scope of the 1949 Act in a Borough like Tottenham is limited, due to the fact that all the houses are fully occupied. One case of a house scheduled as one of historic or architectural interest has occurred and a closing order made. At the time of preparing this report, however, the case has not been concluded. Housing Act, Section 9 The repair of insanitary houses under Section 9, Housing Act, 1936, continues to occupy the greater part of the daily routine. Great care, however, has still to be exercised in deciding which Act is to be used, - the Public Health Act or Housing Act. A new feature has arisen and is one which requires careful consideration, namely, the suggestion on the part of owners that sane of the work specified would, in fact, constitute improvement. If accepted, this might have the effect of increasing rents, e.g., the insertion of a damp proof course may be considered an improvement, the landlord would then increase the rent by an amount equal to 8% of the cost of the improvement. A matter which is continually giving rise to controversy and in the case of tenants -much irritation- is the question of wallpaper or distemper. The normal practice is to ask for repapering where paper already exists Some owners, however, refuse, and insist on distempering. In one case an owner threatened to put on either whitewash or black distemper, Case law has established a decision regarding the provision of hot water supply, which has already had local repercussion. This is an amenity and cannot be required under the Housing Act, since it has been ruled that lack of a hot water supply does not render a house unfit for human habitation. The local effect of this ruling has been that some owners are now refusing to repair or renew geysers, and are refusing to renew fireplaces and stoves with back or side boilers. An interesting comparison can, however, be drawn between the case law decision which rules out the question of hot water supply and the requirements of the Report on the "Standards of Fitness Subcommittee of the Central Housing Advisory Committee." This body 32 includes in their 16 points standard, the following:- (V) be provided with efficient and adequate means of supplying hot water for domestic purposes. Surely "efficient and adequate" cannot be met by a kettle on a gas ring or gas cooker? The following is a summary of work carried out under Section 9 in the owner's default, during the past 14 years, namely :- Year Number of Houses Cost 1937 12 £420o 5. 5. 1938 5 66.l3.ll. 1939 31 605= 3. 5. 1940 3 25. 4. 4. 1911 19 319. 7. 0. 1942 21 543. 4.l0. 1913 114 2,559. 7. 3. 1944 45 1,026. 6. 9. 1945 17 658.3.11. 1946 152 7,329.l6. 8. 1947 241 14,272.16. 9. 1948 181 13,160. 8. 4. 1949 106 6,5930 6. 5. 1950 77 4,035. 8. 5. Sections 11 & 12. The problem of repairing insanitary houses at "reasonable cost" is one which continues to be vague in its interpretation, Increasing use has to be made by the Department of the provision of Section 11, Housing Act, 1936. It should, however, be made clear that its increasing use is to some extent artificial and has been created mainly by force of circumstances,, Whilst house rents have remained fixed, building costs have increased by something like 150% to 200%. Clearly Section 11 was not framed to meet present day conditions and some amendment is required. For the purpose of the Housing Act, house values remain at 1939 level or even earlier, where old controlled houses are involved. It cannot, therefore, be equitable to assess "reasonableness" of the cost of repairs by present day building prices. But as the law stands, public health officers have no option and they are left with no alternative. As to what contitutes "reasonable cost" we know that in pre- 33 1939 it was said that 35% to40% of the value of the property would be the amount which could reasonably be spent; but in 1950 other governing factors must be considered, so that in having regard to the cost of re-placing demolished houses it would not be unreasonable now to spend up to the full value of the house. The last word is with the County Court Judges, but if wholesale individual demolition orders are to be avoided a wide interpretation of what is "reasonable cost" is necessary. In arecent decision (Grimsby Corporation -v- Bacon) the "value" of the house was said to be the "freehold" value. In the first local case the Corporation had regard to Section 3, Housing Act, 1949; and instead of making a demolition order, a closing order was made. The outcome of this case is still undecided Premises the Subjects of Demolition Orders - Not Demolished as at 31st December, 1950. Premises Date of Order 22, Hale Gardens 5. 4. 50. 10, The Hale 5. 4. 50. 55, The Hale 2. 4. 48. 57, The Hale 2. 4. 48. 8A, Lawrence Road 13o 10. 48. 1, Railway Terrace 3. 2. 50. 2, Railway Terrace 3. 2. 50. 3, Railway Terrace 3. 2. 50. 4, Railway Terrace 3. 2. 50. 4, Stanley Grove 1. 6. 43. 31, Tewkesbury Road 8. 8. 49. 5, Union Row 11. 8. 48. 6, Union Row 11. 8. 48. 7, Union Row 11. 8. 48 8, Union Row 11. 8. 48. 34 Premises Demolished During 1950 - Demolition Orders Made Prior to 1950. Premises Date of Order Date Demolished 5, Railway Terrace 25. 8. 41. May 1950 6, " " 4. 6. 42. " 7, " " 4. 6.42. " 8, " " 7. 8. 47. " 9, " " 25, 8. 41. " 10, " " 1. 6. 43. " 12, " " 7. 8. 47. " 14, " " 7. 8. 47. " 15, Tewkesbury Road 20. 5. 48. 8. 2. 50. NOTE: Numbers 11 and 13 Railway Terrace which were the subjects of Closing Orders not Demolition Orders, were also demolished in May, 1950. Premises the Subject of Closing Orders made during 1950. Premises Part of Premises Concerned. Date of Order. 23, High Road Basement front room 4. 8. 50. 8, Moselle Street Whole Basement 9. 5. 50. 10, " " 9. 5. 50. 12 " " " " 9. 5. 50. * 4, Prospect Place Whole House 13.11. 50. NOTB: * On list of premises compiled under Section 30, of Town and Country Planning Act, 1947, and closed under Section 3 Housing Act, 1949. Housing Act, 1936 - Part V; The Tewkesbury Estate, This estate is approximately 23 acres in extent and consists of old worn out houses in respect of which clearance order and compulsory purchase procedure were initiated before the war but which had to be suspended. On the estate, which consists of high density housing, are 458 dwellings and 100 shops with living accommodation. The houses are generally poorly constructed two storied terraced dwelling houses built some sixty to seventy years ago. 35 During the war the estate suffered extensive war damage and following an application by the Tottenham Borough Council, under section 1 of the Town and Country Planning Act, 1944, and the holding of a Public Enquiry in October, 1946, an area of 23.18 acres comprising the Tewkesbury Estate, was approved by the Minister of Town and Country Planning on 30th July, 1947, as being a Declaratory Area which, for the purpose of dealing satisfactorily with the extensive war damage, should be subject to compulsory purchase, and laid out afresh and redeveloped as a whole. The proposed redevelopment of the estate has been carefully considered and follows generally modern planning and housing principles, In this regard particular mention may be made of the closing of redundant roads which existed in the old communication pattern; the provision of three floor terra.ce houses; and the phasing programme. It is proposed to develop by means of blocks of 3, 4, 5 and 6 storey flats; and 2 and 3 storey terrace houses. It is proposed to provide the following accommodation :- 1 Bedroom 27 2 " 201 3 " 200 4 " 28 Total: 456 Dwellings This is equivalent to 26 8 dwellings, or 120 persons per acre of housing land, which will ensure adequate light, air, and general amenity. A primary school site of approximatley 2acres is provided for, together with a community centre, mission hall, public house and playing spaces The present Council slipper baths and wash-houses are to be retained. It is proposed that development of the estate will be divided into phases. It will thus be possible for building to be carried out on the vacant sites, for residents in the old properties to be rehoused, and then for the properties vacated to be demolished. The cycle of building, rehousing, and demolition, will then be continued in an orderly manner. On the 1st April, 1950, after a local inquiry the Ministry of Health confirmed acompulsory purchase order under the Housing Act, 36 1936, for the acquisition of an area comprising five phases of the redevelopment. The area, over 9 acres in extent, comprised the following:- 107 Vacant war-damaged sites 2.61 acres 163 Houses and 2 shops with living accommodation. 4.04 " Miss ion Hall 0.09 " Public Highways 2.40 " Total: 9.14 " It was the obvious choice as the first area for development as it contains over 90% of the vacant war damaged land in the Declaratory Area, and it also comprises, with the exception of a public house,site, all housing development. The work in the first area is being carried out in five phases with building commencing with the first phase on the cleared portion. The rehousing of the people in phase 2 and demolition of their houses will be carried out as accommodation becomes available in the first phase of the work, and similar action will be taken in the 3rd, 4th and 5th period phasing. The following is a summary of the phasing for Area No. 1, namely Compulsory Purchase Area No. 1. Phase Existing Proposed Dwellings Families @ 1.5 per dwelling Dwellings 1 2 3 60 2 29 43 50 3 48 72 67 4 22 33 18 5 65 97 64 166 248 259 Building work commenced in February 1951, and it is anticipated that the different phases of development will then follow one after the other. 37 Public Health Act, 1936. Although there were fewer notices served during the year, this can be accounted for by staff shortages and changes. The volume of work done under the Public Health Act, 1936, is, however, greater in proportion than in the previous year. As I have emphasised in previous annual reports, sore complaints regarding houses are being dealt with under this Act As the older houses in the Borough continue to deteriorate, it becomes increasingly necessary to deal with them on the basis of nuisance rather than as unfit or insanitary houses. In addition to housing complaints, a wider and more miscellaneous variety of complaints are received. Such things as keeping of animals, quarrels and differences between tenants are matters which receive attention A common complaint -not easily solvedis the one where access to the garden or to the lavatory is refused. A feature of notices served under this Act is worthy of special mention, namely the provision whereby work can be done by the Council, by agreement with the person concerned. Section 275 of the Public Health Act, 1936, authorises the Local Authority to do work by agreement, and advantage is taken of this section, particularly where drainage work is involved. Abatement Notices - Legal Proceedings Case 1 An order was made requiring the owner of these mises to complete the remaining works required by a Public Health Act Notice within 28 days. A fine of 20/- with 21/-costs was imposed Case 2. Adjourned sine die as work completed and £1. costs paid Case 3. Adjourned sine die on payment of £1. ls. 0d. costs -work completed. Case 4. Adjourned sine die on commencement of work and payment of £1. costs,, Case 5. Adjourned sine die on commencement of work and payment of £l. costs. 38 Case 6. Adjourned sine die on payment of £1. 1s, 0d. costs and promise to do work in 14 days. Restored for hearing 19th October as work was not done. Order made for work to be done forthwith - fined £1. and £2. 9s. 6d costs. Case 7. Adjourned sine die as work completed and £1. 1s. Od. costs paid. Case 8. Ordered to carry out work in 14 days - awarded 7/6d. costs. Housing Lettings. The annual report for 1949 contained a detailed statement of the steps taken by the department for dealing with enquiries from housing applicants. These enquiries continue to come in, and they are investigated before any recommendations are made. I must, however, comment on the position of persons continuing to occupy houses which have become the subject of demolition orders. The Council have - in my view wisely - accepted the responsibility for rehousing these cases. They have gone even further and given a measure of priority, but it is to be regretted that there are still cases where the occupants have not been rehoused even three years after the demolition order was made and confirmed by the Council. That people continue to occupy such premises is no reflection on the Council, but it is an indication of the acute problem of the insanitary and unfit houses. The following is a summary of the Council's post-war housing schemes as at the 31st May, 1951:- Family Units (1) Accommodation provided:- Permanent Dwellings 358 Temporary Dwellings 315 Requisitioned Property 1,178 Half-way Houses 22 1,873 (2) Permanent Dwellings in progress 265 (3) Proposed Schemes for Permanent Dwellings 1,258 3,396 39 Note:- Post-war housing was delayed by reason of repair of war damage, The extent of this work was as follows:- Houses destroyed 1,070 " seriously damaged 1,470 " slightly damaged 21,700 Approximate cost of work carried out by Council £1¼ million. Accommodation in Post-War Housing Schemes. Unclassified. 1-bed 2-bed 3-bed 4-bed Total (l) Completed Permanent 34 12 286 26 358 (2) Completed Temporary - 315 - - 315 (3) Permanent Dwellings in Progress 40 91 110 24 265 (4) Proposed Schemes 167 99 511 421 60 1,258 167 173 929 817 110 2,196 Rodent Control. Rodent control continues to be carried out in accordance with the Ministry of Agriculture and Fisheries' approved methods, Block control is operated on all possible occasions and, in conjunction with the treatment, drains and sewers are tested. Maintenance treatments have again been carried out in the Corporation sewers these during the months of June and November- December Sewer Maintenance-Results of Baiting in Manholes. June 1950 November - December, 1950 Treatment No. 11 Treatment No. 12 Complete takes 180 Complete takes 464 Good takes 293 Good takes 221 Small takes 375 Small takes 177 No takes 262 No takes 240 Total manholes treated 1,110 Total manholes treated 1.102 Estimated killed 7,403 rats Estimated killed 10,111 rats Summary of Dwelling-houses and Business premises treated during 1950 (1) Dwelling-houses 700 (2) Business and Factory Premises 133 (3) Total charged for (2) above £71. 5s. 5d. 40 Inspections Carried out by the Sanitary Inspectors:- Infectious disease 410 Complaints investigated 4,473 Re-inspections 7,811 Factories 371 Workplaces 32 Dairies, etc. 142 Fruiterers, etc. 130 Fish shops 129 Butchers' shops 156 Bakehouses 99 Other food premises 667 Slaughter-houses 38 Public House urinals 37 Appointments & interviews 698 Drains tested 467 Drains defective 295 Small Dwellings Acquisition Acts 10 Requisitioned houses 139 Stables & mews 10 Outworkers 556 Other visits 1,338 Notices Served. Statutory:- Housing Act, 1936: Section 9 776 Section 11 4 Section 12 12 Public Health Act, 1936: Section 24 59 Section 39 71 Section 45 10 Section 48 7 Section 79 1 Section 83 1 Section 84 1 Section 94 133 1,075 Informal 3,051 41 Defects remedied. Drains reconstructed 41 Drains repaired 199 Drains cleared 148 W. C. Cisterns repaired or renewed 128 W. C. Pans renewed 150 W. C. Pans cleansed 42 Waste Pipes repaired or renewed 150 Rain water pipes repaired or renewed 361 Roofs repaired or renewed 830 Eaves Gutters repaired or renewed 517 Drinking Water Cisterns renewed 15 Drinking Water Cisterns covered 11 Water Service Pipes repaired 71 Water Supply reinstated 29 Yards repaired or reconstructed 126 Sinks renewed or provided 62 Floors repaired or renewed 460 Floors ventilated 246 Dampness remedied- by insertion of damp-proof courses 157 by pointing of brickwork 198 by internal rendering 357 by miscellaneous remedies 205 Window Frames and Sashes repaired or renewed, or painted 614 Coppers repaired or renewed, or provided 26 Fireplaces, Stoves & Ovens repaired or renewed 438 Flues and Chimney Stacks repaired 175 Brickwork of Walls repaired and Walls rebuilt 86 Ventilated Food Stores provided 8 Rooms cleansed 1,473 Staircases, Passages & Landings cleansed 452 Staircases, Balconies & Steps repaired or renewed 115 Noxious Accumulations removed 25 Nuisances arising from Animals abated 12 Miscellaneous Defects remedied 588 42 Repair of Houses by the Councils. Work carried out in default or by agreement with owners during 1950:- Housing Act, 1936: £ s d Section 9 77 premises 4,035. 8. 5. Public Health Act, 1936: Section 24 44 premises 1,677. 15. 6. Section 39 30 premises 787. 5. 10. Section 45 2 premises 17. 7. 0. Section 79 1 premises 15. 0. Section 91 1 premises 102. 15. 9. 6,621. 7. 6. Summary of Disinfestation work during 1950. Cause Private Houses Council Houses Other Premises Total Houses Rooms Houses Rooms Houses Rooms Other Premises Ants 10 2 Nurseries 2 Schools 10 4 Beetles 44 40 3 Schools 2 Bakehouses 1 Shop 1 Laundry 44 40 7 Bugs 251 506 9 19 2 Factories 260 525 2 Fleas 3 5 3 5 Flies 2 4 1 Shop 2 Factories 2 4 3 Moths 1 4 1 4 Silver fish 1 1 1 1 Wood Beetle 4 4 4 4 Total 316 564 9 19 16 325 583 16 Disinfestation upon removal to Council dwellings was carried out in 169 instances. 43 PART IV FACTORIES AND SHOPS Tottenham has a number of industries in its area, and in addition to a general scatter of factories throughout the district, there is a concentration of industry between the River Lea and the High Road. Systematic and regular inspections are carried out and close co-operation is maintained with H.M. Inspectors of Factories. During their inspections the Sanitary Inspectors take the opportunity of visiting the factory canteens and discussing with the canteen staff the various aspects of food hygiene. With the growing trend for workers to have their meals in the works canteen, it is of the utmost importance that the highest standards of hygiene should be maintained in the handling and preparation of food. Factories Act, 1937 Inspections for purposes of provisions as to health (including inspections made by Sanitary Inspectors). Premises Number on Register Number of Inspect ions Written Notices Occupiers prosecuted (i) Factories in which Sections 1, 2, 3, 4 & 6 are to be enforced by Local Authorities. 66 15 2 - (ii) Factories not included in (i) to which Section 7 applies: (a) Subject to the Local Authorities (Transfer of Enforcement) Order, 1938. 660 408 38 - (b) Others - - - - (iii) Other Premises under the Act (excluding outworkers premises). - - - - Total 726 423 40 - 44 Cases in which defects were found. Particulars Number of cases in which defects were found. No. of cases in which prosecutions were instituted Found Remedied Referred To H. M. Inspector By H. M. Inspector Want of cleanliness (S. 1.) 4 4 - 1 - Overcrowding (S. 2.) - - - - - Unreasonable Temperature. (S. 3.) _ _ _ _ Inadequate Ventilation (S. 4.) 1 1 - - . Ineffective drainage of floors. (S. 6.) - - - - - Sanitary Conveniences (S. 7.) (a) Insufficient 3 2 - 1 - (b) Unsuitable or defective. 42 37 - 1 - (c) Not separate for sexes 3 3 - 1 - Other offences (not including offences relating to Outwork). 12 11 1 1 - Totals 65 58 1 5 - NOTE: 7 cases in which defects were found were outstanding at the end of the year. Outworkers (Sections 110 and 111) Regular visits are made by the Sanitary Inspectors to the homes of persons notified to the Department as outworkers. It has been found that the home conditions are generally satisfactory and that the cleanliness in such homes is usually above average. Nature or Work Section 110 Section 111 No. of outworkers in August lists required by Section 110 (i) (c) No. of cases of default in sending lists to Council No. of prosecutions for failure to send lists No. of instances of work in unwholesome premises Not ices served Prosecutions Wearing apparel 322 - - - - - Household Linen 63 - - - - - Brass & Brass Articles 162 - - - - - Artificial Flowers 13 - - - - - Making of boxes or other receptacles or parts thereof made wholly or partially of paper 182 - - 1 1 - Carding etc., of buttons 5 - - - - - Toys 89 - - - - - Lampshades 2 - - - - - Brush manufacture 7 - - - - - Feather sorting 5 - - - - - Making, etc., of Xmas Crackers 14 - - - - - Making, etc., of Umbrellas 1 - - - - - Fur pulling 1 - - - - - Totals 866 - - 1 1 - 45 Shops Acts. The supervision of shops, and effective adminstration of the Shops Acts is secured by the systematic visitation of shops by the Shops Acts Inspector, and an up-to-date register of shop premises is maintained. In the general adminstration of the Shops Acts, 3,238 inspections were made during the year. Most contraventions recorded have been minor defaults, and the non-exhibition of statutory notices, records of young persons hours of employment, in respect of which 289 verbal warnings and notices have been issued. Shops in the Tottenham (Reminder) Area are closed for the weekly half-holiday on Thursday, and in the Harringay Area on Wednesday, at 1p.m. with the exception of Butchers who close on Monday at lp.m. throughout the Borough subject to the alternative day (Saturday) in all cases. Close supervision is exercised in order to see that the weekly half-holiday is correctly observed, 145 visits being made for this purpose. 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 1.30p.m. The rule applies whether the shop is required to be closed for a weekly half-holiday or not. Meal Times. The requirements in respect of assistants' meal times are as follows:- Dinner:- If the hours of employment include the hours from 11.30a.m. to 2.30p.m. each assistant must be allowed an interval of threequarters 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 4.0p.m. to 7.0p.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 46 allowed during the course thereof. General Closing Hours. For the period of the winter months, 5th November, 1950, to 3rd March, 1951, an Order was made for the later closing of hairdressers' and barbers' shops in the Borough at 6.30p.m. There was no suspension of the General Closing hours during the period immediately prior to Christmas, 1950. Sunday Trading. The provisions of the Shops Act restricting Sunday trading are effectively enforced by means of systematic investigations and observations. 78 visits were made for this purpose. Shops Acts and Young Persons Employment Act, 1938. 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 the hours of employment of young persons, and the arrangements made for the health and comfort of shop workers generally. Complaints were received of assistants suffering severely from cold owing to the restrictions on the heating of shops last winter, and the frequent power cuts, which caused a good deal of absenteeism 193 special visits were made in connection with these Acts. It is gratifying to note that the provisions of the Shops Acts generally have been well observed. Shops Acts-Legal Proceedings. Legal proceedings were taken in the following instance:- The occupier of a shop was summoned for failing to close his shop at 1.0p.m. for the weekly half-holiday in contravention of the Tottenham (Remainder) Weekly Half Holiday Order. The defendant was fine £1.10s. 0d. and £1. 1s. 0d. costs. 47 PART V GENERAL Medical Examinations of Candidates for Employment in Established Posts of the Council. During the year 79 candidates were medically examined prior to admission to the superannuation scheme-3 failed to pass the examination. Establishments for Massage & Special Treatment. Part XII of the Middlesex County Council Act, 1944, provides for the annual licensing of establishments of this description. These are defined by the Act as "premises used for the reception or treatment of persons requiring:- (a) Massage manicure or chiropody; or (b) electric treatment or radiant heat light electric vapour or other baths for therapeutic treatment; or # (c) other similar treatments. Eight premises were licensed in the borough, The Council have submitted to the Home Secretary for approval draft byelaws for the regulation of these establishments. Persons in Need of Care and Attention. Previous Annual Reports have set out in some detail the main features of the way in which this work is carried out and the limitations in procedure discovered by practical experience. The problem of caring for the aged has not generally diminished; but notable improvement in the facilities for the aged sick has resulted from the setting up of a geriatric unit at St. Ann's General Hospital, Tottenham. An extension of this service, recently put into operation, followed consultations between the Physician-incharge and the Public Health Department. As is well known the demand on hospital beds for the aged sick far outweighs the availability. To assist the hospital in assessing the urgency of each case, environmental reports are submitted following visits by the sanitary inspector. Home conditions, mental outlook, availability of assistance and Other factors affecting elderly persons alleged to be in need of hospital care are set out in a report 48 sent to the hospital authorities. Conversely, reports are sent to the Health Department in cases where hospital patients are considered fit to be discharged to their homes. In these ways the hospital staff is better able to determine the urgency of a particular case and by an understanding of the home circumstances give assurance in some cases that early discharge from hospital may be effected and so improve the "turnover" of beds. It is satisfying to record that the co-operation of the two bodies is proving most successful. National Assistance Act, 1948. Section 47. It is a matter of regret that we continue to find cases which require action to be taken under the provisions of this Act, The following are example of cases dealt with:- (1) A complaint was received concerning the condition of an upstairs flat. Upon investigation it was discovered that the owneran aged lady-lived on the ground floor. She lived in conditions of utter squallor, and hardly moved out of the kitchen -mentally, however, she was reasonably alert Efforts were made topersuade her to clean up, and offers of home help were made. A suitable period of time was given before further visits were made, but no improvement took place. It was then discovered that she had sold the house and moved into another room on the ground floor Again efforts were made, without avail, to get her conditions improved Finally an application was made to the Magistrates Court for her removal. The removal duly took place, and the lady has subsequently been visited in the residential home. She is happy and well cared for, and has, what she most desired, warmth, food, and company. (2) A telephone message was received from a local doctor stating that he had a patient who refused to go into hospital. He requested assistance from the departments. A visit revealed that an old lady living in an upstairs flat, with her daughter, aged 54, had been confined to her bed for some days. The daughter was mentally deficient, and the downstairs tenant informed us that "neither had eaten anything for days." It was evident after a somewhat incoherent conversation with the old lady that she refused to go into hospital on account of her daughter. Relatives were contacted, and in the meantime application was made to the court. The relatives undertook to care for the daughter, and the court made an order. At the request of the department, the Doctor who requested assistance, was present when the removal took place and the old lady taken 49 into St. Ann's General Hospitals. Both the old lady and her daughter subsequently died, the daughter having been removed by the duly authorised officer. (3) For some time the department kept under observation the case of an old lady living alone in a ground floor flat. She was very bent and had badly ulcerated legs - she moved around with great difficulty. The rooms were littered with parcels and oddments which she alleged she was sending to friends. When it was suggested that she should go into a residential home she refused. It was finally decided to make an application to the court-this succeeded, and the old lady was taken into a residential home. She has been visited on a number of occasions. She has been in bed since the day of her admission. Public Health Laboratory Service. The Public Health Laboratory Service provides a comprehensive service for the bacteriological examination of specimens submitted by general practitioners and local authorities. The existing system for the supply of containers and the delivery of specimens by the Public Health Department remains unchanged. Specimens may be sent to the Public Health Department, and providing they reach there not later than 3.0p.m. on Monday to Friday, and 11.0a.m. on Saturday, they will be sent on the same day by special messenger to the Hornsey branch laboratory. As it is not possible to send a second messenger on any one day, it is essential that specimens be delivered to the Town Hall before the times stated. Alternatively, specimens may be sent direct to the Hornsey laboratory, which remains open until 5.0p.m. on Monday to Friday, and 12 noon on Saturday. The address is:- Public Health Laboratory, Coppett's Wood Hospital, Coppett's Road, N.10. A 24-hour emergency service is maintained by the Central Laboratory at Colindale. The following is a summary of the workcarried out during 1950, namely:- Record of Examinations Throat/Nose Swabs: Total Specimens 1,115 Diphtheria Bacilli 3 Haemolytic Streptococci 194 Vincent's Angina 5 Negative 913 50 Faeces: Total Specimens 273 Salmonella 25 Protozoa 19 Negative 229 Sputum: Total Specimens 14 T. B„ Smear 1 Other Organisms 5 Negative 8 Pertussis: Total Specimens 59 Post-nasal Swabs 5 Negative 54 Ice Cream: Total Specimens 41 Water from Swimming Pools: Total Specimens 3 Miscellaneous Specimens 601 Total number of Specimens 2,106 National Assistance Act, 1948: Section 50: Burials. During the year it was necessary to arrange six burials where deaths occurred, and no suitable arrangements for burial would otherwise have been made. 51 PART VI STATISTICAL SUMMARY Area of the District in acres 3,013 Pre-War Population 144,400 Registrar General's estimate of the Population:- Mid-year, 1950 129,400 Rateable Value £1,009,477 Sum represented by penny rate £4,060 Births and Deaths Registered live-births: Total Males Females legitimate 1,644 836 808 Illegitimate 83 39 44 1,727 875 852 Birth Rate (per 1,000 estimated population) 13.35 Stillbirths: Total Males Females Legitimate 28 15 13 Illegitimate 5 5 0 33 20 13 Stillbirth Rate per 1,000 total (live & still) births 18.75 Deaths Males 704 Total 1,382 Females 678 Death rate (per 1,000 estimated population) 10.68 Deaths from Cancer-Males, 142; Females 120 262 Deaths from Diphtheria - Deaths from Measles - Deaths from Whooping Cough 1 Deaths from Diarrhoea 2 52 Maternal deaths:- Puerperal Sepsis 0 Other Puerperal causes 0 Total 0 Maternal Death Rate (per 1,000 total live & still births) 0.00 Deaths of Infants under 1 year of age: Total Males Females Legitimate 36 19 17 Illegitimate 5 1 4 41 20 21 Infantile Death Rate (all infants per 1,000 live births) 23.74 Legitimate infants per 1,000 legitimate live births 21.9 Illegitimate infants per 1,000 illegitimate live births 60.24 The population shows a decrease of 640 under the figure of 130,040 for 1949; in 1938 it was 144,400. The birth-rate 13.35 compared with 15.45 in 1949 and 13.1 in 1938. Registered live births totalled 1,727, compared with 2,009 in 1949, the proportion of males to females being 875 boys and 852 girls. The infantile death-rate 23.74 was lower than the rate for 1949 24.89. Deaths in the first 4 weeks of life caused a neo-natal mortality of 17.95 per 1,000 live births, as compared with 17.42 in 1949. The maternal death-rate was 0.00 compared with 0.00 in 1949. The general death-rate of the whole population showed a decrease under the previous year-10.68 compared with 11.07. Deaths. The classification of deaths during 1950 is in accordance with the International List of Diseases, Injuries and Causes of Death, as revised in 1948 under the auspices of the World Health Organisation. 53 Births and Infantile Deaths Average Annual Rates Over 10-Year Periods 54 The object of the revision was to secure uniformity in morbidity and mortality statistics throughout the world. Such statistics provide the necessary numerical facts by which it is possible to evaluate health conditions and needs on an international basis and are the indispensable sources of information for guidance in the formulation of sanitary policies and measures. Deaths during the year 1950, of residents of the Borough of Tottenham classified according to Diseases. Cause of Death Males Females Total Tuberculosis of respiratory system 22 11 33 Tuberculosis other forms 2 5 7 Syphilitic disease 5 2 7 Diphtheria - - - Whooping Cough - 1 1 Meningococcal infections - 1 1 Acute poliomyelitis 1 - 1 Measles - - - Other infective & parasitic diseases 1 3 4 Cancer, malignant disease 142 120 262 Leukemia, Aleukemia 2 1 3 Diabetes - 7 7 Vascular lesions of nervous system 60 101 161 Heart diseases 211 218 429 Other circulatory diseases 18 27 45 Influenza 3 3 6 Pneumonia 20 24 44 Bronchitis 82 34 116 Other diseases of respiratory system 3 1 4 Ulcer of stomach & duodenum 18 3 21 Gastritis, enteritis & diarrhoea 2 2 4 Nephritis & nephrosis 4 5 9 Hyperplasia of prostate 20 - 20 Pregnancy, childbirth & abortion - 1 1 Congenital Malformations 4 8 12 Other defined & ill defined diseases 53 79 132 Motor vehicle accidents 11 3 14 All other accidents 14 10 24 Suicide 5 8 13 Homicide & operations of war 1 - 1 701 678 1,382 55 Infantile Deaths in Ages and Sexes daring the year 1950. CAUSE OF DEATH Under 1 week 1 week? 2 weeks 3 weeks Total under 4 weeks 1 - 2 months 3-5 months 6-8 months 9-11 months Total deaths under 1 year Males Females Bronchitis - - - - - 2 - - - 2 1 1 Congenital Malformations, Birth injuries, etc. 7 - 1 - 8 2 - - - 10 5 5 Diarrhoea and Enteritis - - - 1 1 - - - 1 2 1 1 Pneumonia 2 1 - 1 4 - 2 1 - 7 4 3 Prematurity 14 3 - - 17 - - - - 17 9 8 Other causes 1 - - - 1 - - 1 1 3 - 3 Totals 24 4 1 2 31 4 2 2 2 41 20 21 56 Statistics of Tottenham for the Last Twenty Years. Year Population Deaths Death Rate Births Birth Rate Infantile Deaths Infant Death Rate Number of Cases Puerperal Fever and Puerperal Pyrexia Scarlet Fever Diphtheria Typhoid Fever Small Pox 1931 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 1.57 2 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* 136.000 1.406 10.3 1.776* 1.739 12.5 66 37.95 15 335 60 - - 1940 119.400 1.703 14.26 1.666* 1.559 13.95 64 41.05 20 103 28 5 - 1941 105.620 1.418 13.43 1.560* 1.316 14.77 61 46.35 13 103 73 4 - 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 - - 1947 129.140 1.461 11.31 2.785 21.57 76 27.29 24 272 22 1 - 1948 130.000 1.377 10.59 2.233 17.18 53 23.73 5 260 3 - - 1949 130.040 1.440 11.07 2.009 15.45 50 24.89 16 251 4 - - 1950 129.400 1.382 10.68 1.727 13.85 41 23.74 9 356 3 - - * For the years 1939-1941 alternative birth figures were given by the Registrar General:(a) lor 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. 57 Infectious Diseases Average Annual Death Rates Per100,000 Population. 58 Table of Cases of Infectious Disease coming to the knowledge of the Medical Officer of Health during the year 1950, in the Borough of Tottenham, classified according to Diseases and Ages. Under 1 1 2 3 4 5-9 10-14 15-19 20-34 35-44 45-64 65 & up Total Total cases removed to Hospital M F M F M F M F M F M F M F M F M F M F M F M F Scarlet Fever 2 0 4 3 11 9 22 21 31 13 110 91 16 16 1 1 2 1 - - 1 1 - - 356 188 Measles 19 21 58 66 110 69 112 130 118 155 361 387 5 4 1 2 1 1 1 - - 1 - - 1,622 87 Whooping Cough 25 26 25 34 33 33 34 39 37 43 74 93 3 5 - - - 3 - 1 - - - 1 509 39 Pneumonia 3 2 2 - - 1 1 - - 3 3 4 2 2 - 1 5 8 7 6 16 16 10 16 108 26 Erysipelas - - - - - - - - - - - 1 - - 1 - 2 2 1 2 2 6 2 1 20 7 Scabies - - - - - - - - - 2 4 2 2 1 1 - 1 1 - 1 - - - - 15 - Food Poisoning - - - - - - - 2 1 2 2 1 - - - - 1 5 - 1 3 2 - - 20 3 Puerperal Pyrexia - - - - - - - - - - - - - - - 1 - 8 - - - - - - 9 2 Meningococcal Infection 1 - - - - - - - - - - - - - - - - - - - - - - - 3 3 Acute Encephalitis- - - - - - - - - - - - - - - - - - - - - - - - - - - Infective - - - - - -- - - - - - 1 - - - - - - - - - — - - 1 1 Post Infectious - - - - - - - - - 1 - - - - - - - - - - - - - - 1 1 Acute Poliomyelitis- - - - - - - - - - - - - - - - - - - - - - - - - - - Paralytic 1 - - - - - 1 - - 4 - - - - - - - - - - - - - - 7 7 Non paralytic - - - - - - - - - 1 - 1 - - - 1 1 - - - - - - - 4 4 Diphtheria - - - - - - - - - - - - - - - - - - - - - - - - 3 3 Dysentery - - - 1 1 - - - - - 1 - 1 - - - - 1 - - - - - - 5 5 Tuberculosis, Pulmonary - - - 2 - 1 - 1 - - 2 2 2 2 11 15 36 31 15 8 21 3 9 - 161 - Tuberculosis, Other forms - - - 2 - - - 1 - - - 1 - - 2 - 1 2 1 2 1 - - - 13 - 51 49 89 108 155 114 170 195 187 225 558 584 31 31 17 21 50 63 25 22 44 29 21 18 2,857 376 59 Birth-rates, Death-rates, Analysis of Mortality, Maternal Mortality and Case-rates for Certain Infectious Diseases in the year 1950 for Tottenham compared with the Registrar-General's provisional figures based on Quarterly Returns England and Wales 126 County Boroughs & Great Towns (including London) 148 Smaller Towns (Resident Population 25,00050,000 at 1931 Census) London Administrative County Tottenham BIRTHS -Rates per 1.000 Home Population- Live births 15.8 17.6 16.7 17.8 13.35 Still births 0.37 0.45 0.38 0.36 0.28 DEATHS All Causes 11.6 12.3 11.6 11.8 10.68 Typhoid and Paratyphoid 0.00 0.00 0.00 0.00 0.00 Whooping Cough 0.01 0.01 0.01 0.01 0.01 Diphtheria 0.00 0.00 0.00 0.00 0.00 Tuberculosis 0.36 0.42 0.33 0.39 0.31 Influenza 0.10 0.09 0.10 0.07 0.05 Smallpox - - - - - Acute Poliomyelitis (including polioencephalitis) 0.02 0.02 0.02 0.01 0.01 Pneumonia 0.46 0.49 0.45 0.48 0.34 NOTIFICATIONS (Corrected) Typhoid Fever 0.00 0.00 0.00 0.01 0.00 Paratyphoid Fever 0.01 0.01 0.01 0.01 0.00 Meningococcal Infection 0.03 0.03 0.02 0.03 0.02 Scarlet Fever 1.50 1,56 1.61 1.23 2.74 Whooping Cough 3.60 3.97 3.15 3.21 3.89 Diphtheria 0.02 0,03 0.02 0.03 0.02 Erysipelas 0.17 0.19 0.16 0.17 0.15 Smallpox 0.00 0.00 - - - Measles 8.39 8.76 8.36 6.57 12.54 Pneumonia 0.70 0.77 0.61 0.50 0.83 Acute Poliomyelitis (including polioencephalitis) Paralytic 0.13 0.12 0.11 0.08 0.05 Non-paralytic 0.05 0.05 0.06 0.05 0.03 Food Poisoning 0.17 0.16 0.14 0.25 0.15 DEATHS -Rates per 1.000 Live Births- All causes under 1 year of age 29.8 33.8 29.4 26.3 23.74 Enteritis and Diarrhoea under two years of age 1.9 2.2 1.6 1.0 1.16 NOTIFICATIONS (Corrected) -Rates per 1.000 Total (Live and Still) Births- Puerperal Fever and Pyrexia 5.81 7.43 4.33 6.03 5.23 60 APPENDIX Middlesex County Council. Local Area Health Committee No.3 (Hornsey and Tottenham) STATISTICAL RETURN FOR THE TEAR ENDING 31 st DECEMBER, 1950 Joint Population of Area-228,180 61 APPENDIX A National Health Service Act, 1946. Part III Services. Care of Mothers and Young Children. Notification of Births (a) Live births:- (a) Domiciliary 862 (b) Hospitals or Nursing Home 2,342 Stillbirths:- (a) Domiciliary 5 (b) Hospitals or Nursing Home 52 Total 3,261 (These are net figures allowing for transferable births) (b) Death ascribed to Pregnancy or Childbirths Number of women attended in area at home or in nursing homes where deaths were ascribed to pregnancy or childbirth Nil Total number of maternal deaths 2 (includes women admitted direct to hospital) Care of Mothers Ante-natal Clinics No. of sessions held No. of New Cases Total No. of attendances Average attendance per seeeion A.N. P.N. A.N. P.N. 9 1.082 2.594 1.303 19.006 1.331 18.7 (18.67) Separate Post-Natal Clinics are not held. Other Women's Clinics No. of sessions held No. of new Cases Total No. of attendances Average attendance per session Midwives' Clinics 257 26 2.306 8.9 62 Birth Control Clinics. No birth control clinic is provided. Number of cases referred to clinics run by Voluntary Associations Nil Care of Young Children Centres No. of sessions held First Attendances Total Attendances Total No. of Cases seen by Doctor Average Total Attendance per sess ion Under 1 year* Over 1 year* Under 1 year* Over 1 year Infant Welfare 9 1.503 2.735 290 41.171 15.062 14.894 37.4 Toddlers 6 278 - - - 3.563 3.533 12.8 Totals 1.781 2.735 290 41.171 18.625 18.427 34.1 *on date of first attendance Day Nurseries. Number of Days Open Sats. 20 39 20 20 20 20 20 39 198 Mon.Fri. 127 254 254 254 254 254 254 254 1,905 Attendances 2-5 yrs Sats. 24 291 83 93 52 14 51 117 725 Mon Fri. 2, 299 10,337 7, 560 6, 294 3, 132 6, 206 5,738 5, 879 47, 445 0-2 yrs Sats. 17 111 31 20 6 21 10 66 282 Mon.Fri. 721 4, 297 2, 017 2, 231 1, 597 3, 168 2, 199 4,166 20, 396 Number of Children on the Registers at end of year 2-5 years 47 42 28 14 35 29 29 224 0-2 years 20 4 12 9 13 14 18 90 Number of Approved Places 2-5 years 50 45 23 15 30 30 30 223 0-2 years 24 15 23 10 20 10 20 122 Day Nursery Clemence House Ladywell Stonecroft Red Gables Vincent House Park Lane Lordship Lane Plevna Cresc. Totals Number of Children on Waiting List as at 31st December, 1950 102 63 Priority Dental Service. Expectant Mothers Nursing Mothers Children Under 5 Number examined by Dental Officer 457 35 842 Number needing treatment 388 35 781 Number of New cases commenced treatment 377 45 711 Number of cases made dentally fit 220 35 559 Forms of Dental Treatment Provided:- Teeth extracted 335 42 637 Anaesthetics - (a) Local 123 15 122 (b) General 94 6 288 No. of fillings 526 31 1, 023 No. of root fillings - - - No. of crowns and bridges - - - No. of inlays 1 - - Scalings and gum treatment 210 13 125 Silver nitrate treatment 7 - 828 Dressings 92 2 646 Other operations 24 5 198 No. of Radiographs - (a) at C. C. Clinics 36 2 - (b) at Hospital - - - Denture Dressings 210 102 - Dentures provided - (a) Full 31 17 - (b) Partial 49 20 - Number of attendances 949 150 1,702 Number of appointments not kept 307 19 176 Number of half days devoted to Priority Dental Service 297 Midwifery Service. (a) Maternity cases attended. Midwives Employed by - Private Midwives County Council Voluntary Organisations under arrangement with local health authority Hospital Management Committee or Boards of Governors No. of Domiciliary cases attended as Midwife 708 - 17 4 No, of Domiciliary cases attended as Maternity Nurse 154 - - - 64 (b) Administration of Gas and Air Analgesia. Midwives employed by County Council Domiciliary Midwives employed in public midwifery service under Section 23 by voluntary organisations as agents of Local Health Authority Domiciliary Midwives employed in public midwifery service under Section 23 by hospital authorities as agents of Local Health Authority Domiciliary Midwives in private practice or employed by organisations NOT acting as agents of Local Health Authority No. of cases in which gas and air was administered by midwives in domiciliary practice during the year:- (i) When acting as midwife 352 - - - (ii) When acting as maternity nurse 89 - - - (c) Medical aid under Section l4 (1) of the Midwives' Act, 1918 (a) No. of Domiciliary cases in which Medical aid summoned:- (i) Where the medical practitioner had arranged to provide the patient with maternity medical services under the National Health Service 24 (ii) Others 162 Total 186 (b) For cases in Institutions 5 Health Visiting Services. Number of visits paid by all Health Visitors working in the area to:- FIRST VISITS TOTAL VISITS (a) Expectant Mothers 1,782* 4,562 (b) Children under 1 year 2,940* 11,386 (c) Children between 1 and 5 years 75* 16,658 (d) Children of school age 4 1,886 (e) Child Life Protection cases 3 25 (f) Adoption cases 3 20 (g) Other persons 922 1,589 Grand Total 36,126 * Excluding cases known to have been previously visited in this or another area. 65 Number of Health Visitors employed at end of year:- (a) Whole time on Health Visiting - (b) Part time on Health Visiting 29 (c) Equivalent whole time Health Visiting services provided under (b) (all classes including attendances at Child Welfare Clinics) 19 Home Nursing Service. Total Males over 14 Females over 14 M. and F. 14 & under Cases on Register on first day of year 268 79 187 2 New cases during year 2,375 737 1,424 214 Completed cases during year 2,302 711 1,378 213 Cases remaining on Register last day of year 341 105 233 3 Total number of visits during year 50,265 Number of Home Nurses employed at end of year:- (a) Whole time on Home Nursing 10 (b) Part time on Home Nursing 11 (c) Equivalent whole time of staff shown in (b) 7 Domestic Help Service. (a) Number of domestic helps employed on last day of year (whole-time) 17 (b) Number of domestic helps employed on last day of year (part-time) 147 (c) Number included in (b) who are employed on a guaranteed week basis - (d) Number included in (b) expressed in terms of whole-time home helps 83.6 Maternity Tuberculosis Other Total Number of approved applications for service of Home Help received 128 69 728 925 Number of new cases in which help has been provided 128 72 684 884 Number of old cases in which help has been provided 3 91 336 430 66 Vaccinations. Under 1 year 1 to 4 years 5 to 14 years 15 years and over Total (i) No. of persons Primarily vaccinated 665 280 47 126 1,118 (ii) No. of persons re-vaccinated - 1 26 333 360 (iii) Total No. cases specially reported* because of actual or alleged complications of vaccination (a) Generalised vaccinia - - - - - (b) Post vaccinal encephalomyelitis - - - - - (c) Death from complications or vaccination other than (a) or (b) - - - - - * In accordance with the Ministry of Health Circular 64/48, Para. 8. 67 Immunisation Age at date of notification No. of Children Immunised No. of Children re-inforcing injection No. of cases of Diphtheria notified No. of cases included in previous column in which the child had a full course of immunisation No. of deaths from Diphtheria No. of cases included in previous column in which the child had completed a a full course of immunisation Diphtheria only Combined Diphtheria and Whooping Cough Whoop ing Cough only Under One 364 2 96 - - - - - One 1,698 71 138 - - - - - Two 133 14 50 1 1 - - - Three 67 3 16 - 1 - - - Four 50 6 8 9 1 1 - - Five to Nine 89 1 5 232 - - - - Ten to Fourteen 23 1 - 35 1 - - - Total 2, 424 98 313 277 4 1 - - 68 B„ Education Act, 1944 School Health Service Periodic Medical Inspection Entrants Periodic Medical Inspections Total Other Periodic Inspections Second Age Group Third Age Group 4,694 1,953 1, 938 8, 585 2,035 Other Inspections. Special Inspections Re-inspections 5,139 6,159 Classification of the General Conditions of Pupils Age Group No. of Pupils Inspected A (Good) B (Fair) C (Poor) No. % No. % No. % Entrants 4,694 1,842 39.2 2,786 59.4 66 1.4 Second Age Group 1,953 798 40.9 1,124 57.6 31 1.5 Third Age Group 1,938 843 43.5 1,059 54.6 36 1.8 Other Periodic Inspections 2,035 785 38.6 1,222 60.0 28 1.4 Total 10,620 4,268 40.2 6,191 58.3 161 1.5 69 Defects Found by Medical Inspection. Defect or Disease Periodic Inspections Special Inspections No. of Defects No. of Defects 1 2 1 2 Skin 4 23 518 29 Eyes (a) Vision 368 52 203 28 (b) Squint 55 23 12 3 (c) Other 13 13 277 9 Bars (a) Hearing 29 25 26 4 (b) Otitis media 6 31 93 4 (c) Other 7 9 163 11 Nose and Throat 203 299 396 52 Speech. 31 57 14 8 Cervical Glands 9 72 24 3 Heart and Circulation 22 77 68 15 Lungs 6 153 208 29 Developmental - (a) Hernia 1 20 3 - (b) Other 1 28 23 3 Orthopaedic - (a) Posture 27 67 4 - (b) Flat foot 67 91 39 1 (c) Other 114 87 148 22 Nervous System - (a) Epilepsy - 9 8 1 (b) Other 2 15 46 - Psychological - (a) Development 3 27 25 3 (b) Stability 6 43 106 3 Other 23 156 2,474 397 1. Requiring treatment. 2. Requiring to be kept under observation but not requiring treatment. 70 Pupils found to require treatment Number of individual pupils found at periodic medical inspection to require treatment (excluding dental disease and infestation with vermin). Group For defective vision (excluding squint) For any of the other conditions recorded Total individual pupils Entrants 17 333 330 2nd Age Group 118 118 226 3rd Age Group 132 67 190 Total (prescribed groups) 267 518 746 Other periodic inspections 101 84 179 Grand Total 368 602 925 Minor Ailments. (a) Disease of the Skin (excluding uncleanliness) Number of cases treated or under treatment during the year. by the Authority Otherwise Ringworm - (i) Scalp 1 - (ii) Body 20 - Scabies 21 - Impetigo 89 - Other skin diseases 463 14 Total 594 14 (b) Other treatment given not covered by other Tables Number of cases treated by the Authority Otherwise (i) Miscellaneous minor ailments 7,411 214 (ii) Others (specify) - Conjunctivitis 13 - Heart circulation 58 18 Lungs 184 73 Developmental 29 6 Psychological 138 24 Total 7,833 335 71 Eye Diseases, Defective Vision and Squint. Number of cases dealt with by the Authority Otherwise External and other, excluding errors of refraction and squint 361 10 Errors of Refraction (including squint) 2,171 158 Total 2,532 168 Number of pupils for whom spectacles were - (a) Prescribed 1,276* 125 (b) Obtained 1,027# - * Including cases dealt with under arrangements with the Supplementary Ophthalmic Services. # Known to be incomplete as glasses supplied direct to patients by National Health Service Opticians. Diseases and Defects of Ear, Nose and Throat. Number of cases treated by the Authority Otherwise Received operative treatment - (a) for diseases of the ear - 4 (b) for adenoids and chronic tonsillitis - 151 (c) for other nose and throat conditions - 2 Received other forms of treatment 3, 066 62 Total 3, 066 219 Orthopaedic and Postural Defects. (a) Number treated as in-patients in Hospitals 6 By the Authority Otherwise (b) Number treated 1, 196 26 (c) Council Orthopaedic Clinics Clinics No. of new cases Total attendances 2 718 4, 660 72 Child Guidance and Speech Therapy. No. of Pupils treated. Child Guidance Speech Therapy (i) By the Authority 175 688 (ii) Otherwise 85 8 Dental Inspection and Treatment. Age Groups No. inspected No. found to require treatment No. referred for treatment under Local Authority arrangements to County Council Clinics (i) (ii) (iii) 2-4* 132 60 39 5 591 389 259 6 655 443 303 7 780 542 381 8 651 432 331 9 556 394 265 10 595 416 270 11 751 389 258 12 893 517 354 13 803 461 302 14 737 429 265 15 190 95 63 16 St over 62 26 17 Specials 4,643 4,438 4,413 Total 12,039 9, 031 7, 500 * Nursery Schools only. iv. Number of pupils actually treated 7,170 iv(a). Number of pupils treatment completed 5, 321 v. Number of attendances made by pupils for treatment 12, 586 vi. Number of half days devoted to - (a) Inspection 35 (b) Treatment 1,461 (c) Other duties 10 Total 1, 506 vii. Fillings - Permanent teeth 5, 238 Temporary teeth 1,704 Total 6, 942 73 viii. Number of teeth filled. - Permanent teeth 4, 455 Temporary teeth 1,690 Total 6,145 ix. Extractions - Permanent teeth 833 Permanent teeth for Orthodonture 264 TOTAL Permanent teeth 1, 097 Temporary teeth 7, 428 Total 8, 525 X. Anaesthetics - (a) General 1, 480 (b) Local 3, 376 xi. Other Operations - (a) Permanent teeth 1,342 (b) Temporary teeth 3, 569 Total 4, 911 xii. (a) Scaling 209 (b) Gum treatment 73 Special Dental Treatment Undertaken by Dental Officers. Number of root fillings 8 Number of crowns and bridges 4 Number of inlays 2 Number of impressions, etc 105 Number of radiographs - (a) at Dental Clinics 50 (b) at Hospitals - Number of Dentures fitted 22 Number of caps fitted to fractured teeth 30 Number of Special Surgical operations 9 74 Orthodontic Examination and Treatment. Age Group No. of pupils examined at the clinic for treatment by: - No. of pupils referred for treatment by:- Orthodontic Surgeons Dental Officers Orthodontic Surgeons Dental Officers 5 years - - - - 6 " - 1 - 1 7 " - 17 5 12 8 " - 14 4 4 9 " - 12 3 8 10 " - 11 1 10 11 " - 8 2 6 12 " - 3 - 5 13 " - 5 1 4 14 " - 4 - 4 Total - 75 16 54 Orthodontic Surgeons Dental Officers Number of pupils commenced treatment (First attendance) - 73 Number of attendances made for treatment - 1, 205 Number of impressions, etc. - 332 Number of fixed appliances fitted - - Number of removable appliances fitted - 185 Number of pupils treatment completed - 87 Number of radiographs - (a) at Dental Clinics - 67 (b) at Hospitals - - Number of orthodontic sessions (half days) - 94 Infestation with Vermin. Total number of examinations 81,798 Total number of pupils found to be infested 1,334 Total number of individual pupils found to be infested for the first time during current year 527 Number of individual pupils in respect of whom cleansing notices were issued. - (Section 54/2, Education Act, 1944) Number of individual pupils in respect of whom cleansing orders were issued. - (Section 54/8, Education Act, 1944) 75 Employment of Children and Young Persons. 1. Number of children medically examined in order to ascertain whether they were physically fit to undertake employment of a light nature outside school hours 139 2. Number of instances in which the state of health was found to be such that certificates were withheld - 3. Number of children examined as to fitness to take part in entertainment 12 4. Number of cases in which certificates to take part in entertainments were withheld - Education Act, 1944 - Sections 57(3), 57(4) and 57(5). Cases dealt with under Section 57, Education Act, 1941:- Sub-Section 3 14 Sub—Section 4 - Sub—Section 5 1 Cases de-notified under Section 8, Education (Miscellaneous Provisions) Act, 1948 1 Medical Examination of Teachers. (a) Number of Teachers examined as to fitness for appointment 53 (b) Number of Students examined as to fitness for first appointment 12 Medical Examination - Other Staff. (a) Home Helps. 84 (b) Drivers 28 (c) Professional, clerical, etc. 83 76 Return of Handicapped Pupils, year ended 31st December, 1950. CATEGORY ASCERTAINMENT DISTRIBUTION (as at last day of year) No. of ascertained Cases known 1st day of year No. of New Cases ascertained during year No. of ascertained Cases known last day of year In Special Day Schools In Special Residential Schools In Maintained Primary and Secy. Schools In Independent Schools Not at School Total B G B G B G B G B G B G B G B G B G Blind Pupils 5 2 - 3 4 5 - 4 4 - - - - - 1 4 5 Partially Sighted Pupils 8 9 2 6 7 12 6 9 - - 1 2 - - - 1 7 12 Deaf Pupils 10 6 2 1 11 6 7 5 3 1 - - - - 1 - 11 6 Partially Deaf Pupils 5 5 6 2 11 6 5 5 2 - 2 - - - 2 1 11 6 Delicate Pupils 46 17 42 31 34 28 2 1 22 21 9 6 - - 1 - 34 28 Diabetic Pupils - - - - - - - - - - - - - - - - - - Educationally Sub-Normal Pupils 66 52 18 11 67 49 39 31 4 - 22 18 1 - 1 1 67 49 Epileptic Pupils 3 5 - 3 1 7 - - 1 4 - 2 - - - 1 1 7 Maladjusted Pupils 25 6 50 18 62 17 - - 10 3 50 12 - - 2 2 62 17 Physically Handicapped Pupils 37 33 4 8 30 29 25 25 2 1 - 1 - - 3 2 30 29 Pupils with Speech Defects 95 37 69 34 153 56 - - - - 142 54 2 - 9 2 153 56 Pupils with Multiple Defects 8 3 2 - 4 2 2 1 - 1 1 - - - 1 - 4 2 Totals 308 175 195 117 384 217 86 77 48 35 227 95 3 - 20 11 384 217 Grand Totals 483 312 601 163 83 322 3 31 601 Children not ascertained as H. P. but recommended convalescence B G in Holiday Home or Camp School during year ended 31st December, 1950 116 138 77 Orthoptic Treatment. Number of New Cases Total Attendances 81 1,066 In addition, 4 cases were referred to hospital for orthoptic treatment. Chiropody. Expectant and Nursing Mothers and School Children. Expectant and Nursing Mothers BOYS GIRLS 0-5 5-10 10-15 Total 0-5 5-10 10-15 Total Attendandes - FIRST 40 13 21 54 88 9 36 102 147 SUBSEQUENT 46 8 69 190 267 11 134 511 657 CONDITION - Cases treated at Clinic Flat Feet 2 5 1 7 13 1 6 12 19 Callosity 59 - 3 22 25 1 10 32 45 Corns 48 8 6 25 39 4 19 43 66 Deviation of Great Toe 18 - - - - - 1 5 6 Pains in Forefoot 19 - - - - - - 3 3 Foot Strain 1 - - - - - - - - Excessive Perspiration 2 - - 6 6 - 1 8 9 Toes, Clawed 10 2 1 2 5 6 5 17 28 Foot Wart 10 7 71 183 261 10 137 485 63 2 Nails, Club 4 2 3 4 9 2 3 1 6 Ingrowing Nail 4 - 1 1 2 - - 1 1 Infected Bullae - - - - - - - 1 1 CONDITIONS - Cases referred to Orthopaedic Clinic. Hammer Toe - 1 - - 1 - - - - Flat Foot - 6 1 5 12 1 5 7 13 Tailor's Bunion - - - - - - - 1 1 Contracted Toes - 2 - - 2 1 - 3 4 Knock Knee - 5 1 - 6 1 2 3 6 Deviation of Great Toe - - - 2 2 - - 2 2 Toes Clawed 1st 2nd Qtr. - - 1 - 1 1 1 3 5 Retracted Toes 2nd Qtr. - - - - - - 1 — 1 PUBLIC HEALTH IN TOTTENHAM. 1850 - 1872. A hundred years ago Tottenham was in the forefront of public health, as it has been for as long as any of its present inhabitants can remember. It is natural to assume that the two circumstances are connected and that the local government history of the Borough is rather prosaic, with progressiveness and efficiency as constant features of the local administration. The true story is very different and has a much more epic quality. There was a time near the end of the first quarter of its sanitary history when the town was mocked and shunned for the rottenness of its public management. Within a decade it made a brilliant recovery and it redounds to the credit of the inhabitants that by their own efforts they so quickly regained for their town its former good name. The present study of Tottenham covers the period of its rise and fall. It records, to borrow Mr. Arthur Bryants' felicitous phrase, Tottenham's "Years of Endurance". The students of the History Study Group of the London School of Hygiene and Tropical Medicine hope on some future occasion to record in similar fashion the period 1873 to 1900, Tottenham's "Years of Victory". 1 PUBLIC HEALTH IN TOTTENHAM 1850 - 1872 "TOTTENHAM", according to the 1845 edition of Kelly's Directory for London and the Home Counties, "is a suburban town, a railway station and a parish. " It is a cryptic description; but it does by chance effectively concentrate attention on just those features of the place around which its subsequent history turned, For it was the railway - in 1845 a novelty of two years' standing - which, in due course, gave a twist to the character of the quiet, exclusive and quite modern little suburban town, setting it off to swallow up the whole of the ancient and extensive rural parish and so to face the appalling problems of rapid unplanned urbanisation. These are the foundations of Tottenham's mid-nineteenth century history whether the subject is approached from a social or economic or, as in the present case, from a sanitary point of view. The Directory, in its dry way, has something more to tell. The population "is approaching to 9,000". Of this number it lists 575 by name-228 of them under the heading of "gentry" and the balance as "tradesmen". When compared with sililar information provided by the Directory for other districts in and around London, Tottenham stands out as particularly well supplied, for its size, with tradesmen (a category which after the manner of the day included also certain professional classes for there are, for example, no fewer than twelve surgeons and physicians in the trades list) and as strikingly flush with gentry. It was a characteristic of the town to which every contemporary writer makes reference. Albert Hill and Mrs Couchman in their separate "Reminiscences",Frederic Compton in his "Recollections" of the neighbourhood and William Robinson in his robust history of the parish, all write of the fine mansions and villas straddling the High Road and the lesser roads, where men of independent means or London merchants, bankers and business men - no longer impelled to live in and over their City offices, shops and warehouses found it so convenient and so healthy to live. The attraction of Tottenham, as one writer puts it, was that it lay "out of reach of London smoke cloud": and this was an advantage it shared with a number of other "suburban towns" such as Highgate, Norwood, Sydenham and Blackheath, it had scarcely a rival on the score of accessibility. The great Cambridge to London turnpike passed on through Islington and Shoreditch to the heart of the City. Forty minutes in phaeton, gig or carriage, or, for the less fastidious, an hour in Issac's omnibus, and a gentleman could be at his office desk. Behind him he left the local tradesmen and artizans busy in their shops and workrooms and numbers of women and children who worked at the two fitfully active local "manufactories", the one producing crape and the other "India rubber". This hive of activity was mainly confined to the High Road and the adjoining courts and lanes; some of which straggled eastwards, among a warren of cottages where the poorer classes lived, to the marshes and the Lea River. 2 To turn from this brief glimpse of the social and physical structure of the little town a hundred years ago to its cultural and moral pattern an aspect which in the nature of things is intimately linked with any community's attitude towards hygiene - would be difficult were it not that Mr. James Dean, long resident in Tottenham, an agricultural engineer, surveyor and property owner, and a man who had held many public offices in the parish, obligingly compiled a short pamphlet in 1843 entitled "Tottenham and its Institutions." His primary object was to record the great number and variety of philanthropic and provident societies, endowed charities and denominational day and Sunday schools to be found in the place. The list was a substantial one. There was the Garden Allotment Society which provided garden plots "for the respectable and industrious labourer"; the Accumulating Fund Society - really a Building Society "to induce small tradesmen to become provident"; the Savings Bank "under the management of sixty-three gentlemen of the parish" to encourage providence in the lower classes; the Ladies Bible Society and the Church of England Book Lending Library and Clothing Club; the Provident Sick Society and the Lying-in Charity; the Mechanics Library; the Society for Encouraging Industries; the Temperance Society; three separate Almshouse Funds; the free grammar school and various schools for boys and girls supported as separate enterprises by five religious denominations; two infants' schools "to provide useful instruction and careful discipline for the younger children of the poor for a few hours a day while the parents earn something to supply the wants of their families " a formidable volume, indeed, of social services, without taking into account the well regulated poor relief which the ratepayers were providing under the reformed Poor Law. One drawback, as Mr Dean called it, in his parish's near-perfect social system lay in "the fluctuations in the manufacturing processes; at one time active and flourishing and the people get wages and live well, at another time the works are still, distress ensues, immorality abounds and the land and houses have to bear the burden of relief," He concludes, nevertheless, that "few parishes are better off than Tottenham and nowhere are the blessings of Providence more bountifully bestowed upon the poor and the needy of good character by the prosperous and rich." In regard to the general administration of the parish Mr. Dean could give an almost equally favourable account. The clergy "are earnest and exemplary"; the two resident magistrates "upright and merciful"; the parochial officers "perform their several duties efficiently and economically and there is no expenditure of any sort that does not undergo the strictest scrutiny." Within recent years too, there had been a number of progressive developments in the conduct of local affairs. Much parish business of various kinds, formerly conducted under the centuries old system of vestry rule, had been deflected, in the main with the approval of the ratepayers, to newly established "ad hoc" bodies, each of sufficient independence to levy its own rate. In 1833, for example, the inadequate parish constabulary had been absorbed by the Metropolitan Police and the parish now enjoyed "a well regulated police" of a sergeant and twelve 3 constables. A few years later the most onerous of local responsibilities, the relief of the poor, had passed by the Poor Law Amendment Act from the Tottenham Select Vestry-with, according to a "Times" report, "the hearty approvalof that body" - to the united Board of Guardians which served for both Tottenham and Edmonton; to which new body the ratepayers of the parish elected their representatives without reference to the Vestry. With the adoption of the Turnpike Lighting Act in 1841 another body independent of the Vestry had been created - the Lighting Inspectors; and Mr. Dean could record . that "the principal thoroughfare is well lighted and so are the other highways" by means of gas from the Imperial Gas Company's works. Similar in its independence of Vestry rule, a Local Board of Surveyors - to whom Mr, Dean gave credit for "the highways and public walks being in the best condition" - had been set up in 1835 under the General Highways Act. The developments were piecemeal; but within a decade a minor revolution in the parish's administration had been effected. The old allFurpose Vestry rule had been left with little more than the maintenance of the Church and the trusteeship of the common lands and endowed charities as its sphere, and with the quarterly Vestry meetings as a crude device for ventilating opinion on public affairs - a function filched from it, too, in due course by the correspondence columns of the press, when local newspapers made their appearance. But despite these 'improvements' and despite the modernity and greater efficiency of the new arrangements Kr. Dean had to record a serious weakness in this model parish. "There is, I lament to say, one drawback in the character of this otherwise exemplary parish and a very serious drawback it is:-the want of powers to compel the cleansing of the open sewers and drains which so materially affect the health of those who inhabit between the Turnpike road and the river Lea in the precincts of the marshes. There is generally a malaria floating over the low wet lands; when the stench of neglected drains mixes with it, fever and bowel complaints follow, especially among the poor." Kr. Dean had discovered Tottenham's Achilles' heel. But if its sanitary condition was Tottenham's weakness, the same was true of all England. In the previous year (1842) there had appeared the first thorough exposure of the filthiness of the English towns: an official report of the Poor Law Commissioners entitled "The Sanitary Conditions of the Labouring Classes, " written by their secretary, Edwin Chadwick, the foundergenius of the English sanitary reform movement. The phraseology used by Mr. Dean in describing Tottenham's nuisances was Chadwick's and there can be no doubt that it was his report which had pricked Mr. Dean into an awareness of local evils which were, in fact, of long standing. They had been there in 1832 when under the shadow of the first great epidemic of Asiatic cholera, Tottenham, in common with so many other parishes, had been forced to take notice of its stagnating sewers and fouled water supPlies. Vestry administration was not geared for speedy action, and the 4 temporary Board of Health which was quickly established to avert a panic owed more to the initiative of a few of the leading inhabitants than to any effort on the part of the local authority. There had been twenty deaths from cholera in the parish before the subsidence of the epidemic and the disbandment of the Board; but they had occurred mainly among paupers in the workhouse and Tottenham, it was said, "had escaped the pest with comparative immunity." Certainly nothing permanent had been done by the Board to abate the sanitary nuisances, for a few years later they were being regularly represented to the Board of Guardians by Mr. William Hall - a young surgeon recently settled in the area - whom they had appointed in 1838 as their first parish medical off icer Fever cases, he kept reiterating, were constantly cropping up in the cottages which lay alongside the Moselle and the Carbuncle: once clean and natural streams they had been allowed to degenerate into nothing more or less than filthy open sewers. The Guardians' minutes for the same period also record many complaints of annoyances attributed to the sewers from private individuals. The Board had usually acted on the information by issuing warnings to the parties said to be responsible, but it was powerless to go beyond remonstrances for it was never quite clear where the real responsibility for remedying the nuisance lay. Mr. Dean, however, once he was alive to the situation, was bent on action. After carrying out a survey of the streams in conjunction with one of the local surgeons, he personally took out a summons against the local Board of Surveyors (a procedure so little precedented that the case was reported in "The Times") in an attempt to compel the surveyors to clean up the sewers by exercising certain optional powers given them by the Highways Act for "clearing ditches and water courses" The magistrates though sympathetic, had felt bound to dismiss the case for the law on the point was weak and confused. In recounting this experience Mr. Dean concludes:- "Sincerely must every sympathiser with suffering humanity desire that the Bill introduced into Parliament in the last session with a view to improve the drainage of land and the sewerage of cities, towns and other populous places, may soon pass into law; then will Tottenham again become that healthy pleasant village for which it has long been esteemed over most other places in the vicinity of the Metropolis." The Bill of 1843 to which Mr. Dean made reference was, in fact, stillborn. But his efforts were not entirely wasted Shortly afterwards he was himself elected by the Vestry to membership of the Board of Surveyors and soon afterwards there are hints in the Vestry minutes that the Surveyors had become almost alarmingly zealous and inclined to embark on legal proceedings in fulfilling their responsibilities, From 1846, too, the Board of Guardians, having been vested with greater powers by the Nuisance Removal and Disease Preventive Act of that year, became, so its minutes show, more effective as a nuisance removal authority: summonses in increasing numbers being taken out for "overflowing cesspools , 5 "accumulations of noxious and offensive matter" and similar nuisances. All the evidence makes it quite clear that dating from about the time Mr. Dean's pamphlet on Tottenham was published there was a growing body of opinion in the parish in favour of something being done about the local sanitary conditions, and that it was coming to be widely recognised that the key to improvements lay in the energetic use of statutory powers. PUBLIC HEALTH ACT, 1848. Considerable, it may be thought too much, time has been spent in disentangling the threads of a mere precursory phase in the parish's sanitary history. But without knowing something of the background it would be impossible to understand how it came about that Tottenham got off to such a flying start when a way was first opened for the lesser towns and parishes of England to try their hand at sanitary administration, and so became for nearly a decade a model for the country. Chance and circumstance had equipped the parish well for progressiveness in this matter. The healthiness of the place had been the bait on which the little town had established itself as a favoured place of residence for the well-to-do; prestige and every consideration of self interest demanded the preservation of this reputation, Then again, the peculiar local social structure ensured the presence of an unusually high proportion of educated, public spirited men, requisite for putting an improving policy into practice. Finally, as we have already seen, some fraction of the inhabitants had been "tuning in" so to speak to the sanitary idea for a number of years. So that in 1848, when the opportunity came, the parish's sanitary aspirations were formed and ripe for development. Up to this time effective, and that implied statutory, sanitary measures had been within the reach of only the largest and wealthiest towns. For there was no public and general sanitary act which a town might adopt and the costliness of the alternative, namely the procuring of a local improvement act - which was how the Liverpools and Manchesters first procured sanitary powers - was prohibitive for a small town. With the coming into force of the Public Health Act in 1848 an easy and cheap way of obtaining local sanitary powers was open to any place, no matter how small By the Act, a board of health could be set up locally and empowered to take up the management of sewers and drains, the provision of water supplies, the inspection of slaughter houses, the paving of streets and a host of similar hitherto neglected functions: and to levy a rate for these services- The procedure was simple. "Upon the petition of not less than one tenth of the inhabitants rated to the relief of the poor in any place," the General Board of Health (the central department created by the Act for public health purposes) would send one of its superintendent inspectors to hold a public inquiry into the relevant local circumstances, If all went well for the petitioners an order in council would follow, 6 putting the Act locally into force. The first thing for Tottenham to do, therefore, was to prepare a petition. It is, however, one of the few flaws in the astonishingly well documented history of the place that we do not know precisely howorwhen its petitioning was done; we simply know in this connection that Tottenham and a number of other places acted with a swiftness that was embarrassing from the point of view of the General Board. The Act was passed and the General Board came into existence in August, but it was not until November that it got down to keeping minutes and it was sometime during that nonminuted period that petitions from about two dozen places, including Tottenham were formally lodged at the Board's office in Gwydyr House, Whitehall. When a complete, up-to-date and chronological list of petitions was published in December, 1848, Tottenham stood seventh in a list of seventy places. There is some rather flimsy evidence suggesting that it was actually in the previous September that a public meeting had been held in Tottenham, at which the petition was drawn up complete with signatures to the number of 157: a figure which was almost exactly one tenth of the ratepayers, no attempt having been made to do more in this direction than satisfy the minimum requirements. At this stage Tottenham's enthusiasm suffered a series of mild rebuffs. The Metropolitan Commissioners of Sewers had just been established and Tottenham's petition was shelved for three months until it was officially announced that the new Commissioners were not going to spread their net to include Tottenham. While this difficulty was being disposed of a threat of cholera descended on the country and the General Board became so preoccupied with cholera prevention that its inspectors could only manage a trickle of inquiries, Tottenham seemed even to be losing its place in the slow queue and in January, 184-9, the Vestry set up a Sanitary committee of eight members, (including both Mr. Dean and Dr. Hall) with instructions to press the General Board for a firm date for the enquiry andmeantime to collect detailed information about conditions in the parish Early in April the enquiry was at last held and the inspector's report, favourable to the formation of a local board, was quickly available in print. But there, owing to the overloaded state of the General Board's business, the matter again hung fire for months. Just at this time Tottenham for a few weeks knew its second experience of epidemic cholera, but with only twelve deaths it once more escaped lightly in comparison with some of its neighbours. At last in January, 1850, the long awaited Order in Council appeared in the official gazette. And so on the next quarter day, 25th March, 1850, the rated inhabitants, casting their votes for the first time in an election for membership of Tottenham Local Board of Health, saw their parish launched as a responsible local authority. Tne printed report of the inspector referred to in the last paragraph is an interesting document and a useful guide to the nature of the tasks which faced the new Board. It was the work of Mr. William Ranger, C. E.; one of the most experienced of the six superintendent inspectors 7 employed by the General Board, and his expert exposure of the parish's sanitary deficiencies dwarfed to insignificance Mr. Dean's earlier amateurish observations on the subject. Mr. Ranger marshalled his facts and figures in a much more telling fashion. He remarked on the local increase in population - 20% in a decade and on the relatively smaller increase in the number of houses in the same period. He picked on overcrowding as a major evil in parts of the parish. "The house accommodation of the poor is chiefly to be found in lanes, courts and alleys, without drains, ventilation or a supply of water and, in addition, much overcrowded; in some parts a family to a room; hence we have a large amount of disease which, although not producing great mortality, still is approbrious to the place and a heavy burden on the ratepayers" He went on to cite examples. In Union Row, where there were thirty-four houses with one-hundred and fifty-three persons, from thirty to forty cases of fever had occurred in the previous autumn. In another row of six houses (almost the only ones in the parish, so it appeared, with rooms below ground level) there had been thirty-three cases of typhus. As a particularly glaring example of the baneful effects of overcrowding he mentioned Alfred Cottages, where a man, his wife and six children occupied a single room: "the man ill in bed, one boy sick with smallpox and the whole in a filthy state." He had found deficiencies in the ventilation of houses on a wholesale scale; no fewer than twenty-three courts, yards and alleys, comprising 256 houses and 1,198 occupants, were so built up at the ends and backs as to preclude the possibility of through ventilation. In regard to water - "an element with which the district abounds in common wells, streams and rivers," - many of the sources were so grossly polluted that "large masses of the poorer classes are destitute of any supply, except upon purchase at rates of a farthing a gallon obtained from distant streams through the agency of a dozen regular water carriers." Of the public sewers he wrote "the general drift of the evidence adduced showed that there are but few sewers, the inhabitants having availed themselves of the river Moselle, the Carbuncle and other ditches." At least BOO houses passed the overflow from their cesspools or privies direct into the Moselle in its "tortuous course through the centre of the parish." Every ditch and watercourse was fringed with privies and where there were no ditches the sullage from cesspools and privy-pits was thrown into the street. In one part of the village each privy was common to six houses and for 486 houses accommodating 2,048 of the inhabitants the available Privies amounted to 356 in all. Of paving, the parish could boast only 100 yards in the six miles; of footpath and kerbs, less than a mile in fifteen miles of parish roads. He found it difficult to understand how the local board of surveyors - "all of whom are unpaid and irresponsible" could account for the expenditure of the £700 yielded by the highway rate in the previous year. It was a grim tally of defects for a parish priding itself on its healthiness and modernity; where the inhabitants, for the most part, had been thinking of sanitary reform merely in terms of some simple system of 8 covered sewers for the relief of their noses. Nor was it any part of Mr. Ranger's or the General Board's policy to soften the blow; as might so easily have been done either by comparing Tottenham with many other "suburban towns" which, when tested by an inquiry, had proved even more sanitarily rotten or by contrasting its annual death rate of 17.5per 1,000 of the inhabitants with the rates of, say, the City of London or all England, namely, nearly 30 and 22 respectively. On the other hand, when it came to a question of prescribing "remedies", as he called them, Mr. Ranger made it very much his business to play down the difficulties and the financial implications. Tottenham, he understood, lay over "an inexhaustible supply of water well adapted for every domestic purpose" in the sand stratum between the clay and the chalk; in view of the natural pressure of this supply, once deep wells had been sunk "only a very moderate expenditure of engine power will be required for delivering a constant supply of water to every house at all times, as by night as by day, for domestic use and baths without the trouble of filtering or cost of reservoirs." Drainage and sewerage of the whole parish could be arranged on a two-fold plan; in which surface water would be run into the Moselle and other streams on the one hand while the ample water supply would enable the sewage to be flushed along in twelve inch tubular main sewers to the river meadows and the marshes where, by a system of irrigation, the liquid manure would greatly improve and enhance the value of the land. As for house drainage, a figure of £2. 5s. 0d. per house or less than three farthings a week per house if spread over as an improvement rate-would provide sink, syphon-tap and pipes including, a rainwater drop-pipe, head and trap to every two houses Paving for the fronts and backs of tenements might be had at a farthing a week by using "the new asphalt, " which cost so much less than Yorkshire stone. In fact, when aggregated in an improvement rate the cost of all these benefits should not exceed fourpence a week per house. These modest and dream-like estimates of Mr, Ranger's no doubt served his immediate purpose by disarming any opposition to reform on the grounds of ruinous rates, but subsequently they seriously embarrassed the Local Board by providing a legitimate loophole for discontent among the ratepayers when the true costs came to be assessed. In regard to the constitutional details of the proposed Tottenham Local Board of Health, Mr. Ranger recommended, and the Order in Council later confirmed, that the Board should consist of nine members - of whom three were to retire each year - being "residential inhabitants seized or possessed of real or personal estate or not less than £1,000 or rated to the relief of the poor upon an annual value of not less than £30." With the sizeof the Board set low in this way, with the qualifications for membership set high - as high as the Act permitted - and having regard to the weighted and graded system of electoral votes prescribed by the Act, whereby an owner occupier might amass up to twelve votes in his own name, Tottenham society could have the comfort of feeling that responsibility 9 for its public health administration would lie with a relatively exclusive body. THE LOCAL BOARD OF HEALTH, 1850 - 1857. The Local Board, when it met for the first time on 15th April, 1850, unlike the members individually, was "seized and possessed" of absolutely nothing. Meeting in a borrowed room it set about the business of local government without a staff or a bank balance, without the benefit of orders, circulars or memoranda from the General Board, without the comfort of relevant administrative precedents and with nothing in the way of guidance except the prescriptive clauses of the Public Health Act and Mr. Ranger's discourse on "remedies". It is_ not surprising that numbers of the Local Boards which were springing up at this period in different parts of the country under similarly unpropitious circumstances soon wilted and drifted into an ineffective chaos, from which the General Board was powerless to rouse them. Clearly, the future of any Local Board depended above all things at this stage on the ability, determination and public spiritedness of its own members and it makes it the more worthwhile to look a little closer from this point of view at Tottenham, where the Board achieved an unusual measure of early success. There had been no lack of number or variety of candidates for places on Tottenham's Board: thirty-seven had competed, of whom three-fifths when identified in the social classification of Kelly's Directory were of the "gentry" - active or retired City men or men of independent means -and two fifths of the "trades" class - auctioneers, surveyors, farmers, a surgeon, a woollen draper, a builder, a school master, an omnibus proprietor, a butcher and a druggist- Mr. Dean's name was among the nominations but he was denied the opportunity of rendering further services to the parish for just before the election day he died suddenly. The "gentry" triumphed overwhelmingly at the polls. Only one of the nine places fell to a tradesman, an auctioneer; and as if to right this single indiscretion the voters replaced him by a wealthy City underwriter when, being on the retiring rota, he stood for re-election at the end of the first year. At about the same time a death vacancy was very properly filled by the election of the Vicar. Apart from these changes the original Board, by regular re-election of retiring members, remained unchanged for five years. it was a body of some distinction, comprising two members who subsequently gained places in the Dictionary of National Biography, the one as a scientist and Fellow of the Royal Society, the other as a public administrator: a merchant, who was later a Lord Mayor elect of the City and knighted: a partner in a famous private bank: a gentleman farmer, with a name as a geologist: the proprietor of one of the great mansions of the parish, Tottenham Park: and two whose benefactions to the parish 10 place them as men of wealth. They were men in their middle age for the most part - five of them were just over or under fifty - whose religious adherences were almost equally, but not conflictingly, divided between the Church and the Society of Friends - a striking tribute to the general respect given to the Quakers, for there were at the time only sixty families of the persuasion in the whole parish. Such was the Board which for purposefulness and efficiency, for harmony and sense of public responsibility was quite unmatched for at least a generation. One has only to turn the pages of the minutes for the first five years to appreciate that it was with perfect sincerity the Chairman on one occasion wrote:- "Sensible of the responsible nature of the duties committed to their care and prepared to anticipate in the discharge thereof from many of their fellow parishioners determined and systematic opposition, this Board rely with confidence on the support of the General Board of Health to enable them to carry out those works of sanitary improvement which the state of the district demands and which they confidently believe will by the promotion of increased comfort and cleanliness result in a marked improvement in the physical, social and moral condition of a large number of their fellow parishioners, more especially of those belonging to the working classes." By long and frequent meetings, often two a week, the Board moved swiftly through the initial stages of creating an administration, The staff soon comprised a part-time clerk - a local solicitor, who retained the post for nineteen years: a surveyor, who combined service to the Board with private consulting practice in the City; a rate collector, and an inspector of nuisances who also undertook the duties of road surveyor. In a matter of weeks the Board was poring over plans and surveys of the parish and alternative schemes prepared by the surveyor f or drainage, sewerage and the supply of water to the 1,500 or so houses in the built-up area of the parish. There were to be no half measures about the reforms; water closets were to replace all cesspools: ample water for all purposes was to be provided either from wells or from the Lea in which case it would need to be filtered: there was to be a reservoir to ensure a constant supply: and sewers which would discharge direct to the Lea or possibly to a sewage works where manure could be manufactured. It was rumour of the size of the estimates entailed in these schemes which, within five monthsof the Board coming into existence, brought it seriously into conflict with its natural opponents - the smaller ratepayers. A sum, infinitely larger than any previous public expenditure in the parish, namely £12,000 was involved. It was too much to expect the shopkeepers and tenement owners to accept the burden without a struggle. A public protest meeting organized by a number of disaffected tradesmen produced a petition to the General Board to which no fewer than 474 or about one third of all ratepayers attached their signatures. It demanded the abolition of the Local Board on the grounds that it was wholly unnecessary and prone to indulge in "reckless expenditure on impracticable 11 works." It was a formidable attack on a body which had scarcely found its feet, but the General Board fortunately knew precisely how to handle a situation of this kind with promptness and firmness. Superintendent Inspector Sanger was again dispatched to Tottenham; this time to hold an inquiry into the petitioners' allegations. His report represented a complete victory for the Local Board. The leaders of the revolt movement were shown to be unsuccessful candidates for membership of the Board or applicants for posts on the Board's staff. "In the course of a most minute investigation" he wrote, "I saw nothing to justify any censure upon the Local Board; on the contrary I have found they have discharged their duties in a most zealous and praiseworthy fashion. They should be strongly supported against the determined opposition which has been manifested by a portion of the ratepayers." In the statament submitted at this enquiry by the Local Board in its own defence there is a passage which shows how early in its history local government encountered one of its fundamental difficulties. "This Local Board feel it important to call the attention of the General Board to the extreme difficulty, amounting almost to a moral impossibility of obtaining in this (in common with all suburban districts around the metropolis and other large towns) any fair expression of public opinion on matters of a local or parochial nature. More than nine tenths probably of the more influential and wealthy inhabitants of this district are engaged during the day in commercial or mercantile pursuits and, on returning at the close of their day to the retirement of their country houses, manifest extreme reluctance to quit their homes again for the purpose of entering the arena of parish disputes, a circumstance which throws a preponderating power into the hands of the smaller rate-payers of the district." An immediate effect of Mr. Ranger's visit was to encourage the Board to push on vigorously with its programme. The results in three years were astonishing. Mr. Heath, the Clerk to the Board at the end of the year 1853 in a letter to "The Times" proudly and neatly summarised the changes:- "a complete system of drainage and water supply has been provided for all that portion of Tottenham which is continuously built upon. About fourteen miles of sewers and water mains have been laid down, all cesspools emptied and filled in and suitable water closets provided for even the poorest inhabitants who have also a constant supply of pure water obtained from an artesian well and preserved in a covered reservoir laid on to the houses at high pressure. The Board have also recently appointed William Hall, who has been many years the medical officer for the poor of the parish to be its medical officer of health. He reports the health of the inhabitants to be in a very satisfactory state and the happiest results are anticipated from the exertions of the Local Board." For appointing a medical officer of health at this early date-when nott a dozen similar appointments had been made in the whole country-the Board deserves every credit: but Mr. Heath's remarks on the point are a little misleading, for Mr. Hall was to act only for six months (at a salary of £30.) for the specific purpose of reporting on sanitary 12 conditions in the lower parts of the town. The brief appointment duly terminated and it was twenty years before a medical officer of health again appeared on the Board's payroll. But by and large Mr. Heath's was a fair statement of the position and there was probably not another town — no matter of what size — in the country at the time with such a record of sanitary progress as Tottenham. Shortly before his letter was written a singular mark of official favour had been shown to the parish when the members of the General Board, Lord Shaftesbury, Mr. Edwin Chadwick and Dr. Southwood Smith and two of its superintendent inspectors spent a day there inspecting and praising the various sanitary works. Another unusual expression of appreciation of the Local Board's work and of the part Dr. Hall had played in helping to get the Board established was mentioned in amemorandum which he prepared during his brief tenure of the medical officership: "Last summer" he wrote "an old woman in Scotland Green cried out as I passed, ' God bless you doctor for getting us the 'local', you have saved me three halfpence a week in fly-papers: for when we had all the filth about us and no water to wash it away with we were swarmed with them, but I never see a fly now'." The achievements were the more remarkable in the light of exceptional difficulties which had had to be overcome. Nothing had gone according to plan. The contractors for building both the sewage and the water works had gone out of business before their jobs were half completed The engine maker, while building the engine and pumps for the wells, had become a bankrupt. Fresh contracts had been difficult to obtain and in the end the Board had had to do most of the work by direct labour under its own surveyor. As a consequence there was an unhappy and unhealthy financial side to these developments. Estimates had all been exceeded, The specific loan accounts, authorised by the General Board, and the three special improvement rate accounts which varied between one part of the parish and another, had become hopelessly intermingled and confused. The rates, which it had been confidently stated in the early days of the Board should never exceed a shilling in the pound, had risen to over three shillings for some of the inhabitants. To meet the situation the Board had been lured to the slippery slopes of loose accountancy. The weakness on this score may well have sprung from an excusable weariness on the part of the members for the Board had worked extremely hard, and it is significant that in 1854 the Chairman who had been indefatigable in his duties was ordered away on medical grounds for three months rest. Superficially the various services were working as well as could be expected and it must have seemed a safe moment to relax. It was wishful thinking, however, for there was a trickling undercurrent of minor troubles which, while the Board relaxed, steadily massed themselves into a major crisis. By the persistent exercise of powers under its by-laws the Board had been making enemies right and left. Owners of lodging houses had been thoroughly harried, butchers had had to look to their slaughter-houses, builders had found it thoroughly inconvenient to have to submit building projects to the Board for approval. A first class wrangle had arisen 13 between the owner of the largest brickfield in the parish and the Board in regard to certain labourers' cottages which without their consent he had erected hard by the brickfields. On another occasion the proprietor of Tottenham's principal brewery had fought the Board in the courts over the question of their power to close as a nuisance the urinal of a beer shop on the High Road which he owned. But given a general satisfaction among the ratepayers in regard to the water and sewerage which it provided the Board could easily withstand the attacks of one or two disaffected individuals. Tottenham, however, had been growing and the demand for the Board's main services rising by yearly increments of about four hundred to five hundred inhabitants and eighty or so houses. Wells, pumps and a reservoir, designed in 1850 for 1,500 houses were being overstretched to supply nearly 2,000 in 1855. A drought that year precipitated a water shortage: instead of the much vaunted constant supply of water all consumers found themselves cut down to an intermittent service of a few hours daily. It was soon evident that this was not just a temporary failure but was bound up with misassessments of the level of the underground supply. The parish would have to face the burden of major and costly extensions to the water works. Public opinion moved sharply against the Board and its surveyor, upon whose plans the scheme had been based. There was an embarrassing epidemic of refusals to pay the water rate on the grounds that the Board could not expect payment for services not rendered. The evident determination of the Board to proceed by summons against defaulters checked the epidemic, though at one stage the Board only escaped financial paralysis through the ability and willingness of individual members to place substantial sums to the Board's credit as loans free of interest. But far more significant than the financial defections and indicative of how badly the ratepayers' confidence in the Board had been shaken was the result of the next, the 1855, annual election for membership of the Board. For the first time a retiring member who was standing for re-election was rejected at the polls and, adding insult to injury, his successful opponent was none other than the aforementioned local brewer. It was a fateful development, for by his contrariness and quarrelsomeness at meetings of the Board the new member soon brought to an end the harmony which had been such a feature of the proceedings in earlier years and the key to its remarkable capacity for effecting developments rapidly. In due course the surveyor produced and the Board accepted a scheme for extensions to the waterworks, at an estimated cost of £6,000. A ratepayers' defence committee was immediately set up to challenge the discretion of the Board in blindly accepting the scheme of a surveyor in whom the parish had lost confidence and to demand that no action should be taken without consultation with the ratepayers. The Board, characteristically independent, autocratic and contemptuous of public opinion and convinced that there was no alternative to its own proposals (a point on which it was ultimately proved right) showed no disposition to conciliate its opponents. 14 When the acid test of an election came round again the strength of the opposition was made plain: all three retiring members though offering themselves for the election were rejected in favour of "popular" candidates. As a consequence the composition of the Board in 1856 was hostile groups in almost equal strength and it was a difficult year for public business. The final battle was fought in the election of 1857: a resignation during the previous year had raised the vacancies to be filled on this occasion to four. There were nineteen candidates and no dearth of members of the old Board among them. But it was the "popular" candidates who once again swept into victory by securing all four seats, Tottenham, in no uncertain manner, had rejected government at the hands of the benevolent local plutocracy which, thus far in its sanitary history, had virtually monopolised the Local Board. A remarkable feature of the course of events in Tottenham between 1850 and 1857, which will have struck those acquainted with the history of English public health, is how closely the Tottenham Board's experiences mirror those of the General Board of Health The General Board, like Tottenham's Board, the first of its kind, similarly autocratic and independent in outlook, equally determined to press on with sanitary reforms if need be in defiance of public opinion, achieving great success, but making powerful enemies and misjudging at times the complexity of technical problem and finally - in the case of the General Board in 1854 after a life of six years-being ruthlessly and ungraciously ejected from power without acknowledgment for magnificent services rendered Chance had brought these two Boards into a kind of informal alliance; the General Board lending its great authority to support the Tottenham Board against popular ignorance and apathy and, in return, finding in Tottenham a model to which- it could point as an example of what might be done under its firm guidance When the public outcry swept over the General Board in its latter days, under the conviction that the Board was the fountain head of a not-to-be-tolerated, bureaucratic, centralizing policy, it was a fierce widespread movement - a heresy hunt in which friends of the Board could fall under suspicion. And there can be little doubt that it was ripples from the larger issue mingling in Tottenham with the native bred resentment against the Local Board which determined such an utter root and stock rejection of offers of further public service by men who were among the most eligible and worthy of the inhabitants. LOCAL BOARD OF HEALTH, 1858 TO 1863. By 1858 the semi-political disturbances which have just been described had to all intents and purposes subsided and it was in an atmosphere of easy indifference that Tottenham slipped into a new phase in the history of its sanitary administration. The annual election for membership of the Local Board was a tame affair that year: in sharp contrast to the lively scenes in the previous three years it passed off without even a contest. Nor was it merely a temporary retreat to civic apathy. Small polls, (in 1859, for example, fewer than thirty percent of the possible 15 votes were recorded) and the absence of any serious competition for places on the Board (in five of the next twelve years the candidates were unopposed) were to be the rule for a long time to come, despite - so characteristically of English local government - circumstances which often enough seemed to demand the very opposite attitude. A main outcome of the troubled years had been to put Tottenham under entirely new management. Something of a social revolution had taken place within the parish. Men of a very different stamp from those who had steered Tottenham through its earlier sanitary developments now controlled the Board, Social historians seeking the early signs and symptoms of the rising political consciousness of the bourgeoisie would find Tottenham of this period a fruitful field for study. Presently, we too must look a little closer at the nature of the social changes and relate them to developments in the field of public health But before doing so it is necessary to consider a number of events which belong chronologically to the late fifties and which materially affected the course of Tottenham's sanitary progress for a generation. The problem of water shortage which had come to a head in 1855 had been resolved and once again the Board was providing an ample, constant service. But the solution had been costly. Instead of £6,000, the sum which had so alarmed the ratepayers in the original estimate, the Board had found it necessary in 1857 to obtain from the General Board of Health powers to borrow up to £10,000 to pay for the new works. On the other hand it appeared that the supply had been rendered capable of meeting all possible contingencies in the way of droughts or any further increase in the population Under the new arrangements the normal daily output was 600,000 gallons, but it was calculated that by working the pumps through twenty-four hours the prodigious figure of three million gallons could be supplied. The original bore-hole in the Hale (where there was also a reservoir) had been connected by a pipe-line across the marshy lands near the river with a larger and deeper well at Northumberland Park. Moreover, it had seemed to the surveyor a pity while works were in hand not to make use of the extensive area of ground water overlying the new main and this too had been tapped by a shallow system of perforated pipes. Here was an immense and incredible error of judgment, for it was the poor quality riverside lands in particular which, under improving agricultural practices, were being systematically enriched by the by-products from the local sewage works. In the old days of cesspools and private wells a sewage contaminated waters supply had been the lot of perhaps a moiety of the inhabitants. The Board had now unwittingly made the misfortune universal, Almost twenty years later when the mischief was at last exposed in 1873 by a medical inspector from the Local Government Board, he caustically reported, "Had we wished to make an experiment concerning the production of enteric fever and diarrhoea we could scarcely have arranged things better than they have existed in Tottenham since the local water works were extended in 1856." 16 Vieing at most times with the water supply as a major anxiety for the Local Board was the problem of sewage disposal The first ventures in this field in 1852 and 1853, when the procedure had been simply to pour the crude matter from the sewer direct into the river, had brought the Board into sharp conflict with both the River Lea Trustees, who had a healthy distaste for having their waters so flagrantly polluted and the General Board, which on good sanitary grounds strongly condemned the practice. By a stroke of luck Tottenham was able in 1854 to embark on arrangements which satisfied its critics. Mr. William Higgs, chemical and manure manufacturer of Westminster, agreed to rent the Board's rudimentary sewage works at Page Green, extend them at his own cost, deodorise the sewage by a secret process of which he was the patentee, collect for his own profit the residual manure and leave only an unexceptional effluent to run off into the Lea. Mr. Higgs seems to have had a genius for the business and was as good as his word. To quote the Tottenham and Edmonton Advertiser of 1857 (a paper established the previous year), "the water from the main sewer when it has passed through Mr Higgs' hands is perfectly clear and inoffensive: the river at Tottenham is rendered far purer than it has probably been for centuries, and matter of high fertilising power is rescued from waste and at the same time made perfectly innocuous. We strongly recommend agriculturalists and gardeners of all kind to try Mr. Higgs' guano." Alas, with Mr Higgs' death in 1858 these beneficent activities were brought to an end. For a year the Page Green Works wallowed in a mire of untreated sewage, while the Board vainly endeavoured to find a successor, until in desperation it bought from Mr Higgs' executors for £500 the sewage plant on which he, out of his profits, was said to have spent £5,000 The Board's surveyor was put in charge: the manufacture of manure was abandoned: and there was a return to the former bad practices of sewage, but slightly deodorised by lime, being passed straight into the river, - the main source of supply, incredible though it may appear, of the great East London Water Company. It is scarcely surprising that when cholera broke out in 1866, Lord Salisbury, Chairman of the River Lea Trustees publicly accused Tottenham of being the primary cause of an epidemic which effected the untimely death of 3,909 Londoners. Poor Tottenham - a pioneer of sanitary services - without let or hindrance from the central authorities for public health was well on the road to poisoning through deficiencies in its arrangements not only its own inhabitants but vast numbers of others further afield. At this point a small digression from Tottenham's story to the wider issues seems justified. With the aid of the Local Board's well ordered (and fortunately well preserved) minutes we have material for reflecting on the contemporary circumstances which had permitted such a deplorable state of affairs to come about. We can observe that during the period 1850 to 1855, whenever the Local Board applied, as it was bound to do, to the General Board of Health for borrowing powers in connection with any 17 project, a protracted correspondence ensued before the loans were authorised: during this time the proposals were methodically scrutinised and amended in their technical bearing under, we may suspect, the watchful and critical eye of Edwin Chadwick himself. But with the disappearance from the scene in 1855 of Chadwick and the strong central department of which he was the heart and soul and the substitution by Parliament of an enfeebled and shadowy General Board of Health we find that Tottenhams applications, as in the case of the £10,000 for the ill-judged water supply, came to be granted almost by return and without question. Nor was the position improved after 1858 when the General Board was abolished and its functions split between two departments, the Home Office for the legal and financial side of local government business and the Privy Council for medical and scientific matters. As a consequence sanctions for loans were liable to be rubber stamped by the Home Of Office without the sanitary experts of the Privy Council being brought into the picture - witness Tottenham's application in 1858 in connection with the altered scheme for sewage disposal, which entailed the frank pollution of the Lea and so ran counter to the declared policy of the government's medical department. Certainly, much damage had been done in Tottenham, and we may strongly suspect in many another area, before the liaison between the two central departments improved as it did in 1871 when they became fused into a single body, the Local Government Board: and we may feel that Palmerston's government in yielding to popular demands for complete local independence in sanitary administration and permitting first the enfeeblement and then the disintegration of central control of public health must bear a heavy share of the blame for Tottenham's sanitary indiscretions. But we have been guilty both of digressing and anticipating. For, though perpetrated in the late 'fifties, Tottenham's blunders were the delayed action sort In the general contemporary view we must remember Tottenham, sanitarily, was held to be an exceptionally progressive parish and this reputation it retained until about the mid 'sixties. As one of the Standard's correspondents remarked with justification: "Tottenham has made a remarkably spirited outlay on sanitary works for a small parish. " Its water and sewage works were recognised show pieces constantly visited - save during the confusion following Mr Higgs' death when the sewage works were tactfully closed to visitors, - try representatives from parishes near and far about to embark on sanitary schemes on their own account. Many a comparable parish was to know no sanitary administration, other than some fitful nuisance removal activities of a Board of Guardians, until 1872. Of Tottenham's neighbours two, Edmonton and Enfield, were only just beginning to adopt sanitary powers and to establish Local Boards in 1858, while Hornsey and the rest were still later entrants to the field. Even the great Metropolitan parishes, apart from the City of London, had to concede Tottenham a full five years start in sanitary administration. Moreover, in Tottenham the Local Board had always tended to spill over its authority into public responsibility for matters outside the strict field of public health, and it was continuing to expand its administrative empire Early in its history the Board had superseded 18 the Tottenham surveyors to become the parish's highway authority. By the Public Health Act of 1858 parish lighting was snatched from the Local Lighting Inspectors and added to the Board's business, which was still further extended in the following year by the inclusion of the fire brigade. Under the same Act the Board's control over streets and buildings and its bye-law powers generally were also substantially strengthed. So that in one way and another it was becoming an increasingly difficult matter for a Board which had not learnt the merits of the "committee system" to know how to order the priorities of its interests over such a wide field; and a useful function performed by the local press was to remind the Board occasionally that it was primarily a Board of Health. Such, then, was the setting when the Local Board of 1858 - the new style Board it might well be called, bearing in mind the complete change in the character of the membership at this date - took up its duties And since the pattern of membership of the Board was to conform steadily and distinctively to the new style for more than a decade and because they were grimly significant years in Tottenham's sanitary history it is again worthwhile to try to discern what kind of men were at the helm and how they differed from their predecessors Consider the membership in 1858 The nine comprised two local brewers (one of whom was chairman), two doctors in the parish, a linen draper from the High Road, the manager of the india rubber factory, a local insurance and house agent, a retired Army officer and a City banker Recall the predominately wealthy city merchant and landowning membership of the Board of 1850, comprising a high proportion of men of distinction in the world at large, and the shift in power to a new social group is plain enough The preponderance of influence now lay with the erstwhile "trades" class: local professional and business men who both lived and worked in Tottenham, with names and reputations mostly unknown beyond the parish boundary The old Board of "gentry" saw Tottenham as a pleasant, respectable, healthy, accessible dormitory; a place to be improved but also preserved in its quiet exclusiveness The new Board of local men had in mind Tottenham's "bread and butter" attributes: its progress and prosperity - along with that of the great majority of the members themselves it may be observed— was inextricably linked with popularising the parish. For a decade the Board's policy was to bear the mark of this attitude, and in its fulfilment it was to be ably abetted by speculative builders and the promoters of the several railway companies which were shortly to ring and cross the parish with such a lavish network of communications with the metropolis. This Board of 1858 may, for all practical purposes, be looked on as the prototype of successive Boards right up to 1871, when the ratepayers for very good reasons once again showed a determination to bring about a wholesome transfusion of "new-blood" into their representative body. Regular comings and goings of individual members at the elections left unchanged the broad picture of a Board heavily weighted with "local" men. Without entering on a wearisome analysis of the membership during these years we may note one or two curious features. Local doctors, for 19 example, were disproportionately represented: there were always two, and in three of the years three, among the members. Again, the representation of builders soon rose similarly to either two or three in every year. In 1866 and 1867 there was the striking situation of two thirds of the Board's membership being drawn from men of these two occupations. Critics of the Board, and there were many in these two years, were not slow to apply the simile of too many cooks to the confused state in which the Board of "experts" found itself. An important feature, too, was the gradual emergence from the common run of members of a small number of long service men: men whose continued membership extended over ten or twelve years and far exceeded the average. Their seniority soon raised them in influence above their fellows and their foibles and conceits and personal differences of opinion did much to militate against the smooth and efficient conduct of the Board's business The evidence in support of these charges lies not in the discreet and formal minute books, but in the files of the Tottenham and Edmonton Weekly Herald, which within a couple of years of its establishment in 1861 was printing verbatim what was said at the meetings, not excepting asides and innuendoes, so that even today we can recreate the atmosphere of the meetings and the moods of almost every member. Under this fine focus two from among the inner circle of long term men, our old friend Dr William Hall and a Mr. Edward Clarke, builder and contractor, seem to warrant brief biographical notes,both because they shared the honour of the longest continuous membership during this period, namely, fourteen years and because they stood out as such exceptional and contrasting influences in the council chamber and were at one time the leaders of opposed groups on certain vital issues. Dr. Hall we have already met as one of the founders of the Local Board, as Tottenham's first, though very temporary, medical officer of health and as Parish Medical Officer under the Poor Law an office which he retained for the astonishing period of sixty years Add that he was Divisional Surgeon of the Metropolitan Police for only a fractionally shorter period and certifying surgeon under the Factory Act for nearly fifty years and it becomes clear that Dr Hall, quite apart from his connection with the Local Board, was an unusual force in the parish and one of its greatest public servants. The obituary notice which appeared on his death on March 8th, 1901, summarised the balance of his public appointments as "doctor to all the Friendly Societies in the parish, to both the Fishmongers' and the Printers' Asylums and to the Royal Masonic Institute for Boys," His membership of the Board commenced in 1860 - after an unsuccessful candidature for a vacancy in 1857 - and was continuous, with a spell of six years as chairman, until 1874. As a chairman he was undeniably weak and was dubbed by the press "leader of the blundering party." But it was honest blundering and in the Board's darkest days such public confidence as it retained was largely owing to his immense personal influence and popularity in the parish. Dr. Hall stood out at all times as the champion of the parish poor and his warm support of the Board from its earliest days was unquestionably a reflection of his close observa tion of sanitary conditions in the poorer parts of the parish in the 20 course of his various official duties. His retirement followed disillusionment through the steady drift of the Board to ineffectiveness, and as was said at the time "petty jealousies, the bickering,the selfseeking among many members and their interminable talk grieved him and constrained him to retire from such inglorious work." Mr. Edward Clarke was a man of a very different stamp. As a progressive young builder in Tottenham he found it inconvenient seemingly to comply with the new building bye-laws of 1858; for during the first few years that they were in force the Board's minutes show that he was being repeatedly warned for having erected houses without first submitting plans to the surveyor. In 1862 Mr. Clarke had a more unfortunate contact with the Board: for while standing as a candidate at the Board election that year he was found "to have altered certain voting papers and to have acted falsely for persons entitled to vote." He only escaped prosecution by agreeing to publicly advertise his apology to the Board and the fact that he had rendered himself liable to three months' imprisonment with hard labour in the common gaol. In 1865, nevertheless, the Board appointed him to fill an interim vacancy in the membership and he was then described as "one of the largest owners of rateable property in the parish" and as a keen business man whose advice would be invaluable to the Board. From this date his member snip was continuous until 1878. Open voting was still the rule and when Mr. Clarke was standing for re-election there were nearly always ominous references in the press to his "lavish election expenses" and to his having "a large number of votes in his pocket." If Dr. Hall was the champion of the poor Mr. Clarke was the accepted champion of the smaller ratepayers, guarding them he said, "against needless and ill considered expenditure by the Board": and even the press allowed that he was "something of a watchdog over other members and useful". Forceful and irrepressible he was for a short time in 1870 almost a local dictator. In the election of 1877 he headed the polls "with more votes than were ever previously cast for a member". Yet within a few months he had disappeared suddenly from public life having been found guilty of defrauding the Board of Guardians by false contracts and committed to a term of five years penal servitude. We must now turn from these random sidelights on the character of the Board's membership to examine the work devolving on it. It will be recalled that very shortly after the new Board had taken control of affairs both the substantial branches of its public services, the water supply and the sewage works, had got onto a footing which to all appearances placed Tottenham in a very favourable position vis a vis its neighbours. It was a view the Board itself adopted. In 1859 when a proposal, strongly backed by the Advertiser, was again made for appointing a medical officer it was dismissed by the Board, on the grounds that "it was un-ecessary under the present excellent sanitary state of the parish " In point of fact the Board had become so absorbed in the "housing mania" that it had lost interest in the purely sanitary side of its business. Houses were now springing up in the parish at the rate of three hundred a year and though Mr, Edward Clarke was defying the bye-laws and not troubling 21 the Board with advance plans of his work the business at its meetings consisted largely of sanctioning other builders' plans and dealing with the surveyor's proposals for extending the Board's roads, pavements and street lighting to keep pace with new building. By 1863 the Board's total expenditure on paving alone had mounted to the very considerable sum of £21,000. A further £2,000 had been expended in the previous year on a new service reservoir at Wood Green and a constant water supply was being more or less maintained in the face of increased demands. For the sewage works, no less under pressure from the population increase than the water works, the Board had so far provided no comparable extensions and it was temporising with this troublesome situation by discreetly overlooking the fact that a great part of the new housing had as yet not been connected up with the main sewer, which at a cost of £9,000 was being pushed out to Wood Green, and that when the connections came to be made the overtaxed sewage works would break down. Meantime, much of the sewage from the new houses was again trickling through the town to reach the Lea via the Moselle. Though its expenditure was lavish in these various connections the Board's procedures were largely of a routine character Furthermore the current practices of allowing the accounts to run on unbalanced from year to year and of scorning annual estimates as inevitably illusory in an era of such unpredictable expansion made the Board's financial problems considerably less worrying than they ought to have been. Responsibility, in fact, lay so lightly on the Board' s shoulders that the attendances of members fell off sharply. Regular weekly meetings, with avacation in August, had so far been the rule. In 1862 only forty-two meetings were called, and of these six had to be abandoned owing to failure to reach the quorum of three, while another five achieved only a bare quorum In line with this trend the Board in the following year agreed on fortnightly meetings and also clipped an hour off the length of each meeting by making a later start. As for the "building mania," there was scarcely a corner of the parish unaffected by it during this period and it was a fair cross section of the working Londoner, from business man to artisan in search of a suburban dormitory, who was being attracted to Tottenham Wood Green was growing at the rate of "some seventy-five families a year." West Green and Palmers Green were equally active. Shortly Northumberland Park was said to be "nearly all staked out in plots for building." The Great Eastern Railway was the life line of the new inhabitants: "as many as seven hundred mostly workmen" so the Herald reported," are travelling daily by the trains to their work in London," at a return fare of sixpence. For the immigrant businessmen there were rows of pretentious little villas which the anonymous author of "Our Suburban Residence.," (an article published by Charles Dickens in his periodical "All the Year Round"), so pleasantly debunked: their owners were the new "aristocracy of the village," - their hallmark the possession of a first class "season". We may note at this point that the great majority of the new inhabitants were in no position to participate in the conduct of public and parish 22 affairs. For they were industrious folk and, as the author of "Our Suburban Residence" tells us, even the business man left for the City before 9 a.m. and was not seen again in Tottenham until "about 8.30 in the evening." It was a change of the greatest significance to the parish when, at a later date, the commercial tempo eased and a new fund of publicspiritedness from among more leisured city men was released in its service. For all this new life and activity in the parish the local builders were warmly praised. "Great are the improvements" wrote one correspondent of the Advertiser, "being effected through the building mania"., "Everyone must rejoice to see the working classes availing themselves of the enterprise of our builders and coming out to the country to reside", wrote another. But with an honesty that characterised the paper's reporting, (in contrast to its more partisan rival, the Herald) it spoke, too, of an unpleasant side to the picture. As early as 1860 it referred to "the rapid replacement of well built houses by rows of Jerry built dwellings". By 1865 it was deeply regretting "that some of our speculative builders have avariciously succeeded in disfiguring some portions of our district with a new type of hovel, - not only unsightly but unsafe." The dangerously low quality of some of the building had not gone unremarked by the Board. But it had been advised both by the clerk and the surveyor that its bye-laws were virtually powerless against faulty construction. A certain thickness of wall and height of room it could enforce but in regard to the actual building materials used it could take no action. Under these circumstances Mr Kirby, the leading house agent in the parish and himself a member of the Board, felt bound to warn the public in 1863, by a letter to the Herald, that "we have houses erected and now erecting where the mortar is nothing but the earth just as it is dug. And since the pulling down of so many buildings in the City and Westminster for railway and street improvements these wretched materials are what is used for building in our suburb. Yet these places are finished in a very showy style". The whole face of the parish was altering: and so was its character. The old stability and mellowness of its society were being replaced by a flashy vigourousness. Superficially the town was flourishing as it had never done before, but there were underlying weaknesses in the developments which a few of the inhabitants had already observed to be potentially serious. LOCAL BOARD OF HEALTH 1864 TO 1872. The Board's halcyon years lasted until 1864, when "owing to the extreme pressure. of business" it was found necessary to revert to weekly meetings. Each subsequent year the pressure on the members increased; in 1869, for example, sixty-nine ordinary and eleven special meetings were held in a desperate endeavour to cope with a situation which, by then, had got out of control. Before considering the actual events which precipitated all this unwonted activity on the Board's part and culminated in a final debacle one or two very general observations on the 23 stances and the Board's reactions will help to put the whole extraordinary affair in perspective. Whatever failings the individual members may have had they lacked none of the grit, toughness and pertinacity which were so characteristic of the Victorians; for it is a remarkable fact that though members were mercilessly pilloried by the press and at public meetings the number of resignations from the Board during its difficult years was negligible and the attendances at the meetings higher than they had ever been; a case in point being 1869, when more than half the eighty meetings were attended by seven or more of the nine members. The Board misjudged and mismanaged its responsibilities, but it could not be accused of neglecting them. In all fairness to the members it must be observed, too, that their misjudgments stemmed largely from an unbounded faith in the inevitability of material progress which they shared in common with their generation. New knowledge and technical achievements of only a few years standingsteam pumps, wrought iron and glazed stoneware pipes, gas lighting, asphalt, chemicals for the precipitating of sewage - had made all the Board's remarkable public utility services possible; it was natural to cling to the optimistic belief that given a little patience every difficulty encountered would similarly be resolved by some new invention. No Board it is quite certain, no matter how excellent the quality of its membership, could under the circumstances of the day have done much to lessen the trouble which lay ahead of Tottenham. What we shall find as the story develops is that by procrastinating in every difficulty, by refusing obstinately to have the membership increased and by riding roughshod over the ratepayers the Board made disaster certain. The simple truth was that the parish had doubled its population since the establishment of the Board thirteen years earlier and no adequate measures had been taken to buffer it against such an impossible assault on its parochial resources as the increase represented. In fact parochialism, the extreme nineteenth century form of it, was at the root of the mischief which was to dog Tottenham for the next few years. The Local Board, it has to be remembered, was operating in a framework of contemporary thought which still expected a parish to be locally independent and self-contained for all purposes. From time immemorial Tottenham, by well and cesspool, had drawn its water and disposed of its excreta within its own boundaries With the establishment of a Local Board the techniques had been altered but the same self-contained pattern had inevitably been followed and the new water supply and sewage disposal schemes had remained concentrated and confined within its own 4,000 acres. While the population numbered only a few thousands all had been well. When it rose to 20,009 the system was bound to break down. The irony of the situation was that there was water galore in the Lea and New River and a fine potential outlet for sewage through the great main North London Sewer, all near at hand but under the control of other public authorities, and parochialism forbade Tottenham to yield any of its local independence and go seriously in search of these facilities. We must now trace out some of the fruits of this parochialism and unravel the tangled skein of muddle and misfortune which brought the parish to its lowest ebb and to the point in its history where the authors of the present limited study must for the time being leave it. A principal factor in the extra pressure of business which, as already mentioned, fell suddenly on the Board in 1864 was another breakdown in the water supply. On this occasion it marked the end of the "inexhaustable constant supply" of which the Board has so often boasted in recent years. Slight shortages had sometimes occurred in dry weather following the temporary recession of the marsh water part of the supply. It took the Board many months to abandon the hope that this was again the explanation and to begin seeking a remedy. Nor did it ever face up to the fact that the reputedly limitless underground water, the real backbone of its supply, was shrinking and that Tottenham had been dissipating its natural inheritance of water at too great a rate. A deeper bore hole was simply added to the older ones and more powerful pumps provided. By these measures the constant supply was restored for a few months; but from 1867 onwards it was never again within the Board's power to provide anything approaching a regular 24 hour service. The Board's position was the more embarrassing because it had so consistently advertised all the virtues of a constant supply and because it stubbornly maintained that some way of boosting the supply would be discovered without having recourse to any of the London Water Companies. When the Privy Council, in response to a memorial from the inhabitants of Page Green, sent an inspector to report on the water situation in 1866 the Board's observation on his criticism was "that it was proposed to try again to improve the regularity of the supply." In 1872 when, under similar pressure an inspector from the Local Government Board made his report the Tottenham Board's reply was in almost identical terms though in the interval nothing had been done. The Board's position in this connection both legally and by virtue of the capital the parish had already sunk in the water works was unassailable. It could insist on all houses in the parish being connected with its supply and the proposal, diffidently canvassed by the press in 1868, "that the parish's water should come from the New River Company," - which was already supplying a few houses in the part of Wood Green lying above the Board's service reservoir, - implied too great a blow to local pride; and not even the ratepayers were willing to consider it at that date, much less the Board. Though a few years later, when bitter experience had lowered local pride, the Board wisely ignored the attack on its rights when the New River Company unofficially began to infiltrate its territory. The outcome of the Board's mismanagement of the water question may be gauged from a leader in the Advertiser of 1875. "We are tired of the repeated promises of the Board": it declared, "the opulent are either having, regardless of the cost, wells of their own sunk or are applying to the great Water Companies for a supply. The poor are still constrained to put up with no supply or with such a poor one that it is but mockery 25 to call it by such a name. In the streets of the Whitehall District women and children may be seen daily carrying heavy pails of water from the stand pipes or some neighbour's well." It was a description which tallied closely with the one Inspector Ranger had included in his report in 1850 and a sharp reversion from the high standards of 1860. The water supply was not the only way in which the parish was being stripped of its modernity: the disposal of its sewage was suffering a similar relapse. Reference has already been made to an overload on the Board's sewage works being one of the side effects of the population increase. Instead of an extension to the works - a remedy which the Board was not prepared to contemplate on the grounds of cost - the additional sewage was being allowed in part to pass without treatment to the Lea and in part to dissipate itself on land quite unsuitable for the purpose at the door of the works. It was undoubtedly rumours of cholera creeping across Europe in 1865 which almost simultaneously, lowered the tolerance of the two parties most affected by these dilatory practices, the River Lea Trustees on the one hand and the inhabitants of the area around Page Green works on the other hand. The latter expressed their protests in public meetings, followed by representations to both the Secretary of State and the Privy Council, whose intervention secured from the Board soon-to-be -forgotten assurances that the sewage would be confined to the works in future. The Lea Trustees, more wisely, appealed to the law and secured an injunction in the Court of Chancery prohibiting the Local Board from, passing any sewage into the river which had not been adequately treated. Under the circumstances the injunction could not possibly be strictly enforced and was suspended, but only after the Board had agreed to make no fresh connections with its main sewers, under penalty of sequestration of the rates; a restriction which entailed all new houses in the parish being drained to cesspools or the ditches and which, by 1872, had reduced more than a quarter of the total houses to this plight. Writing at this date of Wood Green where the damage was greatest an Advertiser leader referred to "the hosts of cesspools which owners of property had been compelled to make at great expense but which by their overflow poisoned the air and water round about and created such illness that the residents abandoned what was once one of the healthiest spots for miles outside London". This was a sorry retreat from the statement which the Board's clerk had proudly issued to the press fifteen years earlier "that every cesspool in the Parish had been filled in and suitable water closets are provided for even the poorest inhabitants." ihere was yet another way in which the physical discomfort of the inhabitants was being steadily intensified; by "the stinking ditches"as they were called. Tottenham was the focal point of a drainage area which fanned out into the neighbouring districts of Hornsey, Muswell Hill, Colney Hatch and Edmonton. There, too, the populations had increased without compensatory amendments to the sewerage arrangements and consequently, before they even entered the parish, Tottenham's streams were more heavily fouled than they had ever been before, especially the Moselle. In 1866 26 the Board, taking a leal out of the Lea trustees' book, applied for an injunction against its neighbours; but since by this date it was so patently contaminating the Moselle on its own account Tottenhams case failed. This "Moselle Nuisance" was destined to become one of the most intractable causes of friction between the inhabitants and the Board. Poor Tottenham- the epithet was beginning to be regularly applied to it - was doomed, it was said, to tolerate "both its own and its neighbours' sewage. " The underlying community of interests between the various authorities in the Lea Valley drainage area was so obvious that in 1867 Tottenham's Local Board, to its credit, called a meeting of representatives from neighbouring authoritues to discuss proposals for a joint drainage scheme which would end "the tedious round of litigation". It was admitted that "Tottenham was at a deadlock," and a rider added "that what had been its experiences would be the experience of other parishes presently." There were three alternatives to be considered, the first of which clearly sprang from the old chimera of science working miracles; "Could science provide a deodorised sewage? Could the area by combined representation secure a link with the Metropolitan Board of Works' North London main sewer? Could the district find a combined outfall of their own ?" This momentary statesmanship on Tottenham's part was premature; the issues were so confused and so potentially costly that most of the representatives took fright and withdrew after two meetings, although the great civil engineer, Mr. Bazalgette, had been consulted and had reported that a link up with the Board of Works' main was feasible. Tottenham was too easily rebuffed: it should have tried again and again to persuade its neighbours to reconsider Mr. Bazalgette's scheme for the only possible solution to its own problems lay in joint action along these lines. A word ought also to be said about the Board's finances but the surviving information on the point is scanty. Financial statements, which sometimes appeared as advertisements in the press, dealt only with the annual income and expenditure. Accountancy, in the strict sense, was avoided by the Board until 1868, when under the threatening pressure of Mr. Fowler Newsam, one of the resident magistrates, it was constrained to engage an accountant "to ascertain what money the Board had borrowed, what they had done with it and what they now owed." Borrowings, he decided had amounted to £69,097 - 10 - 7, and it ought all to have been spent on public works; but the various accounts had become too interlocked for verification of past expenditure. The loans outstanding amounted to £53,287. He observed (with unconscious humour considering the defects in the Board's public services), "that in twenty years the water works and sewage works would be free of indebtedness and a free gift to the descendants of the present ratepayers." The rates, he thought "were set too low to meet the real demands for income." In regard to the rate collectors' accounts - a point on which Mr. Newsam had asked specifically for information - the deficiency, he believed, "amounted to only £889." The Board's reaction to the report was to make its Clerk, Mr. Heath, who had held the post during the whole of the Board's existence, a scapegoat for the confused state of the accounts and for some 27 of the heavy items of expenditure on litigation: £1310, for example, had been spent in an unavailing legal battle with the Lea Trustees. Mr. Heath was in an uncomfortably vulnerable position when it came to a question of justifying the Board's proneness to litigation, for he was being paid a percentage on all the Board's legal costs; and shortly he resigned. All these various unhappy developments were putting a great strain on the ratepayers. Apart from the inconveniences they were being hit both in their health and their pocket. Take the hypothetical case of a man who, in 1861, decided to settle in the healthy suburb of Tottenham and took a house there; he found it relatively highly rated at 3/- in the pound but was compensated by a quite exceptional range of "main services." But by 1871 he had probably had to go to the expense at some time of having his plumbing rearranged and a cistern fitted to catch the Board's intermittent water and then later, when the failure became chronic and his water closet useless, to share with neighbours the expense of sinking a private well and a cesspool; his rates had risen to 4/9: if he tried to sell his house he found it difficult to do so (the census that year recorded 600 uninhabited houses in the parish) and learnt that he must expect to drop money, for "the depreciation of property in Tottenham in consequence of its evil reputation," to quote a correspondent of the Advertiser, "is at least ten per cent." He was unlikely, perhaps, to have thought of looking up the Registrar General's, Annual Reports, but had he done so he would almost certainly have decided to cut his losses on his house and move out of the parish, for he would have seen that Tottenham's death rate for the decade preceding his taking up residence there has averaged 16.3 per thousand of the population, while the average for the decade of his residence had risen to 18.3 and had climbed sharply during the last three years to a record figure of 21.4 for the year 1871 itself. If he had gone into the London figures he would have found that, latterly, he could have been living at appreciably less risk anywhere in London, apart from the worst East London districts, than in Tottenham. It will be recalled that when the ratepayers got at loggerheads with the Board in 1855, over its autocratic handling of a water shortage, they reacted violently at the polls and quickly gave themselves an entirely new Board. Why, it may be asked, was there no similar revolution ten years later when aggravation was so much greater and more prolonged. The situation was much more complex than it had been during an earlier phase in the parish's local government history. For one thing, since the ratepayers had become more widely dispersed over the parish and more socially heterogeneous they were less effective as a collective political force. Instead of the old single concentration of 1,500 or so ratepayers all living in the vicinity of the High Road with a strong community of interest there were now more than 3,000 scattered in several separate groups corresponding to the different new districts; each had its own special grounds for discontent, - Wood Green, destitute of sewers: Page Green, suffering the smells from the sewage works: the High Road, plagued by the Moselle nuisance, - each had its own Ratepayers' Defence Association 28 and was therefore less disposed to make a united front against the Board. Even the quarterly Vestry Meetings, at one time a rallying point for the whole parish, had lost their significance for a scattered population and consequently their cohesive influence. Furthermore, the old single two fold grouping of the rate bearing population into gentry and tradesmen no longer held good; local professional men, local manufacturers, salaried city businessmen, city clerks and London artisans were all complicating the pattern of local society and stratifying it on such a mixture of new lines that the interests of the various groups were not easily to be brought to a common focus. From the Board's point of view the changes were strengthening for they fortuitously gave it the benefit of the "divide et impera" principle of government. Then again, if the ratepayers wished to use their votes to eject the existing members, as they had once done, they would need to find acceptable candidates willing to stand for election. Here was a difficulty, there was no pool of eager candidates to draw on as there had been in 1855. Board-work it was realised had become "most onerous and difficult," so that as one ratepayer put it, "no man whose time is of value to him can be expected to serve." In this connection Mr. Albert Hill, author of the Reminiscences of Tottenham, found an analogy for the parish's plight in the case of the United States"where the unwillingness of the best men to serve Congress" was equally disastrous. Granted certain defects among the present members there was, nevertheless, the risk that control of the Board might fall into even less desirable hands. The Herald, using as its text the election of 1866 when the only candidate opposing the return of retiring members was the landlord of the "Seven Sisters,"' asked its readers to think carefully before rejecting renewed offers of service from present members, "although we have often had occasion to find fault with their mismanagement of parish business,", for "if the Soard has defects and is a shade despotic, what of it? Bumbledom,is not confined to Tottenham. We might fare worse." It was recognised, too, that the whole blame for the parish's difficulties could not be laid on the Board. The law was deficient: Tottenham, it was felt, should not be baulked by the Lea Trustees' injunction from access to the natural outlet for its sewage and at the same time be denied any legal redress against Edmonton and Hornsey which according to the Board's surveyor "had done what they wanted, namely remove sewage out of their own parishes by using Tottenham's streams," For the defects in the law the Government was felt tobeto blame; "it is to be hoped, " said the Herald, "that the Government will give up its present slipshod method of legislating on sanitary questions which is the cause of burdening this parish with the excreta of its neighbours." The Government, so it seemed was not even helpful: for as the chairman of the Board pointed out on one occasion, "Tottenham is being compelled to carry out experiments in the deodorising of sewage at its own expense which will be used by other authorities later and should be a charge on the Government." Certainly no unprejudiced observor could be entirely devoid of sympathy for the 29 Board; after a careful study of the question Sidney Herbert, who was Under Secretary to the Board of Trade at the time and had been approached by the Tottenham Board to see if he could soften the intransigence of the Lea Trustees, replied that "hewas unable to help the Board but gave full credit to the members for their endeavours to grapple with the extraordinary difficulties with which they were beset". If the various factors and sentiments just referred to rendered the ratepayers less prone in the 'sixties than they had been in the 'fifties to turn members out of office at election times, they were aggresive enough to the Board in other ways. The non-payment of rates was the commonest expression of their indignation: it was a cumulative injury and by 1868 the clerk informed the Board that "the summonses for unpaid rates could be counted by the hundreds." The recognised method, however, for ratepayers to register their strong dissatisfaction was by public protest meetings. Between 1864 and 1872 the parish never went long without the Vestry or one or other of the Defence Associations or some independent group of inhabitants inviting ratepayers to join together in giving vent to their feelings. The outcome of these public meetings was almost invariably either a deputation to the Board, the Home Off ice or the Privy Council. As a rule nothing constructive emerged, nor were the different government inspectors who on five occasions during the period came to Tottenham to investigate ratepayers' allegations able to do more than suggest. palliatives, such as cleaning up the bed of the Moselle or adding a fresh tank to the sewage works, which rebounded on the ratepayers by involving the Board in additional expense. For a time the ratepayers rather pinned their faith on getting rid of the Board entirely or, at least, drastically clipping its wings: the Home Secretary was petitioned either to abolish the Board and allow the inhabitants "in self defence to revert to the old form of government" or to debar it from dabbling in water, sewage, and drainage schemes for, as was pointed out, "in Edmonton there is little drainage and the inhabitants live and thrive under the old system to an extent to make Tottenham wish it had not expended so many thousands on sewage works." There was, however, to be no easy escape from Tottenham's troubles on these lines, for the petitioners were informed that even the Home Secretary had no power to interfere with a local board unless and until it had been found guilty of actual neglect of duty. Alternative proposals which some of the ratepayers presently began to advocate more vigorously and persistently than anything else was that the Board's membership should be increased and that the parish should be divided into wards for electoral purposes. The argument was cogent; an enlarged membership, it was said, would spread the burden of Board-work and lighten the load on individual members sufficiently to induce responsible inhabitants to offer themselves as candidates; while ward voting would stimulate an interest in parish affairs among ratepayers in outlying districts. Though time and again the Board was asked to approve these proposals and seek powers to have its constitution altered accordingly it obstinately refused to do so, on the feeble grounds that the proposals were derogatory to the present members. 30 The truth was that with being so often collectively under fire from the ratepayers and the press the members had got into the habit of presenting a common front to the enemy: they had become bound together into "a family compact," as the Herald called it. The Board had grown to be a single clique: the considerable personal influence of the members was being thrown into the scales at elections to ensure the return to the "family compact" of retiring members or, if a new member was required, the admission to it of candidates whom they supported. Tottenham's government, in fact, had drifted into the hands of virtually a self - electing oligarchy which had lost control of the situation and was yet unwilling to relinquish one iota of its authority. So long as it preserved its solid front Tottenham's oligarchy was protected from external attack by either the ratepayers or, short of a marked change in government policy, by any government department. The Board's only weakness lay in internal stresses and strains which rendered the "family compact" relatively unstable. By 1868 the Herald was making ominous references to the members bickering over which of the many outstanding accounts were to be settled out of the limited funds available in the Board's cash account and which were to be left unpaid; members were said "to be each trying to secure payment of his own friends' bills," A little later the editor remarked that the old tolerance at the meetings had all gone and "recriminations and virtuperations are constant accompaniments of the Board's business." The constant strain of struggling with one emergency after another was beginning to tell on the members and was causing them to stretch the "family compact" to near breaking point. What remains to be described in this study is the sequence of events which exacerbated internal frictions to a point at which they caused the Board to break down completely. Of the many problems which confronted the Board at this time none was more troublesome or controversial than the great sewage question. In the nature of things it was a particularly distasteful vexatious yet impelling subject which members could never escape for long. It is scarcely surprising therefore that it was the primary cause of the anticipated rift in the "family compact". What is rather surprising, however, is the almost melodramatic way in which events actually unfolded themselves to arrive at this result. The astonishing complexity of the local situation between 1869 and 1872 makes it difficult to merge the significant incidents into a clear and balanced picture, but even at the risk of a little discursiveness the salient points must be put on record. For nearly three years under the benefit of repeated suspensions of the Court of Chancery's injunction the roughly limed sewage had continued to pour into the Lea. But the patience of Vice-Chancellor Wood of the Chancery Court was now exhausted: he refused to extend the suspension and threatened the parish with heavy fines until the sewage was either diverted from the river or adequately deodorised. It made 1869 an anxious and hectic year for the Board. A number of "miraculous and secret" methods of deodorising sewage (the Board had exhausted all orthodox ones) were 31 tried. One or two of them "seemed very promising" when demonstrated by the various inventors and patentees in three-pint glasses of fresh sewage under the noses of the members in the Board room: but when applied in full scale trials at the works they all failed. For a short time bargeing the sewage down river was practised: until the Lea Trustees objected owing to complaints received from other users of the river. Removal of the sewage to dumps on neighbouring farms had also been abandoned after a very short trial, for the surveyor reported "that the inhabitants obstruct the passage of the carts through their streets, even at night". Of known methods of treatment only the sewage farm system of irrigation had not so far been attempted. For although the Board had considered the possibility of resorting to irrigation the idea had been abandoned on the grounds that there was no land in the parish suitable for the purpose. Early in 1870, when the Board was quite desperate, Mr. Clarke, who in connection with his own building and contracting business was an intrepid adventurer and more accustomed to handling large schemes than any of the other members, volunteered to work out a plan for a sewage farm which would overcome all the objections previously raised to irrigation. With considerable unwillingness the Board accepted the idea in principle and set up a Sewage Committee of three members - with Mr. Clarke as its chairman and Dr. Hall, serving his fifth term as chairman of the Board, as an ex-officio member- "to carry out a proposed scheme for dealing with the sewage by irrigation." The terms of reference turned out to be unfortunately phrased for they gave Mr. Clarke a loophole for later claiming that the Committee was vested with full powers to put his scheme into effect. Some months later the Board and the parish learnt for the first time the details of Mr. Clarke's scheme, which, with Dr. Hall dissenting strongly, the Sewage Committee had approved. It was certainly a large and bold plan. Two hundred acres of "the Lammas lands over the river in the parish of Walthamstow" were to be bought and turned into a sewage farm: the sewage was to be pumped across the Lea in pipes: the land was to cost about £200 an acre and the total cost of the scheme would be between £50,000 and £80,000: Mr. Rawlinson, an inspector on the Home Office staff, had been consulted on the technical details and had approved them: since land outside the parish was being purchased the scheme could not be carried through without a Local Act being passed to give requisite powers: application to Parliament for the special Act would have to be made immediately if the business was to be completed before the recess; otherwise a whole year might be lost. In presenting his statement Mr. Clarke made no attempt to conceal that he regarded the Sewage Committee as having full authority to handle the whole affair and time being such an important factor a parliamentary agent would be engaged right away to prepare a bill rather than risk delays which would be occasioned if the scheme was subjected to lengthy discussions before the whole Board. A more sensational announcement had never been made in the parish. The Board and the ratepayers were clearly being swept off their feet by 32 Mr. Clarke and his tiny committee. Yet, judged on its merits, his scheme was not without its supporters both in the Board and the parish generally. On the other hand there had all along been plenty of genuine disbelievers in the irrigation idea and to strengthen their following there was now the alarm engendered by the immense costs of the proposed sewage farm (the higher figure mentioned in connection with this one project was equal to the Board's entire expenditure on capital works during the previous twenty years), and the fact that the whole affair smacked of a coup d'etat. The Board and the ratepayers were at once thrown into two sharply divided and fairly evenly matched camps, an "irrigationistf”, party under Mr. Clarke and a "non-irrigationist" party under Dr.. Hall. Mr. Clarke had manoeuvred himself into a strong position. His claim to have been vested with authority by the Board might be a little dubious but he could point to the urgency of the whole question, to the absence of any alternative plan on the opposition's part, to the approval given to his scheme by the Home Off ice inspector and to its favourable reception by the London press; the Standard for example, wrote of "the gentlemen who are styled with irony Tottenham Local Board of Health and who have polluted the Lea for fifteen years in defiance of an injunction of the Court of Chancery are at last about to give up their old slovenly ways of poisoning people by the thousand. We are glad to learn that they are showing a new spirit and are about to apply a plan for irrigation which promises well". For Dr. Hall and his "non-irrigationist" colleagues on the Board the situation was embarrassing Though in a slight majority they were unable to find any constitutional means of checking Mr. Clarke and his wayward Sewage Committee. Nordid they dare to appeal to the Home Secretary either to restore the Board's authority or to oppose the Committee's Local Bill for his office was known to be biassed in favour of irrigation and it was said openly in the press that if he was approached "he was most likely to take the whole question out of the Board's hands and compel the Parish to take an elaborate irrigation scheme, regardless of the costs". One incidental effect of the extraordinary position was a prompt crumpling up of all the Board's longstanding resistance to the pressure of the ratepayers for an increase in the membership. Here was an obvious way, it seemed, to measure the strength of the two parties in the parish and to ease the tension between them in the Board room. The next ordinary annual election lay six months ahead, but if the Board was enlarged there would have to be an immediate election for new members, and one or other party it was argued was sure to secure a clear majority A formal application for an increase of the membership to twelve was lodged with the Home Secretary His approval was soon forthcoming, but the Board's hopes of a quick solution to the deadlock were dashed when it transpired that Parliament was overloaded with business and "the necessary Provisional Order could not be confirmed until the next session", so that a year might easily elapse before authority to hold a special election could be given. For the "non-irrigationistfe" however, there was the minor 33 consolation of learning that Mr. Clarke's intentions of quickly procuring a local Act for the sewage farm had been similarly upset by the inability of Parliament to undertake fresh business. Within the Board the curious stalemate dragged on over the winter; routine business was being carried on in a desultory fashion but there was now no chance of healing the breach over the sewage question at least until the spring when the annual election was due, with a prospect of the issues being decided by the ratepayers at the poll. But meantime the ratepayers were not inactive; owing to the seriousness of the situation from their point of view the vestry meeting, the ancient and lawful parish forum, had come into its own again and was being patronised as it had never been before. The great sewage question had become its principal business: special meetings were being called to keep the inhabitants abreast of the situation, at which both parties stated their points of view. By the end of the winter public opinion had crystallized out. Following a meeting which, according to the Herald "unorecedentedly occupied two nights and was attended by a larger number than ever before, including many of the principal inhabitants who never before attended," it was agreed that a poll of the ratepayers (also unprecedented) must be taken. The outcome was a substantial victory for the "non-irrigationists"'and the Vestry was empowered "to appropriate up to £200 of the Parish Fund to defend the parish against the sewage farm scheme should any attempt be made to obtain a local act for that purpose". There is no need to enlarge on the intense excitement which centred on the next election when it fell due in March 1871. By coincidence both Dr. Hall and Mr. Clarke were due to seek re-election and so was one of Dr. Hall's "non-irrigationist" party. In addition there were six other candidates for the three vacancies whose adherences were thought to be equally divided between the two parties. Mr. Clarke, unmatched in the , parish for political skill and ingenuity, was thought likely to head the poll and by his influence carry two "irrigationists" in with him, for as well as the support he had in the parish he was believed "to have in his pocket the votes of 200 non-resident owners of property". The Herald rightly predicted that "personal friendships would be likely to be sacrificed in this exciting event: it will not be as heretofore a struggle between old retiring members combined and new candidates but a bitter struggle between retiring members". But even this election on which the parish was counting so largely produced only an anticlimax; when the results were made known it was found that the ratepayers had perversely vitiated its real purpose by returning all three retiring candidates and so had simply re-established the Board with precisely its former membership. Moreover, a pure trick of fate had actually accentuated the problem; one of the "non-irrigationist" members - upon whom that party relied for, its fractional majority in the Board - had suddenly left the parish to live elsewhere; instead of nine members the Board was reduced to eight of whom four were staunch "irrigationists" and four equally staunch "non- irrigationists". 34 As far as the Board was concerned the election had produced a fantastic result. What had been a deadlock on the sewage question had been turned into a complete impasse on all other matters. For two months the members, with the value of the casting vote in mind, could not even arrive at a decision as to the chairmanship: through a succession of sterile meetings five of the eight members were at one time or another proposed and seconder for the post but each time the voting ended in a tie. There was nothing in the Public Health Act of 1848, from which the Board still derived its constitution, to provide for a contingency of this nature and an appeal to the home Secretary brought only "his instructions to the members to repay their failure of duty by electing a chairman". The situation was one which favoured Mr. Clarke and he fostered it; for he was again busy with the promotion of a sewage farm bill under the title of the Tottenham Local Board Bill, and he was playing for time. Had the Vestry not forestalled him, he would probably have succeeded in presenting the parish with a fait accompli; but on the strength of the resolution which had empowered it to use the parish funds for the purpose the Vestry applied for and secured an injunction from the Attorney General "to restrain the Board or any Committee of the Board from applying moneys out of rates for the Tottenham Local Board Bill". Mr Clarke quickly recognised that he had suffered a last minute defeat At the next meeting of the Board he abstained from voting and Dr. Hall was re-installed in the Chair. It was now the end of hay 1871. The internecine struggle was to all intents and purposes over: without having contributed anything towards the solution of the sewage question Tottenham's next unhappy task was to assess the extent of the damage which had been done to the parish during the past decade There was evidence of it in every direction The parish's heritage of public harmony and civic enterprise and its reputation as a prosperous, pleasant and healthy district had been thrown away. Public confidence among the inhabitants was at its lowest ebb. The decennial census had revealed that six hundred houses in the parish were standing empty. People were beginning to talk of the high local death rate, so that several of the famous residential schools in the district (including Bruce Castle School) deemed it prudent to publish in the press medical certificates showing the good health records of their pupils. Even with a chairman, the Board remained paralysed and bankrupt: in July, when its bank account should have been flush with rate money, its credit balance was down to 14/11; such was its reputation that even for short term loans it was having to pay 12% interest; and the annual rate estimate, which should have been approved and signed in April* had not been signed "because certain members refuse- to sign and the statutory five signatures are not obtainable." The Herald summed up the situation in a leader on "Poor Tottenham'. Where the Local Board has ruined everything and everybody. Where the Exchequer is empty Where people never stay a week longer than they can help Where the houses are empty- Yet through all the gloom and despondency the inhabitants never 35 tirely lost their resilience. In the same breath in which the Herald spoke of "Poor Tottenham" it was also finding good reason to believe that, given a little respite from mismanagement and a truce to overbuilding by speculative builders, the parish would quickly recover its good name and fill its empty houses. A most encouraging feature was that Parliament had approved the Provisional Order which would allow the Board's membership to be raised from nine members to twelve: the special election for three additional members would soon be held and the Herald had no doubts that good candidates would be found and that the occasion would mark a turning point in the quality of Tottenham's public administration. These high hopes were amply fulfilled. Recent events had caused a resurgence of public spiritedness among a group of inhabitants better qualified to undertake the management of public affairs than the Board's old members. During the emergency the group had combined successfully and by working through the Vestry to get the Sewage Bill quashed had compelled the Local Board back to a proper dependency on the will of the ratepayers. Shortly afterwards they had banded themselves into an association, under the title of the Tottenham Sanitary Association, with the specific object of educating public opinion to the importance of improving the parish's sanitary conditions. Presently the Association pledged itself to support a better type of candidate at Board elections and within a year men of the stamp of Mr. Littler, Q.C., Mr. Read, M. P., and the philanthropic Mr. Pedley had taken their seats on the Board and the process of reclaiming Tottenham and revitalising its local government had begun. FOOTNQTR Unfortunately the authors know of no local sanitary histories which deal with the evolution of sanitary administration in a town or parish during the third quarter of the nineteenth century in the way they have attempted to do in the case of Tottenham, Consequently it is not possible to make a comparison between Tottenham's remarkable experiences and those of other districts, It seems not improbable, however, that they were nearly unique and that no place, sanitarily speaking soared quite so high and fall quite so low all within a space of twenty years. In support of this view there is, on the one hand, evidence to which we have made reference showing that .round about 18 55 Tottenham by contemporary standards had attained the very highest level of sanitary services. On the other hand, to read the voluminous evidence given before the famous Royal Sanitary Commission, which in 18 69 carried out an extensive enquiry into English sanitary practices, is to find nothing so abysmal as the state into which Tottenham had drifted by that date. The Commission, it is true, learnt of districts being entirely devoid of sanitary administration and of others which though under Local Boards of Health had never attempted to modernise their sanitation; but Tottenham, with a facade of sanitary arrangements which were, in fact, rotten to the core by 1869, was in an even worse position In sanitary matters it had been the hapless victim of "vaulting anbition which o' er leaps itself," It seems not unlikely, furthermore, that Tottenham knew uniqueness in another direction, To have experienced within two decades such a strange sequence of local governments as a plutocracy, an oligarchy and a near miss at a dictatorship (or "r«le by a parish Boss" as the Webbs designated similar examples of local dictatorships which they came across-in the course of their studies of the pre-Reform system of parish government) cannot have been the lot of many, if indeed any, other parishes. There is yet another remarkable feature in connection with Tottenham namely, that both the quantity and the quality of material open to those who delve into'its nineteenth century history is rich beyond belief. This material in its different forms has been carefully and wisely collected, concentrated and preserved within the Borough at the Central Library, at Bruce Castle Museum and along with the Council's muniments in the Town Hall. To all those whom the authors have troubled in these quarters in exploring the local records, they wish to tender their sincere thanks To Mr, Lindsay Taylor, Town Clerk: to Mr, E. W. McClellan, Chief Librarian, to mr. F. H. Fen ton, Sub-Librarian and to Mr. C. H, Rock, lately Curator of the Museum they are Particularly grateful for friendly assistance. To Dr. Hogben, Medical Officer of Health, there is a special debt owing, both for his help in many directions and for the encouraging interest he has shewn at all times in the progress of this study. 78 INDEX PAGE Area Health Service 60 Atmospheric Pollution 28 Births and Deaths 59 Burials 50 Catering Establishments 20 Closet Accommodation 28 Closing Orders 34 Council, Members of 1 Deaths 54 Demolition Orders 33 Diphtheria 9 Disinfection 17 Disinfestation 42 Drainage and Sewerage 26 Factories 43 Food-Condemned 22 Hygiene 18 Poisoning 20 Preservation 21 Sampling 23 79 Hawkers 21 Health and Housing Committee 2 housing 29 Housing Act, 1936, s.9 31 Housing Act, 1936, s.ll 32 Housing Act, 1936, s. 12 32 Housing Act, 1936, Part V 34 Housing Act, 1949 30 Lettings 38 Ice Cream 19 Immunisation, Diphtheria 10 Infantile Deaths 55 Infectious Diseases 6 Knackers' Yards 21 Laboratory Service 49 Legal Proceedings 25,37,46 Massage and Special Treatment Establishments 47 Maternal Deaths 52 Measles 15 Medical Examination prior to staff appointments 47 Metropolitan Water Board 2 Milk and Dairies 18 National Assistance Act, 1948, s.47 48 National Assistance Act, 1948, s.50 50 80 National Health Service Act, 1946: Part III Services 61 Notices Served 40 Outworkers 44 Persons in need of Care and Attention 47 Poliomyelitis 16 Public Health Act, Part III 37 Public Health Department, Staff 2 Repairs in Default 42 Rodent Control 39 Sanitary Administration 28 Sanitary Inspectors, Summary of Inspections 40 Scarlet Fever 11 School Health Service 68 Sewerage and Drainage 26 Shops 43 Slaughterhouses 21 Statistical Summary 51 Tewkesbury Estate 34 Tuberculosis 6 Typhoid Fever 16 Water Supply 27 Whooping Cough 13 Work in Default 32