5 AC 43337 THE HEALTH OF ENFIELD 1970 A report by the Medical Officer of Health and Principal School Medical Officer WILLIAM D. HYDE. M B,. Ch. B,. D.P.H. ENF 54 TH E HEALTH OF ENFIELD 1970 A report by the Medical Officer of Health and Principal School Medical Officer WILLIAM D. HYDE, M.B., Ch.B., D.P.H. Introduction 1 The Council 3 Statistics and Social Conditions 7 Personal Health Services 21 Environmental Health Services 65 School Health Services 95 Staff and Training 115 Index 123 Health Office, Gentleman's Row, Enfield, Middlesex. To the Mayor, Aldermen and Councillors of the London Borough of Enfield. I have pleasure in presenting my report on the health of the borough for the year 1970. The report surveys in some detail the activities of the Health Department during the year. As additional comment in this foreword I will say only (hat the vital statistics for the borough compare favourably with the national figures, and that the very low figure of three deaths from respiratory tuberculosis tends to focus attention on the 185 deaths from cancer of the lung and bronchus. The report is presented in three main sections dealing with the three major aspects of the work of the department — personal health, environmental health and school health. The opportunity has been taken this year of changing the appearance, style and format of the report, and in this I acknowledge with thanks the valuable help of Mr. J. McNeil, Senior Administrative Officer. Once again, the contribution of material for, and the compilation of, the report have been dependent on the combined efforts of many people, and I am indeed grateful to my deputy and to the other members of the department for their invaluable help in preparing this report and for their loyal and diligent support during the year. I would also like to record my grateful appreciation of the support and encouragement of the Chairman, Vice-Chairman and members of the Health and other Committees of the Council and the willing co-operation of my colleagues in other departments. WILLIAM D. HYDE Medical Officer of Health Principal School Medical Officer 1 THE COUNCIL THE COUNCIL Mayor Alderman Mrs. S. G. Child. Deputy Mayor Councillor W. J. Watson. ■ The Council Aldermen Mrs. S. G. Child, W. H. Cook, F. C. Cunneen, J. J. Cusack, E. L. Mackenzie, J.P., E. G. McNern, H. S. Newman, B.Sc., B.Sc. (Econ.), W. A. A. Poole, E. S. Taylor, A. J. Young. Councillors J. A. Alcock, Mrs. P. J. Attridge, K. V. Balding, Mrs. B. M. Bennett, T. A. J. Bennett, Samson Bercow, J. Blake, J. R. Bowyer, T. Bragg, J. A. B. Connors, H. W. Corpe, Mrs. E. C. Cousins, D. A. Cox, R. L. Dubow, M.A. (Oxon.), P. G. Elvidge, Mrs. A. L. Emsden, G. G. Eustance, R. W. Fenn, E. C. Francis, C. G. Gander, L. I. Genn, C. C. Goldwater, M. J. Green, H. G. S. Groves, J.P., Miss K. J. Harvey, Mrs. M. M. Hawkins, R. C. Hull, J. W. E. Jackson, A. Jay, Mrs. P. E. Joel, T. G. G. Joel, L. F. Lafitte, G. Leigh, J.P., Barry N. Lewis, Mrs. Hanna Lewis, Mrs. A. R. Lindsay, John L. Lindsay, Mrs. A. Long, Mrs. P. Lyon, V. A. Maskens, A.A.C.C.A., L. C. Merrion, M.B.E., A. E. L. Moulder, D.S.M., W. R. Nunn, J. G. Payne, J. D. Penney, Ph.D., B.Sc. (Eng.), J. L. Posner, A. P. Prior, J. D. Reed, W. Robinson, R. F. Simmons, M. Simpson, David Solomons, W. J. Stiles, C. B. Warren, L. J. D. Warren, Mrs. F. E. Watson, W. J. Watson, Miss S. E. Whelton, C. E. Wright, J.P., J. A. Wyatt. ■ Social Services and Health Committees Chairman Alderman E. C. McNern. Vice-chairman Councillor Mrs. P. E. Joel. Deputy Chairman Councillor Mrs. P. E. Joel. (Health) Deputy Chairman Councillor J. A. Alcock. (Children's) Deputy Chairman Councillor T. A. J. Bennett. (Welfare) Alderman J. J. Cusack. Councillors Mrs. P. J. Attridge, Mrs. E. C. Cousins, D. A. Cox, R. L. Dubow, M.A. (Oxon.), R. W. Fenn, M. J. Green, J. W. E. Jackson, A. Jay, L. F. Lafitte, G. Leigh, J.P., R. F. Simmons. Advisory Member Dr. W. J. G. Meldrum. ■ Social Services and Health Sub-Committees: chairman Alderman E. G. McNern. Vice-Chairman Councillor Mrs. P. E. Joel. Alderman J. J. Cusack. Councillors J. A. Alcock, Mrs. P. J. Attridge, T. A. J. Bennett, R. F. Simmons. 4 THE COUNCIL ■ Education Committee Chairman Councillor Mrs. A. L. Emsden. Vice-Chairman Councillor G. Leigh, J.P. Aldermen W. H. Cook, E. L. Mackenzie, J.P., H. S. Newman, B.Sc., B.Sc. (Econ.), W. A. A. Poole, E. S. Taylor. Councillors J. A. Alcock, Mrs. P. J. Attridge, T. A. J. Bennett, Mrs. B. M. Bennett, Samson Bercow, H. W. Corpe, Mrs. E. C. Cousins, R. L. Dubow, M.A. (Oxon.), L. I. Genn, C. C. Goldwater, Miss K. J. Harvey, R. C. Hull, A. Jay, Mrs. P. E. Joel, L. F. Lafitte, Barry N. Lewis, Mrs. Hanna Lewis, Mrs. A. R. Lindsay, John L. Lindsay, Mrs. P. Lyon, J. G. Payne, J. D. Penney, Ph.D., B.Sc. (Eng.), J. D. Reed, R. F. Simmons, M. Simpson, C. B. Warren, L. J. D. Warren, Mrs. F. E. Watson, Miss S. E. Whelton, C. E. Wright, J.P., W. J. Wyatt. Co-opted Members Mr. J. R. Boast, A.C.I.S., Mr. A. J. Bullock, B.Sc. (Eng.), C.Eng., F.i.Mech.E., Mr. L. J. Crocker, Mr. Gordon Dixon, M.A. (Cantab.), Mr. H. J. Emsden, B.Sc. (Eng.), Mrs. M. Jepson, The Very Rev. Canon D. O'Sullivan, Mr. R. St. John, Rev. A. Skelding, B.A., Mr. A. J. Tanner and Mr. R. G. Vos, B.Sc. ■ Schools Sub-Committee Chairman Councillor Mrs. A. L. Emsden. Vice-Chairman Councillor Mrs. P. Lyon. Alderman H. S. Newman, B.Sc., B.Sc. (Econ.). Councillors T. A. J. Bennett, Mrs. P. E. Joel, G. Leigh, J.P., Mrs. Hanna Lewis, J. G. Payne, C. B. Warren, L. J. D. Warren, Mrs. F. E. Watson. Co-opted Members Mr. L. J. Crocker, Mrs. M. Jepson. ■ Members of Council appointed to Bodies concerned with Health Services Association of Municipal Corporations — Health Committee: Councillor G. Leigh, J.P. Eastern Gas Consultative Council: Councillor J. Blake. Enfield Group Hospital Management Committee: Alderman J. J. Cusack. Enfield Marriage Guidance Council : Councillor Mrs. B. M. Bennett, Councillor Mrs. M. M. Hawkins. Family Planning Association: Councillor Mrs. P. E. Joel. Invalid Children's Aid Association : Councillor Mrs. P. E. Lyon, Councillor J. A. Wyatt. Lee Conservancy Catchment Board : Councillor T. G. G. Joel, Councillor A. E. L. Moulder, D.S.M. London Accident Prevention Council: Councillor P. G. Elvidge, Councillor G. G. Eustance. London Boroughs Association — Social Services Committee : Alderman Mrs. S. G. Child. Middlesex Executive Council: Councillor Mrs. P. E. Joel. National Association for Maternal and Child Welfare : Alderman E. G. McNern, Councillor Mrs. A. L. Emsden, Councillor Mrs. A. R. Lindsay. National Hospital Service Reserve: Councillor Mrs. P. E. Joel. National Society of Children's Nurseries: Councillor Mrs. M. M. Hawkins. National Society for Clean A ir : Councillor T. A. J. Bennett, Councillor Mrs. E. C. Cousins. Pre-School Playgroups Association — Enfield Branch : Alderman E. G. McNern, Councillor J. A. Alcock, Councillor Mrs. P. E. Joel. Southgate Social Services Council: Councillor G. Leigh, J.P., Councillor T. A. J. Bennett. Standing Conference on Investigation of Atmospheric Pollution : Councillor Mrs. P. E. Joel. 5 STATISTICS AND SOCIAL CONDITIONS STATISTICS AND SOCIAL CONDITIONS ■ Tables relating to the London Borough of Enfield 1. General Statistics 2. Vital Statistics 3. infant Mortality 4. Causes of, and ages at, death 5. Road Accidents 6. Infectious Disease : Notification and Deaths 7. Infectious Disease: Tuberculosis—Notification and Deaths 8. Public Health Laboratory Service . Environmental specimens ■ Summary Area (acres) 20,061 Population (Registrar General's Mid-1970 Estimate) 262,690 Number of structurally separate dwellings, including flats 90,587 Number of dwellings constructed during the year 1,221 Rateable value £18,789,716 Product of a 1d. rate £78,150 Uve Births Number 3,834 Rate per 1,000 population (crude) 14.6 Ratio of local adjusted birth rate to national rate 0.95 Rate per 1,000 population (standardised) 15.2 England and Wales 16.0 Illegitimate live births per cent of total live births 7.0 England and Wales 8.0 Stillbirths Number 37 Rate per 1,000 total live births and stillbirths 10 England and Wales 13 Total live and stillbirths 3,871 infant Mortality Infant deaths (deaths under the age of 1 year) 58 Total infant deaths per 1,000 total live births 15.1 England and Wales 18 Legitimate infant deaths per 1,000 legitimate live births 15 England and Wales 17 Illegitimate infant deaths per 1,000 illegitimate live births 14 England and Wales 26 Neo-natal mortality rate (deaths under age of 4 weeks per 1,000 total live births) 11 England and Wales 12 Early neo-natal mortality rate (deaths under the age of 1 week per 1,000 total live births) 9 England and Wales 11 Perinatal mortality rate (stillbirths and deaths under the age of 1 week combined per 1,000 total live and stillbirths) 19 England and Wales 23 Maternal Mortality (including abortion) Number of deaths 2 Rate per 1,000 total live and stillbirths 0.5 Deaths Number of deaths from all causes 3,037 Death rate per 1,000 home population (crude) 11.6 Ratio of local adjusted death rate to national rate 0.94 Death rate per 1,000 home population (standardised) 11.0 England and Wales 11.7 Deaths from cancer (all forms) 683 Death rate from cancer (all forms) per 1,000 population 2.6 8 STATISTICS AND SOCIAL CONDITIONS ■ Social Conditions The London Borough of Enfield covers an area of 20,061 acres and has an estimated population of 262,690 and a rateable value of £18,789,716. Development is well balanced with a wide variety of environmental conditions, ranging from open country, through residential property of all kinds, commercial premises and shopping centres, to industrial areas. Considerable redevelopment was effected during the year in the shopping area known as The Green, Edmonton. For some years increased road traffic has given rise to congestion in this part of the borough, but the traffic flow is now assisted by a new roundabout, and a large multi-storey car park which enables the motoring public to park near at hand when patronising the enclosed shopping area which provides facilities for the former street market. The new swimming pool has replaced Knights Lane Baths, now demolished, and in addition to enjoying the facilities offered at the pool, which is among the most modern in design in the country, the public can make use of sauna and slipper bath facilities which are provided. The transport network serving the borough includes an underground, three suburban and two main railway lines and numerous bus routes. Two trunk roads cross the borough, one from east to west and the other from north to south. The opening of the further stretch of dual carriageway to the northern boundaries on the latter road has brought about a considerable improvement in the traffic flow through Enfield. One first-class road runs north to south and important metropolitan roads run east to west. The borough is well provided with educational, cultural and recreational facilities. The main public building is the Civic Centre, Stiver Street, Enfield, which contains the Mayor's Suite, the Council Chamber, committee rooms and the department of the Town Clerk. The other departments of the Council are housed separately in premises throughout the borough ■ Vital Statistics Births The total number of live births during the year was 3,834, giving a crude birth rate of 14-6 and a standardised birth rate of 15-2 compared with the rate for England and Wales of 16-0. Deaths The number of deaths during the year was 3,037 (1,513 males and 1,524 females) giving a crude death rate of 11-6 and a standardised death rate of 11 0 (England and Wales 11 -7). The more prevalent causes of death were cardio-vascular system 1,495, malignant neoplasm 683, and diseases of the respiratory system (excluding malignant neoplasm) 450. Of the cardio-vascular causes 719 were due to ischaemic heart disease, 375 to cerebrovascular disease, 59 to hypertensive disease, 40 to chronic rheumatic heart disease, 126 to other forms of heart disease, and 176 to other diseases of the circulatory system. Of the malignant neoplasm causes of death 185 (of which 158 were males) involved the lung and bronchus, 86 the intestine, 76 the stomach, 76 the breast, and 13 the cervix of the uterus. O'f the diseases of the respiratory system, bronchitis and emphysema accounted for 186 deaths, pneumonia 211 deaths and tuberculosis three deaths. 9 STATISTICS AND SOCIAL CONDITIONS There were no deaths during the year from diphtheria, whooping cough, poliomyelitis or measles. Forty-six per cent of all deaths, 522 males and 875 females, were of persons aged 75 years or more. Thirty per cent, i.e. 322 males and 618 females, were of persons aged 80 years or more. Nine males and 31 females were aged 95 years or more including three females, two aged 101 years and one aged 102 years. There was one death arising from abortion and one from other complications of pregnancy. Deaths of infants During the year there were 58 deaths of infants under the age of one year, of which 42 were under the age of four weeks, and 35 under the age of one week. The Infant Mortality Rate for the borough was 15-1 compared with 18 for England and Wales. Of the 35 infant deaths which occurred under the age of one week the most common cause of death was prematurity. Of those who died during the later months the most common causes were of cardiac and respiratory origin. Fatal Accidents During the year under review, 32 (19 male, 13 female) Enfield residents died as a result of motor vehicle accidents, and 39 (21 male, 18 female) from other accidents. In addition there were 26 (13 male, 13 female) deaths from suicide compared with 36 last year. A considerable number of deaths occurred from accidents in the home and the most common causes were injuries due to falls which in several cases led to lung complications, asphyxia due to coal gas poisoning, and barbiturate poisoning. Suicide Most of the cases of suicide were by means of barbiturate poisoning or coal gas poisoning, although a few other means were also used. inquests One hundred and ten inquests and 454 post-mortem examinations without inquests were held during the year. In respect of inquests, six deaths were attributed to natural causes, 66 to accidental causes or misadventure, 25 to suicide, two to murder, two to manslaughter, one to alcohol, one to drugs, and in seven cases an open verdict was recorded. Road accidents I am grateful to the Borough Engineer and Surveyor for providing statistics, and for the following report and opinion on road accidents occurring within the Borough : "The total of 2,055 casualties is a 4% increase on the total of 1,977 casualties for 1969. The pedestrian casualty rate has remained steady and the casualties to pedal cyclists shows a decrease of 18% or 41 casualties over 1969. The increase has occurred in the driver and passenger categories of motorised vehicles. It is interesting to note that of the 432 pedestrian casualties 185 or 42% are children under the age of fifteen years. The statistics again emphasise that as far as child pedestrians are concerned one of the major contributory factors is the parked vehicle, in fact 60 or 33% 10 STATISTICS AND SOCIAL CONDITIONS of all child pedestrian casualties were injured whilst crossing the road masked by a stationary vehicle. Of the 328 child casualties, 46 were under five years of age, 181 were aged between five and eleven years and 101 were aged between eleven and fifteen years. The casualty rate of the over 60-year old fell from 230 in 1969 to 200 in 1970, a reduction of 13% but ten of the 21 fatal casualties during the year were of this age range. Since 1965 when the London Borough of Enfield came into being, there have been the following number of casualties on the roads of our Borough:— 1965 — 2,387 1966 — 2,206 1967 — 1,986 1968 — 1,968 1969 — 1,977 1970 — 2,055 TOTAL — 12,579 This total represents one casualty for every 43 yards of roadway that we have in the Borough. If all of these injured persons were laid head to toe in a straight line it would stretch from Tottenham to Waltham Cross and from Chingford to Cockfosters, forming a cross the length and breadth of our Borough, a distance of more than thirteen miles." ■ Prevalence and Control of Infectious Disease Part v Public Health Act 1936 Sections 47-49 Health Services and Public Health*1 Act 1968 Provisions relating to the notification of infectious disease and food poison- ing by medical practitioners to the Medical Officer of Health are found in Part V of the Public Health Act 1936, Sections 47 to 49 of the Health Services and Public Health Act 1968, and the Public Health (Infectious Diseases) Regulations 1968. Two thousand, one hundred notifications were received, and of these 876 (42%) were school children. In addition, head teachers reported 370 cases of suspected infectious disease. Measles Just over 79% of the notifications were for measles : 1,660 cases, showing a slight increase on last year's figure of 1,536 cases. Tuberculosis Forty-three cases of respiratory tuberculosis were reported, and fifteen cases of tuberculosis of other organs including genito-urinary tract, lymph glands and uterus were notified. There were four deaths from the disease. These figures are similar to those for previous years. Food poisoning Thirty-four cases of food poisoning were notified, a substantial increase on last year's figure. The causative organism was Salmonella typhimurium in five cases; other Salmonella organisms accounting for 23 of the remaining cases. All the notifications, with the exception of two family out-breaks, were of sporadic cases. infective Jaundice Forty-seven cases of infective jaundice were notified and contact with a known case was established in three instances; thirteen of the remaining cases were known to have eaten shell-fish. Typhoid fever Two cases of typhoid fever were notified. One case was the son of a known carrier, who has since undergone hospital treatment and has responded successfully. The other case was a woman who had recently returned from holiday in Turkey. 11 STATISTICS AND SOCIAL CONDITIONS Meningitis (acute) Seven cases were notified. There were four deaths. Poliomyelitis No cases of poliomyelitis were reported in the borough during the year. Public Health (Ships) Regulations 1966/8 (Aircraft) Regulations 1966 Port Authorities notified 33 persons as arriving from declared cholera and smallpox endemic areas without valid certificates of vaccination. These people were kept under surveillance for the statutory period and in no case did they develop cholera or smallpox. Disinfection Sections 166-168 Public Health Act 1936 Local authorities have the power to provide a disinfecting station and to arrange for the cleansing and disinfection of premises and articles. Generally, in cases of infectious disease, terminal disinfection of rooms and contents can be satisfactorily effected by a thorough " spring cleaning Sometimes, however, it is deemed necessary to take more rigorous action, and in such cases — of which five occurred in the course of the year — premises are subjected to treatment with formaldehyde. At the Council's disinfecting station, steam is used to disinfect clothes, bedclothing and the like; while articles liable to be damaged by steam, e.g. library books, are treated with formaldehyde. Items treated included thirty garments, 235 library books, and 120 miscellaneous items. Used clothing, consisting of 238 separate items, was treated for despatch abroad to those countries which require certification that treatment has been effected. No charge is made by the Council for these services. References to other work undertaken at the disinfecting station are contained in the item " Disinfestation " in this report. Public Health Laboratory Service The Public Health Laboratory Service at Whipps Cross Hospital, London, E.11, is available for the examination of bacteriological specimens. For the convenience of general practitioners and the public, several specimen collection boxes are positioned at various points throughout the borough. The specimens are collected from the boxes daily and delivered to the laboratory. Throughout the year we have continued to enjoy the invaluable service and assistance of the Director, Dr. Thom, and his staff. 12 STATISTICS AND SOCIAL CONDITIONS TABLE 1 General Statistics Area: (In acres) 20,061 Population: (Registrar General's mid-1970 estimate) 262,690 Number of structurally separate dwellings, including flats 90,587 Number of dwellings constructed during the year 1,221 Rateable value (at 31st December, 1970) £18,789,716 Product of a penny rate: (1970/71 revised estimate) £78,150 13 14 STATISTICS AND SOCIAL CONDITIONS Table 2 Vital Statistics 1970 LIVE BIRTHS Males Females Total EARLY NEO-NATAL DEATHS (deaths under the age of 1 week): Males Females Total Legitimate 1,858 1,696 3,554 Illegitimate 150 130 280 Legitimate 18 17 35 2,008 1,826 3,834 Illegitimate - - - Rate per 1,000 Population 18 17 35 Enfield (Crude) 14.6 Rate per 1,000 live births: Enfield (Standardised) 15.2 Enfield 9.0 England and Wales 16.0 England and Wales 11.0 Enfield Illegitimate live births per cent of total live births 7.0 PERINATAL DEATHS (stillbirths and deaths under the age of 1 week): England and Wales Illegitimate live births per cent of total live births 8.0 Males Females Total STILLBIRTHS Males Females Total Legitimate 34 35 69 Legitimate 16 18 34 Illegitimate 2 1 3 Illegitimate 2 1 3 36 36 72 18 19 37 Rate per 1,000 live and stillbirths: Rate per 1,000 live and stillbirths: Enfield 19.0 Enfield 10-0 England and Wales 23.0 England and Wales 130 MATFRNAL MORTALITY (Includina abortion): INFANT DEATHS (deaths under the age of 1 year): Number of deaths 2 Males Females Total Rate per 1,000 live and stillbirths: Legitimate 32 22 54 Enfield 0.5 Illegitimate 4 — 4 DEATHS FROM ALL CAUSES 36 22 58 Males 1,513 Rate per 1,000 live births: Females 1,524 Enfield: Legitimate 15.0 Total 3,037 Enfield: Illegitimate 14.0 Rate per 1,000 population: Enfield: Combined 15.0 England and Wales: Combined 18.0 Enfield (Crude) 11.6 NEO-NATAL DEATHS (deaths under the age of 4 weeks): Enfield(Standardised) 11.0 Males Females Total England and Wales 11.7 Legitimate 23 18 41 DEATHS FROM CANCER (all forms): Illegitimate 1 — 1 Males 361 24 18 42 Females 322 Rate per 1,000 live births: Total 683 Enfield 110 Rate per 1,000 population: England and Wales 120 Enfield 2.6 Comparability Factors In view of the differing age and sex distribution of local populations, the General Register Office supplies factors for adjusting the birth and death rates to enable comparisons to be made with the rates for other areas and the country as a whole. In addition, the Death Rate Area Comparability Factor is adjusted to take account of the presence of any residential institution in the area. The Comparability Factors for Enfield are: Births 1.04, Deaths 0.95. STATISTICS AND SOCIAL CONDITIONS Table 3 Infant Mortality Deaths from stated causes at various ages under one year of age Cause of Death Under 1 week 1 week and under 4 weeks Total under 4 weeks 4 weeks and under 12 months Total deaths under 1 year Diabetes Mellitus 1 — 1 — 1 Other Endocrine, etc., diseases — — — 1 1 Meningitis — — — 1 1 Other diseases of nervous system — — — 1 1 Pneumonia 3 3 6 4 10 Other diseases of respiratory system — 1 1 2 3 Intestinal obstruction and hernia 3 — 3 1 4 Nephritis and nephrosis — — — 1 1 Congenital anomalies 5 3 8 4 12 Birth injury, difficult labour, etc. 12 — 12 — 12 Other causes of perinatal mortality 11 — 11 1 12 TOTALS 35 7 42 16 58 15 16 STATISTICS AND SOCIAL CONDITIONS Table 4 Causes of, and ages at, death CAUSE OF DEATH Sex Total All Ages Under 4 weeks 4 weeks 6 under 1 year Age in years 1-4 5-14 15-24 25-34 35-44 45-54 55-64 65-74 75 and over Tuberculosis of Respiratory System M 1 - - - - - - - - 1 - - F 1 - - - - - - - - - - 1 Late Effects of Respiratory T.B. M - - - - - - - - - - - - F 1 - - - - - - - - 1 - - Other Tuberculosis M - - - - - - - - - - - - F 1 - - - - - - - - - - 1 Other Infective and Parasitic Diseases M 3 - - - - - - - - 2 1 - F 4 - - - - 1 - - - 3 - - Malignant Neoplasm, Buccal Cavity, etc. M 3 - - - - - - - - - 3 - F 2 - - - - - - - - - 2 - Malignant Neoplasm, Oesophagus M 6 - - - - - - - - 2 3 1 F 7 - - - - - - 1 1 1 1 3 Malignant Neoplasm, Stomach M 45 - - - - - - 1 4 8 19 13 F 31 — — - — — — - - 7 7 17 Malignant Neoplasm, Intestine M 34 — — - - - - - 3 6 12 13 F 52 - - - - - - - 7 10 14 21 Malignant Neoplasm, Larynx M 5 - - - - - - - 1 1 1 2 F 1 - - - - - - - - - - 1 Malignant Neoplasm, Lung, Bronchus M 158 - - - - - - 1 8 54 59 36 F 27 - - - - - - - - 8 9 10 Malignant Neoplasm, Breast M — - — - - - - - - - - - F 76 - - - - - - 2 11 28 14 21 Malignant Neoplasm, Uterus F 20 - - - - - - - 1 4 8 7 Malignant Neoplasm, Prostate M 23 - - - - - - - - 2 6 15 Leukaemia M 12 - - 2 1 - - - 1 1 5 2 F 8 - - - 1 - - - - 1 2 4 Other Malignant Neoplasm M 75 - - - - 1 3 3 2 19 26 21 F 98 - - - 1 1 - 2 11 20 28 35 Benign and Unspecified Neoplasms M 9 - - — — — - 1 2 2 3 1 F 3 - - 1 - - - - - 1 - 1 Diabetes Mellitus M 9 1 - - - - - 1 - 4 1 2 F 11 - - - - - - 1 - 2 2 6 Other Endocrine, etc., Diseases M 3 - 1 - 1 - - - - - 1 - F 5 - - - - 1 - - 1 1 - 2 Anaemias M 4 - - — - - - - - 1 2 1 F 9 - - - - - - - - 1 4 4 Other Diseases of Blood, etc. M - — — — — — — - - - - - F 2 - - - - - 1 - - 1 - - Mental Disorders M 3 - - - - 1 - - 2 - - - F 4 - - - - 1 - - 1 - 1 1 Meningitis M 1 - - 1 - - - - - - - - F 3 - 1 - - - - - - - 1 1 Multiple Sclerosis M - - - - - - - - - - - - F 3 - - - - - - - - 3 — — Other Diseases of Nervous System M 17 — 1 1 — 1 — 1 2 1 5 5 F 22 - - 1 1 - - - 2 - 10 8 Chronic Rheumatic Heart Disease M 18 — — — — — — 1 1 5 8 3 F 22 - - - - - 1 - 1 7 8 5 Hypertensive Disease M 26 - - - - - - - 2 10 6 8 F 33 - - - - - - - 2 3 8 20 17 STATISTICS AND SOCIAL CONDITIONS Table 4 Causes of, and ages at, death Ischaemic Heart Disease M 391 - - - - - - 4 33 115 125 114 F 328 - - - - - 2 5 30 94 197 Other Forms of Heart Disease M 51 - — — — 1 1 1 1 7 13 27 F 75 - - - - - - - 1 2 7 65 Cerebrovascular Disease M 145 - - - - - 2 1 7 21 39 75 F 230 - - - - - - 5 7 24 37 157 Other Diseases of Circulatory System M 73 - - - - - - 1 4 10 17 41 F 103 - - - - 1 - - 2 8 15 77 Influenza M 13 - - - - - - 2 — 3 6 2 F 15 - - - - - - - 1 4 1 9 Pneumonia M 81 3 2 2 — — — 1 1 4 21 47 F 130 3 2 1 — — — 2 1 4 14 103 Bronchitis and Emphysema 141 - - - - - - 1 1 25 48 66 F 45 — — 1 — — — — 1 3 10 30 Asthma 1 - - - - - - - - 1 — — F 3 - - - - - - - 1 — 1 1 Other Diseases of Respiratory System 12 — 1 2 — — — — 1 3 4 1 F 7 1 1 - - - - - - - 2 3 Peptic Ulcer 14 - - - - - - 1 1 2 6 4 F 10 - - - - - - - - 1 2 7 Appendicitis 2 — — — — — — — — — 2 — F 2 - - - - - 1 - - - - 1 Intestinal Obstruction and Hernia 8 2 1 - - - - - - 1 1 3 F 6 1 - - - - - - - - - 5 Cirrhosis of Liver 2 - - - - - - - - 1 - 1 F 3 - - - - - - - - 1 2 — Other Diseases of Digestive System 12 - - - - - - - 1 2 7 2 F 19 — — 1 — — — 1 — 3 5 9 Nephritis and Nephrosis 12 — 1 — — 1 — — — 4 5 1 F 3 - - - - - - - 2 1 — — Hyperplasia of Prostate 2 - - - - - - - - - 2 Other Diseases, Genito-Urinary System 10 - - - - 1 - - - - 4 5 F 11 — — — 1 — — — 1 2 1 6 Abortion F 1 - - - - - - 1 - - - - Other Complications of Pregnancy, etc. F 1 - - - - - 1 - - - - Diseases of Skin, Subcutaneous Tissue 1 - - - - - - - - - 1 — F - - - - - - - - - - - - Diseases of Musculo-Skeletal System 4 - - - - - - - - 1 2 1 F 13 — — — — — — — 1 2 2 8 Congenital Anomalies 11 6 4 1 - - - - - - - - F 4 2 — 1 - - - - - - 1 — Birth Injury, Difficult Labour, etc. 8 8 - - - - - - - - - - F 4 4 - - - - - - - - - - Other Causes of Perinatal Mortality M 5 4 1 — — - - - - - - - F 7 7 — — - — — — — — — — Symptoms and Ill-defined Conditions M 2 — - — 1 — — — — — 1 — F 10 — — — 1 — — — — — 2 7 Motor Vehicle Accidents M 19 — — — - 5 3 1 1 3 4 2 F 13 — — — - 2 2 — 1 2 2 4 All Other Accidents M 21 — — 1 1 2 1 1 1 3 7 4 F 18 — — 1 1 — — 2 — 1 1 12 Suicide and Self-inflicted Injuries M 13 - - - - - 3 — 3 4 2 1 F 13 — — — - 1 1 — 2 3 1 5 AH Other External Causes M 4 — — — - 1 — — 2 1 — — F 4 - - - - - - - 2 1 1 — TOTAL ALL CAUSES MALE 1,513 24 12 10 4 14 13 23 85 330 476 522 FEMALE 1,524 18 4 7 6 8 7 19 66 194 320 875 18 STATISTICS AND SOCIAL CONDITIONS Table 5 Road Accidents Jan. Feb. Mar. Apr. May Jun. July Aug. Sep. Oct. Nov. Dec. Total 1970 Total 1969 Total Accidents 133 137 125 125 128 134 120 123 138 139 160 133 1,595 1,529 Total Casualties 170 179 158 161 168 170 156 171 174 174 201 173 2,055 1,977 Fatal 2 1 5 — 2 3 — 1 3 1 2 1 21 27 Serious 15 13 16 13 22 33 17 24 20 33 23 22 251 275 Slight 153 165 137 148 144 134 139 146 151 140 176 150 1,783 1,675 LOCATION Trunk Roads 21 27 20 21 33 33 26 31 31 30 27 31 331 381 Metropolitan Roads 29 19 20 18 23 20 18 20 16 21 29 18 251 251 Principal Roads 36 27 37 23 29 31 31 31 23 27 34 24 353 340 Class: Roads 22 30 25 45 27 24 21 24 38 38 34 33 361 277 Dist: Roads 25 34 23 18 16 26 24 17 30 23 36 27 299 280 1 595 1 529 TYPES OF ROAD USER Pedestrians 40 26 37 34 34 39 26 34 48 48 42 27 435 436 Pedal Cyclists 11 16 11 13 12 16 18 17 15 12 20 18 179 220 Motor Cyclists and Passengers 9 11 10 10 10 19 11 17 18 8 22 12 157 129 Scooters, Mopeds and Passengers 7 18 3 11 14 16 9 8 9 8 8 7 118 108 P.M.C. Drivers and Passengers 86 87 61 74 77 60 77 73 65 77 81 99 917 886 Drivers and Passengers, Goods and Other Vehicles 17 21 36 19 21 20 15 22 19 21 28 10 249 198 2,055 1,977 AGE GROUPS Under 5 years 3 3 3 7 5 4 3 2 5 4 4 4 47 62 5-14 years 15 14 22 25 28 22 25 32 32 27 26 13 281 246 15-60 years 128 145 121 114 118 130 115 120 118 127 152 139 1,527 1,439 Over 60 years 24 17 12 15 17 14 13 17 19 16 19 17 200 230 2,055 1,977 STATISTICS AND SOCIAL CONDITIONS Table 6 Prevalence and Control of Infectious Diseases Notificaton and Deaths DISEASE Number notified Known to be treated in hospital Attack rate per 1,000 population Deaths Acute Meningitis 7 7 0.03 4 Dysentery 29 5 0.11 - Food Poisoning 34 3 0.13 — Infective Jaundice 47 9 0.18 — Measles 1,660 16 6.32 — Scarlet Fever 121 1 0.46 — Tuberculosis: (a) Respiratory 43 7 0.06 3 (to) Other Forms 15 7 0.06 1 Typhoid Fever 2 2 0.01 — Whooping Cough 141 5 0.54 — Table 7 Prevalence and Control Infectious Diseases Tuberculosis Age in Years New Cases Deaths Respiratory Other Forms Respiratory other Forms M F M F M F M F Under 1 — — — — — — — 1 - 2 — - 1 - - - - 5 - 1 4 - - - - - - 10 - 1 — - - - - - - 15 - — — - — - — - - 20 - 1 2 1 — - — - - 25 - 3 2 2 2 — — - - 35 - 1 5 — — - — - - 45 - — 5 — 3 — — - - 55 - 4 5 1 2 1 1 - - 65 - 3 2 — 1 - — - - 75 and over 1 1 - 1 - 1 - 1 Age unknown — — — 1 — — — — TOTALS 17 26 4 11 1 2 — 1 During the past year there were inward transfers to the Borough of 21 notified cases of respiratory tuberculosis. 19 STATISTICS AND SOCIAL CONDITIONS Table 8 Prevalence and Control of Infectious Disease Public Health Laboratory Service Environmental Specimens Type of Specimen Number submitted by Local Authority Findings Number of Positives Mjlk Pasteurised 113 Failed Methylene Blue Test 6(5½%) Failed Phosphatase Test Nil Sterilised 47 Failed Turbidity Test 1(2%) Ultra Heat Treated 12 Failed Colony Count Test Nil Water 57 Faecal Coli Found Nil Food 8 Pathogenic Organisms Found Nil Ice Cream 30 Failed Methylene Blue Test 8 (27%) 20 PERSONAL HEALTH PERSONAL HEALTH Tables relating to the Personal Health Services: 9 Ante-natal and Post-natal Clinics: Relaxation and Mothercraft Classes 10 Child Health Clinics 11 Dental Care (mothers and young children) 12 Midwives who notified intention to practise within borough 13 Care of Premature Infants 14 Health Visiting 15 Home Nursing 16 Vaccination and Immunisation: Diphtheria, whooping cough, tetanus, poliomyelitis, measles 17 Vaccination and Immunisation: Smallpox 18 Vaccination and Immunisation : Children born in 1968 19 Vaccination and Immunisation: B.C.G. Vaccination 20 Tuberculosis: Chest clinics 21 Chiropody 22 Venereal Diseases 23 Smokers' Clinic 24 Mental Health: Patients under Local Health Authority Care 25 Mental Health: Patients referred to Health Department 26 Domestic Help 27 Development Plan 28 Blindness and Partial Sight Clinics Summary Number of attendances at: Ante-natal clinics 2,739 Post-natal clinics 266 Relaxation and Mothercraft classes 3,597 Child Welfare clinics 77,041 Number of Expectant and Nursing Mothers examined 37 Dental Care Number of Children under five years of age examined 588 Midwifery Number of Midwives who notified their intention to practise in the borough 170 Number of Premature Babies born at home 23 Health Visiting Number of home visits 42,106 Home Nursing Number of visits and treatments 131,607 Vaccination and Immunisation (Persons under 16 years of age) Diphtheria, Whooping Cough, Tetanus, Poliomyelitis: Number of persons who completed primary courses of immunisation against one or more of these diseases 5,977 Reinforcing doses13,610 Measles : Number of persons immunised 2,951 Rubella: Number of persons vaccinated 300 Smallpox: Number of persons vaccinated 1,796 re-vaccinated 1,942 Prophylaxis, Care and After-Care Number of cases of Tuberculosis under treatment or supervision at chest clinics : Respiratory 1,611 Non-respiratory 213 Mental Health Number of attendances at Chiropody clinics 8,218 Number of patients under Local Authority Care 516 Home Help Number of patients referred to the Local Authority 767 Number of cases in which Domestic Help was provided 2,608 22 PERSONAL HEALTH Section 21 National Health Service Act, 1946 Health centres Local health authorities are required to provide, equip and maintain health centres. The Health Centre in Forest Road, Edmonton, known in the design stage as Hertford Road Health Centre, was completed during the latter part of the year. The local authority clinic staff moved in from former unsatisfactory premises close by at the end of November, and were shortly joined by the seven general medical practitioners who have been provided with accommodation at the Health Centre. In addition, part of the accommodation is used for purposes of welfare and rehabilitation by the Welfare Department. I am pleased to report that all the various activities at the Centre were soon satisfactorily under way, and I am grateful to all concerned for the spirit of co-operation which prevailed during the settling-in period. Plans are in being for a further health centre in the Borough in the reasonably near future and a site has been secured off the Hertford Road, near Old Road, in north-east Enfield. Details of future establishments are given in the development plan table. Care of Mothers and Young Children Section 22 National Health Service Act, 1946 It is the duty of every local health authority to make arrangements for the care, including in particular dental care, of expectant and nursing mothers and of children who have not attained the age of five years and who are not attendina orimarv schools maintained bv a local education authority. Ante-natal and Post-natal Sessions A total of 443 women attended ante-natal clinics and 184 for a post-natal examination, compared with figures of 553 and 284, respectively, for 1969. These figures reflect the trend, noted in previous reports, for expectant mothers to be cared for by the general practitioner and hospital services. Five weekly ante-natal clinic sessions were discontinued. Mothercraft and relaxation classes for expectant mothers, held in clinics throughout the borough, continued to be popular, and were attended by 667 women. Many general practitioners who undertake the ante-natal care of their patients refer them to these classes. Child Health Sessions The 2,057 sessions held during the year were attended by 12,758 children. The total number of attendances was 77,041 compared with 83,413 last year. During the year the scheme was continued whereby at various ages between three months and four and a half years, each child in the borough is invited to attend a clinic for the purposes of medical examination and for immunisation and vaccination if arrangements are not being made through the family doctor. In this way it is hoped to achieve regular supervision of the health of the child as well as routine immunisation. Assessment Centres The Report on Child Health Centres accompanying Ministry of Health Circular 34/68 included a recommendation that the early detection of physical, mental and emotional defects should be a major function of a modern preventive health service for the child, but that more comprehensive assessment is a matter for referral through the family doctor to the hospital service, and that hospital authorities should be asked to review their present arrangements for comprehensive assessment centres for handicapped children. Following the continued discussions with the consultant paediatrician at North Middlesex Hospital, an assessment centre was commenced in September at the War Memorial Hospital. Sessions are held monthly and are attended by the consultant paediatrician from Chase Farm Hospital and by a principal 'medical officer and a health visitor from the Health Department. 23 PERSONAL HEALTH Specialist Clinic Referrals Children suffering from defects were referred to clinics as follows: Ophthalmic: 204 new cases; 700 attendances; 80 prescribed spectacles. Ear, Nose and Throat: 37 new cases; 75 attendances. Orthoptic: 72 new cases; 707 attendances. Orthopaedic: 64 new cases; 126 attendances. Speech : 67 new cases; 934 attendances. Audiometric testing: 96 special tests; 40 found to have a hearing loss. Clinic Premises Of the twenty premises in the borough used for clinics, fourteen are purposebuilt, four are adapted premises and two are rented premises. In November all the services provided at Hertford Road Clinic were transferred to the new health centre in Forest Road. The old clinic, which consisted of adapted premises, was then closed. The Ten-Year Plan contains proposals for the replacement by purpose-built premises of two clinics at present in adapted premises, and of one clinic at present held in rented premises. There is also provision in the later years of the plan for additional health premises in the Winchmore Hill area and for the replacement, also by purpose-built health premises, of two more clinics now held in adapted premises. Welfare Foods and Vitamin Supplements The distribution of dried milk, cod liver oil, orange juice and vitamin tablets on behalf of the Department of Health and Social Security, as part of the Welfare Foods Service, continued at the Council's clinics and at a W.R.V.S. centre. The following issues (total value nearly £6,300) were made: National dried milk, 4,649 tins; Cod liver oil, 2,434 bottles; Vitamin tablets, 3,159 packets; Orange juice, 76,709 bottles. In addition, various brands of proprietary dried milk, cereals and vitamin preparations, recommended by medical officers and health visitors in particular cases, were available at clinics, and the total sales amounted to £16,420. Dental Care The number of attendances by expectant and nursing mothers and children under five years of age was similar to last year's figure, but it is gratifying to note that there were greater opportunities for fillings as opposed to extractions. This suggests that the talks and advice on oral hygiene given to mothers are having some beneficial effect. Care of the Unsupported Mother and Her Child Although the majority of unsupported mothers are unmarried, occasionally a married woman for some reason or other finds herself without support. The services of a medical social worker, shared with a neighbouring borough, are available to help in such cases. There are no local authority mother and baby homes in the borough. Use is, therefore, made of homes run by other authorities and by voluntary societies. Of the sixty-three cases referred during 1970 through various channels, eighteen were admitted to mother and baby homes and arrangements were made for some of those remaining to be admitted at an appropriate time. In addition, seven of the cases referred during the previous year were admitted in 1970. The general trend is a moderate reduction in the number of cases referred, and a marked reduction in the number of cases admitted to homes. Where it is the wish of the mother to have the baby adopted, application is made to registered adoption agencies. PERSONAL HEALTH A summary of the outcome of the cases referred during the year is set out below: Babies kept by mother 22 Babies placed for adoption or fostered pending adoption 17 Babies admitted to the care of a voluntary organisation 1 Mothers withdrew application for assistance 6 Pregnancies terminated and miscarriages 8 Final placement of baby outstanding 9 "At Risk" Register A register is kept of children who, because of some factor noted either before, during, or after birth, may be thought to be more liable than other children to suffer a mental or physical abnormality. These children are kept under observation by the department's medical officers until it is established that development is normal. Information concerning a child who may be "at risk" is received from the doctor, health visitor or midwife concerned, and in consequence 717 children were placed on the register during 1970. 592 children were removed from the register in 1970, leaving a total of 1,614 at the end of the year. Of the 384 children who had hearing tests, two appeared to have some loss, and both are still undergoing investigation. Thirty-eight children were reported to be suffering from abnormalities of significance and at the end of the year there were 45 in the section of the register dealing with handicapped children. Incidence of Congenital Abnormalities Detectable at Birth Notifications, with details, of babies, live and stillborn, with a detectable abnormality, are submitted by the doctor or midwife in charge of the confinement. A return of these notifications, amounting to forty-eight for the year, was made to the Registrar General. The national figures may, in due course, prove a valuable means of indicating hereditary, environmental, geographical, seasonal and other factors hitherto unknown, which may influence the development of congenital abnormalities. Phenylketonuria The Guthrie blood test continued to be used for the routine screening of babies for phenylketonuria and 1,571 tests were carried out by this method. In the limited number of cases where for any reason it was not possible to complete a Guthrie blood test, the phenistix test was used, and 292 tests were carried out by this method. None of the tests proved positive. "Battered Babies" Syndrome Circular CMO 2/70 dated 9th February, 1970, from the Department of Health and Social Security, requested that discussions be arranged between the local authority's Children's Officer, Medical Officer of Health and others involved locally with the problem of young children injured by their parents. These include representatives of general practitioners, hospital paediatricians and consultants responsible for accident and emergency departments, the police, and other local people or social agencies such as the National Society for the Prevention of Cruelty to Children. It was suggested in the Circular that the group thus formed could review the local situation and decide what further arrangements should be made to ensure that ail necessary protection and assistance are made available to the child, to others at risk in the family, and to the parents and other adults. It was further suggested that this group should have a continuing function in reviewing the local situation from time to time. 25 PERSONAL HEALTH Arrangements were therefore made to have discussions between officers of the Health and Children's Departments, local paediatricians, police, National Society for the Prevention of Cruelty to Children and a local general practitioner, and a procedure was formulated for the early detection of cases where "battering" is suspected and for the prompt notification to and consultation between all persons who are concerned. It is proposed to have further discussions in 1971 and to keep this procedure under review and make any amendments which prove necessary in the light of practical experience. Since this scheme was adopted, eight cases have been investigated and eventually four children were thought to have received physical abuse, and appropriate action was taken. Circular CMO 6/70 dated 31st July, 1970, from the Department of Health and Social Security, drew attention to the memorandum prepared by the Standing Medical Advisory Committee on the "Battered Babies" Syndrome and arrangements were made for copies of this useful publication to be distributed to appropriate members of the staff. Non-Fatal Accidents to Young Children in their Homes In 1969 arrangements were made for cases of accidental poisoning in children under five years of age, treated at the Enfield Group of Hospitals, to be notified to the Health Office. A health visitor would then visit the parents and discuss with them precautions to prevent recurrence. This procedure was continued, and during 1970 details of one hundred and twelve cases were received under this scheme. On seventeen occasions children had drunk paraffin, turpentine, or domestic cleaning fluids. Thirty-one children had swallowed aspirin tablets and another thirty-one had swallowed other tablets. Eleven children had eaten berries or seeds. The remaining twenty-two had swallowed miscellanous substances and included one child, aged three and a half years, who had eaten the contents of a packet of indoor fireworks ! One child aged nearly two years, who was admitted after swallowing about half a cup of paraffin, was admitted again a few months later for the same reason. On examination at hospital two of the children, each aged one year, were discovered to be suffering from a condition, unrelated to the accidental poisoning, which required investigation. I am glad to be able to report that none of the one hundred and twelve children suffered any serious after-effects. We also have an arrangement with the Ambulance Service whereby the Health Office is notified whenever an ambulance is called to take to hospital a child suffering from a burn or scald. During 1970, two children, aged two years and three years, were notified under this scheme. Family Planning Under the Council's scheme, free advice and treatment continued to be available, through the Family Planning Association, to women in whom pregnancy would be detrimental to health. Sixty-eight women were provided with this service. Clinic premises are made available, without charge, to the Family Planning Association, one of the clinics being used for a regular counselling session for the unmarried. At the end of the year fourteen weekly sessions and one fortnightly session were being held in six of the Council's clinics. The Association continued to hold one session a week at the War Memorial Hospital. Two sessions were held weekly at Chase Farm Hospital for the fitting of intra-uterine devices. 26 PERSONAL HEALTH National Health Service Act, 1946 General medical practitioners provide family planning services under the National Health Service Act 1946. The arrangement continued whereby women who are unable or unwilling to attend a clinic, and to whom pregnancy would be detrimental to health, were referred by the Health Department to the Family Planning Association for the provision of a domiciliary service. Fifty-eight women were referred under this scheme during 1970. The Council pays an annual fee for each case treated. During the year discussion began at the local Maternity Liaison Committee on the development of family planning services in hospitals and the Enfield Hospital Group was informed of the Council's existing schemes. In October the Council decided to adopt Plan No. 6 of the National Family Planning Agency Scheme as from 1st April, 1971. This provides for the continuation of the Council's present arrangements but includes acceptance of a standard definition of a 'medical' case. Day Care for Priority Groups The Council provides day care for children under five years of age in the priority groups (a)at its own day nursery, (b) in the day nurseries of other local authorities in appropriate oases, and (c) with suitable registered private day nurseries, playgroups, and child minders. At the end of the year there were 55 children on the roll of the Council's 55-place day nursery and six placed in day nurseries of other local authorities. There were 22 children in the priority groups on the waiting list for day nursery places. The children of unsupported mothers continued to occupy by far the largest number of places. Seven mothers who applied for places had made other arrangements by the time vacancies could be offered. The Council's day nursery, which is approved for the training of student nursery nurses, is housed in adapted premises where the standard of accommodation conforms, as far as the structural limitations of the building and site area allow, to that recommended by the Department of Health and Social Security. During the next few years it is hoped to provide two new 55-place day nurseries and to replace the present day nursery by a third purpose-built building. It is intended that each nursery should incorporate a 10-place unit for mentally subnormal children. The scheme was continued whereby at the Council's expense children in the priority groups were placed with private day nurseries, playgroups and child minders, in those cases where it was considered that the children would benefit thereby. At the end of the year 42 children were placed under this scheme which provides that no charge be made to the parents for sessional care. For all-day care, however, a charge is made using the assessment scale for admission to a local authority day nursery—unless the child qualifies for free placement because of handicap. Handicapped Children In Playgroups During the year seventeen physically handicapped children, twenty mentally retarded children, fourteen children with retarded speech but of apparently normal intelligence, and twelve disturbed children were placed in play groups and private nursery groups which cater for normal children. Most of these placements were made through the Council's scheme outlined above, but some were made privately. The great majority of these 27 PERSONAL HEALTH capped children were quickly and successfully integrated into the group which they joined and derived great benefit from being placed among normal children. Nurseries and Child Minders Local health authorities are required to make arrangements for the keeping of registers and the supervision of nurseries and child minders. Nurseries and Child Minders Regulation Act 1948, as amended by the Health Services and Public Health Act 1968 During 1970 the number of registered premises (private day nurseries and playgroups) increased from sixty with places for 1,675 children, to 69 with places for 1,961 children. At the same time, the number of registered child minders increased from 176 approved to take 387 children, to 237 approved to take 424 children. Applications for registration as child minders were also received from 64 persons who, for various reasons, decided at a later date to withdraw their applications. One application to register as a child minder was refused. The Council continued to assist in meeting the increasing demands for the day care of pre-school children by making available, where possible, premises for the use of private playgroups; by the employment of a part-time playgroup organiser; and by making an annual grant to the local branch of the Pre-school Playgroups Association with whom regular meetings continued to be held to discuss ways of improving and expanding this service. The course for playgroup leaders run by the Education Committee, and consisting of attendance for one day a week for an academic year, continued to be very popular, and arrangements were made to hold a similar course at a second centre in the borough. The Education Committee also continued to provide evening courses for playgroup leaders. In the autumn, a series of six informal evening meetings for child minders was held at one of the Council's clinics. The programme each evening included a film or a talk followed by discussion on the problems encountered in looking after young children, legislation on child minders, play and play material, dental health, and simple first aid. Attendances were small, but those child minders who came found the course stimulating and enjoyable. Children in Care There are in the borough two residential nurseries under the control of the Children's Department and providing places for thirty-one children. By arrangement with the Children's Officer, each child is medically examined by the Council's medical officers on admission, after every three months, and on discharge. Dental care and immunisation are also arranged by the Health Department. In the ordinary way, general medical services are provided by general medical practitioners. Children placed with foster parents are given statutory, supervisory and general medical care by general medical practitioners but in some cases the statutory medical examination and the examinations for certification of freedom from infection are carried out by the Council's medical officers. Co-ordination of Personal Services The co-ordinating committee, consisting of nominated officers from each of the departments concerned — Town Clerk's, Health, Children's, Welfare, Housing, and Education — continued to meet throughout the year. Two meetings for field staff were held at Bowes Road Clinic, and two films, one entitled "John" and the other "Jane''. were shown. These films illustrate the effect on children of being taken into care. Problem Families At the end of the year there were eighteen families on the register of "problem families Twelve new families had been added to the register during the year and eleven families were receiving continuing supportive care at the end of the year. Two families were rehoused during 1970. 28 PERSONAL HEALTH Population Screening for Carcinoma of the Cervix of the Uterus This service, which commenced in 1966 for women between the ages of 35 and 60 years, was continued during 1970 at ante-natal sessions and at the special clinic sessions which are held when necessary. The test is for apparently healthy women only and no examination, apart from the cervical smear, is carried out. It is recommended that the test be taken at five-yearly intervals. One thousand, five hundred and thirty-eight smears were taken during the year. Cancer cells were found in the smears taken from four married women who were aged 32 years, 33 years, 37 years, and 56 years. Since the service began a total of 10,697 smears have been taken and 25 positive cases found, i.e. 2.3 per 1,000 examinations. Midwifery Section 10 Health Services and Public Health Act 1968 Under Section 10 of the Health Services and Public Health Act 1968 it is the duty of every local health authority to provide a domiciliary midwifery service. The Section enables local health authorities to make provision for midwives to attend women elsewhere than in their own homes or in hospitals vested in the Minister, the intention being to obtain greater flexibility in the deployment of midwives and promote greater co-operation between the local authority midwifery service and general medical practice. The Section also provides for arrangements between local health authorities for the services of midwives employed by one authority to be made available in another authority's area on agreed terms and conditions and for a similar arrangement to be made between a local health authority and a hospital authority. Midwives Act 1951 The local health authority is also the local supervising authority for the purposes of the Midwives Act 1951. The number of births, as well as the percentage of domiciliary births (17.8% this year) has steadily decreased since 1965, whilst the percentage of hospital confinements (64.3% this year) and planned early discharge cases (17.9% this year) has increased. For the first time the number of early discharge cases was greater than the number of domiciliary births. Domiciliary midwives attended 685 confinements. They also undertook the care of 690 patients discharged home after hospital confinement before the tenth day, the majority being patients for whose care arrangements had been made under the Council's planned early discharge scheme. The figure includes, however, those who took their own early discharge from hospital and also some who were booked for home confinement but who were subsequently admitted to hospital as emergency cases. Included in the local figures of confinements are births to some very young teenage girls. The issue of maternity packs and "The Baby Book" to expectant mothers continued as in previous years. Planned early Discharge of Maternity Patients Planned early discharge schemes for suitable patients continued in operation in conjunction with North Middlesex and Chase Farm Hospitals, thereby ensuring availability of maternity beds for the maximum number of those requiring hospital delivery on medical or social grounds. 29 PERSONAL HEALTH Care of Premature Infants Notifications were received of two hundred and sixty-four babies weighing 5½-1b. or less at birth. Of these twenty-three were domiciliary births. One was admitted to hospital. The remaining twenty-two were cared for at home by midwives and all survived. Liaison with General Practitioners A close liaison between midwives and family doctors continued to be maintained. At the end of the year eight midwives were attached to group practices. Portable Incubators During the year portable incubators held at main ambulance depots were used on 24 occasions to transport premature or sick babies to hospital. Heat insulating swaddlers continued to be used by midwives as a standard item of equipment in transporting premature and small babies to hospital. Guthrie Test! Domiciliary midwives continued to collect blood samples for the Guthrie test for phenylketonuria from infants born at home and those born in hospital who had been discharged early to their homes on or before the sixth day after birth. Some repeat tests were also carried out by domiciliary midwives. Hospital ' Flying Squad ' Service There are two "Flying Squads" serving the borough, one based at North Middlesex Hospital and the other at Ohase Farm Hospital. The squads, each of which is in the charge of an obstetrician, provide a 24-hour emergency service for women in labour. They answered fifteen emergency calls during 1970. Analgesia Trichloroethylene inhalers, used by all domiciliary midwives, were regularly tested in accordance with the rules of the Central Midwives' Board. Notification of Intention to Practise Twenty-four domiciliary midwives employed by the borough council and 146 institutional midwives employed at hospitals notified their intention to practise as midwives within the borough during 1970. Disposal of Placentae and Offensive Dressings Disposal points are conveniently situated throughout the borough for use by authorised persons. Training of Pupil Midwives Arrangements continued for pupil midwives "from North Middlesex Hospital to receive their Part II training. From 1st December, 1970, the number of pupils taken at any one time under this scheme was increased from two to four. The continued co-operation of other Departments of the Council and Voluntary Organisations in giving talks, having discussions, and arranging community visits for these pupils was very much appreciated. The Supervisor of Midwives gave assistance, by invitation, at the hospital examination of Part II pupil midwives. Training of Staff of other Agencies As part of their training student nurses from two local hospitals accompanied midwives on visits to patients and at ante-natal clinics. These visits were arranged about once a week. Lectures on the domiliciary midwifery service continued to be given periodically by the Supervisor of Midwives to student nurses at North Middlesex Hospital. Lectures were also given by a domiciliary midwife to home helps during their in-service training courses, and midwives assisted in the school education programme on childbirth. 30 PERSONAL HEALTH Health visiting It is the duty of every local health authority to make provision in their area for the visiting of persons in their homes by health visitors for the purpose of giving advice as to the care of young children, persons suffering from illness and expectant or nursing mothers, and as to the measures necessary to prevent the spread of infection. Section 24, National Health Service Act, 1946 Section 11 of the Health Services and Public Health Act 1968 enables local health authorities to make provision for the visiting by health visitors of persons elsewhere than in their homes, the intention being to promote the more effective deployment of staff and to facilitate co-operation between general medical practice and local health authority services. The section also provides for arrangements between local health authorities for the services of health visitors employed by one authority to be made available in another authority's area on agreed terms and conditions. Section 11, Health Services and Public Health Act 1968 Figures relating to visits to homes by health visitors are set out in Table 14. Other duties included attendance at ante-natal, post-natal and child health clinics, mothercraft and relaxation classes, and the important function of health education practised in the homes, clinics and schools. Health visitors attending the paediatric clinic at Chase Farm Hospital were able to pass on to their colleagues, as appropriate, the advice and instructions given by the consultant paediatrician. Liaison with Hospitals and General Practitioners Health visitors also continued to attend the Maternity Units at North Middlesex Hospital, Highlands Hospital and Chase Farm Hospital. Under the scheme whereby health visitors are enabled to have closer liaison with medical group practices, the health visitor attends the local authority clinic as usual, but her visiting covers the families of the medical group practice instead of a geographical area. At the end of the year five health visitors were attached to five group practices thus serving a total of nineteen general medical practitioners. Due to the acute shortage of health visitors during 1970, there has been no extension of this scheme. A group adviser health visitor continued to work in close liaison with geriatricians at both St. Michael's and North Middlesex Hospitals, so that community services needed by the aged on discharge are arranged and follow-up visits made by health visitors. Relaxation and Mothercraft Relaxation and mothercraft courses for expectant mothers were held at clinics throughout the borough and continued to be popular. A course usually consists of six weekly sessions and during the year 667 women made 3,597 attendances at the 489 sessions held. The film, "To Janet — a Son ?" is seen regularly each month by groups of parents-to-be. Ancillary Help State registered nurses not holding the health visitor's certificate continued to be employed as clinic nurses; at school inspections; for school clinic duties; and to assist at child health clinic sessions. To reduce the time spent by health visitors on clerical work, clerical staff were employed at clinics. We are fortunate to have about 120 voluntary workers to help us at the child health clinics. 31 PERSONAL HEALTH Training of Staff of other Agencies Student nurses from the major local hospitals continued to spend time with health visitors, learning about the preventive services by visiting homes with the health visitor and seeing the work done in the clinics. Lectures were also given to the nurses by the Medical Officer of Health and the Deputy Superintendent Health Visitor. Student nurses from the Middlesex Hospital continued to visit the borough periodically for practical training in community services. The Children's Department and the technical colleges also were given opportunities for their students to learn about the work of the health visitors and the department generally. Slimmers' Advisory Centres During 1970 Slimmers' Advisory Centres for women were arranged at two clinics at which weekly sessions were held. Talks on diet were given by the health visitor and diet sheets and weight record cards were issued. Attendance at twelve consecutive weekly sessions was encouraged. The centres were well attended. Section 25, National Health Service Act, 1946 Home Nursing It is the duty of every local health authority to make provision in their area for securing the attendance of nurses on persons who require nursing in their own homes. Section 11, Health Services and Public Health Act 1968 Local health authorities may make provision for the attendance of home nurses on persons who require nursing elsewhere than in their own homes, thereby facilitating co-operation between general medical practice and local health authority services. Local health authorities may also arrange between themselves for the services of home nurses to be used in one another's area on agreed terms and conditions. There was a substantial increase in the amount of work undertaken by the nurses during the year. Disposable Equipment The use of disposable equipment contributed to the maintenance of improved efficiency and safety. All nurses use disposable syringes, dressing forceps and enemata. Marie Curie Memorial Foundation This Foundation meets the cost of a service, run by the department, which provides day and night nursing and sitter-in care for cancer patients. The Foundation also provides for extra comforts, special needs, items of diet and equipment to assist the nursing of these oases. During the year thirteen patients were provided with this service, the nurses being provided through nurses agencies. Our own home nurses also continued to work a late evening rota to give morphine injections to certain cancer patients not being provided with a nursing service under the Marie Curie Memorial Foundation's scheme and the number of late night visits increased considerably during the year,, Liaison with General Practitioners The number of home nurses attaohed to group practices was increased from seventeen to twenty. Each nurse attends only the patients of the practice to which she is attached, and goes to the surgery daily for consultation and for the treatment of certain ambulant patients. This arrangement is proving satisfactory, although it tends to increase the nurses' case loads. Three nursing auxiliaries were also attached to certain practices, working under the supervision of the home nurses. In the case of patients of the other practices, home nurses continued to maintain a close liaison with the general practitioners concerned. 32 PERSONAL HEALTH Ancillary Help Experience has shown that a large number of visits solely for the bathing of patients can be undertaken by less skilled staff working under the supervision of home nurses, and during the year the number of nursing auxiliaries employed to undertake this work was increased to one full-time and six part-time staff. This arrangement continued to work very well, but the number of auxiliaries employed is still inadequate and does not yet permit full advantage to be gained from the scheme. District Training Courses at North Western Polytechnic continued to be used for the district training of our home nurses. Two nurses usually attend at a time and receive the practical part of their training in Enfield under the general supervision of the Superintendent of the Home Nursing Service and the day-to-day direction of three of our home nurses who have been trained as practical work instructors. Training of Staff of other Agencies As part of their training student nurses from the three major local hospitals and the Middlesex Hospital continued to accompany home nurses on visits to patients. In addition, lectures on the home nursing service continued to be given periodically by the Superintendent of the Home Nursing Service to student nurses at the hospitals. Vaccination and Immunisation Section 26, National Health Service Act, 1946 Vaccination and immunisation are provided jointly by the general medical practitioner and local health authority services under Section 26 of the National Health Service Act 1946. Every local health authority is required under the Act to make arrangements with medical practitioners for the vaccination of persons in the area of the authority against smallpox, and immunisation against diphtheria. The Minister of Health subsequently approved immunisation against whooping cough, poliomyelitis, tetanus and measles as well as vaccination against anthrax of workers in specified industries, but there are no such workers known to be at risk in the borough. In July authorisation was received from the Department of Health and Social Security for vaccination against rubella to be offered to all girls between their eleventh and fourteenth birthdays, priority being given initially to girls in their fourteenth year. The purpose of this campaign is to ensure that girls are offered protection against rubella before reaching child-bearing age, in view of the known association between certain foetal abnormalities and rubella infection in pregnancy. Accordingly, 300 girls were vaccinated against rubella by the end of the year and consents had been received from the parents of a further 1,200 girls to be vaccinated early in 1971. In the case of persons under sixteen years of age a total of 9,228 primary courses of immunisation against diphtheria, whooping cough, tetanus, poliomyelitis, measles and rubella were given, of which 2,936 were undertaken by general medical practitioners and 6,292 by the Council's medical officers. Of the total number of 13,610 reinforcing doses, 3,745 were given by general medical practitioners and 9,865 by the Council's medical officers. With regard to smallpox, general medical praotitioners undertook 1,129 primary vaccinations and 978 re-vaccinations of persons under the age of sixteen years, compared with 667 primary vaccinations and 964 re-vaccinations by the Council's medical officers. 33 PERSONAL HEALTH In accordance with the advice of the Department of Health and Social Security, vaccination against smallpox is carried out "by or with the knowledge of the family doctor Accordingly, before vaccination against smallpox is undertaken by medical officers of the Council, the general medical practitioner concerned is asked to sign a form signifying that to his knowledge there is no contra-indication to vaccination. It is recommended by the Department of Health and Social Security that local authorities should inform general medical practitioners of patients on their lists who have been immunised or vaccinated in local authority clinics and accordingly general practitioners were notified that 13,019 children had received immunisation or vaccination. Consent forms for diphtheria, tetanus and poliomyelitis immunisation continue to be issued to all school entrants so that children whose parents have not taken advantage of facilities available at child health clinics may have this further opportunity. In addition, consent forms for poliomyelitis and tetanus immunisation and smallpox re-vaccination are issued for pupils of fifteen years of age for reinforcing doses. Section 28, National Health Service Act, 1946 Under Section 28 of the National Health Service Act 1946, authority has been given to local health authorities to offer B.C.G. vaccination against tuberculosis to contacts, to staff likely to be exposed to infection, and to certain groups of children and students, including school children between their thirteenth and fourteenth birthdays. Of the 3,770 children eligible for B.C.G. vaccination, the parents of 2,888 children (76.60%) consented to have a tuberculin skin test carried out, and B.C.G. vaccination, if necessary. A total of 2,804 children had a tuberculin skin test, 2,416 (86.16%) were found to require vaccination, and all were vaccinated. Publicity Publicity for immunisation procedures continued in all clinics and in general practitioners' surgeries during the year in the form of posters and leaflets which were varied from time to time. Immunisation in Clinics At appropriate ages, a card is sent to each child, inviting him to be immunised either by his family doctor or by attendance at a clinic, and a leaflet giving information about immunisation accompanies it. This is combined with the periodic or birthday card in which children are invited to attend the clinic for general health purposes. It is considered that the provision of immunisation facilities at each child health session, rather than at specially organised sessions, results in a more successful acceptance rate. Smallpox The recorded number of persons under sixteen years of age who received primary vaccination was 1,796 and 1,942 were re-vaccinated. Of the children born in 1968 (3,966), 2,107 had received primary vaccination by the end of 1970, representing an acceptance rate of 53.12%. Diphtheria The recorded number of persons under sixteen years of age who received a primary course of immunisation was 2,600 and 5,439 received a reinforcing dose. Of the children born in 1968, 3,593 had received primary immunisation by the end of 1970, representing an acceptance rate of 90.59% (England and Wales 80.1%). Whooping Cough The recorded number of persons under sixteen years of age who received a primary course of immunisation was 2,301 and 1,529 received a reinforcing dose. Of the children born in 1968, 3,394 had received primary immunisation by the end of 1970, representing an acceptance rate of 85-57% (England and Wales 78-4%). 34 PERSONAL HEALTH Tetanus The recorded number of persons under sixteen years of age who received a primary course of immunisation was 3,084 and 6,670 received a reinforcing dose. Of the children born in 1968, 3,591 had received primary immunisation by the end of 1970, representing an acceptance rate of 90.54% (England and Wales 80.2%). Poliomyelitis The recorded number of persons under sixteen years of age who received a primary course of immunisation was 2,889 and 6,901 received a reinforcing dose. Of the children born in 1968, 3,355 had received primary immunisation by the end of 1970, representing an acceptance rate of 84.59% (England and Wales 78.5%). Measles The recorded number of persons under sixteen years of age who received primary immunisation was 2,951. Of the children born in 1968, 1,392 had received primary immunisation by the end of 1970, representing an acceptance rate of 35.09%. Distribution of Vaccines The Health Department is responsible for the distribution of vaccines to general medical practitioners. For this purpose collection centres are located at the Health Office; the Town Hall, Palmers Green; and the Central Clinic. Edmonton. Vaccination of Staff It is important to ensure that persons most liable to come into contact with an undiagnosed case of smallpox and those required to deal with an outbreak should maintain a high level of immunity. Included in this category are certain members of the Health Department and their immediate families. The practice of offering and encouraging vaccination annually was continued, and during the year seventy members of the staff were vaccinated. Certain categories of the Council's staff, e.g. labourers, gardeners, motor mechanics and sewage and refuse disposal workers, because of the nature of their work are particularly exposed to the risk of developing tetanus following injury. The Council continued to offer vaccination against tetanus to these groups and by the end of the year twenty-five staff had completed a course of immunisation. Immunisation against influenza was again offered to staff whose duties might bring them into contact with patients suffering from influenza and accordingly one hundred and twenty-seven were immunised. International Cerificates of Vaccination Three forms of International Certificates of Vaccination have been prescribed, namely, for smallpox, cholera and yellow fever. Yellow fever vaccination must, for international and technical reasons, be carried out at centres designated by the Government, and International Certificates of Vaccination against yellow fever are supplied at those centres. Vaccination against any disease other than yellow fever may be performed by a person's own doctor. The International Certificate against smallpox and cholera must be obtained by the traveller himself and taken to the doctor for completion. These forms are usually obtainable, free of charge, from the company arranging the traveller's transport, or otherwise from the Department of Health and Social Security. If the vaccinator is not an authorised user of an approved stamp, the person vaccinated must have the certificate stamped by the local authority in whose area the vaccinator practises. As in previous years, very many International Certificates were stamped in this Department authenticating the signature of the vaccinator. 35 PERSONAL HEALTH Section 27, Motional Health Service Act, 1946 Section 45. London Government Act 1963 Ambulance Service The duty of local health authorities to provide an ambulance service under Section 27 of the National Health Service Act 1946, is, in the case of the London Boroughs vested in the Greater London Council by Section 45 of the London Government Act 1963. As the operational organisation of the London Ambulance Service is not based on the geographical areas of the London Boroughs, statistical information is not available in respect of individual boroughs. Ambulance stations situated within the London Borough of Enfield are: Chase Farm: The Ridgeway, Enfield. Edmonton: Windmill Road, Edmonton. Ponders End: High Street, Ponders End. Service is provided in addition from stations sited outwith the borough. A main control at The Mall, Kenton, covers the whole of the North-West Division of the London Ambulance Service for both emergency and nonemergency work. Ambulances are directed from that control by radio and by direct telephone and teleprinter lines to ambulance stations. Guidance on how to obtain an ambulance is contained in the following notes . For accidents (wherever occurring) and sudden illness in streets, public places and places of employment: Dial " 999 " and ask for " Ambulance For urgent illness in the home : Call a doctor, NOT an ambulance. If admission to hospital is arranged the doctor or the hospital authorities will order the ambulance. For other illnesses, infectious diseases, etc.: Application will usually be made by the hospital concerned, or by a doctor through the Emergency Bed Service. Maternity patients not booked at a hospital should call a doctor or midwife. For booked patients, dial "999", ask for ambulance and, when connected, give name and address and state the hospital at which the patient is booked. Enquiries on general matters : Telephone 01 -633 5000, extension 8933, or write to the Chief Ambulance Officer, London Ambulance Service Headquarters, 150 Waterloo Road, S.E.1. The foregoing information was provided by Dr. A. B. Stewart, Medical Adviser to the Greater London Council, and by Mr. W. E. Cooke, Chief Ambulance Officer, to both of whom I record my thanks. Section 12, Health Services and Public Health Act 1968 Mental Health Act, 1959 Prophylaxis, Care and After-Care A local health authority may make arrangements for the purpose of the prevention of illness, for the care of persons suffering from illness, and for the after-care of such persons. Mental Health Services provided under the Mental Health Act 1959, as amended, are dealt with elsewhere in this report. 36 PERSONAL HEALTH Tuberculosis Arrangements for the provision of this service are shared between the Council and the North-East Metropolitan Regional Hospital Board and are based on the Chest Clinic, situated at the North Middlesex Hospital. Hospital beds are situated at North Middlesex Hospital and Highlands Hospital. Dr. Vernon Davies, Dr. R. H. Elphinstone and Dr. E. N. O'Brien continued to be responsible for the consultant work. I am grateful to Dr. Vernon Davies for supplying me with the detailed information on which this part of the report is based. The Chest Physician, who supervises the work of the tuberculosis health visitors employed by the Council, is responsible not only for all matters concerning diagnosis and treatment but also for the local health authority care and after-care services. The chest clinic service provides facilities for the investigation and treatment of all forms of chest disease. During the year, 4,701 persons attended the Chest Clinic for the first time and were investigated for various chest conditions; and the total number of attendances by all cases was 13,153. Tabulated statistics relating to the work of the Chest Clinic are to be found at the end of this section of the report. It was necessary to examine the high number of 869 new contacts, 600 of which arose from five infectious cases, two of whom were staff members of hospital maternity departments and involved over 400 contacts. The four contacts in whom tuberculosis was diagnosed during the year were all in the families of newly discovered tuberculous cases. Twenty-six infectious patients were treated at the Chest Clinic; of these, nineteen were among the newly diagnosed cases. Thirty-one patients were admitted to the Clinic's tuberculosis wards for in-patient treatment. Of the 161 new tuberculosis cases diagnosed during the year 43 respiratory and 15 non-respiratory cases were formally notified, the remainder being under observation. The number of deaths from tuberculosis during the year was four of which three were due to pulmonary tuberculosis. Home Visiting Two health visitors confined to work from the Chest Clinic, visiting tuberculous and non-tuberculous patients at home; 1,474 visits were paid to 312 tuberculous households. Medical Arrangements for Long Stay Immigrants Arrangements to cover the special problems which may arise in connection with the health and medical treatment of long stay immigrants to this country were set out in Ministry of Health circular CMO 1/65. The procedure for notifying local authorities is intended to ensure that long stay immigrants register with general medical practitioners at an early stage of their life in this country and do not wait until they become ill. It is hoped that those for whom it is appropriate, will accept an X-ray examination at an early stage. During the year, the names of 374 long stay immigrants, resident in the London Borough of Enfield, were notified and successful visits were made by health visitors to many of them. Commonwealth Immigrants Act 1968 There were no instances of persons arriving in Enfield subject to the condition (under the Commonwealth Immigrants Act 1968) that they report to the Medical Officer of Health with a view to further medical examination. 37 PERSONAL HEALTH Rehabilitation Disabled Persons (Employment) Act 1958 The Tottenham Rehabilitation and Sheltered Workshop established in 1948 to make available rehabilitation through training, and subsequent sheltered employment, was approved by the Ministry of Labour, under the Disabled Persons (Employment) Act 1958, for training of selected patients to become journeymen cabinet makers. During the training period, patients are paid training allowances by the Department of Employment and Productivity and, on completing their training, they are appointed to the establishment. Eight places were occupied by Enfield residents at the end of 1970. One Enfield patient retired during the year. The Council continued to sponsor the maintenance of one man at the Papworth Village Settlement, near Cambridge. Non-Tuberculous Chest Disease The Chest Clinic continued its work in the larger field of non-tuberculous chest disease. New cases of bronchitis and emphysema numbered 419, of asthma 191, and carcinoma of the lunq 121. Mass Radiography Mass Radiography Unit 6A of the North East Metropolitan Regional Hospital Board visited the borough during October, when sessions were held on the premises of Enfield College of Technology and Southgate Technical College. A total of 611 persons were X-rayed, of whom eight required further investigation. I am indebted to the Organising Secretary of the Unit for the following information in regard to the further investigations:— Enfield College of Technology Male Female Total Number X-rayed 177 70 247 Requiring further investigation 6 — 6 Abnormalities discovered: Sarcoidosis 1 — 1 Congenital heart abnormality 1 — 1 Prominent pulmonary artery 1 — 1 Not yet classified 1 — 1 Southgate Technical College Number X-rayed 192 172 364 Requiring further investigation 2 — 2 Abnormalities discovered: Abnormality of diaphragm 1 — 1 Did not attend for further investigation (Probably abnormality of pulmonary conus) 1 — 1 Vaccination against Tuberculosis The Council's scheme provides for vaccination with B.C.G. (Bacillus Calmette-Guenin) of persons who are contacts of tuberculosis, long-term immigrants, school children and students attending establishments of further education. During the year 2,579 persons were vaccinated. Vaccination of contacts is carried out by the staff of the Chest Clinic, and of others by the medical staff of this department. 38 PERSONAL HEALTH Loan of Nursing Equipment Other Services The local branch of the British Red Cross Society operates a scheme for the loan of nursing equipment on behalf of the Council. The Society collects a small hire charge from the patient to off-set the cost of replacement of equipment when necessary. If a patient is unable to meet the hire charge, this is paid by the Council which also arranges transport where required. During the year 2,678 items of nursing equipment were lent to patients under this scheme, including 271 wheel-chairs and 32 hospital beds. The electric hoist and ripple chair seat provided in 1966 for a severely paralysed patient continued to be needed by the same patient and a ripple bed provided in 1967 continued to be used. In addition, two new ripple beds were provided for patients during 1970. Loan of Bed Linen To supplement the laundry service for incontinent persons, bed linen is available on loan to those who might otherwise be unable to take advantage of the laundry facilities. Incontinence Pads and Clothing The Council makes free provision of incontinence pads and protective clothing in the form of waterproof pants and knickers at the request of general practitioners and home nurses. Five hundred and eight patients were supplied with 61,236 pads during the year, and fifty with protective clothing. Chiropody This service is provided partly by the direct employment of chiropodists by the Council, and partly by arrangement with voluntary organisations whose expenditure on chiropody is reimbursed by the Council. In the Council's employ at the year's end were the equivalent of 5½ wholetime staff, including a chief chiropodist. They provided a service at ten Council clinics and also a domiciliary service for the benefit of those patients unable, through age or ill-health, to attend the clinics. Unfortunately, it has not proved possible to recruit sufficient chiropodists to meet the increasing demand and for the entire year the department was under its established strength of seven. In view of the shortage of chiropodists, and the increasing demand for treatment during the year, both in the clinics and in patients' homes, it was necessary to restrict new patients to persons in the priority categories, i.e. the elderly, physically handicapped, expectant and nursing mothers. Voluntary organisations involved were the two local divisions of the British Red Cross Society, which provided the service at centres and in the patients' homes; the Southgate Social Service Council, which provided the service in chiropodists' surgeries; and the Southgate Old People's Welfare Committee, which provided the service at a centre and in the patients' homes. The service provided for schoolchildren under the Education Act 1944 is described elsewhere. Venereal Disease There is no special clinic in the borough. It would, however, appear that most patients attend the Prince of Wales Hospital in Tottenham. In their efforts to preserve anonymity, some patients tend to present themselves at clinics far removed from their home district but figures of incidence are available from London Hospitals in respect of Enfield patients. A total of 1,120 new patients attended hospital clinics during the year, an increase over the figure of 979 last year. The borough shares with a neighbouring borough the services of a medical social worker based at the Special Clinic at the Prince of Wales' Hospital. Her duties are to trace contacts, follow-up treatment defaulters, and assist patients in meeting social problems. 39 PERSONAL HEALTH Despite health education carried out over a number of years, the incidence of venereal disease continues to cause anxiety. Formal instruction on sexually-transmitted diseases is now available to all secondary schools. This is given by the Health Education Officer and several schools in the borough have taken advantage of this facility. Health Advice Clinics for the Elderly This service was reorganised during the year. Four clinic sessions continued to be held each month, but from September they took place at the Bowes Road Clinic and at the new Health Centre in Forest Road. The clinics formerly held at two other Council clinics and at the premises of the Southgate Old People's Welfare Committee were discontinued. Referrals are received from general practitioners, health visitors, and from other sources. The purpose of the clinics is to provide advice to retired persons, or those about to retire. The new type of clinic service includes advice on health, diet, environmental aspects and pastimes, as well as a check on vision, hearing, haemoglobin, blood glucose and weight. The service is carried out in relation to such other local authority facilities as chiropody. The clinics are staffed by one of the Council's medical officers, and a health visitor or clinic nurse. A social worker from the Welfare Department also attends each session to advise on facilities available through the Social Services Committee. In each case a medical report is sent to the family doctor. During the year, 52 persons made a total of 131 attendances. Smokers' Clinic It was decided this year, as an experiment, to hold a session at Central Clinic, Plevna Road, once a week throughout the year, instead of holding, as formerly, five courses in different clinics. Each session lasted 2 - 2½ hours and was devoted to talks, films, group discussion and the use of the Wright Peak Flow Meter. Two hundred and two persons attended, an increase of 108 over the previous year; average attendances were between two and three per person, but 48 persons attended four or more sessions. The sessions were conducted by the Principal Medical Officer for Maternity and Child Health and the Health Education Officer, whose enthusiasm contributed in no small measure to the increased attendances. Twenty-nine persons claimed to have stopped smoking while attending the clinic. However, it will not be possible to estimate the benefits or otherwise of holding a weekly session in one clinic throughout the year until an analysis is made of the results of the questionnaires to be sent out the following year. An analysis of the results obtained in 1969 was made by means of a questionnaire sent to the 66 men and 28 women who had attended. Twenty-one men and ten women replied, and of these, seven men and seven women were nonsmokers one year after attending the course. Recuperative Care This scheme provides holidays for persons who are recovering from illness or operation but who do not require nursing care. Normally, application is made by general practitioners on behalf of their patients, who make some contribution towards the cost according to their means. Except in special cases, the period of stay is limited to two weeks. The majority of holiday homes used are situated on the south coast. 40 PERSONAL HEALTI- Adaptation of Homes to Install Artificial Kidney Machines Under this scheme holidays were arranged for 55 adults. There is increasing use of artificial kidney machines in patients' homes in the treatment of chronic renal failure. Hospital authorities provide and maintain the intermittent haemodialysis equipment and provide the relevant medical services. They also pay for the extra cost of electricity and for the installation and rental of a telephone where this is necessary. They have not, however, powers to make adaptations to the home and, in 1968, the Minister of Health approved the making of arrangements by all local health authorities for these purposes and also the making of reasonable charges. A patient being treated in this way requires a room with space for a single bed and the dialysis equipment, and a sink with a good supply of water. The walls and ceiling of the room should be made crack-free and washable, and the floor covering should be waterproof. Special storage space for one month's supply of sterile dressings and of containers of concentrated fluids are required, together possibly with special electric wiring and plumbing. In some cases it may be necessary to build an extension to the house. During the year, applications were made by hospitals in four cases for adaptations to be made to patients' homes for this purpose, including one instance requiring the construction of an extension to the rear of the house. The necessary work was authorised in each case. Hypothermia Circular 19/70, received in November from the Department of Health and Social Security, reminded local authorities of the need to take preventive measures in regard to accidental hypothermia with particular reference to the elderly. The necessary measures to ensure full co-ordination of voluntary and statutory agencies to give practical help in this regard were taken in 1968; a circular was issued reminding all concerned of the arrangements. No instances of morbidity or mortality due to hypothermia were reported. Fluoridation of Public Water Supplies There has been no significant change in the position since my previous reports. It appears that artificial fluoridation of public water supplies, which is favoured by the Council, will not come about until all the local authorities in the area supplied by the water undertakings reach agreement, or unti a decision is made by the Government to be implemented nationally. The General Public Health Education Lectures to groups of members of the general public were given by the Health Education Officer and public health inspectors on the following subjects : prevention of home accidents (22 talks); diet (12); food hygiene (11); maintaining good health (3); cancer (2); the work of the Health Department (2); foot care (1); and atmospheric pollution (1). The Department's display at the Enfield Show was on the subject of smoking. Whole-day displays on home accidents were on two occasions arranged at church halls. Slimmers advisory centres, to which reference is made elsewhere in this report, were started at two clinics by the health visitors. A Mothers' Club, oriented towards health education, continued to meet fortnightly under the sponsorship of health visitors. An anti-smoking clinic and club met weekly 41 PERSONAL HEALTH and was organised by a Principal Medical Officer and the Health Education Officer. Occasional evening meetings were arranged at which immigrant groups could discuss health topics in their own language. Posters on health subjects were displayed on notice boards throughout the Borough, in public buildings, shops and factories, and in doctors' and dentists' surgeries; and leaflets and booklets were distributed. Many members of the staff — in particular health visitors, home nurses, midwives, doctors and public health inspectors — promoted health education in the course of their day-to-day contact with the public. Health Education In Schools The Health Education Section enjoys a good relationship with the Education Department and with the schools. Courses and lectures on smoking, drug addiction, dental health and sex education were arranged for head teachers, teachers and parent-teacher associations. In primary schools, dental health and smoking were the subjects to which attention was mainly directed: A dental health programme in 36 schools was carried out by the Health Education Officer, a dental officer and a health visitor; and the subject of smoking was dealt with at fourteen schools by the Health Education Officer and a doctor. In Secondary Schools, lectures and film programmes on the following subjects have been given, mainly by the Health Education Officer: smoking (20); venereal disease (6); childbirth (4); drug addiction (1); personal hygiene (1). Two health visitors continued a regular syllabus on mothercraft, and, with parental consent, on sex education. Mental Health Act 1959 Health Services and Public Health Act 1968 Mental Health It is the duty of a local health authority to provide mental health services under the Mental Health Act 1959 and subject to the provisions of Section 12 of the Health Services and Public Health Act 1968. The provision of residential accommodation continues to be an important feature of community care services. The Council's ''Windsmill" Recuperative Hostel affords accommodation for those recovering from mental illness, but recourse to voluntary homes and hostels for this class of patient continues to be necessary. The Council's purpose-built hostel for twenty mentally subnormal children, and known as "Cheviots was completed during the year and was due to open on 1st January, 1971. The first of two twentyplace hostels for subnormal adults will be completed during 1971. At the end of the year, the total of all classes of the mentally disordered maintained in residential accommodation, whether local authority hostels, homes run by voluntary associations or in private households, was 84. Tabulated statistics relating to the Mental Health Service are at the end of this section of the report. Mental Illness The London Borough of Enfield is within the catchment area of Claybury and Friern Hospitals, to which patients requiring hospital treatment for mental disorder are admitted. The North Middlesex Hospital provides psychiatric beds in a modern unit to which suitable patients are admitted for short-term observation and treatment. 42 PERSONAL HEALTH Out-patient clinics are held at North Middlesex, Chase Farm, Highlands and War Memorial Hospitals. A 24-hour mental health community service is provided throughout the year by the Council. The Department has established close liaison with the other social work departments and with the consultants at the local hospitals. Domiciliary Service Persons who are, or who have been, suffering from mental disorder are referred from a number of sources to the Health Department for care and support in their own homes. The majority of cases are referred by general medical practitioners. During the year 364 patients were referred for supportive after-care and the number of home visits to mentally ill patients totalled 4,769 in addition to 936 office interviews. It is desirable for a social history to be provided to the psychiatrist by a mental welfare officer on a patient attending an out-patient clinic for the first time. During the year sixteen social histories were supplied on request. In addition, 261 social reports were supplied to psychiatrists at Friern and Claybury Hospitals on new admissions. Department of Health and Social Security circular 4/70, received in March, enclosed a memorandum containing advice from the Standing Mental Health Advisory Committee on psycho-geriatric assessment in hospitals, which the Department of Health and Social Security commended to hospital authorities. The advice emphasised the need to assess elderly patients, wherever possible, without admission to hospital as in-patients, but stressed the value of special psycho-geriatric assessment units for those that require admission for purposes of assessment. The Secretary of State considered that Regional Hospital Boards should consult with local authorities in the planning and operation of these units and he proposed to ask Regional Hospital Boards for progress reports in two years time. The demand for psycho-geriatric admissions for elderly confused patients remains high in Enfield; domiciliary support is provided by the consultant psycho-geriatricians from the local catchment hospitals and social work support is provided by the Council's mental welfare officers, both before admission and after discharge. Hospital Admissions Every effort is made to arrange for admission of patients to psychiatric hospitals informally and 73 were so admitted. In addition, 188 were compulsorily removed to hospital by mental welfare officers under Part IV of the Mental Health Act 1959. The increase in the proportion of compulsory admissions to hospital noted in 1969 was maintained during 1970. This emphasises the need for increased preventive social work support. Enfield Association for Mental Health The inaugural meeting of the Enfield Association for Mental Health took place at the Enfield Baptist Church on Tuesday evening, 16th June. His Worship the Mayor presided and the meeting was addressed by Mr. Christopher Mayhew, M.P., Chairman-Elect of the National Association for Mental Health. This local association will undoubtedly have an important role in the borough for non-statutory interest in the special needs of the mentally sick. The association already provides a coach service to enable relatives to visit patients at Claybury Hospital. Day Rehabilitation Centres The day centre organised by the Psychiatric Rehabilitation Association continued at premises in Tottenham, in the London Borough of Haringey. 43 PERSONAL HEALTH Eleven Enfield residents commenced attendance during the year and five were in attendance at the end of the year, the cost being borne by the Council. In addition, the Council sponsored the attendance of one Enfield resident at the Association's Industrial Education Unit at Bethnal Green. Mention is made later in this report of use by the mentally ill of facilities at the Council's Edmonton Adult Training Centre. Social Centres or Clubs Mental welfare officers supervise the running of a club which is held every Monday from 7.30 p.m. to 10.00 p.m. at the Junior Training School, Waverley Road, Enfield, with a weekly attendance of between 25 and 50 persons. At the end of the year arrangements were in hand to open a second club at the Council's new Health Centre in Edmonton. Discussion Group In October, one of the senior mental welfare officers commenced a weekly discussion group at the Health Office after normal working hours. This group is for married couples whose emotional or psychological problems are manifest in the marital relationship. By the end of the year four couples had attended the discussion group meetings. Residential Accommodation The " Windsmill " Recuperative Hostel has places for 26 persons, men and women. The residents are normally referred from psychiatric hospitals and are usually expected to be capable of working. They are encouraged to resume their places in society with increased confidence. During the year there were twenty admissions and, in addition, one person was admitted for a few days in an emergency. Thirteen persons ceased to reside at the hostel during the year for the following reasons:—eight returned to home or relatives; three returned to hospital; one was admitted to residential employment; one was admitted to an Industrial Rehabilitation Unit. The number of residents at the end of the year was twenty, including six from other authorities. Fifteen were in gainful employment. The Department of Health and Social Security conducted a national census of residential accommodation. The object of the census was to provide an adequate statistical picture of the problems which local authorities face in providing residential accommodation for the elderly, the physically handicapped, and the mentally disordered. Data in respect of "Windsmill" hostel was duly prepared as at 30th April, 1970, and forwarded to the Department of Health and Social Security. Department of Health and Social Security circular 18/69 offered guidance on the custody and administration of medicines for residents in homes for the elderly. The Department also reminded local authorities that similar aspects of safety apply to hostels for the mentally disordered and suggested that appropriate instructions be issued to staff in charge of such hostels on the custody of drugs. The arrangements in this regard were duly reviewed at "Windsmill where the Warden is the "Designated Officer" for the purposes of control of medicines other than those retained by individual residents. In the case of Enfield patients considered to be unsuitable for acceptance in the Council's own hostel the Council continued to accept financial responsibility for their care and maintenance in mental after-care hostels administered by voluntary associations such as the Richmond Fellowship, the S.O.S. Society, and the Mental After Care Association. At the end of the year there were eleven patients maintained in voluntary hostels and one in a private household. 44 PERSONAL HEALTH Domiciliary Service Mental Subnormality The number of subnormal persons in community care at 31st December was 311. The mental welfare officers paid 885 visits, and 51 office interviews were carried out. The Council's adviser in subnormality, Dr. W. Livingston, continued to hold a monthly out-patient clinic for the purpose of assessment and review of mentally subnormal patients in the community, the cases being presented by the mental welfare officers. By the end of the year, 33 patients had been seen by the consultant. Junior Training Schools These schools are provided for children who, under Section 57 of the Education Act 1944 are found to be suffering from a disability of mind of such a nature or to such an extent as to make them unsuitable for education at a school provided by the local education authority. At the Enfield Junior Training School there is provision for 144 children of both sexes, including a small nursery group and a special care unit. All the children in the special care unit have dual handicaps such as spasticity or other physical defects as well as subnormality. The school normally accepts children up to sixteen years of age, but a number of persons over the age of sixteen years continue in attendance and special provision is made for them. The majority of those reaching sixteen years of age transfer to the Adult Training Centre. The vacancies created by the withdrawal of 42 children living in the London Borough of Haringey enabled the school to admit a number of children between the ages of two and four years. Routine medical and dental inspections, speech therapy and physiotherapy are provided through the school health service. The number on roll at the end of the year was 86, plus 27 in the special care unit. There was a good attendance of parents at the Open Day at the school on Wednesday afternoon, 24th June. The children gave displays of school activity, and examples of cookery undertaken by the older children were on exhibition. Guests included the Deputy Mayoress, the Vice-Chairman of the Social Services Committee, the Assistant General Secretary of the National Association for Mental Health, as well as executive members of the Enfield Society for Mentally Handicapped Children. A successful Sports Day was held on 16th July. Transfer of Responsibility The Education (Handicapped Children) Act 1970 made provision for discontinuing the classification of handicapped children as unsuitable for education at school. The operative date will be the 1st April, 1971, when the Education Committee will take over Enfield Junior Training School as a school for educationally subnormal pupils. Enfield Society for Mentally Handicapped Children Throughout the year close contact was continued between the Council and the Society and opportunity was taken at meetings between members and officers of the Council and the Society to exchange information, particularly in regard to changes in the educational provision for children. The Junior Training School was made available to the Society for use as a play centre for four weeks, during the month of August, on every Tuesday, Wednesday and Thursday. Once again, this project proved to be most useful and parents were thus provided with relief from the constant care of their children for a number of hours each day. 45 PERSONAL HEALTH As in my previous reports, I wish to comment upon the generosity, enterprise and co-operation displayed by the Enfield Society for Mentally Handicapped Children. Adult Training Centre The Adult Training Centre at Claverings Industrial Estate, run on similar lines to an ordinary factory, has accommodation for 165 trainees over the age of sixteen years, who are paid a weekly allowance. The scheme of incentive payments provides a minimum payment to each trainee in a full week of ten shillings, and a maximum payment of £2. The number of trainees on roll on 31st December was 150 and there was no waiting list. A proportion of places is occupied by trainees from the London Boroughs of Barnet and Haringey. The Centre also caters for selected mentally ill persons medically recommended to attend a day occupation centre. At the end of the year twenty such persons were in attendance. The aim of this purpose-built centre is to train mentally subnormal persons to become as independent and to lead as full a life as possible. Some trainees are engaged on assembly work sent to the centre by local firms, while others fulfil gardening contracts or work in the fully-equipped laundry section. The latter handles approximately 6,000-7,000 articles of clothing and linen each week, collected from more than 100 different establishments of the Council. The Education Committee continued to supply two part-time visiting teachers to provide formal education to a total of seventeen hours per week. The scheme in which twenty selected trainees work as a group in a local factory under supervision continues to be successful. Another one of these trainees was successfully absorbed into the factory's routine during the year and is working as a full-time employee. All trainees are medically inspected periodically. The visiting medical officer also acts in the capacity of Her Majesty's Appointed Factory Doctor. The Works Safety Committee met on one occasion and considered various aspects of safety in regard to trainees and staff. The Centre became an affiliated member of the British Safety Council in January, 1970. The Centre was formally visited by Her Majesty's Factory Inspectors in May; appropriate action was taken on a number of matters referred by the Inspectors. The Centre was open to the parents and friends of trainees all day on Wednesday, 23rd September. The many visitors included His Worship the Mayor and representatives of local firms with which the Centre has contact. The fourth annual Sports Day was held at Henry Barrass Stadium, Edmonton, on Friday afternoon, 19th June. A full programme of competitions and team events was organised by the Manager and staff of the centre. Trainees from the London Boroughs of Haringey, Waltham Forest and Enfield took part and teams from each borough took part in the inter-centre competitions. Many parents, visitors and trainees watched the events with Alderman E.G. McNern, Chairman of the Social Services Committee, and Councillor Mrs. M. M. Hawkins, who presented the medals to winners. The Haringey team won the team competition for the second year in succession. The Manager and staff continued the club for trainees which is held on the premises from 3 p.m. onwards every Friday. Activities included dancing, singing, ten pin bowling and other games. This club is affiliated to the 46 PERSONAL HEALTH Federation of Gateway Clubs. On 30th May a team of nine trainees took part in the " Gateway Olympics organised by the Metropolitan Region of the National Society for Mentally Handicapped Children at Caterham Barracks, and won the Sports Cup in competition with four other teams from Adult Training Centres in the Metropolitan Region. Hospital Admissions Some severely subnormal persons are handicapped to such an extent that only hospitals can provide the type of care they require. The borough is within the catchment area of South Ockendon and Harperbury Hospitals. There is an acute shortage of beds for such patients and South Ockendon Hospital has a particularly long waiting list, there being at the end of the year 27 Enfield persons on the waiting list, including four urgent cases. To relieve this unfortunate situation, the Council undertook the maintenance of six severely subnormal children in residential homes pending their eventual transfer to hospital, but some of these children had to be placed at a considerable distance from home. Guardianship It was found necessary to receive one severely subnormal person into the Council's guardianship during the year and five persons were still under the formal guardianship of the Council at the end of the year, suitable accommodation being provided in each case. Residential accommodation and Informal Foster Care Various voluntary homes and local authority hostels are used for the informal accommodation of selected cases. The Guardianship Society, Hove, tinues to provide suitable foster homes for nineteen Enfield residents, thirteen of whom attend training centres in the Brighton area. At the end of the year the number of mentally subnormal persons maintained in residential homes and hostels and in informal foster care was sixty, including twelve children. Temporary Care Short term residential care of subnormal persons is arranged to offer relief to parents and guardians, usually at holiday times, to allow them to take a carefree vacation. Twenty-nine admissions to hospital and fifteen admissions to voluntary homes were arranged under this scheme. Nine of the hospital admissions were to Winifred House pre-convalescent hospital for children, Barnet Gate, Arkley, Barnet. Holiday Camps Once again, a very successful summer camp for mentally subnormal children was held for two weeks at St. Mary's Bay Holiday Camp, Dymchurch, Romney Marsh, Kent. Forty-one children from the London Boroughs of Haringey, Barnet and Enfield attended this camp, which was staffed by volunteers from the Council's Junior Training School and other persons who kindly offered their services. Nine adult females and eleven adult males from Enfield attended the Summer Camp arranged for mentally subnormal adults by the London Borough of Haringey at Ramsgate, Kent, for one week in July. Drug dependency In 1969, the Secretary of State for Health and Social Security asked regional hospital boards to keep local health authorities informed of the numbers of in-patients and out-patients undergoing treatment for heroin addiction. Full information on the illicit use of addictive drugs is notoriously difficult to obtain and evaluate, notwithstanding the stringent regulations now in force and the vigilance of the police. However, the Health Department has no definite evidence pointing to drug dependency being a major problem in this borough at present. 47 PERSONAL HEALTH Alcoholism The extent of alcoholism in the borough is not known and hostel provision specifically for this purpose is not included in the Council's Ten-Year Plan. This category of patient would not normally be admitted to the Council's " Windsmill " hostel but one of the persons maintained by the Council in a voluntary home was so placed for rehabilitation following hospital treatment for alcoholism; he made progress and took his own discharge to lodgings. Home Help Service Section 29, National Health Service Act, 1946 A local health authority may make arrangements for providing domestic help households where such help is required owing to the presence of any person who is ill, lying in, an expectant mother, aged, or a child not over compulsory school age within the meaning of the Education Act 1944. In Enfield the Borough Council continued to provide a home help service. The Secretary of State has not yet made use of the powers provided by Section 13 of the Health Services and Public Health Act 1968 (a) to impose on local health authorities the duty to provide or arrange to provide a home help service adequate to the needs of their area, and (b) to enable local health authorities to provide or arrange for the provision of laundry facilities for households for which home help service is being or can be provided. By December, 150 (whole-time equivalent) home helps were employed, compared with 142 the previous year, but, despite improved recruitment, the help available continued to be insufficient to meet increasing demands on the service. In order, therefore, to ensure that as many applicants as possible received assistance, the help provided in individual cases was necessarily limited. The continued provision of transport between districts for the home helps, in addition to encouraging recruitment, also helped to improve the service in those areas where the greatest difficulty is experienced. The figures set out in the table show a continuing decrease in the demand for help in maternity cases and an increase in help for the aged. No cases occurred necessitating assistance under the special scheme whereby domestic help is provided to women suffering from toxaemia of pregnancy. Neighbourly Help Scheme This scheme, which in operation has the effect of reducing slightly the demands on available home help staff resources, provides for the payment of small weekly sums to neighbours who are prepared to give certain domestic help to those in need. The scheme operates on a relatively small scale. Many people are unable or unwilling to undertake the responsibility; others are prepared to help their neighbours without reward. It is, however, necessary that the neighbourly help live near the person requiring assistance, and it is not always possible to link offers of help with persons in need. Ten families received assistance under this scheme, and at the end of the year nine neighbourly helps were employed. in-service Training The in-service training scheme for home helps continued during 1970. Details are given in the section of this report on staff training. Ten-year plan for health services The Department of Health and Social Security again requested the submission of a revised three-year building programme of projects for which it was anticipated that loan sanction would be sought. Although no request was received for a Ten-Year Development Plan the opportunity was taken to review the Council's ten-year plan for the health services. 48 PERSONAL HEALTH Included in the three-year capital works programme are a health centre complex (to include a health clinic, consulting rooms for general medical practitioners, day nursery and day centre for mentally sub-normal infants), two other day nurseries (each including day centres for mentally subnormal infants), a hostel for mentally subnormal adults, and a health clinic to replace services now provided in rented premises. During the year the health centre at Forest Road, off Hertford Road, and the hostel for subnormal children at Baker Street, were completed, equipped, and brought into use. Reports on these two projects occur elsewhere in this report. Nursing Homes Part VI Public Health Act 1936 Nursing Homes Act 1963 Mental Health Act 1959 Local health authorities have a duty to register and inspect nursing homes established in their areas. General Nursing Homes One of the nursing homes registered with the Council is approved for the care of 100 general patients — male and female — and has been inspected regularly. Conditions were found to be satisfactory. A second nursing home, accommodating a total of eight medical and/or chronic sick patients — male and female — was registered at the end of the year. Mental Nursing Homes There is one registered mental nursing home, approved for the care of twenty-seven mentally disturbed and chronic sick patients. The home, which is for both male and female patients, has been regularly inspected during the year. Maternity Homes There are no maternity homes registered in the borough. No private premises in the borough have been approved by the Secretary of State for Health and Social Security under the Abortion Act 1967 as places for treatment for the termination of pregnancy. Certification of blindness and partial sight Section29, National Assistance Act 1948 Arrangements for examination and certification on Form B.D.8 of applicants for admission to the Register of the Blind or the Register of the Partially Sighted maintained by local authorities under Section 29 of the National Assistance Act 1948, are in accordance with the Council's approved scheme. Ninety-nine reports on Form B.D.8 were received in respect of cases dealt with under the scheme for the registration of blind and partially sighted persons. The Chief Welfare Officer arranges for social welfare officers to visit all registered persons and follow up on treatment and advice recommended by the ophthalmic surgeons. Removal to suitable premises of persons in need of care and attention Section 47, National Assistance Act 1948(asamended) The compulsory powers to secure necessary care and attention for persons in the circumstances described in Section 47 of the National Assistance Act 1948 (as amended) were not used during the year. Two cases appeared to come within the scope of this provision but in neither case was it necessary to resort to the statutory procedures. 49 PERSONAL HEALTH Laundry service for incontinent persons Section 84, Public Health Act 1936 Section 42, Middlesex County Council Act 1956 Under Section 84 of the Public Health Act 1936, and Section 42 of the Middlesex County Council Act 1956, a free laundry service is provided for incontinent persons by using the facilities of the laundry at the Adult Training Centre The service is provided on the recommendation of the patient's medical practitioner or the home nurse in attendance. A weekly collection and delivery of laundry is provided. At the end of the year fourteen patients were being provided with this service involving the handling of approximately 98 articles per week. 50 PERSONAL HEALTH Table 9 Care of Mothers and Young Children Ante-natal and Post-natal Clinics: Relaxation and Mothercraft Classes Antenatal Postnatal Relaxation and Mothercraft No. of sessions 527 (combined) 489 No. of women in attendance 443 184 667 Total number of attendances 2,739 266 3,597 No. of clinic premises : 9 Table 10 Care of Mothers and Young Children Child Health Clinics No. of sessions No. of children who attended Total attendances Year of birth Total 1970 1969 1965-68 2,057 3,301 3,196 6,261 12,758 77,041 No. of clinic premises : 20 51 PERSONAL HEALTH Table 11 Care of Mothers and Young Children Dental Care Dental Services Expectant and Nursing Mothers Children under 5 years of age Examined 37 588 Commenced treatment 46 304 Courses of treatment completed 14 181 Treatments provided : Extractions 17 65 Fillings 104 431 Teeth otherwise conserved — 224 Crowns and Inlays 1 — Other operations 8 28 Radiographs 2 — General Anaesthetics — 39 Dentures provided 5 — 52 PERSONAL HEALTH Table 13 Midwifery Care of Premature Infants Number of Premature Babies Born at Home Premature Babies Born and Nursed at Home Number Died during first 24 hours Survived to end of 28 days 23 22 — 22 Table 12 Midwifery Midwives who notified their intention to practise within the Borough during 1970 Domiciliary Institutional Employed by the Borough In Private Practice Hospitals Nursing Homes Total 24 — 146 170 53 PERSONAL HEALTH Table 14 Health Visiting Visits to Homes by Health Visitors * Number of Visits First Visits Total Visits Expectant Mothers 993 1,563 Children : born in 1970 3,828 9,517 born in 1969 3,458 7,825 born in 1965-68 7,819 16,604 Persons aged 65 years and over 971 2,769 Mentally Disordered Persons 57 257 Patients discharged from Hospitals (other than Mental and Maternity) 177 252 Infectious Disease Households 29 34 Miscellaneous 1,140 3,285 TOTAL 18,472 42,106 * This Table excludes visits by Tuberculosis Health Visitors. 54 PERSONAL HEALTH Table 15 Home Nursing Work Undertaken by the Home Nurses Number of Visits and Treatments Number of Patients Number of Patients under the age of 5 years Number of Patients aged 65 years or over Number of Visits of over one hour duration included in the Total 131,607 5,755 370 2,821 779 55 PERSONAL HEALTH Table 16 Vaccination and Immunisation Immunisation against Diphtheria, Whooping Cough, Tetanus, Poliomyelitis, Measles, and Rubella Persons aged under 16 years (a) Completed Primary Courses Type of Vaccine Year of Birth Others under age 16 Total 1970 1969 1968 1967 1963/6 1. Quadruple — — — — — — — 2. Triple DTP 113 1,924 232 16 15 1 2,301 3. Diphtheria/Pertussis — — — — — — — 4. Diphtheria/Tetanus 2 95 41 10 106 41 295 5. Diphtheria — — 1 — 3 — 4 6. Pertussis — — — — — — — 7. Tetanus — 5 — — 3 480 488 8. Salk — — — — — — — 9. Sabin 76 2,043 368 45 213 144 2,889 10. Measles 2 1,008 921 424 522 74 2,951 11. Rubella — — — — — 300 300 12. Lines 1 +2 + 3 + 4 +5 (Diphtheria) 115 2,019 274 26 124 42 2,600 13. Lines 1+2+3 + 6 (Wh. Cough) 113 1,924 232 16 15 1 2,301 14. Lines 1+2 + 4 + 7 (Tetanus) 115 2,024 273 26 124 522 3,084 15. Lines 1+8 + 9 (Polio) 76 2,043 368 45 213 144 2,889 (b) Reinforcing Doses Type of Vaccine Year of Birth Others under age 16 Total 1970 1969 1968 1967 1963/6 1. Quadruple — — — — — — — 2. Triple DTP — 76 866 73 429 85 1,529 3. Diphtheria/Pertussis — — — — — — — 4. Diphtheria/Tetanus — 4 101 24 3,594 148 3,871 5. Diphtheria — — — — 34 5 39 6. Pertussis — — — — — — — 7. Tetanus — 1 2 15 51 1,201 1,270 8. Salk - - - - - - - 9. Sabin — 51 207 38 4,043 2,562 6,901 10. Lines 1+2 + 3 + 4 + 5 (Diphtheria) — 80 967 97 4,057 238 5,439 11. Lines 1+2+3 + 6 (Wh. Cough) — 76 866 73 429 85 1,529 12. Lines 1+2 + 4 + 7 (Tetanus) — 81 969 112 4,074 1,434 6,670 13. Lines 1+8 + 9 (Polio) — 51 207 38 4,043 2,562 6,901 56 PERSONAL HEALTH Table 17 Vaccination and Immunisation Smallpox Vaccination Persons aged under 16 years Age at Date of Vaccination Number of Persons Vaccinated Re-vaccinated Under 3 months 21 — 3 months and under 6 months 9 — 6 months and under 9 months 15 — 9 months and under 12 months 24 — 1 year 1,312 — 2- 4 years 298 549 5-15 years 117 1,393 TOTAL 1,796 1,942 Table 18 Vaccination and Immunisation Completed Primary Courses of Immunisation by end of 1970 of Children born in 1968 Number of Children in Enfield born in 1968: 3,966 Immunisation Against No. of Children Immunised (Enfield) Acceptance Rate per cent Enfield England & Wales Diphtheria 3,593 90.59 80.1 Whooping Cough 3,394 85.57 78.4 Tetanus 3,591 90.54 80.2 Poliomyelitis 3,355 84.59 78.5 Smallpox 2,107 53.12 Not available Measles 1,392 35.09 Not available Table 19 Vaccination and Immunisation B.C.G. Vaccination Number of parents approached for consent 3,770 Number of parents who consented 2,888 Number of children given Tuberculin Test (Heaf Gun) 2,804 Number of children found to be positive 335 Number of children found to be negative 2,416 Number of Tuberculin Tests not read 53 Number of children given B.C.G. vaccination 2,416 Number of children found to be negative but not vaccinated - 57 PERSONAL HEALTH Table 20 Prophylaxis, Care and After-Care Tuberculosis: Statistics of Chest Clinic 1. Number of cases of tuberculosis under treatment, supervision or observation at 31st December, 1970: Respiratory Non-Respiratory Men Women Children Total Men Women Children Total 857 642 115 1,611 76 125 12 213 2. Number of cases of respiratory tuberculosis under Section 1 above, new to the clinic (but excluding transfers from other clinics) during the year ended 31st December, 1970: Classification* Non-Bacteriologically Confirmed Bacteriologically Confirmed Men Women Children Total Men Women Children Total Group I 23 19 16 58 3 4 — 7 Group II 35 29 — 64 6 4 — 10 Group III 3 — — 3 2 — — 2 61 48 16 125 11 8 — 19 3. Number of cases of non-respiratory tuberculosis included in Section 1 above, new to the clinic (but excluding transfers from other clinics) during the year ended 31st December, 1970: Men Women Children Total 5 11 1 17 4. Number of cases included in Section 1 above, whose bronchopulmonary secretion was positive during the year 26. * The three sub-divisions of new respiratory cases are estimated as follows from the standard P.A. film: Group I — Total area of disease not exceeding one-third of one lung in aggregate. Group II — Total area of disease not exceeding two-thirds of one lung in aggregate. Group III — Total area of disease exceeding (including miliary disease) two-thirds of one lung in aggregate. Tuberculous pleural effusions, pleural thickening without obvious lung involvement and enlarged hilar glands are placed in Group I. 58 PERSONAL HEALTH Table 21 Chiropody Service (a) Attendance at Clinics Category of Patient New Cases : First attendances Old Cases: First attendances during the year Reattendances Total attendances for treatment Elderly Persons (over 65 years of age) 341 1,308 5,771 7,420 Physically Handicapped 1 11 36 48 Expectant and Nursing Mothers 4 6 67 77 School Children 7 5 31 43 Pre-school children — — — — Others 32 106 492 630 TOTAL 385 1,436 6,397 8,218 Number of Clinic Sessions — 1,662 (b) Domiciliary Chiropody Service Number of Patients Number of Treatments 949 4,368 (c) Services provided by Voluntary Organisations Number of Patients Number of Treatments Treated at Centres 807 4,404 Domiciliary Cases 334 1,567 At Private Surgeries 33 323 TOTAL 1,174 6,294 Number of Sessions at Centres — 595 Table 22 Prophylaxis, Care and After-Care Venereal Diseases Hospital Number of New Cases Totals Syphilis Gonorrhoea Other Conditions Prince of Wales' 7 100 575 682 Westminster — 1 4 5 The Middlesex — 5 101 106 The London — 11 76 87 St. Bartholomew's — 5 48 53 Royal Free — 3 10 13 St. Thomas' — 9 27 36 Royal Northern — 26 112 138 TOTAL 7 160 953 1,120 59 PERSONAL HEALTH Table 23 Smokers Clinic, 1969 Replies to Questionnaires Date Sex Attended 5 Sessions Attended 3 - 4 Sessions Attended 1 - 2 Sessions Total Attended No. of Replies Not Smoking Smoking Total Attended No. of Replies Not Smoking Smoking Total Attended No. of Replies Not Smoking Smoking 13.1.69-10.2.69 M 5 2 — 2 5 4 1 3 5 - - - F 2 1 1 - 3 2 1 1 2 1 — 1 18.2.69-18.3.69 M 2 — — — 1 — — — 5 1 — 1 F - - - - - - - - - - - - 10.4.69-8.5.69 M 2 — — — 4 1 — 1 6 4 2 2 F 1 —- — — 2 2 2 — 4 1 — 1 9.10.69-6.11.69 M 7 2 2 — 4 2 — 2 12 2 1 1 F 2 - - - - - - - 6 3 3 — 13.11.69-11.12.69 M 1 1 — 1 5 1 1 — 2 1 — 1 F — — — - 2 - - - - - - - TOTALS M 17 5 2 3 19 8 2 6 30 8 3 5 F 5 1 1 — 7 4 3 1 16 5 3 2 % Replies (of Total Attended) M - 30 - - - 42 - - - 27 - - F - 20 - - - 57 - - - 31 - - % Non-Smokers (of Replies Received) M - - 40 - - - 25 - - - 38 - F - - 100 - - - 75 - - - 60 - 60 PERSONAL HEALTH Table 24 Mental Health Patients under Local Health Authority Care at 31st December, 1970 Mentally III Mentally Handicapped and Severely Mentally Handicapped Under age 16 yrs. Aged 16 yrs. to 64 yrs. Aged 65 yrs. and over Total Under age 16 yrs. Aged 16 yrs. and over Total M F M F M F M F M F 1. Number of patients under care on 31st December, 1970 - - 78 115 6 6 205 72 53 88 98 311 2. (a) Attending day training centre - - 14 7 3 - 2 4 56 41 62 73 - (b) Awaiting admission — — — — — — — 4 5 - - 9 3. (a) Resident in L.H.A. home /hostel - - 6 7 - - 13 - - 7 - 7 (b) Awaiting residence in L.H.A. home/hostel - - - - - - - - - 1 - 1 (c) Resident at L.H.A. expense in other residential homes/hostels - - 3 4 1 2 10 6 6 8 13 33 (d) Resident at L.H.A. expense by boarding out in private household - - - - - 1 1 - - 5 15 20 4. Receiving home visits and not included in (2) and (3) - - 56 101 2 3 162 6 3 11 11 31 5. No. of patients in L.H.A. area on waiting list for admission to hospital at 31.12.70 (a) In urgent need of hospital care - - - - - - - - 3 - 1 4 (b) Not in urgent need of hospital care - - - - - - - 8 3 9 3 23 6. No. of admissions for temporary residential care, e.g. to relieve the family, during 1970 (a) To N.H.S. Hospitals - - - - - - - 18 4 4 3 29 (b) Elsewhere — — 1 — — - 1 2 2 3 8 15 61 PERSONAL HEALTH Table 25 Domestic Help Number of Cases in which Domestic Help was provided during 1970 65 years or over at time of first visit Aged Under 65 years on First Visit Maternity Chronic Sick Tuberculous Mentally Disordered Others Total[/##] 2,075 81 258 9 2 183 2,608 Table 26 Mental Health Patients referred to Health Department during year ended 31st December, 1970 Referred by Mentally III Mentally Handicapped and Severely Mentally Handicapped Under age 16 yrs. Aged 16 yrs. and over Total Under age 16 yrs. Aged 16 yrs. and over Total M F M F M F M F General Practitioners 2 - 77 190 269 1 — — 2 3 Hospitals, on discharge from inpatient treatment 1 - 55 102 158 - - 4 1 5 Hospitals, after or during outpatient or day treatment - - 30 46 76 - - - - - Local Education Authority - - - - - 15 12 2 2 31 Police and Courts 1 - 17 11 29 - - - - - Other Sources - 2 74 89 165 7 2 12 10 31 TOTAL 4 2 253 438 697 23 14 18 15 70 62 PERSONAL HEALTH Table 27 Development Plan Year Legislation Project No. of Places or Population Served Address 1971 National Health Service Act 1946 Section 21 1. Health Centre Complex Old Road Re-development area (a) Health Centre 10,000 - 20,000 Section 22 (b) Day Nursery 55 places Health Services and Public Health Act 1968, Section 12 (c) Day Centre for mentally sub-normal infants 10 places 1972 National Health Service Act 1946 Section 22 2. Day Nursery incorporating 55 places Adjacent to Central Clinic, Plevna Road, Edmonton, Health Services and Public Health Act, 1968, Section 12 Day Centre for mentally subnormal infants 10 places or in Southgate Health Services and Public Health Act 1968, Section 12 3. Hostel for mentally subnormal adults 20 places Montagu Road, Edmonton 1973 National Health Service Act 1946 Section 22 4. Day Nursery incorporating 55 places Adjacent to Central Clinic, Plevna Road, Edmonton, or in Southgate Health Services and Public Health Act 1968, Section 12 Day Centre for mentally subnormal infants 10 places National Health Service Act 1946 Section 22 5. Health Clinic 10,000-20,000 Angel Road/Fore Street area 1974 Health Services and Public Health Act 1968, Section 12 6. Occupation Centre for mentally ill 20 places New Southgate Redevelopment area or other suitable site Suitable site Health Services and Public Health Act 1968, Section 12 7. Day Centre for elderly mentally ill 25 places 1975 National Health Service Act 1946 Section 22 8. Health Clinic 10,000-20,000 Broomfield Park area 1976/1981 National Health Service Act 1946 Section 21 or 22 9. Health Centre or Clinic 10,000-20,000 Winchmore Hill area Health Services and Public Health Act 1968, Section 12 10. Occupation Centre for mentally ill 20 places Suitable site Health Services and Public Health Act 1968, Section 12 11. Occupation Centre for mentally ill 20 places Suitable site National Health Service Act 1946 Section 21 or 22 12. Health Centre or Clinic 10,000-20,000 The Grange area, Southgate National Health Service Act 1946 Section 21 or 22 13. Health Centre 10,000-20,000 Barrowell Green area, Southgate 63 PERSONAL HEALTH Table 28 Certification of Blindness and Partial Sight Follow-up of Registered Blind and Partially Sighted Persons in 1970 Causes of Disability Cataract Glaucoma Retrolental Fibroplasia Myopia Other (i) Number of cases registered during the year in respect of which Forms B.Q.8. recommended: (a) No treatment 1 1 - 3 26 (b) Treatment (medical, surgical, optical or ophthalmic medical supervision) 10 14 - 7 37 (ii) Number of cases at (i) (b) above which on follow-up action: (a) Have completed treatment — - - - - (b) Treatment started, but not completed 4 13 - 6 29 (c) Awaiting treatment 4 1 - 1 4 (d) Refused treatment 2 — - - - (e) Died or removed from the Borough — — — — 4 (iii) Number of new cases registered during 1970 11 15 - 10 63 (iv) Total number of cases registered as at 31st December, 1970 754 64 ENVIRONMENTAL HEALTH ENVIRONMENTAL HEALTH Tables relating to the Environmental Health Service 29 Water Supply: Chemical and mineral analysis 30 Water Supply: Bacteriological results 31 Water Supply: Representative sample 32 Smoke Control Areas 33 Food and Drugs : Samples submitted to public analyst 34 Food and Drugs : Ice-cream—bacteriological examination 35 Food and Drugs : Milk—bacteriological examination 36 Food and Drugs: Prosecutions 37 Housing : Inspections and defects 38 Housing: Defects remedied 39 Shops and Offices 40 Factories and Workshops: Inspection 41 Factories and Workshops : Defects found 42 Inspections and Complaints : Inspections, interviews and visits of public health inspectorate 43 Inspections and Complaints : Summary of complaints Summary water Supply Number of chemical and mineral samples 491 Number of bacteriological samples: Before treatment 10,504 After treatment 5,071 smoke Control Areas Number of premises (total to end of 1970) 74,250 Acreage (total to end of 1970) 16,820 Food and Drugs Number of samples analysed 712 Number of samples of ice-cream bacteriologically examined 30 Number of samples of milk bacteriologically examined 172 Number of samples of milk analysed in Department's own laboratory 184 Housing Number of dwelling houses inspected 17,856 Number of housing defects remedied 3,413 Shops and offices Number of visits to registered premises 4,325 Factories and Workshops Number of inspections 497 Number of defects found 11 Number of defects remedied 3 inspections and Complaints Number of inspections and visits 59,830 Number of complaints and requests for visits 10,295 66 ENVIRONMENTAL HEALTH Water Supply Part IV, Public Health Act 1936, as amended by Sec. 28, Water Act 1945, Sec. 78 Public Health Act 1961 It is the duty of every local authority to take such steps as are necessary for ascertaining the sufficiency and wholesomeness of water supplies within their district. Ten samples were submitted for bacteriological examination, and all were satisfactory. With one exception, the water supply to all dwellings in the borough is direct from the public mains supply. Most of the borough is supplied by the Metropolitan Water Board, but the Hadley Wood and Cockfosters area is supplied by the Lee Valley Water Company. Frequent samples for chemical and bacteriological examination were taken by both undertakings and all proved satisfactory. I am grateful to the Director of Water Examination of the Metropolitan Water Board for the following report on the supply to the London Borough of Enfield: "1. (a) The supply was satisfactory both as to (i) quality, and (ii) quantity throughout 1970. (b) All new and repaired mains are disinfected with chlorine; after a predetermined period of contact the pipes are flushed out and refilled; samples of water are then collected from these treated mains; and the mains are returned to service only after the analytical results are found to be satisfactory. The quality control from these laboratories is carried out by means of daily sampling from sources of supply, from the treatment works or well stations, from the distribution system, and through to the consumer. Any sign of contamination or any other abnormality is immediately investigated. (c) (i) The Board has no record of the number of structurally separate dwellings supplied in your area, but the population supplied direct according to the Registrar General's estimates at 30th June, 1970, was 258,265. (ii) No houses were permanently supplied by standpipe. (d) No artificial fluoride is being added, and where the fluoride content is indicated in the analyses it represents the naturally occurring fluoride in the water. 2. (a) The supply was derived from the following works and pumping stations:— River Thames-derived water to the west and north of the borough, with some well water from Hoe Lane, Hadley Road and Waltham Abbey pumping stations. The south-east portion of the borough in Edmonton receives New River-derived water. No new sources of supply were instituted and there were no changes to the general scheme of supply in your area. The number of samples collected and the bacteriological and chemical analyses of the supply from the above sources after treatment are shown on the attached sheets (see tables). (b) On account of their hardness content and alkaline reaction the Board's river and well water supplies are shown to be not plumbo-solvent. It should, however, be appreciated that all types of water pick up varying amounts of metal from the material of water piping, particularly when it is newly installed; this applies to copper, zinc, iron and also to lead." 67 ENVIRONMENTAL HEALTH Baths, Washhouses, Bathing Places, etc. Part VIII, Public Health Act 1936 Local authorities may provide and control baths, washhouses and bathing places. A new covered pool, together with slipper and Sauna baths, was opened early in the year at Knights Lane, Edmonton, replacing facilities formerly available on a nearby site. Within the borough three open-air and four covered swimming pools are provided for the general public and include a total of twenty slipper baths. There are children's paddling pools at two of the swimming pools and in some parks. In addition to these facilities, five swimming pools are available for the exclusive use of school children. All bathing water is subject to regular chlorination. Automatic filtration and chlorination plants are installed at the public baths, at the swimming pool used exclusively by school children and at the school pools. Water supply is from the public water mains except for a school swimming pool supplied by a deep well. Bathing water samples are tested at the baths at regular intervals during the day for the presence of free chlorine which is indicative of the effectiveness of the treatment. Samples are also regularly submitted to the laboratory for bacteriological examination and chemical analysis. During the year all 48 samples submitted for bacteriological examination were satisfactory. The total attendances at the public swimming pools and the slipper baths were respectively, 658,508 and 55,765. Sewerage and Sewage Disposal Public Health Act 1936 Public Health Act 1961 Rivers (Prevenintion of Pollution) Act 1961 Middlesex County Council Acts 1956 arid 1961 Under the Public Health Acts of 1936 and 1961, it is the duty of the local authority to provide for the sewerage of their district, while the Rivers (Prevention of Pollution) Act 1961 makes further provisions for maintaining or restoring wholesomeness of rivers in respect of sewerage and sewage disposal. Other provisions in respect of drains and sewers are made in the Middlesex County Council Acts 1956 and 1961. The Borough Engineer and Surveyor is responsible for sewers under the highways, apart from trunk sewers, which are the responsibility of the Greater London Council. During the year, further foul and surface water sewers were reconstructed to cope with the still increasing flows due to the development of residential and industrial areas. The houses in some rural parts of the Borough are not sewered but depend on water carriage systems discharging into cesspools or septic tank disposal systems. The Council provides a cesspool emptying service for which a charge is made. However, sewerage schemes are being carried out to eliminate cesspools wherever practicable. During the year a foul sewer was completed in Burnt Farm Ride, Cattlegate Road and Theobalds Park Road and a number of properties connected thereto. 68 ENVIRONMENTAL HEALTH The Health Department undertakes the clearance of sewers on private property and 2,597 stoppages were cleared. Repair of drains and private sewers is the responsibility of the users and three formal notices were served for the repair of drains and four for the repair of private sewers. By the end of the year all the notices had been complied with, the four sewers having been repaired by the Council in default of the owners from whom the cost was recovered. London Government Act, 1963 Under the London Government Act 1963 the Greater London Council is responsible for sewage disposal. Two disposal works are within the Borough, one at Deephams and the other at Ponders End. The Ponders End Works will continue until extensions have been completed at the Deephams Works. For certain information in this report I am indebted to the Borough Engineer and Surveyor. Public Conveniences Public Health Act 1936 Section 87 The Council provide 55 public conveniences, including those sited in parks and open spaces. Staffing, cleansing and maintenance of these iences are the responsibility of the Health Department. Also, by arrangement with The London Transport Executive, conveniences are available for use by the public at Southgate and Oakwood Underground Stations, while further additional public facilities are available at two public houses in the Borough. Twelve of the conveniences are staffed by attendants. The remainder receive regular attention from a mobile team of cleaners, or from part-time cleaners. A new public convenience was opened in September, 1970, in the new Edmonton Town Centre; and the mobile convenience provided for temporary use whilst the redevelopment was taking place has been closed. Two conveniences which were closed because of severe damage caused by vandalism remained closed throughout the year. Refuse Collection and Disposal Section 72 Public Health Act 1936 section 51 Public Health Act 1961 London Government Act, 1963 Provisions are made under Section 72 of the Public Health Act 1936 empowering local authorities to provide a refuse collection service, and Section 51 of the Public Health Act 1961 enables authorities to provide receptacles for refuse and litter in any public place and to empty these containers. Refuse disposal is a function of the Greater London Council under Schedule 11 of the London Government Act 1963. In Enfield refuse collection is a function of the Department of the Borough Engineer and Surveyor. Two hundred and forty-eight men are employed on refuse collection and 124 on road sweeping. The cleansing fleet consists of 91 vehicles, 30 of which are pedestrian controlled street sweeping vehicles. With vehicular traffic considerably hindering street cleansing work, mechanical sweeping of main roads has been introduced with considerable success. A 10 cubic yard container collection service has been introduced to service hospitals, schools and commercial premises at which the volume of refuse arising is considerable. 69 ENVIRONMENTAL HEALTH During the year a new larger capacity compression vehicle was purchased in anticipation of the longer haul to the Greater London Council's new incineration plant at Angel Road, Edmonton, N.18. This plant is considered to be one of the largest and most modern in the world and although it was hoped to have it in operation during 1970 technical difficulties have been experienced in the use of the specialised machinery and the plant was still not functioning fully at the end of the year. Refuse from the borough is at present being transfer loaded at depots in Montagu Road, Carterhatch Lane and Barrowell Green and subsequently utilised for land reclamation outside the borough. Facilities are also provided at these depots for the public to dispose of unwanted items. A new large centralised waste paper baling depot, designed to handle paper salvage from Enfield, Haringey and Waltham Forest, is being constructed at Montagu Road. It is hoped to have this depot operative during the early part of 1971, and all domestic and commercial premises will be encouraged to keep their paper salvage separate from the refuse. In the autumn there was a withdrawal of labour by local authority manual staff resulting in a breakdown in the refuse collection service for nearly six weeks. However, the men maintained the service to hospitals, etc., on a voluntary basis. Plastic sacks were made available to the public and their use considerably reduced the public health risk. The refuse depots remained open and the public were able to dump their own refuse. Because of the protracted nature of the dispute, large quantities of refuse accumulated at the depots and it was necessary to spray the rubbish on a number of occasions because of the potential health hazard involved. Civic Amenities Act 1967 The Civic Amenities Act 1967 makes provision for the orderly disposal of disused vehicles, equipment and other rubbish. Under Section 23 of the Removal of Refuse Regulations 1967 local authorities are able to remove anything other than a motor vehicle, which has been abandoned either on land or the highway. I am grateful to the Borough Engineer and Surveyor for much of the information contained in this report. Clean Air Smoke Control Areas Clean Air Act 1956 Since the inception of the Clean Air Act, 1956, most local authorities, including Enfield, have made steady progress in establishing smoke control areas. On 1st November the No. 17 Order came into force, covering an area of 1,008 acres in the extreme South-West of the borough and bringing another 7,579 premises under Smoke Control. No. 18 Order, covering part of the South-East area of the borough and which earlier in the year had been submitted to the Minister of Housing and Local Government, was unfortunately, for economic reasons, withdrawn. The preparation of further Orders was suspended. Another factor which has affected smoke control is the shortage of solid smokeless fuel caused mainly by changes in technology in the gas industry with the advent of North Sea gas. In July the Minister of Housing and Local Government issued a circular (63/70) advising local authorities of this shortage, and stating that because of this he would suspend smoke control orders where local authorities thought this advisable. The matter was discussed by the London Boroughs' Association, who recommended that individual boroughs should suspend 40% of their smoke control orders. 70 "CHEVIOTS" CHILDREN'S HOSTEL THE HEALTH CENTRE : RECEPTION AREA THE HEALTH CENTRE: CONSULTING ROOM ANTI-SMOKING CLINIC, WITH "SMOKING SUE" SCHOOL HEALTH It was difficult to find a logical basis for selecting the areas to be suspended, but it was finally decided to confine the suspension—from 8th December, 1970 to 31st March, 1971—to a single area of the borough, with a clear boundary which could be recognised by all, i.e. the area South of a line running from the borough boundary at Cat Hill, along Bramley Road, Slades Hill, Windmill Hill, Church Street, and Southbury Road, and West of the Great Cambridge Road, omitting No. 17 area in the extreme South-West of the borough. Approximately 85% of the area and 75% of the premises of the borough are estimated to be already covered by smoke control orders. It is hoped that coverage of the remainder of the borough will not be long delayed, as any appreciable break in continuity will materially diminish the effect of past publicity and lead to a deterioration in public relations. Industrial Atmospheric Pollution The majority of furnaces in the borough are used for heating or steam raising, and it is encouraging to see how little smoke is produced from this type of plant. Few hand-fired furnaces remain, and modern mechanical stokers can operate to a high degree of efficiency, with minimum smoke emission. The same can be said of oil-burning equipment, and the few cases of complaints of excessive emission were found to be due to mechanical breakdown, and in no case was it necessary to take formal action. There are, however, a number of mechanically fired furnaces where wood waste is used as fuel, sometimes with supplementary oil burners. These furnaces operate quite well provided that a consistent feed of fuel is maintained, but considerable smoke can be caused by hand-firing large pieces of waste wood, a practice to be discouraged. The installation of hogging mills, although expensive and apt to be noisy, will reduce the wood to chip size and allow it to be burned satisfactorily. Efforts are being made to encourage firms to take wood waste and other combustible material direct to the nearby refuse destructor at Angel Road as an alternative to hand-firing and the use of small incinerators on individual premises. With the advent of North Sea gas a number of firms are installing furnaces with burners designed to operate on either gas or oil, the oil to be used only for short periods in winter during heavy demand on gas. If residual oil with relatively high sulphur content is used even for these short periods, quite <high chimneys to ensure dispersion of sulphur dioxide will be required. The lighter distillate oil, although initially more expensive, has a low sulphur content and can, therefore, be used with lower chimneys. Section 3 Clean Air Act 1956 Section 6 Clean Air Act 1968 During the year the installation of thirty new furnaces was approved under Section 3 of the Clean Air Act 1956. Eleven requests for approval of chimney height under Section 6 of the Clean Air Act 1968 for furnaces exceeding one-and-a-half million B.T.U.'s per hour were approved. Alkali, Etc., Works Regulation Act, 1906 A disturbing feature of air pollution in Enfield is the emission of smoke and fumes from processes registered under the Alkali, etc., Works Regulation Act 1906. In two cases the nuisance is aggravated by the fact that much of the emission is at low level and affects a considerable number of premises. Measurement of Pollution During the year measurement of pollution from smoke and sulphur dioxide was continued in the Borough using nine standard volumetric instruments at the same sites as during 1969. When a broad comparison is made covering all instruments, no significant change from last year appears in the general level of pollution; but the decline in the amount of sulphur dioxide and smoke in the atmosphere over the last ten years has been quite dramatic and it may be that pollution levels are now settling to a new normal level. Significant reductions in these pollutants may be increasingly difficult to effect, but continued efforts must be made in that direction. 71 ENVIRONMENTAL HEALTH Five of the instruments are situated in the vicinity of the new Greater London Council destructor at Angel Road and the smoke and sulphur dioxide in this area have now been measured for two successive years. Towards the end of the year the destructor plant was gradually being brought into use but to date it has never approached full working capacity. It is hoped that this modern plant will operate without increasing pollution in the area. During 1968, in co-operation with the Ministry of Technology, the level of carbon monoxide from road vehicles was continuously monitored at a site on the busy thoroughfare in Church Street, Enfield. Following the introduction of the traffic scheme for the Town Centre an attempt was made during 1970 to carry out a similar investigation on the same site for comparison purposes. The infra-red gas analyser used in this work is a delicate and complicated instrument and, unfortunately, all efforts to obtain continuous reliable readings proved abortive. A further attempt will be made during 1971. Food and Drugs Food and Drugs Act 1955 The Food and Drugs Act 1955 provides regulations covering most aspects of the processing and selling of food and drugs for human consumption. Food and Drugs (Milk) Act 1970 The Food and Drugs (Milk) Act 1970 which came into operation on 29th January, 1970, authorises the treatment of milk by the application of steam in such a manner that the percentages of fat and solids not fat are unaltered. The Cheese Regulations 1970 came into force on 31st January, 1970, and superseded the Cheese Regulations 1965 (as amended). They prescribe compositional standards for a number of additional varieties of cheese or processed cheese which may be sold by varietal name only. Calcium hydroxide has been added to the list of permitted ingredients. The Labelling of Food Regulations 1970 revoke the Labelling of Food Regulations 1967 and supersede the Labelling of Food Order 1953 (as amended) on 1st January, 1973. The principal changes are the addition of restrictions on claims and descriptions applied to foodstuffs as follows :— (a) claims based on the value in, or benefit to be derived from foods; on their ability to provide energy; on their calorie content; or that they are a source of protein; (b) claims as to the presence of vitamins and minerals; (c) claims that foods are starch-reduced or can aid slimming, including a prohibition on claims that foods have specific weight reducing properties; (d) claims that foods are suitable or have been specially prepared for diabetics; (e) claims that foods have tonic, restorative or medical properties. The Cream Regulations 1970 superseded the Food Standards (Cream) Order 1951 on the 1st January, 1970. They specify new requirements for the composition and description of cream, permit added ingredients, subject to limits, and make provision for the labelling and advertisement of cream. The Emulsifiers and Stabilisers in Food (Amendment) Regulations 1970 came into force on 1st September, 1970, and removed brominated edible vegetable oils from the permitted list. These oils were used as an emulsifier in some cloudy soft drinks. 72 ENVIRONMENTAL HEALTH The Colouring Matter in Food (Amendment) Regulations 1970 are operative from 1st January, 1971, and remove the red colour, Ponceau MX, from the permitted list. The Soft Drinks (Amendment) Regulations 1970 came into force on the 3rd November, 1970, and permit the term "artificial sweetener" to be used on labels for a further period of twelve months. The Food Hygiene (General) Regulations 1970 come into force on 1st March, 1971. They supersede the Food Hygiene (General) Regulations 1960 and 1962 and the principal changes are :— (a) raw food which has to be milled or refined to make it fit for human consumption is brought within the scope of the Regulations; (b) before food is offered for sale it must be separated from any food which is unfit for human consumption; (c) animal feed must not be kept in a food room unless in a suitable closed container; (d) any person handling open food must wear clean and washable overclothing; (e) the business of packing or storing eggs, fruit or vegetables on farm premises is made subject to certain requirements. Composition and Labelling Eight hundred and ninety-six samples of food and drugs were examined, a sampling rate of 3.4 per 1,000 of the population. The Public Analyst reported adversely on 64 samples. Of these, 36 were samples of packaged foods which were incorrectly labelled; 26 samples were unsatisfactory, inferior or unfit to eat; and in two cases both labelling infringements and unsatisfactory conditions were found. A sample of " Pure Virgin Olive Oil ", the description of which indicates its origin from the first pressing of green olives, was found to have been prepared from black olives. A product marked " Apple Molasses " extravagantly claimed to contain the "sun ripened goodness of over 12 lb. of apples with beet molasses". It should also be emphasised that beet molasses is an unusual ingredient for human consumption in this country. The Public analyst, in a comprehensive report, strongly criticised the claims made for a well-known imported tonic. The use of the name " Elixir" suggested magical properties not confirmed by analytical results. The importer has undertaken to amend the advertising material and the labelling of the product. A sample described as " Calorie reduced mashed potato " was found to have had its bulk substantially increased by an inert indigestible vegetable compound which has the effect of reducing the number of calories per ounce but also changing the potato into a compound food. Action is being taken to have this misleading wording altered. The number of items of Continental grocery goods completely devoid of any English on their labels increases each year and this leaves most people to guess at the contents from the pictorial representation on the label. An imported carton which appeared from the picture to be plum juice was found to be 50% deficient in juice, and the importer agreed to label it as a fruit drink. Food Complaints During the year 146 food complaints were received. These were all investigated and in the majority of cases warning letters were sent. 73 ENVIRONMENTAL HEALTH However, on twenty-four occasions proceedings were instituted and the results of the legal proceedings are given in Table 36. Many of the complaints received concerned mouldy foods due in most cases to poor stock rotation. Recent publicity on the date marking of perishable foods has highlighted the difficulties in this area of food control, but it is hoped that the Ministry of Agriculture's Food Standards Committee will make recommendations that will lead to a satisfactory solution of the problem Once again a number of complaints were received concerning the unsatisfactory condition of milk bottles. Many receive considerable misuse by the general public but dairies have a responsibility to ensure that their products reach the consumer in a sound and wholesome condition. Unsound Food All types of food are inspected to ensure their fitness. Frequent requests from food vendors are received for the inspection of foodstuffs and fifty-two tons of food were condemned by the Department. Food Hygiene The Food Hygiene (General) Regulations 1960 and the Food Hygiene (Market Stalls and Delivery Vehicles) Regulations 1966, provide for the cleanliness of food premises and stalls, etc. Two manufacturers within the Borough export food and to comply with import regulations of countries receiving the goods, eight certificates of fitness, which must accompany the food, were issued. Registration of Food Premises Premises used for the manufacture, storage and sale of ice-cream or the preparation or manufacture of preserved and pickled foods must be registered by the local authority. There are 737 premises registered in respect of ice-cream and 366 in respect of preserved foods. Middlesex County Council Act, 1950 Under the Middlesex County Council Act 1950, hawkers of food must be licensed. Before the licence is granted vehicles and storage arrangements are inspected to ensure they are satisfactory, and at the end of the year fifty-one persons were licensed as hawkers of food. Ice-Cream The manufacture of pre-packed ice-cream is now mainly undertaken by large organisations who exercise strict quality and hygiene control. In accordance with the provisions of the Ice-Cream (Heat Treatment, etc.) Regulations, 1959, samples of loose or soft ice-cream were submitted for bacteriological examination. Any samples falling within Grades III and IV as determined by the methylene blue test were considered to be unsatisfactory. Traders with unsatisfactory samples were advised as to proper methods of sterilising equipment, after which satisfactory results were obtained. Milk, Dairies and Cream Substitutes The Milk (Special Designation) Regulations, 1963/1965, require any person producing, treating, storing or distributing milk to be licensed and to comply with these regulations and with the Milk and Dairies (General) Regulations 1959. Producers' licences are issued by the Minister of Agrioulture, Fisheries and Food through the County Agricultural Executive Committee. At the end of 1970 there were four such licences current. Two premises are licensed by the Council for the treatment of milk and two hundred and twelve premises are licensed for the purpose of distribution. ENVIRONMENTAL HEALTH The Milk (Special Designations) Specified Areas Order 1951 restricts the sale of milk by retail to the designated milks, i.e. Pasteurised, Sterilised, Ultra Heat Treated and Untreated. Dealers' licences were issued under the following designations: 132 Pasteurised; 158 Sterilized; 56 Ultra-Heat Treated; and 23 Untreated. Milk is supplied in bulk tankers to the processing dairies from a wide area. Supplies are sampled regularly to check the bacteriological content of the milk. Of the 172 samples examined only in seven instances were the results unsatisfactory. The quality of pasteurised milk supplied to schools continued to be satisfactory. The Milk and Dairies (General) Regulations 1959 make provisions in respect of hygiene, construction, equipment and cleansing of premises where milk is produced, processed, handled or stored. Regular inspections were carried out and conditions were found to be satisfactory. Markets, Slaughterhouses and Knackers' Yards There are no cattle markets, slaughterhouses or knackers' yards within the area. Housing Council Housing At the end of the year 19,714 dwellings were under the control of the Council—807 more than the figure for the previous year. Accommodation included 2,851 one-bedroom, 7,162 two-bedroom and 9,032 three-bedroom units. Nine hundred and forty-seven applicants on the housing list were re-housed, as also were 129 homeless families. Eighteen applicants were approved for more suitable accommodation because of disablement, health or social problems. On 31st December there were 6,719 names on the waiting list, including those of less than 12 months standing. Twenty-nine applicants were awarded priority on grounds of ill-health or disablement. I am grateful to the Housing Manager for supplying the above information. Overcrowding Housing Act 1957 Statutory action was taken to abate one case of overcrowding as defined by the Housing Act 1957. Houses in multiple Occupation Housing Acts 1957, 1961,1964 and 1969 A local authority may require a person controlling a house in multiple occupation to provide certain amenities and may limit the number of persons in that house. The Council has adopted standards in respect of both overcrowding and amenities, and has also submitted to the Ministry for approval a scheme of registration under powers given in the Act of 1969. An appreciable number of dwelling houses are occupied by two or more families, but relatively few are over-occupied; and with regard to provision of amenities, formal action was necessary in only seven cases. Despite this, however, public health inspectors paid no less than 852 visits to houses in multiple occupation. Slum Clearance and Individual Unfit Houses One clearance area comprising five unfit properties was confirmed by the Minister of Housing and Local Government. New clearance areas, of which there were seven, comprised 45 unfit properties. Three hundred and sixtytwo dwellings were demolished in areas subject to compulsory purchase orders. 75 ENVIRONMENTAL HEALTH Acquisition and Improvement of Houses Housing Acts 1958/1969 A local authority may make advances for house purchase or improvement, and may provide grants for home improvements and the conversion of buildings into additional units of accommodation. Except for standard grants (for which the financial limit is £200), grants and loans are made at the local authority's discretion. The maximum improvement grant normally available is £1,000 per dwelling—although for conversion of a three storey dwelling the maximum is raised to £1,200. Two hundred and eight dwelling houses were improved, 197 of these receiving standard grants which were for the provision of full standard amenities. The 1964 Housing Act gave local authorities power to declare Improvement Areas and the Council were able to require 'landlords to provide standard amenities at their properties. Seven such areas were declared in the borough. The 1969 Housing Act enables the local authority to declare general improvement areas aimed at raising the level of all amenities in the neighbourhood. Under the Act of 1964 tenants of houses outside improvement areas can require the owner to provide standard amenities. The Council may assist owners with loans and grants for this purpose. Negotiations were commenced with owners in 41 such cases. House Purchase and Housing Act 1959 Housing (Financial Provisions) Act 1958 Three hundred and fourteen applications for loans for house purchase were made to the Council, and £824,038 was advanced for this purpose. All applications were dealt with by the Town Clerk, and claims of overcrowding in support of applications were investigated by the Health Department. Rent Regulation Rent Acts, 1957, 1965 ,1968 The Rent Acts include provisions for regulation of tenancy, rents and security of tenure and restrictions on eviction. There is also provision whereby landlords may increase rents in order to keep rent controlled property in good repair; but tenants may apply for a certificate of disrepair which abates the increased rent until required repairs have been carried out. One certificate of disrepair and one certificate of cancellation were issued. The Housing Act 1969 provides for rents to be regulated in certain dwellings with standard amenities, or improved with or without the assistance of the local authority. Landlords may apply to the local authority for the issue of a qualification certificate stating that the property complies with the provisions of the Act, and on this evidence the Rent Officer may declare it a regulated tenancy and fix a fair rent. Where a dwelling does not have the standard amenities the Council may issue a provisional qualification certficate prior to the works being carried out. During the year 903 applications for qualification certificates were received and 417 certificates were issued. Land Charges Act 1925 Land Charges Nine thousand and seventeen inquiries (1,853 more than the previous year) were received concerning properties within the borough. The necessary searches were made and the information supplied. Caravans Caravan Sites and Control of Development Act 1960 The Caravan Sites and Control of Development Act 1960 makes provision for the licensing and control of sites by local authorities and authorises local authorities to provide and operate caravan sites. ENVIRONMENTAL HEALTH Caravan Sites Act 1968 The Caravan Sites Act 1968 restricts the eviction from caravan sites of occupiers of caravans, and makes provision for the establishment of such sites by local authorities for the use of gypsies. Part II of this Act, which requires the provision of such sites by certain local authorities, came into operation on the 1st April, 1970. Local authorities were asked to give notice to the Minister by the 30th September, 1970, of the number and location of sites to be provided by them. The Council expressed its intention of providing a site but the location has yet to be decided. Pending the provision of a permanent site, a temporary area was allocated on land in Turkey Street, with sufficient accommodation for twelve caravans. The site is not provided with roads or hard-standings. Several occupants have endeavoured to overcome this by laying hard-core on and adjacent to their pitches. The general appearance of the site is poor and conditions in winter months are not satisfactory. Toilet facilities have been provided on a minimal communal basis. Communal use means that frequently the hygienic conditions are not satisfactory and the facilities provided become unusable. Middlesex County Council Act 1944 The provisions of the Middlesex County Council Act 1944 were invoked to bring about the removal of caravans from unauthorised sites. Nominal fines were imposed by the Court but the gypsies remained in the Borough, moving from one open site to another until it suited their purpose to go. It was hoped that the provision of the temporary site would overcome the problem of itinerant caravanners parking without authority on open ground throughout the eastern half of the borough. However, there is a tendency for the gypsy community to return, in the autumn, to this area, and this year proved no exception. All efforts to persuade the gypsies to remove from the land, which was variously owned, met with failure, and forcible eviction was resorted to in some instances. In the Borough there is one privately owned licensed residential site containing sixteen caravans Eighteen caravan sites at individual nurseries for the use of employees are also licensed. A further site owned by the Council and situated in the Green Belt is to be closed down. Housing accommodation was offered to the occupants and the majority accepted, only two caravans remaining at the end of the year. Canal Boats Sections 249-258 Public Health Act 1936 Section 79, Public Health Act 1961 The River Lea Navigation runs through the eastern extremity of the borough from north to south. The canal boats using this waterway for the transport of goods are not residential and do not therefore require registration for public health purposes. Shops and Offices Offices, Shops & Railway Premises Act 1963 The Offices, Shops and Railway Premises Act 1963 is designed to raise the standard of working conditions, thereby promoting the health, welfare and safety of the employees. Broadly, the Act gives the office and shop worker protection similar to that afforded to the industrial worker by the Factories Acts. Enforcement of the provisions of the Act is divided between Her Majesty's Factory Inspectorate and local authorities. Her Majesty's Factory Inspectorate enforce the provisions in Crown property, local authority premises, railway premises and offices and shops in factories covered by the Factories Act 1961. 77 ENVIRONMENTAL HEALTH Responsibility in respect of all other shops and offices is vested in local authorities. Since the passing of the Act several Orders and Regulations have been made prescribing standards for the provision of washing facilities, sanitary accommodation, first aid equipment, etc., and explanatory circulars have been issued. By the end of the year the total number of registered premises in the borough was 3,054. A total of 4,325 visits were made and 151 new registrations were received during the year. Sixty-nine notices were served in respect of contraventions of the Act. However, these were minor in character, the most common faults being inadequate lighting and sanitary accommodation. Fifty-two accidents were reported but none was of a serious nature. In the majority of these cases carelessness appears to have been a contributory factor. More thought and care in the handling of goods and equipment and instructions on the best methods to use would probably lead to a reduction in the number of these minor accidents. Shops Act 1950 The Shops Act 1950 deals with hours of closing, conditions of employment, Sunday trading and general matters relating to these subjects. One successful prosecution was made under this Act and the shop concerned was fined £10. Shops (Early Closing Days) Act 1965 The Shops (Early Closing Days) Act 1965 enables an occupier of a shop to select' the weekly half holiday. Departmental records indicate that there are 1,861 shops within the borough. Market and Street Trading Provisions relating to street trading were included in the Middlesex County Council Acts and Byelaws made thereunder and were extended by the Local Law (North-West London Boroughs) Order 1965. There were no prosecutions in relation to street trading during the year. Until the Autumn the street market, with 36 licensed sites, traded six days a week at Edmonton Green. These traders were then moved to the new market square forming part of the Edmonton Green Redevelopment Area. There are now 48 licensed market traders on this new site. A further four licensed traders are situated in other parts of the borough. A privately owned covered market which traded in the Edmonton area has been demolished under the Edmonton Green Redevelopment Scheme and the traders have been offered alternative accommodation in the new precinct. A private market is held in the Enfield market square every Saturday. During the year 3,972 visits were made to shops and stalls. Some of these were primary inspections to premises where a change in use had occurred. Minor contraventions noted were found to have been remedied on reinspection. No prosecutions were taken. Hairdressers' and Barbers' Premises Section 77, Public Health Act 1961 Byelaws have been made to ensure the cleanliness of premises and of instruments and other materials which hairdressers' use in the course of their work. One hundred and seventy-five visits were made by the public health inspectors and conditions were found to be generally satisfactory. 78 ENVIRONMENTAL HEALTH Section 21, Greater LondonCouncil (General Powers) Act 1967 Any person who carries on the business of a hairdresser or barber is required to be registered by the local authority. Two hundred and fourteen persons are registered for this purpose in Enfield. Massage and Special Treatment Establishments Middlesex County Council Act 1944 London Government Act 1963 Privately run establishments carrying on business for the purposes of providing massage and other special treatments are required by the Council to be licensed under the provisions of the Middlesex County Council Act, 1944, as amended by an Order made under The London Government Act, 1963. Licences expire on 31st March each year. Twenty-nine applications for renewal were received and approved. Two new licences were granted and one application was refused. All premises were inspected by a public health inspector and new premises were inspected, in addition, by a medical officer. Licensed Premises Licensing Act, 1964 The Licensing Act, 1964, provides that applications be made to the Licensing Justices for licences to sell intoxicating liquors for consumption on or off the premises and for the registration of club premises. When a club first makes application for the registration of premises an officer of the Jocal authority may, on giving due notice under Section 45 of the Act, enter and inspect the premises. Sixty-four applications were referred, necessitating one hundred and two inspections of premises by public health inspectors. Conditions generally were found to be satisfactory. Betting and Gaming Premises Betting, Gaining and Lotteries Act 1963/64 Applications for permits for amusements with prizes under the Betting, Gaming and Lotteries Acts 1963/64 and the Gaming Act 1968, are dealt with by the Town Clerk, to whom reports are submitted by the Health Department on the general suitability of premises, sanitary conditions, and, in the case of premises handling food, on compliance with the Food Hygiene Regulations. Fifty-seven applications were dealt with, necessitating sixty-five inspections by the public health inspectors. Fifty-three applications were approved and three were refused. One case was still under consideration. The Council may object to the grant of applications for Betting Office Licences made to the Betting Licensing Committee under the Betting, Gaming and Lotteries Acts 1963/64 and the Gaming Act 1968, are dealt with of the Department on the conditions obtaining at the premises concerned. Eight applications were referred. Ten inspections were made by the public health inspectors and the Council's requirements were met in all cases. Nurses Agencies Nurses Agencies Act 1957 and the Nurses Agencies Regulations 1961 and 1968 Nurses agencies are required to be licensed by the Borough Council. At the end of 1970 there were two licensed agencies in the Borough. 79 ENVIRONMENTAL HEALTH Employment Agencies Part 14 of the Middlesex County Council Act Act 1944 Applications for licences are dealt with by the Town Clerk, who referred 33 such applications to this Department for reports on the suitability of facilities and accommodation. The public health inspectors made 50 visits. Twenty-five renewals and eight new applications were approved. Factories and Workplaces Factories Act 1961 Local authorities are responsible for the enforcement of provisions relating to the cleanliness, overcrowding, temperature, ventilation, drainage of floors, and the provision of sanitary accommodation at factories where mechanical power is not used. Where mechanical power is used only the provisions concerning sanitary accommodation apply. In accordance with Section 8 (5) of the Act, a register is kept of all factories situated in the district. During inspections made by public health inspectors some minor defects were found. In the majority of casses these defects were remedied by the end of the year and it was not necessary to institute legal proceedings. In 1970 the Secretary of State of the Department of Employment and Productivity set up a Committee to review the provision made for the safety and health of persons in the course of their employment, and to consider whether any changes are needed. The Committee is expected to report in late 1971. Outworkers Section 133(1) Factories Act 1961 Occupiers of factories are required to notify to local authorities the names and addresses of persons employed by them and working in their own homes. Section 134 Factories Act 1961 The Council has a duty to decide whether any place where outwork is done is likely to be injurious or dangerous to the health of the employees. Inspections for this purpose are carried out when any new address appears on the lists. Thirty-eight visits were made by public health inspectors to the homes of outworkers, and conditions were found to be satisfactory. The following table shows, by trades, the number of outworkers in the district. Artificial flowers 3 Bed linen, etc. 2 Boxmaking, etc., wholly or partially of paper 2 Carding, etc., of buttons 1 Lace-making 1 Paint boxes and paint brushes 1 Toys and Games 40 Wearing apparel 136 186 ENVIRONMENTAL HEALTH Rag Flock and Other Filling Materials Rag Flock and Other Filling Materials Act 1951 The purpose of the Rag Flock and Other Filling Materials Act 1951, and the Rag Flock and Other Filling Materials Regulations 1961 and 1965, is to secure the use of clean filling materials in upholstered articles and other articles which are stuffed or lined. Local authorities are required to register premises where filling materials are used for upholstering, the stuffing and lining of bedding, toys, etc. At the end of the year eighteen premises were registered to use filling materials. Sixteen visits were made to these premises and conditions were found to be satisfactory. Offensive Trades Section 107 Public Health Act 1936 In addition to the trades listed by the Act, a local authority may by order declare other offensive trades. No " offensive trades " were operating in the borough during the year. Inspections and Complaints The public health inspectors paid 59,830 visits to premises, including dwelling 'houses, business, industrial and food premises. The slowing down of the clean air programme had, of course, the effect of reducing the number of visits to premises in connection with the adaptation of appliances. However, increased publicity and encouragement from the Government in the sphere of home improvements led to a sharp increase in the number of visits made by inspectors to premises which might prove suitable for conversion. Many matters were resolved without the necessity of serving notices, although it was found necessary to serve 303 informal and 279 statutory notices, which resulted in repairs and sanitary improvements to dwellings being effected. Legal proceedings were instituted in fifteen cases. Complaints and requests for visits numbered 10,295. Of these 2,457 were notifications of blocked or defective drains. Although owners are themselves responsible for clearing drains, the Council provides a service designed to eliminate in the shortest possible time what may constitute a hazard to public health. Noise In recent years there has been a gradual change in the public reaction to noise. Press and television give wide publicity to extreme oases such as aircraft noise in the vicinity of airports or traffic noise from new road systems. Noise from a small factory may be very much less in total, but the annoyance to residents in a limited area may be as great as in the more widely publicised cases. Complaints regarding relatively small installations formed the greater proportion of noise complaints received during the year. 81 ENVIRONMENTAL HEALTH Complaints of noise covered a wide range of activities, including machines in launderettes, testing of compressors, use of forklift trucks at night, air extraction plant of various types and the operation of pneumatic road breakers without mufflers. Eight hundred and thirty-nine visits were made by public health inspectors during 1970 in connection with noise nuisance. One complaint referred to noise from the air conditioning plant serving a computer room in a new office block, the plant being situated on the roof of the building. The volume of the noise was not high and during the day was lost in traffic and other noises in the area. At night, however, a persistent hum was clearly heard and was a nuisance to a number of residents. Measurements of noise level were made during the night, both at ground level near the houses affected and on the roof of the office block, and as a result it was suggested that an acoustic screen should be erected around the plant. A temporary screen proved satisfactory and is to be replaced by a permanent and weatherproof structure. Noise from ventilating plant and exhaust fans can be disturbing and several such cases were dealt with during the year. This type of noise can often be brought to acceptable limits by fitting attenuators to the outlet ducts. Generally these attenuators have to be purpose-made for the particular plant and this sometimes involves delay in completing remedial work. Occasionally complaints are received of noise from industrial sewing machines being operated by outworkers in dwelling houses. Conditions are aggravated by the structure of most houses being unsuitable for such machines and by work often being done in the evening. The spread of this activity has been limited by the action of the Council in refusing to allow the establishment of this type of work in dwellings. A private Court action in one case resulted in an injunction and damages being granted. In dealing with complaints of noise it is impossible to apply a rigid numerical standard for sound level readings. Each case must be judged on its merits and consideration given not only to loudness but to the characteristics, time and duration of the noise, the local conditions and whether the best practicable means have been taken to prevent the noise. The most difficult cases arise where double-shift or night-shift work is carried out in the proximity of dwellings. Operations which cause no comment during the day can be disturbing to residents during the night even when all possible steps are taken to reduce noise. In practice, reminders are frequently required of the need for adequate supervision on night-shift work to ensure that proper consideration is shown for adjoining householders. The Council has statutory power to deal with noise which constitutes a nuisance, but by far the most satisfactory way of dealing with noise nuisance is to prevent it occurring. Increasing emphasis is being given to this aspect of noise control work and every endeavour is made to inspect, during the planning stage, proposals which might involve noisy processes or machinery. Industrialists are becoming more aware of the effect of noise on the environment and are becoming more ready to discuss ways of reducing noise and preventing nuisance. Such co-operation is also to the advantage of the firms concerned, since it is easier and cheaper to incorporate precautions against noise production at the time of installation rather than carry out work to established machinery or buildings. Disinfestation Sections 83-86, Public Health Act 1936 as amended by Sections 35-37, Public Health Act 1961 The Council is empowered to deal with filthy or verminous premises and articles and also with persons. 82 ENVIRONMENTAL HEALTH Facilities are provided at the Council's treatment centre for the cleansing and treatment of scabetic and verminous persons. During the year 138 persons were treated, 125 for scabies and thirteen for pubic lice. Seventy-three requests for treatment of verminous premises were dealt with. At the disinfecting station 772 articles of bedding and 255 garments were treated. References to other work undertaken at this station are contained in the item " Disinfection " in this report. Pest Control Rats and Mice Prevention of Damage by Pests Act 1949 The occupier of premises is required to notify the local authority of infestation at those premises by rats or mice. It is also the responsibility of the occupier to take steps to destroy them. In Enfield rodent control is undertaken as a public health service, and householders and occupiers of business premises may have the assistance of trained council staff, without charge in the case of householders. The majority of complaints received concerning rats are attributable to defective drains and sewers. When complaints are received, adjoining premises are surveyed and, where necessary, the drains tested. Although there was no evidence of any concentrated major infestation 7,657 visits to premises were made by the rodent control staff and 1,644 visits in connection with complaints concerning rats and mice were made by the public health inspectors. In all, 3,558 premises were visited. Pigeons Section 74 Public Health Act 1961 The pigeon continued to be a serious nuisance, causing damage to crops and buildings. It is now one of the commonest pests. Fernal pigeons, and in some cases wood pigeons, have adapted themselves to urban life, and because people encourage their presence by feeding these birds, their numbers continue to rise. Section 74 of the Public Health Act 1961 enables a local authority to take steps to abate the nuisance caused by pigeons and other birds. Forty-two treatments were carried out. A further five treatments were carried out where large congregations of pigeons had accumulated under railway bridges. Wasps and Bees Garden pests continue to be a common cause for complaint by householders : 814 wasps' nests, together with 76 bees' nests were destroyed and 269 other insect infestations were treated. Control is the responsibility of the householders. However, some people are nervous of stinging insects and others may be handicapped by age or infirmity, and the Department provides a free service for this work. From time to time complaints are made to the Department concerning foxes, squirrels, rabbits and moles. Help is given wherever possible either in a practical way or by advice and, if necessary, by the loan of equipment. Animal Care Diseases of Animals Act 1950 All aspects of animal care, including movement, protection and quarantine during outbreaks of notifiable disease, are dealt with by the Act. Controls may limit movement and provide for the cleansing and disinfection of premises and vehicles occupied by animals. 83 ENVIRONMENTAL HEALTH The autumn saw the start of a countrywide outbreak of fowl pest. Special Orders declaring infected areas were made by the Minister in an effort to contain the outbreak. No cases were notified during 'the year in the Enfield area. No other oases of notifiable diseases occurred in animals within the area during the year. Diseases of Animals (Waste Food) Order 1957 The Diseases of Animals (Waste Food) Order 1957 requires licensing where plant and equipment are used for the boiling of waste foods for animal feeding. There are fourteen pig keepers within the borough and their premises are inspected periodically by the public health inspectors. Only three of these use plant and equipment for the boiling of waste foods and they are licensed for that purpose. Riding Establishments Act, 1964 Riding Establishments Act 1970 The Riding Establishments Act 1964 empowers a local authority to inspect premises used as riding establishments and to license them if satisfactory. These powers were further extended by the Riding Establishments Act 1970, which sets out the conditions local authorities are required to take into account when considering applications. Provisional licences may be granted in cases where it is considered that full licences are not justified. The provisions of the new Act are operative from the 1st January, 1971. There were five licensed establishments in the Borough at the end of the year. Pet Animals Act 1951 Under the Pet Animals Act 1951, persons keeping a pet shop must be licensed by the local authority. The licence contains conditions relating to suitable accommodation for the livestock, provision of food and drink, avoidance of the sale of mammals at too early an age, prevention of infectious disease, and fire precautions. Eighteen persons were licensed at the end of the year and their premises had been inspected and were found to be satisfactory. Animal Boarding Establishments Act 1963 The Animal Boarding Establishments Act 1963 provides that no person may keep boarding establishments for dogs or cats without a licence from the local authority. In addition to provisions similar to those required by the Pet Animals Act 1951 the person licensed must keep a register of animals and their owners. Three persons were licensed to keep an animal boarding establishment. The premises were inspected and were found to be satisfactory. Ionising Radiations Radioactive Substances Acts 1948-1960 Nuclear Installations Act 1954 A tomic Energy Authority Acts 1954-1959: The legislation governing the use of radioactive substances, registration of users, and disposal of wastes includes the Radioactive Substances Acts 1948-1960, the Nuclear Installations Act 1954, Atomic Energy Authority Acts 1954-1959 and the Nuclear Installations (Licensing and Insurance) Act 1959. Nuclear Installations (Licensing and Insurance) Act 1959 There are at present fourteen users of radioactive materials in the borough registered with the Department of the Environment. National arrangements exist for dealing with incidents involving radioactive substances, e.g. damage to containers on premises where expert assistance is not immediately available, or accidents to vehicles carrying radioactive substances. No such incidents were reported during the year. 84 ENVIRONMENTAL HEALTH Burial and Cremation Section 50, National Assistance Act 1948 This authority has a duty to bury or cremate the body of any person who has died or been found dead in the borough in circumstances where it appears to the Council that no other suitable arrangements for the disposal of the body can be made. The bodies of five persons were dealt with in this way. Exhumations Burial Act 1857 It is considered advisable that the Medical Officer of Health should be informed whenever a licence for the removal of human remains is granted so that he may be in a position to take any action that may appear to be necessary in the interests of public health. Two exhumations took place at cemeteries within the borough. A public health inspector was present to ensure that the conditions of the Home Office Exhumation Certificate were observed. Mortuary Section 198, Public Health Act 1936 A local authority may provide a mortuary and a postmortem room. The Council provides a service through arrangement with the Hospital Management Committee for the use of the facilities at the Prince of Wales Hospital, Tottenham, at an agreed charge. The mortuary facilities were used on 701 occasions. Average Results in milligrams per litre where applicable Table 29 Water Supply Metropolitan Water Board Chemical and Mineral Analysis Thames Derived New River Derived Hoe Lane Well Derived Hadley Road Well Derived Waltham Abbey Well Derived Number of Samples 363 104 4 4 4 Ammoniacal Nitrogen 0.026 0.008 0.100 0.170 0.20 Albuminoid Nitrogen 0.083 0 061 0.026 0.015 0.034 Nitrate Nitrogen 4.8 5.2 0.0 0.4 0.5 Oxygen abs. from KMnO4, 4 hrs. at 27°C. 1.02 0.61 0.29 0.19 0.38 Hardness (total) CaC03 274 304 398 272 276 Hardness (Non-carbonate) CaC03 79 79 154 40 59 Magnesium as Mg. 5 5 — — — Sodium as Na 27.7 30.9 — — — Potassium as K 5.6 4.9 — — — Chloride as CI 40 45 38 24 28 Phosphate as PC4 2.7 1.9 — — — Silicate as SiO2 9 10 — — Sulphate as SO4 70 71 — — — Natural Fluoride as F 0.20 0.20 0.55 1.10 0.70 Surface-active material as Manoxol OT 0.03 0.02 — — — Turbidity units 0.1 0.0 0.5 0.1 0.3 Colour (Burgess units) 11 8 8 4 4 pH Value 7.9 7.8 7.2 7.4 7.4 Electrical Conductivity (Micromhos) 570 620 700 550 540 85 ENVIRONMENTAL HEALTH* Table 30 Water Supply Metropolitan Water Board Average Bacteriological Results Results before Treatment Thames Derived New River Derived Hoe Lane Well Derived Hadley Road Well Derived Waltham Abbey Well Derived Number of Samples 8,259 1,510 246 242 247 Agar Plate Count per ml. 20-24 hrs at 37°C 31.9 46.1 0.1 0.1 0.0 3 days at 22°C. — — 17 9 30 Coliform Count Percentage of samples neg. in 100 ml. 37.91 42.91 98.37 80.99 99.60 Count per 100 ml. 17.3 8.1 0.1 0.5 — Escherichia coli Count Percentage of samples neg. in 100 ml. 53.58 60.79 100.0 84.30 100.0 Count per 100 ml 4.7 2.2 — 0.3 — Results after Treatment Number of Samples 3,710 516 254 248 253 Agar Plate Count per ml. 20.24 hrs. at 37°C 8.0 10.9 0.3 0.1 0.2 3 days at 22°C. — — 7 33 38 Coliform Count Percentage of samples neg. in 100 ml. 99.92 100.0 100.0 100.0 100.0 Escherichia coli Count Percentage of samples neg. in 100 ml. 99.97 100.0 100.0 100.0 100.0 Table 31 Water Supply Lee Valley Water Company Representative Sample Chemical Results Expressed in Milligrams per Litre Appearance Clear and Bright Ammoniacal Nitrogen 0.00 Colour (Burgess) Less than 5 Albuminoid Nitrogen 0.00 Odour/Taste Nil Nitrate Nitrogen ... 6.3 Turbidity 0 Nitrite Nitrogen 0.00 Conductivity 560 Oxygen Absorbed 0.00 Total Solids 370 Fluoride less than 0.2 pH 7.2 Silica 9 Free CO2 49 Iron 0.02 Alkalinity (CaCO3) 225 Other metals: Copper/Zinc/Lead Absent Carbonate Hardness 225 Phosphate 0.15 Non.Carbonate Hardness 100 Residual Chlorine nil Total Hardness 325 Temperature (°C.) 11.0 Bacteriological Examination No. of Colonies Developing on Agar 1 day at 37°C. 2 days at 37°C. 3 days at 20°C. 0 per ml. 0 per ml. 12 per ml. Present in Absent from Probable No. Presumptive Coli.Aerogenes — ml. 100 ml. 0 per 100 ml. E. Coli — ml. 100 ml. 0 per 100 ml. CI. Welchii — ml. — ml. 86 ENVIRONMENTAL HEALTH Area No. of Premises (At date of declaration) Acreage  Table 32 Clean Air Smoke Control Areas Area of Borough (in acres) 20,061 No. of premises at 31st December, 1970 107,183 ENFIELD 1. Turkey Street, Cambridge Road, Hoe Lane, New River ... 516 68 2. Cheshunt Boundary, Bulls Cross, Carterhatch Lane, Turkey Street, Railway Line 2,831 604 3. Carterhatch Lane, New River, Southbury Road, Hertford Road 2,017 525 4. Cheshunt Boundary, Barnet Boundary, Enfield Road, The Ridgeway, Lavender Hill, Forty Hill 3,046 6,690 5. Lancaster Road, The Ridgeway, Church Street, Baker Street ... 3,600 405 EDMONTON 1. Gt. Cambridge Road, Church Street, Latymer Road 417 93 2. Bury St. West, Firs Lane, Hedge Lane, Gt. Cambridge Road 2,092 353 3. Church Street, Gt. Cambridge Road, Westerham Avenue, Victoria Road 1,786 213 4. Bury Street, Gt. Cambridge Road, Latymer Road, Church Street, Hertford Road 1,951 152 5. North Circular Road, Chequers Way, Haringey Boundary, Bull Lane 3,933 425 6. Old Enfield Boundary, Carrs Lane, Ridge Avenue, Gt. Cambridge Road 5,661 639 7. Angel Road, Fore Street, Park Lane, Bull Lane, Haringey Boundary, Kimberley Road 4,160 388 SOUTHGATE 1. Old Enfield Boundary, Barnet Boundary, Bramley Road 980 502 2. Bramley Road, Barnet Boundary, Oakwood Railway Line 2,943 416 3. Old Enfield Boundary, Oakwood Railway Line, Winchmore Hill Road 2,095 392 4. Winchmore Hill Road, Bourne Hill, Winchmore Hill Railway Line 1,765 417 5. Carrs Lane, Old Enfield Boundary, Grange Park Railway Line, Station Road, Bush Hill 1,250 213 LONDON BOROUGH OF ENFIELD 11. Myddleton Avenue, Birkbeck Road, Baker Street, Southbury Road, New River 3,337 335 12. Church Street, Windmill Hill, Enfield Road, Lonsdale Drive, Green Dragon Lane, Old Edmonton Boundary, The Town Railway Line 3,892 935 13. Sandhurst Road, Hertford Road, Town Road, Picketts Lock Lane, William Girling Reservoir 4,635 668 14. Fords Grove, Station Road, Winchmore Hill Railway Line, Hedge Lane, Firs Lane 2,895 302 15. Old Enfield/Edmonton Boundary, Enfield Town Railway Line, Southbury Road, Nags Head Road, Lea Valley Road, Ponders End Railway Line 6,111 604 16. Hedge Lane, Palmers Green Railway Line, Enfield/Haringey Boundary, Chequers Way, Connaught Gardens 4,758 473 17. Ashfield Parade, The Bourne, Bourne Hill, Palmers Green Railway Line, Enfield/Haringey Boundary, Enfield/Barnet Boundary 7,579 1,008 TOTAL 74,250 16,820 87 ENVIRONMENTAL HEALTH Table 33 Food and Drugs Samples Submitted to Public Analyst Sample Total Number Procured Number Unsatisfactory Baby Foods 4 2 Beverages, fruit juices, syrups, etc. 56 4 Biscuits 26 1 Bread 7 2 Butter and Margarine 32 1 Cakes 27 4 Cereals 10 — Cheese 49 2 Coffee 7 — Confectionery 35 4 Cooking fats, including lard, etc. 7 — Cooking oil 3 1 Cream 10 3 Dessert Products 12 2 Drugs 20 3 Fish and fish products 18 2 Flour 18 1 Fruit (all kinds) 34 4 Jams and preserves 29 2 Jelly 6 2 Meat and meat products 105 10 Milk (various) 11 1 Nuts 6 — Puddings 6 1 Salt, mustard and pepper 6 — Sauces and pickles 55 3 Soup 13 1 Spices, etc. 8 — Sugar 5 — Tea 7 — Vegetables (fresh and canned) 33 1 Miscellaneous 47 7 TOTAL 712 64 (9%) Table 34 Food and Drugs Bacteriological Examination of Ice-Cream Methylene Blue Test Vendor Type of Ice-Cream Results Grade Grade Grade Grade 1 2 3 4 Shop Premises Loose or Soft 9 6 5 2 Mobile Traders Loose or Soft 4 3 — 1 88 ENVIRONMENTAL HEALTH Designation Number of Samples Results Table 35 Food and Drugs Bacteriological Examination of Milk 1. Methylene Blue Test (for keeping quality) Satisfactory Void Unsatisfactory Pasteurised 113 102 (90%) 5 (4½%) 6 (5½%) Designation Number of Samples Results 2. Phosphatase Test (for efficiency of pasteurisation) Satisfactory Void Unsatisfactory Pasteurised 113 113 (100%) — — Designation Number of Samples Results 3. Turbidity Test (for efficiency of sterilisation) Satisfactory Void Unsatisfactory Sterilised 47 46 (98%) — 1 (2%) Designation Number of Samples Results 4. Colony Count (for efficiency of treatment) Satisfactory Void Unsatisfactory Ultra Heat Treated 12 12 (100%) — — Complaint Fine Costs Table 36 Food and Drugs Prosecutions Dirty milk bottle £75 0 0 £10 10 0 Dirty milk bottle £75 0 0 £10 10 0 Dirty milk bottle £50 0 0 £10 0 0 Glass in bottle of cream £10 0 0 £10 0 0 Plastic material in loaf of bread £20 0 0 £5 5 0 Piece of metal in loaf of bread £30 0 0 £10 0 0 Blade in loaf of bread £40 0 0 £10 0 0 Metal nut in bread £50 0 0 £10 0 0 Foreign body in bread £30 0 0 £5 0 0 Dirty loaf of bread £30 0 0 £2 0 0 Foreign body in loaf £50 0 0 £10 0 0 Cigarette in roll £30 0 0 £5 0 0 Cigarette end in shortcake £30 0 0 £5 0 0 Black substance in doughnut £30 0 0 £5 0 0 Insect in shortcake biscuits £20 0 0 £5 0 0 Mouldy chocolate cake £20 0 0 £3 0 0 Foreign matter in bun £20 0 0 £10 0 0 Mouldy processed cheese £10 0 0 £3 10 0 Mouldy sausage rolls £10 0 0 — Mouldy sausage roll £20 0 0 £5 0 0 Medical dressing in meat £10 0 0 £10 0 0 Unsound packet of cooked meat £30 0 0 £10 0 0 Mouldy sausages £30 0 0 £5 5 0 Sour beef sandwiches £20 0 0 £5 0 0 89 ENVIRONMENTAL HEALTH Table 37 Housing Inspections and Defects 1. Inspection of Dwelling-houses: (i) Total number of dwelling-houses inspected for housing defects (under Public Health or Housing Acts) 17,856 (ii) Number of dwelling-houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation 45 (iii) Number of dwelling-houses (exclusive of those referred to under the preceding sub-head) found not to be in all respects reasonably fit for human habitation 701 2. Remedy of defects during the year without service of formal notices: Number of defective dwelling-houses rendered fit in consequence of informal action 303 3. Action under Statutory Powers during the year: A. Proceedings under Sections 9, 10 and 12 of the Housing Act, 1957. (i) Number of dwelling-houses in respect of which notices were served requiring repairs 9 (ii) Number of dwelling-houses which were rendered fit after service of formal notices: (a) By owners 3 (b) By Local Authority in default of owners Nil B. Proceedings under Public Health Acts: (i) Number of dwelling-houses in respect of which informal notices were served requiring defects to be remedied 625 Number of dwelling-houses rendered fit 303 (ii) Number of dwelling-houses in respect of which formal notices were served requiring defects remedied 301 Number of dwelling-houses rendered fit after service of formal notice: (a) By owners 272 (b) By Local Authority in default of owners ... 4 C. Proceedings under Section 17 of the Housing Act, 1957: (i) Number of dwelling-houses in respect of which Demolition Orders were made Nil (ii) Number of dwelling-houses demolished in pursuance of Demolition Orders Nil 90 ENVIRONMENTAL HEALTH Nature of Defect Number Table 38 Housing Housing Defects Remedied Brickwork, pointing and wallplaster defective 95 Dampness 134 Doors — defective 14 Drains — stopped up 2,597 Drains — defective or broken 16 Dustbins — defective 1 Floor — defective 41 Guttering and rainwater pipes — defective 92 Paving — broken 8 Refuse Accumulation 18 Roofs — defective 130 Sink Wastes — defective 14 Verminous and dilapidated conditions 67 Water — not provided or disconnected 8 Water-closets — defective 49 Water-closets — defective or broken pans 8 Windows — defective or broken 121 Class of Premises Number of Registered Premises receiving a general inspection Total visits of all kinds to Registered Premises Table 39 Shops and Offices Visits under Offices, Shops and Railway Premises Act 1963 Offices 152 933 Retail Shops 235 2,648 Wholesale Shops, Warehouses 44 547 Catering Establishments open to public, Canteens . 36 195 Fuel Storage Depots — 2 467 4,325 Premises Number on Register Inspections Number of written Notices Occupiers Prosecuted Table 40 Factories and Workshops inspections for purposes of Provisions as to Health (i) Factories in which Sections 1, 2, 3, 4 and 6 are to be enforced by Local Authorities 59 56 — — (ii) Factories not included in (i) in which Section 7 is enforced by the Local Authority 744 257 3 — (iii) Other premises in which Section 7 is enforced by the Local Authority (excluding Outworkers' premises) 41 112 — — 844 425 3 — 91 ENVIRONMENTAL HEALTH Table 41 Factories and Workshops Cases in which Defects were found Particulars Number of cases in which defects were found Number of Found Remedied Referred to H.M. Inspector Referred by H.M. Inspector cases in which prosecutions were Instituted Want of Cleanliness (S.1) 1 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 — — — — — (b) Unsuitable or defective 8 1 — 1 — (c) Not separate for sexes 1 — — — — Other offences against the Act (not including offences relating to Outworkers) — — — — — 11 3 — 1 — Table 42 Inspections and Complaints Inspections, Interviews and Visits of the Public Health Inspectorate Animal Welfare 203 Bacteriological Samples 501 Betting and Gaming, Licensed Premises, Employment Agencies 227 Caravans 450 Clean Air 7,425 Drainage Works 2,200 Factories and Workshops 497 Food and Drugs 2,909 Food Premises 3,925 Hairdressers' Premises 175 Hawkers (Vehicles and Stores) 165 Housing Purchase Advances 507 Housing and Public Health: Initial Inspections 17,856 Other Inspections 6,086 Houses in Multiple Occupation 852 Infectious Diseases 873 Interviews 1,016 Merchandise Marks 305 Milk Distributors and Dairymen 679 Noise Nuisances 839 Offices and Shops 4,325 Rodent Control 1,644 Shops and Street Trading 3,972 Miscellaneous 2,182 TOTAL 59,813 92 ENVIRONMENTAL HEALTH 93 Table 43 Inspections and Complaints Summary of Complaints and Requests for Visits Accumulation of refuse 188 Animal welfare 1 Bees 76 Blocked or defective drains 2,457 Dampness in premises 278 Defective water-closets 418 Defective water fittings 65 Defective roofs 137 Disinfection and disinfestation 64 Improvement grants 608 Insanitary or defective conditions of premises 518 Insect infestations 276 Noise Nuisance 88 Pigeons 85 Rats or mice 2,164 Scabies 12 Smoke nuisance and Clean Air inquiries 475 Squirrels 41 Unsatisfactory housing conditions including overcrowding 54 Unsound food 149 Verminous premises 73 Wasps 1,038 Miscellaneous 1,030 TOTAL 10,295 SCHOOL HEALTH SCHOOL HEALTH Tables relating to the School Health Service 44 Medical Inspection 45 Defects found at periodic and special inspections 46 Special Inspections and Re-inspections 47 Hearing Tests 48 Infestation with Vermin 49 Medical Treatment: Defects treated 50 Ear, Nose and Throat Clinics 51 Ophthalmic Clinics 52 Orthoptic Clinic 53 Orthopaedic Clinic 54 Speech Therapy 55 Child Guidance Clinic 56 Dental Inspection and Treatment 57 Children in Special Schools Summary School Population 41,337 Routine Medical inspection Number of children examined 9,225 Number found to be satisfactory 9,225 Number found to be unsatisfactory Nil Medical Treatment Total attendances: Minor Ailments 19,737 Ear, Nose and Throat 770 Ophthalmic 4,802 Orthoptic 1,610 Orthopaedic 115 Speech 2,753 Child Guidance 1,497 Handicapped Children Receiving Specoal Education Total number of children 463 Number attending Day Special Schools 348 Number attending Residential Special Schools 115 Routine Dental Number of children examined 29,730 inspectKMi^and Number found to need treatment 12,511 Number treated by School Dental Officers 5.810 96 SCHOOL HEALTH Medical inspection section 48 Education Act 1944 The purpose of the medical inspection required by Section 48 of the Education Act 1944 is to ensure the fitness of school children to derive the maximum benefit from the education provided. The procedure adopted for the medical inspection, at appropriate intervals, of pupils attending maintained schools has followed the same pattern as in previous years. Full medical inspection is provided at school entry, at ten years of age and during the last statutory year at school, with a vision test only at eight years of age. The form of appointment for the medical inspection invites a parent to be present, thus providing an opportunity for parent and medical officer to discuss the child's health and allied problems. An estimate of the child's physical condition is made at the time of the inspection and of the 9,225 examined in 1970 all were classified as satisfactory. Following the final medical inspection before leaving school the Careers Officer is notified if, for health reasons, a pupil should not undertake certain types of employment. Medical inspection is not provided at the ten independent schools in the borough but these schools are included in the B.C.G. vaccination scheme. Medical officers are available to visit, mainly in a consultative capacity, the two technical colleges in the borough. Southgate Technical College was visited thirteen times and 300 first year students consulted the medical officer. Certain parts of the Family Law Reform Act 1969 came into force on the 1st January, 1970, and one particular Section amends the age of consent and provides that a minor who has attained the age of sixteen years may consent, as if he were of full age, to surgical, medical or dental treatment. This was brought to the attention of Southgate Technical College for the amendment, as necessary, of the questionnaire used in connection with the medical officers' visits to the college. The Mass Radiography Unit visited both technical colleges in the Autumn and 247 students from Enfield College of Technology and 364 from Southgate Technical College had chest X-rays. Colour vision Persons with defective colour vision are unable to follow certain occupa- tions. So that pupils may be made aware of any such defect reasonably early in their school lives, the intermediate periodic medical inspection —at approximately ten years of age—includes a colour vision test by the Ishihara method. Those found by this method to have a defect are further tested by the less selective Giles Archer Lantern Test. One hundred and thirty-one boys and five girls were found by the Ishihara test to have a degree of colour blindness. Of the ninety-nine boys and six girls tested by the Giles Archer Lantern, nine boys were found to be normal, twenty-six boys and five girls were found to be safe, and sixty-four boys and one girl unsafe in relation to certain standards for employment. Hearing The employment of one full-time and one part-time audiometer operator enables children to be sweep tested three times during their school life and more frequently on request or where there is known or suspected hearing loss. In addition, some pre-school children are tested either by audiometry or free field testing. One of the audiometer operators attends the ear, nose and throat clinics and tests children as requested by the consultants. 97 SCHOOL HEALTH Children failing their hearing tests are referred for investigation to medical officers or family doctors and may, following this, be referred to ear, nose and throat consultants or audiology clinics although many require only minor treatment for the conditions affecting their hearing. Of the 76 children referred to the school ear, nose and throat clinics, sixteen are still attending for observation; twenty-one were referred to hospitals for operation or other treatment; eleven underwent hospital treatment followed by observation at clinics; eighteen were discharged following minor treatment; six required no treatment; and four failed to attend. Only two commercial hearing aids were purchased during the year, all other needs being met by the issue of National Health Service body-worn and head-worn aids. Enfield children attending the audiology clinic in the neighbouring Borough of Haringey are supervised by the peripatetic teacher of the deaf attached to the clinic. The Department of Education and Science has provided information on the expansion and importance of this service, and discussions are taking place on the possibility of more comprehensive provision for the Borough. Requests have been received from Southgate Technical College for 124 students to have hearing tests and it is expected that these will be carried out early in 1971. Two students from Enfield College of Technology who were tested and found to have a hearing loss were referred to their general practitioner. Foot inspections Regular foot inspections by the school nurses in all schools in the Borough revealed 1,387 new cases of plantar warts from the 86,582 inspections undertaken. An informative pamphlet is available to assist in recognising verrucae in the early stages, and containing advice on treatment and on the prevention of the spread of infection. Inspections for cleanliness Section 54 Education Act 1944 School nurses visit the primary schools each term in order to carry out inspections for the detection of verminous head conditions and to secure the cleansing of the person and clothing of pupils, if necessary. Although 4,347 more inspections were made compared with the previous year, forty-one fewer children were found to be in a verminous condition. Medical treatment Section 48 Education Act 1944 It is the duty of every local education authority to make such arrangements for securing the provision of free medical treatment for pupils for whom primary, secondary or further education is provided by them at any school or county college or any other educational establishment maintained by them as are necessary for securing that comprehensive facilities for free medical treatment are available to them, either under the Education Act 1944 or otherwise. Minor ailments clinics Sessions staffed by a medical officer and a nurse are held at thirteen clinic premises in the Borough during term time, and parents may take their children along for advice on any condition, no appointment being necessary. At many of the clinics nurses hold additional sessions for the treatment of skin infections and minor injuries and defects. Some children are referred to these sessions so that conditions found at periodic and special inspections may be followed up; some are referred at the suggestion of head teachers and school nurses; and some attend for periodic medical inspection, having been absent from school when inspection took place there. Examinations for the issue of employment and entertainment certificates are also undertaken at these clinics. During school holidays special sessions, as and when required, are arranged. The total attendance at these clinics was 1,085 more than in the previous year. 98 SCHOOL HEALTH Ear, nose and thotat clinics At Edmonton Central Clinic one or two sessions each month were held, depending upon the number of patients to be seen. At Southbury Clinic, because fewer patients were being referred, sessions were held during alternate weeks instead of weekly. The consultants at both clinics hold local hospital appointments. For many years a weekly session had been held at Broomfield Park Clinic. Following the unfortunate death of the consultant on 4th August, and because the Regional Hospital Board could not provide a replacement, it was necessary to discontinue holding sessions. Alternative arrangements were made for the 33 children on the register. Ophthalmic clinics Three sessions each week continue to be held at Southbury Clinic and two essions every other week at Bowes Road Clinic. At Edmonton Central Clinic the number of sessions per week was reduced at the end of November from three to two. This reduction was associated with the retirement of the consultant, who, fortunately, was prepared to continue attendance at the clinic twice a week. Orthoptic clinics Treatment continues, as in previous years, to be provided by a full-time orthoptist attending the three ophthalmic clinics in the Borough and treating those children referred to her by the ophthalmologists. Both pre-operative and post-operative treatment is provided. Orthopaedic clinic New referrals to this clinic were more than double those for the previous year. Two sessions a month were therefore held. Foot deformities, knock knees, postural defects and suspected congenital hip deformities in babies continued to be the main defects referred, but in one case a child was found to be suffering from muscular dystrophy and was transferred to hospital. Children requiring physiotherapy attend hospital for this purpose. The services of a part-time physiotherapist continued to be available, and treatment was given on two mornings a week to children at Hazelbury Open Air School, twice a week at Durants School for Educationally Sub-normal children, and twice a week at the Junior Training School. One hundred and fourteen children suffering from asthma, bronchitis, cerebral palsy, muscular dystrophy, foot and postural defects received a total of 3,800 treatments. Speech clinics The number of sessions normally held each week at eight clinic premises and at the special schools was unavoidably reduced following the resignation in September of one of the full-time speech therapists, for whom no replacement could be secured. As a result, waiting lists for treatment unfortunately lengthened, and the ultimate effect is reflected in the statistical table. Defects treated by the speech therapists may be placed broadly in one of three categories: retarded speech and language development; articulation difficulties; stammer. Four students from the Oldrey-Fleming School of Speech Therapy attended the Central Clinic for varying periods for practical training Some children of average intelligence but with severe speech defects would benefit from intensive speech therapy and special teaching. Unfortunately, however, the number of places available in special residential schools throughout the country is inadequate, and the waiting time for admission is very long indeed. Some authorities, therefore, have established small units attached to, or in close proximity to, ordinary schools. Here, the children receive the intensive therapy they need and can also, so far as is possible, be integrated into the ordinary life of the school. The possibility of such a local unit warrants further consideration. 99 SCHOOL HEALTH Child guidance Centre and Clinic The Child Guidance Centre and Clinic is situated at 8 Dryden Road, Bush centre and clinic Hill Park, and has an establishment of a part-time psychiatrist (eight sessions per week), four psychiatric social workers, four educational psychologists and two psychotherapists Although the centre and clinic are housed in one building, the work falls broadly into two categories, namely, educational problems and the assessment of intelligence on the one hand and emotional and psychiatric problems on the other. Cases are referred to the psychiatrist by hospital staff, by assistant medical officers and general medical practitioners, or even in some cases directly by parents. In conjunction with the centre and clinic there is the Selection Unit at Chase Side School for twenty young children suffering severe emotional disorder who are admitted on the recommendation of the psychiatrist. There is also a small full-time class for hyperactive infants. The Unit provides a therapeutic environment in which further assessment of the problems and abilities of these children is possible, as many of them are non-speaking and in other ways inaccessible. Elsewhere, remedial classes are provided for very small groups of children with specific learning difficulties who attend part-time. Nutrition Although advice on nutrition is generally available at medical inspections, it was decided to make a more positive approach to the problem of the overweight child and the underweight child, and to introduce a scheme whereby such children may receive further advice and help. Only two cases of underweight children came to light, and in each of these the parents preferred to consult their family doctor. Overweight children proved to be in far greater numbers. The parents of 159 such children were approached, and in 75 cases the Department's offer of advice and help was accepted. At the end of the year, however, only 43 children were then attending at regular intervals for advice and for the recording of their weight, etc. Some degree of success has been achieved under this scheme, which, of course, must rest largely upon the co-operation of parents and children. One outstanding "success story" is worthy of note: that of the elevenyear-old girl who in seven months reduced from eleven stone nine pounds to nine stone seven-and-a-half pounds. Enuresis Twenty-two automatic enuresis alarm devices are available locally to assist in the treatment of enuretic children. The list of children awaiting issue of these alarms contained 59 names at the end of the previous year. To that figure 78 further names were added during 1970, making a total of 137. Fifty-six children were issued with alarms. Of 20 others offered alarms, thirteen no longer required them and no response was received in the case of the remaining seven. During the year, 38 children responded successfully and three improved, but in fifteen cases no success was reported. A check made after six months of 35 reported cured cases revealed that 20 were still dry and two had relapsed; and thirteen failed to keep appointments. Sixty-one names remained on the list at the end of the year, and it is perhaps understandable that some parents—far from being dismayed at learning of the existence of a waiting list—expressed relief on finding that they were not alone with their problem. Recuperative holidays Four children were sent on recuperative holidays of two weeks duration. Holidays arranged by the British Diabetic Society and by the British Epilepsy Association were also enjoyed by two Enfield children. 100 SCHOOL HEALTH Dental service Section 48 Education Act 1944 It is the duty of the local education authority to provide medical inspection at appropriate intervals for pupils in attendance at any school or county college maintained by them, and every local education authority shall have power to provide for such inspection of senior pupils in attendance at any other establishment maintained by them. Medical inspection, which is compulsory for such pupils, is deemed to include dental inspection. Section 4 Education (Miscellaneous Provisions) Act 1953 Under Section 4 of the Education (Miscellaneous Provisions) Act 1953, the local education authority has duties and powers in regard to the provision Provisions) of free dental treatment, similar to those for medical treatment. Dental treatment, however, may only be provided by the authority through persons employed by the authority or under arrangements made with the hospital service and not through the general dental service. There are nine clinics in the borough, providing dental suites with a total of thirteen surgeries, one surgery being used exclusively for orthodontics and three surgeries being used for the dual purpose of dentistry and orthodontics. All premises are fitted with up-to-date equipment, including air turbine high speed instruments, and, for greater convenience, all anaesthetic apparatus is standard throughout (Walton) as also are the X-ray machines. During the year under review 29,730 pupils were examined for the first time, 5,393 more than the previous year. Of these 12,511 were found to require treatment. Compared to last year's figures which were 24,337 examined and 10,332 requiring treatment, the figures for this year show a gratifying move in the right direction. A number of children, of course, receive treatment through the general dental service. Attention was mainly directed to juniors and infants, the groups in which caries experience is most prevalent. This is shown by an increase in the numbers of fillings in deciduous teeth of 867, and by a marked fall in extractions in the same group. The total number of extractions, in both permanent and deciduous, continues to fall each year, indicating a general improvement in the condition of the teeth. The Borough is still fortunate to have a good and flourishing orthodontic service. In March, a dental officer from the Department of Education and Science visited the Borough in order to review the dental services. Subsequently a letter was received from the Department in which it was stated that " Inspections were carried out at a satisfactory rate per session, and that an above average proportion of the school population was inspected. The pattern of treatment remains good, with low prevalences of general anaesthetics and emergencies, and high ratios of teeth filled to extracted. Work output has fallen, but a chronic shortage of surgery assistants has been a contributory factor. Enfield is fortunate in having a number of very attractive clinics, but although the equipment was generally sound, there is a need to replace the less satisfactory items, in order to avoid heavy expenditure later." It was also stated that: " A dental auxiliary could contribute greatly to the treatment of children under five." The filling of this post is under consideration. Dental health education, which has been energetically pursued in cooperation with the Health Education Officer, has no doubt played a large part in the interest shown by parents in the dental welfare of their children. Mr. Phillips, the Chief Dental Officer and Principal School Dental Officer, wishes to record his thanks to his staff for their help and loyalty, and to all those members of the Department whose efforts contributed to the smooth running of the service. 101 102 SCHOOL HEALTH Handicapped pupils Education Act 1944 The local education authority has the statutory duty of ascertaining what children require special educational treatment and providing for their special education. Special educational treatment is provided in the special schools maintained by the Borough, by other local education authorities and by voluntary bodies. At the end of the year 348 Enfield pupils were attending day special schools, and 115 were placed in residential schools. The categories of handicapped pupils defined under the Handicapped Pupils and Special Schools Regulations 1959 and 1962, are blind, partially sighted, deaf, partially hearing, educationally sub-normal, epileptic, maladjusted, physically handicapped, pupils suffering from speech defect, and delicate. (a) Blind—No children were ascertained during the year. At the end of the year there were four children in special schools. (b) Partially Sighted—No children were ascertained during the year. At the end of the year there were nine children (including one with a dual handicap) in special schools. One child was receiving home tuition. (c) Deaf—Two children were ascertained during the year and both were admitted to special schools. At the end of the year there were twenty children in special schools. (d) Partially Hearing—Six children were ascertained during the year; four were admitted to special schools, one to the day nursery and •one to a play group At the end of the year 34 children were in special schools, two in play groups, one in the day nursery and four in ordinary schools. (e) Educationally sub-normal—Eight children were formally ascertained during the year; four were admitted to special schools, three to play groups and one was in the junior training school awaiting a place in a special school. At the end of the year 92 children (including three with dual handicaps) were in special schools, two in play groups and one in the junior training school. In addition 112 children were attending Durants and Oaktree Schools on an informal basis. (f) Epileptic—No children were ascertained during the year. At the end of the year three children (including one with a dual handicap) were in special schools. One child was receiving home tuition. (g) Maladjusted-Thirty-one children were ascertained during the year: 19 were admitted to special schools, and twelve are awaiting placement. At the end of the year 92 children (including two with dual handicaps) were in special schools, 24 in ordinary schools, and two in approved schools. One was not attending school. One was in the junior training school. (h) Physically Handicapped—Two children were ascertained during the year: one was admitted to a special school and one is awaiting placement. At the end of the year 35 children (including two with dual handicaps) were in special schools, six in ordinary schools and two were not in school. (i) Speech—No children were ascertained during the year. At the end of the year one child was in a special school and one in an ordinary school. (j) Delicate—Fifteen children were ascertained during the year: thirteen were admitted to special schools and two are awaiting placement. At the end of the year 61 children were in special schools, and four in ordinary schools. One child was not attending school. SCHOOL HEALTH Special schools The Education Committee maintains four day special schools and one residential special school. All admit a proportion of children from other boroughs. Durants and Oaktree day schools provide accommodation for 320 educationally sub-normal boys and girls, who are medically examined annually. Speech therapy is provided, and at Durants School, where some of the pupils have dual handicaps, the physiotherapist—who attended twice weekly—gave twelve children a total of 427 treatments. The educational psychologists paid 34 visits to the schools for the purpose of educational assessments. Hazelbury Day Open Air School provides places for 140 children of all ages who are delicate or who have minor physical handicaps. A medical officer visits the school fortnightly, and medically examines the children once a term. The pupils have three meals a day and medical care and treatment are provided by a nurse attached to the school. The physiotherapist visited the school twice weekly and 88 children received a total of 2,873 treatments. Eight children suffering from cerebral palsy, muscular dystrophy and foot defects were treated individually; the others, with conditions such as asthma and bronchitis, were treated in groups. The school nurse continued to supervise the children visiting the swimming baths. Aylands day school, opened in 1969, provides places for 50 maladiusted boys and girls. The children are medically examined annually and seen periodically by a psychiatrist. Wavendon House residential school for 50 maladjusted boys, opened as such in 1969. Those boys at the school whose parents live in Enfield are medically examined annually during the school holidays and are also seen periodically by a psychiatrist. A general medical practitioner looks after the health of the boys during term time. When a departmental dental officer visited the school in February to inspect the pupils and carry out all necessary treatment, the boys' dental condition was found to be well above average. Home and hospital tuition Section 56 Education Act 1944 In cases where children cannot, for various reasons, attend school, local education authorities are empowered to provide home tuition. This provision was made for six children during the year. In addition, tuition was also provided in the paediatric ward of the North Middlesex Hospital. Children unsuitable for education at school Section 57 (amended) of the Education Act 1944 During the year decisions were recorded in respect of thirteen children found to be suffering from a disability of mind of such a nature or to such an extent as to make them unsuitable for education at school. Under the provisions for a review of such ascertainments one child was examined and found to be suitable for admission to a school for educationally sub-normal pupils. Circular 16/70 from the Department of Health and Social Security draws attention to the transfer of responsibility for the education of mentally handicapped children to Education Departments under The Education (Handicapped Children) Act 1970. Department of Education and Science circular 15/70 provides some details of the Act and gives the 1st April, 1971, as the operative date for this transfer. From this date the existing provision for notifying a child as unsuitable for education at school will cease and the provisions of Section 34 of the Education Act 1944 regarding special educational treatment will apply to such children. 103 SCHOOL HEALTH Vaccination and immunisation Statistics and details of the vaccination and immunisation of school children, provided under Sections 26 and 28 of the National Health Service Act 1946 are fully dealt with elsewhere in the report. Head Teachers continued to co-operate in the distribution of consent forms, which serve not only to emphasise to parents the need for immunological protection for their children, but also to remind them that a reinforcing dose may be due. To minimise interference with the children's school work, vaccination and immunisation are undertaken at the schools when the number of children is sufficiently great to warrant this. Employment of children Children and Young Persons Act 1933 (amended by the Education Acts) In accordance with the Bye-laws, 436 children were examined and certifi- cates were issued in all cases certifying that their employment would not be prejudicial to their health or physical development and would not render them unfit to obtain proper benefit from their education. Similarly five children were examined and granted certificates enabling them to take part in entertainments. It was not necessary to invoke Section 59 of the Education Act 1944 to prohibit or restrict the employment of any child. Children in care The Council has, under the control of the Children's Officer, accommodation for 65 school children in its five homes. Although the children receive general medical care from a general medical practitioner, each home is visited approximately six times a year by a medical officer of the Department who advises generally on diet, health and hygiene, and examines the children on admission and annually. The Department's medical officers also supervise, in the same way, two homes situated in the Borough which belong to the London Borough of Barnet and which accommodate 21 school children. Children in foster homes are under the medical care of general medical practitioners. Co-operation with hospitals The paediatricians at Chase Farm Hospital, Highlands Hospital and North Middlesex Hospital provide the department with much valuable information, which enables medical officers and school dentists to be alerted to the special needs of particular children. Prevalence and control of infectious disease Sonne dysentery All schools are asked to notify the Department immediately two or more children in one class show symptoms of digestive upset, with or without diarrhoea. There were no outbreaks of Sonne Dysentery in schools in the borough; only twelve sporadic cases were reported among ten schools. Scabies Forty-nine children were treated for scabies during the year, a decrease in number from the previous year. Reporting of infectious disease Head teachers reported 370 school children as suffering from infectious diseases. 104 SCHOOL HEALTH The chronically sick and disabled persons act 1970 A joint circular issued in August, 1970, commented in general terms on this Act. The matters to which it directed attention included the Sections covering the educational needs of children suffering from autism or other forms of early childhood psychosis and acute dyslexia, and also the deaf/ blind. A separate Circular 12/70, published in July, 1970, by the Department of Education and Science, had already urged authorities to review their local provisions and future plans for the education of children with combined defects of vision and hearing. We were able to notify the Chief Education Officer that only two such children were known. One was attending a school for the blind, and the other was attending the Junior Training School. Arrangements had been made for the latter to be assessed at one of the special centres of the Royal National Institute for the Blind. Research Survey of physically handicapped children in ordinary schools A request was received from the Special Services Branch of the Department of Education and Science for help in a nationwide survey of physically handicapped children attending ordinary schools. The purpose of the survey was to determine (a) how many physically handicapped children there are in ordinary schools; (b) the nature and degree of their handicap; (c) if they absorb too much of the teachers' time at the expense of the non-handicapped children; (d) if they derive as much educational benefit and receive as much medical and nursing attention as they might do in a special school. Questionnaires were completed in respect of 150 children suffering from one or more of twenty-five defects. Seventy-six local schools were involved. Avoidance of carcinogenic aromatic amines in schools and other educational establishments Administrative memorandum 3/70 published by the Department of Education and Science on the 23rd January, 1970, repeated advice given in a departmental circular in 1967 and provided a fuller list of potentially carcinogenic substances which should not be kept in or used in school laboratories. Ionising radiations In accordance with instructions issued by the Department of Education and Science, the Secretary of State's approval is required before certain radioactive sources are used in schools. Almost all the secondary schools in the borough are so authorised. In 1964 various government departments jointly produced a Code of Practice for the Protection of Persons against Ionising Radiations arising from Medical and Dental Use. This Code applies to the Council's eight dental clinics which have X-ray machines. During the year 663 pupils were X-rayed. The number of X-rays taken during the year was 1,592, including 1,454 for orthodontic purposes. 105 SCHOOL HEALTH Table 44 Medical Inspection pupils attending maintained primary and sedondary schools (inculding nursery and special schools) No. of pupils who have received a full medical examination Pupils found to require treatment (excluding dental diseases and infestation with vermin) for defective vision (excluding squint) for any other condition Total individual pupils 1966 and later 307 10 44 54 1965 1,415 95 236 322 1964 1,641 106 247 347 1963 210 21 35 53 1962 62 6 12 18 1961 71 8 13 21 1960 677 87 99 173 1959 1,750 251 223 456 1958 974 133 118 245 1957 176 29 18 45 1956 432 83 42 116 1955 and earlier 1,510 326 130 450 Total 9,225 1,155 1,217 2,300 106 SCHOOL HEALTH Table 45 medical inspection defects found at periodic and special inspections (Classified in accordance with the reqirements of the Department of Education and Science) Defect or Disease Periodic Special Requiring Treatment Requiring Observation Requiring Treatment Requidring observation Skin 250 2 74 1 (a) Vision 1,155 527 122 112 (b) Squint 49 7 13 2 (c) Other 30 — 41 6 Ears (a) Hearing 52 57 170 50 (b) Otitis Media 12 — 20 2 (c) Other 29 2 35 7 Nose and Throat 253 19 37 9 Speech 40 19 16 2 Lymphatic Glands 3 2 1 — Heart 38 6 2 2 Lungs 99 1 10 3 Developmental (a) Hernia 10 — 1 — (b) Other 71 65 15 21 Orthopaedic (a) Posture 1 7 1 — (b) Feet 43 11 2 4 (c) Other 34 10 35 8 Nervous System (a) Epilepsy 30 — — — (b) Other 9 1 — 2 Psychological (a) Developmental 4 — — — (b) Stability 57 35 42 63 Abdomen 41 2 8 1 Other 146 30 207 111 107 SCHOOL HEALTH Table 46 Medical inspection Special inspection and re-inspections Number of special inspections (including freedom from inspection infection examination prior to school journeys and special examination at schools, special schools, children's homes, etc.) 4,851 Number of re-inspections 2,412 Table 47 Hearing tests by audiometer (a) Routine tests in school. 1st Test Both ears Failures one ear Total Of total failures number already known to have hearing loss ReTests right left Entrants 4,765 75 45 58 178 13 840 8-9 years 4,754 69 41 45 155 37 627 12-13 years 3,462 38 28 30 96 31 383 Total 12,981 182 114 133 429 81 1,850 (b) Special tests in clinics. Age Group 1st Test Failures one ear Of total failures number already known to have hearing loss ReTests Both ears right left Total Pre-school 96 26 6 8 40 4 10 School Children 490 133 74 81 288 21 236 Total 586 159 80 89 328 25 246 No.of children in schools (excluding special schools for the deaf or partially hearing) who have hearing aids 55 108 SCHOOL HEALTH Table 48 Inspections for 126 cleanline ss Infestation with vermin (a) Total number of examinations of pupils in school 78,518 (b) Total number of individual pupils found to be infested 126 (c) Number of individual pupils in respect of whom cleansing notices were issued (Section 54 (2) Education Act 1944) 24 Table 49 Medical treatment Defects treated at minor ailments clinics (Classified n accordance with the requirments pf the Department of Ecucation and Science Skin: Ringworm (i) Scalp — (ii) Body Scabies - Impetigo 14 Other 2,202 Eye Disease 111 Ear Defects 49 Miscellaneous 1,438 Total attendances at Minor Ailments Clinics 19,737 Number of Special Inspections at Minor Ailments Clinics 1,942 Number of Re-examinations at Minor Ailments Clinics 727 Table 50 Ear, nose and throat clinecs Total attendances 770 New cases 189 i Number of individual children seen 374 Number who received treatment at E.N.T. Clinics 163 Number referred to hospital for tonsillectomy and/or adenoidectomy 92 Number referred to hospital for other treatment 40 Number referred for X-ray 25 109 SCHOOL HEALTH Table 51 Total attendances 4,802 Ophthalmic clinics New cases 594 Number of individual children seen 2,707 Number of children who were prescribed glasses 1,004 Table 52 Total attendances 1,610 Orthoptic clinics New cases 48 Number of Individual children treated 346 Number discharged: Orthoptically satisfactory with operation 2 Orthoptically satisfactory without operation 52 54 Number discharged not orthoptically satisfactory but: 1. Relief of symptoms 1 2. Intermittent Binocular Single Vision 11 3. Appearance satisfactory: (a) with improved visual acuity 14 (b) without improved visual acuity 5 Number discharged but treatment not completed : (a) Left school 1 (b) Left district 9 (c) Failed to attend 7 (d) Referred elsewhere 9 57 Number of appointments made and not kept 638 Table 53 Total attendances at Orthopaedic Surgeon's Clinic 115 Orthopaedic clinic Number of new cases seen by Orthopaedic Surgeon 70 Number of cases discharged 63 110 SCHOOL HEALTH Total attendances 2,753 Table 54 New cases 108 Speech therapy Children under treatment or observation for the following: special schools Retarded speech and language development 77 Articulation defects 279 Stammer 25 381 Discharged: Cured 39 Improved 36 Defaulted 18 Left district 17 110 Number of individual children seen by psychiatrist: New cases (including 12 pre-school children) Table 55 165 Child guidance Follow-ups clinic 41 Annual revisions 27 Treatment 9 Total attendances for iagnosis and treatment by psychiatrist 532 Number of individual children treated by psychotherapist 47 Total attendances for treatment by psychotherapist 965 111 SCHOOL HEALTH Table 56 5-9 years 10-14 years 15 years and over Total Dental service Dental inspection Attendances and Treatment: and treatment First visit for treatment 3,171 2,336 303 5,810 Subsequent visits 4,621 7,986 1,748 14,355 Total visits 7,792 10,322 2,051 20,165 Additional courses of treatment commenced 548 248 42 838 Fillings in permanent teeth 1,430 4,315 1,254 6,999 Fillings in deciduous teeth 5,896 860 — 6,756 Permanent teeth filled 1,244 3,827 1,126 6,197 Deciduous teeth filled 5,447 785 — 6,232 Permanent teeth extracted 91 616 98 805 Deciduous teeth extracted 1,795 900 2,695 General anaesthetics 612 333 11 956 Emergencies 349 109 18 476 Number of pupils X-rayed 663 Prophylaxis 795 Teeth otherwise conserved 1,360 Number of teeth root filled 15 Inlays 1 Crowns 15 Courses of treatment completed 5,418 Orthodontics: Cases remaining from previous year 419 New cases commenced during year 242 Cases completed during year 166 Cases discontinued during year 43 Number of removable appliances fitted 596 Number of fixed appliances fitted 68 Pupils referred to hospital consultant 4 Total attendances at clinics 6,545 Prosthetics: Pupils supplied with full upper or full lower dentures (first time) — — — Pupils supplied with other dentures (first time) — 4 — 4 Number of dentures supplied — 4 — 4 Anaesthetics: General Anaesthetics administered by Medica I Officers 956 Inspections: (a) First inspection at school. Number of pu Dils 24,877 (b) First inspection at clinic. Number of pu Dils 4,853 Number of (a) +(b) found to require reatment 12,511 Number of (a) +(b) offered treatment 11,820 (c) Pupils re-inspected at school clinic 2,715 Number of (c) found to require treatme nt 1,151 Sessions: Sessions devoted to treatment (incl. 788 orthc >dontic se ssions) 3,225 Sessions devoted to inspection 234 Sessions devoted to Dental Health Education 24 112 SCHOOL HEALTH Category Day Table 57 Residential Handicapped Blind 1 children 3 Children in Partially sighted 8 special schools ■ Deaf 12 8 Partially hearing 31 3 Educationally sub-normal : (formally ascertained) 77* 15 (not formally ascertained) 112 — Epileptic — 3 Maladjusted 31 61 Physically handicapped 27 8 Speech — 1 Delicate 49 12 * Includes three girls living in Clay Hill Hostel for educationally sub-normal girls. Eleven children with more than one defect are included in the category of their major defect. 113 STAFF AND TRAINING STAFF AND TRAINING Medical Officer of Health and Principal School Medical Officer Staff W. D. Hyde, M B., Ch.B., D.P.H. Deputy Medical Officer of Health and Deputy Principal School Medical Officer J. D. Russell, M B., B.S., D.P.H. (resigned 14.2.70); B. J. Cooper, M.B., Ch.B., D.Obst.R.C.O.G., D.C.H., D.P.H., Barrister-at-Law (appointed 2.3.70). Principal Medical Officers Leonora A. Crawford, M.B., B.S., D.P.H., D.C.H.; M. L. Graeme, M.A., M.B., B.Ch., D.P.H. (resigned 16.8.70); Monica E. Watkins, M.B., B.S. (appointed 23.10.70). Senior Medical Officers Monica E. Watkins, M.B., B.S. (promoted Principal Medical Officer 23.10.70); Isobel H. Caddy, M.B., Ch.B., D.P.H. (appointed 21.12.70). Medical Officers in Department Grace J. Adam, M.B., Ch.B. (part-time from 18.2.70)-, Isobel H. Caddy, M.B., Ch.B., D.P.H. (promoted Senior Medical Officer 21.12.70); Janet F. Cambell, M.B., Ch.B., D.C.H. (part-time from 1.4.70); Theresa M. Chan Kin, M.B., B.Ch., B.A.O., D.P.H.; Rosa Merzer, L.R.C.P. and S. (Edin.), M.D. (Bologna); Nora T. U. O'Callaghan, M.B., B.Ch., B.A.O., D.P.H.; Joyce S. Parish, M.B., B.Ch.; Estella G. Pollock, M.B., B.S., D.C.H.; Mary Roland, M.R.C.S., L.R.C.P., D.P.H.; Ann J. Wiseman, M.B., B.S., D.P.H. (resigned 1.11.70). Consultant Psychiatric Advisers Mental Illness: F. D. Kelsey, B.M., B.Sc., D.P.M.; Sheila D. Miles, M.B., B.S., D.P.M. Consultant Chest Physician Mental Subnormality: W. Livingston, B.A., M.R.C.P., L.R.C.P., D.P.M. J. Vernon Davies, M.D., B.S., M.R.C.P. Hospital Consultants and Specialists (Undertaking sessions at Council Clinics) Ear, Nose and Throat: F. P. M. Clarke, B.Sc., B.A., L.R.C.P., L.R.C.S. (died 4.8.70); R. T. S. Goodchild, M.B., B.S., F.R.C.S.(Ed.), D.T.M. & H„ D.L.O.; M. B. Stanton, M.B., B.S., F.R.C.S., D.L.O. Orthopaedic: R. C. Farrow, M.A., B.M., B.Ch., F.R.C.S. Ophthalmic: E. M. Galton, M.B., B.S., D.O.M.S.; J. Joels, M.B., Ch.B., D.O.M.S.; K. Wahab, M B., B.S., D.O. Chief Dental Officer and Principal School Dental Officer T. J. Phillips, L.D.S., R.C.S. Orthodontists R. Bergman, L.D.S., D.(Orth.), R.C.S. (part-time)-, Helen E. Brearley, L.D.S., R.C.S.; Elizabeth C. Bird, B.D.S., L.D.S., D.(Orth.), R.C.S. (part-time). Dental Officers J. A. H. Edmonds, L.D.S. (U. Durh.), (part-time)-, Clara S. Emmer, M.D.; A. M. Irene Halsall, L.D.S., R.C.S. (part-time); Claire A. M. Lawson, L.D.S., R.C.S. (part-time)-, Myrtle L. Lovatt, L.D.S., R.C.S. (part-time); C. A. Martinez, L.D.S. (U. Liv.); C. Pollock, L.D.S., R.C.S.; Eva J. Salisch, B.D.S., L.D.S., R.C.S.; E. UnderhiII, L.D.S., R.C.S. (part-time from 8.9.70). 116 STAFF AND TRAINING Public Analyst T. McLachlan, A.C.G.F.C.. F.R.I.C.. M.I.Biol. Deputy Public Analyst (post Vacant). Veterinary Surgeon J. R. Stockman, M.R.C.V.S. Chief Public Health Inspector J. C. Lightfoot, F.A.P.H.I. Deputy Chief Public Health Inspector G. Rawlinson, M.A.P.H.I. Senior Public Health Inspectors R. L. Burkill, F.A.P.H.I.; G. E. Laney, M.A.P.H.I.; R. E. Williams, M.A.P.H.I. Principal Mental Welfare Officer A. Duff, Dip. S.SS., M.S.M.W.O. Deputy Principal Mental Welfare Officer S. S. Robinson, C.S.W. (resigned 15.7.70). Senior Mental Welfare Officers J. H. Cotton, M.A., C.P.S.W. (resigned 24.4.70); Mrs. H. M. Smith, R.M.N., S.R.N., C.S.W.; Mrs. C. Cooknell, B.Soc.S., C.S.W. (appointed 17.8.70). Superintendent Health Visitor Miss M. A. E. Radford, R.F.N., S.R.N., S.C.M., H.V. (retired 13.1.70). Deputy Superintendent Health Visitor Miss P. Z. M. J. MacLaughlin, S.R.N., S.C.M., H.V., P.H.A. (Cert.) Non-medical Supervisor of Midwives Miss M. Palmer, S.R.N., S.C.M., R.M.N, (retired 17.5.70); Miss D. Hall, S.R.N., S.C.M. (appointed 18.5.70). Senior Midwife Mrs. M. J. Fitzjohn, S.R.N., S.C.M. (retired 8.7.70); Mrs. P. Haddon, S.R.N., S.C.M. (appointed 9.7.70). Superintendent of Home Nursing Service Mrs. M. Pickering, S.R.N., N.D.N, (cert.). Senior Home Nurse Mrs. E. Maile, S.R.N. Home Help Organiser Mrs. G. Webber (retired 30.11.70). Area Home Help Organisers Miss A. Alcock; Mrs. B. I. Graham; Mrs. H. I. Tarrant. 117 STAFF AND TRAINING Chief Administrative Officer S. N. Dance. Deputy Chief Administrative Officer D. A. Hastings. Senior Administrative Officers E. J. A. Golding; L. G. Coe, F.R.S.H., D.M.A.; A. K. Clark, D.P.A.; A. Shaw, D.M.A. (resigned 13.9.70); S. Law (appointed 25.9.70). Other staff establishment Health visitors—group advisers (3), field work instructors (3), health visitors/school nurses (48), tuberculosis health visitors (2), student health visitors (6); midwives (30); home nurses (43), nursing auxiliaries (4); assistant area home help organisers (3); dental surgery assistants (11); mental welfare officers (9), trainee mental welfare officers (3); health education officer (1); health education technician (1); speech therapists (3); senior orthoptist (1); audiometer operators (2); physiotherapist/ remedial gymnast (1); chief chiropodist (1), chiropodists (6); medical social worker (1); pre-school playgroup organiser (1). Public Health Inspectors — specialists (3), district (16), student (6); shops and street trading inspectors (3); technical assistants (4). Senior administrative officers (2), administrative officers (9), senior clerical officers (4), clerical officers (51), shorthand/audio typists (11), telephonists (2), administrative trainee (1). Rodent control officer (1), rodent control assistants (3), sewermen (skilled) (7), disinfector/convenience foreman (1), disinfector drivers (2), convenience attendants (75), driver/cleaners conveniences (4), male cleaners conveniences (4), driver/handymen (3), porter/messenger (1), clinic/health centre caretaker/cleaners (19), home helps (160). Health Centre Administrative officer (1), clerical assistant (1); domestic staff (5). Day Nursery Matron — Miss M. W. Betteridge; deputy matron (1), warden (1), nursery nurses/students (10); domestic staff (5). Adult training centre Manager — W. J. Redmond; assistant manager (1), laundry supervisor (1), senior instructors (2), instructors (12), welfare assistant (1); domestic staff (4), van driver (1). Junior training school Head teacher — Mrs. E. F. Hudson; deputy head teacher (1), teachers (10), assistant supervisors (6), trainee supervisors (2), general assistant (1); domestic staff (3), coach guides (3). Mental health hostel Warden — H. Dutton; assistant warden (1); domestic staff (3). Hostel for mentally sub-normal children Warden —J. Bull; deputy warden resident (1), assistant warden resident (1), assistant wardens non-resident (3); domestic staff (3), coach driver (1). 118 STAFF AND TRAINING The following whole-time equivalent personnel comprise the establishment of the Health Department: Administrative, Professional and Technical Officers 413 Manual Workers 311 724 Dr. J. D. Russell, Deputy Medical Officer of Health, who was a most competent and co-operative colleague, left in February to return to his native Australia. His departure was a great loss to the department. We were, however, very fortunate in securing the capable services of Dr. B. J. Cooper who, in March, joined us from Cambridge as successor to Dr. Russell. There were other changes among the senior medical staff. We were sorry to lose the services of Dr. M. L. Graeme, Principal Medical Officer (School Health) who resigned to take up an appointment with the Department otf Education and Science. Dr. L. A. Crawford, who was Principal Medical Officer for Maternity and Child Health, transferred to the vacancy created by Dr. Graeme's resignation. Dr. M. E. Watkins, Senior Medical Officer for Mental Health, etc., was appointed Principal Medical Officer (Maternity and Child Health), and Dr. I. H. Caddy (Departmental Medical Officer), was appointed Senior Medical Officer. It is with deep regret that the death of Dr. F. P. M. Clarke on 4th August, 1970, is recorded. Dr. Clarke, as an E.N.T. consultant, had for many years undertaken a weekly session at the Broomfield Park Clinic. Several long-serving officers retired after many years of service in the area. Dr. G. J. Adam, Departmental Medical Officer, after twenty years devoted service to the mothers and children of the borough, retired from full-time service but agreed to continue in a part-time capacity, and we appreciate the continuation of her most competent and diligent service. Miss M. Radford (Superintendent Health Visitor), retired after 31 years service; Miss M. Palmer (Nonmedical Supervisor of Midwives), after 24 years; and Mrs. G. Webber (Home Help Organiser), after 23 years. All will be remembered for the many years of service they gave to the community in their respective spheres, as also will Miss M. M. James (nursery nurse), after 26 years, and Mrs. H. J. Grigson (home nurse), after 20 years' service. Miss M. J. Fitzjohn, who, in the latter years of her service, most competently undertook the duties of senior midwife, also retired after seven years service in the area of the borough. In the administrative sphere the retirement took place of Mr. B. R. Allen (senior administrative officer), after 35 years; Mrs. G. Ogden (administrative officer), after 22 years; Miss I. Bowie (clerical officer), after 30 years; and Miss G. Edwards (clerical officer), after 17 years. To all those officers who retired during the course of the year under review, I extend my thanks for their years of service. Several other officers resigned during the year to take up other appointments. These included Mr. A. Shaw, senior administrative officer; Mr. S. Robinson, Deputy Principal Mental Welfare Officer; and Mr. J. Cotton, Senior Mental Welfare Officer. Medical Assessment and Examination The London Borough of Enfield is a large employer of many categories of officers and manual workers. There are approximately 9,000 persons in the employ of the borough. Medical assessments undertaken by the Health Department for all departments of the Council totalled 1,888. 119 STAFF AND TRAINING Teachers Pre-employment Medical Assessments It is a requirement of the Department of Education and Science that all intending teachers before their entry into training colleges, and all teachers taking up their first teaching posts other than direct from a training college, shall be subject to medical examination. Those medically fit in these circumstances are admitted to a national superannuation scheme at the commencement of their careers. Sixty-three teachers and 216 trainees were passed as fit and were admitted to the national scheme. Other teachers transferring to the staff of the Council are subject to medical assessment or medical examination as may be necessary. There were 332 teachers assessed and of this number six required medical examination. None was found unfit. Others In accordance with the schemes of conditions of service laid down by the National Joint Council for Local Authorities' Administrative, Professional, Technical and Clerical Services, the Greater London Joint Council for Local Authorities' Services (Manual Workers), and the Whitley Councils for the Health Services, candidates for employment are medically assessed for fitness for admission to the Council's Sickness Pay and Superannuation Schemes. Nine hundred and five assessments were made. In thirty-five cases medical examination was necessary and three were found to be unfit. Sickness Absence Medical Assessments Medical assessments were made in accordance with the schemes of conditions of service relating to prolonged absence due to illness and thirty-four employees were found to be incapable of discharging efficiently the duties of their employment. Remission of Pension Contributory employees are subject to medical examination when they wish on retirement to remit part of their pension under the schemes of conditions of service. No such case arose during the year. Training The training of staff is a matter of major importance, not only to ensure that administrative, professional, technical and clerical officers obtain at least basic qualification, but also to see that officers keep abreast of modern developments. Facilities for training are offered by a large number of educational bodies throughout the country, and London is particularly fortunate. The Education Committee of the Greater London Whitley Council, of which the borough council is a member, provides vocational courses of benefit to local government officers. The Borough Council is also a member of the London Boroughs' Training Committee, which provides centrally organised opportunities for training which develop and sustain the skills of workers in the Health, Welfare and Children's Departments. 120 STAFF AND TRAINING The Borough Council has an Advisory Committee on Education, Training and Qualifications of local government officers. The Committee consists of representatives from each of the main departments of the borough council. Dr. B. J. Cooper represented the Health Department. The Advisory Committee meets regularly to consider and make recommendations concerning applications by officers for approval to attend courses leading to recognised qualifications. A half-day meeting held in January and organised by the Principal Medical Officer for School Health, was attended by 107 members of the Health, Education, Children's and Welfare Departments of this Borough and of the neighbouring Boroughs of Barnet and Haringey. The meeting, with the permission of the Chief Education Officer, was held at the Teachers' Centre, Craddock Road, Enfield, and the subject was " Subnormality and Severe Subnormality The principal speaker was Dr. Livingston (Deputy Physician Superintendent, Leytonstone House Hospital), who explained the problems facing hospitals for the subnormal and severely subnormal. Miss Bambridge, one of the Borough's educational psychologists, discussed psychometric assessments; and Mr. Griffiths and Mr. Queen, Headmasters of Oaktree and Durants Schools for Educationally Subnormal Pupils, respectively, spoke on the education of the subnormal child. Unfortunately, Mrs. Hudson, Head Teacher of the Junior Training School, was prevented by illness from attending the meeting, where she was to have spoken on the care of the severely subnormal child. This most informative meeting concluded with the showing of some colour slides on the activities at Durants School. The in-service training courses for selected groups of home helps were continued during 1970. Each course consisted of five separate talks, followed by discussion, each session lasting altogether about two-and-a-half hours. The Home Help Organiser gave the introductory and final talks. During the sessions a principal medical officer, a mental welfare officer, a welfare officer, a midwife and a home nurse all gave addresses. The Health Education Officer gave a practical demonstration on the prevention of accidents in the home. A further demonstration was given with the help of the Casualties Union, during the home nursing sessions. The talk on mental welfare included the showing of the film " Stress The continued success of this in-service training is most encouraging. Lectures were arranged within the Department for health visitors on the following subjects: the implication and implementation of health education; the care of children's feet; obesity; and young children in brief separation. Courses attended by Health Department staff (the number of officers attending is shewn in brackets after each course) Medical Officers National Association for Mental Health refresher course — 5 days (1); Home dialysis —1 day (1); Developmental paediatrics in general practice and child health— ten Thursdays (1); The Handicapped Child — 2 days (1); Obstetrics and gynaecology — 2 days (1); Obstetrics and gynaecology and problems of planned parenthood — 5 days (1). Dental Officers and Assistants Diploma in Dental Public Health — 3 terms of ten weeks (1); Course for dental nurses — two terms part time (2). 121 STAFF AND TRAINING Public Health Inspectors Weekend Seminar — 3 days (4); Advances in Food Inspection — 3 days (2); Noise control — 5 days (1); Measurement of Dust Concentration and size of Ducts and Chimneys — 2 days (1); Bacteriology of Food Inspection and Preservation — Day release (1); Poultry Hygiene and Inspection — 3 days (1); Specification and Estimates for repair and maintenance and improvements of buildings—Day release 30 weeks (2); Public Health Inspectors Diploma of Public Health Inspectors Education Board — Sandwich course for 3 years (2), Day release for 4 years (4); Diploma in Air Pollution — Day release 1 year (2). Mental Welfare Officers Certificate in Social Work — 2 year course second year (2), first year (3); Course for Mental Health social workers-—day release (2). Health Visitors Field work instructors course — 3 parts, each of 10 days (1); Refresher course —10 days (1); General practitioner attachment —10 days (1); Course for Local Government Officers employed in Health Departments — 2 parts each of 10 days (1); Discussion group—'Methods for Health Visitors — 6 Mondays (1); Health visiting, the next decade — 5 days (1); Health Visitors training course — 1 year (8); Detection of hearing defects in infant and pre-school children — 2 days (2); Health Education in schools — 2 days (1). Midwives and Home Nurses Nurse administrators — 5 days (1); Practical work instructors course — 10 days (1); District Nurse training course —13 weeks (4); Refresher courses for midwives — 1 week (3); First line management — 5 days (1). Home Help Organisers Recall days — 1 day (3); Weekend school — 3 days (1). Health Education Technician Intensive Course G.C.E. 'A' level — 1 term (1). Administrative and Clerical Officers Induction course — day release (5); Diploma in Municipal Administration — day release (4); Local Government Examination Board examination — day release (1). Day Nursery Students Further course in nursery education — 6 weeks (1); Nursery Nurses examination board nertificatfi course — riav release (R) Staff at Junior Training School Course for Teachers of Mentally Handicapped Children — 2 year course (1). Staff at Adult Training Centre Course for instructors in Adult Training Centres — day release (1). 122 INDEX INDEX Pages on which Statistical Tables appear are indicated in bold type. Accidents: Fatal 10 Road 10 18 Young Children 26 Adult Training Centre 46 Aircraft 12 Alcoholism 48 Ambulance Service 36 Analgesia—Midwifery 30 Animal Care 83 Ante-natal Clinics 23 51 Assessment Centres 23 Atmospheric Pollution: Industrial 71 Measurement of 71 "At Risk" Register 25 Audiometric testing 24 Barbers' Premises 78 Baths, Washhouses, Bathing Places, etc.68 "Battered Babies" Syndrome 25 B.C.G. Vaccination—see Vaccination and Immunisation Bed-linen, Loan of 39 Bees 83 Betting and Gaming Premises 79 Births 9 Blindness and Partial Sight, Certification of 49 64 Bodies Concerned with Health Services 5 Burial and Cremation 85 Canal Boats 77 Caravans 76 Carcinogenic aromatic amines in schools and other educational Establishments, avoidance of 105 Carcinoma of the Cervix of Uterus, Population Screening for 29 Care and After Care 36 58 59 Chest Disease, Non-tuberculous 38 Child Guidance 100 111 Child Minders 28 Child Health 23 51 Assessment Centres 23 Children, Employment of 104 Children in Care 28 104 Children Unsuitable for Education at School 103 Chiropody 39 59 Chronically Sick and Disabled Persons Act, 1970 105 Clean Air 70 87 Cleanliness, Inspections for 98 109 Clinics: Ante-natal 3 51 Child Guidance 100 111 Child Health 23 51 Chiropody 39 59 Ear, Nose and Throat 24 99 109 Health Advice for the Elderly 40 Immunisation at 34 Minor Ailments 98 109 Ophthalmic 24 99 110 Orthopaedic 24 99 110 Orthoptic 24 99 110 Post-natal 23 51 Premises 24 Smokers' 40 60 Speech 24 99 111 Colour Vision 97 Committees: Education 5 Health 4 Social Services 4 Congenital Abnormalities 25 Co-ordination— Personal Health Services 28 Council 4 Courses: see Staff Cremation and Burial 85 Day Care for Priority Groups 27 Deaths 9 16 19 Infants 10 15 Dental Service: Mothers and Young Children 24 52 School Children 101 112 Development Plan 48 63 Diphtheria, Immunisation against 34 56 57 Disinfection 12 Disinfestation 82 Disposable Equipment—home nursing 32 Domestic Help 62 Drug Dependency 47 Dysentery 104 Ear, Nose and Throat Clinics 99 109 Education Committee 5 Education: Schools Sub-Committee 5 Elderly Persons, Advice Clinics for 40 Employment Agencies 80 Employment of Children 104 Enfield Association for Mental Health 43 Enfield Society for Mentally Handicapped Children 45 Enuresis 100 Environmental Health Services 65 Exhumations 85 Factories and Workplaces 80 91 92 Family Planning 26 Fluoridation of Public Water Supplies 41 "Flying Squad" Service— see Midwifery Food and Drugs.: 72 88 89 Complaints 73 Composition and labelling 73 Food Premises—Registration of 74 Hygiene . 74 Ice-Cream 74 88 Milk, dairies and cream substitutes 74 Unsound food 74 Food Poisoning 11 Foot Inspections 98 General Statistics 13 Guardianship 47 Hairdressers' and Barbers' Premises 78 Handicapped Children 102 113 Handicapped children in playgroups 27 Health Centres 23 Health Committee 4 Health Department Premises (see map) Health Education 41 Health Visiting 31 54 Health Visitors: Ancillary help 31 Liaison with general practitioners 31 Liaison with hospitals 31 Hearing Tests 97 108 Holiday Camps 47 Holidays—Recuperative 40 100 Home and Hospital Tuition 103 Home Help Service 48 62 Home Nurses: Ancillary help 33 Liaison with general practitioners 32 Home Nursing: 32 55 Disposable equipment 32 Hospital Services 104 124 INDEX Pages on which Statistical Tables appear are indicated in bold type. Housing : 75 90 91 Acquisition and improvement of houses 76 Multiple occupation 75 Overcrowding 75 Rent regulation 76 Slum Clearance 75 Unfit houses 75 Hypothermia 41 Immigrants 37 Immunisation—see Vaccination and Immunisation Incontinence Pads and Clothing 39 Incontinent Persons, Laundry Service for 50 Incubators, Portable 30 Infectious Disease, Prevalence and Control of 11 19 104 Infective Jaundice 11 Inquests 10 Inspections and Complaints 81 92 93 Inspections for Cleanliness 98 109 International Certificates of Vaccination 35 Ionising Radiations 84 105 Junior Training Schools 45 Kidney Machines—adaptation of homes 41 Laboratory Service 12 20 Land Charges 76 Laundry Service for Incontinent Persons 50 Licensed Premises 79 Marie Curie Memorial Foundation 32 Market and Street Trading 78 Markets, Slaughterhouses and Knackers' Yards 75 Massage and Special Treatment Establishments 79 Mass Radiography 38 Measles 11 —Immunisation against 35 56 57 Medical Assessment—Staff 119 Medical Inspection—School Children 97 106 107 108 Medical Treatment—School Children 98 109 Meningitis 12 Mental Health, Enfield Association for 43 Mental Health Service: 42 61 62 Mental Illness: 42 Day Rehabilitation Centres 43 Discussion Group 44 Domiciliary Service 43 Hospital admissions 43 Residential accommodation 44 Social Centres or Clubs 44 Mentally Handicapped Children, Enfield Society for 45 Mental Subnormality: 45 Adult Training Centre 46 Domiciliary Service 45 Guardianship 47 Holiday Camps 47 Hospital Admissions 47 Informal foster care 47 Junior Training Schools 45 Residential accommodation 47 Temporary care 47 Mice 83 Midwifery: 29 Analgesia 30 "Flying Squad" Service 30 Planned Early Discharge 29 Midwives: Co-operation with general practitioners 30 Notification of intention to practise 30 53 Minor Ailments Clinics 98 109 Mortuary 85 Mothercraft and Relaxation 31 51 Mothers and Young Children 23 51 52 Neighbourly Help Scheme 48 Noise 81 Non-fatal accidents to young children in their homes 26 Nutrition 100 Nurseries and Child Minders 28 Nurses' Agencies 79 Nursing Equipment, Loan of 39 Nursing Homes: 49 General 49 Maternity 49 Mental 49 Offensive Dressings 30 Offensive Trades 81 Offices and Shops 77 91 Ophthalmic Clinics 24 99 110 Orthopaedic Clinic 24 99 110 Orthoptic Clinics 24 99 110 Outworkers 80 Personal Health Services : 21 Co-ordination of 28 Persons in Need of Care and Attention 49 Pest Control 83 Phenylketonuria 25 30 Pigeons 83 Placentae and Offensive Dressings, Disposal of 30 Playgroups 27 Poliomyelitis 12 57 —Immunisation against 35 56 Post-natal Clinics 23 51 Premature Infants: Care of 30 53 Premises, Health Department 24 Problem Families 28 Prophylaxis, Care and After-Care 36 58 59 Public Conveniences 69 Public Health Laboratory Service 12 20 Rag Flock and Other Pilling Materials 81 Rats and Mice 83 Recuperative Care 40 100 Refuse Collection and Disposal 69 Relaxation and Mothercraft 31 51 Research 105 Rodent Control— see Pest Control Rubella—Immunisation against 56 Scabies 104 School Health Service 95 Sewerage and Sewage Disposal 68 Ships 12 Shops and Offices 77 91 Slimmers' Advisory Centres 32 Slum Clearance 75 Smallpox : Vaccination against 34 57 Smoke Control Areas 70 87 Smokers' Clinic 40 60 125 INDEX Pages on which Statistical Tables appear are indicated in bold type. Social Conditions 9 Social Services Committee 4 Sonne Dysentery—see Dysentery Specialist Clinics—see Clinics Special Schools: 103 113 Speech Therapy 111 Speech Clinics 99 111 Staff: 116 Courses 121 Medical assessment and examination 119 Training 30 32 33 48 Vaccination of 35 Statistics and Social Conditions 7 Statistics : General 13 Vital 9 14 Street trading 78 Sub-Committees: Education Schools 5 Health Sub-Committee 4 Social Services Sub-Committee 4 Suicide 10 Ten-Year Plan for Health Services 48 62 Tetanus: Immunisation against 35 56 57 Training of Staff of Other Agencies ... 30 33 Training—Staff 120 Tuberculosis: 11 19 37 58 Home visiting 37 Rehabilitation 38 Vaccination against 38 57 Typhoid Fever 11 Unfit Houses 75 Unsupported Mother and Her Child 24 Vaccination and Immunisation: 33 56 104 Diphtheria 34 56 57 International Certificates 35 Measles 35 56 57 Poliomyelitis 35 56 57 Publicity 34 Rubella 56 Smallpox 34 57 Staff 35 Tetanus 35 56 57 Tuberculosis (B.C.G.) 38 57 Vaccines, distribution of 35 Whooping Cough 34 56 57 Venereal Disease 39 59 Vermin, Infestation with 109 Vital Statistics 9 14 Vitamin supplements 24 Wasps and Bees 83 Water Supply: 67 85 86 Fluoridation of 41 Welfare Foods and Vitamin Supplements 24 Whooping Cough : Immunisation against 34 56 57 Workplaces 80 91 92 Workshops 80 91 92 126