THE HEALTH OF ENFIELD 1972 A report by the Medical Officer of Health and Principal School Medical Officer WILLIAM D HYDE MB Ch B D P H ENF 56 London Borough of Enfield THE PUBLIC HEALTH SERVICES 1872 - 1974 Quae sint, quae fuerint, quae mox ventura trahantur. The main provisions of the National Health Service reorganisation Act 1973 come into effect on the 1st April, 1974. It had thus seemed to me that it would be appropriate and useful to embody in my Annual Report for 1973 a comprehensive review of the development of, and progress made in, the Community Health Services since the appointment locally of the first Medical Officer of Health in 1872 up to the time when this post is abolished at the end of March, 1974. I realised, however, that difficulties would be met in embarking on such a review. One difficulty arises from the amalgamation of Edmonton, Enfield and Southgate to form the London Borough of Enfield in 1965, and the fact that complete statistics and records for each of the constituent boroughs do not appear to exist. Another is the fact that by the time local and national vital statistics are available for 1973 and the first quarter of 1974, the post of Medical Officer of Health will have been abolished. Largely for these reasons the idea of a complete review and summary has been abandoned. However, the unfortunate delay in the issue of my report for 1972 - despite abridgement of text and omission of photographs - does provide an opportunity, with 1974 upon us, to set out a few historical notes on local authority health services. There is perhaps no better way of comparing with earlier times the present-day extent of the duties of the Medical Officer of Health, or the changing pattern of local authority health services, than to direct attention to the Annual Report of the Medical Officer of Health of Enfield for 1888, which is reproduced at the end of these notes. This is the oldest available Annual Report of a Medical Officer of Health of the constituent authorities. Of course, public health measures started a very long time ago, and although in the Middle Ages medical care was undertaken mainly by the religious orders, examples of public health measures could be found in sanitary regulations issued in the City of London at that time; whilst overseas - in Venice - there was provided the first Quarantine Station in 1448. During the Tudor Period, medicine and surgery became more organised and the Parish became the centre of local government with some sanitary duties; and then the eighteenth century saw the growth of scientific medicine with Jenner's promotion of smallpox vaccination in 1796, the provision of Poor Law Hospitals, and even lectures on Public Health at Edinburgh University. However, most people would agree that in this country the starting point of modern public health was the nineteenth century, during the era of Dr. Southwood Smith and Edwin Chadwick who exposed the insanitary conditions of the time. Incidentally, it is interesting to note in connection with recent problems related to the spread of cholera, that it was a cholera epidemic in this country that led to temporary legislation which set up a Consultative Board of Health, under the chairmanship of the President of the Royal College of Physicians, to advise on means of protection; and also local Boards of Health with powers to appoint inspectors to deal with gross sanitary defects. The first great landmark in public health legislation was the Public Health Act of 1848, which gave many permissive sanitary powers to local Boards of Health and allowed the appointments of Medical Officers of Health. But it was not until the Public Health Act of 1871 that every Urban Sanitary Authority was required to appoint a Medical Officer of Health (the Diploma in Public Health became a compulsory qualification in 1888) and every Urban and Rural Sanitary Authority was required to appoint an Inspector of Nuisances. The designation of the latter was changed to Sanitary Inspector in 1922 and subsequently to Public Health Inspector in 1956. The Enfield Local Board of Health made its first appointment of Inspector of Nuisances at its first meeting on 19th August, 1850, and the Edmonton Local Board of Health did likewise the following day. Both Boards, however, appear to have been somewhat tardy in appointing Medical Officers of Health - until pressure from the Local Government Board resulted in the first appointment to Enfield on 26th July, 1872, and to Edmonton on 17th March, 1874. Subsequently, on 22nd June, 1880, a separate appointment of Medical Officer of Health was made for the Western district of Edmonton, which became established as Southgate on 29th September, 1881. During the nineteenth century there was much legislation on environmental health but little on personal health, and the main responsibilities of the Medical Officer of Health during that period were therefore mainly concerned with environmental conditions. One of the statutory duties of the Medical Officer of Health is still to inform himself respecting all matters affecting the public health in the district and advising the local authority on any such matter. The main responsibilities of the Medical Officer of Health at the end of the nineteenth century were in connection with the control of infectious disease, including vaccination against smallpox; hospitals for infectious disease; disease prevention generally; housing, e.g. overcrowding, insanitary dwellings, slum clearance, common lodging houses, etc; sewerage; water supplies; refuse collection and disposal; mortuaries and burial grounds; public health nuisances generally; offensive trades; pure air; certain working conditions and sanitation in factories; food hygiene and adulteration; and the collection of statistics. During the early part of the present century many responsibilities, mainly by personal health legislation, were added to the Medical Officer of Health's duties. These were concerned with the employment of domiciliary midwives; notification of births; district nursing service; health visiting service; maternity and child welfare service and clinics; infant life protection; mental deficiency and mental illness in the community; immunisation against infectious diseases; treatment of venereal disease; laboratory service; municipal hospitals and institutions (probably the first union of preventive and curative medicine under the Medical Officer of Health except for infectious disease hospitals and treatment of venereal disease); health centres; ambulance service; and school health service (in most cases the Medical Officer of Health also became School Medical Officer). To me it seems that over the years it has been the function of the Medical Officer of Health to have placed upon him responsibility not only for those local authority and community activities with a considerable medical or preventive health content (many of which he pioneered), but also for activities which fell to him as a convenient administrative arrangement. Consequently, many of his former responsibilities - some of which required specialised medical knowledge or specialist skill or knowledge in other disciplines - have been gradually taken over by specialists and by other local government departments or other bodies, including medical consultants in the Hospital Service; bacteriologists and pathologists in the public Health Laboratory Service; Engineers and Chemists in Local Authorities, Water Authorities and Sewage Authorities; and Local Authority Social Services Departments. Other activities have been taken over by the Local Education Department, the Local Authority Housing Department, the Local Authority Parks Department and also by the Ministry of Agriculture, Fisheries and Food. On the other hand, many new responsibilities - due to scientific discoveries and developments - have come within the ambit of the Medical Officer of Health. At midnight on 31st March, 1974, the post of Medical Officer of Health will be abolished. However, under the National Health Service Reorganisation Act 1973, and Regulations, it is intended that arrangements be made between Local Authorities, Local Education Authorities and the newly established Area Health Authorities for the provision, through medical officers and other officers of the Area Health Authority, of such medical and other advice and support as a Local Authority might need, especially in the field of environmental health, the school health service, social services, etc. Therefore, on the passing of the Medical Officer of Health there will be available to Local Authorities and Local Education Authorities the services of new types of medical officers, i.e. the Community Physicians of the new National Health Service. As I have already stated, it has not been possible to unfold the full story or to give statistical records of the various Medical Officers of Health of the three constituent Boroughs of the London Borough of Enfield. As far as the original Enfield constituent is concerned, however, there have been since the first Medical Officer of Health was appointed in 1872 - eight Medical Officers of Health of whom the present - and last - holder of the post will have been the longest serving Medical Officer of Health, having held the office in Enfield for nearly thirty years, in addition to over four years as deputy. January, 1974 WILLIAM D. HYDE Medical Officer of Health Principal School Medical Officer ENFIELD LOCAL BOARD OF HEALTH. MEDICAL OFFICER OF HEALTH'S ANNUAL REPORT, Gentlemen, During the year 1888 there were registered the births of 521 boys and 415 girls, a total of 936 births. The total number of deaths was 462, making an addition to the population by excess of births over deaths of 474. I estimate the present population of the parish at not much short of 24,000. Taking this as the basis, the birth-rate was 39 per thousand, and the death-rate 1925 per thousand; the latter is higher than it has ever been before in my experience. The death-rate of the last five years was 14 8, 15-16, 17 5, 16 48, and 16-34. The deaths were distributed among the different ages as follows: FOR TJHE YEAF^ 1888. Carlton House, Baker Street. Maj^ch 28th, 1889. Under 1 year Between i and 5 127 74 47 '7 25 24 29 34 43 31 5 5 15 25 25 35 35 45 45 55 55 65 65 75 75 85 85 and upwards 1 1 The increase has been chiefly among young children below 5, i.e. 201 last year against 104 in 1887 ; and also among old people over 65, namely 85 in 1888, against 73 in 1887. The deaths have been thus classified :— 1888. 1887 Specific febrile, or zymotic diseases 111 86 Constitutional diseases 71 52 Developmental diseases 51 27 Local diseases 195 179 Deaths from violence 10 9 111 defined or not specified causes 25 21 It will be seen that there was an increase of deaths from zymotic diseases, namely 25 more. This was partly due to diphtheria at the beginning of the year, which caused 41 deaths against 34 last year, but more especially to the prevalence of whooping-cough, which killed 21 last year, and only 6 in 1887. The deaths from enteric fever were 11, against 5 in 1887. Measles caused 7 deaths, and scarlatina 11. Diarrhoea was only the cause of 15 deaths, a very low mortality. Consumption killed 32 persons, still a low average compared with the whole country. Cancer caused 8 deaths. Bronchitis was the cause of 49 deaths, chiefly of young infants ; pneumonia, of 14. Cirrhosis of the liver caused 10 deaths, a disease entirely due to alcoholic liquors. There were 32 cases certified as due to old age, namely 7 between 65 and 75 ; 17 between 75 and 85 ; and 8 over 85. I have referred to the epidemics of diphtheria and whooping-cough. Measles has also been rather abundant and there have been several local outbreaks of scarlatina, though never a general epidemic. Abortive efforts were made to secure a house for a local fever hospital, and the matter now stands for arrangement with other Local Boards if possible. This is still an urgent necessity, and if, as some wish, the stringency of the vaccination laws is to be diminished, it can only be safely done by a far more stringent plan for compelling the registration of every case of small pox and other infectious diseases under a heavy penalty and the immediate removal of all such cases from their homes to an isolated building The following is the detailed summary of the sanitary work done during the year. Number of houses and premises inspected, also works in progress and repairs 2,783 Notices issued for sanitary repairs to houses, drains, etc. 87 Letters sent in lieu of notices 121 Houses, or parts of, repaired, cleansed, and white-washed, etc., together with other premises limewashed 195 House drains disconnected from closet drains, or repaired, cleansed, properly trapped, etc. 242 Privy and other cesspools emptied 52 House drains constructed and connected with Board's sewers 41 New w.c's built 11 Dust bins provided 30 Cases of scarlet fever removed to London Fever Hospital 4 Do. do. ,, Union Infirmary 2 Do. diphtheria ,, Hospital 1 Ventilating pipes fixed to old drains 19 Manure heaps removed 32 Houses fumigated, also the bedding, etc., disinfected 128 H ouses furnished with a proper supply of water 76 Cisterns fixed for domestic use 55 Water supplies provided to w.c.'s 68 Slaughterhouses inspected. Cowsheds, dairies, and milkshops do 54 Bake-houses do. J. JAMES RIDGE, M.D.f B.S., B.A., B.Sc. Lond., Medical Officer of Health. THE HEALTH OF ENFIELD 1972 A report by the Medical Officer of Health and Principal School Medical Officer WILLIAM D HYDE MB Ch B DPH Introduction 1 The Council 3 Statistics and Social Conditions 4 Personal Health Services 13 Environmental Health Services 32 School Health Service 55 Premises 67 Staff 68 Index 71 Health Office, Gentleman's Row, Enfield, Middx. June, 1973 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 1972. The report follows the usual pattern in surveying in some detail the main activities of the Health Department during the year, and is presented in three 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 and that there were only four deaths from respiratory tuberculosis and that the deaths from lung cancer were slightly less than last year's figures — but still over 200 for the second successive year. The year saw the beginning of the early stages of practical preparation for the reorganisation of the National Health Service. A series of National Health Service Reorganisation Circulars began to be issued from the Department of Health and Social Security and there was also a Report of the Working Party on Medical Administrators and a Report on Management Arrangements for the Reorganised Health Service which appeared to propose a most complicated form of management. The National Health Service Reorganisation Bill was published, the purpose of which was to enact in legislation the Government's proposals set out in the White Paper "National Health Service Reorganisation, England", the intention of which primarily was to improve the service to the patient by unifying the local administration of the National Health Service under new health authorities covering the whole field of health care. The Bill, the main purposes of which are as follows, sets the framework, but much of the detail will be dealt with in Regulations or Orders: To unify the local administration of the National Health Service under new health authorities covering the whole field of health care; to provide means in each area of representing the interests of the community; to ensure that the views of the health professions are given full weight in the planning and management of services; to continue the National Health Service responsibility for providing facilities in support of the medical and dental teaching functions of universities; to provide for collaboration between the National Health Service and the services for which local authorities are responsible and between the National Health Service and voluntary organisations; to provide for the establishment of Health Service Commissioners for England and for Wales to investigate complaints against Health Service Authori ties. 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 Mayor: Councillor L.I. Genn, F.C.I.S. Deputy Mayor: Alderman E.G. McNern 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.P., 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, F.C.I.S., C.C. Goldwater, M.lnst.M., B.G. Grayston, M.J. Green, H.G.S. Groves, J.P., F.R.I.C.S., 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., Barrister-at-Law, F.C.I.S., Mrs. A.M. Lennox, J.P., Mrs. A.R. Lindsay, Mrs. P. Lyon, V.A. Maskens, 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.J. 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, A.C.C.A., 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 L.F. Lafitte Alderman Mrs. S.G. Child, W.H. Cook, W.A.A. Poole, E.S. Taylor, W.J. Watson, F.R.I.C.S., A.J. Young (ex-officio). Councillors Mrs. P.J. Attridge, J.A. Barkus, Mrs. V.W. Bennett D.L. Bernstein, A.C.A., C.G. Bobbin, J.P., Mrs. E.C. Cousins, C.S. Dawson, R.L. Dubow, M.A. (Oxon) G.G. Eustance, M.D. Frohnsdorff, M.A. (Cantab), Mrs. I.V. Garvey, C.C. Goldwater, M., Inst.M., B.G. Grayston, A. Jay, Mrs. P.E. Joel, T.G.G. Joel, C.G. Lacey, G. Leigh, J.P., Barrister at-Law, F.C.I.S., Mrs. A.M. Lennox, J.P., Mrs. A.R. Lindsay, Mrs. P. Lyon, Miss P. Oborn, J G. Payne, Revd. A.C.J. Rogers, M.A. (Cantab), R.F. Simmons, M. Simpson, W.J. Stiles, J.D. Veitch, L.J D. Warren, Mrs. F.E. Watson, J.A. Wyatt. Co-opted Members: Mr. J.R. Boast, A.C.I.S., Mr. A.J. Bullock, B.Sc. (Eng.) C.Eng., F.I. Mech.E., Mr. L.J. Crocker, Mr. H.J. Emsden, B.Sc. (Eng.) (Lond.), Revd. B.F. Ffrench, Miss K.J. Harvey, Revd. D. Jameson, Mrs. M. Jepson, Mr. H.S. Newman, B.Sc., B.Sc. (Econ), Mr. R. St.John, Mr. R.G. Vos, B.Sc. Schools Sub Committee Chairman: Alderman Mrs. A.L. Emsden Vice-Chairman: Councillor Mrs. P. Lyon Aldermen W.H. Cook, E.S. Taylor. Councillors C.S. Dawson, R.L. Dubow, M.A. (Oxon), M.D. Frohnsdorff M.A. (Cantab), B.G. Grayston, Mrs. P.E. Joel, T.G.G. Joel, L.F. Lafitte, J.G. Payne, W.J. Stiles. Co-opted Members: Mr. L.J. Crocker, Mrs. M. Jepson, Mr. H.S. Newman, B.Sc., B.Sc. (Econ.). 3 STATISTICS AND SOCIAL CONDITIONS Summary Area (acres) 20,061 Population (Registrar General's Mid-1972 Estimate) 265,910 Number of structurally separate dwellings, including flats 93,163 Rateable value £19,535,237 Product of a new penny rate £192,000 Live births Number 3,559 Rate per 1,000 population (crude) 13.4 Ratio of local adjusted birth rate to national rate 0.92 Rate per 1,000 population (standardised) 13.7 England and Wales 14.8 Illegitimate live births per cent of total live births 7.0 England and Wales 9.0 Stillbirths Number 31 Rate per 1,000 total live births and stillbirths 9.0 England and Wales 12.0 Total live and stillbirths 3,590 Infantmortality Infant deaths (deaths under the age of 1 year) 54 Total infant deaths per 1,000 total live births 15 England and Wales 18 Legitimate infant deaths per 1,000 legitimate live births 14 England and Wales 17 Illegitimate infant deaths per 1,000 illegitimate live births 33 England and Wales 21 Neo natal mortality rate (deaths under age of 4 weeks per 1,000 total live births) 12 England and Wales 12 Early neo natal mortality rate (deaths under the age of 1 week per 1,000 total live births) 10 England and Wales 10 Perinatal mortality rate (stillbirths and deaths under the age of 1 week combined per 1,000 total live and stillbirths) 18 England and Wales 22 Maternal mortality Number of deaths 2 Rate per 1,000 total live and stillbirths 0.6 Deaths Number of deaths from all causes 3,291 Death rate per 1,000 home population (crude) 12.4 Ratio of local adjusted death rate to national rate 0.95 Death rate per 1,000 home population (standardised) 11.5 England and Wales 12.1 Deaths from cancer (all forms) 705 Death rate from cancer (all forms) per 1,000 population 2.7 4 STATISTICS AND SOCIAL CONDITIONS Social conditions The London Borough of Enfield covers an area of 20,061 acres and has an estimated population of 265,910 and a rateable value of £19,535,237. 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. With a proposal to open to the public three hundred and thirty acres of park land at Trent Park in March, 1973, the leisure time facilities in the borough will be further improved. The provision of picnic areas, adequate car parking spaces, a three mile horse ride, and fishing which will be allowed by permit from the two lakes in the grounds, will offer the town dweller every inducement to forsake the urban environment for a day in rural surroundings. A public eighteen-hole golf course under construction on land bordering Trent Park is due to open in October, 1973. Picketts Lock Centre is the first major development of the Lee Valley Regional Park Authority, due to open in March, 1973. In addition to a nine-hole golf course there will be in the Centre considerable provision for indoor recreational facilities which will include a bowling green, swimming pool and floodlit pitch for football, hockey and tennis. 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. One first-class road runs north to south and important metropolitan roads run east to west. 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 3,559, giving a crude birth rate of 13.4 and a standardised birth rate of 13.7 compared with the rate for England and Wales of 14.8. Deaths The number of deaths during the year was 3,291 (1,623 males and 1,668 females) giving a crude death rate of 12.4 and a standardised death rate of 11.5 (England and Wales 12.1). The causes of death remain reasonably consistent with previous years, the most prevalent being cardiovascular system, 1,711 deaths (52% of all deaths); malignant neoplasm, 705 deaths (21% of all deaths); diseases of the respiratory system (excluding malignant neoplasm), 476 deaths (14% of all deaths). Of the 1,711 cardio-vascular causes 908 were due to ischaemic heart disease, 406 to cerebro-vascular disease, 57 to hypertensive disease, 27 to chronic rheumatic heart disease, 123 to other forms of heart disease and 191 to other diseases of the circulatory system. Of the 705 malignant neoplasm causes of death, 203 (of which 166 were male) involved the lungs and bronchus, 92 the intestine, 69 the stomach and 80 the breast. Of the diseases of the respiratory system, bronchitis and emphysema accounted for 156 deaths, pneumonia 269 deaths and tuberculosis four deaths. There were no deaths during the year from diphtheria, whooping cough, poliomyelitis or measles. Forty-seven per cent of all deaths, (559 males and 1,002 females) were of persons aged 75 years or more; thirty-two per cent (352 males and 698 females), were of persons aged 80 years or more. Ten males and 46 females were aged 95 years or more, including five females aged 100 years, four aged 101 years and one aged 102 years. Deaths of infants During the year there were 54 deaths of infants under the age of one year, of which 42 were under the age of four weeks and 34 under the age of one week. The infant mortality rate for the borough was 15 compared with 17 for England and Wales. Most of the deaths of infants under four weeks were due to congenital anomalies, birth injury and difficult birth. Of the twelve deaths of infants between the ages of four weeks and one year, five were due to respiratory diseases, and three to congenital anomalies. 5 STATISTICS AND SOCIAL CONDITIONS Fatal accidents During the year 33 (20 males, 13 females) Enfield residents died as a result of motor vehicle accidents and 38 (11 males, 27 females) from other accidents. There were 19 deaths (12 males, 7 females) from suicide. Inquests During the year 99 inquests and 636 post mortem examinations without inquests were held. Road accidents I have, on previous occasions, expressed the view that the four main factors causing road accidents are haste, impatience, selfishness and downright bad manners by all categories or road users. I subsequently added "motorway madness" (a form of suicidal and homicidal indifference to obvious road dangers in spite of adequate warning) and now I feel that "cheating" at traffic controls and road direction signs should be included. 1 am grateful to the Borough Engineer and Surveyor for providing the following information relating to road accidents. 1965 1966 1967 1968 1969 1970 1971 1972 Accidents 1859 1685 1532 1560 1529 1595 1570 1586 Casualties 2387 2206 1986 1968 1977 2055 2029 2077 Fatal 26 34 28 25 27 21 28 29 Serious 423 365 364 354 275 251 295 257 Slight 1938 1807 1594 1589 1675 1783 1706 1791 Location Trunk roads 397 410 327 319 381 331 350 360 Metropolitan roads 298 277 252 266 251 251 233 276 Principal roads 484 422 392 392 340 353 337 325 Classified roads 373 311 256 308 277 361 356 327 District roads 307 265 305 275 280 299 294 298 Types of road user Pedestrians 456 432 414 462 436 435 469 447 Pedal cyclists 302 266 233 198 220 179 170 169 Motor cyclists and passenger 300 239 199 194 129 157 170 129 Scooters, mopeds and passenger 307 229 153 135 108 118 91 65 Drivers of cars and passengers 760 850 805 801 886 917 925 1010 Drivers and passengers of goods and other vehicles 262 190 182 178 198 249 204 257 Age groups Under 5 years 52 61 59 61 62 47 73 78 5 -14 years 249 251 237 271 246 281 291 284 15 -60 years 1881 1719 1525 1463 1439 1527 1456 1498 Over 60 years 205 175 165 173 230 200 209 217 See Tables (1), (2), (3) and (4). Prevalence and control of infectious diseases Part V Public Health Act 1936 Sections 47-49 Health Services and Public Health Act 1968 Public Health IInfectious Diseases) Regulations 1968 Measles Nine hundred and seventy-one notifications of infectious disease and food poisoning were received from medical practitioners and of these 404 (42%) were school children. In addition, head teachers reported 382 cases of suspected infectious disease. There were 450 cases (269 fewer than last year) which accounted for 46% of all notifications of infectious diseases. 6 STATISTICS AND SOCIAL CONDITIONS Tuberculosis Fifty-seven cases of respiratory tuberculosis were notified, and eighteen cases of tuberculosis of other organs were also notified. There were four deaths from respiratory tuberculosis. Food poisoning Forty-three cases of food poisoning were notified — 35 less than last year. The causative organism was Clostridium Welchii in eight cases while Salmonella organisms accounted for 32 of the remaining notifications. Infective jaundice Dysentery (Sonne) Typhoid During May an outbreak of food poisoning occurred in a group of children returning from an "adventure school" in Wales. A number of staff and children were ill and eight were found to be suffering from infection by Clostridium Welchii, but the causative organism was not isolated from food eaten by the party. Sixty-nine cases of infective jaundice were notified and contact with a known case was established in 30 instances. Eighteen, including four known to have had contact with a case, were known to have eaten shellfish within the previous 40 days. Two hundred and twenty-six cases were notified as against 67 persons last year. One hundred and seventy-six cases were associated with outbreaks of Sonne Dysentery at three schools and two day nurseries. One case of typhoid fever occurred in a child aged six years. He had been looked after by his grandmother, since identified as a carrier. Paratyphoid fever No cases of paratypoid fever were notified during the year. Meningitis (acute) Twelve isolated cases were notified. Poliomyelitis Two cases of paralytic poliomyelitis were reported in the borough during the year. In one instance the infection was apparently contracted abroad. Diphtheria One case of diphtheria occurred in a resident of the borough while in North Africa on holiday. Encephalitis One case of acute encephalitis was notified. The patient was a coach driver who travelled throughout (acute) the country. Malaria Three cases of malaria were notified, the patients having contracted the disease abroad. Leptospirosis Public Health (Ships) Regulations 1970 Public Health (Aircraft) Regulations 1970 Disinfection Sections 166 — 168 Public Health Act 1936 Public Health Laboratory Service One case of Leptospirosis was reported. The patient, a housewife, had cut her hand whilst clearing a drain. Port Health Authorities notified 27 persons and three persons respectively as arriving from declared smallpox and cholera endemic areas. All were kept under surveillance for the statutory period and in no case did they develop smallpox or cholera. Local authorities have the power to provide a disinfecting station and to arrange for the cleansing and disinfection of premises and articles. In most cases of infectious disease terminal disinfection of rooms and contents can be satisfactorily effected by a thorough "spring cleaning" using soap and water. Sometimes, cleansing with white fluid disinfectant or even the use of formaldehyde is necessary. During the year, only three properties were treated with formaldehyde. At the Council's disinfecting station, items treated by steam or formaldehyda included 25 garments, 134 articles of bedding and 303 library books. Used clothing, consisting of 68 separate items, was treated for despatch to countries which require certification that treatment has been effected. No charge is made by the Council for these services. The Public Health Laboratory Service at Whipps Cross Hospital, London, E.11, is available for the examination of bacteriological specimens. For the convenience of general practitioners and the public, several specimen collection boxes are positioned at various points throughout the borough. The specimens are collected from the boxes daily and delivered to the laboratory. 7 STATISTICS AND SOCIAL CONDITIONS We record our appreciation of the invaluable service made available throughout the year by the Director, Dr. Thorn, and his staff. See Tables (5), (6) and (7). (1) General statistics Area: (In acres) ... 20,061 Population: (Registrar General's mid-1972 estimate) ... 265,910 Number of structurally separate dwellings, including flats ... 93,163 Rateable value (at 31st December 1972) £19,535,237 Product of a new penny rate: (1972/73 revised estimate) ...£192,000 (2) Vital statistics 1972 Males Females Total LIVE BIRTHS Legitimate 1,758 1,562 3,320 Illegitimate 118 121 239 1,876 1,683 3,559 Rate per 1,000 population Enfield (crude) 13.4 Enfield (standardised!. 13.7 England and Wales 14.8 Enfield illegitimate live births per cent of total live births 7.0 England and Wales illegitimate live births per cent of total live births 9.0 STILLBIRTHS Legitimate 14 16 30 Illegitimate - 1 1 14 17 31 Rate per 1,000 live and stillbirths: Enfield 9.0 England and Wales 12.0 INFANT DEATHS (deaths under the age of 1 year): Legitimate 23 23 46 Illegitimate 4 4 8 27 27 54 Rate per 1,000 live births: Enfield: Legitimate 14.0 Enfield: Illegitimate 33.0 Enfield: Combined 15.0 England and Wales: Combined 17.0 NEO-NATAL DEATHS (deaths under the age of 4 weeks): Legitimate 15 20 35 Illegitimate 3 4 7 18 24 42 Rate per 1.000 live births: Enfield 12.0 England and Wales 12.0 EARLY NEO-NATAL DEATHS (deaths under the age of 1 week): Legitimate 10 17 27 Illegitimate 3 4 7 13 21 34 8 STATISTICS AND SOCIAL CONDITIONS (2) Vital statistics 1972 contd. Rate per 1,000 live births: Enfield 10.0 England and Wales 10.0 PERINATAL DEATHS (stillbirths and deaths under the age of 1 week): Males Females Total Legitimate 24 33 57 Illegitimate 3 5 8 "27" 38 65 Rate per 1,000 live and stillbirths: Enfield 18.0 England and Wales 22.0 MATERNAL MORTALITY (including abortion): Number of deaths 2 Rate per 1,000 live and stillbirths: Enfield 0.6 DEATHS FROM ALL CAUSES: 1,623 1,668 3,291 Rate per 1,000 population: Enfield (crude) 12.4 Enfield (standardised) 11.5 England and Wales 12.1 DEATHS FROM CANCER (all forms): 379 326 705 Rate per 1,000 population: Enfield 2.7 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 1.02, Deaths 0.93. 9 10 CAUSE OF DEATH TOTAL(ALL AGES) AGE GROUPS - MALES AGE GROUP - FEMALES STATISTICS AND SOCIAL CONDITIONS (3) Causes of, and ages at, death Under 4 Weeks 4 weeks & under 1 vr' 14 I 5 - 14 15-24 I 25 - 34 35 44 45 - 54 55 - 64 65 - 74 75 + TOTAL MALES Under 4 Weeks 4 weeks & under 1 vr. 1-4 5-14 15 - 24 | 25 - 34 I 35-44 45 - 54 55 - 64 65 - 74 75 + TOTAL FEMALES B4 Enteritis and other diarrhoeal diseases 2 _ 1 — — — — — — — — — 1 — — — — — — — 1 — — — 1 B5 Tuberculosis of Respiratory system 2 — — — — — — — — — — — — — — — — — — — — 1 1 _ 2 B6 (1) Late Effects of Respiratory T.B. 2 — — — — — — — 1 1 _ —- 7 _ — — — —- — - — — — — — B6 (2) Other Tuberculosis 1 — — — — 1 — — — — — — 1 — — — — — — — — — — — B11 Meningococcal Infection 5 — 1 2 — — — — — — — 1 4 — — —— — 1 — — — — — — 1 B18 Other Infective and parasitic diseases 10 — 1 — — — - 1 1 — i 1 5 — — — — — — — 3 1 — 1 5 B19 (1) Malignant Neoplasm, Buccal Cavity etc. 6 — — — — — — — — _ 1 1 7 — — — — — — — — 3 1 — 4 B19 (2) Malignant Neoplasm, Oesophagus 19 — — — — — — — 1 3 7 1 17 — — — — — — — 1 3 1 7 7 B19 (3) Malignant Neoplasm, Stomach 69 — — — — — — — 1 16 18 10 45 — — — — — — 1 2 4 9 8 24 B19 (4) Malignant Neoplasm, Intestine 92 — — — — — — — 5 11 5 14 35 — — — — — — — 4 7 18 78 57 B19 (5) Malignant Neoplasm, Larynx 1 — — — — — — — — — 1 — 1 — — — — — — — — — — — — B19 (6) Malignant Neoplasm, Lung, Bronchus 203 — — — — — — 1 15 46 79 75 166 — — — — — — — 3 13 13 8 37 B19 (7) Malignant Neoplasm, Breast 80 — — — — — — — — 1 _ — 1 — — — — — 1 7 13 16 16 76 79 B19 (81 Malignant Neoplasm, Uterus 15 — — — — — — — — — — — — — — — — — — 2 3 2 5 3 15 B19 (9) Malignant Neoplasm, Prostate 27 — — — — — — — 1 5 4 17 77 — — — — — — — — — — — — B19 (10) Leukaemia 17 — — — — 1 — — 3 1 1 7 8 — — 1 — — — 1 — 1 3 3 9 B19 (11) Other Malignant Neoplasms 176 - - - 2 1 2 3 9 77 27 16 87 - - 2 — 1 2 4 10 15 20 40 94 B20 Benign and Unspecified Neoplasms 6 — — - 1 — — ? 1 4 — — — — — — 1 — 1 — — 2 B21 Diabetes Mellitus 36 — — — — — — — 1 4 4 3 12 — — — — — — 1 — 2 4 17 24 B22 Avitaminoses, etc. 1 — — — — — — — — — — 1 1 — — — — — — — — — — — — B46 (1) Other Endocrine etc. Diseases 1 — — — — — — — — — — — — — — — — — — — — — — — 1 B23 Anaemias 6 - — — 1 — — — __ 1 _ 7 4 — — — — — — — — 1 — 1 2 B46 (2) Other Diseases of Blood, etc. 2 — — — — — — — 1 — _ _ 1 — — — — — — 1 — — — — 1 B46 (3) Mental Disorders 6 — — — — — — — — 1 7 3 — — — — — — — — — — 3 3 B24 Meningitis 1 — — — — 1 — — — — — — 1 — — — — — — — — — — — — B46 (4) Multiple Sclerosis 6 — — — — — — 1 1 2 _ — 4 — — — — — — — 1 1 — 2 B46 (5) Other Diseases of Nervous System 28 — — — 1 1 1 1 — 7 1 8 15 — — — — — 1 1 3 1 4 3 13 B26 Chronic Rheumatic Heart Disease 27 — — — — — — 1 _ 1 3 — 5 — — — — — — 1 — 6 10 5 22 B27 Hypertensive Disease 57 — — — — — — — — 3 8 10 71 — — — — — — — — 4 4 78 36 B28 Ischaemic Heart Disease 908 — — — — — 3 17 49 1351167 141 517 — — — — — — — 9 34 96 757 396 B29 Other Forms of Heart Disease 123 — — — — — — — 1 R 16 77 45 — — — — 1 — — 1 3 13 60 78 B30 Cerebrovascular Disease 405 — — — — — — — 5 18 47 74 139 — — — — — 1 1 2 23 57 187 266 B46 (6) Other Diseases of Circulatory System 191 — — — — — — — 2 15 19 38 74 — — — — 1 — 7 — 5 17 97 117 B31 Influenza 17 — — — — 1 — 2 — 1 1 3 8 — — — — — — — — — 1 8 9 B32 Pneumonia 269 — 1 — — — — — 2 6 76 78 113 1 — — — — — 2 — 6 18 179 156 B33 (1) Bronchitis and Emphysema 156 — — — — — 1 1 2 11 56 58 179 — — — — — — — — 2 5 20 27 B33 (2) Asthma 4 — — — — — — — — 1 1 _ 7 — — — — — — 1 — — — 1 2 B46 (7) Other Diseases of Respiratory System 26 -— 4 1 1 — - — — 3 7 7 13 1 — — 1 - — — 1 — 3 7 13 B34 Peptic Ulcer 22 — — — — — — — 2 1 6 3 17 — — — — — — — — 1 2 7 10 B35 Appendicitis 1 — — — 1 — — — — — — — 1 — — — — — — — — — — — — B36 Intestinal Obstruction and Hernia 15 — — — — — — — — 1 1 7 4 1 — — — — — 1 _ 1 4 4 11 B37 Cirrhosis of Liver 6 — — — — — — — 1 2 1 - 4 — — — — — — — — 1 1 _ 2 B46 (8) Other Diseases of Digestive System 29 — — — — — — 2 1 ? 7 4 11 — — — — — 1 1 _ 4 7 10 18 B38 Nephritis and Nephrosis 14 — — — — — — — — 7 7 1 5 — _ — — 1 — _ 1 2 4 1 9 B39 Hyperplasia of Prostate 8 — — — — — — — — _ 7 6 8 — — — — — — — — — — — — B46 (9) Other Diseases, Genito - Urinary System 12 — — — — — — — — — 7 3 5 — — — — — — — 2 — 1 4 7 B41 Other Complications of Pregnancy, etc. 2 — — — — — — — — — — — — — — — — — 2 — — — — — 2 B46 (10) Diseases of Skin, Subcutaneous Tissue 3 — — — — — — — — — — — — — — — — — — — — — 1 2 3 B46(11) Diseases of Musculoskeletal system 19 — — — — — 1 — — — 7 7 5 — — — — — — — — 2 2 10 14 B42 Congenital Anomalies 20 4 1 1 — — — 1 2 _ — — 9 5 2 — — — — — 1 2 1 — 11 B43 Birth Injury, Difficult Labour, etc. 17 11 — — — — — — — — — — 11 6 — — — — — — — — — — 6 B44 Other Causes of Perinatal Mortality 13 3 — — — — — — — — — — 3 10 — — — — — — — — — — 10 B45 Symptoms and III Defined Conditions 9 — — — — — — — — 1 — — 1 — — — — — — — — — — 8 8 BE47 Motor Vehicle Accidents 33 — — — 1 6 1 1 1 4 3 3 70 — — — 1 3 — — 1 2 1 5 13 BE48 All Other Accidents 38 — — — — 2 1 2 2 3 — 1 11 — 1 — — 7 1 — — 2 6 15 27 BE49 Suicide and Self-inflicted Injuries 19 — — — — — 2 2 1 7 7 3 17 — — — — 7 - — — 1 — 4 7 BE50 All Other External Causes 8 - - - - 1 1 1 — - — — 3 - - - - - 2 3 - - 5 TOTAL ALL CAUSES 3291 18 9 4 7 16 13 37 111 340 509 559 1673 24 3 3 3 17 9 28 63 176 345 1002 1668 STATISTICS AND SOCIAL CONDITIONS (4) 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 year Enteritis and other diarrhoeal diseases 1 1 Meningococcal infection — 1 1 Other infective and parasitic diseases — 1 1 Pneumonia 1 1 2 Other diseases of respiratory system 1 4 5 Intestinal obstruction and hernia 1 — 1 Congenital anomalies 9 3 12 Birth injury, difficult labour, etc. 17 _ 17 Other causes of perinatal mortality 13 — 13 Accidents (non-vehicular) — 1 1 TOTALS 42 12 54 (5) Prevalence and control of infectious disease: notifications and deaths Disease Notified Known to be treated in hospital Attack rate per 1,000 population Deaths Acute encephalitis 1 1 0.01 — Acute meningitis 12 12 0.05 1 Diphtheria 1 1 0.01 - Dysentery 226 5 0.85 — Food poisoning 43 15 0.16 - Infective jaundice 69 23 0.26 - Leptospirosis 1 1 0.01 — Malaria 3 3 0.01 — Measles 450 6 1.69 — Poliomyelitis 2 1 0.01 - Scarlet fever 68 1 0.26 — Tuberculosis: (a) respiratory 57 15 0.21 4 (b) other forms 18 8 0.07 1 Typhoid 1 1 0.01 - 11 STATISTICS AND SOCIAL CONDITIONS (6) Prevalence and control of infectious disease: tuberculosis Age in years New Cases Deaths Respiratory Other forms Respiratory Other forms M F M F M F M F Under 1 _ _ _ _ 1 - 2 3 _ — 5- 3 1 10- 8 4 — — — — — — 15- 3 1 20 - 3 2 1 3 — — 1 — 25 - 3 3 4 — — — — — 35 - 5 1 1 2 — — — — 45 - 2 2 4 - 1 - - - 55 - 2 3 — — 1 1 — — 65 - 4 2 _ 3 — 1 75 and over - - - - - - - - Age unknown — — — — — — — — Totals 35 22 10 8 2 2 1 - During the year there were inward transfers to the Borough of thirteen notified cases of respiratory tuberculosis and one other form of tuberculosis. (7) Public Health Laboratory Service: environmental specimens Type of specimen Number submitted by local authority Findings Number Unsatisfactory Milk (Pasteurised) 113 Failed Methylene Blue Test 6 (5%) 113 Failed Phosphatase test Nil Milk (Sterilised) 23 Failed turbidity test Nil Milk (Ultra Heat Treated) 37 Failed colony count test Nil Water 115 Faecal coli found Nil Food 47 Pathogenic organisms foi nd Nil 12 PERSONAL HEALTH Summary Clinics Number of attendances at: Ante-natal clinics 2,178 Post-natal clinics 249 Relaxation and mothercraft classes 3,604 Child Welfare clinics 67,289 Dental care Number of expectant and nursing mothers examined 29 Number of children under five years of age examined 522 Midwifery Number of midwives who notified their intention to practise in the borough 168 Number of premature babies born at home 13 Health visiting Number of home visits 39,524 Home nursing Number of visits and treatments 165,085 Vaccination and Diphtheria, Whooping Cough, Tetanus, Poliomyelitis: Immunisation Number of persons who completed primary courses of immunisation against (Persons under 16 one or more of these diseases7,289 years of age) Reinforcing doses 7,762 Measles: number of persons immunised 2,176 Rubella: number of persons vaccinated 2,188 Prophylaxis, care Number of cases of Tuberculosis under treatment, supervision and after—care or observation at the chest clinic at 31st December 1972: Respiratory 1,502 Non-respiratory 227 Number of attendances at chiropody clinics 9,698 Health centres In addition to the Health Centre at Forest Road, Edmonton, which was opened in January, 1971, plans are now in hand for a second health centre, to be situated in the Old Road redevelopment area, north-east Enfield. It is anticipated that building will commence in the summer of 1973. Accommodation will be provided for six general practitioners and the local health authority services, and on the ground floor there will be a day nursery with 55 places and day centre providing ten places. This latter part of the complex will be under the control of the Social Services Department. Care of mothers and young children Section 22 It is the duty of every local health authority to make arrangements for the care, including in particuNationalHealth lar dental care, of expectant and nursing mothers and of children who have not attained the age of Service Act 1946 five years and who are not attending primary schools maintained by a local education authority. Ante-natal and post-natal sessions Attendance figures reflect the continuing trend for expectant mothers to be cared for by the general medical practitioner and hospital services. Mothercraft and relaxation classes continue to be well attended and many general practitioners who undertake ante-natal care refer their patients to these classes. Child health sessions Details of the child health sessions held during 1972 are given in the relevant table. The scheme was continued whereby each child up to the age of four years is invited periodically to attend a clinic for medical examination, and also for immunisation and vaccination where arrangements are not being made through the family doctor. This scheme is directed towards maintaining routine immunisation in addition to regular supervision of the child's health. 13 PERSONAL HEALTH Centres for assessment of handicap in children The assessment clinic continued to be held approximately once a month throughout the year at the War Memorial Hospital and has proved to be a valuable step in increasing co-operation between the hospital paediatric service and the local authority health service. The sessions are attended by the consultant paediatrician from Chase Farm Hospital, the principal medical officer for school health and the appropriate health visitor. Specialist clinic referrals Details of pre-school children attending ophthalmic, ear, nose and throat, orthoptic, orthopaedic, and speech clinics, and for special audiometric tests, are given in the relevant table. Clinic premises Premises in the borough used for clinic purposes are: fourteen purpose built; four adapted; two rented. The Ten-Year plan, details of which are given elsewhere in this report, contains proposals for the replacement of certain clinics by purpose-built premises. Welfare foods and vitamin supplements On behalf of the Department of Health and Social Security, as part of the Welfare Foods Service, the distribution of dried milk, vitamin drops for children and vitamin tablets for expectant mothers continued at the clinics. The following issues (total value £2,641) were made: National Dried Milk, 4,364 packets; vitamin drops, 9,592 bottles; vitamin tablets, 1,573 containers; orange juice (discontinued), 18,733 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 £15,049. Dental care Details of examination and treatment of expectant and nursing mothers and children under five years of age are given in the relevant table. To make known to a wider number of parents the dental facilities available at clinics for pre school children, reference to those facilities is made on the forms taken home by older children for whom parental consent to dental treatment is required. "At risk" register A register is kept of children who, because of some factor noted either before, during, or after birth, may be thought to be more liable than other children to suffer a mental or physical abnormality. These children are kept under observation by the Department's medical officers until it is established that development is normal. Information concerning a child who may be "at risk" is received from the doctor, health visitor or midwife concerned. Of the 508 children who had hearing tests, six appeared to have some loss and are under observation. 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 56 for the year, was made to the Registrar General. Phenylketonuria The Guthrie blood test continued to be used for the routine screening of babies for phenylketonur In the limited number of cases where for any reason it was not possible to complete a Guthrie bloi test, the phenistix test was used. Tests were also carried out for histidinaemia and homocystinuria. "Battered babies" syndrome The group of local authority officers and other persons and organisations concerned with cases of young children injured by their parents gave further consideration to this problem during 1972. The procedure, devised in 1970 for the early detection of cases where "battering" is suspected, was kept under review. During the year sixteen cases of suspected "battering" were investigated and six children were considered to have received physical abuse. Of these six children, all of whom had been admitted to hospital, five were returned to the care of their parents, who continue to receive supportive care. The sixth child, who had been placed with prospective adoptive parents, was discharged to the care of the organisation concerned with arrangements for adoption. Non-fatal accidents to young children in their homes Under an arrangement with the Enfield Group of Hospitals cases of children under five years of age treated for accidental poisoning are reported to the Medical Officer of Health. During 1972 details of 66 such cases were received: 32 children had taken aspirin tablets, twelve had swallowed other types of tablet, and the remaining 22 had taken a miscellaneous assortment of substances. Under a similar arrangement the Ambulance Service advise the Health Office whenever an ambulance is called 14 PERSONAL HEALTH to take to hospital a child suffering from a burn or scald. In the course of the year three such instances were notified. In all cases a health visitor calls on the parents and discusses with them precautions to prevent recurrence. Family planning The provision of family planning services for Enfield residents on an agency basis by the Family Planning Association continued during 1972. Free consultation for all cases and free supplies for medical cases are provided at clinics. A free domiciliary service is available for medical cases unable to use the clinic service. In October the Council agreed to .the provision by the Brook Advisory Centres of family planning services on an agency basis for Enfield residents. This organisation's service is orientated towards the younger age groups. Under the provisions of the National Health Service (Family Planning) Amendment Act 1972, the Council decided to provide through the Family Planning Association in 1973 a vasectomy service on the same basis as that for contraceptive services already provided by the Council. 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 officer on admission, after every three months (every month if under one year of age), 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 certificates of freedom from infection are carried out by the Council's medical officers. Co-ordination of personal services The co-ordinating committee, consisting of officers from the Town Clerk's, Health, Social Services, Housing and Education Departments, continued to meet during the year. Case conferences were held at regular intervals, and ad hoc meetings arranged at short notice to consider urgent cases. Problem families Fourteen new families were added to the register of "problem families" during the year. Twenty cases from the register were discussed at conferences attended by officers from the departments concerned. Ten families were receiving continuing supportive care at the end of the year. Three families were rehoused. The immediate problems of the remaining seven families were dealt with and a review of their cases arranged as necessary. Population screening for carcinoma of the cervix of the uterus The routine testing of women for carcinoma of the cervix of the uterus continued during 1972 at ante-natal sessions and at special clinic sessions held for these tests only. Repeat tests are offered at five-yearly intervals as recommended by the Department of Health and Social Security. Statistics relating to this service are given in the relevant table. See Tables (8), (9), (10), (11), (12) and (13) Section 10 Health Services and Public Health Act 1968 Midwifery Section 10 of the Health Services and Public Health Act 1968 requires every local health authority to provide a domiciliary midwifery service. The Section also provides for greater flexibility in the deployment of midwives; promotes greater co-operation between the local health authority midwifery service and general medical practice; provides for reciprocal arrangements between one local health authority and another and similarly between a local health authority and a hospital authority. In February reciprocal arrangements were made with Hertfordshire County Council for midwives of either authority to cross the Hertfordshire/Enfield border to attend patients who are booked with midwives attached to general practitioner group practices. Midwives Act 1951 The local health authority is also the local supervising authority for the purposes of the Midwives Act 1951. 15 PERSONAL HEALTH Liaison with hospitals Planned early discharge schemes for suitable patients continued to be in operation in conjunction with North Middlesex and Chase Farm Hospitals, and a few patients were accepted from hospitals outside the borough. This scheme ensures availability of maternity beds for the maximum number of those requiring hospital delivery on medical or social grounds. As a further step in liaison towards an integrated health service, a scheme was commenced during May in co-operation with Chase Farm and Highlands Hospitals whereby domiciliary midwives attended selected patients in these hospitals for their delivery and nursing care, continuing this care in their homes following an early discharge. Liaison with general practitioners A close liaison continued between midwives and general practitioners. One further attachment was arranged during the year thus providing cover for 44 general practitioners at 15 practices by 14 midwives. Prevention of haemolytic disease of the new-born In January a scheme was introduced whereby all Rhesus-negative mothers delivered at home are given an injection of Anti-D Immunoglobulin if this is found to be necessary by the result of a blood test taken from the mother and from the umbilical cord immediately after delivery. This injection prevents the formation of antibodies which could be detrimental to the life and health of a subsequent sibling. Six mothers received the injection during the year. Portable incubators Portable incubators, held at the main ambulance depots in the borough, were used to transfer 24 premature or sick babies to hospitals. Midwives were given instruction in the use of the equipment by the ambulance service personnel. Inhalational analgesia Trichloroethylene inhalers, used by all domiciliary midwives for the relief of pain in labour, were regularly tested in accordance with the rules of the Central Midwives Board. Disposal of placentae and offensive dressings Disposal points are situated throughout the borough for use by authorised persons. Training of pupil midwives Arrangements continued for pupil midwives from North Middlesex Hospital to receive Part II training and the continued help and co-operation given by other departments of the Council, by voluntary organisations and by general practitioners were very much appreciated. Sixteen pupils were trained during the year by approved teaching midwives with 100% pass at the first sitting of the examination. The Supervisor of Midwives gave assistance by invitation at the hospital examination of Part II pupil midwives. Training of staff of other agencies As part of their obstetric training student nurses from two local hospitals accompanied midwives on visits to patients and at ante-natal clinics. Lectures were given by the Supervisor of Midwives to second year student nurses at the North Middlesex Hospital. Parentcraft Midwives share the responsibility with health visitors for attending parentcraft films held for prospective parents, in order to promote discussion and questions. They also assist health visitors in the programmes in mothercraft and relaxation held at local authoritv clinics. All patients booked for delivery at home or at local hospitals are sent details of films anc classes to be held. See Tables (14), (15), (16) and (17). Section 24, National Health Service Act 1946 Health visiting Local health authorities are required to make certain provisions for the visiting of persons in th homes. Section 11, Health Services and Public Health Act 1968 Section 11 of the Health Services and Public Health Act 1968 provides for the visiting by health visitors of persons elsewhere than in their homes, thereby promoting more effective deployment of staff and facilitating co-operation between general medical practice and local health authority services. The section provides also for reciprocal arrangements between one local health authority and another. 16 PERSONAL HEALTH Liaison with hospitals Liaison with local hospitals in the paediatric, maternity and geriatric units was extended. This helped to ensure continuity of care between hospital and the rest of the community. Liaison with general practitioners General practice attachment arrangements have developed, there now being fourteen health visitors working with a total of 41 general medical practitioners. Relaxation and mothercraft Relaxation and mothercraft classes for expectant mothers were held regularly and evening showings of the film "To Janet — a Son? " for parents-to-be continued to prove popular. Slimmers advisory courses Slimmers advisory courses continued to be held at Bullsmoor Clinic and at the Health Centre where an additional evening session was introduced. Referrals were made by general practitioners, hospital medical staff, health visitors and school medical officers. Ancillary help State registered nurses were employed to assist at medical inspections in the schools, to carry out hygiene inspections in primary schools, to assist at minor ailments and child health clinics. Clerical help continued to be provided. We are grateful to the many voluntary workers who help with the routine non-professional work of the child health clinics. Training of staff of other agencies Student nurses from the North Middlesex, Chase Farm, Great Ormond Street and the Middlesex Hospitals spent a day observing the work of health visitors and school nurses. Our health visitor group advisers gave talks and took part in discussions on community care in the nurse training schools. See Table (18). Section 25 National Health Service Act 1946 Section 11 Health Services and Public Health Act 1968 Home nursing The provision of nurses to attend persons in their own homes and elsewhere included a reciprocal arrangement with Hertfordshire County Council for nursing staff attached to general practitioners to attend their patients residing on either side of the border. Marie Curie Memorial Foundation During the year increasing use was made of the Marie Curie night nursing service for terminal cancer patients. Nurses were provided through a local nurses' agency for nineteen patients. Evening nursing service The evening nursing service has proved of inestimable value for seriously ill patients and a tremendous support for their relatives. Liaison with general practitioners There has been no further increase in group practice attachments but a good liaison was maintained between the nursing staff and general practitioners not involved in attachment schemes. Liaison with hospitals District nurses attended the geriatric ward rounds at two local hospitals and the nursing problems of patients being discharged home were discussed, facilitating continuity of patient care. Ancillary help Nursing auxiliaries continued to assist the district nurses with the more routine tasks of bathing the frail, elderly and disabled patients. Training Three student district nurses qualified for the National Certificate in District Nursing and two more commenced the Winter course at the North West Polytechnic. Two members of the staff qualified as Practical Work Instructors in order to assist with the practical training of students. Student nurses from North Middlesex, Chase Farm, Great Ormond Street, and The Middlesex Hospitals spent a day observing the work of district nurses. The Superintendent of the Home Nursing Service gave talks and took part in discussions on community care. See Table (19). 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. 17 PERSONAL HEALTH The campaign for vaccination against rubella was pursued for eleven and twelve year old girls and resulted in the vaccination of 2,188 girls. A total number of 11,653 primary courses of immunisation against diphtheria, whooping cough, tetanus, poliomyelitis, measles and rubella were given to persons under 16 years. Of these, 2,771 were urdertaken by general medical practitioners and 8,882 by the Council's medical officers: 7,762 reinforcing doses were also given, 2,673 of these by general medical practitioners and 5,089 by the Council's medical officers. As recommended by the Department of Health and Social Security, medical practitioners continued to be informed of the patients on their lists who had been immunised or vaccinated at local authority clinics and 11,294 notifications of immunisation were sent. Of the 4,044 children eligible for B.C.G. vaccination, the parents of 3,163 children (77.96%) consented to have a tuberculin skin test carried out and B.C.G . vaccination if necessary. A total of 3,102 had a tuberculin skin test; 2,742 (88.93%) were found to require vaccination and 2,740 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 3,264 and 3,425 received a reinforcing dose. Of the children born in 1970 (3,834) 2,878 had received primary immunisation by the end of 1972, representing an acceptance rate of 75.06%. Whooping Cough The recorded number of persons under sixteen years of age who received a primary course of immunisation was 2,867 and 490 received a reinforcing dose. Of the children born in 1970, 2,656 had received primary immunisation by the end of 1972, representing an acceptance rate of 69.27%. Tetanus The recorded number of persons under sixteen years of age who received a primary course of immunisation was 3,890 and 3,931 received a reinforcing dose. Of the children born in 1970, 2,878 had received primary immunisation by the end of 1972, representing an acceptance rate of 75.06%. Poliomyelitis The recorded number of persons under sixteen years of age who received a primary course of immunisation was 3,396 and 3,813 received a reinforcing dose. Of the children born in 1970, 2,907 had received primary immunisation by the end of 1972, representing an acceptance rate of 75.82%. Measles The recorded number of persons under sixteen years of age who received primary immunisation was 2,176. Of the children born in 1970, 1,723 had received primary immunisation by the end of 1972, representing an acceptance rate of 44.94%. Rubella The recorded number of persons under sixteen years of age who received primary immunisation was 2,188. Distribution of vaccines The Health Department is responsible for the distribution of vaccines to general medical practitioners and collection centres are located at the Health Office, Enfield; 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 68 members of staff were vaccinated. 18 PERSONAL HEALTH 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. Despite the usually poor response the Council again offered vaccination against tetanus to these groups and by the end of the year 36 members of staff had either completed a course of immunisation or received a reinforcing dose. A further eight staff had commenced a course of immunisation before the end of the year. Immunisation against influenza was again offered early during the winter to staff whose duties might bring them into close contact with patients suffering from influenza. One hundred and forty-nine staff were immunised against the 'Asian' type and subsequently 78 of these also accepted immunisation against the 'English' type. 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 centre; designated by the Government, and International Certificates of Vaccination against yellow fever art supplied at those centres. Vaccination against any disease other than yellow fever may be performed by a person's own doctor The International Certificate against smallpox and cholera must be obtained by the traveller himsel and taken to the doctor for completion. These forms are usually obtainable, free of charge, from th< 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 ol the vaccinator. See Table (20). 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 London, 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, N.18. Ponders End High Street, Ponders End Service is provided in addition from stations sited outwith the Borough. The control system of the ambulance service has recently been re-organised, and as a result of this the emergency work for the whole of the Greater London area is dealt with from a new control containing the latest equipment at the headquarters of the service in Waterloo Road, S.E.1. Non-emergency work for the North-East Division, in which the London Borough of Enfield is now situated, is controlled from llford Control, situated in Aldborough Road South, llford. Ambulances are directed by radio and by direct telephone lines and telex 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. 19 PERSONAL HEALTH 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 a midwife. For booked patients, dial "999", ask for "Ambulance", and, when connected, give name and address and state the hospital at which the patient is booked. Enquiries on general matters: Telephone (01) 928 0333, extension 321, or write to the Chief Ambulance Officer, London Ambulance Service Fleadquarters, 220 Waterloo Road, S.E.1. 8SD. 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 Chest clinic service Arrangements for the provision of this service are shared between the Council and the North East Metropolitan Regional Hospital Board. The chest clinic is situated at the North Middlesex Hospital and there are chest wards at North Middlesex and Highlands Hospitals. Dr. Vernon Davies, Dr. R.H. Elphinstone and Dr. E.N. O'Brien continued to be responsible for the consultant work, and 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 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. An important aspect of the work of the chest clinic is the follow-up and examination of contacts of new cases of tuberculosis. Of the 65 new notified respiratory cases (all children), nine were found among the 577 new contacts examined during the year, four being in one family. One of the new infectious respiratory cases was undergoing training at a Government training centre and a technical college and it was found that he had been in contact with 302 people, many of whom had moved to other parts of the country. Home visiting Two tuberculosis visitors continued to work from the chest clinic, visiting tuberculous and nontuberculous patients at home. Non-tuberculous chest disease The chest clinic continued its work in the larger field of non-tuberculous chest disease, including bronchitis, emphysema, asthma, and carcinoma of the lung. 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 include a procedure for notifying local authorities in order 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 489 long-stay immigrants, resident in the London Borough of Enfield, were notified. Commonwealth Immigrants Act 1968 There was one instance of a child arriving in Enfield subject to the condition (under the Commonwealth Immigrants Act 1968) that she report to the Medical Officer of Health with a view to further medical examination. In two other cases, referral to a chest clinic for further investigation was recommended by the medical officer at the airport after the person had been X-rayed on arrival. 20 PERSONAL HEALTH Rehabilitation Disabled Persons (Employment) Act 1958 The Tottenham Rehabilitation and Sheltered Workshop, established in 1948 to make available rehabilitation through training, and subsequent sheltered employment, was approved by the Minister of Labour, under the Disabled Persons (Employment) Act 1958, for the training of selected patients to become journeymen cabinet makers. During the training period patients are paid training allowances by the Department of Employment and Productivity, and on completing their training they are appointed to the establishment. Seven places were occupied by Enfield residents at the end of the year. Vaccination against tuberculosis The Council's scheme provides for vaccination with B.C.G. (Bacillus Calmette-Guerin) of persons who are contacts of tuberculosis, long-term immigrants, school children, and students attending establishments of further education. Vaccination of contacts is carried out by the staff of the chest clinic, and of others by the medical staff of this department. Mass radiography Mass Radiography Unit 6A of the North East Metropolitan Regional Hospital Board visited the Borough during the year. Sessions were held at Little Park Gardens, Enfield, on twelve occasions, primarily for "at risk" staff, although members of the public were able to attend. Visits were also made to a number of industrial premises, Southgate Technical College and the Enfield College of Technology. A total of 3,131 persons were X-rayed and of these 32 required further investigation. I am indebted to the Organising Secretary of the Unit for the following information:— Male Female Total Little Park Gardens — 12 visits Local authority staff 206 945 1,151 General public 177 205 382 Contact groups 1 11 12 General practitioner referrals 13 4 Total number X-rayed 385 1,164 1,549 Requiring further investigation 5 11 16 Abnormalities (a) Pulmonary tuberculosis Requiring treatment — — — Requiring close clinic supervision 1 — 1 Requiring occasional clinic supervision — — — Presumed healed, discharged — 3 3 (b) Other Primary carcinoma of lung 1 — 1 Acquired abnormalities of the heart — 1 1 Abnormalities of the diaphragm 1 1 2 Other abnormalities — 1 1 Group in which significant tuberculosis was discovered Requiring close clinic supervision - local authority staff 1 1 Other work in the area Stonehill Furniture, Edmonton 319 23 342 Uniflex Limited, Edmonton 105 11 116 Government Training Centre, Enfield 251 15 266 Fleetway Limited, Edmonton 120 34 154 Thomas Morson, Ponders End 111 31 142 Enfield College of Technology 127 72 199 Southgate Technical College 197 166 363 Total number X-rayed 1,230 352 1,582 21 PERSONAL HEALTH Male Female T otal Groups attending Contact groups 371 49 420 Organised groups 858 303 1,161 General public 1 — 1 Requiring further investigation 12 4 16 Abnormalities (a) Pulmonary tuberculosis Requiring treatment 1 1 Requiring close clinic supervision — — — Requiring occasional clinic supervision 1 — 1 Presumed healed, discharged - - - (b) Other Primary carcinoma of lung — 1 1 Pulmonary fibrosis 1 — 1 Abnormalities of the diaphragm 1 — 1 Pleural effusion 1 — 1 Other abnormalities 4 — 4 Group in which significant tuberculosis was discovered Requiring treatment — contact group 1 _ 1 See Table (21). Loan of nirsing 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 offset 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 2,576 items of equipment were lent to patients, including 186 wheelchairs and 22 hospital beds. 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 at the request of general practitioners and home nurses. During the year 675 patients were provided with 86,352 pads, and 60 patients with 72 items of 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 this service continued to increase during the year, both for clinic treatment and for treatment at home. The voluntary organisations involved were the two local divisions of the British Red Cross Society, which provided 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. At the end of the year the service provided by the Southgate Social Service Council was, at the request of that organisation (which was being disbanded), transferred to the direct administration of the Health Department. See Table <22). 22 PERSONAL HEALTH Venereal disease There is no special clinic in the borough. It would, however, appear that most patients attend the Prince of Wales's 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. Details of attendances at these clinics during 1972 are given in the relevant table. This borough shares with a neighbouring borough the services of a medical social worker. She is based at the special clinic at the Prince of Wales's Hospital, and her duties are to trace contacts, follow-up treatment defaulters, and assist patients in meeting social problems. Despite the efforts in health education over a number of years, the incidence of venereal disease continues to cause anxiety. See Table (23). Health advice clinics for the elderly This service continued to be available at two premises in the borough but because of the low demand only a few sessions were required during the year. 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 pasttimes, 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. 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. Smokers advice clinic Sessions were held at Bowes Road Clinic, Southbury Road Clinic, and the Health Centre, Forest Road. The Health Centre sessions had a better attendance than those at the two clinics. During 1972 a total of 43 men and 47 women attended, of whom thirteen men and fifteen women stopped smoking while attending the course. During the year, a survey was made of men and women who had attended the smokers' advice clinic during 1970 and 1971, and who completed questionnaires on their first visit to the clinic, and again a year after their attendance. Fifty men and 36 women fulfilled these criteria. Nineteen (38%) of the men, and thirteen (36%) of the women were non-smokers one year after attending the clinic. An attempt was made to correlate success in stopping smoking with the answers given on the original questionnaire. No correlation was found between success in stopping smoking and age, years of smoking, advice from the general practitioner, or irritability if deprived of a cigarette. However, a correlation was found between success in stopping smoking and the number of cigarettes smoked a day: 50% of those who previously smoked 1-10 cigarettes a day were not smoking at the end of a year; 44% of those who previously smoked 11 - 20 cigarettes a day were not smoking at the end of a year; 31% of those who previously smoked more than 20 cigarettes a day were not smoking at the end of a year. The numbers involved were too small to be statistically significant but the investigation will continue. Eleven (one-third) of those who stopped smoking said that it had been easier than they expected. See Table (24). Home dialysis There is increasing use of home dialysis units in the treatment of chronic renal failure. Hospital authorities provide and maintain the intermittent haemodialysis equipment, provide the relevant medical services, pay for the extra cost of electricity and for the installation and rental of a telephone where this is* necessary. 23 PERSONAL HEALTH However, it is the local health authority which is empowered to make arrangements for the adaptation of the home. Special electric wiring and plumbing may be needed, and in some cases it may be necessary to build an extension to the house. Applications were received from hospitals for adaptations for this purpose to be made at the homes of five patients. The necessary work was authorised in each case. 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 For most of the year the post of Health Education Officer was vacant. Nevertheless, all requests for lectures, films and materials have been met. Much of the work was in secondary schools, information being requested on such subjects as first aid, contraception, sexually transmitted diseases, antismoking and human relationships. Often these were dealt with not as individual topics, but as part of a course, with each topic leading on to the next. Junior schools and Girl Guides have co-operated with us in producing interesting displays on such topics as anti-smoking, safety with fire and fireworks, and safety in the home. These have been exhibited in the display cabinet outside the Health Office. The activities of the Health Education Section have included talking to women's groups on several subjects including nutrition, contraception, and breast cancer. Commercial firms within the borough continue to use the facilities available and ask for help in arranging lectures for their employees, including provision of a speaker to take part in a course for pre-retirement employees. Ten-year plan for health services As required by the Department of Health and Social Security a revised three-year building programme of projects for which it was anticipated loan sanction would be sought was prepared during the year, and the Council's ten-year development plan for the health services was reviewed and amended. The ten-year development plan — for the years 1973 - 1983 — includes projects under the National Health Service Act 1946 and the Public Health Act 1936. Three health clinics and three health centres are included under the former Act, and a cleansing station and two public conveniences under the latter. Details are shown in the relevant table. See Table (25). 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. One of the nursing homes registered with the Council is approved for the care of 109 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. 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. There are no maternity homes registered in the borough. 24 PERSONAL HEALTH 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. Removal to suitable premises of persons in need of care and attention Section 47 National Assistance Act 1948 (as amended ) 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. Section 84 Public Health Act 1936 Section 42 Laundry service for incontinent persons The Council provides a free weekly collection and delivery laundry service for incontinent persons by using the facilities of the laundry at the Adult Training Centre. The service is available on the recommendation of the patient's medical practitioner or the home nurse in attendance. Middlesex County Council Act 1956 At the end of the year nineteen patients were being provided with this service, involving the handling of approximately 133 articles per week. STATISTICAL INFORMATION (8) Ante-natal and post-natal clinics; relaxation and mothercraft classes Sessions No. Attending Total Attendances Ante-natal 454 321 2,178 Post-natal 144 249 Relaxation and mothercraft 487 660 3,604 (No. of clinic premises: 9) (9) Child health clinics No. of sessions — 2,069 Total attendances _ 67,289 No. of children attending according to year of birth: 1972 - 3,071; 1971 - 3,332; 1967-70 5,320, Total — 11,723 (No. of clinic premises: 20) (10) Attendances of pre-school children at specialist and other clinics Clinic New cases Attendances Ophthalmic 210 552 (77 were prescribed spectacles) Ear, nose and throat 11 18 Orthoptic 71 717 Orthopaedic 38 59 Speech 51 656 Audiometric tests: No. of special tests 36 No. found to have a hearing loss 11 25 PERSONAL HEALTH (11) Dental care Dental Services Expectant and Nursing Mothers Children under 5 years of age Examined 29 522 Commenced treatment 38 277 Courses of treatment completed 12 201 Treatments provided: Extractions 37 50 Fillings 51 318 Teeth otherwise conserved — 221 Crowns and inlays — — Other operations 11 26 Radiographs — — General anaesthetics Dentures provided 3 4 21 (12) "At risk" register Number of children placed on register 759 Number of children removed from register 687 Number on register 31.12.72 1,912 Number of children who had hearing tests 508 Number of children reported to be suffering from abnormalities of significance 39 Number in section of register dealing with handicapped children 11 (13) Population screening for carcinoma of the cervix of the uterus Smears taken during 1972: 2,633 Cases in which cancer cells were confirmed 3 Ages of positive cases 45, 51 & 56 years Marital state of positive cases: ... All married Total smears taken from 1966 to 1972 14,695 Total positive cases found 35 Number of positive cases per 1,000 examinations 2.4 (14) Midwives who notified their intention to practise within the Borough during 1972. Domiciliary: Employed by local health authorities 30 In private practice — Institutional: Hospitals 138 Nursing homes — Total 168 (15) Care of premature infants Premature babies (a) born at home 13 (b) born and nursed at home 13 (c) died during first 24 hours - (d) survived to end of 28 days 13 26 PERSONAL HEALTH (16) Domiciliary midwives' deliveries Home confinements Deliveries in Enfield by Enfield midwives 552 by Hertfordshire midwives 1 Deliveries in Hertfordshire by Enfield midwives Hospital confinements — Deliveries by Enfield domiciliary midwives 15 (17) Patients discharged early from hospital for nursing care 0- 2 days 3 - 7 days 8 + days Total Planned early discharges 107 269 — 376 Unplanned early discharges 21 250 70 341 Booked for home confinement, delivered in hospital 91 49 3 143 Total 219 568 73 860 (18) Visits to homes by health visitors (excluding visits by tuberculosis visitors) First visits Total visits Expectant mothers 1,021 1,418 Children: born in 1972 3,573 9,043 born in 1971 3,462 7,363 Other children under 5 years 7,387 14,151 Persons aged 65 years and over 1,372 3,046 Other persons 1,816 3,292 Infectious disease households 34 51 Other households 606 1,160 Total 19,271 39,524 (19) Work undertaken by home nurses Number of visits and treatments 165,085 Number of patients 10,106 Number of patients under age of 5 years 909 Number of patients aged 65 years or over 3,807 27 PERSONAL HEALTH (20) Vaccination and immunisation: persons aged under 16 years (a) Completed primary courses Type of vaccine Year of Birth Others under age 16 Total 1972 1971 1970 1969 1965/68 1. Quadruple DTPP _ - - - - 2. Triple DPT 46 1,928 829 41 20 3 2,867 3. Diphtheria/Pertussis — — — — — — - 4. Diphtheria/Tetanus — 156 105 20 91 22 394 5. Diphtheria — — — — 3 — 3 6. Pertussis — — — _ _ — — 7. Tetanus — — — 1 3 625 629 8. Salk — — — — — - - 9. Sabin 23 2,057 944 66 146 160 3,396 10. Measles — 946 902 135 178 15 2,176 11. Rubella — — — — — 2,188 2,188 12. Lines 1+2+3+4+5 (Diphtheria) 46 2,084 934 61 114 25 3,264 13. Lines 1+2+3+6 (Whooping Cough) 46 1,928 829 41 20 3 2,867 14. Lines 1+2+4+7 (Tetanus) 46 2,084 934 62 114 650 3,890 15. Lines 1+8+9 (Polio) 23 2,057 944 66 146 160 3,396 (b) Reinforcing doses Type of vaccine Year of Birth Others under age 16 Total 1972 1971 1970 1969 1965/68 1. Quadruple DTPP _ _ _ _ 2. Triple DPT — 44 43 14 335 54 490 3. Diphtheria/Pertussis — — - - - - - 4. Diphtheria/Tetanus — 2 9 7 2,762 137 2,917 5. Diphtheria — — — — 17 1 18 6. Pertussis — — — — — — — 7. Tetanus — — 1 6 172 345 524 8. Salk _ _ — — — — — 9. Sabin — 20 44 10 3,192 547 3,813 10. Lines 1+2+3+4+5 (Diphtheria) — 46 52 21 3,114 192 3,425 11. Lines 1+2+3+6 (Whooping cough) — 44 43 14 335 54 490 12. Lines 1+2+4+7 (Tetanus) — 46 53 27 3,269 536 3,931 13. Lines 1+8+9 (Polio) — 20 44 10 3,192 547 3,813 (21) Chest clinic Men Women Children Total (i) Tuberculosis (a) Cases of tuberculosis under treatment, supervision or observation at 31st December 1972 Respiratory 767 597 138 1,502 Non-respiratory 80 133 14 227 (b)Cases of respiratory tuberculosis (whether notified or not) new to the clinic (but excluding transfers from other clinics) during the year ended 31st December 1972: Non-bacteriologically confirmed 55 46 26 127 Bacteriologically confirmed 9 7 - 16 (c) 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 1972: 8 8 - 16 (d)Cases included in (a) above, whose broncho-pulmonary secretion was positive during the year 24 28 PERSONAL HEALTH (21) Chest Clinic (continued) (ii) General Total attendances at chest clinic during 1972 12,420 New patients during year 4,450 New cases of bronchitis 564 New cases of carcinoma of the lung 139 !iii) Work of the tuberculosis visitors Total visits to tuberculous households 1,229 Total tuberculous households visited 356 Other visits by tuberculosis visitors 701 (22) Chiropody service (a) Clinics Category of patient New cases: first attendances Old cases: first attendances during the year Reatten dances Total attendances for treatment Elderly persons (over 65 years of age) 269 1,614 7,142 9,025 Physically handicapped 5 14 62 81 Expectant and nursing mothers 4 10 17 31 School children 8 6 44 58 Pre-school children 1 - - 1 Others 7 112 383 502 294 1,756 7,648 9,698 Number of clinic sessions: 1,732 Domiciliary service Patients Treatments (b) 1,180 4,453 (c) Services provided by voluntary organisations Treated at centres 831 4,444 Domiciliary cases 248 1,513 At private surgeries 26 218 1,105 6,175 Number of sessions at centres: 574 29 PERSONAL HEALTH (23) Venereal diseases Hospital Number of new cases Totals Syphilis Gonorrhoea Other conditions Prince of Wales's 6 119 849 974 Westminster — 3 22 25 The Middlesex 1 22 210 233 The London 2 5 46 53 St. Bartholomew's — 4 37 41 Royal Free — 2 22 24 St. Thomas's — — 14 14 Royal Northern 5 53 94 152 Central Middlesex — 1 5 6 University College 3 24 131 158 17 233 1,430 1,680 (24) Smokers'advice clinic - 1971 Replies to questionnaires Attended 5 or more sessions Attended 3 - 4 sessions Attended 1 - 2 sessions total attended No. of replies No. not smoking total attended No. of replies No. not smoking total attended No. of replies No. not smoking M F M F M F M F M F M F M F M F M F 18 13 9 4 5 4 17 12 4 1 1 0 56 37 9 7 1 1 % Replies (of total attended) 50 31 24 8 16 19 % Non- smokers (of replies received) 56 100 25 0 11 14 30 PERSONAL HEALTH (25) Development plan Year Legislation Project Population served Address 1973 National Health Service Act 1946 Section 22 Health clinic 10,000 • 20,000 Temporary clinic Southgate area to replace Grange Clinic 1974 National Health Service Act 1946 Section 21 Health centre 10,000 - 20,000 Angel Rd./Fore St. Area (replacing St. John's Clinic) 1975 National Health Service Act 1946 Section 22 Health clinic 10,000 - 20,000 Palmers Green (replacing Broomfield Clinic) 1977 83 National Health Service Act 1946 Section 22 Health clinic 10,000 - 20,000 Winchmore Hill Area National Health Service Act 1946 Section 21 Health centre 10,000 - 20,000 Barrowell Green National Health Service Act 1946 Section 21 Health centre 10,000 • 20,000 Southgate, when site available resulting from reallocation of land uses Public Health Act Projects 1974 Public Health Act 1936 Section 86 Cleansing station Lower Edmonton Redevelopment Area (replacement) 1974 Public Health Act 1936 Section 87 Public convenience Ponders End (replacing Nags Head Road Convenience) 1975 Public Health Act 1936 Section 87 Public convenience Enfield Town Southern Precinct 31 ENVIRONMENTAL HEALTH Summary Water supply Number of chemical and mineral samples 535 Number of bacteriological samples: 1. Before treatment 11,381 2. After treatment 5,472 Smoke control areas Number of premises (total to end of 1972) 74,250 Acreage (total to end of 1972) 16,820 Food and drugs Number of samples analysed 665 Number of samples of ice-cream bacteriologically examined 29 Number of samples of milk bacteriologically examined 173 Number of samples of milk analysed in Department's own laboratory 130 Housing Number of dwelling houses inspected 11,201 Number of housing defects remedied 3,388 Offices, shops and railway premises Number of visits to registered premises 3,407 Factories and workshops Number of inspections 166 Number of defects found 9 Number of defects remedied 5 Inspections and complaints Number of inspections and visits 54,749 Number of complaints and requests for visits 10,182 Water Supply Part IV, Public Health Act 1936, as amended by Sec. 28, It is the duty of a local authority to ensure the wholesomeness and sufficiency of the water supply. Seven samples were submitted for bacteriological examination by the Department and all were satisfactory. Water Act 1945, Sec. 78, Public Health Act 1961 In Enfield, the water supply, with one exception, is from the public mains. 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 chemical and bacteriological sampling by both undertakings proved satisfactory. I am grateful to the Director of Water Examination of the Metropolitan Water Board for the following report: 1. (a) The supply was satisfactory both as to (i) quality, and (ii) quantity throughout 1972. (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, 1972, was 261,431. (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 parts of the Borough are supplied with River Thames-derived water from the Thames Valley grouped works, with some well water from Hadley Road, Hoe Lane and Waltham Abbey pumping stations. Part of the Borough is supplied from Coppermills Works and the southeastern portion in Edmonton is supplied with New River-derived water. 32 ENVIRONMENTAL HEALTH 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 statistical 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 (26), (27) and (28). Baths, washhouses, bathing places, etc. Part VIII of the Public Health Act 1936 Local authorities may provide baths, washhouses and bathing places. In Enfield there are three open-air and three covered swimming pools together with 33 showers ar slipper baths provided for the general public. Sauna baths are also available at the Edmonton Gree swimming pool in Knights Lane, Edmonton. In addition, six swimming pools of which four a covered, are available for the exclusive use of school children. Automatic filtration and chlorinatic plants are installed at all baths and the water supply is from the public service mains. Water samples are tested at the baths at regular intervals during the day for the presence of fr< chlorine. Samples are also submitted to the public health laboratory for bacteriological examinatic and chemical analysis. During the year all 108 samples submitted to the laboratory were satisfactor The total attendance at the public swimming pools and slipper baths during the year was 782,168. Sewerage and sewage disposal Public Health Act 1936 Public Health Act 1961 Middlesex County Council Acts 1956 and 1961 It is the duty of the local authority to provide for the sewerage of their district. The Borough Engineer and Surveyor is responsible for sewers under highways apart from trunk sewers, which are the responsibility of the Greater London Council. During 1972 work was completed on the Enfield Main Foul Sewer Scheme. The sewer now links the Bush Hill area to the Greater London Council trunk sewer at Conduit Lane, Edmonton, relieving existing heavily surcharged sewers and allowing for the sealing of relief overflows. Work also continued on the Eastern Enfield Flood Alleviation Scheme, which is designed to relieve flooding in the area during times of storm. Numerous other drainage schemes were undertaken to rectify faults in existing sewers, or to provide increased capacity occasioned by redevelopment. The Health Department undertakes the clearance of sewers on private property, and 2,725 stoppages were cleared. The user of a drain or private sewer is responsible for maintaining it in good repair. Three formal notices for repair to drains and eight for the repair of private sewers were served. By the end of the year the repair works to the defective sewers were completed and two of the drainage notices had been complied with. London Government Act 1963 The Greater London Council is responsible for sewage disposal, and there are two disposal works within the Borough: one at Deephams, and the other at Ponders End, operated by the London Borough of Enfield. Some digested sewage sludge is pumped to the Ramney Marsh drying beds for treatment before being removed for disposal. The remainder is pumped by underground pipes to the Beckton works prior to being disposed of at sea. For certain information in this report I am indebted to the Borough Engineer and Surveyor. Section 87 Public Health Act 1936 Public conveniences 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. In 33 ENVIRONMENTAL HEALTH addition, 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 cleaning team or from part-time cleaners. By the end of the year, one of the three conveniences closed because of vandalism had been demolished. Arrangements were also in hand to deal with one of the other damaged conveniences in the same way. Refuse collection and disposal Section 72 Public Health Act 1936 Local authorities may provide a refuse collection service and may also provide and empty litter receptacles in public places. Section 51 Public Health Act 1961 London Government Act 1963 In Enfield refuse collection is the responsibility of the Borough Engineer and Surveyor who employs a labour force of 384, including 11 7 men on road sweeping duties. The cleansing fleet consists of 101 vehicles, 30 of which are pedestrian-controlled street sweeping vehicles. A dustless collection service was introduced in parts of the borough, using the disposable plastic sack system. The central paper baling plant at Montagu Road, Edmonton, handles paper salvage from Enfield, Haringey and Waltham Forest. Refuse disposal is undertaken by the Greater London Council. The Edmonton incineration plant at Angel Road now handles all the refuse from the London Borough of Enfield, amounting to some 98,000 tons per year. Civic Amenities Act 1967 Provision is made for the orderly disposal of disused cars and bulky refuse, etc. There is a reception area for disused cars at Carterhatch Lane, Enfield, and other refuse may be disposed of, free of charge, at three depots within the borough. This service is extensively used by the public. Section 23 of the Removal of Refuse Regulations 1967 enables authorities to remove abandoned articles other than motor vehicles from land or the highway. Deposit of Poisonous Waste Act 1972 The depositing of poisonous or polluting waste on land is now prohibited and the local authority must be given notice of any intended movement of such waste. The Greater London Council is responsible for enforcing these provisions in the Enfield area. I am grateful to the Borough Engineer and Surveyor for much of the information contained in this section of the report. Air pollution measurement Clean air Air pollution measurement has been carried out since 1962, when the former Borough of Enfield was selected to participate in a national survey of air pollution organised by the then Department of Scientific and Industrial Research. Measuring apparatus was set up at four sites selected to provide a representative coverage of the whole Borough. The original situations were at Honilands School, Lovell Road, Enfield; Brimsdown Pumping Station, Stockingswater Lane, Enfield; Bush Hill Park Library, Fourth Avenue, Enfield; and Merryhills School, Bincote Road, Enfield. The instrument at the latter site was removed about four years ago. The apparatus used consists of a small pump which draws air through a meter and then through a filter paper and finally through a chemical solution. The two main pollutants in the atmosphere are smoke, which consists mainly of smoke particles of unburnt carbon, and sulphur dioxide. The filter paper retains smoke particles and the chemical solution absorbs sulphur dioxide. The average daily figure for smoke and sulphur dioxide for 1962 and 1972 are shown in the following tables. 34 ENVIRONMENTAL HEALTH Smoke (Microgrammes per cubic metre): average daily amounts. Honilands Brimsdown Bush Hill Park [Month 1962 1972 1962 1972 1962 1972 January 95 59 143 81 155 64 February 64 45 128 60 164 N March 88 67 143 70 184 72 April 36 27 84 31 78 32 May 24 18 54 29 45 21 June 13 20 11 24 24 N July 21 14 36 19 29 13 August 17 23 35 N 19 20 September 35 34 67 40 35 30 October 118 21 174 32 177 22 November 111 35 191 38 239 37 December 133 43 306 42 329 39 Sulphur Dioxide (Microgrammes per cubic metre): average daily amounts Honilands Brimsdown Bush Hill Park Month 1962 1972 1962 1972 1962 1972 January 190 130 290 258 241 172 February 129 120 282 271 194 N March 183 145 322 289 271 143 April 92 55 193 98 129 79 May 70 57 146 137 94 75 June 65 44 99 61 81 N July 65 42 66 53 77 66 August 46 42 46 N 64 49 September 77 59 124 111 98 73 October 137 114 224 170 202 101 November 199 102 331 106 270 128 December 362 173 499 203 499 229 N — Invalid result Smoke is caused by the incomplete combustion of fuel and is evidence of inefficiency. An open coal burning firegrate has a low degree of efficiency and smoke emitted at low level from domestic chimneys is considered to be the main source of smoke in the atmosphere; modern furnaces burning coal or oil have a much higher efficiency and produce relatively small amounts of smoke. The quantity of sulphur dioxide emitted into the atmosphere is, of course, related to the amount of sulphur in fuel. This impurity is present in coal and fuel oil but it is only found in small quantities in solid smokeless fuels, domestic grade fuel oils, and town and natural gas. The amount present in the atmosphere is, therefore, dependent on the class of fuel and quantity being burnt. The two bar charts show the average amounts of smoke and sulphur dioxide measured at the three stations during the six winter months, Januarv to March and October to December for the years 1962 to 1972. These charts show that the decrease in smoke was most marked in the first five years of measuieinent. The decrease in sulphur dioxide has also levelled off in the past five years and the indications are that this trend will continue unless there is a pronounced changeover to fuels having a low sulphur content. There is little doubt that the main reason for the reduced level of smoke pollution in the air is due to the implementation of smoke control area programmes not only in Enfield but throughout Greater London. At present about 87% of premises in Enfield are in smoke control areas and two further 35 ENVIRONMENTAL HEALTH 36 ENVIRON MENTAL HEALTH areas will come into operation in August 1973 and August 1974. It is hoped that the final smoke control area will come into operation in 1975. Industry has been steadily changing over from coal-fired boilers to oil-fired plant with the consequent reduction in smoke and particularly in grit and dust emission. There has also been an appreciable trend in local industry towards the use of lighter and more refined oil which has a higher calorific heating value and a lower sulphur content than the heavier grades of fuel oil. In the last few years some large industries have changed over to natural gas and there is every indication that this trend will increase — and this, too, will have an appreciable effect in reducing pollution. In a survey of the boiler plant of 220 local industrial premises it was found that 77% used oil, 11% gas, 4% coal and 8% other fuels. Pollution from lead Tetra-ethyl lead is added to petrol as an anti-knock agent to prevent pinking and increase engine efficiency in motor vehicles. During the year an instrument was installed at a site alongside the North Circular Road to measure the amount of lead in the air. The method used was to draw a measured amount of air through a filter paper and measure the amount of lead in the stain on the paper, the filter papers being changed weekly. These measurements taken over a period of several months showed that the lead content varied between one microgramme per cubic metre and 3.6 microgrammes per cubic metre. These levels are typical of measurements taken in other urban areas where there is heavy traffic. A second instrument was set up to measure lead emissions from a local factory where the recovery of lead from scrap was undertaken. The lead was emitted in the form of fume from a low chimney and in the form of dust from fine particulate matter stored for further processing. Before being discharged into the atmosphere, the fume was passed through a filter to remove lead and dust, and regular samples of the flue gas were taken by an inspector of the Department of the Environment to ascertain that emissions of lead did not exceed the standards laid down by the Department. The measurements taken by this second instrument, which was sited close to the chimney outlet, showed that the levels of lead in the air were far below the amounts permitted by the Department of Trade and Industry for atmospheres inside factories. Many samples of roadway dust were taken around factories where lead is used in quantity, and all but one were satisfactory. One set of samples taken near the gates of a factory showed that lead levels in the roadway dust were higher than elsewhere. Immediate steps were taken to have the roadways cleansed and precautions taken to ensure that no excess dust containing lead was transmitted outside the factory. Car exhausts A series of measurements of nitric oxide and nitrogen dioxide in the air from motor car exhausts is being carried out on a site alongside the North Circular Road. See Table (29). Food and drugs Food and Drugs Act 1955 The Food and Drugs Act 1955 and regulations made under the Act deal with the processing and selling of food and drugs for human consumption. In July, the Foods Standards Committee published its report on the Date Marking of Food, in which legislation is proposed, after a period of three years, to introduce a system of "open date" marking for pre-packed foods. Composition and labelling Six hundred and sixty-five samples of food and drugs were submitted to the public analyst and 130 samples of milk were examined in the Department's own laboratory, representing a sampling rate of three per 1,000 of the population. All samples of milk were satisfactory, but the public analyst reported adversely on 124 samples of food: 96 were of packaged foods incorrectly labelled, and 28 were of inferior quality or unfit. In one case, both labelling infringement and unsatisfactory conditions were found. Advice on the Labelling of Food Regulations 1970 was given during the year to manufacturers and importers to enable arrangements to be made for their new labels to comply with these Regulations. Under the present legislation imported foods show the greatest number of contraventions in relation to labelling. 37 ENVIRONMENTAL HEALTH Pesticides in food The Association of Municipal Corporations for the third year in succession invited the Council to take part in a programme of sampling of foodstuffs in order to determine the amount of residual pesticides present. During the period May to August 1972, a total of nineteen samples of specified foods were bought from local shops and submitted to the Public Analyst. As in previous years the levels of pesticides found in these samples were not excessive. Food complaints During the year, 186 food complaints were received. These were all investigated and in the majority of cases warning letters were sent. However, proceedings were instituted on 33 occasions and the results are shown in the appropriate table. Many of the complaints received concerned foreign matter in food products. Unsound food All types of food are inspected to ensure their fitness. There were frequent requests from food vendors for the inspection of foodstuffs and sixty tons of food were subsequently condemmed 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. To comply with foreign import regulations eighteen certificates of fitness, accompanying the food consignments, were issued. Imported Food Regulations 1968 These Regulations require the examination of imported foods intended for human consumption. Where the containers have not been examined at the port of entry, the importers give the port health authority an undertaking that the containers have been sealed and will not be opened until they reach their destination. During the year port health authorities notified 22 such consignments as arriving in the borough and in each case the consignment was examined and found to be satisfactory. 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 766 premises registered for ice-cream and 121 in respect of preserved foods. Middlesex County Council Act 1950 At the end of the year 59 hawkers of food were licensed by the local authority, after inspection of vehicles and storage arrangements. Ice-cream Ice cream (Heat Treatment, etc) Regulations 1959 In accordance with these regulations 29 samples of loose or soft ice-cream were submitted for bacteriological examination. Milk, Dairies and Cream Substitutes Milk (Special Designation) Regulations 1963/65 These regulations require any person producing, treating, storing or distributing milk to be licensed. Producers' licences are issued by the Minister of Agriculture, Fisheries and Food through the County Agricultural Executive Committee. At the end of the year four persons were licensed. During the year two premises were licensed by the Council for the treatment of milk and 228 premises for distribution. The Milk (Special Designations) Specified Areas Order 1951 restricts the sale of milk by retail to the designated milks. Dealers' licences were issued under the following designations: Pasteurised, 160; Sterilised, 164; Ultra-heat treated, 110; and Untreated, 7. Supplies are sampled regularly to check the bacteriological content of the milk. Of the 1 73 samples examined, four were unsatisfactory. The quality of pasteurised milk supplied to schools continued to be satisfactorv. Mi Ik and Dairies (General) Regulations 1959 Provisions are made in respect of hygiene, construction, equipment and cleansing of premises where milk is produced, processed, handled or stored. Regular inspections were carried out and conditions were found to be satisfactory. Markets, slaughterhouses and knackers' yards There are no cattle markets, slaughterhouses or knackers' yards within the borough. See Tables (30), (31) and (32). 38 ENVIRONMENTAL HEALTH Housing Council housing At the end of the year there were 19,980 properties controlled by the Council. This accommodation consisted of 3,408 one-bedroom, 7,177 two-bedroom, 9,114 three-bedroom, and 281 four or fivebedroom units. Six hundred and fourteen applicants were rehoused during the year and on the 31st December there were 5,848 applicants on the waiting list. Fifty-five people were awarded priority on grounds of illhealth or disablement. I am grateful to the Housing Manager for supplying the above information. Improvement areas Housing Act 1964 Seven "improvement areas" have been declared by the Council in which property owners could be required to provide standard amenities in their houses. Improvement work in these areas has continued. Negotiations were commenced in 44 cases with property owners outside improvement areas where they had been required by their tenants to improve their houses. Housing Act 1969 Local authorities may declare "general improvement areas". Public interest in grants for environmental improvement in addition to those for dwellings has been disappointing. However, two further areas were surveyed during the year. Housing Act 1971 Grants for environmental treatment were further increased in 1971. In the spring the Department of the Environment organised a publicity campaign in the Greater London area to encourage the comprehensive improvement of houses in the private sector. The Council as its contribution carried out the major improvement and alteration of two acquired properties and used them as showhouses. One house had an improved kitchen and rear bathroom extension added, while the other, a larger property, had part of the rear bedroom converted into a bathroom and water closet. The properties were on public view for four weeks during April and May with public health inspectors on duty to offer advice and assistance. In the autumn, the Department of the Environment requested local authorities to make a survey of the housing stock within their districts and to formulate an overall strategy for dealing with unfit houses and other properties below standard. A 5% random sample survey was carried out by public health inspectors and 3,509 properties inspected. It is estimated that some 325 houses are unfit and nearly 7,500 houses in the borough are capable of being improved up to the 12 point standard. Housing Acts 1958/ 69 Housing Finance Act 1972 Grants are available for home improvement and conversion of property to provide additional units of accommodation. Other than standard grants, for which the limit is £200, these grants are made at the discretion of the Council. The maximum grant is £1,000 per dwelling although this may be raised to £1,200 if the conversion of three-storey building is involved. Three hundred and eight discretionary and 116 standard grants were made to provide houses with full standard amenities. House Purchase and Housing Act 1959 Housing (Financial Provisions) Act 1958 Four hundred and thirty-eight applications for house purchase loans were dealt with by the Town Clerk, £483,990 being advanced. Where claims of overcrowding in support of applications are made, these are investigated by the public health inspectorate. Overcrowding Housing Act 1957 Two notices to abate cases of overcrowding were served during the year. Houses in multiple occupation Housing Acts 1957, 1961. 1964 and 1969 The local authority may limit the number of persons living in a house in multiple occupation and require the person having control to provide certain amenities. The Council has adopted standards in respect of both overcrowding and amenities and a scheme for registration has been approved by the Ministry. 39 ENVIRONMENTAL HEALTH Relatively few houses in the borough are over-occupied and no formal action was necessary with regard to provision of amenities. Two hundred and thirteen visits were made by public health inspectors to houses in multiple occupation. Slum clearance and individual unfit houses Two clearance areas were confirmed by the Minister with several others awaiting confirmation. Two new areas comprising 52 properties were reported to the Council as unfit for human habitation. Eleven individually unfit houses were also reported, leading to seven closing orders and four demolition orders being made. Rent Acts 1957, 1965,1968 Housing Finance Act 1972 The Rent Acts made provision for the regulation of tenancy, rents, security of tenure and the restrictions on eviction. Controlled tenants have been able to apply for a Certificate of Disrepair where their homes have been in need of repair. The Housing Finance Act 1972 brings this procedure to an end six months before the tenancy becomes decontrolled. Housing Act 1969 Housing Finance Act 1972 Provision is made for rent to be regulated in dwellings with standard amenities. Landlords are able to apply to the local authority for a qualification certificate confirming that the property is provided with standard amenities and is in a good state of repair. With the issue of these certificates, the Rent Officer is able to declare a regulated tenancy and fix a fair rent. The Housing Finance Act 1972 introduced a phased programme for bringing all dwellings out of rent control based on their rateable values. See Tables (33) and (34). Land charges Land Charges Act 1925 Land Charges Act 1972 Enquiries received concerning properties within the borough totalled 10,318. The necessary searches were made and the information supplied. Caravans Caravan sites and Control of Development Act 1960 The Caravan Sites and Control of Development Act 1960 makes provision for the licensing and control of sites by local authorities and authorises them to provide and operate caravan sites. There is one privately owned residential site for sixteen caravans in the borough while nine sites on nursery land are licensed for use by employees. No sites are operated by the Council in this area. Caravan Sites Act 1968 This Act provides protection for occupiers of residential caravans on caravan sites and requires certain local authorities, including the London Boroughs, to provide adequate accommodation for gipsies residing in or resorting to the area. A site providing not less than fifteen pitches is the standard accepted by the Department of the Environment and plans for the provision of such a site are now well advanced The temporary site on land adjacent to the Great Cambridge Road near Turkey Street will continue in use until the new site is available. Middlesex County Council Act 1944 The provision of a temporary site has not prevented the unauthorised use of vacant areas of land in the borough and it is extremely difficult to control such use. Any open site is vulnerable and the powers provided by this Act have not prevented continued misuse of such sites. Fines imposed by the court have not acted as a deterrent. 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. 40 ENVIRONMENTAL HEALTH Offices, shops and railway premises Offices, Shops and Railway Premises Act 1963 The Act and subsequent Orders and Regulations are designed to raise the standard of working conditions thereby promoting health, welfare and safety of employees. Her Majesty's 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. At the end of the year there were 3,102 registered premises in the borough including 47 new registrations. Three thousand four hundred and seven visits were made by the public health inspectorate. Thirty-three notices were served in respect of contraventions of the Act. However, these were of a minor nature, the most common faults being associated with cleanliness, lighting and sanitary accommodation. Sixty-five accidents were reported but none was of a serious nature. In the great majority of cases carelessness appeared to be an important factor, especially in the handling of goods and equipment. Shops Act 1950 There are 1,849 shops within the borough. The Shops Act 1950 deals with hours of closing, conditions of employment, Sunday trading, etc., while the Shops (Early Closing Days) Act 1965 enables an occupier of a shop to select the weekly half-holiday. One prosecution was taken under this legislation during the year. 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 traders on the Edmonton Green Market Square site. Four licensed traders are situated in other parts of the borough while a private market is held in the Enfield Market Square every Saturday. During the year 2,341 visits were made to shops and stalls, including primary inspections of premises. There were a number of minor contraventions but these were found to have been remedied on reinspection. 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. Eighty-two 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 Two hundred and twenty-two persons are registered by the Council to carry on the business of a hairdresser or barber in Enfield. Massage and special treatment establishments Middlesex County 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 to be licensed by the Council. Twenty-six applications for renewal were received and approved and two new licences were granted. No applications were refused. Licensed premises Licensing Act 1964 Applications are 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 92 inspections of premises by public health inspectors. Conditions generally were found to be satisfactory. 41 ENVIRONMENTAL HEALTH Betting and gaming premises Betting, Gaming and Lotteries Act 1963 Gaming Act 1968 Applications for permits for amusements with prizes on unlicensed premises are dealt with by the Town Clerk. Reports are submitted by 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. Thirteen applications were dealt with necessitating 29 inspections by the public health inspectors. Ten of these applications were approved and three 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. Two applications were referred by the Town Clerk to the Health Department for a report on the conditions at the premises concerned. Seven inspections were necessary before conditions on the premises were considered satisfactory. Nurses agencies Nurses Agencies Act 1957 Nurses Agencies Regulations 1961 and 1968 Nurses agencies are required to be licensed by the Council. At the end of 1972 there were three licensed agencies in the borough Employment agencies Middlesex County Council Act 1944 Part 14 The Town Clerk referred 36 applications for licences to this Department for reports on the suitability of facilities and accommodation. The public health inspectors made 51 visits. Thirty renewals and six new applications were approved. Factories and workplaces Factories Act 1961 Where a factory uses no mechanical power the local authority enforces provisions relating to cleanliness, overcrowding, temperature, ventilation, floor drainage and toilet accommodation. Where power is used only provisions concerning sanitary accommodation apply. Public health inspectors found a number of minor defects, the majority of which were remedied without recourse to legal proceedings. As required by the Act a register is kept of all factories within the district. See Tables (36) and (37). Outworkers Section 133(1) Factories Act 1961 Occupiers of factories are required to notify local authorities of the names and addresses of persons employed by them as outworkers. Section 134 Factories Act 1961 Inspections are carried out when new addresses appear on the lists to ensure that premises are not likely to be injurious or dangerous to the health of employees. Public health inspectors made 25 visits to the homes of outworkers and conditions were found to be satisfactory. Outworkers in the district, by trades, are as follows: bed linen, etc., 5: box making, etc., wholly or partially of paper, 8; carding, etc., of buttons, 1; paint boxes and paint brushes, 1; toys and games, 27; wearing apparel, 121. Total: 163. Rag flock and other filling materials Rag Flock and Other Filling Materials Act 1951 Rag Flock and Other Filling Materials Regulations 1971 Local authorities are required to register premises where filling materials are used. Visits were made to such premises, of which there are sixteen registered, and the conditions were found to be satisfactory. 42 ENVIRONMENTAL HEALTH Offensive trades Section 107 Public Health Act 1936 No offensive trades were operating in the borough during the year. Inspections and complaints The public health inspectors paid 54,732 visits to premises, including dwelling houses, business industrial and food premises. A housing survey carried out on behalf of the Department of the Environment to ascertain the condition of housing stock within the area necessitated a substantial increase in the number of visits by inspectors to dwelling houses. Although many matters were resolved without serving notices, it was found necessary to serve 317 informal and 259 statutory notices in respect of defects in dwelling houses and food premises. Although in most cases repairs were effected, legal proceedings were instituted in three instances. Of the 10,182 complaints and requests for visits, 2,727 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 Complaints of nuisance from noise have continued during the year, ranging from noisy loudspeakers at auction sales to noise from industrial plant in factories. In many cases a great amount of upheaval and costly alteration might be saved if the possible noise from the machine when operating was given greater consideration at the design stage, and also if the siting and installation of the machine in the factory were given detailed consideration. In contracts for civil engineering work made by the Council an assurance is sought that noise levels from machinery will be within the standards laid down in the report of the Committee on the Problem of Noise, and checks are made to ensure that a contractor can meet these standards. An example of the assistance given to other departments of the Council is an assessment of the noise levels from major road traffic likely to be experienced on a proposed new housing development, in order that preventive action may be taken. Disinfestation Sections 83-86 Public Health Act 1936 as amended by Sections 35-37 Public Health Act 1961 The Council is empowered to deal with filthy or verminous persons, premises and articles. Facilities are provided for the cleansing and treatment of scabetic and verminous persons at the Council's treatment centre, Knights Lane, Edmonton, N.9. During the year 129 persons were treated: 128 for scabies and one for pubic lice. One hundred and nineteen requests for treatment of verminous premises were dealt with and 62 garments and articles of bedding were disinfested at the Council's disinfecting station. References to other work undertaken at this station are contained in the item "Disinfection" in this report. Pest control Rats and mice Prevention of Damage by Pests Act 1949 Where premises are infested by rats or mice the occupier is required to notify the local authority and take such steps as are necessary to control the infestation. The Health Department provides a rodent control service which is available to householders and occupiers of business premises. No charge is made for this service in respect of domestic premises. The majority of rat infestations are attributable to defective drains and sewers. Although there were no major infestations during the year, 8,536 visits were made by rodent control staff and 558 visits by public health inspectors in connection with rodent control. In all, 2,705 premises were visited. 43 ENVIRONMENTAL HEALTH Pigeons Section 74 Public Health Act 1961 Pigeons cause considerable damage to buildings and crops. Thirty-two treatments were carried out, 525 birds being destroyed. Wasps and bees Although the control of garden pests is the responsibility of the householder, many people sought the help of the Health Department. A free service is provided for those handicapped by age, infirmity or other causes and who are unable to help themselves. Thirty-three wasps' nests and eighteen bees' nests were destroyed, and 59 other insect infestations were treated. Help is also given wherever possible when complaints are received concerning foxes, squirrels, rabbits and moles. Animal care Diseases of Animals Act 1950 All aspects of animal care including movement, protection and quarantine during outbreaks of notifiable disease, are dealt with by the Act. Controls may limit movement and provide for the cleansing and disinfection of premises and vehicles occupied by animals, but no action was necessary during the year. Diseases of Animals (Waste Food) Order 1957 There are eight pig keepers within the borough and their premises are inspected periodically. Four of these use plant and equipment licensed under the Order for boiling waste foods for pig feeding. Riding Establishmen ts Acts 1964 and 1970 At the end of the year there were five establishments in the borough fully licensed under the legislation. Pet Animals Act 1951 Persons keeping a pet shop are required to be licensed by the local authority. Conditions relate to suitable accommodation of 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. Twenty persons were licensed at the end of the year and their premises were found to be satisfactory on inspection. Animal Boarding Establishments Act 1963 In addition to provisions similar to those required by the Pet Animals Act 1951 a person licensi under the Animal Boarding Establishments Act 1963 must keep a register of animals in their char and their owners. Three persons were licensed and their premises were found to be satisfactory < inspection. Ionising radiations Radioactive Substances Acts 1948-1960 The use of radioactive substances, the registration of users, and the disposal of waste are governed by legislation. At present twenty-one users of radioactive materials in the borough are registered with the Department of the Environment. Nuclear Installations Act 1954 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. Atomic Energy Authority Acts 1954-1959 Nuclear Installations (Licensing and Insurance) Act 1959 44 ENVIRONMENTAL HEALTH Burial and cremation Section 50, National Assistance Act 1948 This authority has a duty to bury or cremate the body of any person who has died or 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 body of one person was dealt with in this way. Exhumations Burial Act 1857 The Medical Officer of Health is informed whenever a licence for the removal of human remains is granted to enable him to take any necessary action in the interests of public health. Six exhumations took place at cemeteries within the borough. A public health inspector was present to ensure that the conditions of the Home Office Exhumation Certificate were observed. Mortuary Section 198, Public Health Act 1936 The Council provides a mortuary and a post-mortem room by arrangement with the Hospital Management Committee and the London Borough of Haringey at an agreed charge for the use of facilities at the Prince of Wales Hospital, Tottenham, and the local authority mortuary in Hornsey. 45 ENVIRONMENTAL HEALTH STATISTICAL INFORMATION (26): Water supply - Metropolitan Water Board: chemical and mineral analysis Average results in milligrams per litre where applicable New River Derived Copper -mills Derived Thames Derived Hoe Lane Well Derived Hadley Road Well Derived Waltham Abbey Well Derived Number of samples 104 52 364 4 4 4 Ammoniacal Nitrogen 0.014 0.019 0.031 0.088 0.130 0.190 Albuminoid Nitrogen 0.050 0.100 0.069 0.026 0.019 0.022 Nitrate Nitrogen 7.9 8.9 6.9 0.7 0.7 0.6 Oxygen abs. from KMn04 4 hrs. at 27oC 0.70 1.36 1.06 0.37 0.22 0.50 Hardness (total) CaC03 308 309 274 454 280 278 Hardness (noncarbonate) CaCO3 80 96 82 186 44 58 Magnesium as Mg. 5.5 6.0 5.0 26.0 26.5 22.0 Sodium as Na. 28.8 34.6 24.5 - - - Potassium as K 5.1 7.3 5.5 - - - Chloride as CI 42 50 35 33 22 25 Phosphate as PO4 2.1 4.0 2.8 - - - Silicate as Si02 10 10 10 - - - Sulphate as SO4 52 72 58 - - - Natural Fluoride as F 0.15 0.17 0.15 0.49 0.95 0.43 Surface-active materials as Manoxol OT 0.02 0.02 0.02 - - - Turbidity units 0.1 0.1 0.1 0.6 0.4 0.2 Colour (Burgess units) 9 14 13 9 4 9 pH Value 7.8 7.9 7.9 7.3 7.5 7.5 Electrical Conductivity (Micromhos) 640 680 570 810 560 550 46 ENVIRONMENTAL HEALTH (27) Water supply - Metropolitan Water Board: average bacteriological results Results before treatment New River Derived Copper -mills Derived Thames Derived Hoe Lane Well Derived Hadley Road Well Derived Waltham Abbey Well Derived Number of samples 1,506 994 8,087 251 293 250 Agar Plate Count per ml. 20-24 hrs. at 37°C ... 58.8 82.2 42.3 0.3 0.6 0.1 3 days at 22°C — — — 11 38 12 Coliform Count Percentage of samples neg in 100 ml. 55.91 41.65 41.94 98.41 68.60 99.60 Count per 100 ml. 4.2 17.2 10.2 — 2.2 — Escherichia coli Count Percentage of samples neg in 100 ml. 70.25 61.89 56.76 99.20 72.01 99.60 Count per 100 ml. 1.1 2.6 4.0 — 1.4 — Results after treatment Number of samples 510 255 3,891 254 252 251 Agar Plate Count per ml. 20-24 hrs. at 37°C ... 3 days at 22°C 20.1 9.4 10.0 0.4 15 0.2 8 0.1 9 Coliform Count Percentage of samples neg in 100 ml. 100.0 100.0 99.85 100.0 100.0 100.0 Escherichia coli Count Percentage of samples neg in 100 ml. 100.0 100.0 99.97 100.0 100.0 100.0 47 ENVIRONMENTAL HEALTH (28) Water supply - Lee Valley Water Company: representative sample Chemical results expressed in milligrammes per litre Appearance: Clear and bright Ammoniacal Nitrogen ... 0.04 Colour (Burgess) Less than 5 Albuminoid Nitrogen 0.02 Odour/Taste Nil/nil Nitrate Nitrogen 5.7 Turbidity 0 Nitrite Nitrogen 0.00 Conductivity 610 Oxygen Absorbed 0.38 Total solids 440 Fluoride less than 0.2 pH 7.1 Silica 8 Free CO2 34 Iron less than 0.02 Alkalinity (CaCo3) 210 Other metals absent Carbonate Hardness 210 Phosphate 0.09 Non-Carbonate Hardness 100 Residual Chlorine Nil Total Hardness 310 Temperature °C 11 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. 2 per ml. 0 per ml. Presumptive Coli-Aerogenes Present in Absent from Probable No. — ml. 100 ml. 0 per 100 ml. E. Coli — ml. 100 ml. 0 per 100 ml. Cl.Welchi — ml. — ml. 48 (29) Clean air: smoke control areas ENVIRONMENTAL HEALTH (Area of Borough 20,061 acres; number of premises at 31st December, 1972: 110,686) Area No. of premises included (at date of declaration) Acres (a) Areas in operation: Enfield 1 - 5 inclusive 12,010 8,292 Edmonton 1 - 7 inclusive 20,000 2,263 Southgate 1 - 5 inclusive 9,033 1,940 London Borough of Enfield 11-17 inclusive 33,207 4,325 74,250 16,820 (b) Order made to come into operation in 1973: London Borough of Enfield 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 (30) Food and drugs: samples submitted to public analyst Samples Procured Unsatisfactory Baby foods 6 1 Beverages, fruit juices, syrups, etc 53 9 Biscuits 25 4 Bread 7 2 Butter and margarine 11 — Cakes 24 4 Cereals 15 2 Cheese 19 3 Coffee 4 — Confectionery 38 6 Cooking fats, including lard, etc 7 1 Cooking oil 2 — Cream 9 1 Dessert products 41 11 Drugs 16 6 Fish and fish products 26 7 Flour 5 — Fruit (all kinds) 31 5 Jams and preserves 32 4 Jelly 3 — Meat and meat products 70 10 Milk (various) 26 7 Nuts 3 — Salt, mustard and pepper 4 — Sauces and pickles 51 17 Soup 24 4 Spices, etc 21 6 Sugar 5 — Tea 4 — Vegetables (fresh and canned) 41 10 Miscellaneous 42 4 TOTAL 665 124 (16%) 49 ENVIRONMENTAL HEALTH (31) Food and drugs: result of bacteriological examination of ice-cream (loose or soft). Methylene Blue Test Grade 1 Grade 2 Grade 3 Grade 4 From shop premises 12 8 2 6 From mobile traders — 1 — — (32) Food and drugs: prosecutions Complaint Fine Costs £ £ Foreign matter in bottle of milk 100.00 10.00 Foreign matter in bottle of milk 20.00 5.00 Foreign matter in bottle of milk 20.00 5.00 Foreign matter in bottle of milk 20.00 5.00 Foreign matter in bottle of milk 100.00 10.00 Excessive water in bottle of milk 100.00 10.00 Dirty milk bottle 100.00 10.00 Dirty milk bottle 100.00 10.00 Dirty milk bottle 100.00 15.00 Weather-stained milk bottle 100.00 — Ball-bearing in loaf of bread 35.00 10.00 Grease in loaf of bread 25.00 10.00 Grease in loaf of bread 100.00 10.00 Insect in loaf of bread 20.00 10.00 Insect in bread roll 20.00 10.00 Drawing pin in loaf of bread 20.00 5.00 Metal in loaf of bread 70.00 13.00 Metal in loaf of bread 50.00 10.00 Dirty loaf of bread 25.00 10.00 Discolouration of loaf of bread 25.00 10.00 Mouse droppings in bread rolls 50.00 10.00 Bad smelling frozen peas 25.00 5.00 Pin in packet of frozen fish 50.00 5.00 Nail in sausage 10.00 10.00 Glass in pork pie 25.00 5.00 Insect in steak and kidney pie 10.00 10.00 Wood in Spanish salad 25.00 5.00 Mouldy sponge roll 50.00 10.00 Mouldy madeira cake 25.00 5.30 Match-stick in pastry 25.00 16.30 Foreign matter in chocolate bar — 10.00 Mouldy piece of cheese 30.00 10.00 Bad smelling corned beef 25.00 — 50 ENVIRONMENTAL HEALTH (33) Housing: inspections and defects Inspection of dwelling houses: Total number of dwelling houses inspected for housing defects (under Public Health or Housing Acts) 11,201 Action under Statutory Powers during the year: 1. Proceedings under Public Health Acts: (a) Number of dwelling houses in respect of which informal notices were served requiring defects to be remedied 317 (b) Number of dwelling houses rendered fit 195 (c) Number of dwelling houses in respect of which formal notices were served requiring defects to be remedied 250 (d) Number of dwelling houses rendered fit after service of formal notice (i) by owners 178 (ii) by local authority in default of owners 10 2. Proceedings under Sections 9, 10 and 12 of the Housing Act 1957: (a) Number of dwelling houses in respect of which notices were served requiring repairs 9 (b) Number of dwelling houses which were rendered fit after service of formal notices (i) by owners 4 (ii) by local authority in default of owners 1 3. Proceedings under Section 42 of the Housing Act 1957: Number of dwelling houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation 52 4. Proceedings under Section 17 of the Housing Act 1957: (a) Number of dwelling houses in respect of which demolition orders were made 4 (b) Number of dwelling houses demolished in pursuance of demolition orders 4 51 ENVIRONMENTAL HEALTH (34) Housing: defects remedied Nature of defect Number Brickwork, pointing and wallplaster - defective 57 Dampness 90 Doors - defective 6 Drains - stopped up 2,725 Drains - defective or broken 28 Dustbins - defective 2 Flooring - defective 25 Guttering and rainwater pipes - defective 81 Paving - broken 4 Refuse accumulation 22 Roofs - defective 148 Sink wastes - defective 18 Verminous and dilapidated conditions 65 Water - not provided or disconnected 16 Water-closets - defective 50 Windows - defective or broken 51 (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 274 672 Retail shops 762 2,170 Wholesale shops, warehouses 145 381 Catering establishments open to public, canteens 102 184 1,283 3,407 (36) Factories and workshops: inspections for purposes of provisions as to health Premises Number on Register Inspections Number of written Notices (i) Factories in which Sections 1,2,3, 4 and 6 are enforced by Local Authority 39 13 - (ii) Factories not included in (i) in which Section 7 is enforced by the Local Authority 708 113 4 (iii) Other premises in which Section 7 is enforced by the Local Authority (excluding outworkers' premises) 35 9 - 782 135 4 52 ENVIRONMENTAL HEALTH (37) Factories and workshops: cases in which defects were found Particulars Number of cases in which defects were Found Remedied Referred to H.M. Inspector Referred by H.M. Inspector Want of cleanliness (S.1.) 1 1 - - Overcrowding (S.2.) - - - - Unreasonable temperature (S.3.) - - - - Inadequate ventilation (S.4.) 2 - - - Ineffective drainage of floors (S.6.) - - - - Sanitary conveniences (S.7.) (a) Insufficient - - - - (b) Unsuitable or defective 3 3 - - (c) Not separate for sexes 3 1 - - Other offences against the Act (not including offences relating to outworkers) - - 2 - 9 5 2 - (38) Inspections and complaints: inspections, interviews and visits of the public health inspectorate Animal welfare 120 Atmospheric pollution 1,890 Bacteriological samples 577 Caravans: residential sites 193 gypsies and other itinerants 179 Clean Air Act 2,057 Drainage works 1,202 Factories and workshops 166 Food and drugs 2,264 Food premises 3,653 Hairdressers' premises 82 Hawkers (vehicle and storage) 262 House purchase advances 425 Housing and public health: Inspection of defects 1,257 Home improvements 12,502 Qualification Certificates 1,571 Housing survey 4,106 Other inspections 8,160 Houses in multiple occupation 213 Infectious diseases 1,514 Interviews 900 Licensing, betting and gaming, licensed premises, employment agencies, etc 285 Milk distributors and dairymen 374 Noise nuisances 687 Offices and shops 3,407 Pest control 1,336 Public conveniences 50 Shops Act and street trading 2,341 Tips 69 Water 144 Miscellaneous 2,746 54,732 53 ENVIRONMENTAL HEALTH (39) Inspections and complaints: summary of complaints and requests for visits Accumulation of refuse 144 Bees 18 Blocked or defective drains 2,727 Dampness in premises 242 Defective water-closets 425 Defective water-fittings 30 Defective roofs 90 Disinfection and disinfestation 12 Improvement of property 1,074 Insanitary or defective conditions of premises 445 Insect infestations 306 Noise nuisance 57 Pigeons 109 Rats or mice 2,734 Scabies 7 Smoke nuisance and Clean Air enquiries 176 Squirrels 67 Unsatisfactory housing conditions including overcrowding 32 Unsound food 169 Verminous premises 84 Wasps 54 Miscellaneous 1,180 10,182 54 SCHOOL HEALTH Summary School population 44,005 Routine medical inspection Number of children examined 11,261 Number found to be satisfactory 11,261 Number found to be unsatisfactory Nil Medical treatment Total attendances: Minor ailments 21,758 Ear, nose and throat 217 Ophthalmic 3,922 Orthoptic 1,709 Orthopaedic 44 Speech 2,638 Child guidance 1,156 Handicapped children receiving special education Total number of children 629 Number attending day special schools 515 Number attending residential schools 111 Number attending special language class 3 Routine dental inspection and treatment Number of children examined 35,313 Number found to need treatment 13,936 Number treated by school dental officers 7,255 Medical inspection Section 48 Education Act 1944 The purpose of the medical inspection required by Section 48 of the Education Act 1944 is to ensure the fitness of school children to derive the maximum benefit from the education provided. The procedure adopted for the medical inspection, at appropriate intervals, of pupils attending maintained schools has followed the same pattern as in previous years, apart from the introduction of an additional vision test at twelve years. Approval was, however, given for a limited trial of a system of selective medical examinations for ten-year-old children in a part of the borough during 1973. At present 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 and at twelve years. 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 estimate of the child's physical condition is made at the time of the inspection and the 11,261 examined in 1972 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 employ ment. In 1973 some changes will take place in this procedure following the introduction of the Employment Medical Advisory Service Act 1972. Medical inspection is not provided at the eight 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 made arrangements with general medical practitioners, but students are informed that they can receive B.C.G. vaccination. The mass radiography unit continues to visit both colleges in the autumn. One hundred and ninety-nine students from Enfield College of Technology and 363 from Southgate Technical College attended for chest X-ray examination. Four from Southgate and one from Enfield were referred for further investigation but no subsequent action was deemed necessary. Colour vision 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 55 SCHOOL HEALTH 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 twenty-nine boys and five girls were found by the Ishihara test to have a degree of colour blindness. Of the 153 boys and eight girls tested by the Giles Archer Lantern, seven boys and three girls were found to be normal, 95 boys and five girls were found to be safe and 49 boys unsafe in relation to certain standards for employment. Arrangements were made for two boys to be re-tested. Hearing 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 clinic and tested children as requested by the consultant. Children failing their hearing tests are referred for investigation to the department's medical officers or to family doctors, and may, following this, be referred for further investigation — although many require only minor treatment. Sixty-eight children attended the school ear, nose and throat clinic, eighteen are still attending for observation, 38 were referred to hospital for operation or other treatment and twelve required no treatment. Since ear, nose and throat clinic sessions ceased at Edmonton Central Clinic, 103 children have been referred, through the School Health Service, to Highlands Hospital. Forty-three required operative treatment; 23 received other forms of treatment; nineteen required no treatment; eleven failed to attend; and three left the district. Reports have not yet been received on the remaining four. Only two commercial aids were purchased during the year, all other needs being met by the issue of National Health Service body-worn and head-worn aids. Enfield children attending the audiology unit in the neighbouring Borough of Haringey are supervised by the peripatetic teacher of the deaf attached to the clinic. This teacher will also be assessing the needs of all those children with hearing aids, in ordinary schools, who have so far been unsupervised. An induction loop and amplifier have been fitted in an ordinary primary school for the benefit of a partially hearing girl and similar arrangements are in hand for a girl in another primary school. Foot inspections Regular foot inspections by the school nurses in all schools in the borough revealed 1,751 new cases of plantar warts from the 86,459 inspections undertaken. An informative pamphlet is available tc parents to assist them in recognising verrucae in the early stages and containing advice on treatmenl and on the prevention of the spread of infection. See Tables (40), (41), (42) and (43). Inspections for cleanliness School nurses visit 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, i1 necessary. See Table (44). Medical treatment Section 48 Education Act 1944 Free medical treatment was provided in accordance with the requirements of Section 48 of the Education Act 1944. 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. 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. At many of the clinic premises nurses hold additional sessions for the treatment of skin infections and minor injuries and defects. 56 SCHOOL HEALTH Ear, nose and throat clinic A total of fifteen sessions, all at Southbury Clinic, were undertaken by a consultant holding a local hospital appointment. The smaller number of sessions, compared with previous years, is explained by the current practice of following up patients at hospital clinics. Ophthalmic clinics Two sessions every other week are held at Bowes Road Clinic, two sessions a week at Edmonton Central Clinic, and three sessions a week at Southbury Clinic. Orthoptic clinics Pre-operative and post-operative treatment was provided by a full-time orthoptist at the three ophthalmic clinics in the borough. Orthopaedic clinic Fewer cases were referred compared with previous years, and during part of the time no consultant was available. For these reasons only eleven sessions were held during the year. Children requiring physiotherapy attended hospital for this purpose. Physiotherapy Twice-weekly visits by a part-time physiotherapist were made to Hazelbury Open Air School and to Durants and Waverley Schools for Educationally Sub-normal Children, where some of the children received treatment either weekly or twice weekly. Speech clinics Due largely to staff shortages there are waiting lists for treatment both at clinics and special schools and in one special school no treatment has been provided since the commencement of the autumn term. One child suffering from language retardation has been assessed and accepted for treatment at the Wolfson Centre and Department of Developmental Paediatrics and will be attending four mornings a week at the Centre's language class. Three of the four children attending this class during the year have now been discharged and their speech therapy will be continued locally. Three students from schools of speech therapy attended the Edmonton Central Clinic during the year for practical training. 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. 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 non-speaking and in other ways inaccessible. Elsewhere, remedial classes are provided for very small groups of children with specific learning difficulties, who attend part-time; additionally a small full-time class for hyperactive infants is now held under the supervision of the teacher in charge of the Selection Unit. Nutrition Advice on nutrition is available both individually and by group method, and is supplemented by the use of diet sheets and weight charts. At the end of the year 37 overweight children were attending clinics for advice. No underweight children were referred. Enuresis Twenty-two automatic enuresis alarm devices are available locally to assist in the treatment of enuretic children. Fifty two children were issued with these alarm devices during the year. Six months after success had been reported a check made in 22 cases revealed that eleven were still dry; ten had relapsed; one had left the district. Recuperative holidays One child was sent on a recuperative holiday of two weeks duration and three children had holidays arranged by the British Epilepsy Association.See Tables (45), (46), (47), (48), (49), (50), (51) and (52). 57 SCHOOL HEALTH Dental service Section 48 Education Act 1944 Section 4 Education (Miscellaneous Provisions) Act 1953 Dental inspection and dental treatment were provided under the relevant legislation. Nine clinics in the borough have dental suites with a total of thirteen surgeries, one surgery being used exclusively for orthodontics and three 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. Following the visit by one of its dental officers to review the borough's dental services, the Department of Education and Science reported that "The Authority achieves a good inspection performance with nearly all of the school population inspected on an annual basis" and also that the pattern of treatment remains good. It was further stated that clinics are generally well maintained; but despite this, it was possible for certain improvements to be undertaken in the course of the year. A modern dental unit was installed at Albany Clinic; chair conversions were effected at Southbury Clinic; and double glazing (to minimise traffic noise) and a controlled air vent were introduced at Silver Street Clinic. Unfortunately, there was a sharp decrease in the number of sessions devoted to dental health education. This was due largely to the fact that the Department was without the services of a Health Education Officer during the greater part of the year. Education in dental health is, of course, practised by the Department's dental officers as part of their normal work — mainly within the confines of their surgeries. The Council's Wavendon House residential special school in Buckinghamshire was visited. All the pupils were inspected and simple conservative treatment carried out. In the relevant statistical table detailed information is given in respect of dental inspection and treatment and also on the orthodontic service. See Table (53). Handicapped pupils Education Act 1944 A 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. The categories of handicapped pupils defined under the Handicapped Pupils and Special Schools Regulations 1959 and 1962 are: (a) Blind — No children were ascertained during the year (b) Partially sighted — Five children were ascertained during the year: three were placed in day special schools and two are awaiting placement (c) Deaf — One child was ascertained during the year but left the district before placement (d) Partially hearing — Two children were ascertained during the year and are attending ordinary schools where they are supervised by a peripatetic teacher of the deaf (e) Educationally sub-normal — Ten children were ascertained during the year, including two with dual handicaps: eight were admitted to special schools and two are awaiting placement (f) Epileptic — Three children were ascertained during the year including one with a dual handicap: two were placed in special schools and one is awaiting placement. (g) Maladjusted — Thirteen children were ascertained during the year: nine were placed in special schools and four are awaiting placement (h) Physically handicapped — Eighteen children were ascertained during the year: twelve were placed in special schools; one was placed in a day nursery; four are awaiting placement; and one left the district before placement (i) Speech - Two children were ascertained during the year: one was admitted to a special school and one to a special language class on a part-time basis 58 SCHOOL HEALTH (j) Delicate — Eleven children, one with a dual handicap, were ascertained during the year: six were placed in special schools; two are awaiting placement; and three left the district before placement. Special schools Education (Handicapped Children) Act 1970 The Education Committee maintains five day special schools and one residential special school. All admit a proportion of children from other boroughs. Waverley School (Day) has accommodation for 150 educationally sub-normal children and includes a nursery class and a special care unit. Weekly visits are paid by a medical officer. The children are medically examined annually; a speech therapist visits weekly; and a physiotherapist visits twice weekly. Durants and Oaktree Schools (Day) provide accommodation for 320 educationally sub-normal boys and girls, who are medically examined annually. Speech therapy was suspended at Durants School after the summer term owing to staff shortages, but one session weekly continued at Oaktree School. Durants School, where some pupils have dual handicaps, is attended twice weekly by a physiotherapist. 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. Each child is medically examined annually - or more frequently where it appears desirable. The physiotherapist visits the school twice weekly. 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 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 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 to inspect the pupils and carry out simple treatment. The boys' dental condition was found to be generally satisfactory. Provision of milk in schools Education (Milk) Act 1971 The Education (Milk) Act 1971 restricts 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. The provision of milk in school was certified as necessary for health reasons in the case of seventy children. Seven 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. 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 emphasise to parents the need for immunological protection for their children, but also to remind 59 SCHOOL HEALTH them that a reinforcing dose may be due. To minimise interference with the children's school work, vaccination and immunisation are undertaken at the schools when the number of children is sufficiently great to warrant this. Employment of children Section 59 Education Act 1944 Of 324 children examined, certificates were issued to 323 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. A further seven children were examined and granted certificates enabling them to take part in entertainments. The Employment Medical Advisory Service Act 1972 Plans were in hand for this Act to become effective on the 1st February, 1973. In addition to its other duties, the Employment Medical Advisory Service will have a special responsibility, in cooperation with the School Health Service and the Youth Employment Service, for advising on the employment of young persons. The screening of teenagers for haemoglobinopathies Certain types of severe anaemia in childhood are of a hereditary character and are relatively common in the Mediterranean and West Indian races. Based on a proposal put forward by Dr. Wickes, paediatrician at North Middlesex Hospital, a scheme has been evolved whereby blood tests are offered to teenagers of the Cypriot, African and West Indian races so that carriers of anaemia may be detected and have the genetic risks involved in marriage explained to them. Information about the scheme is given at the school leaving medical examination to those pupils likely to be affected. Explanatory leaflets and forms have been prepared in English, Turkish and Greek and discussions have taken place with a Turkish Cypriot race relations officer and a leader of the Greek Cypriot Community. The consultant haemotologist at North Middlesex Hospital has arranged for the testing of the blood samples. Requests for information about the scheme have been received from medical sources at home and overseas. Children in care Five children's homes, under the control of the Social Services Department, accommodate 64 school children. They are visited approximately six times a year by the Department's medical officers, who advise on diet, health and hygiene and examine the children on admission and annually. General medical care of the children in these homes and in foster homes is undertaken by general medical practitioners. The Department's medical officers also attend, in order to give advice, etc., two homes within the borough which belong to the London Borough of Barnet and accommodate 21 school children. Co-operation with hospitals Information received from paediatricians at local hospitals about the special needs of certain children proved most useful to the Department's medical and dental officers. Once a month the Principal Medical Officer for School Health attended a paediatric assessment clinic at the Enfield War Memorial Hospital. 60 SCHOOL HEALTH Reports were received on six school children who had been admitted to hospital after eating or drinking unwisely. One had imbibed a quantity of cherry brandy; one had taken 40 junior aspirins; and another had consumed phenytoin tablets. In three cases laburnum seeds had been the attraction. Fortunately, all the children recovered. Prevalence and control of infectious disease Sonne dysentery There were outbreaks in two schools in the borough involving a total of 72 children. In addition, 37 sporadic cases were reported. Scabies Seventy children were treated for scabies during the year, and clinic nurses inspected 2,291 school children in classes where cases had occurred. German measles (rubella) Although not usually a serious disease, it has been established that rubella, occurring in a woman during the early months of pregnancy, may cause congenital defects in the foetus. Upon the occurrence of rubella in school children, the mothers of the pupils are advised, as also are female members of the staff so that they may, if considered advisable, consult their doctor and take any other action necessary. Reporting of infectious disease Head teachers reported 382 school children as suffering from infectious diseases. Tuberculosis of the lungs It was considered advisable to investigate the school contacts of a pupil notified as suffering from tuberculosis of the lungs. The following figures relate to the investigation which was carried out by the staff at the Edmonton Chest Clinic: Number of contacts 157 Number of contacts who had previously had B.C.G. vaccination 133 Number of contacts approached for consent to investigation 24 Number of contacts for whom consent received 16 Number who gave consent and had satisfactory X-ray results 13* Number who gave consent but failed to attend for investigation 3 *Five of these were subsequently given B.C.G. vaccination. Ionising radiations In accordance with instructions issued by the Department of Education and Science, the approval of the Secretary of State is required before certain radio-active sources may be used in schools. One comprehensive school has been given authority to use open sources, and almost all comprehensive schools are authorised to use closed sources. In addition, the Education Department is in consultation with the Department of Education and Science regarding the purchase, for the shared use of schools in the borough, of a type of X-ray apparatus for the examination of the structure of materials. A revised code of practice for the protection of persons against ionising radiations arising from medical and dental use was produced in 1972; there are no major differences between this and the one previously circulated. The code applies to the Council's eight dental clinics which have X-ray machines. During the year 717 pupils were X-rayed at dental clinics; 1,722 X-rays were taken, including 1,486 for orthodontic purposes. 61 SCHOOL HEALTH STATISTICAL INFORMATION (40) 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 1968& later 589 37 68 100 1967 1,983 142 292 410 1966 1,772 130 306 411 1965 236 21 38 56 1964 85 5 13 18 1963 73 7 10 15 1962 914 139 111 234 1961 2,202 351 274 592 1960 759 109 121 214 1959 186 21 19 38 1958 77 17 9 26 1957 & earlier 2,385 539 270 745 Totals 11,261 1,518 1,531 2,859 (41) 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 272 3 62 4 Eyes: (a) vision 1,518 891 350 123 (b) squint 37 — 7 — (c) other 30 — 30 — Ears: (a) hearing 113 76 186 84 (b) otitis media 11 — 4 — (c) other 20 — 11 3 Nose and throat 300 23 95 8 Speech 51 22 20 8 Glands 8 2 — — Heart 38 15 — 1 Lungs 161 7 3 3 Developmental: (a) hernia 16 9 3 1 (b) other 102 106 32 26 Orthopaedic: (a) posture 4 2 1 1 (b)feet 32 6 7 4 (c) other 45 4 19 2 Nervous system: (a) epilepsy 29 — 1 — (b)other 4 — 1 1 Psychological: (a) development — — 60 — (b) stability 97 73 50 47 Abdomen 21 5 — — Other 258 33 176 82 62 SCHOOL HEALTH (42) Medical inspection: special inspections and re-inspections Special inspections (including freedom from infection examinations prior to school journeys and special examinations at schools, special schools, children's homes, etc.) 5,820 Re-inspections 3,301 (43) Hearing tests by audiometer: (a) Routine tests in schools Age Group 1st Test Failures Of total failures number already known to have hearing loss Re-tests Both ears one ear Total right left Entrants 4,802 159 60 71 290 53 938 8-9 years 4,713 115 49 62 226 96 624 12-13 years 2,523 44 22 22 88 55 276 Total 12,038 318 131 155 604 204 1,838 (b) Special tests in clinics Pre-school 36 5 2 4 11 1 7 School children 280 93 40 29 162 102 158 Total 316 98 42 33 173 103 165 Number of children in schools (excluding special schools for the deaf or partially hearing) who have hearing aids 55 (44) Inspections for cleanliness: Infestation with vermin Examinations of pupils in school 83,265 Individual pupils found to be infested 147 Individual pupils in respect of whom cleansing notices were issued (Section 54(2) Education Act 1944) 49 (45) 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 2 (ii) body 1 Scabies 1 Impetigo 25 Other 2,356 Eye disease 31 Ear defects 21 Miscellaneous 987 Total attendances at minor ailments clinics 21,758 Special inspections at minor ailments clinics 1,819 Re-examinations at minor ailments clinics 943 63 SCHOOL HEALTH (46) Ear, nose and throat clinic Total attendances 217 New cases 113 Individual children seen 166 Received treatment at E.N.T. clinic 28 Referred to hospital for tonsillectomy and/or adenoidectomy 57 Referred to hospital for other treatment 22 Referred for X-ray 11 (47) Ophthalmic clinics Total attendances 3,922 New cases 677 Individual children seen 2,507 Children prescribed glasses 921 (48) Orthoptic clinics Total attendances 1,709 New cases 128 Individual children treated 453 Discharged: Orthoptically satisfactory with operation 3 Orthoptically satisfactory without operation 77 80 Discharged not orthoptically satisfactory but: 1. intermittent binocular single vision 8 2. appearance satisfactory: (a) with improved visual acuity 12 (b) without improved visual acuity — 3. treatment not completed: (a) Left district 16 (b) Failed to attend 10 (c) Referred elsewhere 2 48 Appointments made and not kept 541 (49) Orthopaedic clinic Total attendances at Orthopaedic Surgeon's Clinic 44 New cases seen by Orthopaedic Surgeon 29 Cases discharged 26 64 SCHOOL HEALTH (50) Physiotherapy School Children treated Treatments given Durants School 10 680 Hazelbury Open Air School 59 2,315 Waverley School 12 840 (51) Speech therapy: clinics and special schools Total attendances 2,638 New cases 106 Children under treatment or observation for the following: Retarded speech and language development 119 Articulation defects 303 Stammer 32 454 Discharged: Cured 48 Improved 46 Defaulted 13 Transferred elsewhere for treatment or left district 10 117 (52) Child guidance clinic Individual children seen by psychiatrist: New cases (including seven pre-school children) 139 Cases followed up 41 Annual revisions 7 Treatment 4 Total attendances for diagnosis and treatment by psychiatrist 385 Individual children treated by psychotherapists 42 Total attendances for treatment by psychotherapists 771 65 SCHOOL HEALTH (53) Dental service: dental inspection and treatment 5-9 years 10 - 14 years 15 years and over Total Attendances and Treatment: First visit for treatment 3,735 3,056 464 7,255 Subsequent visits 4,806 7,994 1,552 14,352 Total visits 8,541 11,050 2,016 21,607 Additional courses of treatment commenced 417 226 51 694 Fillings in permanent teeth 1,467 4,707 1,113 7,287 Fillings in deciduous teeth 5,897 797 — 6,694 Permanent teeth filled 1,279 4,145 980 6,404 Deciduous teeth filled 5,459 738 — 6,197 Permanent teeth extracted 160 725 101 986 Deciduous teeth extracted 2,157 967 — 3,124 General anaesthetics 631 413 15 1,059 Emergencies 521 141 15 677 Number of pupils X-rayed 717 Prophylaxis 1,172 Teeth otherwise conserved 1,184 Number of teeth root filled 6 Inlays - Crowns 21 Courses of treatment completed 7,089 Orthodontics: Cases remaining from previous year 325 New cases commenced during year 212 Cases completed during year 326 Cases discontinued during year 43 Number of removable appliances fitted 642 Number of fixed appliances fitted 53 Pupils referred to hospital consultant 2 Total attendances at clinics 6,763 Prosthetics: Pupils supplied with full upper or full lower dentures (first time) — — — — Pupils supplied with other dentures (first time) — 2 1 3 Number of dentures supplied — 2 1 3 Anaesthetics: General Anaesthetics administered by Medical Officers 1,059 Inspections: (a) First inspection at school. Number of pupils 29,392 (b) First inspection at clinic. Number of pupils 5,921 Number of (a) + (b) found to require treatment 13,936 Number of (a) + (b) offered treatment 13,340 (c) Pupils re-inspected at school clinic 3,164 Number of (c) found to require treatment 1,360 Sessions: Sessions devoted to treatment (incl. 802 orthodontic sessions) 3,533 Sessions devoted to inspection 237 Sessions devoted to Dental Health Education 16 66 HEALTH DEPARTMENT PREMISES HEALTH OFFICE PUBLIC CONVENIENCES Gentleman's Row, Enfield (Telephone Edmonton: 01-366 1262) Annexe: 100 Church Street, Enfield Angel Road, N.18. Bury Street West, N.9. SUB OFFICES Bush Hill Park Parade, Enfield. Church Fields, N.9. Edmonton Central Clinic, Plevna Road, N.9. Church Street, Great Cambridge Road, N.9. Craig Park, N.18. Southgate Town Hall, Green Lanes, N. 13 Cuckoo Hall Ground, N.9. Southgate Town Hall, Green Lanes, N.13. Fjrst Avenue N 18 The Green, N.9. Health Centre Jubilee Park, N.9. Montagu Road Playing Fields, N.9. 2a Forest Road, N.9. Silver Street, N.18. Tatem Park (Cambridge Roundabout), N.13. Tramway Avenue, N.9. CLINICS Victoria Road, N.9. Weir Hall, Silver Street, N.18. Edmonton: Central - Plevna Road, N.9. Enfield: Ridge House - Church Street, N.9. Brigadier Hill, Enfield. St. John s - Claremont Street, N.18. Carterhatch Lane, Enfield. Silver Street - Silver Street, N.18. Church Street Enfie|d Weir Hall - Silver Street, N.18. Forty HaM Forty HM| Enfie|d Green Street, Brimsdown. Enfield: Hawthorn Grove, Enfield (North Enfield Rec.) Albany - Bell Lane, Enfield (Education premises) Hertford Road, Enfield (Durants Park). Bullsmoor - Kempe Road, Enfield High Street, Ponders End Grange Park - Church-in-the-Orchard, N.21. (Ponders End Rec. Ground). Green Street - Green Street, Enfield Highway King George Playing Fields, Enfield. Hadley Wood - Courtleigh Avenue, Hadley Wood. Lancaster Road, Enfield. Lavender - Lavender Road, Enfield (Education Lincoln Road, Bush Hill Park. premises) Head Road, Ponders End. Lincoln Road - Lincoln Road, Bush Hill Park. ' Russe" Road- FortV Hill, Enfield. Merryhills - Enfield Road, Enfield. Southbury Road, Enfield. Rosemary Avenue Rosemary Avenue, Enfield. Sydney Road, Enfield. St. Stephen's - St. Stephen's Road, Enfield Town Park' Enfield- Wash Turkey Street, Enfield. Southbury - Glyn Road, Ponders End. Whitewebbs Park (Central), Enfield. Southgate: Southgate: Bowes Road 269 Bowes Road, N.11. Broomfield • Broomfield House, Broomfield Park, Arnos Park, N.11. N.13 Boundary Playing Fields, N.13. DeBohun-Green Road, N.14.(Education premises) Bramley Sports Ground, N.14. The Grange - The Bourne, N.14. Broomfield Park, N.13. The Laurels - Barrowell Green, N.21. Fords Grove, Wmchmore Hill, N.21. Grovelands Park, N.21. North Circular Road, Bowes Road, N.13. OTHER PREMISES Oakwood Park, N.14. Southgate Cemetery, N.14. Tottenhall Sports Ground, N.13. Disinfecting Station: Montagu Road, N.9. The Triangle, Palmers Green, N.13. Treatment Centre (Cleansing): Town Hall, N.9. Winchmore Hill Road Car Park, N.14. 67 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 (resigned 31.3. 72) Principal Medical Officers: Leonora A. Crawford, M.B., B.S., D.P.H., D.C.H., M.F.C.M.; Monica E. Watkins, M.B., B.S., M.F.C.M. Senior Medical Officers: Elizabeth A. Brown, M.B., B.S., D.P.H., M.F.C.M. (appointed 4.4.72); Therese M. Chan Kin, M.B., B.Ch., B.A.O., D.P.H., M.F.C.M. Medical Officers in Department: Grace J. Adam, M.B., Ch.B. (part-time); Vernell T. Allen, M.B., B.S.; Janet F. Cambell, M.B., Ch.B., D.C.H. (part-time); 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 Chest Physician: J. Vernon Davies, M.D., B.S., M.R.C.P. Hospital Consultants and Specialists (undertaking sessions at Council Clinics): Ear, Nose and Throat — 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. (died 12.11. 72) 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. Underhill, L.D.S., R.C.S. (part-time) (resigned 7.9.72). Public Analyst: T. McLachlan, A.C.G.F.C., F.R.I.C., M.I. Biol. Deputy Public Analyst: (post vacant) Veterinary Surgeon: J.R. Stockman, M.R.C.V.S. Chief Public Health Inspector: J.C. Lightfoot, F.A.P.H.I. Deputy Chief Public Health Inspector: G. Rawlinson, M.A.P.H.I. Senior Public Health Inspectors: R.L. Burkill, F.A.P.H.I.; G.E. Laney, M.A.P.H.I.; R.E. Williams, M.A.P.H.I. Chief Nursing Officer: Miss V.M. George, S.R.N., D.N. (Tutor) Cert., S.C.M. H.V. (appointed 7.4.72) Superintendent Health Visitor: Miss P.Z.M.J. MacLaughlin, S.R.N., S.C.M., H.V., P.H.A. (Cert.) (resigned 4.5.72) Non-medical Supervisor of Midwives: Miss D. Hall, S.R.N., S.C.M. Superintendent of Home Nursing Service: Mrs. M. Pickering, S.R.N., N.D.N, (cert.) Health Education Officer: Miss T. Bamford, S.R.N., S.C.M., H.V., Dip in Health Education (resigned 31.5. 72). 68 STAFF Chief Administrative Officer: S.N. Dance. Deputy Chief Administrative Officer: E.J.A. Golding. Senior Administrative Officers: A.K. Clark, D.P.A., S. Law, Miss D. Hamer, J. Humblestone. Other staff establishment Health visitors — group advisers (3), field work instructors (4), health visitors/school nurses (46), tuberculosis health visitors (2), student health visitors (7); midwives (30); home nurses (45), nursing auxiliaries (6); dental surgery assistants (12); health education technician (1); speech therapists (3); senior orthoptist (1); audiology technicians (2); physiotherapist/remedial gymnast (1); chief chiropodist (1),chiropodists (7); medical social worker (1). Public health inspectors — specialists (3), district (16), student (6); technical assistants (7). Senior administrative officer (1), administrative officers (7), senior clerical officers (3), clerical officers (48), shorthand/audio typists (9), 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). Health centre: Administrative officer (1), clerical assistant (1), caretaker (1), domestic staff (2). The following whole time equivalent personnel comprised the establishment of the Health Department: Administrative, Professional and Technical Officers 331 Manual Workers 103 434 Several long-serving officers retired during the year including Mrs. P. Page (home nurse) after 24 years, and Mrs. R. Rhodes (home nurse) after ten years. To all officers who retired during the year under review I extend my thanks for their past services. Officers resigning during the year included Dr. B. Cooper, Deputy Medical Officer of Health; Miss Z. MacLaughlin, Superintendent Health Visitor; Mrs. C. Tubbs, Senior Nurse; Miss T. Bamford, Health Education Officer; Mr. L. Hibbs, Specialist Public Health Inspector; Miss C. Calkin, Group Adviser Health Visitor; and Miss Shipley, Speech Therapist. With deep regret I have to record the death on the 12th November, of Dr. Wahab, the ophthalmic specialist who attended Southbury Clinic, and on the 16th July of Mrs. G.M. Eyden, who held a senior clerical post in the Department. 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 2,291. 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. Sixty teachers and 238 trainees were passed as fit and were admitted to the national scheme. 69 STAFF Other teachers transferring to the staff of the Council are subject to medical assessment or medical examination as may be necessary. There were 357 teachers assessed and of this number one 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 six hundred and thirty five assessments were made. Ten were found to be unfit. Sickness absence medical assessments Medical assessments were made in accordance with the scheme of conditions of service relating to prolonged absence due to illness, and seventeen employees were found to be incapable of discharging efficiently the duties of their employment by reason of permanent ill health or infirmity of mind or 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. 70 INDEX Pages on which Statistical Tables appear are indicated in bold type Accidents: Fatal 6 Road 6 Young children 14 Aircraft 7 Air pollution 34 Car exhausts 37 Lead 37 Ambulance service 19 Analgesia 16 Animal care 44 Ante-natal clinics13 25 "At Risk" register 14 26 Audiometric testing 25 56 63 Barbers' premises 41 Baths, washhouses, bathing places, etc 33 "Battered babies" syndrome 14 B.C.G. vaccination - see Vaccination and Immunisation Bed-Linen, loan of 22 Bees 44 Betting and gaming premises 42 Births 5 Burial and cremation 45 Canal boats 40 Caravans 40 Carcinoma of the cervix of ute uterus, population screening for 15 26 Care and after care 20 Chest disease, non-tuberculous 20 Child guidance 7 65 Child health 3 25 Children, employment of 0 Children in care 5 60 Chiropody 2 29 Clean air 4 49 Cleanliness , inspections for 6 63 Clinics: 7 Ante-natal 3 25 Assessment 4 Chest 0 28 Child guidance 7 65 Child health 3 25 Chiropody 2 29 Ear, nose and throat 5 57 64 Health advice for the elderly 23 Immunisation 8 Minor ailments 6 63 Ophthalmic 5 57 64 Orthopaedic 5 57 64 Orthoptic 5 57 64 Post-natal 3 25 Premises 4 Slimmers 7 Smokers' 3 30 Specialist 4 25 Speech 25 57 65 Colour vision 55 Committees: Education 3 Diphtheria 7 Immunisation against 18 28 Disinfection 7 Disinfestation 43 Dysentery 7 61 Ear, nose and throat clinics 25 57 64 Education Committee 3 Education Schools Sub-Committee 3 Elderly persons, advice clinics for 23 Employment agencies 42 Employment Medical Advisory Service Act 1972 60 Employment of Children 60 Encephalitis 7 Enuresis 57 Environmental health services 32 Evening nursing service 17 Exhumations 45 Factories and Workplaces 42 52 53 Family planning 15 Flouridation of public water supplies 24 Food and drugs 37 49 50 Complaints 38 Composition and labelling 37 Food premises - registration of 38 Hygiene 38 Ice-cream 38 50 Milk, dairies and cream substitutes 38 Pesticides in food 38 Unsound food 38 Food poisoning 7 Foot inspections 56 General statistics 8 Haemoglobinopathies, screening of teenagers for 60 Haemolytic disease of the newborn, prevention of 16 Hairdressers'and barbers'premises 41 Handicapped children 58 Health centres 13 67 Health Committee 3 Health Department premises 67 Health education 24 Health office 67 Health visiting 16 27 Health visitors: Ancillary help 17 Liaison with general practitioners 17 Liaison with hospitals 17 Hearing tests 25 56 63 Holidays - recuperative 57 Home and hospital tuition 59 Home nurses: Ancillary help 17 Liaison with general practitioners 17 71 INDEX Pages on which Statistical Tables appear are indicated in bold type Health 3 Congenital abnormalities 14 Co-ordination- personal services 15 Council 3 Cremation and burial 45 Deaths 5 10 Infants 5 11 Dental service: Mothers and young children 14 26 School children 58 66 Development plan 24 31 Dialysis, home 23 Incontinence pads and clothing 22 Incontinent persons, laundry service for 25 Incubators, portable 16 Infectious disease, prevalence and control of 6 11 12 61 Infective jaundice 7 Inquests 6 Inspections and complaints 43 53 54 Inspections for cleanliness 56 63 International certificates of vaccination 19 Ionising radiations 44 61 Kidney machines - adaptation of homes 23 Laboratory service 7 12 Land charges 40 Laundry service for incontinent persons 25 Leptospirosis 7 Licensed premises 41 Malaria 7 Marie Curie Memorial Foundation 17 Market and street trading 41 Markets, slaughterhouses and "knackers" yards 38 Massage and special treatment establishments 41 Mass radiography 21 Measles 6 Immunisation against 18 28 Medical assessment - staff 69 Medical inspection - school children 55 62 63 Medical treatment - school children 56 63 Meningitis 7 Midwifery 15 Analgesia 16 Early discharges 27 Prevention of haemolytic disease of the newborn 16 Midwives: 27 Liaison with hospitals 17 Home nursing 17 27 Hospitals, co-operation with 17 60 Housing 39 51 52 Council housing 39 Improvement areas 39 Multiple occupation 39 Overcrowding 39 Slum clearance 40 Unfit houses 40 Hypothermia 23 Immigrants 20 Immunisation-see Vaccination and Immunisation Persons in need of care and attention 25 Pest control 43 Phenylketonuria 14 Physiotherapy 57 65 Pigeons 44 Placentae and offensive dressings, disposal of 16 Poliomyelitis 7 Immunisation against 18 28 Post-natal clinics 13 25 Premature infants, care of 26 Premises, Health Department 67 Problem families 15 Prophylaxis, care and after-care 20 Public conveniences 33 67 Public health laboratory service 7 12 Rag flock and other filling materials 42 Recuperative care 57 Refuse collection and disposal 34 Relaxation and mothercraft 17 25 Rodent control - see Pest Control Rubella 61 Immunisation against 18 28 Scabies 61 School health service 55 Sewerage and sewage disposal 33 Ships 7 Shops and offices 41 52 SIimmers advisory centres 17 Slum clearance 40 Smoke control areas 34 49 Smokers'clinic 23 30 Social conditions 5 Sonne dysentery - see Dysentery Specialist clinics see Clinics Special schools 59 Speech clinics 25 57 Speech therapy 65 Staff 68 Medical assessment and examination 69 Training 17 Vaccination of 18 72 INDEX Pages on which Statistical Tables appear are indicated in bold type Liaison with general practitioners 16 Liaison with hospitals 16 Notification of intention to practise 26 Pupils 16 Milk in schools 59 Minor ailments clinics 56 Mortuary 45 Mothercraft and relaxation 17 25 Mothers and young children 13 Noise 43 Non-fatal accidents to young children in their homes 14 Nurses agencies 42 Nursing equipment, Loan of 22 Nursing homes 24 Nutrition 57 Offensive dressings 16 Offensive trades 43 Offices and shops 41 52 Ophthalmic clinics 25 57 64 Orthopaedic clinic 25 57 64 Orthoptic clinics 25 57 64 Outworkers 42 Paratyphoid fever 7 Parentcraft 16 Personal health services 13 Statistics and social conditions 4 Statistics: General 8 Vital 5 8 Street Trading 41 Ten-year Plan for Health Services 24 31 Tetanus, immunisation against 18 28 Training 7 Training of staff of other agencies 16 17 Tuberculosis 7 12 20 28 61 Home visiting 20 Rehabilitation 21 Vaccination against 21 Typhoid fever 7 Unfit houses 40 Vaccination and immunisation 17 28 59 Diphtheria 18 28 International certificates 19 Measles 18 28 Poliomyelitis 18 28 Publicity 18 Rubella 18 28 Staff 18 Tetanus 18 28 Tuberculosis (B.C.G.) 21 Vaccines, distribution of 18 Whooping cough 18 28 Venereal disease 23 30 Vermin, infestation with 56 63 Vital statistics 5 8 Vitamin supplements 14 Wasps and bees 44 Water supply 32 46 47 48 Fluoridation of 24 Welfare foods and vitamin supplements 14 Whooping cough, immunisation against 18 28 Workplaces 42 52 53 73