AC 43337 THE HEALTH OF ENFIELD 1971 A report by the Medical Officer of Health and Principal School Medical Officer WILLIAM D.HYDE. M.B. Ch.B.. D.PH. ENF 55 THE HEALTH OF ENFIELD 1971 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 59 School Health Services 85 Staff and Training 105 Index 113 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 1971. The report surveys in some detail the activities of the Health Department during the year, and 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. I am glad to say that the vital statistics for the borough compare favourably with the national figures but it is depressing to have to report an increase in deaths from lung cancer by 20% over last year's figure and nearly 30% over the figure three years ago. In the realm of communicable diseases, it is disappointing to note the increased incidence of venereal disease. It is disappointing, also, to have to record a fall in the number and percentage of children for whom their parents accepted various immunisation procedures against infectious diseases. During the year certain activities of the Health Department, especially those concerned with Mental Health, became the responsibility of the newly formed Social Services Department. The emphasis placed by the Council and by its predecessor on the importance of developmental plans for the Community Mental Health Services has resulted in the present extensive services provided within the Borough. These - detailed in the body of this Report - include a twenty-four hour cover for domiciliary services and hospital admissions; a variety of hostels; an adult training centre providing not only a wide range of assembly work but also a laundry and contract gardening; and a junior training centre (now Waverley School) with a nursery group and special care unit. The services include arrangements for foster care, guardianship, holiday camps and other holiday arrangements, and provision has also been made for psychiatric, psycho-geriatric and assessment clinics, a social centre and evening social clubs, discussion groups and sports days. A request was received from the Department of Health and Social Security for co-operation in promoting parallel development of community and hospital services for the mentally ill. This is of particular importance in view of the planned hospital development within the Borough in the immediate future. Once again, I am indebted and grateful to 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 colleagues in other departments. WILLIAM D. HYDE Medical Officer of Health Principal School Medical Officer 1 . THE COUNCIL THE COUNCIL Mayor Alderman W.J. Watsor,F.R.I.C.S. Deputy Mayor Councillor L.I. Genn The Council Aldermen Mrs. S.G. Child, W.H. Cook, P.G. Elvidge, Mrs. A.L. Emsden, J.L. Lindsay, E.G. McNern, W.A.A. Poole, E.S. Taylor, W.J. Watson, F.R.I.C.S., A.J. Young. Councillors J.A. Alcock, D.W. Attridge, Mrs. P.J. Attridge, K.V. Balding, J.A. Barkus, Mrs. V.W. Bennett, D.L. Bernstein, A.C.A., C.G. Bobbin, J.R. Bowyer, L. Carton, E.E. Collingridge, J.A.B. Connors, Mrs. E.C. Cousins, J.J. Cusack, R. Daultry, C.S. Dawson, R.L. Dubow, M.A. (Oxon), G.G. Eustance, M.D. Frohnsdorff, M.A. (Cantab), Mrs. I.V. Garvey, L.I. Genn, C.C. Goldwater, M.lnst.M., B.G. Grayston, M.J. Green, H.G.S. Groves, J.P., W.E. Haynes, E.T. Hendrick, J.W.E. Jackson, A. Jay, Mrs. P.E. Joel, T.G.G. Joel, R.G. Kendall, A. Kinsler, C.G. Lacey, L.F. Lafitte, H.E. Latty, G. Leigh, J.P., Mrs. A.M. Lennox, J.P., Mrs. H. Lewis (resigned 31.8.71), Mrs. A.R. Lindsay, 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, Miss P. Oborn, J.G. Payne, F.R. Pleasance, J.D. Reed, Revd. A.C. Rogers, M.A. (Cantab), R.F. Simmons, M. Simpson, E.J.C. Smythe, Mrs. R.A. Smythe, W.J. Stiles, G.W. Taylor, P.A. Thomas, A.D. Veitch, L.J.D. Warren, Mrs. F.E. Watson, J.A. Wyatt. Health Committee Chairman Councillor Mrs. P.E. Joel Vice-Chairman Councillor A. Jay Alderman W.H. Cook Councillors J.A. Barkus, J.J. Cusack, G.G. Eustance, M.J. Green, V.A. Maskens, J.G. Payne, Mrs. R.A. Smythe. Advisory Member Dr. W.J.G. Meldrum Education Committee Chairman Alderman Mrs. A.L. Emsden Vice-Chairman Councillor G. Leigh, J.P. Aldermen Mrs. S.G. Child, W.H. Cook, W.A.A. Poole, E.S. Taylor, W.J. Watson (ex-officio), A.J. Young (ex-officio) 4 THE COUNCIL Councillors Mrs. P.J. Attridge, J.A. Barkus, D.L. Bernstein, A.C.A., C.G. Bobbin, Mrs. E.C. Cousins, R. Daultry, C.S. Dawson, R.L. Dubow, M.A. (Oxon), G.G. Eustance, M.D. Frohnsdorff, M.A. (Cantab), L.I. Genn, C.C. Goldwater, B.G. Grayston, E.T. Hendrick, A. Jay, Mrs. P.E. Joel, T.G.G. Joel, C.G. Lacey, L.F. Lafitte, Mrs. A.M. Lennox, J.P., Mrs. H. Lewis, B.A. (resigned 31.8.71), Mrs. A.R. Lindsay, Mrs. P. Lyon, Miss P. Oborn, J.G. Payne, A.C.J. Rogers, M.A. (Cantab), R.F. Simmons, M. Simpson, W.J. Stiles, Co-opted Members L.J.D. Warren, Mrs. F.E. Watson, J.A, Wyatt. 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. H.J. Emsden, B.Sc. (Eng.), (Lond.), Miss K.J. Harvey, Revd. D. Jameson, Mrs. M. Jepson, Mr. H.S. Newman, B.Sc., B. Sc. (Econ). Mr. R. St. John, Revd. A. Skelding, B.A., Mr. R.G. Vos, B.Sc. Schools Sub-Committee Chairman Alderman Mrs. A.L. Emsden. Vice-Chairman Councillor Mrs. P. Lyon. Alderman W.H.Cook. Councillors C.S. Dawson, R.L. Dubow, M.A. (Oxon.), C.C. Goldwater, B.G. Grayston, Mrs. P.E. Joel, T.G.G. Joel, G. Leigh, J.P., W.J. Stiles, L.J.D. Warren. . Co-opted Members Mr. L.J. Crocker, Mrs. M. Jepson, Mr. H.S. Newman, B.Sc., B.Sc. (Econ.) Members of Council appointed to Bodies concerned with Health Services Association of Municipal Corporations — Health Committee: Councillor G. Leigh, J.P. Enfield Group Hospital Management Committee: Councillor J.J. Cusack. Enfield Marriage Guidance Council: Councillor Mrs. V.W. Bennett, Councillor Mrs. P. Lyon. Family Planning Association: Councillor A. Jay. Lee Conservancy Catchment Board: Councillor T.G.G. Joel. London Accident Prevention Council: 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, Alderman Mrs. A.L. Emsden, Councillor Mrs. A.R. Lindsay. National Society of Children's Nurseries: Councillor J.G. Payne. National Society for Clean Air: Councillor M.J. Green, Councillor Mrs. E.C. Cousins. Pre-School Playgroups Association — Enfield Branch: Councillor A. Jay, Councillor Mrs. P.E. Joel. Southgate Social Services Council: Councillor G. Leigh, J.P., Councillor L.F. Lafitte. Standing Conference on Investigation of Atmospheric Pollution: Alderman W. H. Cook. 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-1971 Estimate) 266,230 Number of structurally separate dwellings, including flats 91,408 Number of dwellings constructed during the year 725 Rateable value £19,301,215 Product of a new penny rate £190,000 Live Births Number 3,828 Rate per 1,000 population (crude) 14.4 Ratio of local adjusted birth rate to national rate 0.94 Rate per 1,000 population (standardised) 15.0 England and Wales 16.0 Illegitimate live births per cent of total live births 7.0 England and Wales 8.0 Stillbirths Number 42 Rate per 1,000 total live births and stillbirths 11.0 England and Wales 12..0 Total live and stillbirths 3,870 Infant Mortality Infant deaths (deaths under the age of 1 year) 57 Total infant deaths per 1,000 total live births 14.9 England and Wales 18.0 Legitimate infant deaths per 1,000 legitimate live births 14.0 England and Wales 17.0 Illegitimate infant deaths per 1,000 illegitimate live births 27.0 England and Wales 24.0 Neo-natal mortality rate (deaths under age of 4 weeks per 1,000 total live births) 10.0 England and Wales 12.0 Early neo-natal mortality rate (deaths under the age of 1 week per 1,000 total live births) 8.0 England and Wales 10.0 Perinatal mortality rate (stillbirths and deaths under the age of 1 week combined per 1,000 total live and stillbirths) 19.0 England and Wales 22.0 Maternal Mortality (including abortion) Number of deaths 1 Rate per 1,000 total live and stillbirths 0.3 Deaths Number of deaths from all causes 3,139 Death rate per 1,000 home population (crude) 11.8 Ratio of local adjusted death rate to national rate 0.97 Death rate per 1,000 home population (standardised) 11.2 England and Wales 11.6 Deaths from cancer (all forms) 728 Death rate from cancer (all forms) per 1,000 population 2.7 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 266,230 and a rateable value of £19,301,215. 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. The amenities of the borough are soon to be improved by the addition of two new golf courses: one now under construction at Trent Park; the other near the eastern boundary at Picketts Lock, where the Lea Valley Park Plan includes a golf course and recreational facilities - now well advanced. 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, Silver 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, but work is in progress to extend the Civic Centre in Silver Street to accommodate the staffs of all the Council's main departments. Vital Statistics Births The total number of live births during the year was 3,828, giving a crude birth rate of 14.4 and a standardised birth rate of 15.0 compared with the rate for England and Wales of 16.0. Deaths The number of deaths during the year was 3,139 (1,593 males and 1,546 females), giving a crude death rate of 11.8 and a standardised death rate of 11.2 (England and Wales 11.6). The more prevalent causes of death were cardio-vascular system 1,626, malignant neopasm 728, and diseases of the respiratory system (excluding malignant neoplasm) 435. Of the cardio-vascular causes 849 were due to ischaemic heart disease, 392 to cerebro-vascular disease, 75 to hypertensive disease, 31 to chronic rheumatic heart disease, 134 to other forms of heart disease, and 145 to other diseases of the circulatory system. Of the malignant neoplasm causes of death 222 (of which 177 were males) involved the lung and bronchus, 78 the intestine, 63 the stomach, 86 the breast, and seven the cervix of the uterus. Of the diseases of the respiratory system, bronchitis and emphysema accounted for 151 deaths, pneumonia 244 deaths and tuberculosis six deaths. There were no deaths during the year from diphtheria, whooping cough, poliomyelitis or measles. 9 STATISTICS AND SOCIAL CONDITIONS Forty-six per cent of all deaths, 551 males and 897 females, were of persons aged 75 years or more. Thirty per cent, i.e. 302 males and 641 females, were of persons aged 80 years or more. Nine males and 34 females were aged 95 years or more including five females, two aged 100 years and three aged 101 years. There was one death arising from abortion. Deaths of infants During the year there were 57 deaths of infants under the age of one year, of which 38 were under the age of four weeks and 31 under the age of one week. The Infant Mortality Rate for the borough was 14.9 compared with 18.0 for England and Wales. Most of the deaths of children under the age of four weeks were due to congenital anomalies, birth injury and difficult birth, whereas most of those over the age of four weeks were due to pneumonia and other diseases of the respiratory system. Fatal Accidents During the year under review, 26 (18 male, eight female) Enfield residents died as a result of motor vehicle accidents, and 41 (20 male, 21 female) from other accidents. A surprising number of deaths continues to occur from accidents in the home. In addition there was the depressing figure of 22 (eight male, 14 female) deaths from suicide. Inquests Ninety inquests and 518 post-mortem examinations without inquests were held during the year. In respect of inquests, six deaths were attributed to natural causes, 53 to accidental causes or misadventure, 22 to suicide, one to manslaughter, and in eight cases an open verdict was recorded. Road Accidents The Borough Engineer and Surveyor has kindly provided statistics, and the following report and opinion on road accidents which occurred in the Borough: "The number of persons injured on the roads of the Borough during 1971 totalled 2,026, a reduction of 29 on the previous year. Whilst a reduction is a step in the right direction, a closer look at the statistics reveals some disturbing features. Despite an overall reduction there were increases in the following categories:- (i) Serious and fatal casualties have risen to 323, an increase of 18% on the 1970 figure; (ii) Casualties to children have risen by 10%; (iii) Casualties to the elderly have risen by 4½%. It is difficult to generalise on the increasing numbers of serious and fatal injuries but factors include the following - the increasing density of vehicles on the highway, the inability due to financial limitations of improving the road network to deal safely with this increased density, the failure of many motorists to observe the Highway Code and the law. There appears to be a general unwillingness by society, to judge by some Court decisions and press articles, to accept the seriousness of driver responsibility in fatal accidents. 10 STATISTICS AND SOCIAL CONDITIONS The increase in child casualties has taken place mainly in the 'under 5-year old' age group. There is good reason to believe that many of these accidents would not have occurred if the child had been accompanied by an adult. One-third of the children in this category were injured whilst travelling in private cars. The need for a safety harness with or without special seats cannot be overemphasised." (See Tables, 1,2,3,4 and 5). Prevalence and Control of Infectious Disease part v. Public Health Act 1936 Sections 47-49 Health Services and Public Health act 1968 Public Health (Infectious Diseases) Regulations 1968 Provisions relating to the notification of infectious disease and food poisoning by medical practitioners to the Medical Officer of Health are found in Part V of the Public Health Act 1936, Sections 47 - 49 of the Health Services and Public Health Act 1968, and the Public Health (Infectious Diseases) Regulations 1968. One thousand, two hundred and thirteen notifications were received, and of these 467 (38%) were school children. In addition, head teachers reported 350 cases of suspected infectious disease. Measles Over 59% of the notifications were for measles: 719 cases, showing a substantial decrease on last year's figure of 1,660 cases. Tuberculosis Sixty-four cases of respiratory tuberculosis were notified. Twelve cases of tuberculosis of other organs were also notified including genito-urinary tract and neck glands. There were six deaths from respiratory tuberculosis. Food Poisoning Seventy-eight cases of food poisoning were notified, a substantial increase on last year's figure. The causative organism was Clostridium Welchii in 43 cases while Salmonella organisms accounted for 29 of the remaining cases. An outbreak of Clostridium Welchii food poisoning occurred in May in four primary schools. Thirty-four staff and six children were affected in the four schools, which are all supplied with school meals from the same kitchen. The item of food responsible was beef served for lunch on the day preceding the outbreak. The causative organism was isolated from the meat and from faecal specimens obtained from some of the patients. Infective Jaundice Thirty-one cases of infective jaundice were notified and contact with a known case was established in four instances. Five of the other cases were known to have eaten shellfish within the previous 40 days. Dysentery (Sonne) Sixty-seven cases were notified as against 29 persons last year. Two schools were affected by small outbreaks of Sonne Dysentery involving 23 children. Typhoid and Paratyphoid Fever No cases of typhoid or paratyphoid fever were notified during the year. Meningitis (acute) Fourteen isolated cases were notified. There was one death. Poliomyelitis No cases of poliomyelitis were reported in the Borough during the year. Malaria One case of malaria was notified, the patient having contracted the disease abroad. 11 STATISTICS AND SOCIAL CONDITIONS Public Health (Ships) Regulations 1970 Public Health (Aircraft) Regulations 1970 Port Authorities notified 196 and fifteen persons respectively as arriving from declared cholera and smallpox areas. One hundred and eighty-nine of the 196 persons had been on holiday in Spain and Portugal, which in the Autumn had been declared cholera endemic areas. All were kept under surveillance for the statutory period and in no case did they develop cholera or smallpox. Disinfection Sections 166-168 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 may be necessary to take more rigorous action by treating the premises with Formaldehyde. During the year it was found necessary to treat only one property in this way. 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 52 garments, 234 library books and 171 miscellaneous items. Used clothing, consisting of 45 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 tion boxes are positioned at various points throughout the borough. The specimens are collected from the boxes daily and delivered to the laboratory. We record our appreciation of the invaluable service made available throughout the year by the Director, Dr. Thom, and his staff. (See Tables, 6,7, and8). 12 STATISTICS AND SOCIAL CONDITIONS Table 1 General Statistics Area:(ln acres) 20,061 Population: (Registrar General's mid-1971 estimate) 266,230 Number of structurally separate dwellings, including flats 91,408 Number of dwellings constructed during the year 725 Rateable value (at 31st December 1971) £19,301,215 Product of a new penny rate: (1971/72 revised estimate) £190,000 13 STATISTICS AND SOCIAL CONDITIONS Table 2 Vital Statistics 1971 LIVE BIRTHS Males Females Total EARLY NEO-NATAL DEATHS (deaths under the age of 1 week): Males Females Total Legitimate 1,858 1,710 3,568 Illegitimate 116 144 260 Legitimate 15 11 26 Illegitimate 1 4 5 1,974 1,854 3,828 16 15 31 Rate per 1,000 Population Rate per 1,000 live births: Enfield (Crude) 14.4 Enfield 8.0 Enfield (Standardised) 15.0 England and Wales 10.0 England and Wales 16.0 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 Legitimate 33 28 61 Illegitimate 6 6 12 STILLBIRTHS Males Females Total 39 34 73 Legitimate 18 17 35 Illegitimate 5 2 7 Rate per 1,000 live and stillbirths: 23 19 42 Enfield 19.0 England and Wales 22.0 Rate per 1,000 live and stillbirths: Enfield 11.0 MATERNAL MORTALITY (Including abortion): England and Wales 12.0 Number of deaths 1 Rate per 1,000 live and stillbirths: Enfield 0.3 INFANT DEATHS (deaths under the age of 1 year): Males Females Total DEATHS FROM ALL CAUSES Legitimate 26 24 50 Illegitimate 3 4 7 Males 1,593 29 28 57 Females 1,546 Total 3,139 Rate per 1,000 live births: Rate per 1,000 population: Enfield: Legitimate 14.0 Enfield: Illegitimate 27.0 Enfield (Crude) 11.8 Enfield: Combined 14.9 Enfield (Standardised) 11.2 England and Wales: Combined 18.0 England and Wales 11.6 NEO—NATAL DEATHS (deaths under the age of 4 weeks) : DEATHS FROM CANCER (all forms): Males Females Total Males 376 Legitimate 17 16 33 Females 352 Illegitimate 1 4 5 Total 728 18 20 38 Rate per 1,000 live births: Rate per 1,000 population: Enfield 10.0 Enfield 2.7 England and Wales 12.0 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. 14 STATISTICS AND SOCIAL CONDITIONS Table3 Infant Mortality Deaths from stated causes at various ages under one year of age Cause of Death Under 4 weeks 4 weeks and under 12 months Total deaths under 1 vear Enteritis and other diarrhoeal diseases – 1 1 Heart disease — 1 1 Pneumonia 3 6 9 Other diseases of repiratory system 1 8 9 Intestinal obstruction and hernia 1 — 1 Congenital anomalies 11 1 12 Birth injury, difficult labour, etc 13 1 14 Other causes of perinatal mortality 9 – 9 All other external causes — 1 1 TOTALS 38 19 57 15 STATISTICS AND SOCIAL CONDITIONS Table 4 Causes of, and ages at, death CAUSE OF DEATH Sex All Ages Under 4 weeks 4 weeks & under 1year Age in years 1-4 5-14 15-24 2534 35-44 45-54 55-65 65-74 75 and over Enteritis and other Diarrhoeal Diseases M _ _ — _ - - - - - - - - F 1 – 1 – – – – – – – – – Tuberculosis of Respiratory System M 1 — — — — — — — — 1 — — F 1 — — — — — — — — — 1 – Late Effects of Respiratory T.B. M 2 _ _ _ _ – – – – 1 1 — F 2 — — — — — — — 1 1 — — Other Infective and Parasitic Diseases M 2 – – – – – – – – 2 – – F 4 - - - - - — — 1 1 2 Malignant Neoplasm, Buccal Cavity etc. M 1 — — — — — — — — — 1 – F 6 — — — — — — — — 2 1 3 Malignant Neoplasm, Oesophagus M 11 — — - - - - - 1 5 3 2 F 5 — — — — — — — — 2 1 2 Malignant Neoplasm, Stomach M 45 — _ _ - - - - 3 12 20 10 F 18 — — — — — — — — 8 5 5 Malignant Neoplasm, Intestine M. 34 — _ - - - - 1 2 13 7 11 F 44 — — — — — — — 3 12 11 18 Malignant Neoplasm, Larynx M 2 _ — - — - - - - 1 1 - F _ _ _ _ _ — — — — — — — Malignant Neoplasm, Lung, Bronchus. M 177 _ _ _ _ _ - 1 10 67 72 27 F 45 - - - - — 1 1 8 7 15 13 Malignant Neoplasm, Breast M 1 — — — — — — – — – 1 12 F 85 — — — — — — 5 17 31 20 1 Malignant Neoplasm. Uterus F 15 — - - — — — 1 2 3 5 4 Malignant Neoplasm, Prostate M 21 — — — — — — — — 3 7 11 Leukaemia M 10 - - - - 1 - - 1 2 3 3 F 6 — — 1 1 — — — — 1 — 3 Other Malignant Neoplasms M 80 – _ _ 1 1 2 1 8 23 27 17 F 122 - - - - 2 2 8 14 20 38 38 Benign and Unspecified Neoplasms M 2 — — — 1 — — 1 — – – – F 4 – — — — — — — — — 3 1 Diabetes Mellitus M 5 — _ - - - - 1 - 2 1 1 F 15 – - - - - — — — 1 6 8 Other Endocrine etc. Diseases M — — — — — — — – — – – – F 3 — — — — — — — — – — 3 Anaemias M 2 _ _ — 1 — - - — - 1 - F 6 - - - - - – - — — 1 5 Other Diseases of Blood, etc. M 1 — — — — — — — – 1 — – F — — – — — — — – – – – – Mental Disorders M 1 — — — — — — — – 1 – – F 2 – – — – – — — – – – 2 Meningitis M 1 – – – – – – – – – – 1 F - - - - - - - – — – — — Multiple Sclerosis M 1 — — — — — — — — 1 — — F 6 _ - — — — — 1 2 1 2 — Other Diseases of Nervous System M 13 - - - - - - 1 - 1 7 4 F 12 _ — 1 — — — — 1 1 3 6 Chronic Rheumatic Heart Disease M 12 — _ - - - - 1 1 4 4 2 F 19 _ _ _ — — — 1 4 5 9 Hypertensive Disease M 22 — - - - - - 1 2 3 9 7 F 53 _ _ — — — — 2 3 3 12 33 Ischaemic Heart Disease M 513 _ _ _ _ _ _ 13 46 132 171 151 F 336 – - - - - 1 - 6 21 89 219 16 STATISTICS AND SOCIAL CONDITIONS Table 4 Causes of, and ages at, death Other Forms of Heart Disease M 48 — 1 — 1 — — — 1 6 12 27 F 86 — — — — 2 — — — 3 13 68 Cerebrovascular Disease M 151 - - - - 2 1 2 5 20 50 71 F 241 — - - — - - - 6 16 43 176 Other Diseases of Circulatory System M 50 — — — 1 — — 1 2 8 14 24 F 95 - - - - - - 1 2 1 15 76 Influenza M — — — — — — — — — — — — F 3 – – – – – – 1 1 1 Pneumonia M 111 1 3 _ _ 1 _ 1 2 8 19 76 F 133 2 3 - - - - 1 3 5 13 106 Bronchitis and Emphysema M 118 — — — — — — — 3 15 41 59 F 33 – – – – – – – 1 1 7 24 Asthma M — — — — — — — — — — — — F 2 – – – 1 – 1 Other Diseases of Respiratory System M 17 1 5 _ _ _ _ _ 1 3 1 6 F 12 - 3 - - - - – – 2 1 6 Peptic Ulcer M 13 — — — — — — — — 5 4 4 F 10 - - - - - - - - 1 3 6 Appendicitis M 2 — — — — 1 — — — — — 1 F 2 — — — — — — — — — 2 — Intestinal Obstruction and Hernia M 4 1 _ _ _ _ — 1 — 1 _ 1 F 4 — — — — — — — — — — 4 Cirrhosis of Liver M 1 _ _ _ _ _ _ _ _ _ 1 _ F — — — — — _ — — — — — — Other Diseases of Digestive System M 12 _ _ _ _ _ _ 1 1 5 _ 5 F 16 - - - - - - - 2 1 1 12 Nephritis and Nephrosis M 11 — — — — — — — 1 4 3 3 F 4 – – – – – – – – 2 1 1 Hyperplasia of Prostate M 7 - — — _ _ _ - _ 2 5 Other Diseases, Genito-Urinary System M 7 — - — — — — — — — 3 4 F 15 — — — — — — — 1 3 3 8 Abortion F 1 - - - - - 1 - - - - - Diseases of Skin, Subcutaneous Tissue M 1 — — — — — — — — — — 1 F 1 — — — — — — — — — — 1 Diseases of Musculoskeletal System M 8 _ - _ - - - 1 - 1 2 4 F 7 — — — — — — — — — 3 4 Congenital Anomalies M 7 3 _ 3 _ _ _ _ _ 1 _ _ F. 14 8 1 1 - - - - - 2 2 - Birth Injury, Difficult Labour, etc. M 9 8 1 – – – – – – – – – F 5 5 – _ – – – — — _ — — Other Causes of Perinatal Mortality M 4 4 _ _ _ _ _ _ _ _ _ — F 5 5 — — — — - — - — — - Symptoms and III Defined Conditions M _ _ _ _ _ — _ — — _ — — F 2 _ _ _ _ _ _ _ _ _ 2 Motor Vehicle Accidents M 18 _ _ 2 1 4 3 2 _ 2 _ 4 F 8 _ _ _ 1 1 _ _ _ – 3 3 All Other Accidents M 20 – – 2 – 3 1 1 3 3 – 7 F 21 - - 1 - 1 – – 2 1 2 14 Suicide and Self-inflicted Injuries M 8 — — — — — — 2 — 3 1 2 F 14 – – – - - - - 4 8 2 – All Other External Causes M 6 _ 1 _ _ _ 1 2 _ 2 — — F 2 - - — - - - 1 - - 1 - TOTAL ALL CAUSES M 1,593 18 11 7 6 13 8 35 93 362 489 551 F 1,546 20 8 4 2 6 5 21 81 166 336 897 17 STATISTICS AND SOCIAL CONDITIONS Table 5 Road Accidents Jan. Feb. Mar. Apr. May Jun. July Aug. Sept. Oct. Nov. Dec. Total 1971 Total 1970 Total Accidents 134 126 115 125 116 128 107 137 120 146 155 159 1,568 1,595 Total Casualties 176 165 134 153 147 160 138 183 164 190 210 206 2,026 2,055 Fatal 3 3 2 2 2 3 2 – – 2 7 2 28 21 Serious 24 26 15 14 29 21 20 33 23 23 32 35 295 251 Slight 149 136 117 137 116 136 116 150 141 165 171 169 1,703 1,783 LOCATION Trunk Roads 25 23 27 23 26 24 17 39 27 37 39 43 350 331 Metropolitan Roads 28 25 16 19 13 19 16 17 16 17 29 18 233 251 Principal Roads 24 28 24 27 24 32 29 28 29 34 20 36 335 353 Classified Roads 25 24 24 32 34 23 23 24 25 32 47 43 356 361 District Roads 32 26 24 24 19 30 22 29 23 26 20 19 294 299 1,568 1,595 TYPES OF ROAD USER Pedestrians 42 37 40 38 30 44 31 44 30 41 47 45 469 435 Pedal Cyclists 18 17 13 13 12 14 9 16 9 17 18 14 170 179 Motor Cyclists & Passengers 8 13 12 21 8 17 14 14 18 17 15 13 170 157 Scooters, Mopeds & Passengers 3 6 6 8 13 8 3 7 9 15 9 4 91 118 Drivers of Cars & Passengers 94 87 48 50 61 60 68 83 81 77 101 112 922 917 Drivers & Passengers Goods & Other Vehicles 11 5 15 23 23 17 13 19 17 23 20 18 204 249 AGE GROUPS 2,026 2,055 Under 5 years 5 4 11 6 1 9 7 11 7 8 3 1 73 47 5 - 14 years 12 18 26 26 25 33 20 31 22 31 22 25 291 281 15-60 years 143 121 79 106 108 109 97 122 121 127 163 157 1,453 1,527 Over 60 years 16 22 18 15 13 9 14 19 14 24 22 23 209 200 2,026 2,055 18 STATISTICS AND SOCIAL CONDITIONS Table 6 Prevalence and Control of Infectious Disease Notification and Deaths DISEASE Number Notified Known to be treated in hospital Attack rate per 1,000 population Deaths Acute Meningitis 14 14 0.06 – Dysentery 67 3 0.22 – Food Poisoning 78 3 0.29 — Infective Jaundice 31 9 0.12 — Malaria 1 1 0.01 — Measles 719 12 2.61 - Scarlet Fever 111 4 0.42 - Tuberculosis: (a) Respiratory 64 20 0.24 6 (b) Other Forms 12 5 0.05 - Whooping Cough 116 3 0.44 — Table 7 Prevalence and Control of Infectious Disease Tuberculosis Age in Years New Cases Deaths Repiratory Other Forms Repiratory Other Forms M F M F M F M F Under 1 — 2 — — — — — – 1 5 2 — 1 — — — – 5 1 2 1 1 — — - — 10 4 1 — 1 — - — — 15 2 1 – — – — — — 20 3 2 1 — - — — — 25 4 3 — 2 — — – — 35 6 4 2 1 — - — — 45 5 1 — 1 — 1 - — 55 8 3 1 - 2 1 — — 65 — 3 — – 1 1 — — 75 and over 2 — — — — — — — age unknown — — — — — — — — Totals 40 24 5 7 3 3 — - During the year there were inward transfers to the Borough of fifteen 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 Milk (Pasteurised) 118 Failed Methylene Blue Test 4(3%) 118 Failed Phosphatase Test Nil Milk (Sterilised) 25 Failed Turbidity Test Nil Milk (Ultra Heat Treated) 34 Failed Colony Count Test Nil Water 79 Faecal Coli Found Nil Food 35 Pathogenic Organisms Found Nil 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 Summary Number of attendances at: Clinics Ante-natal clinics 2,626 Post-natal clinics 276 Relaxation and Mothercraft classes 3,573 Child Welfare clinics 75,661 Dental Care Number of Expectant and Nursing Mothers examined 29 Number of Children under five years of age examined 598 Midwifery Number of Midwives who notified their intention to practise in the borough 175 Number of Premature Babies born at home 17 Health Visiting Number of home visits 37,191 Home Nursing Number of visits and treatments 145,736 Vaccination and Immunisation (Persons under 16 years of age) Diphtheria, Whooping Cough, Tetanus, Poliomyelitis: Number of persons who completed primary courses of ation against one or more of these diseases 6,946 Reinforcing doses 10,806 Measles: Number of persons immunised 2,213 Rubella: Number of persons vaccinated 2,872 Prophylaxis, Care and After-Care Number of cases of Tuberculosis under treatment, supervision or observation at the chest clinic at 31 st December 1971: Respiratory 1,523 Non-respiratory 213 Number of attendances at Chiropody clinics 8,283 Mental Health Number of patients under Local Authority Care at 31st March 1971 588 Number of patients referred to the Local Authority during period 1st January - 31st March 1971 131 HomeHelp Number of cases in which Domestic Help was provided during period 1st January - 31st March 1971 2,102 22 PERSONAL HEALTH Section 21, National Health Service Act 1946 Health Centres I made reference in last year's Report to the completion of the Health Centre in Forest Road, Edmonton, at the end of 1970, and the subsequent occupation of the building by seven general medical practitioners, the local authority health services and some welfare and rehabilitation facilities for the physically handicapped. One of the advantages of the Health Centre has been the facilitating of the process of attachment of nursing and midwifery staff to general practice, and the closer professional association resulting from this and the shared facilities - as well as the greater opportunities for co-operation between general medical practitioners and local authority health and social services staff. The Health Department meeting room on the first floor has been used regularly for meetings of medical officers, nursing staff, health education activities, psycho-geriatric clinics and for mothers' club meetings. Little progress was made during the year on the proposed health centre at Old Road, Enfield. Section 22 National Health Service Act 1946 Care of Mothers and Young Children 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 attending primary schools maintained by a local education authority. Ante-natal and Post-natal Sessions A total of 410 women attended ante-natal clinics and 196 for a post-natal examination, compared with 443 and 184 respectively for 1970. These figures reflect the trend, noted in previous reports, for expectant mothers to be cared for by the general medical practitioner and hospital services. Mothercraft and relaxation classes for expectant mothers, held in clinics throughout the borough, continued to be popular, and were attended by 662 women. Many general practitioners who undertake the ante-natal care of their patients refer them to these classes. Child Health Sessions The 2,041 sessions held were attended bv 12.906 children. The total number of attendances was 75,661, compared with 77,041 the previous year. The scheme was continued whereby, at various ages between three months and four years, each child in the borough is invited to attend a clinic for the purpose 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 Assessment Clinic continued to be held once a month throughout the year at the War Memorial Hospital. The sessions were attended by the Consultant Paediatrician from Chase Farm Hospital, and the Principal Medical Officer for School Health; the appropriate health visitor also attended with each child. Children with all types of handicap are seen at this clinic, and diagnosis and management are discussed, and appropriate action taken. This should prove to be a valuable step towards increasing cooperation between the hospital paediatric service and the Local Authority Health Service. Specialist Clinic Referrals Children suffering from defects were referred to clinics as follows:— Ophthalmic: 158 new cases; 660 attendances; 81 prescribed spectacles. Ear, nose and throat: 40 new cases; 55 attendances. Orthoptic: 65 new cases; PERSONAL HEALTH 739 attendances. Orthopaedic: 48 new cases; 90 attendances. Speech: 49 new cases; 614 attendances. In addition, 51 special audiometric tests were carried out and 30 cases were found to have a hearing loss. Clinic Premises Of the twenty premises in the borough used for clinics, fourteen are purpose built, four are adapted premises and two are rented premises. The Ten -Year plan, details of which are given elsewhere in this report, contains proposals for the replacement of certain of these clinics by purpose-built 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. During the year cod liver oil and orange juice were replaced by vitamin drops for children and a new vitamin tablet for expectant mothers. The following issues (total value £5,860) were made: National dried milk, 4,215 tins; Cod liver oil, 1,103 bottles; Vitamin tablets, 2,198 packets; Orange juice, 69,211 bottles; Vitamin drops, 4,930 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 £15,530. Dental Care The total number of expectant and nursing mothers and children under five years of age examined was similar to last year's figure, although there was an increase in the number of children under five years of age who attended for treatment and a decrease in the number of expectant and nursing mothers. Care of the Unsupported Mother and Her Child Although the majority of unsupported mothers are unmarried, occasionally a married woman may for some reason or other find herself without support. The services of a social worker are shared with a neighbouring borough. As there are no local authority mother and baby homes in the borough, use is made of those of other authorities and of voluntary society homes, one of which caters especially for the very young expectant mother. Of the nineteen cases referred during the first three months of the year through various channels such as social workers, general medical practitioners, health visitors, voluntary social workers, the National Council for the Unmarried Mother and Her Child, etc., three were admitted to mother and baby homes and arrangements were made for others to be admitted at the appropriate time. In addition, one of the cases referred during 1970 was admitted during this three-month period. On the 1st April, 1971, responsibility for this service was transferred, by the Local Authorities Social Services Act 1970, from the Health Department to the Social Services Department. "At Rsk" 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 the names of 789 children were placed on the register during 1971. Five hundred and sixty-three names were removed from the register in 1971, leaving a total of 1,840 at the end of the year. Of the 440 children who had hearing tests, nine appeared to have some loss, eight are still undergoing investigation and one has been issued with a hearing aid. Thirty children were reported to be suffering from abnormalities of significance and at the end of the year there were 28 children in the section of the register dealing with handicapped children. 24 PERSONAL HEALTH 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 60 for the year, was made to the Registrar General. Phenylketonuria "Battered Babies" Syndrome The Guthrie blood test continued to be used for the routine screening of babies for phenylketonuria and 1,175 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 34 tests were carried out by this method. None of the tests proved positive. The group of local authority officers and other persons and organisations concerned with the problem of young children injured by their parents, which was formed in 1970 following the receipt of a circular from the Department of Health and Social Security, gave further consideration to this problem during 1971. The procedure devised in 1970 for the early detection of cases where "battering" is suspected, was revised. During the year nine cases of suspected "battering" were investigated and four children were considered to have received physical abuse. Appropriate action was taken. 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 reported to the Medical Officer of Health to enable a health visitor to visit the parents and discuss with them precautions to prevent recurrence. This procedure was continued, and during 1971 details of 99 incidents were received under this scheme. Eighteen children had drunk paraffin, turpentine, or domestic cleaning fluids. Thirty-seven children had swallowed aspirin tablets and 28 children had swallowed tablets other than aspirin. The remaining sixteen children had swallowed miscellaneous substances and included one child who was alleged to have swallowed two "stink bombs"! One child, aged two years, was admitted after swallowing some aspirin tablets and re-admitted two months later after swallowing another type of tablet. I am glad to be able to report that none of the children concerned suffered any serious after-effects. We also have an arrangement with the Ambulance Service whereby the Health Office is informed whenever an ambulance is called to take to hospital a child suffering from a burn or scald. During 1971, two children, aged two years and three years, were notified under this scheme. Family Planning In October, 1970, the Council decided to adopt Plan No. 6 of the National Family Planning Agency Scheme as from 1st April, 1971, and this scheme came into effect as from that date. This scheme provided for the continuation of the Council's arrangements for the provision of a free family planning service to Enfield residents at sessions provided by the Family Planning Association, for "medical" cases only. It included the acceptance of a standard definition of "medical" case. In November, 1971, the Council adopted Plan No. 5 of the above Agency scheme which provides, for Enfield residents attending F.P.A. clinic sessions, free consultation and free supplies to "medical" cases and free consultation only for non-medical cases. This modification to the family planning service was made effective from the date of the Council's decision. 25 PERSONAL HEALTH Clinic premises continued to be made available without charge to the Family Planning Association, one of the premises being used for a regular counselling session for the unmarried. At the end of the year thirteen weekly sessions and two fortnightly sessions were being held in six of the Council's clinics. The Association also held two sessions a week at the War Memorial Hospital and two sessions each week at Chase Farm Hospital, these latter sessions being for the fitting of intra-uterine devices only. General medical practitioners provide family planning services under the National Health Service. 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 Office to the Family Planning Association for the provision of a free domiciliary service. The Council pays an annual fee for each case provided with this service. Seventy-two women were referred under this scheme during 1971. Day Care for Priority Groups The Council provides day care for children under five years of age in the priority groups at its own day nursery, in the day nurseries of other local authorities in appropriate cases, and with suitable registered private day nurseries, playgroups, and child minders. On 31st March 1971, after which responsibility for this service was transferred from the Health Department to the Social Services Department by the Local Authorities Social Services Act 1970, there were 62 children on the roll of the Council's 55-place day nursery and nine placed in day nurseries of other local authorities. There were 36 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. The Council continued its scheme for the placement at its expense of children in the priority groups with private day nurseries, playgroups and child minders, where it was considered that this would be of benefit to them, and on 31st March, 40 children were placed under this scheme which provides that no charge be made to the parents for sessional care; but, for all-day care, 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. Nurseries and Child Minders Nurseries and Child Minders Regulation Act 1948, as amended by the Health Services and Public Health Act 1968 Under the Nurseries and Child Minders Regulation Act 1948, as amended by the Health Services and Public Health Act 1968, a local health authority was required to make arrangements for the keeping of registers and the supervision of nurseries and child minders. However, the Local Authorities Social Services Act 1970 assigned these functions to the Social Services Committee and Director of Social Services from the 1st April, 1971. The number of registered premises (private day nurseries and play-groups) on 31st March, 1971, was 69 with places for 1,987 children, compared with the same number of premises registered for 1,961 children at the end of 1970. During the first three months of the year, the number of registered child minders increased from 237 approved to take 424 children to 242 approved to take 420 children. Applications for registration as child minders were also received from six persons who, for various reasons, decided at a later date to withdraw their applications. During this three-month period one person was successfully prosecuted for child minding without being registered under the above Act. 26 PERSONAL HEALTH The Council continued to assist in meeting the increasing demands for the day care of pre school children by making available where possible clinic 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 courses 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. The Education Committee also continued to provide evening courses for playgroup leaders. Children in Care There are in the borough two residential nurseries under the control of the Social Services Department and providing places for 28 children. By arrangement with the Director of Social Services, each child is medically examined by the Council's medical officers on admission, after every three months (every month if under one year old), 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, i.e. Town Clerk's, Health, Social Services, Housing, and Education, continued to meet during the year. Case conferences were held at regular intervals: new cases were discussed and old ones reviewed where necessary. In addition, ad hoc meetings were arranged at short notice to consider urgent cases. During the year sixteen cases from the register of "problem families" were discussed at conferences attended by officers from departments concerned with their supportive care. Eleven new families were added to the register during the year. Problem Families Seven families were receiving continuing supportive care at the end of the year, three families were rehoused during 1971 and one boy with behaviour problems was placed in a suitable school. The immediate problems of the remaining five families were dealt with and review of their cases will be arranged if necessary. This service, which commenced in 1966 for women between the ages of 35 and 60 years, was continued during 1971 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. During the year 1,365 smears were taken. Cancer cells were found in the smears taken from seven women. They were all married and their ages ranged from 37 to 52 years. Since the service began a total of 12,062 smears have been taken and 32 positive cases found, i.e. 2.7 per 1,000 examinations. In October details were received from the Department of Health and Social Security of a national recall scheme to enable women who had had a first test since the beginning of 1967 to be followed up at five-yearly intervals and Population Screening for Carcinoma of the Cervix of the Uterus 27 PERSONAL HEALTH offered a further test. Arrangements were also made for women who had had a first test under the Council's local scheme which commenced early in 1966 to be offered a re-test. National Surveillance of Congenital Rubella Defects Department of Health and Social Security circulars CMO 6/71 and CMO 7/71 addressed to local authorities and general medical practitioners suggested long term surveillance to determine the effect of rubella (german measles) vaccine on the incidence of congenital defects due to rubella. The surveillance programme, organised by two central registries (one in the Department of Paediatrics, University of Leeds, and the other at the Hospital for Sick Children, Great Ormond Street, London) involves screening, by means of the collection of blood samples, for rubella antibodies in all newly discovered cases of congenital deafness and in any other children thought to be suffering from the effects of congenital rubella. The surveillance will probably continue for a period of at least ten years and this department will be taking part in the programme.(See Tables 9, 10 and 11). Section 10 Health Services and Public Health Act 1968 Midwifery 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 health 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. Each year since 1965 the percentage of domiciliary births has decreased, and in 1971 stood at 15.8%: less - for the second yar in succession - than hospital planned early discharge cases. The latter represented 16.8% of the total, and other hospital births (with no planned early discharge) accounted for the remaining 67.4%. Domiciliary midwives attended 606 confinements. They also undertook the care of 644 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. 28 PERSONAL HEALTH Notifications were received of 250 babies weighing 51/2 lb or less at birth. Of these seventeen were domiciliary births. Two were admitted to hospital. The remaining fifteen were cared for at home by midwives and all survived. Care of Premature Infants A close liaison between midwives and family doctors continued to be maintained. Attachment arrangements were made for a further five midwives in respect of six practices, making a total of thirteen midwives attached to fourteen practices, serving a total of 42 general practitioners. Liaison with General Practitioners During the year portable incubators held at main ambulance depots were used on 44 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. Portable Incubators 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. During the year the tests made on these blood samples were extended to include a test for histidinaemia and homocystinuria. Guthrie Tests There are two "flying squads" serving the borough, one based at North Middlesex Hospital and the other at Chase 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 six emergency calls during 1971. Hospital "Flying Squad" Service Trichloroethylene inhalers, used by all domiciliary midwives, were regularly tested in accordance with the rules of the Central Midwives' Board. Analgesia Twenty-eight domiciliary midwives employed by local health authorities and 147 institutional midwives employed at hospitals notified their intention to practise as midwives within the borough during 1971. Notification of intention to Practise Disposal points are conveniently situated throughout the borough for use by authorised persons. Disposal of Placentae and Offensive Dressings Arrangements continued for pupil midwives from North Middlesex Hospital to receive their Part II training. The number of pupils taken at any one time under this scheme was 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 and also lectured to Part I pupils about the local supervising authority and the domiciliary midwifery service. Training of Pupil Midwives 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 domiciliary midwifery service continued to be given periodically by the Supervisor of Midwives to student nurses at North Middlesex Hospital. Midwives assisted in the school health education programme on childbirth. (See Tables 12 and 13). Training of Staff of other Agencies 29 PERSONAL HEALTH Section 24, National Health Service Act, 1946 Health Visiting It is the duty of every local 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 11, Health Services and Public Health Act 1968 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. Figures relating to visits to homes by health visitors are set out in the relevant table. 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. Liaison with Hospitals and General Practitioners 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. Health visitors also continued to attend the Maternity Units at North Middlesex Hospital, Highlands Hospital and Chase Farm Hospital. 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 for the aged on discharge are arranged and followup visits made by health visitors. A modest increase in attachment arrangements to general medical practitioners was possible, two additional practices being involved, bringing the total at the end of the year to seven health visitors attached to seven practices, serving a total of 26 general practitioners. Relaxation arid 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 662 women made 3,573 attendances at the 490 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 child health clinic sessions, for school inspections, and school clinic duties. To reduce the time spent by health visitors on clerical work, clerical staff were employed at clinics. We are fortunate to have 107 voluntary workers to help us at the child health clinics. 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 Superintendent Health Visitor. Student nurses from the Middlesex Hospital continued to 30 PERSONAL HEALTH visit the borough periodically for practical training in community services. The Social Services 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. Weekly sessions of the slimmers' advisory service were held at two centres. The average attendance was 29 at the Health Centre (a total of 1,470 attendances at 51 sessions) and 42 at Bullsmoor Clinic (a total of 2,101 attendances at 50 sessions). Referrals were made by general practitioners, local hospitals, local authority medical officers and health visitors. Talks on diet were given by the health visitors, and diet sheets and weight record cards were issued. Attendance at twelve consecutive weekly sessions was encouraged. (See Table 14). Slimmers' Advisory Centres 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 25, National Health Service Act, 1946 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, and at the end of the year negotiations with a neighbouring authority were well advanced. There was a substantial increase in the amount of work undertaken by nurses during the year. Section 11, Health Services and Public Health Act 1968 Disposable Equipment The use of disposable equipment contributed to the maintenance of improved efficiency and safety. All nurses used 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 cases. During the year eleven 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. This arrangement was superseded in September by the commencement of an evening nursing service which has proved a very valuable service for seriously ill patients and tremendous support for the relatives. The provision of an all-night nursing service is another objective. Evening Nursing Service Attachment arrangements were made for a further two practices, making a total of 22 home nurses attached to seventeen practices, serving a total of 55 general practitioners. Liaison with General Practitioners 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. 31 PERSONAL HEALTH 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 four 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. Lectures and Talks During the year, four of the home nurses gave lectures in local schools on first aid and home nursing. In addition, talks were given in the evenings on district nursing to three associations attached to local churches. (SeeTable 15). Section 26, National Health Service Act 1946 Vaccination and Immunisation 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. Authorisation has also been received for vaccination against rubella for girls between their eleventh and fourteenth birthdays. In July the Secretary of State accepted the advice of the Joint Committee on Vaccination and Immunisation which concluded that with the changes in ithe prevalence of smallpox in the countries overseas and the diminishing likelihood of the occurrence of outbreaks in this country, smallpox vaccination need not now be recommended as a routine procedure in early childhood. However, travellers to and from areas of the world where smallpox is endemic or countries where eradication programmes are in progress should still be protected by recent vaccination. The campaign for vaccination against rubella for twelve-year old and thirteenyear old girls was continued. The response was excellent and resulted in the vaccination of 2,872 girls. In the case of persons under sixteen years of age a total of 12,031 primary courses of immunisation against diphtheria, whooping cough, tetanus, poliomyelitis, measles and rubella were given, of which 2,757 were undertaken by general medical practitioners and 9,274 by the Council's medical officers. Of the total number of 10,806 reinforcing doses, 3,295 were given by general medical practitioners and 7,511 by the Council's medical officers. In accordance with the recommendation of the Department of Health and Social Security that local authorities should inform medical practitioners of patients on their lists who have been immunised or vaccinated in local authority clinics, a further 14,810 notifications of immunisation were sent. Parents of all school entrants continue to be issued with consent forms for 32 PERSONAL HEALTH Section 28 National Health Service Act 1946 immunisation against diphtheria, tetanus and poliomyelitis so that any child who has not been immunised may take advantage of this further opportunity. In addition consent forms are distributed to pupils of fifteen years of age for reinforcing doses against tetanus and poliomyelitis. 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 3,766 children eligible for B.C.G. vaccination, the parents of 2,895 children (76.87%) consented to have a tuberculin skin test carried out, and B.C.G. vaccination if necessary. A total of 2,828 children had a tuberculin skin test, 2,566 (90.38%) were found to require vaccination and 2,549 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. Diphtheria The recorded number of persons under sixteen years of age who received a primary course of immunisation was 2,992 and 3,911 received a reinforcing dose. Of the children born in 1969 (3,890) 3,062 had received primary immunisation by the end of 1971, representing an acceptance rate of 78.71% (England and Wales 80%). Whooping Cough The recorded number of persons under sixteen years of age who received a primary course of immunisation was 2,604 and 711 received a reinforcing dose. Of the children born in 1969, 2,878 had received primary immunisation by the end of 1971, representing an acceptance rate of 73.98% (England and Wales 77.9%). Tetanus The recorded number of persons under sixteen years of age who received a primary course of immunisation was 3,678 and 4,983 received a reinforcing dose. Of the children born in 1969, 3,067 had received primary immunisation by the end of 1971, representing an acceptance rate of 78.84% (England and Wales 80.1%). Poliomyelitis The recorded number of persons under sixteen years of age who received a primary course of immunisation was 3,266 and 5,809 received a reinforcing dose. PERSONAL HEALTH Of the children born in 1969, 3,066 had received primary immunisation by the end of 1971, representing an acceptance rate of 78.81% (England and Wales 79.5%). Smallpox The recorded number of persons under sixteen years of age who received primary vaccination was 1,574 and 1,555 were re-vaccinated. Of the children born in 1969, 1,728 had received primary vaccination by the end of 1971, representing an acceptance rate of 43.41%. (Following the advice received from the Joint Committee on Vaccination and Immunisation in July, smallpox vaccination is not now recommended as a routine procedure in early childhood). Measles The recorded number of persons under sixteen years of age who received primary immunisation was 2,213. Of the children born in 1969, 1,837 had received primary immunisation by the end of 1971, representing an acceptance rate of 47.22%. (England and Wales 45.8%). Distribution of Vaccines The Health Department is responsible for the distribution of vaccines to general medical practitioners and 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. Annual vaccination was again urged and accordingly 53 members of 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 again offered vaccination against tetanus to these groups and by the end of the year fourteen members of staff had either completed a course of immunisation or received a reinforcing dose. A further 21 staff had commenced a course of immunisation before the end of the year. In view of the poor response to this offer of immunisation it is to be hoped that many more of this "high risk" group will avail themselves of the opportunity for protection against tetanus next year. In view of an apparent significant rate of protection given by immunisation against influenza last year, staff whose duties might bring them into contact with patients suffering from influenza were again offered this protection during the autumn and 151 members of staff were immunised. International Certificates 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. 34 PERSONAL HEALTH 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 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. (See Tables 16, 17, 18 and 19). Section 27, National 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: 35 PERSONAL HEALTH Telephone 01-928 0333, extension 321, or write to the Chief Ambulance Officer, London Ambulance Service Headquarters, 220, 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 Prophylaxis, Care and After-Care A local health authority may make arrangements for the purposes of the prevention of illness, for the care of persons suffering from illness, and for the after-care of such persons. Tuberculosis Arrangements for the provision of this service are shared between the Council and the North East Metropolitan Regional Hospital Board and are based at the Chest Clinic, situated at the North Middlesex Hospital. Hospital beds are situated at North Middlesex Hospital and Highlands Hospital. Dr. Vernon Davies (who was elected to the Fellowship of the Royal College of Physicians during the year), 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 4,357 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 12,423. Tabulated statistics relating to the work of the Chest Clinic are to be found at the end of this section of the report. Twenty-nine infectious patients were treated at the Chest Clinic; of these 22 were among the newly diagnosed cases. Forty-three patients were admitted to the Clinic's tuberculosis wards for in-patient treatment. Of the 174 new tuberculosis cases provisionally diagnosed during the year, 64 respiratory and twelve non-respiratory cases were formally notified, the remainder being under observation. In addition, fifteen cases were transferred from other areas to the care of the Chest Clinic. Seventeen of the 73 new notified respiratory cases (one adult and sixteen children) were found among the 456 new contacts examined during the year, which underlines the importance of this aspect of the work of the Chest Clinic. Four families accounted for nine of the children. Home Visiting Two health visitors continued to work from the Chest Clinic, visiting tuberculous and non-tuberculous patients at home; 1,296 visits were paid to 331 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 36 PERSONAL HEALTH for notifying local authorities is intended to ensure that long stay immigrants register with general medical practitioners at an early stage in 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 290 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. Rehabilitation 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 the training of selected patients to become journeymen cabinet makers. Disabled Persons (Employment) Act 1958 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. Seven places were occupied by Enfield residents at the end of the year. 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 368, of asthma 282, and carcinoma of the lung 127. Mass Radiography Mass Radiography Unit 6A of the North East Metropolitan Regional Hospital Board visited the Borough during the year. Sessions were held at a number of locations throughout the area including industrial premises, Southgate Technical College and the Enfield College of Technology. A total of 7,970 persons were X-rayed and of these 52 required further investigation. I am indebted to the Organising Secretary of the Unit for the following information:— Location Male Female Total Bush Hill Park 217 256 473 Edmonton Green 780 1,176 1,956 British Oxygen Co., Edmonton 920 223 1,143 "The Cart Overthrown" Public House 450 329 779 Edmonton Incineration Plant 217 11 228 Ruberoid Limited, Brimsdown 269 27 296 Thorn AEI Limited, Enfield 1,116 952 2,068 Enfield College of Technology 261 90 351 Thomas Morson Limited 167 42 209 Southgate Technical College 257 210 467 Total number X-rayed 4,654 3,316 7,970 (General public) (1,217) (1,482) (2,699) (Organised groups) (3,437) (1,834) (5,271) Requiring further investigation 31 21 52 37 PERSONAL HEALTH Vaccination against Tuberculosis The Council's scheme provides for vaccination with B.C.G. (Bacillus CalmetteGuerin) of persons who are contacts of tuberculosis, long-term immigrants, school children and students attending establishments of further education. During the year 2,701 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. (See Table 20). Loan ofNursing 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 2,080 items of nursing equipment were lent to patients under this scheme, including 363 wheel-chairs and seventeen 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. At the end of the year seven ripple beds provided by the department were in use for very ill patients. 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. During the year 582 patients were provided with 66,288 pads during the year, and 48 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. The demand for the service continues unabated and a new weekly session was started in November at Lincoln Road Clinic. Domiciliary work in particular is increasing at a fast pace: at present about 100 patients are visited each week and just under half the total sessions available are devoted to this work. Inevitably, many clinic patients eventually become domiciliary cases when for various reasons the mobility of the elderly diminishes. The voluntary organisations involved were the two local divisions of the British Red Cross Society, which provided the services 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. (See Table 21). 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 1,486 new patients attended hospital clinics during the year, compared with the figure of 1,120 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 38 PERSONAL HEALTH duties are to trace contacts, follow-up treatment defaulters, and assist patients in meeting social problems. 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. (See Table 22). Health Advice Clinics for the Elderly This service continued to be available at Bowes Road Clinic but because of the low demand only a few sessions were required during the year. The sessions at the Health Centre in Forest Road were also continued; but here again attendances were small and during the year this facility was transferred to premises in Pymmes Park, used by the Edmonton Old People's Welfare Committee, where an improvement in attendance was achieved. The cooperation of that Committee in making this arrangement was much appreciated. Referrals are received from general practitioners, health visitors, and from other sources. The purpose of the service is to provide advice to retired persons, or those about to retire. It 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 other local authority facilities such as the Health Department's chiropody service and the facilities provided by the Social Services Department. The sessions are staffed by one of the Council's medical officers and a health visitor or clinic nurse. In each case a medical report is sent to the patient's family doctor. The Smokers Clinic As was the case last year, sessions were held throughout the year at Central Clinic, Plevna Road, with a break during the summer months. The sessions lasted for two to two-and-a-half hours, were devoted to talks, films, group discussions and the use of the Wright Peak Flow Meter, and were conducted by the Principal Medical Officer for School Health together with the Health Education Officer. Guest speakers attended some sessions. One hundred and fifty-one persons attended altogether, and 34 of them claimed to have stopped smoking while attending the clinic. Although this represents a drop in the total number of persons attending, compared with the previous year's figure, there is an actual increase in the number of persons claiming to have stopped smoking. An analysis of the results obtained in 1970 was made by means of a questionnaire sent to 80 men and 81 women. Twenty-two men and twentytwo women replied, and of these fourteen men and ten women were nonsmokers one year after attending the course. (See Table 23). 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 the stay is limited to two weeks. The majority of holiday homes used are situated on the south coast. Under this scheme eight holidays were arranged for adults during the first three months of the year after which responsibility for this service was transferred from the Health Department to the Social Services Department by the Local Authority Social Services Act 1970. 39 PERSONAL HEALTH Adaptation of Homes to Install Artificial Kidney Machines 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 then 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 is required, together with special electric wiring and plumbing where necessary. In some cases it may be necessary to build an extension to the house. During the year, applications were received from hospitals for adaptations for this purpose to be made at the homes of three patients and the necessary work was authorised in each case. Circular LHAL 19/71, issued in June by the Department of Health and Social Security, asked local authorities to review their arrangements for dealing with these cases to ensure that no avoidable delay occurred. A meeting, at which were represented all departments of the Council concerned with these adaptations, was arranged. The Administrator for this service from the hospital most concerned with Enfield cases was also present. Modifications were made in the procedure, aimed at reducing to a minimum the time necessary for each stage to be completed. Hypothermia A reminder was again issued at the beginning of the winter to general medical practitioners, medical and nursing staff, public health inspectors and social workers regarding the measures which would help to prevent accidental hypothermia, with particular reference to the elderly. Details were given of the practical help available from voluntary and statutory agencies. 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 until a decision is made by the Government to be implemented nationally. Health Education As the functions of the Department's Health Education Section have become more widely known, so the work has expanded, and the year has been increasingly busy and stimulating. Enquiries have been received not only from the public generally but also from a wide range of students, and the facilities of the section have also been made available to tutors, training course organisers and lecturers from colleges. The General Public The Health Education Officer gave talks on the following subjects to various organisations: Prevention of Home Accidents (4); Maintenance of good health (8); The Importance of proper food (4); Cancer Education (2); Dental Health (6); Anti-Smoking Education (1); Communication (1); Drugs (3); Health Education Methods (1); The Work of the Health Department (1). 40 PERSONAL HEALTH In addition, at the request of local factories, lectures were given to staff and apprentices on anti-smoking education and on sexually transmitted diseases. Throughout the year there was a sustained effort to involve an increasing number of the department's staff in health education projects, resulting in greater participation by medical officers, dental officers, health visitors, midwives and home nurses. Talks and discussions were arranged at six youth clubs on such topics as drugs, personal relationships, sexually transmitted diseases, smoking, and accident prevention. At one of the youth clubs a health visitor arranged a course on child care and management which was very well received. On the selected health education topics promoted during the year health visitors designed and made displays which were exhibited in the Council's clinics. Lectures on health education have been given, during in-service training courses, to residential child care house parents (Home Office course), to play group leaders (Social Services) and also to Scout leaders. Some of the benefits of health education were brought to local authority staff, the Health Department clerical staff having lectures on emergency resuscitation, and all women teachers being offered a lecture by Dr. Maurice Sutton on "Cancer, particularly cancer of the breast". The response from those wishing to attend was overwhelming, and the lecture had to be repeated on three separate occasions. Schools Much of the work of the Health Education section takes place in schools, and teachers continue to use the Section for reference and teaching aids. Lectures were given by the Health Education Officer at Trent Park Teachers' Training College, and a five week course of lectures for teachers on "New Aspects of Sex Education" was arranged at the Teachers' Centre. Designed to assist teaching in all aspects of sex education, the course was well attended and well received. In the junior schools, dental health programmes were arranged in 39 schools and anti-smoking education has been given to the third and fourth years (10-11 years old) in 25 schools. In the Secondary Schools the following lectures were given: anti-smoking (10); sexually transmitted diseases (13); contraception (14); drugs (3); birth (2); personal relationships (2). Those on sexual subjects are given only at the request of the head teachers, authorised by the Chief Education Officer, and with parental consent. Instruction in mothercraft, given by Health Visitors, has continued in schools, pupils at one school taking the National Association for Maternal and Child Welfare Diploma Course and Examination. Four Secondary Schools arranged "Learning to Live" courses for various age groups, and the Health Education Officer was invited to contribute. In all schools, the teachers are encouraged in involvement and follow-up work. Hazelbury Secondary School deserves a special mention, as throughout the summer term, the second year students were given one whole morning each week on health education. The project, entitled "Disease and Its Relationship 41 PERSONAL HEALTH to Health in the Community", was designed by the Health Education Officer. Members of the Health Department staff, as well as outside speakers, gave the lessons, and the class teachers, all very much involved, continued to use the teaching material, often throughout the day. The Course was very much appreciated by both teachers and pupils. The Health Education Officer has spoken at seven meetings of Parents/ Teacher Associations on various health topics. Perhaps the most exciting part of the health education section's work during 1971 was the filming of anti-smoking education at Carterhatch Junior School for a television programme in the Panorama series early in the year. Mental Health Act 1959 Health Services and Public Health Act 1968 Local Authority Social Services Act 1970 Mental Health It has been 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 Local Authority Social Services Act 1970 transferred to the Social Services Committee and Social Services Department, on 1st April, 1971, responsibility for much of the Mental Health Service; consequently, this section of the report covers only the first three months of the year. 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 "Cheviots" hostel for twenty mentally subnormal children was opened on 1st January, 1971, and the first of two twenty-place hostels for subnormal adults - in Montagu Road - was in an advanced state of construction on 31st March. 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 95 on 31st March. 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. Outpatient clinics are held at North Middlesex, Chase Farm, Highlands and War Memorial Hospitals. A 24-hour mental health community service continued to be provided by the Health Department which had 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 for care and support in their own homes. The majority of cases are referred by general practitioners. Up to 31st March, 102 patients were referred for supportive after-care and the number of home visits to mentally ill patients totalled 1,069 in addition to 154 office interviews. 42 PERSONAL HEALTH It was thought desirable for a social history to be provided by a mental welfare officer on a patient attending an out-patient clinic for the first time, and up to 31st March six social histories were supplied on request. In addition three social reports were supplied to Friern and Claybury Hospitals on new admissions. 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 admissions of patients to psychiatric hospitals informally and 37 were so admitted. In addition, 38 were compulsorily removed to hospital by mental welfare officers under Part IV of the Mental Health Act 1959. Day Rehabilitation Centres The day centre organised by the Psychiatric Rehabilitation Association continued at premises in Tottenham, in the London Borough of Haringey. Two Enfield residents commenced attendance during the first three months of the year and six were in attendance at the end of the period, the cost being borne by the Council. Social Centres or Clubs Mental welfare officers supervised the running of clubs which were held every Monday from 7.30 p.m. to 10.00 p.m. at the Junior Training School, Waverley Road, Enfield, and at the Health Centre, Forest Road, Edmonton. The weekly attendances at both clubs were between 25 and 50 persons. 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 first three months of the year there were two admissions. One person ceased to reside at the hostel on re-admission to hospital. The Council continued to accept financial responsibility for the care and maintenance of Enfield patients considered to be unsuitable for acceptance in the Council's own hostel, 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 March there were ten patients maintained in voluntary hostels. (See Tables 24 and 25). Mental Subnormality The borough is within the catchment area of South Ockenden and Harperbury Hospitals, to which patients requiring hospital care for mental subnormality are admitted. Domiciliary Service The number of subnormal persons in community care at 31st March, 1971, was 320. The mental welfare officers paid 234 visits, and sixteen office interviews were carried out during the first three months of the year. The Council's adviser in subnormality, Dr. W. Livingston, continued to hold out-patient clinics at the offices of the Health Department for the purpose of assessment and review of mentally subnormal patients in the community. Cases were presented by mental welfare officers in circumstances where where specialist medical advice was required. During the period two 43 PERSONAL HEALTH patient clinics were held and five patients were seen by the consultant. Junior Training schools Junior training schools were provided under the control of the Health Department for children who, under Section 57 of the Education Act 1944, were 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. The Education (Handicapped Children) Act 1970 made provision to bring such children within the educational system, and this was effected on 1st April, 1971. At the Enfield Junior Training School, there was 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 had a dual handicap such as spasticity or other physical defects, as well as subnormality. The school normally accepted children up to sixteen years of age but a number of persons over the age of sixteen years continued in attendance and special provision was made for them. The majority of those reaching sixteen years of age transferred to the Adult Training Centre. Routine medical and dental inspections, speech therapy and physiotherapy, were provided through the School Health Service. The number on roll at the end of the Spring Term was 122, including those in the special care unit. Enfield Society for Mentally Handicapped Children In previous reports, I have commented upon the generosity, enterprise and co-operation displayed by the Enfield Society for Mentally Handicapped Children. The Society continued to undertake valuable work on behalf of handicapped children of all ages and I am happy to record, once again, that the Health Department continued to enjoy a most cordial relationship with the Society. 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 50p and a maximum of £2. The number of trainees on roll on 31st March was 163. There was no waiting list. Some places were reserved for trainees from the London Boroughs of Barnet and Haringey and the centre also catered for selected mentally ill persons recommended to attend a day occupation centre. The aim of this purpose-built centre has been 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 whilst 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 establishments of the Council. Arrangements were made for a re-organisation of the layout of the laundry equipment in order to effect more efficient working. The Education Committee continued to supply two part-time visiting teachers to provide formal education to a total of seventeen hours per week. Nearly all trainees received benefit from this service. The scheme by which twenty selected trainees worked in a local factory under supervision continued to be successful. All trainees are medically inspected periodically, the visiting medical officer also acting in the capacity of Her Majesty's Appointed Factory Doctor. 44 PERSONAL HEALTH The Works Safety Committee met on one occasion and considered various aspects of safety in regard to trainees and staff. The centre is an affiliated member of the British Safety Council. The manager and staff continued the club for trainees which is held on the premises from 3.00 p.m. onwards every Friday. Activities included dancing, singing, ten pin bowling and other games. This club is affiliated to the Federation of Gateway Clubs. Hospital Admissions Some severely subnormal persons are handicapped to such an extent that only hospitals can provide the type of care they require. There was an acute shortage of beds for such patients and South Ockenden Hospital had a long waiting list. At the end of March 27 persons were on the waiting list, including four urgent cases. To relieve this unhappy situation, the Council had undertaken maintenance of six severely subnormal children in residential homes - some at a considerable distance from Enfield - pending their eventual transfer to hospital. In February, the North East Metropolitan Regional Hospital Board intimated that a 100-bed unit for the mentally handicapped had been opened at Little High Wood, Brentwood. Guardianship At the end of March, five persons were under the formal guardianship of the Council, 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, continued to provide suitable foster homes for nineteen Enfield residents, thirteen of whom attended training centres in the Brighton area. At the end of March, the number of mentally subnormal persons maintained in residential homes and hostels and in informal foster care was 72, including sixteen children. "Cheviots" Hostel "Cheviots", the Council's purpose-built twenty-place hostel for subnormal children in Cheviot Close, Enfield, opened on 1st January, 1971, the furnishing, equipping and staffing of the hostel having been completed during the preceding months. At the end of March, four children were in residence', one of whom had been withdrawn from hospital care. "Cheviots" provides long-term and short-term care for children aged between five and sixteen years in circumstances where they cannot be managed satisfactorily in their own homes, and, in general, every endeavour is made for the hostel to be run on similar lines to an ordinary children's home. Admission is on medical recommendation and subject to acceptance by a panel of officers appointed for this purpose. Children in residence attended the Enfield Junior Training School to which they were conveyed daily under arrangements made by the Council 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. Two admissions were arranged during the quarter, both of these being to Winifred House pre-convalescent hospital for children, Barnet Gate, Arkley, Barnet. Holiday Camps Preparations were commenced during the quarter for a two weeks summer camp for mentally subnormal children to be held at St. Mary's Bay Holiday Camp, Dymchurch, Romney Marsh, Kent, and bookings were made 45 PERSONAL HEALTH for 40 children from both Enfield and the London Borough of Haringey Arrangements were also agreed with the London Borough of Haringey for mentally handicapped adults resident in Enfield to attend for one week at a holiday camp on the South Coast, the arrangements to be made by the London Borough of Haringey. (See Tables 24 and 25). Alcoholism The extent of alcoholism in the borough is not known and hostel provision specifically for this purpose was not included in the Council's Ten-Year Plan but the Council has, in the past, on medical recommendation, accepted responsibility at a voluntary home for patients so placed for rehabilitation following hospital treatment for alcoholism. Section 29, National Health Service Act 1946 Home Help Service Under the National Health Service Act 1946 a local health authority was empowered to make arrangements for providing domestic help for 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 such a service through the Health Department until 31st March, 1971. In March, 1971, the Secretary of State exercised his powers under Section 13 of the Health Services and Public Health Act 1968 to impose as from 1st April, 1971, on local health authorities the duty to provide or arrange to provide a home help service adequate to the needs of their area and 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. However, the Local Authorities Social Services Act 1970 assigned these functions to the Social Services Committee and Director of Social Services from 1st April, 1971. Although there was marked improvement in the number of home helps recruited during the first three months of the year, the amount of help available continued to be below that required to meet the increased demand. By 31st March, 1971, nearly 156 whole-time equivalent home helps were employed - compared with the figure of 150 for the end of the previous year but it was still necessary to continue to limit the hours of help provided in individual cases in order to assist as many applicants as possible. The continued provision of transport for home helps between districts of the borough has encouraged recruitment and made a better service possible in areas where the greatest difficulty is normally experienced. During the three-month period, 2,102 cases were provided with help. Of these 1,769 were persons aged 65 years and over, eight were maternity cases, 235 were chronic sick or tuberculous, and two were mentally disordered. The remaining 88 cases were assisted for various reasons, such as postoperative hospital discharge, ante-natal conditions, and acute illness. No cases required assistance under the special scheme for the provision of domestic help for mothers suffering from toxaemia of pregnancy. Neighbourly Help Scheme Under this scheme neighbours may be paid a small weekly sum to provide limited domestic help to those in need. The neighbourly help keeps a friendly eye on the patient and undertakes or helps with certain household duties, such as fire-lighting, preparing meals, shopping and cleaning. The scheme operates on a relatively small scale as many prefer to be truly neighbourly and 46 PERSONAL HEALTH give their services without charge, whilst others are unwilling to accept the responsibility. Every effort is made to foster the scheme, thereby easing a little the demand on the limited home help staff resources. However, it is essential for the neighbourly help to live nearby, and, mainly for this reason, it is not always possible to link offers of help with persons in need. During the three-month period, nine families received assistance under this scheme, and onthe31st March, 1971, nine neighbourly helps were employed. (See Table 26). Ten-year plan for health services As in previous years, a revised three-year building programme of projects for which it was anticipated that loan sanction would be sought was submitted to the Department of Health and Social Security; and at the same time the Council's ten-year development plan for the health services was reviewed and adjusted. Details of the revised development plan are shown in the relevant table. 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 in the Old Road Redevelopment area; two health clinics (one to replace old premises in a redevelopment area, and one to replace sessions now held in rented premises); a replacement public convenience in Palmers Green; and the replacement of the cleansing station in the Lower Edmonton redevelopment area. The ten-year development plan includes additionally in the following seven years, two health clinics (one a replacement) and a health centre. Part VI Public Health Act 1936 Nursing Homes Act 1963 Mental Health Act 1959 Nursing Homes 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 (female). The other is approved for eight medical and/or chronic sick patients (male and female). Both have been inspected regularly and conditions were found to be satisfactory. Mental Nursing Homes There is one registered mental nursing home, approved for the care of 27 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. Approved Premises under Abortion Act 1967 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. 47 PERSONAL HEALTH Section 47, National Assistance Act 1948 (as amended) Removal to suitable premises of persons in need of care and attention 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 procedure. Section 84, Public Health Act 1936 Laundry service for incontinent persons 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. Section 42, Middlesex County Council Act 1956 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 thirteen patients were being provided with this service involving the handling of approximately 90 articles per week. 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 461 (combined) 490 No. of women in attendance 410 196 Total number of attendances 2,626 276 3,573 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 1971 1970 1966-69 2,041 3,420 3,299 6,187 12,906 75,661 No. of clinic premises: 20 Table 11 Care of Mothers and Young Children Dental Care Dental Services Expectant and Nursing Mothers Children under 5 years of age Examined 29 598 Commenced treatment 30 305 Courses of treatment completed 14 235 Treatments provided: Extractions 12 81 Fillings 37 452 Teeth otherwise conserved — 454 Crowns and inlays — - Other operations 12 47 Radiographs — — General Anaesthetics — 41 Dentures provided 1 — 49 PERSONAL HEALTH Table 12 Midwifery Midwives who notified their intention to practise within the Borough during 1971 Domiciliary Institutional Total Employed by local health authorities In Private Practice Hospitals Nursing Homes 28 147 175 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 17 15 — 15 Table 14 Health Visiting Visits to Homes by Health visitors *Number of Visits First Visits Total Visits Expectant Mothers 888 1,262 Children: born in 1971 3,915 9,596 born in 1970 3,307 7,300 born in 1966-69 7,096 13,808 Persons aged 65 years and over 1,064 2,363 Mentally Disordered Persons 70 240 Patients discharged from Hospitals (other than Mental and Maternity) 202 280 Infectious Disease Households 27 44 Miscellaneous 1,068 2,298 TOTAL 17,637 37,191 *This Table excludes visits by Tuberculosis Health Visitors. 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 145,736 8,782 805 3,372 1,037 50 PERSONAL HEALTH Table 16 Vaccination and Immunisation Immunisation against Diphtheria, Whooping Cough, Tetanus, Poliomyelitis, Measles and Rubella Persons aged under16 years (a) Completed Primary Courses Type of Vaccine Year of Birth Others under age 16 Total 1971 1970 1969 1968 1964/7 1. Quadruple DTPP - - — — - - - 2. Triple DTP 67 1,714 775 29 15 4 2,604 3. Diphtheria/Pertussis - - - - - - - 4. Diphtheria/Tetanus 1 115 84 15 150 21 386 5. Diphtheria - - - * - 1 1 2 6. Pertussis - - - - - - - 7. Tetanus ' - - - - 2 686 688 8. Salk - - - - - - - 9. Sabin 32 1,887 892 58 215 182 3,266 10. Measles - 819 825 238 307 24 2213 11. Rubella - - - - 2,872 2,872 12. Lines 1+2+3+4+5 (Diphtheria) 68 1,829 859 44 166 26 2,992 13. Lines 1+2+3+6 (Whooping Cough) 67 1,714 775 29 15 4 2,604 14. Lines 1+2+4+7 (Tetanus) 68 1,829 859 44 167 711 3,678 15. Lines 1+8+9 (Polio) 32 1,887 892 58 215 182 3,266 (b) Reinforcing Doses Type of Vaccine Year of Birth Others under age 16 Total 1971 1970 1969 1968 1964/7 1. Quadruple DTPP - - - - - - - 2. Triple DTP - 61 108 56 369 117 711 3. Diphtheria/Pertussis - - - - - - - 4. Diphtheria/Tetanus - 7 10 15 2,966 188 3,186 5. Diphtheria - - - - 10 4 14 6. Pertussis - - - - - - - 7. Tetanus - - 1 1 51 1,033 1,086 8. Salk - - - - - - - 9. Sabin - 52 91 34 3,317 2,315 5,809 10. Lines 1+2+3+4+5 (Diphtheria) - 68 118 71 3,345 309 3,911 11. Lines 1+2+3+6 (Whooping Cough) - 61 108 56 369 117 711 12, Lines 1+2+4+7 (Tetanus) - 68 119 72 3,386 1,338 4,983 13. Lines 1+8+9 (Polio) - 52 91 34 3,317 2,315 5,809 51 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 15 - 3 months and under 6 months 8 - 6 months and under 9 months 9 - 9 months and under 12 months 8 - 1 year 1,201 - 2 - 4 years 216 466 5 - 15 years 117 1,089 TOTAL 1,574 1,555 Table 18 Vaccination and Immunisation Completed Primary Courses of Immunisation by end of 1971 Children born in 1969 Number of Children in Enfield born in 1969: 3,890 Immunisation Against No. of Children Immunised (Enfield) Acceptance Rate per cent. Enfield England and Wales Diphtheria 3,062 78.71 80 Whooping Cough 2,878 73.98 77.9 Tetanus 3,067 78.84 80.1 Poliomyelitis 3,066 78.81 79.5 Smallpox 1,728 43.41 Not available Measles 1,837 47.22 45.8 Table 19 Vaccination and Immunisation B.C.G. Vaccination Number of parents approached for consent 3,766 Number of parents who consented 2,895 Number of children given Tuberculin Test (Heaf Gun) 2,828 Number of children found to be positive 233 Number of children found to be negative 2,556 Number of Tuberculin Tests not read 39 Number of children given B.C.G. vaccination 2,549 Number of children found to be negative but not yet vaccinated 7 52 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, 1971: Respiratory Non-Respiratory Tuberculosis: Men Women Children Total Men Women Children Total. 793 607 123 1,523 73 126 14 213 2. Number of cases of respiratory tuberculosis (whether notified or not) new to the Clinic (but excluding transfers from other clinics) during the year ended 31st December, 1971: Non-Bacteriologically Confirmed Bacteriologically Confirmed Men Women Childen Total Men Women Children Total 25 7 19 51 10 12 - 22 3. Number of cases of non-respiratory tuberculosis (whether notified or not) new to the clinic (but excluding transfers from other clinics) during the year ended 31st December, 1971: Men Women Children Total 4 6 2 12 4. Number of cases included in Section 1 above, whose bronchopulmonary secretion was positive during the year 29 53 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 treatmentp Elderly Persons (over 65 years of age) 348 1,463 5,887 7,698 Physically Handicapped 1 6 — 7 Expectant and Nursing Mothers 4 4 5 13 School Children 5 9 47 61 Pre-school children — — — — Others 5 125 374 504 TOTAL 363 1,607 6,313 8,283 Number of Clinic Sessions — 1,623 (b) Domiciliary Chiropody Service Number of patients Number of Treatments 1,009 4,557 (c) Services provided by Voluntary Organisations Number of Patients Number of Treatments Treated at Centres 797 4,487 Domiciliary Cases 326 1,566 At Private Surgeries 33 303 TOTAL 1,156 6,356 Number of Sessions at Centres - 601 Table 22 Prophylaxis, Care Venereal Diseases Hospital Number of New Cases Totals Syphilis Gonorrhoea Other Conditions Prince of Wales' 6 130 798 934 Westminster — 2 15 17 The Middlesex 1 21 211 233 The London 1 4 52 57 St. Bartholomew's — 7 59 66 Royal Free — — 17 17 St. Thomas' — 4 26 30 Royal Northern 2 42 87 131 Dreadnought Seamen's — — 1 1 TOTAL 10 210 1,266 1,486 54 PERSONAL HEALTH Table 23 Smokers' Clinic 1970 Replies to Questionnaires Attended 5 or more Sessions Attended 3 - 4 Sessions Attended 1 - 2 Sessions Total attended No. of replies Not Smoking Total attended No. of replies Not Smoking Total attended No. of replies Not Smoking M F M F M F M F M F M F M F M F M F 15 14 8 4 6 4 18 26 9 7 6 3 47 41 5 11 2 3 % Replies (of total attended) 53 29 50 27 11 27 % Non- Smokers (of replies received) 75 100 67 43 40 27 55 56 PERSONAL HEALTH Table 24 Mental Health Patients under Local Health Authority Care at 31st March, 1971 Mentally ill Mentally Handicapped and Severely Mentally Handicapped Under Aged 16 yrs. Aged 65 yrs. Total Under Aged 16 yrs. Total age 16 yrs. to 64 yrs. and over age 16 yrs. and over M F M F M F M F M F 1. Number of patients under care on 31st March, 1971 1 - 104 151 6 6 268 74 57 90 99 320 2. (a) Attending day training centre - - 16 9 3 - 28 65 41 66 66 238 (b) Awaiting admission — — 1 — — — 1 1 3 — — 4 3. (a) Resident in L.H.A. home/ hostel - - 6 7 - - 13 2 2 4 - 8 (b) Awaiting residence in L.H.A. home/hostel - - - - - - - - - - - - (c) Resident at L.H.A. expense in other residential homes/hostels — — 4 3 1 2 10 6 8 15 14 43 (d) Resident at L.H.A. expense by boarding out in private household — — — — — — — — — 5 16 21 4. Receiving home visits and not included in (2) or (3) 1 - 77 132 2 4 216 - 3 - 3 6 5. No. of patients in L.H.A. area on waiting list for admission to hospital at 31.3.71 (a) In urgent need of hospital care - - - - - - - 1 2 1 4 (b) Not in urgent need of hospital care - - - - - - - 8 4 9 2 23 6. No. of admissions for temporary residential care, e.g. to relieve the family (a) To N.H.S. Hospitals — — — — — — — 2 — — — 2 (b) Elsewhere — — — — — — — — — — — — PERSONAL HEALTH Table 25 Mental Health Patients referred to Health Department during period 1st January -31st March, 1971 Referred by Mentally ill 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 — — 10 8 18 — — — — — Hospitals, on discharge from in-patient treatment — — 7 11 18 — — — — — Hospitals, after or during out-patient or day treatment 1 — 15 35 51 — — — — — Local Education Authority — — — — — 2 — — — 2 Police and Courts — — — — — — — — — — Other Sources - - 10 5 15 9 6 4 8 27 TOTAL 1 - 42 59 102 11 6 4 8 29 Table 26 Domestic Help Number of Cases in which Domestic Help was provided during period 1st January - 31st March 1971 Aged 65 years or over at time of first visit Aged Under 65 years on First Visit Total Maternity Chronic Sick Tuberculous Mentally Disordered Others 1,769 8 227 8 2 88 2,102 57 58 PERSONAL HEALTH Table 27 Development Plan Year Legislation Project No. of Places or Population Served Address 1972 National Health Service Act 1946 Section 21 Section 22 1. Health Centre Complex Old Road Re-development area, Enfield (a) Health Centre 10,000-20,000 (b) Day Nursery 55 place Social Health Services and Public Health Act 1968, Section 12 (c) Day Centre for Mentally sub-normal infants 10 place Services Department National Health Service Act 1946 Section 22 2. Health Clinic 10,000-20,000 The Grange Area, Southgate 1973 National Health Service Act 1946, Section 22 3. Health Clinic 10,000-20,000 Angel Road,/ Fore Street area, Edmonton 1975 National Health Service Act 1946 Section 22 4. Health Clinic 10,000-20,000 Palmers Green, Southgate 1976 National Health Service Act 1946 Section 22 5. Health Clinic 10,000-20,000 Winchmore Hill area, Southgate 1977/ 82 National Health Service Act 1946 Section 21 6. Health Centre 10,000-20,000 Barrowell Green, Southgate Public Health Act Projects 1973 Public Health Act 1936 Section 87 1. Public Convenience - Triangle, Palmers Green (replacement) 1974 Public Health Act 1936 Section 86 2. Cleansing Station — Lower Edmonton redevelopment area (replacement) ENVIRONMENTAL HEALTH ENVIRONMENTAL HEALTH Tables relating to the Environmental Health Service 28 Smoke Control Areas 29 Food and Drugs: Samples submitted to public analyst 30 Food and Drugs: Ice-cream — bacteriological examination 31 Food and Drugs: Milk — bacteriological examination 32 Food and Drugs: Prosecutions 33 Housing: Inspections and defects 34 Housing: Defects remedied 35 Offices, Shops and railway premises 36 Factories and Workshops: Inspection 37 Factories and Workshops: Defects found 38 Inspections and Complaints: Inspections, interviews and visits of public health inspectorate 39 Inspections and Complaints: Summary of complaints 40 Water Supply: Chemical and mineral analysis 41 Water Supply: Bacteriological results 42 Water Supply: Representative sample Summary Water supply Number of chemical and mineral samples 484 Number of bacteriological samples: 1. Before treatment 10,408 2. After treatment 5,224 Smoke Control Areas Number of premises (total to end of 1971) 74,250 Acreage (total to end of 1971) 16,820 Food and Drugs Number of samples analysed 740 Number of samples of ice-cream bacteriologically examined 42 Number of samples of milk bacteriologically examined 177 Number of samples of milk analysed in Department's own Laboratory 172 Housing Number of dwelling houses inspected 15,892 Number of housing defects remedied 3,520 Offices, Shops and Railway Premises Number of visits to registered premises 4,598 Factories and Workshops Number of inspections 516 Number of defects found 31 Number of defects remedied 22 Inspections and Complaints Number of inspections and visits 58,790 Number of complaints and requests for visits 8,512 60 ENVIRONMENTAL HEALTH Water Supply Part IV, Public Health Act 1936, 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. Five samples were submitted for bacteriological examination by the Department 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 1971. (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 the 30th June, 1971, was 262,294. (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:— The west and north of the borough are supplied with Thames-derived water with some well water from Hoe Lane, Hadley Road and Waltham Abbey pumping stations. The south-east portion in Edmonton receives New Riverderived water. Part of the western boundary of the borough is supplied by the Lee Valley Water Company. 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." (See Tables 40, 41 and 42). 61 ENVIRONMENTAL HEALTH Baths, Washhouses, Bathing Places, etc. Part VIII. Public Health Act 1936 Local authorities may provide baths, washhouses and bathing places. Within the borough three open air and three covered swimming pools are provided for the general public and include a total of 33 showers and slipper baths. Sauna baths are also provided at the Edmonton Green Swimming Pool in Knights Lane, Edmonton. In addition, six swimming pools, of which four are covered, are available for the exclusive use of school children. Automatic filtration and chlorination plants are installed at all baths and the water supply is from the public water mains. 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 water treatment. Samples are also regularly submitted to the laboratory for bacteriological examination and chemical analysis. During the year all 74 samples submitted for bacteriological examination were satisfactory. The total attendance at the public swimming pools and slipper baths during the year was 879,984. Sewerage and Sewage Disposal Public Health Act 1936 Public Health Act 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 the 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. Rivers (Prevention of Pollution)Act 1961 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 1971, work was executed on two main major drainage relief projects, namely the Enfield Main Foul Sewer and the Eastern Enfield (Green Street) Flood Alleviation Scheme. The Enfield main foul sewer is designed to relieve the existing heavily surcharged sewers in the area, while the Green Street Scheme is designed to relieve general flooding at times of storm. Further foul and surface water drainage schemes were prepared to cope with either the inadequacies of the existing sewer systems or to provide increased capacity for the more intense development now taking place within the district. The Health Department undertakes the clearance of sewers on private property, and 2,883 stoppages were cleared. Repair of drains and private sewers is the responsibility of the users and two formal notices were served for the repair of drains and seven for the repair of private sewers. By the end of the year, the drainage notices had been complied with, and repair works to the defective sewers were in hand. 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, operated by the London Borough of Enfield, will continue in operation until a new pumping station is completed at Deephams, although extensive works were completed at Deephams during the year. Digested sewage sludge continued to be pumped to the drying beds at Ramney Marsh prior to its removal by contractors. In early December, a new sludge pumping main to the Beckton Works began to operate and in 62 ENVIRONMENTAL HEALTH future about one half of Deephams' sludge will be pumped direct to Beckton. For certain information in this report I am indebted to the Borough Engineer and Surveyor. Public Conveniences Section 87 Public Health Act 1936 The Council provide 50 public conveniences, including those sited in parks and open spaces. Staffing, cleansing and maintenance of these conveniences are the responsibility of the Health Department. Also, by arrangement with the London Transport Board, 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. Eleven of the conveniences are in the main fully staffed by attendants. The remainder receive regular attention from a mobile team of cleaners, or from part-time cleaners. At the end of the year, arrangements were made to demolish one of the two conveniences which had been closed because of damage by vandals. Refuse Collection and Disposal Section 72 Public Health Act 1936 Section 51 PublicHealth Act 1961 London Government Act 1963 Under Section 72 of the Public Health Act 1936 local authorities are empowered to provide a refuse collection service while Section 51 of the Public Health Act 1961 enables authorities to provide receptacles for refuse and litter in public places and to empty these containers. In Enfield, refuse collection is a function of the Department of the Borough Engineer and Surveyor, while disposal is undertaken by the Greater London Council under Schedule 11 of the London Government Act 1963. Two hundred and fourteen men are employed on refuse collection and 153 on road sweeping. The cleansing fleet consists of 101 vehicles, thirty of which are pedestrian-controlled street-sweeping vehicles. A ten cubic yard container collection is provided to service hospitals, schools and commercial premises where there is considerable volume of refuse. The Greater London Council's new Edmonton Incineration Plant at Angel Road became fully operative. This plant, considered to be one of the largest and most modern of its type in the world, now handles all the refuse from the Enfield Area. The new large Central Paper Baling Plant at Montagu Road, Edmonton, was completed and now handles paper salvage from Enfield, Haringey and Waltham Forest. 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, authorities are able to remove anything other than motor vehicles which have been abandoned on the highway or land. I am grateful to the Borough Engineer and Surveyor for much of the information contained in this section of the report. Clean Air Smoke Control Areas Clean Air Act 1956 It has been the policy in Enfield to maintain a continuous smoke control programme. By this means, the work of adapting fireplaces is fairly continuous, the financial load is spread evenly over a reasonable period, and the impact of publicity is not lost between successive Orders. It is encouraging to report, therefore, that No. 18 Smoke Control Order - withdrawn in 1970 - 63 ENVIRONMENTAL HEALTH was resubmitted to the Department of the Environment at the end of the year and that the necessary preliminary arrangements were put in hand. The Order will affect 3,176 premises covering 1,046 acres in the south-east area of the Borough and, if confirmed, will come into operation on 1st August, 1973. In common with many other boroughs, the possible shortage of solid smokeless fuel resulted in Smoke Control Orders being suspended in a large part of the borough from 8th December, 1970, to 31st March, 1971. This left householders in this area free to purchase and use bituminous coal if they wished. However, supplies of smokeless fuel were better than had been expected and the winter passed with apparently little hardship because of limited fuel supply - and there was no significant increase in pollution. The only part of the borough remaining to be dealt with by Smoke Control Orders after the No. 18 Order is confirmed will be in the north-east. This area includes approximately 11,000 premises and it is hoped that it can be covered by two Orders, planned so that they will maintain continuity with completion of the programme for the borough by 1975. Industrial Atmospheric Pollution Already the impact of natural gas is being felt in industrial areas of Enfield, and some major furnace operators have changed, or are in the process of changing, from heavy oil to natural gas. This means a marked reduction in the total emission of sulphur dioxide in these areas. Some operators are taking advantage of the Gas Board scheme of planned interruptable supplies. This offers favourable tariffs if a cut in supply is accepted for a limited number of days during periods of heavy demand, and requires the use of alternative fuel for such periods. It is encouraging to see that the trend for alternative fuels is towards the light distillate oil, with low sulphur content. Section 3 Clean Air Act 1956 Section 6 clean Air Act 1968 During the year the installation of 40 furnaces was approved under Section 3 of the Clean Air Act 1956. Nine requests for approval of chimney height under Section 6 of the Clean Air Act 1968 for furnaces exceeding one-and-a- quarter million B.T.U.'s or its equivalent were approved. Alkali, Etc., Works Regulation Act 1906 Complaints of nuisance from processes registered under the Alkali, etc., Works Regulation Act 1906 are not infrequent, and one series of emissions from registered processes resulted in a petition from over 800 householders. The Health Committee referred this case to the Secretary of State for the Environment for investigation by the Alkali Inspectorate. At the request of the Alkali Inspector, continuous daily measurements of sulphur dioxide were taken in the vicinity of the premises concerned. Although the average readings obtained were not significantly different from the general level in the area, this fact does not diminish the nuisance and annoyance complained of by householders during particular weather conditions. Measurement of Pollution Measurement of pollution from smoke and sulphur dioxide was continued at the nine sites used during 1969 and 1970. Three of the sites are those used during the national survey some years ago, and the fourth is in a residential area. The results were broadly comparable with those of the previous years, and no significant trend was apparent. Five of the instruments have been used to monitor pollution in the vicinity of the new Greater London Council refuse disposal plant at Angel Road, Edmonton, but although the plant is now in operation, there has been no change in the levels of smoke or sulphur dioxide. 64 ENVIRONMENTAL HEALTH During 1970, an attempt was made to measure carbon monoxide from vehicular traffic in Church Street, Enfield, but because of technical difficulties with the infra-red gas analyser used for this purpose, the readings were considered unreliable. During 1971 the work was continued and recordings of the level of carbon monoxide were made from May until the end of the year. The purpose of the investigation was to compare present conditions with those existing in 1968/69, prior to the introduction of the one way traffic system. There is now a general reduction in the level of carbon monoxide, and, in particular, the total times for concentrations above 30 parts per million are low, occurring for less than 0.02% of the period sampled. (See Table 28). 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. The Preservatives in Food (Amendment) Regulations 1971 came into force on 1st September, 1971, limiting the amount of sodium nitrate used in bacon, ham and pickled meat. During the year a great deal of publicity was focused on manufacturers' methods of date coding of perishable food stuffs. These indicate either the date of packing or the date when the food should be removed from sale. The Composition and Labelling Food Standards Committee was asked to review the whole question of date marking and this Council has submitted its observations to that body. Seven hundred and forty samples of food and drugs were submitted to the public analyst and 172 samples of milk were examined in the Department's own laboratory, representing a sampling rate of 3.4 per 1,000 of the population. The Public Analyst reported adversely on 92 samples. Of these, 64 were samples of packaged foods which were incorrectly labelled; 28 samples were unsatisfactory, inferior or unfit to eat. In three cases both labelling infringements and unsatisfactory conditions were found. All samples of milk were satisfactory. The new Labelling of Food Regulations which come into force on the 1st January, 1973, provide, inter alia, for an improved standard of legibility on labels, and therefore the attention of a number of manufacturers was drawn to the lack of contrast between the printing on the label and the background colour. Pastel backgrounds with printing in a deeper shade of the same colour can be confusing, particularly to those with poor eyesight. Fluorescent lighting, now a standard feature in supermarkets, is available in four shades of "white", and at least one of these shades - "warm white" - lessens the contrast to a point where even a person with normally acute vision has difficulty in reading the smaller print. The "Elixir" mentioned in last year's report was the subject of further consideration, but it was decided that amended labelling and advertising appeared satisfactory. The matter will be kept under review. A sample of a simulated meat product with "cheese like" flavour was found to be deficient in protein on the stated content. A recent advance in food technology has been the production of vegetable protein with the texture of meats such as beef, ham or chicken. Approved additives supply the flavour and colour. It is important that such products should state clearly their duration and should not mislead as to their nutritive value. In this instance the manufacturer has agreed to delete the protein claim. Two products, crystallised fruits and iced biscuits, were found to contain 65 ENVIRONMENTAL HEALTH non-permitted colouring matters. "Rolls and butter" sold in a large factory canteen were found to be rolls spread with margarine or a mixture of butter and margarine. On investigation it was found that these rolls, for the mid-morning break, were cut and spread by the night-shift. Rolls to be filled with cheese were spread with margarine but were not separated adequately from those spread with butter, and confusion occurred when the day shift took over. The rolls are now placed in colour coded cellophane bags. Food Complaints During the year, 189 food complaints were received. These were all investigated and in the majority of cases warning letters were sent. However, on 34 occasions proceedings were instituted and the results of the legal proceedings are shown in the appropriate table. Many of the complaints received concerned mouldy foods, due in most cases to poor stock rotation. Once again complaints were received concerning the unsatisfactory condition of milk bottles. Although it must be agreed that many receive considerable misuse by the public, 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 31 tons of food were condemned by the Department. Food Hygiene The Food Hygiene (General) Regulations 1970 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, ten 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 759 premises registered in respect of icecream and 367 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 that they are satisfactory, and at the end of the year 55 persons were licensed as hawkers of food. Ice-Cream The manufacture of pre-packed ice-cream is now mainly undertaken by large organisations which 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 three and four 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. 66 ENVIRONMENTAL HEALTH Milk, Dairies and Cream Substitutes The Milk (Special Designation) Regulations 1963/65 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 Agriculture, Fisheries and Food through the County Agricultural Executive Committee. At the end of 1971 there were four such licences current. Two premises are licensed by the Council for the treatment of milk and 210 premises are licensed for the purpose of distribution. 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: 146 Pasteurised; 166 Sterilised; 94 Ultra-Heat Treated; and 7 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 177 samples examined, only in four 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 the conditions were found to be satisfactory. Markets, Slaughterhouses and Knackers' Yards There is no cattle markets, slaughterhouses or knackers' yards within the borough. (See Tables 29, 30, 31 and 32). Housing Council Housing At the end of the year 20,165 dwellings were under the control of the Council - 451 more than the figure for the previous year. This accommodation included 2,595 one-bedroom, 7,324 two-bedroom, 9,167 three-bedroom and 316 four- or five-bedroom units. Nine hundred and twenty-nine applicants on the housing list were rehoused, as also were 122 homeless families. On 31st December there were 4,648 names on the waiting list, including those of less than twelve months' standing. Thirty-eight applicants were awarded priority on the grounds of ill-health or disablement. I am grateful to the Housing Manager for supplying the above information. Overcrowding Housing Act 1957 No statutory action was necessary to abate cases 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 the controller of 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 the Ministry has approved a scheme of registration under the powers given in the Act of 1969. Many dwellings are occupied by two or more families, but relatively few are over-occupied; and with regard to provision of amenities, no formal action 67 ENVIRONMENTAL HEALTH was required during the year. Nonetheless, public health inspectors paid 533 visits to houses in multiple occupation. Slum Clearance and Individual Unfit Houses No clearance areas were confirmed by the Minister in 1971 but there are several awaiting confirmation. 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. These grants and loans are made at the authority's discretion, excluding standard grants for which the financial limit is £200. The maximum sum normally available through an inprovement grant is £1,000 per dwelling although for conversion of a three-storey dwelling the maximum is raised to £1,200. Four hundred and seven dwelling houses were improved, 148 of these receiving standard grants which were for the provision of full standard amenities. The 1964 Housing Act empowers local authorities to declare improvement areas where the Council are able to require landlords to provide standard amenities at their properties. The seven areas declared within the Borough during 1970 are still in operation. The 1969 Housing Act enables the local authority to declare general improvement areas aimed at raising the environmental conditions of the locality. The 1964 Housing Act makes provision for tenants with houses outside improvement areas to require the owner to provide standard amenities. The Council may assist these owners with loans and grants for this purpose. Negotiations were commenced with owners in thirteen such cases. House Purchase and Housing Act 1959 Housing (Financial Provisions)Act1958 Four hundred and thirty-three applications for loans for house purchase were made to the Council, and £693,965 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 make provision for the regulation of tenancy, rents, and security of tenure and restrictions on eviction. Provision is also made for landlords to increase rents in order to keep rent controlled property in good repair; tenants may however apply for a certificate of disrepair which abates the increased rent until required repairs have been carried out. One such certificate of disrepair was issued. Housing Act 1969 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 or their agents 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 upon this evidence the Rent Officer may declare it a regulated tenancy and fix a fair rent. In addition to this where a dwelling does not have the standard amenities the Council may issue a provisional qualification certificate prior to the works being carried out. During the year 1,737 applications for qualification certificates were received and 577 certificates were issued. (See Tables 33 and 34). 68 ENVIRONMENTAL HEALTH Land Charges Land Charges Act 1925 Nine thousand three hundred and five enquiries 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 Caravan Sites Act 1968 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. The Caravan Sites Act 1968 restricts the eviction from caravan sites of occupiers of caravans, and makes provision for the establishment of sites by local authorities for the use of gypsies. The Council has considered a site on land to the East of Montagu Road, Edmonton. Pending the provision of a permanent site, a temporary area has been allocated on land in Turkey Street, with sufficient space for twelve caravans. The site is not provided with roads or hard-standings. The general appearance, especially in the winter months, is poor, and conditions generally are not satisfactory. Toilet facilities provided on a minimal communal basis means that frequently the hygienic conditions are not up to standard. Middlesex County Council Act 1944 In the Spring the provisions of the Middlesex County Council Act 1944 were again invoked to bring about the removal of caravans from unauthorised sites. In spite of fines imposed earlier in the year, the Autumn saw the return of substantial numbers of gypsies to the Eastern part of the Borough. In the Borough there is one privately owned licensed residential site of sixteen caravans, and nine sites at individual nurseries are licensed for employees' use only. In October a site owned by the Council was finally closed following the re-housing of the last tenants. 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 are for the transport of goods and are not used for residential purposes. Offices, Shops and Railway Premises Offices, Shops & Railway Premises Act 1963 Factories Act 1961 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 employees. The Act gives the office and shop worker protection similar to that afforded to the industrial worker by the Factories Acts. Enforcement of the Act is divided between Her Majesty's Factory Inspectorate, Her Majesty's Inspectors of Mines, 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. Her Majesty's Inspectors of Mines are responsible for enforcement in offices, shops and fuel storage premises in mines and quarries. Responsibility in respect of all other shops and offices is vested in local authorities. Since the passing of the Act a number of Orders and Regulations have been made prescribing standards for the provision of washing facilities, sanitary accommodation, first aid equipment: several explanatory circulars have also been issued. 69 ENVIRONMENTAL HEALTH At the end of the year the total number of registered premises in the Borough was 2,959. A total of 4,598 visits were made and 84 new registrations were received during the year. Fifty-six notices were served in respect of contraventions of the Act. However, these were of a minor nature, the most common faults being inadequate lighting and sanitary accommodation. Seventy accidents were reported but none was of a serious nature. In the majority of cases, carelessness again appears to be an important factor. More care in the handling of goods and equipment would probably lead to a reduction in the number of these 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. No prosecutions were taken under this Act during the year. 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 1,850 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 during the year. There are 48 licensed traders on the market square forming part of the Edmonton Green re-development scheme. A further four licensed traders are situated in other parts of the Borough. A private market is held in the Enfield market square every Saturday. During the year, 3,768 visits were made to shops and stalls. Some of these were primary inspections to premises where a change in use had occurred. Where minor contraventions were noted, these were found to have been remedied on re-inspection. No prosecutions were taken. (See Table 35). Hairdressers' and Barbers' Premises Section 77, Public Health Act 1961 Byelaws have been made to ensure the cleanliness of premises, instruments and other materials which hairdressers use in the course of their work. Ninety-nine visits were made by the public health inspectors and conditions were found to be generally satisfactory. Section 21, Greater London Council (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 twenty-two persons are regjstered for thjs purpose in Enfield. Massage and Special Treatment Establishments Middlesex Country Council Act 1944 London Government Act 1963 Privately run establishments carrying on business for the purpose 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 the 31st March each year. Twenty-nine applications for renewal were received and approved and one new licence was granted. No applications were refused. All premises were inspected by a public health inspector and new premises were inspected, in addition, by a medical officer. 70 Broomfield Clinic, Broomfield Park, N.13. (1) Delivery of bathroom unit at site (2) Craning over the terrace IMPROVEMENT OF OLDER HOUSES The use of prefabricated bathroom units greatly speeds up the improvement of terraces of similar houses. The photographs show the sequence of the operation. (3) Lowering on to the prepared base (4) The finished bathroom THE EDMONTON INCINERATOR The Greater London Council's new Edmonton Incineration Plant at Angel Road. ENVIRONMENTAL HEALTH Licensed Premises 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 local authority may, on giving due notice under Section 45 of the Act, enter and inspect the premises. Sixty-four applications were referred, necessitating 98 inspections of premises by public health inspectors. Conditions generally were found to be satisfactory. Licensing Act, 1964 Betting and Gaming Premises Under the Betting, Gaming and Lotteries Acts 1963/64 and the Gaming Act 1968, applications for permits for amusements with prizes on unlicensed premises are dealt with by the Town Clerk. Reports are submitted from the Health Department on the general suitability of the premises, sanitary accommodation and, in the case of premises handling food, on compliance with the Food Hygiene Regulations. Eleven applications were dealt with necessitating thirteen inspections by the public health inspectors. Nine of these applications were approved and two were still under consideration at the end of the year. The Council may object to the granting of Betting Office licences when applications are made to the Betting Licensing Committee under the provisions of the Betting, Gaming and Lotteries Acts 1963/64 and the Gaming Act 1968. Eight applications were referred and the Health Department reported on the conditions at the premises concerned. Eight inspections were made by the public health inspectors and the Council's requirements were met in all cases. Betting, Gaming and Lotteries Act 1963/64 Gaming Act 1968 Nurses Agencies Nurses agencies are required to be licensed by the Council. At the end of 1971 there were three licensed agencies in the Borough. Nurses Agencies Act 195 7:Nurses Agencies Regulations 1961 and 1968 Employment Agencies Applications for licences are dealt with by the Town Clerk, who referred 30 applications to this Department for reports on the suitability of facilities and accommodation. The public health inspectors made 48 visits. Twentyseven renewals and three new applications were approved. Part 14 of the Middlesex County Council Act 1944 Factories and Workplaces 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 no mechanical power is 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 the public health inspectors found some minor defects. However, at the end of the year, the majority of these defects had been remedied and it was not necessary to institute any legal proceedings. ( See Tables 36 and 37). Factories Act 1961 71 ENVIRONMENTAL HEALTH Section 133 (1) Factories Act 1961 Outworkers 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 list. Thirty-one visits were made by the 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 2 Bed linen, etc. 2 Boxmaking, etc., wholly or partially of paper 4 Carding, etc., of buttons 1 Lace-making 1 Paint boxes and paint brushes 3 Toys and games 35 Wearing apparel 151 199 Rag Flock and Other Filling Materials Act 1951 Rag Flock and Other Filling Materials The purpose of the Rag Flock and Other Filling Materials Act 1951 and the Rag Flock and Other Filling Materials Regulations 1971 is to secure the use of clean filling materials in upholstered, lined, or stuffed articles. Local authorities are required to register premises where filling materials are used for upholstering and for the stuffing and lining of bedding, toys, etc. In November, the Rag Flock and Other Filling Materials Regulations 1971, which amended the Regulations of 1961 and 1965, extended the list of filling materials to include rubberised hair, cellular rubber and wood fillings. At the end of the year sixteen premises were registered to use filling materials. Eight visits were made to these premises and conditions were found to be satisfactory. Section 107 Public Health Act 1936 Offensive Trades 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. 72 ENVIRONMENTAL HEALTH Inspections and Complaints The public health inspectors paid 58,790 visits to premises, including dwelling house, business, industrial and food premises. Continued publicity and encouragement from the Government in the sphere of home improvement meant a substantial increase in the number of visits made by inspectors to premises which might prove suitable for conversion or improvement. Although many matters are resolved without the necessity of serving notices, it was found necessary to serve 342 informal and 255 statutory notices, which resulted in repairs to dwellings being effected. Legal proceedings were instituted in eight cases. Of the 8,512 complaints and requests for visits,1,851 were notifications of blocked or defective drains. Although owners are responsible for clearing drains the Council provides a service designed to eliminate possible hazards to public health. (See Tables 38 and 39). Noise There is now an increasing awareness of noise and the nuisance and annoyance it can cause. It is also being realised that modern techniques, good planning and consideration for neighbours can do much to prevent noise or bring it to acceptable levels. Seven hundred and forty-nine visits were made during the year in connection with complaints of noise of various kinds. As in other years, refrigerating and ventilating plant, and circulating pumps in launderettes, caused nuisance and annoyance to occupiers of adjoining premises. Often, elementary precautions during installation would have prevented trouble. In such cases, it is often found that the noise is related to vibration being transmitted to the fabric of a building, resulting in the generation of noise at some distance from the source. This can usually be prevented by introducing flexible couplings on pipework and ducting and ensuring that the motors are suitably mounted. There were also complaints during the year from three separate sites where sheet pile driving operations were carried out. Fortunately, this type of work is fairly rare, for the noise produced by conventional impact pile driving is very great and there is a high degree of metallic resonance. On the last occasion, after representations by the Department, vibratory driving heads were used. This resulted in a marked reduction of noise, the level being slightly less than that produced by a road breaker fitted with an efficient muffler. There would seem to be a case for advising that pile driving operations in the vicinity of dwellings should be carried out either by vibratory or jacking methods. There is an increasing willingness by industrialists and others to deal with potentially noisy plant before it is installed. Not only does this save cause for complaints arising, but it avoids heavy expenditure in altering plant after it has been installed and is in operation. Several such cases were dealt with during the year. These involved discussions with the Eastern Gas Board regarding precautions to be taken at a gas decompression unit, where noise from the plant might affect adjoining houses. There was consultation between the Borough Architect and this Department regarding the development of two sites for housing, and the noise levels which might be anticipated from traffic on main roads in the vicinity. A survey was made of the background noise levels in the area, including motor and railway traffic noise, and this information will be used in designing the buildings to ensure acceptable noise levels within the dwellings. 73 ENVIRONMENTAL HEALTH Sections 83-86, Public Health Act 1936 as amended by Sections 35-37, Public Health Act 1961 Disinfestation The Council is empowered to deal with filthy or verminous premises and articles and also with persons. Facilities are provided at the Council's treatment centre for the cleansing and treatment of scabetic and verminous persons. During the year 123 persons were treated, 121 for scabies and two for pubic lice. Ninety-four requests for treatment of verminous premises were dealt with. At the disinfecting station 60 garments and articles of bedding were disinfested. References to other work undertaken at this station are contained in the item "Disinfection" in this report. Rats and Mice Prevention of Damage by Pests Act 1949 Pest Control If premises are infested by rats or mice the occupier is required to notify the local authority and to take the necessary steps to destroy the pests. 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. No charge is made for this service in the case of householders. The majority of complaints 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 major infestation 7,776 visits to premises were made by the rodent control staff and 748 visits by the public health inspectors in connection with complaints of rats and mice. In all 2,692 premises were visited. Pigeons Section 74 Public Health Act 1961 The pigeon continued to be a serious nuisance, causing damage to buildings and crops. Ferral and wood pigeons, which have adapted themselves to urban life, have apparently continued to increase in numbers. Section 74 of the Public Health Act 1961 enables a local authority to abate the nuisance caused by pigeons and other birds. Thirty-eight treatments were carried out. Wasps and Bees Many householders complain to the Health Department of garden pests, particularly wasps. Six hundred and nine wasps' nests and 49 bees' nests were destroyed, and 231 other insect infestations were treated. Although control of such pests is the responsibility of the householder the Department provides a free service for people who are unable to help themselves, e.g. those handicapped by age or infirmity. When complaints are received 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. Diseases of Animals Act 1950 Animal Care 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. Fowl Pest At the beginning of the year the outbreak of fowl pest throughout the country continued. Further orders were made by the Minister restricting movements of poultry and registration of shows and exhibitions. Although one infected case which occurred in Enfield during April resulted in the issue of a certificate of an infected area by the Ministry of Agriculture, Fisheries and Food, it was withdrawn two months later. 74 ENVIRONMENTAL HEALTH The Diseases of Animals (Waste Food) Order 1957 requires premises to be licensed 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. Five of these use plant and equipment for boiling of waste foods and they are licensed for that purpose. Diseases of Animals (Waste Food) Order 1957 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 in considering applications. Provisional licences may be granted in cases where full licences are not justified. There were five licensed establishments in the borough at the end of the year. Riding Establishments Act 1964 Riding Establishments Act 1970 Under the Pet Animals Act 1951, persons keeping a pet shop are required to be licensed by the local authority. Conditions relate to suitable accommodation for the livestock, provision of food and drink, avoidance of the sale of mammals at too early an age, the prevention of infectious disease, and fire precautions. Thirteen persons were licensed at the end of the year and their premises have been inspected and found to be satisfactory. Pet Animals Act 1951 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 found to be satisfactory. Animal Boarding Establishments Act 1963 Ionising Radiations 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. There are at present seventeen 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. Radioactive Substances Acts 1948-1960 Nuclear Installations Act 1954 Atomic Energy Authority Acts 1954-1959 Nuclear Installations (Licensing and Insurance) Act 1959 Burial and Cremation This authority has a duty to bury or cremate the body of any person who has died or who has been found dead in the borough in circumstances where it appears 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. Section 50, National Assistance Act 1948 75 ENVIRONMENTAL HEALTH Burial Act 1857 Exhumations 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 necessary in the interests of public health. Five 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. Section 198, Public Health Act 1936 Mortuary A local authority may provide a mortuary and a post-mortem 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. 76 ENVIRONMENTAL HEALTH Table 28 Clean Air Smoke Control Areas Area of Borough (in acres) 20,061 No. of premises at 31st December, 1971 109,109 (a) Areas in Operation Area No. of Premises included (At date of declaration) Acreage 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 Street 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 (b) Orders make to come into operation in 1973 LONDON BOROUGH OF ENFIELD Area No. of Premises included (At date of declaration) Acreage 18. Church Street, Town Road, Picketts Lock Lane, Enfield/Waltham Forest Boundary, Enfield/Haringey Boundary, Angel Road, Fore Street, Victoria Road 3,176 1,046 The number of premises included in Areas at the date of declaration will be less than the present number of premises in these Areas because of the exclusion of premises scheduled for redevelopment at the time the Smoke Control Areas were declared, and because of new building and conversion of larger houses into flats since the declaration of the Areas. 77 ENVIRONMENTAL HEALTH Table 29 Food and Drugs Samples submitted to Public Analyst Sample Total Number Procured Number Unsatisfactory Baby Foods 4 1 Beverages, fruit juices, syrups, etc. 57 2 Biscuits 21 4 Bread 7 2 Butter and Margarine 39 — Cakes 16 1 Cereals 26 3 Cheese 32 3 Coffee 4 — Confectionery 30 4 Cooking fats, including Lard, etc. 5 — Cooking oil 1 — Cream 9 2 Dessert Products 17 3 Drugs 38 6 Fish and fish products 35 6 Flour 7 1 Fruit (all kinds) 35 6 Jams and preserves 31 1 Jelly 1 — Meat and meat products 107 11 Milk (various) 15 1 Nuts 4 — Salt, mustard and pepper 6 — Sauces and pickles 50 6 Soup 18 5 Spices, etc. 14 1 Sugar 9 1 Tea 6 - Vegetables (fresh and canned) 55 12 Miscellaneous 41 11 TOTAL 740 92 (12½%) Table 30 Food and Drugs Bacteriological examination of ice-cream Methylene Blue Test Vendor Type of Ice-Cream Results Grade 1 Grade 2 Grade 3 Grade 4 Shop Premises Loose or Soft 11 12 9 6 Mobile Traders Loose or Soft - - 2 2 78 ENVIRONMENTAL HEALTH Table 31 Food and Drugs Bacteriological examination of milk 1. Methylene Blue Test (for keeping quality) 2. Phosphatase Test (for efficiency of pasteurisation) 3. Turbidity Test (for efficiency of sterilisation) 4. Colony Count (for efficiency of heat treatment) Designation Number of Samples Results Satisfactory Void Unsatisfactory Pasteurised 118 114 (96½%) — 4 (3½%) Designation Number of Samples Results Satisfactory Void Unsatisfactory Pasteurised 118 118 (100%) — — Designation Number of Samples Results Satisfactory Void Unsatisfactory Sterilised 25 25 (100%) — — Designation Number of Samples Results Satisfactory Void Unsatisfactory Ultra Heat Treated 34 34 (100%) — — Table 32 Food and Drugs Prosecutions Complaint Fine Costs Sour smelling sausages £ 5.00 £40.00 Bad smelling sausages £ 40.00 £ 5.00 Unsound condition of sausages £ 20.00 — Glass in bottle of milk £ 10.00 £10.00 Glass in bottle of milk £ 25.00 £ 5.00 Glass in bottle of milk £100.00 £15.75 Glass in bottle of milk £100.00 £10.00 Foreign body in bottle of milk £ 30.00 £10.00 Foreign body in bottle of milk £100.00 £15.00 Foreign body in bottle of milk £ 50.00 £10.00 Paint on inside of milk bottle £100.00 £10.00 Metal cap in bottle of milk £ 10.00 £ 5.00 Wood in loaf of bread £ 35.00 £ 5.00 Wood in loaf of bread £ 20.00 £10.00 Foreign matter in loaf of bread £ 30.00 £15.00 Insect in loaf of bread £ 25.00 £ 5.00 Mouldy loaf of bread £ 15.00 £ 5.00 Mouldy loaf of bread £ 60.00 £10.00 Mouldy loaf of bread £ 15.00 £ 3.00 Mouldy loaf of bread £ 60.00 £10.00 Mouldy wrapped loaf of bread £ 75.00 £53.75 Offensive smell from bacon joint £ 40.00 £ 5.00 Bad smelling bacon £ 15.00 — Fly in pork pie £ 20.00 £ 3.00 Mouldy pork pie £ 40.00 £ 5.00 Earwig in yoghurt £ 20.00 £15.00 Mildew in yoghurt £ 25.00 £ 4.50 Mouldy cornish pastie £ 25.00 £ 5.00 Metal washer in green beans £ 30.00 £ 5.00 Glass in meat £ 25.00 £ 5.00 Bolt in rhubarb £ 35.00 £ 5.00 Dehydrated condition of jelly cream £ 25.00 £ 5.00 Part of thumb nail in banana dessert £ 25.00 £ 5.00 Wasp in turkish delight £ 5.00 £ 5.00 79 ENVIRONMENTAL HEALTH Table 33 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) 15,892 (ii) Number of dwelling-houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation 82 (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 398 2. Remedy of defects during the year without service of formal notices: Number of defective dwelling-houses rendered fit in consequence of informal action 174 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 2 (ii) Number of dwelling-houses which were rendered fit after service of formal notices: (a) By owners 2 (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 342 Number of dwelling-houses rendered fit 174 (ii) Number of dwelling-houses in respect of which formal notices were served requiring defects remedied 255 Number of dwelling-houses rendered fit after service of formal notice: (a) By owners 171 (b) By Local Authority in default of owners ... 6 C. Proceedings under Section 17 of the Housing Act, 1957: (i) Number of dwelling-houses in respect of which Demolition Orders were made 2 (ii) Number of dwelling-houses demolished in pursuance of Demolition Orders 2 80 ENVIRONMENTAL HEALTH Table 34 Housing Housing Defects remedied Nature of Defect Number Brickwork, pointing and wallplaster defective 89 Dampness 130 Doors - defective 7 Drains - stopped up 283 Drains - defective or broken 24 Dustbins - defective 2 Floor - defective 31 Guttering and rainwater pipes - defective 70 Paving - broken 3 Refuse Accumulation 6 Roofs - defective 33 Sink Wastes - defective 16 Verminous and dilapidated conditions 54 Water - not provided or disconnected 10 Water-closets - defective 60 Windows - defective or broken 102 Table 35 Offices, Shops and Railway Premises Visits under Offices, Shops and Railway Premises Act 1963 Class of Premises Number of Registered Premises receiving a general inspection Total visits of all kinds to Registered Premises Offices 126 919 Retail Shops 213 2,932 Wholesale Shops, Warehouses 73 606 Catering Establishments open to public, Canteens 21 141 433 4,598 Table 36 Factories and Workshops Inspections for purposes of Provisions as to Health Premises Number on Register Inspections Number of written Notices Occupiers Prosecuted (i) Factories in which Sections 1,2,3,4 and 6 are enforced by Local Authorities 46 23 - - (ii) Factories not included in (i) in which Section 7 is enforced by the Local Authority 735 376 12 - (iii) Other premises in which Section 7 is enforced by the Local Authority (excluding Outworkers' premises) 39 86 - - 820 485 12 - 81 ENVIRONMENTAL HEALTH Table 37 Factories and Workshops Cases in which Defects were found Particulars Number of cases in which defects were Number of cases in which prosecutions were instituted[/##] Found Remedied Referred toH.M. Inspector Referred by H.M. Inspector Want of Cleanliness (S.1) — — 3 - - Overcrowding (S.2) - - - - - Unreasonable temperature (S.3) — — - - — Inadequate Ventilation (S.4) — — - — — Ineffective drainage of floors (S.6) - - — — — Sanitary Conveniences (S.7) (a) Insufficient — — - - - (b) Unsuitable or defective 30 22 - - - (c) Not separate for sexes 1 - - - - Other offences against the Act (not including offences relating to Outworkers) - - 4 - - 31 22 7 - - Table 38 Inspections and Complaints Inspections, Interviews and Visits of the Public Health Inspectorate Animal Welfare 118 Atmospheric Pollution 2,555 Bacteriological Samples 623 Caravans: Residential Sites 210 Gypsies & Other Itinerants 252 Clean Air Act 2,518 Drainage Works 1,797 Factories and Workshops 516 Food and Drugs 2,826 Food Premises 3,927 Hairdressers' Premises 99 Hawkers (Vehicles and Stores) 201 Housing Purchase Advances 492 Housing and Public Health: Inspection of Defects 895 Home Improvements 12,955 Qualification Certificates 2,208 Other Inspections 9,673 Houses in Multiple Occupation 533 Infectious Diseases 1,190 Interviews 1,034 Licensing, Betting & Gaming, Licensed Premises, Employment Agencies, etc. 234 Merchandise Marks 143 Milk Distributors and Dairymen 489 Noise Nuisances 749 Offices and Shops 4,598 Pest Control 1,453 Public Conveniences 143 Shops and Street Trading 3,986 Tips 112 Water 189 Miscellaneous 2,072 TOTAL 58,790 82 ENVIRONMENTAL HEALTH Table 39 Inspections and Complaints Summary of Complaints and Requests for Visits Accumulation of Refuse 160 Bees 49 Blocked or defective drains 1,851 Dampness in premises 166 Defective water-closets 390 Defective water fittings 26 Defective roofs 86 Disinfection and disinfestation 11 Improvement grants 691 Insanitary or defective conditions of premises 410 Insect infestations 231 Noise nuisance 78 Pigeons 94 Rats or mice 2,244 Scabies 11 Smoke nuisance and Clean Air inquiries 226 Squirrels 36 Unsatisfactory housing conditions including overcrowding 82 Unsound food 111 Verminous premises 125 Wasps 590 Miscellaneous 844 TOTAL 8,512 Table 40 Water Supply Metropolitan Water Board Chemical and Mineral Analysis Average Results in milligrams per litre where applicable Thames Derived New River Derived Hoe Lane Well Derived Hadley Road Well Derived Waltham Abbey Well Derived Number of Samples 364 104 4 4 4 Ammoniacal Nitrogen 0.029 0.017 0.089 0.140 0 190 Albuminoid Nitrogen 0.084 0.063 0.027 0.018 0.040 Nitrate Nitrogen 6.1 6.4 0.3 0.3 0.2 Oxygen abs. from KMnO4 4 hrs. at 27°C. 1.04 0.60 0.23 0.14 0.33 Hardness (total) CaCO3 281 302 438 278 273 Hardness (Non-carbonate) CaCO3 90 84 191 51 66 Magnesium as Mg. 5 5 - - - Sodium as Na. 23.5 30.3 - - - Potassium as K 5.1 5.2 - - - Chloride as CI 34 42 28 22 27 Phosphate as PO4 2.3 1.8 - - - Silicate as SiO2 10 9 - - - Sulphate as SO4 64 62 - - - Natural Fluoride as F. 0.15 0.20 0.40 1.10 0.65 Surface-active materials as Manoxol OT 0.02 0.02 Turbidity units 0.1 0.1 0.6 0.1 0.2 Colour (Burgess units) 13 9 11 6 6 pH Value 7.8 7.8 7.1 7.2 7.4 Electrical Conductivity (Micromhos) 580 630 780 550 550 83 ENVIRONMENTAL HEALTH Table 41 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 8,154 1,504 249 250 251 Agar Plate Count per ml. 20-24 hrs. at 37°C 53.9 82.8 0.1 0.4 0.2 3 days at 22°C - - 14 64 9 Coliform Count Percentage of samples neg. in 100 ml. 40.37 40.69 100.0 84.00 99.20 Count per 100 ml. 12.2 14.2 - 3.1 0.1 Escherichia coli Count Percentage of samples neg. in 100 ml. 54.91 60.31 100.0 86.00 100.0 Count per 100 ml. 5.1 2.5 - 2.2 - Results after Treatment Number of Samples 3,901 515 253 249 254 Agar Plate Count per ml. 20-24 hrs. at 37°C 8.4 14.7 0.1 0.1 0.8 3 days at 22°C - - 8 11 17 Coliform Count Percentage of samples neg. in 100 ml. 99.51 100.0 100.0 100.0 99.61 Escherichia coli Count Percentage of samples neg. in 100 ml. 99.97 100.0 100.0 100.0 100.0 Table 42 Water Supply Lee Valley Water Company Representative Sample Chemical Results Expressed in Milligrammes per Litre Appearance Clear and Bright Ammoniacal Nitrogen 0.02 Colour (Burgess) Less than 5 Albuminoid Nitrogen 0.00 Odour/Taste Nil/Nil Nitrate Nitrogen 8.0 Turbidity 0 Nitrite Nitrogen 0.00 Conductivity 600 Oxygen Absorbed 0.30 Total Solids 445 Fluoride less than 0.2 pH 7.2 Silica 15 Free CO2 30 Iron less than 0.02 Alkalinity (CaCo3) 210 Other metals: Copper/Zinc/Lead absent Carbonate Hardness 210 Phosphate 0.11 Non-Carbonate Hardness 120 Residual Chlorine Nil Total Hardness 330 Temperature (°C) 8.5 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. 1 per ml. 4 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. 84 SCHOOL HEALTH Tables relating to the School Health Service 43 Medical Inspection 44 Defects found at periodic and special inspections 45 Special inspections and Re-inspections 46 Hearing Tests 47 Infestation with Vermin 48 Medical Treatment: Defects treated 49 Ear, Nose and Throat Clinics 50 Ophthalmic Clinics 51 Orthoptic Clinic 52 Orthopaedic Clinic 53 Speech Therapy 54 Child Guidance Clinic 55 Dental Inspection and Treatment 56 Children in Special Schools Summary Routine Medical Inspection School Population 43,290 Number of children examined 12,050 Number found to be satisfactory 12,050 Number found to be unsatisfactory Nil Medical Treatment Total attendances: Minor Ailments 19,674 Ear, Nose and Throat 541 Ophthalmic 4,795 Orthoptic 1,765 Orthopaedic 73 Speech 2,706 Child Guidance 1,168 Handicapped Children Receiving Special Education Total number of children 601 Number attending Day Special Schools 492 Number attending Residential Special Schools 109 Routine Dental Inspection and Treatment Number of children examined 35,089 Number found to need treatment 14,157 Number treated by School Dental Officers 6,888 86 SCHOOL HEALTH Medical inspection 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 development. An estimateof the child's physical condition is made at the time of the inspection, and the 12,050 examined in 1971 were all 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 nine independent schools in the borough, but these schools are included in the B.C.G. vaccination scheme. Medical Officers no longer visit the two technical colleges, each of which has now made arrangements with general medical practitioners. Arrangements have continued, however, for students to be offered B.C.G. vaccination, and the Mass Radiography Unit continues to visit both colleges in the Autumn. Of 351 students from Enfield College of Technology who attended for chest X-ray examination, five were referred for investigation. In the case of two of these no further action was subsequently deemed necessary, and the other three remained outstanding, being subject to six-monthly check. From Southgate Technical College 467 students attended for chest X-ray examination. Only one was referred for investigation, and in this case no further action was subsequently considered necessary. Section 48 Education Act 1944 Persons with defective colour vision are unable to follow certain occupations. In order 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 forty-two boys and eight girls were found by the Ishihara test to have a degree of colour blindness. Of the 81 boys and five girls tested by the Giles Archer Lantern, sixteen boys and two girls were found to be normal, nineteen boys and two girls were found to be safe and 46 boys and one girl unsafe in relation to certain standards for employment. Colour Vision Children are 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 audiology technicians attended the ear, nose and throat clinics and tested children as requested by the consultants. 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 105 Hearing 87 SCHOOL HEALTH children referred to the school ear, nose and throat clinics, 22 are still attending for observation; 49 were referred to hospitals for operation or other treat ment; two underwent hospital treatment followed by observation at clinics; thirteen were discharged following minor treatment; sixteen required no treatment; and three failed to attend. Five commercial hearing aids were purchased during the year, all other needs being met by the issue of National Health Service body-worn and headworn 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 Chief Education Officer's efforts to appoint a peripatetic teacher for this Borough have met with no success, so that an expansion of this service has not been possible. An induction loop and an amplifier have been fitted in one ordinary primary school for the benefit of a partially hearing boy and a similar arrangement is proposed to enable a partially hearing girl to listen to the schools' television programmes. Foot inspections Regular foot inspections by the school nurses in all schools in the Borough revealed 1,337 new cases of plantar warts from the 81,128 inspections undertaken. An informative pamphlet is available to parents to assist them in recognising verrucae in the early stages, and containing advice on treatment and on the prevention of the spread of infection. (See Tables 43,44,45 and 46). 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. (See Table 47). 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 clinic premises 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. 88 SCHOOL HEALTH Consultants holding local hospital appointments held sessions at Southbury Clinic on alternate weeks and at Edmonton Central Clinic twice a month. The consultant attending Edmonton Central Clinic retired at the end of the year and it was reluctantly agreed, after representations from the Regional Hospital Board, that sessions at that clinic be discontinued and the patients asked to attend either Chase Farm Hospital or Highlands Hospital. Forty-eight children attending the clinic were therefore referred for treatment at one of these hospitals. Ear, nose and throat clinics Three sessions each week continue to be held at Southbury Clinic, two a week at Edmonton Central Clinic, and two every other week at Bowes Road Clinic. Ophthalmic 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. Orthoptic clinics After last year's very high level of new referrals to this clinic the numbers dropped considerably and as a result only seventeen sessions were held during the year. Foot deformities, knock knees, postural defects and suspected congenital hip deformities in babies continued to be the main defects referred. Children requiring physiotherapy attend hospital for this purpose. Orthopaedic clinic The services of a part-time physiotherapist continued to be available. Treatment was given twice a week to children at Hazelbury Open-air School, and at Durants and Waverley Schools for educationally subnormal children. Ninety-six children suffering from asthma, bronchitis, cerebral palsy, muscular dystrophy, foot and postural defects received a total of 4,510 treatments. Physiotherapy It was possible, during the year, to increase by five the number of sessions held each week in clinic premises and special schools by the appointment of two part-time therapists; but there are still waiting lists for this treatment both at clinics and in special schools. Defects treated by the speech therapists may be placed broadly in one of three categories: retarded speech and language development; articulation difficulties; stammer. During the year three children suffering from language retardation were assessed at the Wolfson Centre and Department of Developmental Paediatrics, and commenced attending four mornings a week at the Centre's language class. Encouraging reports on their progress have been received. One student from the Oldrey-Fleming School of Speech Therapy attended the Edmonton Central Clinic for one session a week during the last quarter of the year for practical training. Discussions have taken place with the Chief Education Officer on the possibility of establishing a special unit locally to cater for those children of Speech clinics 89 SCHOOL HEALTH average intelligence but with severe speech defects who would benefit from special teaching combined, where appropriate, with speech therapy. It is hoped that it will be possible to make satisfactory arrangements in the near future. Child guidance centre and clinic The Child Guidance Centre and Clinic is situated at 8 Dryden Road, Bush Hill Park. There is staffing provision for a part-time psychiatrist (eight sessions per week), four psychiatric social workers, four educational psychologists and two psychotherapists. The Education Committee is responsible for appointing staff other than the psychiatrist, who is appointed by the North East Metropolitan Regional Hospital Board. 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. The educational psychologists deal mainly with problems arising in school. If the problem seems to be of emotional origin, the child may be referred to the psychiatrist by the school medical officer, family doctor, hospital service, and sometimes by the parents themselves. The psychiatric social worker's duties are with the parents of children with problems, and the psychotherapists see children for regular treatment sessions. In conjunction with the centre and clinic there is the Selection Unit at Chase Side School for twenty young children suffering severe emotional disorder. They are admitted on the recommendation of the psychiatrist. 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 nonspeaking and in other ways inaccessible. Elsewhere, remedial classes are provided for very small groups of children with specific learning difficulties, who attend part-time; additionally a small full-time class for hyperactive infants is now held under the supervision of the teacher in charge of the Selection Unit. The recent provision of Aylands, a day school for 50 maladjusted boys and girls of all ages, and the conversion of Wavendon House to a residential school for maladjusted boys has greatly improved the prospects of satisfactory placement for many of the children seen at the Child Guidance Clinic. Nutrition Although advice on nutrition is generally available at medical inspections, the more positive approach to the problem of the overweight child and the underweight child - inaugurated last year - was continued. Advice, both individually and by group method, was supplemented by the use of diet sheets and weight charts. No underweight children were referred for advice. At the end of the year 45 children were attending. Enuresis Twenty-two automatic enuresis alarm devices are available locally to assist in the treatment of enuretic children. Alarms were issued to 56 children during the year. Eighteen other children were offered alarms but eight no longer needed them, and the remaining ten did not accept the offer. 90 SCHOOL HEALTH Twenty-one children responded successfully, one improved and in eleven cases no success was reported. After six months a check of 26 reported cured cases revealed that ten were still dry and six had relapsed; and ten failed to keep appointments. Three children were sent on recuperative holidays of two weeks duration and one child attended a holiday camp under arrangements made by the British Epilepsy Association. (See Tables 48,49,50,51,52,53 and 54). Recuperative holidays Dental service 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 48 Education Act 1944 Under Section 4 of the Education (Miscellaneous Provisions) Act 1953, the local education authority has duties and powers in regard to the provision 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. Mr. Phillips, the Chief Dental Officer and Principal School Dental Officer, reports that 35,089 pupils were examined for the first time during the year by the Borough's Dental Service, this being 5,359 more than last year. Of those inspected 14,157 (40.3%) were found to require treatment, and of these, 13,299 (93.9%) had been offered treatment by the end of the year. Of those offered treatment, 6,888 (51.7%) accepted treatment through the School Dental Service. It must be remembered, however, that some parents prefer to arrange dental treatment through the general dental service. The School Dental Service provides for the day special schools, and also for the Borough's Wavendon House Residential Special School for educationally sub-normal boys. In addition to ordinary dental treatment, the orthodontic service continues to be in demand. Throughout the year, 6,400 attendances were made; 208 new cases were started; and 246 cases were completed. All dental prosthetic and orthodontic appliances are made at the Hendon dental laboratory, and throughout the year four dentures, 564 removable orthodontic appliances, and 72 fixed orthodontic appliances were supplied. Dental health education - energetically pursued by dental officers and by the Health Education Officer - was much appreciated by both teaching staff and pupils. Although the Borough is fortunate in the standard of its premises and of much of its equipment, certain improvements became possible during the year. At the Central Clinic, a modern unit with a parallel beam light replaced the existing unit and light in Surgery No. 1, and a similar light was fitted in Section 4 Education (Miscellaneous Provisions) Act 1953 91 SCHOOL HEALTH Surgery No. 2 for the use of the orthodontists. Up-to-date high speed drills were installed at Ridge House and Laurels Clinics, in order to give maximum efficiency. (See Table 55). 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 492 Enfield pupils (of which 118 were in attendance at Waverley School - formerly the Junior Training School) were attending day special schools, and 109 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 — Two children were ascertained during the year, and both were admitted to special schools. At the end of the year there were five children in special schools. (b) Partially Sighted — One child was ascertained during the year and is awaiting placement. At the end of the year there were seven children (including one with a dual handicap) in special schools. One child was receiving home tuition and two were in ordinary schools. (c) Deaf — No children were ascertained during the year. At the end of the year there were fifteen children in special schools. (d) Partially Hearing — Ten children were ascertained during the year:six were admitted to special schools, two to playgroups, one remained in an ordinary school and one left the district. At the end of the year 35 children were in special schools, two in playgroups, one in a day nursery, four in ordinary schools and one was not placed. (e) Educationally Sub-normal — Seven children were ascertained during the year: two were admitted to special schools and five are awaiting placement. At the end of the year 173 children (including three with dual handicaps) were in special schools and six were in ordinary schools. In addition 157 children were attending special schools on an informal basis. Eighty-eight of the children formally ascertained and 30 of those placed on an informal basis were attending Waverley School which, prior to 1st April, 1971, had been the Junior Training School. (f) Epileptic — Two children were ascertained during the year: one is awaiting placement and one is attending an independent boarding school. At the end of the year one child (with a dual handicap) was at a special school, one was receiving home tuition, one was attending an ordinary school, one an independent boarding school and one (with a dual handicap) was not attending school. (g) Maladjusted — Twenty-two children were ascertained during the year: thirteen were admitted to special schools, eight are awaiting placement and one is in an approved school. At the end of the year 104 children (including two with dual handicaps) were in special schools, nineteen in ordinary schools, four in approved schools and two (including one with a dual handicap) were not attending school. 92 SCHOOL HEALTH (h) Physically Handicapped — Ten children were ascertained during the year: seven were admitted to special schools, one is attending an independent school, and two are awaiting placement. At the end of the year 40 children (including two with dual handicaps) were in special schools, ten in ordinary schools and two were not at school. (i) Speech — Three children were ascertained during the year: one was admitted to a special school and two to a special language class on a part-time basis. At the end of the year there were two children in special schools and three in a special language class. (j) Delicate — Eighteen children were ascertained during the year: fourteen were admitted to special schools, three continued in ordinary schools and one left the district. At the end of the year 62 children (including one with a dual handicap) were in special schools and five (including one with a dual handicap) in ordinary schools. The Education Committee maintains five day special schools and one residential special school. All admit a proportion of children from other boroughs. Special Schools Waverley School (Day), formerly the Junior Training School, became the responsibility of the Education Department from the 1st April, 1971, when The Education (Handicapped Children) Act 1970 transferred from Health Departments the responsibility for the education of mentally handicapped children. The school has accommodation for 150 educationally sub-normal children and includes a nursery class and a special care unit. A medical officer visits the school weekly and the children are routinely medically examined annually. A speech therapist also visits weekly; and nine children received a total of 650 treatments by the physiotherapist on her twiceweekly visits. Durants and Oaktree Schools (Day) provide accommodation for 320 educationally sub-normal boys and girls who are routinely medically examined annually. Speech therapy is provided, and at Durants School, where some of the pupils have dual handicaps, the physiotherapist - who attends twiceweekly - gave eight children a total of 550 treatments. Hazelbury Open Air School (Day) 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 annually or more frequently where it appears desirable. 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 79 children received a total of 3,310 treatments. Nine children suffering from orthopaedic disabilities 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 School (Day) provides places for 50 maladjusted boys and girls. The children are routinely medically examined annually and seen periodically by a psychiatrist. Wavendon House residential school provides places for 50 maladjusted boys. Those boys at the school whose parents live in Enfield are routinely medically examined annually during school holidays and are also seen periodically by a psychiatrist. A general medical practitioner looks after the health of the boys during term time. The Principal School Dental Officer visits the school twice annually to inspect the pupils and carry out simple treatment. The boys' dental condition was found to be generally satisfactory. (See Table 56). Education (Handicapped Children) Act 1970 93 SCHOOL HEALTH Education (Milk) Act 1971 From the beginning of the Autumn term the Education (Milk) Act 1971 restricted the duty of local education authorities to provide milk in schools to the following: all children up to the end of the Summer Term next following their seventh birthday; pupils of all ages in special schools; and other children in primary schools where a certificate given by a medical officer of the authority states that a child's health requires that he should be provided with milk at school. Parents of children at primary schools were invited by the Chief Education Officer to inform the Principal School Medical Officer if they thought their children should receive milk in school for health reasons. Head teachers who themselves may be of the opinion that individual children should be considered were asked to advise parents to apply. Medical Officers carrying out routine medical examinations in schools and clinics were requested to submit recommendations in appropriate cases. By the end of the year the provision of milk in school had been certified as necessary for health reasons in the case of 72 children. Eleven applications were not sustained. 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 ten 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 34 Education Act 1944 From the 1st April, 1971, under The Education (Handicapped Children) Act 1970, the provision for notifying a child as unsuitable for education at school ceased and the provisions of Section 34 of the Education Act 1944 regarding special educational treatment applied to such children. 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 this report. Head Teachers continue to co-operate in the distribution of consent forms, which serve not only to emphasize to parents the need for immunological protection for their children, but also to remind them that a reinforcing dose may be due. To minimize 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 Section 59 Education Act 1944 In accordance with the Bye-laws, 365 children were examined and certificates 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 three 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. 94 SCHOOL HEALTH Children in care Five children's homes, under the control of the Social Services Department since 1st April, 1971, accommodate 64 school children and are visited approximately six times a year by medical officers from the Department. The medical officers advise generally on diet, health and hygiene and examine the children on admission and annually. General medical care is undertaken by a general practitioner. The Department's medical officers also supervise, in the same way, two homes situated in the Borough, belonging to the London Borough of Barnet, and accommodating 21 school children. Children in foster homes are under the general 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. Reports were also received during the year concerning six school children who had been admitted to hospital after having variously consumed "bleach", "detergent", "toadstool", gin, lotion for removal of warts, and sedative tablets prescribed for a parent. Happily, all recovered. 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 outbreaks in two schools in the Borough involving a Scabies total of 24 children. In addition, nine sporadic cases were reported. German Measles (Rubella) Forty-seven children were treated for scabies during the year, and clinic nurses inspected 1,140 school children in classes where cases had occurred. Rubella is not usually a serious disease but it has been established that rubella, occurring in a woman during the early months of pregnancy, may cause congenital defects in the foetus. The advice of the Department of Education and Science has been followed and, on the occurrence of rubella in school children, steps are taken to advise mothers of pupils,and also female members of the staff, in order that, if necessary, they may consult their doctor and take any other necessary action. Reporting of infectious disease Head teachers reported 350 school children as suffering from infectious diseases. 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. One comprehensive school has now been given authority to use open sources and almost all comprehensive schools are authorised to use closed sources. 95 SCHOOL HEALTH 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 723 pupils were X-rayed. The number of X-rays taken during the year was 1,721, including 1,566 for orthodontic purposes. 96 SCHOOL HEALTH Table 43 Medical Inspection Pupils attending maintained primary and secondary schools (including nursery and special schools) Age groups inspected (by year of birth) 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 1967 and later 407 19 49 62 1966 1,933 124 331 441 1965 1,852 135 317 432 1964 296 22 38 59 1963 72 8 8 15 1962 63 7 12 19 1961 878 136 126 241 1960 2,085 356 297 604 1959 1,032 153 140 267 1958 255 48 37 81 1957 592 123 81 182 1956 and earlier 2,585 564 282 725 Total 12,050 1,695 1,718 3,128 97 SCHOOL HEALTH Table 44 Medical Inspection Defects found at periodic and special inspections (Classified in accordance with the requirements of the Department of Education and Science) Defect or Disease Periodic Special Requiring Treatment Requiring Observation Requiring Treatment Requiring Observation Skin 386 4 67 11 Eyes (a) Vision 1,695 696 262 81 (b) Squint 53 7 3 — (c) Other 37 — 24 3 Ears (a) Hearing 70 125 115 49 (b) Otitis Media 17 — 18 2 (c) Other 41 6 24 5 Nose and Throat 374 15 68 5 Speech 57 27 29 9 Lymphatic Glands 3 — 1 — Heart 37 11 1 — Lungs 137 8 7 2 Developmental (a) Hernia 13 2 1 2 (b) Other 104 125 10 18 Orthopaedic (a) Posture 3 2 — — (b) Feet 45 12 7 6 (c) Other 29 9 18 3 Nervous System (a) Epilepsy 31 1 2 — (b) Other 5 — 1 2 Psychological (a) Development — — 30 2 (b) Stability 84 99 52 61 Abdomen 36 5 4 — Other 268 50 137 76 98 SCHOOL HEALTH Table 45 Medical Inspection Special inspections and re-inspections Number of special inspections (including freedom from infection examination prior to school journeys and special examination at schools, special schools, children's homes, etc.) 5,376 Number of re-inspections 2,403 Table 46 Hearing tests by audiometer (a) Routine tests in school Age Group 1st Test Failures Of total failures number already known to have hearing loss ReTests Both ears one ear Total right left Entrants 5,652 95 64 70 229 34 938 8-9 years 2,648 63 30 36 129 61 496 12-13 years 3,003 38 15 25 78 48 311 Total 11,303 196 109 131 436 143 1,745 (b) Special tests in clinics Age Group 1 st T est Failures Of total failures number already known to have hearing loss ReTests Both ears one ear Total right left Pre-School 51 14 7 9 30 2 8 School Children 475 121 46 56 223 38 197 Total 526 135 53 65 253 40 205 No. of children in schools (excluding special schools for the deaf or partially hearing) who have hearing aids 55 99 SCHOOL HEALTH Table 47 Inspections for cleanliness Infestation with vermin (a) Total number of examinations of pupils in school 70,525 (b) Total number of individual pupils found to be infested 107 (c) Number of individual pupils in respect of whom cleansing notices were issued (Section 54 (2) Education Act 1944) 44 Table 48 Medical treatment Defects treated at minor ailments clinics (Classified in accordance with the requirements of the Department of Education and Science) Skin: Ringworm (i) Scalp 1 (ii) Body — Scabies 1 Impetigo 12 Other 2,130 Eye Disease 42 Ear Defects 31 Miscellaneous 1,154 Total attendances at Minor Ailments Clinics 19,674 Number of Special Inspections at Minor Ailments Clinics 1,696 Number of Re-examinations at Minor Ailments Clinics 833 Table 49 Ear, nose and throat clinics Total attendances 541 New cases 235 Number of individual children seen 370 Number who received treatment at E.N.T. Clinics 102 Number referred to hospital for tonsillectomy and/or adenoidectomy 126 Number referred to hospital for other treatment 27 Number referred for X-ray 23 100 SCHOOL HEALTH Table 50 Ophthalmic clinics Total attendances 4,795 New cases 667 Number of individual children seen 2,269 Number of children who were prescribed glasses 1,019 Table 51 Orthoptic clinics Total attendances 1,765 New cases 71 Number of individual children treated 378 Number discharged: Orthoptically satisfactory with operation 4 Orthoptically satisfactory without operation 59 63 Number discharged not orthoptically satisfactory but: 1. Intermittent Binocular Single Vision 6 2. Appearance satisfactory: (a) with improved visual acuity 7 (b) without improved visual acuity 5 Number discharged but treatment not completed: (a) Left district 7 (b) Failed to attend 4 (c) Referred elsewhere 1 30 Number of appointments made and not kept 585 Table 52 Orthopaedic clinic Total attendances at Orthopaedic Surgeon's Clinic 73 Number of new cases seen by Orthopaedic Surgeon 41 Number of cases discharged 37 101 SCHOOL HEALTH Table 53 Speech therapy Clinics and special schools Total attendances 2,706 New cases 104 Children under treatment or observation for the following: Retarded speech and language development 100 Articulation defects 241 Stammer 37 378 Discharged: Cured 52 Improved 16 Defaulted 19 Transferred elsewhere for treatment or left district 19 106 Table 54 Child guidance clinic Number of individual children seen by psychiatrist: New cases (including 9 pre-school children) 162 Follow-ups 39 Annual revisions 21 Treatment 5 Total attendances for diagnosis and treatment by Psychiatrist 426 Number of individual children treated by psychotherapist 35 Total attendances for treatment by psychotherapist 742 102 SCHOOL HEALTH Table 55 Dental service Dental inspection and treatment 5-9 years 10-14 years 15 years and over Total Attendances and Treatment: First visit for treatment 3,782 2,723 383 6,888 Subsequent visits 5,187 8,305 1,585 15,077 Total visits 8,969 11,028 1,968 21,965 Additional courses of treatment commenc ed 492 258 51 801 Fillings in permanent teeth 1,595 5,195 1,065 7,855 Fillings in deciduous teeth 6,446 846 — 7,292 Permanent teeth filled 1,387 4,586 952 6,925 Deciduous teeth filled 6,002 764 — 6,766 Permanent teeth extracted 112 731 92 935 Deciduous teeth extracted 2,119 891 — 3,010 General anaesthetics 746 367 21 1,134 Emergencies 432 123 21 576 Number of pupils X-rayed 723 Prophylaxis 985 Teeth otherwise conserved 1,700 Number of teeth root filled 18 Inlays 2 Crowns 14 Courses of treatment completed 7,157 Orthodontics: Cases remaining from previous year 452 New cases commenced during year 208 Cases completed during year 246 Cases discontinued during year 88 Number of removable appliances fitted 564 Number of fixed appliances fitted 72 Pupils referred to hospital consultant 3 Total attendances at clinics 6,400 Prosthetics: Pupils supplied with full upper or full lower dentures (first time) - - - - Pupils supplied with other dentures (first time) - 3 1 4 Number of dentures supplied — 3 1 4 Anaesthetics: General Anaesthetics administered by Medical Officers 1,134 Inspections: (a) First inspection at school. Number of pupils 29,411 (b) First inspection at clinic. Number of pupils 5,678 Number of (a) + (b) found to require treatment 14,157 Number of (a) + (b) offered treatment 13,299 (c) Pupils re-inspected at school clinic 2,492 Number of (c) found to require treatment 1,213 Sessions: Sessions devoted to treatment (incl. 751 orthodontic sessions) 3,448 Sessions devoted to inspection 227 Sessions devoted to Dental Health Education 56 103 SCHOOL HEALTH Table 56 Handicapped children Children in special schools Category Day Residential Blind - 5 Partially sighted 6 1 Deaf 10 5 Partially hearing 33 2 x Educationally sub-normal: (formally ascertained) 159* 14 (not formally ascertained) 157 - Epileptic — 1 Maladjusted 42 62 Physically handicapped 33 7 Speech 1 1 Delicate 51 11 *Includes two girls living in Clay Hill Hostel for educationally sub-normal girls. xThe total of 159 children formally ascertained includes 88 attending Waverley School; and of the 157 not formally ascertained 30 attend Waverley School. Ten children with more than one defect are included in the category of their major defect. 104 STAFF AND TRAINING STAFF AND TRAINING Staff Medical Officer of Health and Principal School Medical Officer W.D. Hyde, M.B., Ch.B., D.P.H. Deputy Medical Officer of Health and Deputy Principal School Medical Officer B.J. Cooper, M.B., Ch.B., D.Obst.R.C.O.G., D.C.H., D.P.H., Barrister-at-Law Principal Medical Officers Leonora A. Crawford, M.B., B.S., D.P.H., D.C.H.; Monica E.Watkins, M.B., B.S. Senior Medical Officer Isobel H. Caddy, M.B., Ch.B., D.P.H. (resigned 12.9. 71) Medical Officers in Department Grace J. Adam, M.B., Ch.B. (part-time); Vernell T. Allen, M.B., B.S. (appointed 1.9.71); Janet F. Cambell, M.B., Ch.B., D.C.H. (part-time); Sook Peng Chan, M.B., B.S. (appointed 15.3.71); 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. 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. MentalSubnormality: W. Livingston, B.A., M.R.C.P., L.R.C.P., D.P.M. Consultant Chest Physician J. Vernon Davies, M.D., B.S., M.R.C.P. Hospital Consultants and Specialists(Undertaking sessionsat Council Clinics) Ear, Nose and Throat: 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. Underbill, L.D.S., R.C.S. (part-time). 106 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.l. Senior Public Health Inspectors R.L. Burkill, F.A.P.H.I.; G.E. Laney, M.A.P.H.l.; R.E. Williams, M.A.P.H.l. Principal Mental Welfare Officer A. Duff, Dip.S.SS., M.S.M.W.O. Deputy PrincipalMental Welfare Officer (post Vacant): Senior Mental Welfare Officers Mrs. H.M. Smith, R.M.N., S.R.N., C.S.W.; Mrs. C. Cooknell, B.Soc.S., C.S.W. (post Vacant): Superintendent Health Visitor Miss P.Z.M.J. MacLaughlin, S.R.N., S.C.M., H.V., P.H.A. (cert.)(appointed1.4.71). Non-medical Supervisor of Midwives Miss D. Hall, S.R.N., S.C.M. Senior Midwife Mrs. P. Haddon, S.R.N., S.C.M. Superintendent of Home Nursing Service Mrs. M. Pickering, S.R.N., N.D.N, (cert). Senior Home Nurse Mrs. E. Tubbs, S.R.N. Home Help Organiser Mrs. B.I. Graham Health Education Officer Miss T. Bamford, S.R.N., S.C.M., H.V., Dip. in Health Education 107 STAFF AND TRAINING Chief Administrative Officer S.N. Dance Deputy Chief Administrative Officer D.A. Hastings (retired 31.3. 71).; E.J.A. Golding (appointed 19.4. 71). Senior Administrative Officers L.G. Coe, F.R.S.H., D.M.A.; A.K. Clark, D.P.A.; S. Law; Miss D. Hamer (appointed 19.1.71); J. Humblestone (appointed 23.8.71). Other Staff Establishment Health visitors—group advisers (3), field work instructors (3), health visitors/ school nurses (46), tuberculosis health visitors (2), student health visitors (6); midwives (30); home nurses (45), nursing auxiliaries (6); area home help organisers (3), assistant area home help organisers (3); dental surgery assistants (12); mental welfare officers (9), trainee mental welfare officers (3); health education technician (1); speech therapists (3); senior orthoptist (1); audiology technicians (2); physiotherapist/remedial gymnast (1); chief chiropodist (1), chiropodists (6½); medical social worker (1); pre school playgroup organiser (1). Public Health Inspectors—specialists (3), district (16), student (6); technical assistants (shops and street trading inspectors) (2); technical assistants (5). 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) (6), disinfector/convenience foreman (1), disinfector drivers (2), convenience attendants (75), driver/cleaners conveniences (2), male cleaners conveniences (3), driver/handymen (3), porter/messenger (1), clinic/caretaker/cleaners (9),home helps (160). Health Centre Administrative Officer (1), clerical assistant (1), caretaker (1), domestic staff (2). Day Nursery Matron—Miss M.W. Betteridge (retired 31.3.71), 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); housekeeper (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). 108 STAFF AND TRAINING The following whole-time equivalent personnel comprised the establishment of the Health Department until 1st April, 1971. Administrative, Professional and Technical Officers 413 Manual Workers 311 724 With the transfer of certain functions to the recently created Social Services Department some members of the staff also were necessarily transferred. Whilst regretting the departure of such staff, several of whom had worked for many years in the Health Department, I would like to record my appreciation of their past services and wish them success in the future. Several long-serving officers retired after many years service: Mr. D.A.B. Hastings (Deputy Chief Administrative Officer) after no less than 48 years; Miss M.W. Betteridge (Matron, Fore Street Day Nursery) after 31 years; Mr. A. Robinson (Shops & Street Trading Inspector) after 24 years; Mrs. E.M. Jeffrey (Audiology Technician) after 24 years; Mrs. C. Killingback (Home Nurse) after 22 years; Mrs. E.J. Richards (Clerical Officer) after 21 years; Mrs. M.A. Griffin (Home Nurse) after 17 years; Mrs. G.M. Sharman (Clerical Officer) after 17 years. To all those Officers who retired during the year under review I extend my thanks for their past services. Dr. I.H. Caddy, after many years' service in the area, resigned on the 12th September in order to take up an appointment with Surrey County Council. Dr. Caddy joined the Middlesex County Council (Area 1) in 1951 as an assistant medical officer and continued in that capacity until her promotion to Senior Medical Officer in December, 1970. Other officers who resigned during the year include Mrs. J.F. Nicholas (Group Adviser) and Mrs. K. Fife (Clerical Officer), the latter to take up an administrative appointment elsewhere in the Council's service. With deep regret I have to record the death of Mr. J.T. Lathlean on the 7th March, 1971. Mr. Lathlean, who held an administrative post in the department, originally joined the Middlesex County Council in 1949. 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 2,234. Pre-Employment Medical Assessments Teachers 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. 109 STAFF AND TRAINING Fifty-eight teachers and 275 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 413 teachers assessed and of this number eleven 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. One thousand four hundred and eighty-eight assessments were made. In 54 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 sixteen employees were found to be incapable of discharging efficiently the duties of their employment by reason of permanent ill-health or infirmity of mind and body. 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 and Social Services Departments. 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. 110 STAFF AND TRAINING The Advisory Committee meets regularly to consider and make recommendations concerning applications by officers for approval to attend courses leading to recognised qualifications. A course on Preparation for Childbirth, held at Merryhills Clinic on Monday 24th May, 7th June and 14th June, was attended by members of the health visiting and midwifery staff. The course was under the direction of Mrs. M. Williams, M.C.S.P. A Symposium on Family Planning was organised by the Family Planning Association at Bowes Road Clinic on Monday 10th May and Tuesday 25th May. This was attended by members of the health visiting and midwifery staff. Talks by the Milk Marketing Board were given to all nursing personnel. Courses attended by Health Department staff (the number of officers attending is shown in brackets after each course) Medical Officers Geriatrics Services—1 day (1); Community Developmental Paediatrics — 6 days (3); Diagnosis and Treatment of the Deaf Child—3 days (1); Post-Graduate General Course—6 days (1); Rehabilitation of the Cancer Disabled—1 day (1); Infections and Viruses—1 day (2); Speech and Learning Problems in Children—½ day (2); Maternal and Child Welfare—3 days (1); Social Obstetrics in 70's—1 day (1); Incompatibility and Mental retardation—1 day (1). Public Health Inspectors Poultry Hygieneand Inspection—3 days (2); Advances in Food Inspection— 3 days (2); Pollution from Combustion Processes—3 days (1); Institute of Shops Acts Administration-3 days (1); National Society for Clean Air-4 days (1); Bacteriology and Food Chemistry—5 days (1); Diploma of Public Health Inspectors—Day Release—4 years—(2); Diploma of Public Health Inspectors—Sandwich Course—3 years (2). Health Visitors Field work Instructors Course—30 days (1); Course for Clinic Nurses—6 days (1); Assessors of Supervised Practice in Health Visiting—4 days (1); Health Visitors Refresher Course—10 days (2); Training of Student Health Visitors—2 days (3); Whither Community Midwifery—1 day (4); Middle Management—20 days (1); Integrated Care of Psychiatric Patients—1 day (1); Method for Health Visitors—3 days (1); Rehabilitation of the Cancer Disabled — 1 day (1). Midwives Refresher Course— 6 days (2); Developments in the Treatment of Gynaeco- logical Disorders—1 day (2); Whither Community Midwifery—1 day (2); Teaching in Preparation for Parenthood—8 days (1); Preparation for Integration—1 day (1); Preparation for Childbirth—3 days (2). Home Nurses First Line Management—5 days (1); Working in General Practice—5 days (1); Practical Work Instruction Course—10 days (2); District Nurse Training—13 weeks (4); Rehabilitation of Cancer Disabled—1 day (1); Clinical Procedure in General Practice—2 days (3); Family Stress in Long Term Illness-1 day (3); Continuity of Patient Care-1 day (2); Principles and 111 STAFF AND TRAINING Planning of In-Service Training-5 days (1); British Diabetic Association— 1 day (2); Care of Feet—1 day (1); Partners in Patient Care—2 days (1). Dental Staff Certificate of Dental Surgery Assistants-day release (1). Medical Auxiliaries Course on Audiology (1); The Chiropodial Environment—4 days (1); Display Techniques — 4 days (1). Administrative and Clerical Officers Summer School (University of Kent)—4 days (1); Diploma in Municipal Administration—day relea se (7); Local Government Examination Board — day release (2); Ordinary National Certificate for Public Administration— day release (1); General Certificate of Education 'A' Level English—day release (1). Manual Workers Day release course for Shop Stewards in Local Government—1 day a week for 10 weeks. 112 INDEX INDEX Pages on which Statistical Tables appear are indicated in bold type. Accidents: Fatal 10 Road 10 18 Young Children 25 Adult Training Centre 44 Aircraft 12 Alcoholism 46 Ambulance Service 35 Analgesia-Midwifery 29 Animal Care 74 Ante-Natal Clinics 23 49 Assessment Centres 23 Atmospheric Pollution: Industrial 64 Measurement of 64 "At Risk" Register 24 Audiometric Testing 99 Barbers' Premises 70 Baths, Washhouses, Bathing Places etc. 62 "Battered Babies" Syndrome 25 B.C.G. Vaccination-see Vaccination and Immunisation Bed-linen, Loan of 38 Bees 74 Betting and Gaming Premises 71 Births 9 Bodies Concerned with Health Services 5 Burial and Cremation 75 Canal Boats 69 Caravans 69 Carcinoma of the Cervix of Uterus, Population Screening for 27 Care and After Care 36 Chest Disease, Non-tuberculous 37 Child Guidance 90 102 Child Minders 26 Child Health 23 49 Children, Employment of 94 Children in Care 27 95 Children Unsuitable for Education at School 94 Chiropody 38 54 Clean Air 63 77 Cleanliness, Inspections for 88 100 Clinics: Ante-natal 23 49 Child Guidance 90 102 Child Health 23 49 Chiropody 38 54 Ear, Nose and Throat 89 100 Health Advice for the Elderly 39 Immunisation at 33 Minor Ailments 88 100 Ophthalmic 89 101 Orthopaedic 89 101 Orthoptic 89 101 Post-natal 23 49 Premises 24 Smokers' 39 55 Speech 89 102 Colour Vision 87 Committees: Education 4 Health 4 Congenital Abnormalities 25 Congenital rubella defects, National Surveillance of 28 Co-ordination — Personal Services 27 Council 4 Courses: see Staff Cremation and Burial 75 Day Care for Priority Groups 26 Deaths 9 16 19 Infants 10 15 Dental Service: Mothers and Young Children 24 49 School Children 91 103 Development Plan 47 58 Diphtheria, Immunisation against 33 51 Disinfection 12 Disinfestation 74 Disposable Equipment - home nursing 31 Domestic Help 46 57 Dysentery 11 95 Ear, Nose and Throat Clinics 89 100 Education Committee 4 Education: Schools Sub-Committee 5 Education (Milk) Act 1971 94 Elderly Persons, Advice Clinics for 39 Employment Agencies 71 Employment of Children 94 Enfield Society for Mentally Handicapped Children 44 Enuresis 90 Environmental Health Services 59 Evening nursing Service 31 Exhumations 76 Factories and Workplaces 71 81 82 Family Planning 25 Fluoridation of Public Water Supplies 40 "Flying Squad" Service — see Midwifery Food and Drugs:... 65 78 79 Complaints 66 Composition and labelling 65 Food Premises - Registration of 66 Hygiene 66 Ice-Cream 66 Milk, dairies and cream substitutes 67 Unsound Food 66 Food Poisoning 11 Foot Inspections 88 Fowl Pest 74 General Statistics 13 Guardianship 45 Hairdressers' and Barbers' Premises 70 Handicapped Children 92 104 Health Centres 23 Health Committee 4 Health Department Premises (see map) Health Education 40 Health Visiting 30 50 Health Visitors: Ancillary Help 30 Liaison with general Practitioners... 30 Liaison with Hospitals 30 Hearing Tests 87 99 Holiday Camps 45 Holidays - Recuperative 39 91 Home and Hospital Tuition 94 Home Help Service 46 57 Home Nurses: Ancillary help 31 Liaison with General Practitioners.. 31 Home Nursing: 31 50 Disposable Equipment 31 Hospital Services 95 Housing 67 80 81 Acquisition and improvement of houses 68 Council housing 67 Multiple occupation 67 Overcrowding 67 Rent Regulation 68 Slum Clearance 68 Unfit houses 68 Hypothermia 40 Immigrants 36 Immunisation - see Vaccination and 114 INDEX Pages ori which Statistical Tables appear are indicated in bold type. Immunisation Incontinence Pads and Clothing 38 Incontinent Persons, Laundry Service for 48 Incubators, Portable 29 Infectious Disease, Prevalence and Control of 11 19 95 Infective Jaundice 11 Inquests 10 Inspections and Complaints 73 82 83 Inspections for Cleanliness 88 International Certificates of Vaccination 34 Ionising Radiations 75 95 Junior Training Schools 44 Kidney Machines-adaptation of homes 40 Laboratory Service 12 20 Land Charges 69 Laundry Service for incontinent Persons 48 Licensed Premises 71 Malaria 11 Marie Curie Memorial Foundation 31 Market and Street Trading 70 Markets, Slaughterhouses and 'Knackers' yards 67 Massage and Special Treatment Establishments 70 Mass Radiography 37 Measles 11 Immunisation against 34 51 Medical Assessment-Staff Medical Inspection-School Children 87 97 98 99 Medical Treatment-School Children 88 100 Meningitis 11 Mental Health Service 42 56 57 Mental Illness 42 Day Rehabilitation Centres 43 Domiciliary Service 42 Hospital admissions 43 Residential accommodation 43 Social Centres or Clubs 43 Mentally Handicapped Children, Enfield Society for 44 Mental Subnormality 43 Adult Training Centre 44 Domiciliary Service 43 Guardianship 45 Holiday Camps 45 Hospital Admissions 45 Hostel 45 Informal Foster Care 45 Junior Training Schools 44 Residential Accommodation 45 Temporary Care 45 Mice 74 Midwifery: 28 Analgesia 29 "Flying Squad" Service 29 Planned Early Discharge 28 Midwives: Co-operation with general Practitioners 29 Notification of intention to practise 29 50 Minor Ailments Clinics 88 100 Mortuary 76 Mothercraft and Relaxation 30 49 Mothers and Young Children 23 49 Neighbourly Help Scheme 46 Noise 73 Non-fatal accidents to young children in their homes 25 Nutrition 90 Nurseries and Child Minders 26 Nurses' Agencies 71 Nursing Equipment, Loan of 38 Nursing Homes: 47 General 47 Maternity 47 Mental 47 Offensive Dressings 29 Offensive Trades 72 Offices and Shops 69 81 Ophthalmic Clinics 89 101 Orthopaedic Clinic 89 101 Orthoptic Clinics 89 101 Outworkers 72 Personal Health Services: 21 Co-ordination of 27 Persons in Need of Care and Attention 48 Pest Control 74 Phenylketonuria 25 29 Physiotherapy 89 Pigeons 74 Placentae and Offensive Dressings, Disposal of 29 Poliomyelitis 11 — Immunisation against 33 51 Post-natal Clinics 23 49 Premature Infants: Care of 29 50 Premises, Health Department (see map) Problem Families 27 Prophylaxis, Care and After-care 36 Public Conveniences 63 Public Health Laboratory Service .. 12 20 Rag Flock and Other Filling Materials 72 Rats and Mice 74 Recuperative Care 39 91 Refuse Collection and Disposal 63 Relaxation and Mothercraft 30 49 Rodent Control - see Pest Control Rubella-Immunisation against 51 Scabies 95 School Health Service 85 Sewerage and Sewage Disposal 62 Ships 12 Shops and Offices 69 81 Slimmers Advisory Centres 31 Slum Clearance 68 Smallpox Vaccination against 34 52 Smoke Control Areas 77 Smokers' Clinic 39 55 Social Conditions 9 Sonne Dysentery-see Dysentery Specialist Clinics-see Clinics Special Schools 93 104 Speech Therapy 102 Speech Clinics 89 102 Staff; 106 Courses 111 Medical assessment and examination 109 Training 110 Vaccination of 34 Statistics and Social Conditions 7 Statistics: General 13 Vital 9 14 Street Trading 70 Ten-Year Plan for Health Services 47 58 Tetanus-Immunisation against 33 51 Training of Staff of Other Agencies 29 30 32 Training-Staff 110 Tuberculosis: 11 36 19 53 Home visiting 36 Rehabilitation 37 Vaccination against 38 52 115 INDEX Pages on which Statistical Tables appear are indicated in bold type. Typhoid Fever 11 Unfit Houses 68 Unsupported Mother and Her Child 24 Vaccination and Immunisation 32 51 94 Diphtheria 33 51 International Certificates 34 Measles 34 51 Poliomyelitis 33 51 Publicity 33 Rubella 51 Smallpox 34 52 Staff 34 Tetanus 33 51 Tuberculosis (B.C.G.) 38 52 Vaccines, distribution of 34 Whooping Cough 33 51 Venereal Disease 38 54 Vermin, Infestation with 100 Vital Statistics 9 14 Vitamin supplements 24 Wasps and Bees 74 Water Supply: 61 83 84 Fluoridation of 40 Welfare Foods and Vitamin Supplements 24 Whooping Cough: Immunisation against 33 51 Workplaces 71 116