HAR 1 HARINGEY HEALTH IN 1965 The Annual Report of the Medical Officer of Health & Principal School Medical Officer. HARINGEY HEALTH IN 1965 The Annual Report of the Medical Officer of Health & Principal School Medical Officer. To: The Worshipful the Mayor, Aldermen and Councillors of the London Borough of Haringey. Mr. Mayor, Ladies and Gentlemen, I have the honour to present the first annual report to the people of the London Borough of Haringey for the year ended 31st December, 1965. During the first quarter of the year, the four authorities - Middlesex, Tottenham, Hornsey and Wood Green - were responsible for the services, and statistics from them have been included to complete the full year. The staff from the four authorities were transferred into office accommodation at Tottenham Town Hall where an early difficulty with telephone communications showed that a health department makes much more use of verbal communication than was required for the routine work of the former Borough. The enthusiasm and tolerance on the part of the new Council combined with the industry and conscientiousness of the staff ensured that in spite of re-organisation the health services to the public continued without a hitch. This first annual report includes a large number of statistics which will form a base line for the measurement of future progress and thanks are due to the senior members of the Department for their contributions to the report. The report gives information about the action taken to improve or ameliorate environmental conditions by the introduction of new standards of amenity for houses in multiple occupation, information about a new improvement area and about the clearance of unfit houses. During the year there has been considerable progress with clean air and we now accept as normal the absence of foggy winters. However, even when the whole of the Borough becomes a smoke controlled area, an event expected about 1970, it will still be necessary to ensure that no new forms of pollution damage the purity of the air we breathe. A new clinic was opened in October at Fortis Green which now houses the maternity and child welfare clinic from the former Electricity Showrooms, together with the school dental and minor ailments clinics from ColdfalI Avenue. The clinic is housed in attractive premises not far from the busy shopping centre at Muswell Hill. During the year considerable interest was shown in the establishment of the service for examination of cervical smears with a view to the prevention of cancer of the uterus. I would drawn attention, however to the fact that only seven women under the age of 75 died from this cause in contrast to the fact that the corresponding total of people who died from lung cancer was no fewer than 155, or twenty times as many. The mental health service has had to develop in the only London Borough which found itself devoid of premises for this purpose, but fortunately we have been able to use the facilities offered by the neighbouring authorities of Barnet and Enfield, which provide the services of a junior training school, an adult training centre and hostels for the mentally ill. During the year much thought and consideration has been given to the planning of various types of premises for the future mental health services of the Borough. In conclusion, I wish to record my thanks to the Chairman and Members of Committees, and especially to Councillor Moss, Chairman of the Health and Welfare Committee, for encouragement and support, and to the Town Clerk, and especially to Mr. Wickens, Assistant Town Clerk, and other Chief Officers of the Council for their invaluable assistance. My thanks are due to the staff of the health department, and especially to Mr. Relleen, Chief Administrative Officer, for loyal and efficient service during the period of the evolution of the new authority. I have the honour to be Your obedient Servant, J.L. PATTON, Medical Officer of Health. HEALTH AND WELFARE COMMITTEE 1965/66 The Mayor - Councillor Victor Butler, J.P. (ex-officio) Alderman - V.P. Gellay, B.Sc., A.Inst.P., A.R.I.C. " - J. Martin Councillor - Mrs. L.A. Angell " L. Cohen " Mrs. D. Cunningham " Mrs. D.C. Findley " F.C.V. Hayward " F.A. Knight " Mrs. L.H. Lipson, M.C.S.P., H.T. " J. Lotery " C.D. Moss (Chairman) " R. Parker " Mrs. M.E. Protheroe (Vice-Chairman) " Mrs. Brenda S. Remington, B.A. " Mrs. J.E. Thexton " R.G. Wigley " James T. Wilkins STAFF OF HEALTH DEPARTMENT as at 31.12.65 Medical Officer of Health and Principal School Medical Officer J.L. PATTON, M.B., Ch.B., D.P.H. Deputy Medical Officer of Health and D.P.S.M.O: W.T. ORTON, M.B., B.Ch., B.A.O., D.P.H. Principal Medical Officers: School Health Mary C. Douglas, M.B., Ch.B., D.P.H. Maternity and Child Welfare Ruth Y. Golder, M.B., Ch.B., D.R.C.O.G., D.P.H. Mental Health U.P. Seidel, M.B., B.S., D.P.H. Senior Medical Officer: Elizabeth P. Cloake, M.B., B.S., D.R.C.O.G., D.P.H. Assistant Medical Officers: Sara R. Abels, M.B., B.Ch., B.A.O., L.M. T.H. Elias, M.B., B.S., M.R.C.S., L.R.C.P., D.P.H. Joan F. Nicholls, M.B., B.S., D.C.H., D.P.H. Mohinder K. Seehra, L.S.M.F., M.B., B.S. Eva M. Diamond, L.R.C.P., L.R.C.S. J.J. Troy, M.B., B.Ch., B.A.O., D.R.C.O.G., D.P.H., L.R.F.P.S. Esther M. Waterhouse, M.D. Ann R.T. Wilson, M.B., B.S. Z. Zubrzycki, Med.Dipl., D.P.H. 1 vacancy and 12 sessional M.Os. Chief Dental Officer: and Principal School Dental Officer: G.C.H. Kramer, L.D.S., R.C.S. Dental Officers: Jacqueline Adamson B.D.S., L.D.S., R.C.S. N. Ansbergs, D.D.D. Mary C. Dixon, L.D.S., R.C.S. M.C. Downer, L.D.S., R.C.S. Alison G. Little, L.D.S., R.C.S. 3 sessional dentists: 1 dental auxiliary (part-time): 3 vacancies Orthodontists: Joy Maclnerney, L.D.S., D.Orth., R.C.S., B.D.S. 1 sessional orthodontist: 1 specialist dental surgery assistant and 1 vacancy: 7 dental surgery assistants Public Analyst: W.B. Chapman, B.Sc., F.R.I.C. Superintendent Health Visitor: Mary Smith, S.R.N., S.C.M., H.V. Deputy Superintendent Health Visitor: Vacancy 2 Senior Health Visitors: Joan Beese, S.R.N., H.V. Edith N. Gibbon, S.R.N., S.C.M., H.V. Irene E.G. Marriott, S.R.N., S.C.M., H.V., Diploma in Social Studies Doreen I. Wigglesworth, S.R.N., H.V. 2 vacancies for senior health visitors: 24 health visitor/school nurses: 2 sessional health visitor/ school nurses, 4 vacancies: 3 T.B. health visitors: 11 clinic nurses: 1 sessional clinic nurse: 4 day nursery matrons: 4 deputy matrons: 2 wardens: 18 staff nursery nurses: 3 part-time staff nursery nurses: 2 nursery assistants. Non-medical Supervisor of Midwives: and Superintendent of Home Nurses: Dorothy Jobling, S.R.N., R.F.N., S.C.M., M.T.T.C.Dip. Deputy Non-medical Supervisor of Midwives: Vacancy 21 midwives: 2 part-time midwives Deputy Superintendent of Home Nurses: Berthe F. Specht, S.R.N., S.C.M., Q.N. 30 home nurses: 5 part-time home nurses: 2 vacancies for bath unit attendants Chiropodists: 4 sessional chiropodists Chief Mental Welfare Officer: L.R. Lee, C.S.W., S.R.N., R.M.N., R.M.P.A., Deputy Chief Mental Welfare Officer: E. Inglis, R.M.N. 2 senior mental welfare officers: 6 mental welfare officers Home Help Organiser: Dorothy I. Williams, S.R.N., R.F.N., D.I.H.H.O. 3 assistants: 206 home helps Red Gables Mother and 3aby Home: Matron: Mabel K. Hopkins, S.R.N. Deputy Matron: Margaret Chamberlain, S.R.N., S.C.M. 1 staff nurse (part-time): 3 attendants Sheltered Workshops: Manager/Instructor: W.R. Osment 2 assistants Medical Auxiliaries: 2 physiotherapists: 1 vacancy 1 occupational therapist 3 speech therapists (sessional): 1 vacancy 1 orthoptist: 1 vacancy 2 audiometricians: 1 vacancy Social Workers: Hilda J. Howse, M.B.E., S.R.N., S.C.M., H.V., Diploma in Social Science Dorothy Myer, A.I.M.S.W. 3 Health Education Officer: Sheila M.P. Frost, S.R.N., S.C.M., H.V. 1 assistant Chief Public Health Inspector: W.J. Wilson, D.P.A., M.P.H.I.A., M.R.S.H. Deputy Chief Public Health Inspector: E.S. Glegg, M.P.H.I.A., A.M.I.P.H.E. Senior Public Health Inspectors: F.H. Canton, M.P.H.I.A. E.S. Gray, M.P.H.I.A. A.E. Clarke, M.P.H.I.A., A.M.I.P.H.E. J.A. Harris, M.P.H.I.A. W..E. Goodfellow, M.P.H.I.A. F. James, M.P.H.I.A. 19 public health inspectors: 3 technical assistants Food and Drugs Officer: A.J.C. Roker Shops Inspector: T.E. Goodwin 2 assistants Foreman Disinfector: W.W. Hooper 1 deputy foreman disinfector and senior rodent operative: 8 public health general assistants: 3 rodent operatives. Mortuary Attendant: S.J. Twinn 1 assistant ADMINISTRATIVE STAFF Chief Administrative Officer: W.L.N. Relleen, T.D., D.P.A. Deputy Chief Administrative Officer: D.B. Davies, D.P.A. Accounts, Wages, Supplies, Buildings and Child Health and Domiciliary Care Division: Transport Division: H.J. Dunham, B.A. (Divisional Head) N.P. Child (Divisional Head) S.E. Woodroffe (Section Head) L.E. Wells (Section Head) Hetty L. Somers (Section Head) J.W. Bailey (Section Head) 29 administrative and clerical assistants: 7 clerical assistants: 1 vacancy 7 part-time clerical assistants Prevention, Care, After-Care and Mental Environmental Health and Infectious Diseases Control Health Division: Division: P.V. Ingram (Divisional Head) A.W. Lawrence, M.P.H.I.A. (Divisional Head) Hazel Gill (Section Head) H.C.B. Wheal (Section Head) Hilda Burrows (Section Head) H.P. Bradford (Section Head) 8 clerical assistants 13 administrative and clerical assistants Secretariat: A. Balls (Section Head) Ann Gates (Supervisor of Typing Section) Florence Wetherall (M.O.H's secretary) 5 administrative and clerical assistants: 1 part-time clerical assistant: 6 shorthand-typists: 4 copy-typists 2 part-time copy-typists 4 VITAL STATISTICS Area of District (in acres) 7,491 Population - Mid-year 1965 Registrar General's estimate 256,750 Rateable Value as at 1st April 1965 £13,277,781 Sum represented by penny rate £54,000 Approximate Number of Dwellings in District 70,842 Registered live births: Males 2,848 Females 2,763 5,611 Birth rate per 1,000 estimated population 21.85 No. of live births which were illegitimate 726 (12.94%). Stillbirths: Males 34 Females 46 80 Stillbirth rate per 1,000 total (live and still) births 14.06 No. of stillbirths which were illegitimate 11 (13.75%) Deaths: Males 1,386 Females 1,479 2,865 Death rate per 1,000 estimated population 11.16 Maternal Mortality: Deaths from Puerperal Causes 3 Death rate per 1,000 total (live and still) births 0.527 Deaths of infants under 1 year of age (Infant Mortality) (a) Legitimate Males 40 Females 37 77 Death rate per 1,000 legitimate live births 15.76 (b) Illegitimate Males 12 Females 11 23 Death rate per 1,000 illegitimate live births 31.68 (c) Total Males 52 Females 48 100 Death rate per 1,000 total live births 17.82 Deaths of Infants under 4 week (Neo-natal Mortality) 73 Rate per 1,000 live births 13.01 Deaths of Infants under 1 week (Early Neo-natal Mortality) 66 Rate per 1,000 live births 11.76 Stillbirths and deaths under 1 week (Perinatal Mortality) 146 Rate per 1,000 live and still births 25.65 Comparability Factors To enable local vital statistics to be compared with other districts or with national figures, the Registrar General issues comparability factors for correcting crude birth and death rates. These factors make allowance for the way in which the sex and age distribution of the local population differs from that for England and Wales as a whole. The death rate comparability factor has been adjusted specifically to take account of the presence of residential institutions in the area. To compare the crude 1965 rates for Haringey with the national rates, Haringey's figures must first be multiplied by the appropriate comparability factors, which are 0.92 for births and 0.97 for deaths. 5 CLASSIFIED DEATHS OF HARINGEY RESIDENTS SHEWING AGE GROUP AND SEX DISTRIBUTION 1965 DISEASE Total Under 4 weeks 4 weeks and under 1 year 1-4 5-14 15-24 25-34 35-44 45-54 55-64 65-74 75 and over M F M F M F M F M F M F M F M F M F M F M F M F Tuberculosis, respiratory 8 3 — — — — — — — — — — — — — 1 1 1 2 — 2 — 3 1 Tuberculosis, other — — — — — — — — — — — — — — — — — — — — — — — — Syphilitic disease 1 2 — — — — — — — — — — — — — — — — — — 1 1 — 1 Diphtheria — — — — — — — — — — — — — — — — — — — — — — — — Whooping Cough — — — — — — — — — — — — — — — — — — — — — — — — Meningococcal infection — — — — — — — — — — — — — — — — — — — — — — — — Acute poliomyelitis — — — — — — — — — — — — — — — — — — — — — — — — Measles — — — — — — — — — — — — — — — — — — — — — — — — Other infective and parasitic disease 2 1 — — 1 — — — — — — — — — 1 1 — — — — — — — — Malignant neoplasm, stomach 34 34 — — — — — — — — — — — 1 — 1 4 2 10 3 12 12 8 15 Malignant neoplasm, lung bronchus 174 25 — — — — — — — — — — — — 2 1 15 — 61 3 57 15 39 6 Malignant neoplasm, breast — 58 — — — — — — — — — — — — — 3 — 10 — 20 — 7 — 18 Malignant neoplasm, uterus — 15 — — — — — — — — — — — 1 — 1 — 1 — 1 — 3 — 8 Other malignant and lymphatic neoplasm 147 163 — — 1 — — — — 1 3 — 3 3 9 6 14 10 41 34 35 50 41 59 Leukaemia, Aleukaemia 14 5 — — — — 2 — 2 — 1 — — — 2 — 1 — 2 1 2 3 2 1 Diabetes 5 15 — — — — — — — — — — — 3 1 — — — 3 — 1 5 — 7 Vascular lesions of the nervous system 114 212 — — — — — — — — — — — 1 2 4 10 6 25 23 27 44 50 134 Coronary disease, angina 341 255 — — — — — — — — — — 2 — 7 — 39 10 98 27 94 65 101 153 Hypertension, with heart disease 13 24 — — — 1 — — — — — — — — — — — — 2 — 5 7 6 17 Other heart disease 61 147 — — — — — — — — — — — 1 1 1 3 10 8 8 13 23 36 103 Other circulatory disease 71 94 — — — — — — — — — — — — — 1 4 6 8 7 18 18 41 62 Influenza 1 1 — — — — — — — — — — — — — — — — — — — — 1 1 Pneumonia 73 114 3 3 6 8 1 5 — 1 — — — — — 2 — — 3 1 19 8 41 86 Bronchitis 113 47 — — — — — — — — — — — — — — 5 3 17 5 46 9 45 30 Other diseases of respiratory system 15 9 — — — — — — — — — — — — — — — — 4 — 3 2 8 7 Ulcer of stomach & duodenum 14 12 — — — — — — — — — — — — — — 2 — 4 — 3 1 5 11 Gastritis, enteritis & diarrhoea 5 9 1 — — — — — — — — — — — — — — — — — 2 3 2 6 Nephritis & nephrosis 9 7 — — — — — — — — — 1 1 — 2 — — — 4 1 2 3 — 2 Hyperplasia of prostate 3 — — — — — — — — — — — — — — — — — — — 1 — 2 — Pregnancy, childbirth & abortion — 3 — — — — — — — — — 1 — 2 — — — — — — — — — — Congenital malformations 11 16 5 7 1 3 — 3 — 1 2 — — — — — — — 1 2 — — 2 — Otherdefined & ill defined diseases 96 164 30 23 1 2 2 2 2 1 — — 4 2 3 3 8 6 7 16 18 32 21 77 Motor Vehicle accidents 24 7 — — — — — — 3 — 8 1 1 — 1 — 4 1 1 2 3 1 3 2 All other accidents 24 26 1 — 2 1 1 — 1 2 2 1 2 1 3 1 1 2 5 1 2 2 4 15 Suicide 12 10 — — — — — — — — — — — 2 2 3 2 1 4 1 3 2 1 1 Homicide & Operations of War 1 1 — — — — — — — — — — — 1 1 — — — — — — — — — Total 1,386 1,479 40 33 12 15 6 10 8 6 16 4 13 18 37 29 113 69 310 156 369 316 462 823 6 NOTIFICATIONS OF INFECTIOUS DISEASE DURING 1985 BY SEX AND AGE GROUPS Under 1 1 2 3 4 5-9 10-14 15-19 20-34 35-44 45-64 65 + Total M F M F M F M F M F M F M F M F M F M F M F M F Scarlet Fever — — 1 2 3 2 10 7 4 9 39 43 8 11 2 6 — 2 — — — — — — 149 Measles 32 40 133 135 149 129 152 149 125 115 314 340 15 14 7 8 3 6 4 6 — — — — 1876 Whooping Cough 1 1 2 6 5 3 2 2 1 5 5 5 1 1 — — 1 — — — — — — — 41 Pneumonia — — 1 2 — — — — — — 3 2 3 — 3 2 3 — — — 10 4 4 3 40 Erysipelas — — — — — — — — — — — — — — — — 1 2 — — 2 2 1 — 8 Food Poisoning 3 1 3 1 — — 2 1 2 — 2 2 — 2 — 1 5 2 3 3 1 — 1 3 38 Puerperal Pyrexia — — — — — — — — — — — — — — — 2 — 14 — 2 — — — — 18 Ophthalmia Neonatorum 1 1 — — — — — — — — — — — — — — — — — — — — — — 2 A. Encephalitis INF — — — — 1 — — — — — — — — — — — — — — — — — — — 1 " P-INF — — — — — — — — — — — — — — — — — — — — — — — — — Acute Polio P — — — — — — — — — — — — — — — — — — — — — — — — — " " N.P. — — — — — — — — — — — — — — — — — — — — — — — — — Meningococcal Inf. 1 — — — 1 — — — — — — 1 — — — — — — — — — — — — 3 Diphtheria — — — — — — — — — — — — — — — — — — — — — — — — — Typhoid 1 — — — — — — — — — — — — — — 1 1 — — — — — — — 3 Para-typhoid — — — — — — — — — — — — — — — — — — — — — — — — — Dysentery 2 1 4 4 5 5 4 7 — 4 7 8 9 5 2 5 2 1 2 1 2 1 — — 81 Scabies (Tottenham) — — — — — — 2 — — — — — 6 2 — 4 4 4 — 3 6 3 — — 34 T.B. Resp. 1 — — 1 2 3 2 2 — — 1 3 — 1 3 — 17 19 7 7 22 7 7 6 111 T.B. M.CNS — — — — — — 1 2 — — — — — — — — — — — — — — — — 2 T.B. Others — — — — — — — — — — — — — — — — 2 5 1 1 1 — — 1 11 Smallpox — — — — — — — — — — — — — — — — — — — — — — — — — Malaria — — — — — — — — — — — — — — — — — — — 1 — — — — 1 7 INFECTIOUS DISEASES In spite of the increasing concentration of effort in other aspects of public health, infectious disease control remains one of the most important and receives the closest attention. The most not able development was the inauguration of a weekly bulletin to general practitioners in July. Since then, every doctor in Haringey has received a brief, up-to-date account of the latest situation in infectious disease at breakfast time each Saturday. This has also afforded an opportunity for the individual general practitioner to pass on information which is published for the benefit of others. The value of this has been especially evident with regard to infective hepatitis, revealing many more cases than had previously been suspected. The bulletin has also been useful for announcements of public health or medical interest. Local doctors have expressed their appreciation of this venture, and I would like to thank them for their co-operation. Food Poisoning All four members of a Haringey family were infected by Salmonella enteritidis while staying at a seaside holiday camp in July. This type of organism was also responsible for an outbreak of food poisoning among guests at a wedding reception in another borough in October. Two Haringey residents were affected. One of them was a food handler who was excluded from work and compensated for loss of income until clear of the disease. A local hospital requested the advice of the Health Department on Salmonella typhimurium infection in two wards. The hospital was visited and recommendations were made regarding organisation and equipment. Measles The incidence of this disease increases sharply in alternate years. 1965 was a "quiet" year. Measles vaccination has now been approved by the Ministry of Health, and is being carried out by general practitioners on a limited scale. Staphylococcal Infection A woman became seriously ill with a staphylococcal infection while in a local maternity unit. She was transferred to an infectious diseases hospital where she recovered. Members of the Health Department staff visited the unit at the request of the medical supervisor, and a number of agreed recommendations were carried out. Meningococcal Meningitis Three sporadic cases occurred in children, the eldest of which was five years old. Poliomyelitis The odds against poliomyelitis spreading to Haringey by way of normal travel and contact during the outbreak in Blackburn during the summer were fairly high, but there was anxiety that they might have been lowered substantially if thousands of supporters from Tottenham went therefor the Rovers' match in August. There was considerable relief when the game was cancelled. No cases of poliomyelitis occurred in Haringey during the year. Typhoid A young woman from Italy, employed in a factory outside Haringey, was admitted to Coppetts Wood Hospital at the Deginning of June, suffering from typhoid fever. She had arrived in this country a month previously and had been ill for three weeks. Contacts in her home, the neighbourhood and her place of work were followed up intensively, but no other cases were discovered. Enquiries led to the source of the disease being located in Italy, and the patient admitted to eating raw mussels from the Bay of Naples at the time when infection might have been expected to have occurred. She made a satisfactory recovery in hospital. 8 A seven months old baby was admitted to Coppetts Wood Hospital at the end of September suffering from typhoid fever, and responded to treatment. Investigations in the home, a multi-occupied house, revealed that his father was a likely source of the infection. A "fever" in the West Indies nearly twenty years previously is thought to have been the origin of his typhoid carrier state. He, too, was treated in hospital, apparently with good result. The mother showed signs of having been infected in the past, but she, the remaining children and all the other inhabitants of the house were free of the disease. The family later moved to an address elsewhere in the Borough. The staff of the Health Department were also employed in the investigation of the contacts of typhoid cases in other local authority areas. As the result of an outbreak in a ward of a hospital in an adjoining borough, 65 people-discharged patients, staff, voluntary workers, relatives and friends-living in Haringey were followed up and found to be clear. 37 residents of this Borough who may have been contacts of a case in a seaside resort, were also investigated and shown to be negative. It is not without significance that the three cases that occurred in Haringey all originated abroad. The greater popularity of foreign travel is likely to increase this danger in future, especially since this disease is not regarded as seriously in some countries as here. The kind of difficulties that can arise is illustrated by an incident that occurred in October. A woman telephoned the Health Department to say that her husband, who had flown to France the previous day, was in a hospital with suspected typhoid. Since typhoid is not an internationally notifiable disease, a letter, written in French, was sent to the hospital concerned, asking if this was correct. Meanwhile, the family were followed up as typhoid contacts. The hospital's reply stated only the date of the patient's admission and discharge, by which time he had returned home. Fortunately, he was found to have in his possession a copy of a letter to the doctor who sent him into hospital. This was translated and a copy sent to his general practitioner. It stated that typhoid and Malta Fever were suspected but not confirmed, and that he recovered after treatment. Our own investigations were subsequently negative. Evidence was obtained that he might have been infected while on holiday in the South of France during the summer, and this was sent to the French authorities; but there is no information as to whether this was followed up or not. While the risk of catching typhoid abroad is small, it is not insignificant, and the temporary inconvenience of T.A.B. injections is well worth while as a protection, especially if visiting Southern Europe or more distant places. Dysentery Bacillary dysentery caused by Shigella sonnei is a common, but usually mild infection. Many cases are not notified and there are numerous symptomless carriers. A Haringey contact of a typhoid outbreak in a hospital in a neighbouring borough was discovered to be a carrier of a dysentery organism, Shigella flexneri. Smallpox There were no cases this year, due no doubt to strict international control of the disease, although the advice of the Medical Officer of Health and his deputy was requested by general practitioners in a few instances where it was suspected. The vaccination rate is still too low, and anxiety must remain whenever a case occurs. International air travel has been blamed a good deal for the increase in this menace, but one wonders why this fact has never been used to advantage. A five hundred seater aircraft will be flying inafew years, and holidays on other continents will be financially possible for most people. Is this not then an opportunity to remind parents that many countries will not admit travellers who have not been vaccinated, and that the most suitable age is between one and two years? Malaria A woman recently arrived from Ghana was admitted to hospital suffering from malignant tertian malaria. We were asked to follow up in Haringey some members of a party who had been on holiday in Tunisia. Another member of the group, living elsewhere in London, was suffering from Malignant tertian malaria. Fortunately, there were no further cases. 9 The second example is in some ways more sinister than the first in that the illness occurred in a tourist from this country. This is another instance of the hazards resulting from the increased range of transport, and the disease is also found in two other North African countries - Morocco and Algeria. Every intending traveller should enquire, and it is the duty of every agency to inform him, about the health risks of countries to be visited. Where malaria is concerned, a suitable prophylactic drug should be taken regularly, not only while in the malarious region but for a full month after leaving it. Rubella Rubella or German Measles is a mild infectious disease that would hardly deserve mention here were it not for the serious developmental defects it can cause to the unborn child in the first three or four months of pregnancy. Two cases occurred in children in a crowded hostel for homeless families. Gammaglobulin injections were given to all mothers living there who were less than four months pregnant. A scheme is now in operation in Haringey whereby any pregnant woman teacher who is exposed to the risk of rubella at school is either transferred to another school or allowed leave on full pay until four months pregnant. Leprosy Two patients who changed their addresses and defaulted in treatment were visited and persuaded to re-attend hospital. This is a dangerous but not highly infectious disease. Powers to control unco-operative patients were very limited in 1965, but have since been considerably extended. Infective Hepatitis This virus infection,also known as epidemic jaundice, is a major problem in other advanced countries such as North America and Australia. It is not so common in the British Isles, and certainly is not so highly infectious as many of the diseases that are encountered here. However, it is not notifiable in numerous local authority areas, including this one, and there is mounting evidence that it occurs more frequently than had been realised. Our own interest in this was stimulated by the floods in South Tottenham on 20th July. It was wondered if the inability of the drains to cope with the enormous volumes of water might have caused backflow and exposed the inhabitants to increased risk of the disease. Consequently, an item was inserted in the weekly infectious diseases bulletin to general practitioners, asking them to inform the Health Department of any cases they encountered, especially in those districts. The response was generous. It soon became clear that the hypothesis was not confirmed by the facts, and that the disease had actually been present before as well as after the floods. Visits to the households involved revealed other affected people, and the ultimate picture was of a thin scattering of cases throughout the Borough, with two concentrations in Tottenham: one in three houses where the families were related to one another; the other in a block of flats. Attempts were made to find links between these two episodes, but the evidence was not forthcoming. If the disease should become notifiable, more effective measures to limit the spread could be taken in future. In October a case occurred at a densely occupied hostel for homeless families. In view of the riskof infection, a proportion of the residents was given preventive injections of gamma globulin, supplied by Colindale Public Health Laboratory. All are now being followed up as part of a national survey of this preparation. No further cases have appeared. There were 36 known cases during the year, 24 of which came to our notice through general practitioners. 10 Medical Arrangements for Long-stay Immigrants Local authorities are informed of the destination addresses of immigrants arriving in this country, sothat they can be visited by the public health inspector or health visitor and given general information about the health services and persuaded to get themselves and their dependents registered with general medical practitioners with a view particularly to chest X-ray where this is appropriate. The scheme was put into operation during the first quarter of 1965. 805 notifications were received during the year, 397 (49.3 per cent) of which were contacted. Experience has shown that the rate of contact is unlikely to exceed one half of the total. The main reasons for non-contact are either the incorrect and/or accommodation address, where the immigrant is unknown or no further information can be obtained, or removal to another place without leaving a forwarding address. More of the latter might be located were it not for the heavy pressure of other work on the staff concerned, who are often obliged to postpone the visit for two to three weeks. Difficulties have also occurred over the unusual names of some of the immigrants. Some measure of the extent of immigration may be gathered from an investigation into the November births which revealed that 99 out of the 404 babies born during that month were coloured. VACCINATION AND IMMUNISATION Vaccination against Smallpox The following table records the number of persons underthe age of 16 known to have been vaccinated or re-vaccinated during the year by general practitioners and clinic medical officers:- Under 1 year 1 year 2 - 4 5 - 15 Total Number of Primary Vaccinations 168 1142 460 61 1831 Number of Re-vaccinations — 4 14 29 47 NOTE The recommended age for primary smallpox vaccination is now between one and two years, which explains the high total in this age group. In the clinic, infants under one year are not vaccinated except for some special indication, usually travel abroad, which is most frequently West Indian or African families returning to their own countries. Immunisation against Diphtheria, Whooping Cough, Tetanus and Poliomyelitis The following tables record the number of persons under the age of 16 known to have received a primary course of immunisation or re-inforcing dose during the year by general practitioners or clinic staff. A. The number who completed a full course of Primary Inmunisation Age at date of Immunisation Quadruple Triple Dip/WC Dip/Tet Dip WC Tet Salk Sabin Total 0-1 year 11 1785 2 18 18 — — 1 299 2134 1-2 years 24 1868 — 15 11 — 2 13 2663 4596 2-4 years 7 280 1 18 2 — 1 5 603 917 4-6 years — 84 — 80 3 — 27 5 336 535 6-16 years — 31 2 39 12 — 60 4 101 249 Totals 42 4048 5 170 46 — 90 28 4002 8431 11 Contents of some of the Vaccines used:- 1. Quadruple - Diphtheria, Whooping Cough, Tetanus and Polio combined 2. Triple - Diphtheria, Whooping Cough and Tetanus combined 3. Salk - Poliomyelitis Vaccine 4. Sabin - Oral Poliomyelitis Vaccine B. The number who received a re-inforcing dose Age at date of Immunisation Quadruple Triple Dip/WC Dip/Tet Dip WC Tet Salk Sabin Total 0-1 year — 8 — 3 — — — — — 12 1-2 years 1 537 — 13 2 — — 6 79 638 2-4 years 10 1129 — 37 8 — — 12 63 1259 4-6 years 5 628 — 363 100 — 13 14 310 1433 6-16 years — 32 1 68 63 — 16 6 48 234 Totals 16 2334 1 484 173 — 29 38 501 3576 NOTE 1. Tetanus Vaccination Active immunisation against tetanus is being encouraged as far as possible, which explains the predominance of the combined vaccines containing tetanus over the plain whooping cough, or diphtheria/Whooping cough combined vaccines which have almost gone out of use. Children of school age who have not been immunised against tetanus in infancy are being encouraged to have a primary course of tetanus vaccination when their re-inforcing dose against diphtheria is given at school entry. 2. Poliomyelitis Vaccination The popularity of the oral Sabin vaccine over the Salk vaccine given by injection is obvious. One of its advantages is that it can safely be administered by the clinic nurses. SANITARY CIRCUMSTANCES OF THE AREA Drainage and Sewerage There are separate systems of drainage for soil and surface water. The former connects into the East Middlesex Drainage System and the sewage is treated at Deephams Purification Works, Edmonton. The surface water sewers eventually discharge into local streams most of which are culverted and ultimately connect with the River Lea. Incorrect drainage connections at times cause the pollution of surface water. Close liaison is maintained with the Lee Conservancy Catchment Board's Inspectors so that action to deal with any pollution may be taken as soon as possible. A technical assistant is engaged for most of his time in tracing drainage connections and reporting any detected faults or deficiencies. Flooding The resources of the Department were fully extended in July 1965 when an exceptionally heavy rainfall occurred (3.08 inches in two hours) and a number of houses throughout the Borough were partially flooded. Several school halls were made available to the Department, and sodden bedding and carpets were dried out by the use of warm air blowers and dehumidifiers. A number of houses were treated by the use of under-floor warm air blowers, but so great was the demand for this type of work that the assistance of the Royal Air Force had to be obtained. The exceptionally heavy rainfall caused dampness in many other properties and all requests for assistance and advice were dealt with as quickly as possible. 12 FLOODING IN HARINGEY A householder in Russell Road, discusses the flooding with Mr. W.J. Wilson, Chief Public Health Inspector, as a warm air blower machine goes into action to dry out a home. The machine is one of 13 hired by Haringey Council - 10 from the RAF - to help with clearing up operations. Water Supplies Dr. Windle Taylor, Director of Water Examination, Metropolitan Water 3oard, has kindly supplied the following information regarding Haringey's water supplies:- "The water supply to the area has been satisfactory both in quality and quantity during 1965. The higher elevations of the area around Muswell Hill are supplied with River Thames derived water, and the remainder of the area is supplied with New River derived water which is a mixture of water from the River Lea and a number of wells. During the summer months the locality of Northumberland Park also receives water from Park well (with its relatively high content of natural Fluoride). The results of the chemical and bacteriological analysis of these sources, together with information about their fluoride content, is set out on the following page. These waters are not liable to any plumbo solvent action and immediate steps are taken to identify and remedy any contamination that may occur. The water is supplied direct to the premises, none being permanently supplied by standpipes. There have been no important extensions of trunk mains in your area nor any change in the general scheme of supply during 1965. New service mains extending to a total distance of 794 yards have been laid by the 3oard during 1965. This new work was adequately chlorinated and samples of water in the mains proved satisfactory before being put into service." 13 AVERAGE RESULTS OF THE CHEMICAL AND BACTERIOLOGICAL EXAMINATION OF THE WATER SUPPLIED TO THE LONDON BOROUGH OF HARINGEY FOR THE YEAR 1965 (Milligrams per litre (unless otherwise stated)) Description of the Sample No. of samples Ammonia Nitrogen Albuminoid Nitrogen Nitrate Nitrogen Chlorides as C1 Oxygen abs. from Permanganate 4 hrs. at 27°C Turbidity Units Colour Burgess Units Hardness (Total) Hardness (noncar bonate) PH Value Phosphate as P04 Silicate as Si02 Sulphate as S04 Fluoride as F Magnesium as Mg. Surface Active Material as Manoxol Electri- ical Conductivity (micromhos) New River derived 104 0.053 0.065 5.7 42 0.72 0.1 7 302 66 7.7 1.4 12 60 0.25 5 0.07 610 Park well 3 0.135 0.045 0.1 26 0.26 0.2 3 264 46 7.3 0.7 500 Thames derived N. of River 207 0.060 0.091 4.2 41 1.20 0.1 15 272 68 7.6 1.9 10 64 0.25 4 0.11 570 BACTERIOLOGICAL RESULTS - YEARLY AVERAGES, 1965 BEFORE TREATMENT AFTER TREATMENT Number of samples Agar plate count per ml. Conform count Escherichia coil count Number of samples Agar plate count per ml. Coliform count Escherichia coil count 20-24 hours at 37°C 3 days at 22°C Per cent samples negative in 100 ml. Count per 100 ml. Per cent samples negative in 100 ml. Count per 100 ml. 20-24 hours at 37°C 3 days at 22°C Per cent samples negative in 100 ml. Per cent samples negative in 100 ml. New River derived 514 6.4 - 100.0 100.0 Park well 62 0.8 62 85.48 0.5 90.32 0.2 63 0.5 38 100.00 100.0 Thames derived N. of River 2046 7.4 99.95 100.0 14 Swimming Baths and Paddling Pools Specialist chemists in water examinations attached to the Scientific Branch of the Greater London Council act as agents for the Health Department of the London Borough of Haringey in the periodic bacteriological and chemical sampling of the waters in all public and school swimming baths and paddling pools within the Borough. Smoke Control Areas On the 1st April 1965, when the Council of the London Borough of Haringey assumed responsibility for the operation of the Clean Air Act, there were three smoke control orders which had been confirmed and were in the process of being brought into operation. These were the Tottenham (No.5) Order which related to an area of 603 acres containing 1,429 Corporation dwellings, 2,300 G.L.C. dwellings and 3,595 privately owned dwellings, and the Wood Green (Nos. 7 and 8) Orders which dealt with 82 acres containing 67Corporation dwellings and 1,325 privately owned houses. A fourth Order, the Hornsey (No.7) Order, which was awaiting approval by the Ministry of Housing and Local Government, was confirmed on the 21st May, 1965. This order covered an area of 262 acres containing 5,385 dwellings. There was heavy pressure on the Department in dealing with applications for grant in respect of the 14,000dwellings in the four areas and contractors were also finding difficulties in meeting the resultant demand for estimates and installations. In consequence, it was necessary for the Council to defer the operative dates of the Tottenham Order from the 1st July to the 1st November 1965 and the Hornsey Order from the 1st December 1965 to the 1st April 1966. Furnace Installations Fifteen notifications were received in accordance with Section 3 of the Clean Air Act 1956 of proposals to install furnaces and boiler plants. Chimney Heights Eleven notices were received under Section 10 of the Clean Air Act of proposals for new chimneys serving furnace installation. In four cases the proposed chimney heights were considered to be inadequate and revised heights were subsequently agreed. In five other cases advice was given to the Companies concerned before firm proposals were submitted to the Council. Investigation of Atmospheric Pollution At the beginning of the year there were eleven sites at which daily measurements of smoke and sulphur dioxide were taken. This number was reduced to ten in June as a consequence of closure of Bounds Green Secondary Modern School. Towards the end of the year discussions commenced with the Divisional Officer of the Ministry of Technology with a view to the reduction of the sites to a number giving greater ease of management whilst at the same time providing adequate information on the trend inthe Borough of sulphur dioxide and smoke pollution. Table A which follows shows the readings taken during the period April 1964 to March 1965. Standard deposit gauges to collect falling grit and dust are sited at Hornsey Town Hall and the Electricity Sub-station at Hampden Road, N.8. Table B below shows the extent of such deposits during 1965. 15 Table A Average Daily Reading of Smoke and Sulphur Dioxide In the Atmosphere, 1964/5 (Microgrammes per cubic metre) Month Hornsey Town Hall, N.8 North Hill, N.8 Fortis Green, N.10 Burghley Road, N.8 Lome House, N.4 Tottenham Tech. College, N.15 Devonshire Hill, N.17 Markfield School, N.15 Civic Centre, N.22. Bounds Green, N.22 Woodside School, N.22 (a) Smoke April, 1964 73 61 48 72 73 N 62 52 55 41 - May, ,, 39 39 28 39 38 N 29 29 31 29 - June, ,, 37 37 27 33 45 N 32 22 29 22 - July, ,, 27 30 21 23 24 23 22 21 21 24 20 August, ,, 13 36 15 N 34 N 25 25 23 24 N Sept. ,, 7 28 17 40 29 36 39 34 34 - 30 Oct, ,, 93 120 89 145 133 115 139 103 114 93 117 Nov. ,, 74 75 63 121 129 98 114 82 80 73 68 Dec. ,, 80 100 80 157 N 111 130 115 113 N 132 Jan. 1965 70 71 N 103 134 83 104 72 53 56 86 Feb. ,, 84 82 68 74 118 79 89 78 78 90 76 March, ,, 61 68 71 102 100 83 107 76 64 72 57 (b) Sulphur Dioxides April, 1964 162 213 149 164 207 207 158 192 174 189 - May, ,, 98 125 88 94 111 N 80 124 91 58 - June, ,, 121 153 107 117 133 N 83 112 176 65 - July, ,, 82 109 89 78 82 85 70 114 89 117 59 August, ,, 57 79 54 N 71 N 81 104 81 97 N Sept. ,, 79 103 75 83 83 87 79 121 80 - 72 Oct. ,, 219 204 124 220 204 299 235 275 221 285 194 Nov. ,, 223 230 109 234 238 192 228 275 181 228 180 Dec. ,, 239 202 98 198 233 210 240 284 200 N 218 Jan. 1965 252 241 N 220 245 189 215 235 158 179 253 Feb. ,, 257 220 167 234 245 208 186 240 154 238 171 March, ,, 240 227 192 262 246 226 257 190 257 259 190 NOTE: 'N' indicates that number of readings insufficient to give accurate average 16 Table B Monthly Deposit Gauge Readings, 1965 Month Hornsey Town Hall Site Hampden Road, N.8 Site Rainfall (Inches) Deposits - Tons per square mile Rainfall (inches) Deposits - Tons per square mile Dissolved Undissolved Total Dissolved Undissolved Total January 1.54 4.97 4.99 9.96 1.72 6.53 4.26 10.79 February 0.50 2.71 3.93 6.64 0.38 2.69 4.27 6.96 March 2.10 4.43 11.67 16.10 1.99 4.35 7.59 11.94 April 1.89 7.31 9.44 16.75 2.21 7.79 18.43 26.22 May 1.89 4.39 16.89 21.28 1.88 5.34 10.45 15.79 June 1.38 3.77 11.45 15.22 1.45 4.04 10.80 14.84 July 4.95 6.35 8.43 14.78 3.66 4.93 9.91 14.84 August 1.90 3.64 15.85 19.49 1.91 4.41 17.20 21.61 September 3.73 8.58 5.57 14.15 3.46 9.18 5.54 14.72 October 1.28 4.58 5.81 10.39 1.42 5.64 5.96 11.60 November 2.14 6.49 8.38 14.87 2.23 6.06 4.82 10.88 December 4.07 8.41 7.07 15.48 4.24 9.32 4.51 13.83 Total 27.37 65.63 109.48 176.11 26.55 70.28 103.74 174.02 Rodent Control An intensive programme of rodent control is in progress. It was necessary to carry out a full survey throughout the new 8orough to assess the extent of the problem, and a modern technique which requires three visits at intervals of seven days each, was used. Of the 3,386 known soil sewer manholes within the Borough 2,721 (slightly over 80%) were treated, and the results obtained showed that the infestation was much greater in the eastern part of the Borough where drains are usually older and more shallow. This exercise was followed by a further treatment using a different technique and a different type of poison. The success of this system cannot be assessed until the work has been continuously in operation for two or more years. Rodent infestation also occurs on the surface in sporadic outbreaks; these are treated promptly and efforts are made to ascertain the cause of the outbreaks. A large controlled tip for refuse disposal is situated in the central part of the Borough. This was formerly treated against rodent infestation by a firm of contractors but the work is now undertaken by the Department's own staff. The following is a summary of premises treated for rodent infestation in 1965:- 1. Houses 1,438 2. Shops 73 3. Factories 74 4. School Canteens 43 5. Miscellaneous 66 6. Total charges for 2 - 5 above - £243.2s.0d 17 18 Details of sewer treatments are set out below:- RODENT CONTROL SEVIER TREATMENT - HARINGEY 1965 Area No. Total Manholes Baited Manholes 2nd Visit No take Part Complete 3rd Visit No take Part Complete Hornsey 1 East 458 330 277 38 15 303 22 5 Hornsey 2 Central 450 281 242 28 11 274 - 7 Hornsey 3 West 442 285 279 1 5 282 - 3 Hornsey 4 North 356 229 222 3 4 225 3 1 Wood Green 5 East 320 314 234 28 52 260 40 14 Wood Green 6 East 337 310 218 27 65 246 19 45 Tottenham 7 South 526 495 221 52) 115) 107 303 53) 97) 42 Tottenham 8 North 497 477 258 40) 72) 107 252 68) 98) 59 3386 2721 1951 404 366 2145 400 176 TOTAL SOIL SEWER MANHOLES IN BOROUGH 3386 TOTAL SOIL SEWER MANHOLES BAITED 2721 (80.2%) 1st Revisit (after 7 days) No Take 1951 (71.6%) Partial take 404 (14.8%) Complete take 366 (13.6%) 2nd Revisit (after further 7 days) No take 2145 (78.8%) Partial take 400 (14.7%) Complete take 176 ( 6.5%) Insect Pests The Department gives free assistance to householders in securing the elimination of insect pests. Non-domestic premises are also treated on request but a charge is made to cover the cost of the service. The following is a summary of treatment carried out in 1965:- Premises Treated Insect Pest Houses Other Premises Ants 39 4 Beetles and Cockroaches 93 14 Bugs 87 7 Fleas 29 - Flies and Bluebottles 10 2 Wasps 296 9 Others 17 - 571 36 Mortuary From the 1st April 1965 the modern Public Mortuary situated at Myddleton Road, Hornsey, N.8. has been used for the reception of bodies for the whole of the Borough. Prior to the 1st April bodies from Tottenham and Wood Green were taken to the Prince of Wales's Hospital Mortuary. During 1965, 277 bodies were received into Hornsey mortuary and post-mortem examination was made in 272 cases. Noise Nuisance A number of complaints were investigated of disturbance arising from noise which was usually generated in factories in close proximity to residential premises, of which the following is a typical instance:- Following complaints from a resident of noise from a nearby factory measurements were made in a cottage opposite the factory, a microphone being placed in a front first floor room with the casement window open 6". Recordings were made at hourly intervals from 8 p.m. to 5 a.m. inclusive. These recordings were subsequently analysed into third octaves and a measurement in A-weighted decibels (dBA)taken when the sound level was fairly steady. The sound level inside the room with the window slightly open varied from 56-60 dBA during the two hours between8 and 10 p.m., between 52-56 dBA between 10 p.m. and midnight, and 50-52 dBA between midnight and 5 a.m. The frequency distribution of the noise was fairly consistent at all hours and tended to be predominantly low frequency sound. There were, however, marked peaks in the noise spectrum at the third octave frequencies centred on 160 and 315 cycles per second, the peak at 315 c.p.s. appeared to die away between 10 and 11 p.m. while that at 160c.p.s. remained very constant throughout the night. The levels measured in A-weighted decibels were much above the 35 dBA recommended by the Wilson Committee for maximum internal levels at night in urban dwellings. The Company concerned were informed of the findings and with the aid of tape recordings and tabulation analysis figures it was possible to trace the machines which were the major source of the noise and recommendations were madeas to what mechanical measures could be taken to bring about a reduction in the noise to reasonable limits. 19 20 Inspections carried out by Public Health Inspectors FIRST RE-INSPECTION Statutory Nuisance 3773 3319 Drainage 830 47 Drain Tests 145 17 Surface Water Pollution 39 29 Vermin and Pests 170 12 Rodents 211 68 Accumulation of Refuse 121 11 Smoke Observations 77 6 Smoke Control 4866 1 Noise 123 18 Disrepair Certificates 24 11 Housing Surveys 1479 218 Multiple Occupation 1819 592 Overcrowding 35 21 Other inspections under Housing Act 111 239 Mortgage Advances 19 - Improvement Grants 1 - Infectious Disease 395 46 Food Poisoning 84 10 Factories with Mechanical Power 62 4 Factories without Mechanical Power 2 - Outworkers 27 - Offices General Inspection 285 69 Offices and other visits 153 12 Bakehouses 53 8 Bakers and Flour Confectioners 30 2 Butchers 114 7 Canteens and Kitchens 25 6 Confectioners - Sugar 46 3 Fishmongers 90 8 Fried Fish Shops 42 4 Greengrocers 87 14 Grocers 269 23 Hawkers of Food 24 1 Prepared Food Premises 3 - Public Houses and Off Licences 41 2 Restaurants and Cafes 224 27 Slaughterhouses 441 10 Other Food Premises 28 1 Street Traders 82 - Food Sampling 154 5 Ice Cream Sampling 14 - Mi Ik Sampl ing 12 - Surrender of Unsound Food 184 7 Investigation of Food Complaints 163 15 Bacteriological examination of Food 110 - Hairdressers 9 - Old People's Welfare 18 - Pet Animals Act 4 - Places of Public Entertainment - - Other visits 2969 99 No access 2204 8 Defects Remedied Drains reconstructed 22 Drains repaired 134 Drains cleared 57 W.C. Cisterns repaired or renewed 106 W.C. Pans renewed 50 W.C. Pans Cleansed 11 Waste pipes repaired or renewed 87 Rain water pipes repaired or renewed 127 Roofs repaired or renewed 473 Eaves gutters repaired or renewed 166 Drinking water cisterns renewed 4 Drinking water cisterns covered 5 Water service pipes repaired 27 Water supply reinstated 13 Yards repaired or reconstructed 41 Sinks renewed or provided 22 Floors repaired or renewed 218 Floors ventilated 13 Dampness remedied 434 Window frames and sashes repaired, renewed or painted 296 Coppers repaired, renewed or provided 2 Fireplaces, stoves and ovens repaired or renewed 31 Flues and chimney stacks repaired 27 Brickwork of walls repaired and walls rebuilt 61 Ventilated food stores provided 30 Rooms cleansed 5 Staircases, passages and landings cleansed 10 Staircases, balconies and steps repaired or renewed 45 Noxious accumulations removed 112 Nuisances arising from animals abated 9 Miscellaneous defects remedied 868 Statutory Notices Served Housing Act 1957 Section 9 (Repairs) 8 Section 78 (Overcrowding) 12 Housing Act 1961 (Houses in Multiple Occupation) Section 15 (Amenities) 17 Section 16 (Escape in case of fire) 7 Section 19 (Limitation of number of occupants) 12 21 Statutory Notices Served (Contd.) Public Health Act 1936 Section 39 (Drainage) 26 Section 45 (Repair of W.Cs) 10 Section 79 (Accumulations of refuse) 11 Section 92/93 (Statutory nuisances) 273 Public Health Act 1961 Section 17 Drainage) 79 Tottenham Corporation Act 1952 Section 36 (Drainage) 15 Section 43 (Urgent Repairs) 125 Work executed by the Council Work carried out in default of or by agreement with the owners during 1965:- Housing Act 1957 Section 9 (Repairs) 2 premises Housing Act 1961 Section 16 (Escape in case of fire) 1 premise Public Health Act 1936 Section 39 (Drainage) 3 premises Section 45 (Repair of W.Cs) 2 premises Section 79 (Removal of refuse accumulation) 8 premises Section 92 and 275 (Repairs) 1 premise Public Health Act 1961 Section 22 (Drainage) 25 premises Section 17 (Drainage) 23 premises Tottenham Corporation Act 1952 Section 36 (Drainage) 4 premises Section 43 (Emergency Repairs) 38 premises Rag Flock and Other Filling Materials Act 1951 There are no establishments licensed for the manufacture of rag flock, but 25 premises are registered for the use of filling materials. Abatement of Statutory Nuisances 3,773visits were made to investigate complaints and on 1,111 occasions it was found that conditions existed which warranted action under Part III of the Public Health Act 1936 to secure the abatement of statutory nuisances, most of which related to defects in dwellings. It was usually possible to secure remedial action by informal procedure but in 273 instances it was necessary to serve statutory notices. Diseases of Animals Act 1950 The Council is the responsible local authority under the Diseases of Animals Act. Arrangements have been made for full co-operation with the Divisional Veterinary Officer, Ministry of Agriculture, Fisheries and Food, Hertford, and plans have been made to deal with any emergency which may arise. 22 Pet Shops and Animal Boarding Establishments 24 premises are licensed as pet shops and one licence was issued in respect of an animal boarding establishment. The premises were inspected by the public health inspectors, and the CounciI have arranged for any necessary veterinary supervision of the premises and animals to be carried out by Mr. F.G. Buxton, F.R.C.V.S. HOUSING Clearance of Areas of Unfit Houses The Health Department is responsible for the preparation and submission of reports in connection with the closure and demolition of houses which are no longer capable of being utilised as living accommodation. For this purpose it is essential to keep under surveillance every occupied dwelling house within the Borough and in particular all old houses which are nearing the end of their useful life. During the year information was collected about all known properties, both individually and by area, regarded as being unfit for habitation. After survey, the entent of the necessary demolition and replacement of houses was tabulated and the areas were recorded and defined on a map. The suggested clearance areas were listed in order of degree of unfitness and a programme of clearance divided into 2-year, 5-year and 10-year periods was drawn up for approval by the Council. This programme requires the demolition of approximately 3,400 dwelling houses and the re-housing of approximately 4,340 families. Details of areas which are already the subject of Clearance and Compulsory Purchase Order at the end of the year are given below. 1. Areas confirmed before 1st April 1965 not yet demolished Church Road/Kings Road, N.17 195 houses - 239 families Tewkesbury Road/Seven Sisters Road, N.15 92" - 121" Milton Road/Willow Walk, N.15 77 " - 85" St. Mary's Road, N.8 128" - 235" Wood Green (Acacia Road, etc.), N.22 61" - 67" 2. Areas confirmed during 1965 Park Lane/Waverley Road, N.17 152 houses - 244 families Culvert Road/Woodvilie Road, N.15 63" - 94" Clyde Road/Elizabeth Place, N.15 94" - 109" Osborne Grove, N.4 18" - 30" 3. Clearance Areas represented during 1965 Northumberland Park/Willoughby Park Road/West Road, N.17 41 houses - 95 families Hornsey Vale, N.8 147" - 113" 4. Area of Unfit Houses acquired for demolition during 1965 Tottenham Lane/Church Path/Ada Cottage, N.8 15 houses - 16 families Public Inquiries by the Ministry of Housing and Local Government were held during the year in respect of Compulsory Purchase Orders affecting the Culvert Road/Woodvilie Road Area and the Clyde Road/ Elizabeth Place Area. It will be appreciated from the above lists that there are many sub-standard houses which are the subject of Compulsory Purchase Orders and in which the occupiers must continue to exist until new accommodation becomes available. These houses, through lack of maintenance, deteriorate rapidly and the stage can be reached where particular houses may become either a danger to the occupants or dilapidated to an intolerable degree. In such cases the Housing Department is asked to carry out or expedite temporary repairs or re-housing. 23 With a view to facilitating the preparation of clearance programmes in the future and in order to consider the condition of houses and areas comprehensively, a map of the Borough is being prepared showing areas or groups of houses according to life expectancy taking into account age and condition. This will be compiled over a period of time so as to assess as accurately as possible the comparative fitness of properties in the various streets and districts. Individual Unfit Houses The following seven privately owned properties were the subject of Closing Orders made during the year:- 4 Ipplepen Road, N.15 35 Woodstock Road, N.4 4 Russell Road, N.15 32 Daleview Road, N.15 85 St. James Lane, N.10 171 Northumberland Park, N.17 53 Western Road, N.22 A Closing Order on part of the basement flat at 27 Pemberton Road, N.4. was determined following completion of all work necessary to meet the requirements of Underground Rooms Regulations. Purchase in Advance of Council's Requirements During the year over 150 houses were inspected at the request of the Valuation Officer where these have been offered to the Council in advance of area Compulsory Purchase Order schemes. Uplands Road Improvement Area This area, which comprises 93 houses, was declared an Improvement Area by the Council on the 26th July, 1965. By the end of the year the Committee had considered representations made as a result of the Council's proposals in respect of six dwellings and progressive steps were being taken to deal with the remainder of the tenanted dwellings (approximately 30 in number) which were capable of improvement. In November, ahouse in the road fell vacant and was offered for sale. Immediate steps were taken by the Council to negotiate for its purchase with a view to improving the premises and using it as a Demonstration House. This area is being used as a 'proving ground' to gain official experience in this completely new field and it is hoped that in the near future it will be possible to declare further improvement areas in other parts of the Borough. Improvement of Houses not in Improvement Areas Three requests have been received from tenants for the Council to take action to secure that their houses are provided with amenities to the full standard. In each case the landlord has been notified and in one of the houses the improvements are in hand. Discussion with the landlords are continuing in the other two cases. 7Houses in Multiple Occupation The new Borough was faced with the choice of three different standards of amenity under Section 15of the Housing Act 1961. The following standards have been derived from the best in the three boroughs. 1. Natural and Artificial Lighting Every habitable room being a room used or suitable for use for living or sleeping purposes, shall be provided with one or more windows in the external walls of the room and having an aggregate area clear of the window frame amounting to not less than one-tenth of the area of the floor of the room. Every kitchen, scullery, bathroom, water closet, staircase, landing, corridor and passage shall, where practicable, be provided with one or more windows in the external walls and adequate to provide a reasonable degree of natural lighting therefor. 24 Every habitable room and every kitchen, scullery, bathroom, water closet, staircase, landing, corridor and passage shall be provided with adequate means of artificial lighting which shall be availableduring the hours of darkness and the means of operating such lighting shall be readily available to all persons properly within the said habitable room, kitchen, scullery, bathroom, water closet, staircase, landing, corridor and passage. 2. Ventilation Every habitable room shall be provided with one or more windows which can be opened directly into the external air to an extent equivalent in aggregate area to not less than one-twentieth of the floor area of the room. Every kitchen, scullery, bathroom, water closet, staircase, landing, corridor and passage shall be provided as far as practicable with one or more windows which can be opened directly into the external airsufficient toprovide reasonably adequate natural ventilation and where the provision of such reasonable ventilation by means of a window or windows is not practicable there shall be provided adequate permanent ventilation by other approved means. 3. Water supply A sufficient supply of wholesome water for domestic purposes shall be provided on the storey or one of the storeys in which the room or rooms in separate occupation of each family occupying the house is situated. 4. Personal Washing Facilities Inconnectionwitheachroomorrooms occupied as a separate dwelling there shall be provided a hot and cold water supply at awash-hand basin or at a sink and also a fixed bath or shower in a bathroom with hot and cold water supply. Where it is impracticable for the bathroom to be within the room or rooms occupied as a separate dwelling it shall be in such a position with in the curtilage of the building as to be readily accessible from such room or rooms. In such cases the provision shall be in the ratio of one fixed bath or shower to ten persons irrespective of age. 5. Drainage and Sanitary Conveniences The number of water closets to be provided in a house in multiple occupation shall be as follows:- (a) one water closet for every four habitable rooms. (b) one water closet for every eight persons (irrespective of age.) and the number of water closets provided shall be adequate to meet both the conditions of (a) and (b), providing that not more than one water closet shall be required for any one family. The water closets shall be readily accessible to the persons by whom they are intended for use and adequate provision shall be deemed to have been provided only if at least one water closet is situated not more than one floor distant from any room or rooms occupied as a separate dwelling. 6. Facilities for the storage, preparation and cooking of food, and for the disposal of waste water Adequate facilities for the storage, preparation and cooking of food and for the disposal of waste water shall be provided for any room or rooms occupied as a separate dwelling and such facilities shall include a food store, utility services and a sink properly connected to the drainage system and provided with a constant supply of wholesome water at the sink. Such facilities shall not be installed on any common landing, passage or staircase. Where such facilities are provided within a readily accessible communal kitchen there shall be a separate food store for each family and sinks at the rate of not less than one sink for every eight persons. 7. Installations for space heating or for the use of space heating appliances Within every room used or suitable for use for living and/or sleeping purposes there shall be provided: (a) adequate fixed space heating convection appliances properly connected to and served by a suitable hot water or other heat transfer medium; or (b) a proper hearth and chimney opening and flue suitable for the reception of a proper and adequate space heating solid fuel, gas or liquid fuel appliance, and where the fuel to be used is gas an adequate proper convenient gas supply; or (c) adequate and properly positioned number of electric power points. 25 The adoption of this standard has meant that houses in both Hornsey and Tottenham which had in the past been inspected and Drought up to the standard then in operation in those boroughs, may be lacking in some amenities of the new code. Most important is that provision of baths and hot water is now required. Since April, the inspectors have completely inspected 521 houses. Of these 193 were found to be satisfactory. 56 cases of penal over crowding were found, but it was only necessary to serve formal notices under Section 78 of the Housing Act 1959 in 14 of these cases. Action to deal with other matters in houses in multiple occupation during this time, e.g. nuisances under the Public Health Act 1936, choked drains, etc., necessitated the service of 197 other notices. Progress is being made with the provision of additional amenities, but each case requires individual assessment and very often protracted negotiation and correspondence with owners, agents, and sometimes principal tenants where they are responsible for the multiple occupation of a house. House to house inspections could be carried out in many areas if the staff were available, but this work has had to be confined to a few roads and is constantly interrupted by the inspectors concerned having to deal with serious conditions in other properties. One of the problems associated with this work arises from the physical limitations of the houses whereby it may not be possible to install a bath and/or W.C. in a house having regard to its occupation at the time of inspection. A number of occasions have arisen where this has been found to be impossible and the procedure of making a "Direction" under Section 19 of the Housing Act 1961 to deal with the overoccupation of the house in relation to the amenities existing by specifying the number of people who may live there, has been employed in some cases. "Nil Directions" in respect of a part of a house have also been used in order to ensure that when the particular part of the house becomes vacant it shall remain vacant until the facilities necessary to bring the house up to standard can be installed in that particular room or rooms; e.g. the provision of extra baths or W.Cs. The Fire Prevention Officer has been consulted in regard to the requirements of Section 16 of the Housing Act 1961 (escape in case of fire). The normal procedure has been to arrange a meeting at the premises with the owner and the public health inspector so that there is no doubt as to the recommendation put forward by the Fire Officer and suggested alternatives can be discussed on site. Informal action in pointing out to owners their obligations under Section 12 of the Housing Act 1961 relating to Management Orders has frequently resulted in improved conditions and it has only been necessary to make Management Orders in two cases. Although notices of the intention to make such Orders were served in a number of other cases, work was carried out and conditions improved sufficiently between the service of the notices and the date of the Committee meeting to obviate the need for Orders. Procedure under this section is somewhat lengthy and every effort is made to get work done by negotiation in the first instance. 26 HOUSES IN MULTIPLE OCCUPATION Return for 9 months to 31.12.65 Number of houses completely inspected 521 representing approximately 2,100 lettings. Number of houses found satisfactory 193 Number of houses where informal notices relative to S15/S16 sent 225 Number of houses where discussions are in progress 100 approximately Number of houses where Fire Prevention Officer's recommendation sent 9 Number of cases of penal overcrowding 56 Number of formal Notices sent under S.15 Housing Act 1961 10 Number of formal Notices sent under S.16 Housing Act 1961 2 Number of formal Notices sent under S.78 Housing Act 1957 14 Other notices served (Public Health Acts & Housing Act Sec.9) 197 Further visits in connection with multiple occupation 613  Complete works Repairs W.Cs provided 25 External - Major 12 Baths " 5 Minor 64 Sinks " 34 Internal - Major 18 Water heaters provided 66 Minor 161 Cooking facilities provided 15 Overcrowding abated:- 46 Food stores provided 37 penal 28 Space Heating " 13 non-penal, 18 Fire escape 6 Certificate of Disrepair The following statement gives details of application for Certificates under the Rent Act 1957 which were dealt with during 1965:- No. of applications for Certificates of Disrepair 19 Decision on applications:- Disapproved 1 Approved for some but not all defects listed 8 Approved for all defects listed 10 No. of landlords' undertakings accepted 11 No. of Certificates issued 7 No. of Applications for Cancellation of Certificates 16 No. of objections to cancellation by tenants 2 No. of Certificates cancelled 15 No. of Certificates issued as to remedying of defects undertaken by landlord 6 All defects remedied 5 Some defects remedied No defects remedied 1 Housing Applications - Assessment on Medical Grounds Where housing applicants submit medical evidence supporting their requests for rehousing in Corporation dwellings, their case is considered by a senior medical officer of the Health Department for medical assessment. In the last nine months of 1965, 302 cases were investigated, and recommendations made upon medical priorities. Until the end of October every case was visited, but the increased numbers that required assessment eventually made this impossible. If possible, recommendations are now made on the basis of the medical evidence submitted and the information regarding the existing accommodation on the Housing Department's files. Where, however, there are special circumstances a visit to the home is still made. Month Total Number District Source of Request Hornsey Tottenham Wood Green Housing Department Hospital, G.P. or Clinic Tenant, Health Visitor, P.H.I. April 20 8 11 1 13 1 6 May 15 2 12 1 6 1 8 June 6 - 6 - 5 - 1 July 13 3 9 1 3 7 3 August 38 17 16 5 31 4 3 September 57 34 17 6 47 7 3 October 56 25 22 9 47 4 5 November 51 22 18 11 41 3 7 December 46 21 19 6 34 7 5 TOTALS 302 132 130 40 227 34 41 208 cases were visited before assessment and revisits made in 35 instances. 27 FOOD HYGIENE The regular inspection in the light of the Food Hygiene Regulations 1960 of premises used for the preparation, storage and sale of food intended for human consumption is an important aspect of the work of the Department. The number of food businesses being carried on by persons of other than British nationality appears to be increasing and the difficulties of communication call for regular and patient work by the inspector. During the year 76 summonses were issued in respect of food hygiene offences in 14 premises. Fines and costs imposed totalled £388. The total number of food shops as at 31st December 1965 was as follows:- Bakers 103 Butchers 177 Cafes and dining rooms 230 Confectioners 542 Fishmongers 83 Fruiterers and greengrocers 239 Grocers 480 Off Licences and public houses 257 Registered Food Premises At the 31st December 1965 the following premises were registered under Section 16 of the Food and Drugs Act 1955:- Sale of ice cream 797 Manfr. and sale of ice cream 16 Storage of ice cream 1 Cooking of hams and other meat 62 Fish frying 55 Fish curing (smoking) 3 Sausage manufacturers 103 Preparation of 'Hot Dogs' 1 Preparation of jellied eels 3 Shellfish 2 Prepared Foods 13 Pickle making 1 Pickling meat 5 Total 1062 In addition the following classes of food hawkers and their storage premises are registered under Section 11 of the Middlesex County Council Act 1950:- Articles No. of Hawkers registered No. of storage premises Fruit and vegetables 156 107 Shellfish 20 8 Fish 9 5 Ice Cream 23 2 Light Refreshments 15 4 Peanuts 3 2 Eggs 3 - Groceries 4 2 Confectionery 1 1 Totals 234 131 28 Milk and Dairies Regulations During the year eleven further applications for registration as milk distributors were dealt with. No applications were received in respect of dairies. Of the eleven new registrations, four were for new premises and the other seven were in respect of change of proprietorship of previously registered premises. No. of distributors 212 No. of dairies 8 Meat Inspection There are two slaughterhouses and one knackers yard in the Borough. One slaughterhouse, which deals mainly with the slaughter of horses and cows, is supervised by one of the public health inspectors. The other slaughterhouse undertakes regular daily slaughtering of pigs, goats and sheep, and in order to ensure inspection of every animal slaughtered, a rota of fourteen inspectors is arranged to cover three sessions each day for six days in each week. Summary of Carcases inspected 1965 Horses Cows Calves Sheep and Lambs Pigs excl. Sows Sows Goats Number killed 93 23 419 2,320 12,737 3,363 35 Number inspected 93 23 419 2,320 12,737 3,363 35 All Diseases except Tuberculosis and Cysticercosis Whole carcases condemned 2 8 1 29 6 1 - Carcases of which some part of organ was condemned 35 7 5 - 2,089 336 2 Percentage of number inspected affected with disease other than tuberculosis and cysticercosis 39.78 65.22 1.43 1.25 16.45 10.02 5.71 Tuberculosis only Whole carcases condemned - - - - 3 - - Carcases of which some part or organ was condemned . . . _ 141 125 _ Percentage of number inspected affected with Tuberculosis - - - - 1.13 3.72 - (Note: No case of cysticercosis was reported during the year). Food: Fitness for Human Consumption Regular samples are taken of cooked meats for bacteriological examination by the Central Public Health Laboratory at Colindale. Of 119 samples of sliced meats and sausages, 67 warranted further investigation of the methods of storage and serving. A sample of full-cream milk food and 21 specimens of frozen egg yolk all gave satisfactory results. Results which showed above-average bacterial counts were reported to the proprietors of the premises concerned and advice given for improvements in equipment or handling arrangements which could not be enforced by law. Instances of this were the purchase of a new slicing machine to be used exclusively for cooked meats, separate from the machine used for bacon slicing. Specimens of food were submitted to the Department by purchasers who considered the foodstuff unfit for human consumption for various reasons. 29 All such complaints were thoroughly investigated, the shopkeeper and manufacturers interviewed and in a number of instances specimens submitted either to the Public Analyst or the Central Public Health Laboratory. Where circumstances justified it legal proceedings were instituted. Food complaints received in 1965 related to the following matters:- Mould growth in milk Foreign bodies in bread (6 cases) Mould growth in meat pies (2 cases) Insect in jam Cigarette end in pack of bacon Cigarette end in sausage Unsound eggs; and Unsound icing mix Legal proceedings were taken in respect of fourteen offences and resulting fines and costs totalled £314. Unsound Food Surrendered or Condemned Tons Cwts libs Meat 1 1 4 Cooked meat and meat products 6 Canned meats - 15 12 Fish - - 80 Fruit and vegetables - 3 34 Tinned food other than meat 2 9 41 Total 4 9 65 The Liquid Egg (Pasteurisation) Regulations 1965 These regulations apply to liquid whole eggs, i.e. mixture of yolk and albumen. There is no pasteurising plant in the Borough but consignments from abroad of frozen pasteurised separated egg albumen or egg yolks are sent into cold stores which are supervised by the Department. As the AlphaAmylase test cannot be applied satisfactorily to separated yolk or albumen, random samples are taken for bacteriological examination. All tests proved satisfactory. Milk Supplies - Brucella Abortus No samples of milk were submitted for examination for Brucella Abortus during the year 1965. Arrangements have now been made for two samples to be submitted monthly to the Central Public Health Laboratory for this purpose. Food Sampling The Council have appointed Mr. W.B. Chapman, B.Sc., F.R.I.C. of the Scientific Division of the Greater London Council as the Public Analyst for Haringey. Systematic sampling was commenced when the sampling officer was appointed in September, but a limited number of specimens were submitted to the Public Analyst before that date. These related principally to foodstuffs which had been the subject of complaints and upon which comment has been made in a previous paragraph. The Analyst makes comprehensive reports on samples submitted, and includes comment when the foodstuff as packaged fails to meet the Statutory standards. Milk is checked for chemical and bacteriological quality and for the presence of antibiotics. The analyst has been asked to carry out such tests from time to time as may be reasonable to ensure the absence from the milk samples of insecticidal residues or radiation fall-out. He also comments on misleading labels and any unsuitable form of packaging. Manufacturers have been given details of the Analyst's findings and comments and in all cases have taken steps to rectify deficiencies reported. 30 Food Samples Article No. of Samples Provided Unsatisfactory Composition Labelling Angelica 2 - - Butter 4 - - Cheese 7 - - Cherries (Glace) 6 - 2 Coffee (instant) 6 - 2 Colouring Agents 7 - - Cornflour 2 - - Custard Powder 3 - - Drugs 24 - - Flour 6 - - Fruit (dried) 5 - - Jellies 6 - 2 Milk 39 3 - Milk (tinned) 3 - - Mincemeat 9 - - Pastes (Potted) 14 - - Pastry 5 - - Peas (Tinned) 6 - - Salmon (Tinned) 4 - 1 Sausages 8 - - Spices and herbs 11 2 - Suet 7 3 - Tomato Puree (Tinned) 4 2 - 188 10 7 The following are details of the unsatisfactory samples:- Milk. One sample was low in fat content 2.8% compared with a minimum presumptive standard of 3.0%. Two other samples were deficient in solids not fat 8.4% as against a minimum presumptive standard of 8.5%. None of the samples was bottled in the Borough and as the deficiencies could result from natural causes the Health Departments of the areas where the bottling took place were notified and invited to continue the investigations. Spice and Herbs. Two samples of ground nutmeg were found to be deficient in volatile oils. It was considered that the most likely cause of this was the method of packaging and the manufacturers were so advised. They have now commenced to pack this foodstuff in non-absorbent containers. Suet. Three samples of shredded suet were unsatisfactory by reason of slight rancidity. This matter was investigated in conjunction with the suppliers with a view to the introduction of a satisfactory system of storage and distribution so as to ensure proper stock rotation and the removal from sale of outdated goods. Tomato Puree (tinned). Two samples of tinned tomato puree were found to contain an excessive quantity of tin; 400 and 350 parts per million respectively. The recommended maximum content is 250 p.p.m. As these two tins were imported from Italy the matter has been reported to the Ministry of Agriculture, Fisheries and Food. Further samples are being taken and investigations are continuing. 31 The following labelling faults were brought to the notice of the packers who undertook to remedy the matters:- Glace Cherries (2 samples) - labels did not give name or list of ingredients Instant Coffee (2 samples)- described as "100%'pure coffee" should be "soluble solids of coffee" Jellies (2 samples) - weight of jelly less than that given on labels Tinned Salmon (1 sample) - ambiguously described as "Red Cohoe Salmon" This is a medium red salmon. Offices, Shops and Hallway Premises Act 1963 Systematic inspections are being carried out to ensure that the requirements of the Act are observed. In the majority of cases the attention of the persons responsible is drawn informally to matters in which the premises do not comply with the Act. In view of the considerable number of premises affected, it will be sometime before all are visited. It will be realised that the premises vary considerably and uniformity of administration by different local authorities is secured by Iiaison with the Deputy Superintending Inspector of Factories appointed under Section 7. ln Circular 9(1) the Ministry of Labour asked that reports should include comments on the standards of lighting found in offices and shops inspected during the last three months of 1965. Whilst it was not possible to make specific light measurements in the premises inspected the following general comments can be made on the conditions found:- 1. The majority of inspections were carried out during the hours of daylight. The general impression was that with supplementary artificial lighting working conditions were reasonable in workrooms but in some instances the lighting was poor in the passages and staircases. 2. No specific standards of lighting, in terms of lumens, have been recommended in advice to occupiers. 3. No instances of excessive glare have been observed. Registrations and General Inspections in 1965 Class of Premises Number of premises registered during 1965 Number of registered premises at end of year Number of registered premises receiving a general inspection in 1965 Offices 30 499 27 Retail shops 76 1,292 218 Wholesale shops, warehouses 14 75 10 Catering establishments open to the public, canteens 17 135 30 Fuel storage depots - 4 - Totals 137 2,005 285 32 Persons employed In Registered Premises Class of Workplace No. Offices 6,995 Retail Shops 7,062 Wholesale department, warehouses 1,501 Catering establishments open to the public 1,095 Canteens 207 Fuel storage depots 50 TOTAL 16,910 Males 7,861 Females 9,049 TOTAL NUMBER OF VISITS OF ALL KINDS BY INSPECTORS TO REGISTERED PREMISES UNDER THE ACT - 519 NOTE: "General Inspection" means any inspection of premises to which the Act applies which is undertaken for the purpose of ascertaining whether all the relevant provisions of the Act and instruments thereunder are complied with as regards those premises; and "registered premises" means any premises in respect of which a registration notice under Section 49 of the Act has been received. Analysis of Contraventions found Section Type of Contravention No. found Section Type of Contravention No. found 4 Cleanliness 60 14 Seats (sedentary workers) 1 5 Overcrowding 3 15 Eating facilities 3 6 Temperature and thermometers 119 16 Floors, passage and stairs 32 7 Ventilation 24 17 Fencing exposed parts machinery 3 8 Lighting 15 18 Protection of young persons from 9 Sanitary conveniences 50 dangerous machinery - 10 Washing facilities 65 19 Training of young persons 11 Supply of drinking water 3 working at dangerous machinery - 12 Clothing accommodation 5 23 Prohibition of heavy work - 13 Sitting facilities 3 24 First aid general provisions 93 Total 479 Reported Accidents Work Place Number reported Total No. Investigated Action taken on cases investigated Prosecution Formal warning Informal warning No action Offices 5 2 - 1 - 1 Retail shops 35 15 - - 3 12 Wholesale shops, Warehouses 19 13 - 1 2 10 Catering establishments open to public, canteens 4 3 . _ _ 3 TOTALS 63 33 - 2 5 26 33 Analysis of Reported Accidents Offices Retail Shops Wholesale shops, Warehouse Catering establishments open to public, canteens Fuel storage depots Machinery 1 - 1 - - Transport 1 1 5 - - Falls of persons 1 15 4 1 - Stepping on or striking against object or person - 1 - 1 - Handling goods - 5 5 1 - Struck by falling object - 5 1 - - Fires and explosions - 2 - 1 - Use of hand tools - 2 2 - - Not otherwise specified 2 4 1 - - TOTALS 5 35 19 4 - Shops Act 1950 - 1965 A total of 1,886 shops were inspected during the year. The following contraventions were noted:General Sec.17 (2) Assistants weekly half holiday notice not displayed 161 Sec.32 (2) Record of hours of employment of young persons not displayed 72 Sec.32 (3) Abstract of provisions of employment of young persons not displayed 68 Closing Hours Sec. 2 (1) Failed to close at prescribed hour 6 Sec. 1 (1) (Early closing day) failed to close at 1 p.m. 5 Sec. 1 (2) Failed to exhibit early closing day notice 12 Sec.13 (1) Failed to exhibit exempted trade notice 21 Sunday Trading Sec.22 (3) Failed to keep record of hours of employment 3 Sec.57 Failed to exhibit Sunday Trading Notice 11 Registered Jewish Traders 7 Orthodox Jewish Traders were registered under Section 53; no infringements of the conditions were noted. Middlesex County Council Act 1944 Street Trading 49 Street Trading sites were I icensed; verbal warnings were given in a number of cases for obstructing the highway or footpath. Factories There is some scatter of light industry throughout the Borough but most of the factories are concentrated in the eastern part, particularly in the vicinity of the River Lea. Sanitary accommodation in factories requires constant surveillance and the inspection of other environmental conditions in factories without mechanical power is also the responsibility of the public health inspector. 34 Good co-operation is maintained between the Department and H.M. Inspector of Factories in matters of mutual interest. Premises No. on Register No. of Inspections Written Notices Occupier Prosecuted (i) Factories in which Sections 1, 2, 3, 4 and 6 are enforced by local authority 103 2 - - (ii) Factories not included in (i) in which Section 7 is enforced by local authority 1072 66 2 - (iii) Other premises in which Section 7 is enforced by local authority (excluding outworkers premises) 4 - - - TOTALS 1179 68 2 - Summary of Defects found in Factories Particulars Number of cases in which defects were found Found Remedied Referred to Factories Inspector Referred by Factories Inspector Want of cleanliness (S.1) 1 1 - 1 Overcrowding (S.2) - - - - Unreasonable temperature (S.3) - - - - Inadequate ventilation S.4) - - - - Ineffective drainage of floor (S.6) - - - - Sanitary conveniences (S.7) (a) Insufficient 2 2 - 1 (b) Unsuitable or defective 4 2 - 4 (c) Not separate for sexes - - - - Other offences against the Act (not including offences relating to outworkers) _ - . - TOTALS 7 5 - 6 Outworkers Visits were made by public health inspectors to the homes of persons notified to the Department as outworkers in accordance with the requirements of Section 133 of the Factories Act 1961. In no case was it found that work was being undertaken in unwholesome premises, and no employer was found to have defaulted in making the required returns. The following is a summary of the types of work undertaken by outworkers in the Borough:- 35 Wearing apparel 386 Household linen 2 Curtains and furniture hangings 5 Upholstery work 1 Umbrellas 2 Artificial flowers 12 Brush making 4 Cardboard boxes 41 Feather sorting 2 Boxing, carding of buttons 153 Christmas crackers and stockings 19 Lampshades 4_ 631 CARE OF MOTHERS AND YOUNG CHILDREN Notification of Births The following table shows the births notified during the year:- Live births (a) Domiciliary 897 (b) Hospital or Nursing Home 4,696 Still births (a) Domiciliary 3 (b) Hospital or Nursing Home 75 5,671 Ante-natal Clinics The numbers of patients attending ante-natal clinics at the eleven centres in the Borough has fluctuated slightly throughout the year but has shown no major changes. The main difference that has been noticed in 1965 as compared with previous years has followed the introduction of catchment area organisation by the Regional Hospital Boards. This has meant the hospitals have taken responsibility forfinding bedsfor patients who require institutional delivery living within defined areas. It has put an end to the bad old system under which some mothers had no definite booking right up to the onset of labour and were admitted to whatever bed was available through the Emergency Bed Service. All mothers who need hospital beds are now given a definite booking in early pregnancy and are no longer in a state of worry and anxiety in late pregnancy. Ante-natal work is done more in Hornsey clinics than in other parts of the Borough because of the unusual position of the Alexandra Maternity Home. All the ante-natal supervision of patients booked there has always been done in local authority clinics and this system continues although in other parts of the Borough, for patients booked in other hospitals, general practitioners are gradually taking over a greater proportion of the work. The catchment area scheme has had some disadvantages in connection with the Alexandra Maternity Home and has caused it to be underbooked and incompletely filled in some months. The area from which it could accept patients was increased, from Hornsey only, to include parts of Barnet, Camden and Islington and, to allow for more bookings from these areas, criteria for booking were tightened to allow only those expecting first babies or those whose social conditions would not permit home confinement to be admitted. The flow of patients from other areas has not been as expected, resulting in underbooking, but this is now improving and it is hoped that soon a complete solution will be found which will be fairer to all concered. 36 The following table give details of attendance at all clinics in the Borough:- Name of Clinic Number of sessions held Total attendances Average attendance per session A.N. P.N. Allison Hall 98 1818 84 19.4 Church Road 72 1211 53 17.5 Fort is Green 98 1884 72 19.9 Hornsey Town Hall 155 2634 127 17.8 Mildura Court 64 1446 67 23.6 Stroud Green 77 1482 55 19.9 The Chestnuts 141 1837 130 13.9 Lordship Lane 141 1079 103 8.4 Park Lane 103 1178 144 12.8 Gordon Road 77 1226 105 17.3 White Hart Lane 51 504 15 10.2 TOTALS 1077 16299 955 16.0 Midwives Ante-natal Clinics The following table shows the attendances made during the year:- Midwlves Clinics Number of sessions held Total number of attendances Average attendance per session Allison Hall 8 33 4.1 Fort is Green 21 92 4.4 Hornsey Town Hall 24 145 6.0 Mildura Court 3 17 5.7 Stroud Green 16 63 4.0 Chestnuts 50 167 3.3 Park Lane 48 229 4.8 Lordship Lane 10 50 5.0 Gordon Road 44 299 6.8 TOTALS 224 1095 4.9 Congenital Malformations Notifications of children born with a congenital abnormality are received from hospitals, clinics and domiciliary midwives, and details of these are passed to the Registrar General under the scheme which was started at the beginning of 1964. Names are not given as the purpose is simply to collect statistics. During the year 108cases were notified in Haringey. Report is made on place of birth of the child, whether live or still birth, whether single or multiple birth, age of mother and the number of previous live and still births born to the mother. Eight still births were notified with severe malformation and a number of other babies died In early life who had malformations incompatible with extra uterine life. Many of the malformations are of a relatively mild nature, e.g. extra digits which can probably be removed without ill effect, mild talipes which is amenable to early manipulative treatment, etc. All notifications are carefully scrutinised and children's names are added to the Observation or Handicapped Register to ensure that they are examined at the appropriate time and that treatment is given where required. 37 Mothercraft and Relaxation Classes Associated with ante-natal clinics the eleven centres offer mothercraft instruction and relaxation exercises to mothers. This is given by the health visitors and they find the mothers keenly interested and receptive to the talks and discussions. Midwives co-operate in most courses of instruction by demonstrating the analgesic machines used in labour. These classes are considered to be one of the more important branches of health education undertaken in the Borough. The following table shows attendances at Mothercraft clinics during the year:- Clinics Number of sessions held Total number of attendances Average attendance per session Allison Hall 26 78 3.0 Church Road 54 309 5.7 Fort is Green 47 448 9.5 Hornsey Town Hall 35 292 8.4 Mildura Court 45 232 5.2 Stroud Green 44 509 11.6 The Chestnuts 50 328 6.6 Lordship Lane 51 420 8.2 Park Lane 48 294 6.1 Gordon Road 19 137 7.2 White Hart Lane 26 137 5.3 TOTALS 445 3184 7.2 Infant Welfare Clinics These clinics are probably the best-known service provided by the Department, and continue to be very much appreciated by mothers with young babies. The following table gives attendances during the year at the various clinics:- Name of Centre Number of sessions held Total attendances Average attendance per session Number of cases seen by M.O. Number of cases referred elsewhere Allison Hall 155 6867 44.3 2113 - Church Road 208 4915 23.6 1685 33 Fort is Green 141 5258 37.3 1325 23 Hornsey Town Hall 155 7172 46.3 2591 42 Mildura Court 104 4690 45.1 1547 - Stroud Green 104 5558 53.4 1550 3 The Chestnuts 199 8369 42.1 2364 43 Lordship Lane 204 6447 31.6 1675 23 Park Lane 155 6035 38.9 1684 41 Somerset Road 151 4343 28.8 1407 15 Alexandra Park 52 3005 57.8 913 - Gordon Road 105 6144 58.5 2478 - White Hart Lane 153 7161 46.8 1591 45 TOTALS 1886 75964 40.3 22923 268 38 Toddlers Clinics These are separate sessions held for children between two and five years of age, attendances at which are normally arranged by appointment. The following table give details of attendances at the individual clinics:- Name of Centre Number of sessions held Total attendances Number of cases seen by M.O. Average attendances per session Allison Hall 28 565 540 20.2 Church Road 24 353 313 14.7 Fortis Green 32 388 388 12.1 Hornsey Town Hall 48 810 792 16.9 Mildura Court 50 784 630 15.7 Stroud Green 23 363 363 15.8 The Chestnuts 49 772 772 15.7 Lordship Lane 52 678 67-8 13.0 Park Lane 49 706 706 14.4 Somerset Road 51 506 506 9.9 White Hart Lane 19 244 244 12.8 TOTALS 425 6169 5932 14.5 Daily Guardian Scheme This voluntary scheme for registration and supervision by health visitors of mothers willing to mind one or two children is a most valuable addition to the day care of children. There are always some names to offer to those who are looking for a daily guardian; the main trouble is that they are not always in the right place and not at a convenient distance from the child's own home. Number of Daily Guardians on register 148 Number of Daily Guardians minding Children 79 Number of Children being minded 90 Total number of Children minded during the year 233 Total number of days minded 24924 Day Nurseries All four day nurseries are approved as training schools for student nursery nurses. The course of training is for two years. Park Lane, Stonecroft and Plevna have two new students each year, but because of the limited facilities only one student can be accommodated at White Hart Lane Nursery. Students are away from the nurseries at the Technical College on two days each week for theoretical training. Staff absences due to sickness lower the actual ratio of staff to children, to what at times must be considered a dangerously low level. Students or Inadequate number of staff may at times be left to supervise too high a proportion of children. The trend over recent years of children being admitted from broken homes or homes where there is only one parent, continues to be the main reason for admission. It is recognised that these children show more signs of emotional disturbance than the child with a normal home background and therefore need specialised treatment. Allchildrentaketimetoadjusttonewsurroundingsandneed varying amounts of individual attention. The maladjusted or partially-hearing child must of necessity receive special attention. There were 173 new admissions during the year. All these factors at times produce evidence of overstrain on the staff. The remedy may be that along with many other local health authorities, students should be considered as supernumerary, as well as the exclusion of the matron from the ratio of staff to children, as recommended in the Ministry of Health Circular. 39 The followina table shows the attendance at individual nurseries durina the vear:- Name of Nursery Number of approved places at end of year Number of chiIdren on register at end of year Total number of attendances Average dally attendance Under 2 2 - 5 Under 2 2 - 5 Under 2 2 - 5 Total Stonecroft 15 43 15 44 1692 8589 10281 41.6 Park Lane 20 30 16 32 3329 7115 10444 40.9 Plevna 20 30 8 38 1537 6553 8090 31.7 White Hart Lane 10 30 7 30 2156 6785 8941 35.0 TOTALS 65 133 46 144 8714 29042 37756 149.2 Private Day Nurseries and Registered Child Minders The following table gives comparative information concerning registered private day nurseries, child minders and play groups, in April 1965 and April 1966:- Nurseries taking children for the whole of the day Child Minders Play Groups Number Registered places Number Registered places Number Registered places April 1965 2 63 8 70 7 182 April 1966 2 63 9 74 12 260 New registrations April 1965 to April 1966 - - 1 4 5 78 Details of the new registrations are as under:- Child Minder - Mrs. V.M. Wilson, 29 Colless Road, N.15 - Receives four children Play Groups - Wood Green Pre-school Play Group Association, Trinity Church Hall, N.22. - Takes 16 children Mrs. D. McKie, 42 Ridge Road, N.8 - Takes 6 children Hornsey Integration Committee, St. Peter's Church Hall, Wightman Road, N.8. - Takes 20 children Mrs. J. Mathieson, 10 Stanhope Gardens, N.6 - Takes 12 children Hornsey Housebound Wives, St. Saviour's Church Hall, Alexandra Park Road, N.10 - Takes 24 children At early meetings of the Health and Welfare Committee, standards to be applied to the care of children during the day were agreed. It was decided that special standards should be agreed for play groups, these being open for a maximum of four hours in the day and providing no meals and no sleeping accommodation. Only children over the age of two years can be received in these circumstances. The most noticeable feature of the year has been the increase in the number of play groups. In many, the mothers participate in the organisation, either by taking turns to give voluntary help to the matron or by forming fund raising activities to supply new equipment and toys. The Council have contributed to the funds of the Hornsey Integration Committee's play group at St. Peter's Church Hall, Wightman Road, wherethe fees to parents are very small with a view toencouraging attendance by non-English speaking children, to help them to be ready for school at the age of five years. 40 Distribution of Welfare Foods The following table gives details of the distribution of these foods during the year:- National Dried Milk (tins) Orange Juice (bottles) Cod Liver Oil (bottles) Vit.A & D. Tabs, (packets) 29875 70230 6627 5836 Dental Care for the Priority Classes Under Part III of the National Health Service Act 1946, local health authorities are requested to make special provision for the dental care of expectant and nursing mothers and for children under school age, so that these priority classes have a guarantee of treatment. Our facilities are sufficient to make possible the offering of treatment to all who are entitled, and the acceptance represents about 8% of the total dental services provided by the Borough in 1965. In the early days of the present National Health Service, these priority classes had the greatest difficulty in obtaining any dental treatment, but of recent years and especially in Middlesex the very large number of dental practitioners willing and anxious to receive patients has obviated any such difficulty. The ideal arrangement would be for every expectant mother already to be attending her dental practitioner as routine, and in due course at the appropriate age for children also to become regular patients in their turn. Such, unfortunately, is often not the case, and it is only ante-natal medical advice which draws attention to the need for dental treatment. Equally, It often happens that the dental needs of young children are only discovered as a result of their attendance at 'toddler' clinics, the mother either being totally unaware of the defects or wrongly believing that 'they are only the baby teeth, so they do not matter'. Where mother and child welfare clinics are held in the same building as a dental clinic, it is very convenient for dental inspection to be carried out at the same visit with any necessary treatment subsequently being provided by appointment. It is hoped that close liaison between the medical and dental services will permit dental advice and treatment for the priority service patients to be made available to the greatest advantage of those in need, and that the scope be extended as more of the appropriate clinics come under the same roof in the new premises planned by the Borough. Dental disease in the expectant or nursing mother may adversely affect her own general health or that of her baby, and it is highly desirable that attendance in the dental surgery for inspection becomes accepted by young children as a routine event before the need for treatment ever arises. Nothing could be worse for the future acceptance of dental treatment as a normal part of life than when attendance results from severe pain, with a disastrous association in the young mind of the two experiences the reafter. The London Borough of Haringey became an autonomous authority on 1st April 1965, whereas the figures of treatment for the priority service which follow relate to the whole of the year 1965. The total include those for the first quarter of the year and at that time were attributable to the former County of Middlesex. It will be apparent that treatment is predominantly conservative and we shall strive to maintain this pattern in the future, with the preservation of a healthy, full natural dentition in every case possible as our target. Expectant and nursing mothers Pre-school children Number examined by dental officer 207 707 Number requiring treatment 193 506 Attendances for treatment 1052 1572 Patients rendered dentally fit 108 374 Number of fil lings 639 1053 Number of extractions 215 235 Scalings and gum treatment 185 - Silver nitrate treatment - 664 Other operations 512 439 Number of general anaesthetics 22 119 Number of radiographs 24 4 Number of dentures provided - full 15 - partial 46 2 41 Fluoridation in the Interests of Dental Health The Ministry's Circulars 28/62and 12/63 had encouraged the three former Borough Councils and the Middlesex County Council to consider the fluoridation of water supplies, and the subject was then reconsidered by the new Borough following Circular 15/65. A visit was arranged to the Borough by two of the country's leading experts on this subject. Dr.Dalzeil Ward, from the Central Council for Health Education, spoke in favour of fluoridating drinking water supplies and he described all the benefits to the dental health of future generations which would ensue, and Dr. H.M. Sinclair of Oxford made the case against fluoridation. When the matter was f irst discussed by the Council, the Health and Welfare Committee reported in favour of fluoridation but the Council referred the recommendation back and asked for a report on alternative methods. The Health and Welfare Committee considered a report on the use of fluoride tablets but they were not in favour of the introduction of this method and their recommendation (in June 1966) "that the Council inform the Metropolitan Water Board and the Ministry of Health that they would support the fluoridation of water supplies", was approved. MIDWIFERY SERVICE As from 1st April 1965, the administration of the midwives' night duty rota system was transferred from the former Middlesex Ambulance Department to the Night Service Department of the Whittington Hospital. The transition was effected smoothly, and the system operates most successfully. The Department is grateful to the Whittington Hospital for their ready co-operation and the very efficient service given. The provision of transport for midwives without cars who are summoned to emergency labour cases was taken over by the Council's Cleansing and Transport Department during the day, and by radio-controlled mini-cabs by night. The Ambulance Service may still be used if no other form of transport is available. It is appropriate here to stress the weight of equipment which a midwife has to carry with her. This consists of a delivery bag (weight approximately 12lbs.), an analgesic machine, which may be Trilene Tecota Mark VI (7lbs), or the Entonox (nitrous oxide and oxygen) which was introduced at the end of 1965 (10lbs.) and an oxygen sparklet for resuscitation of the newborn (6lbs). The number of home deliveries conducted by domiciliary midwives was 880 - a slight drop on the previous year, nodoubt due to the decrease in the national birth rate and the increased number of planned early discharges after hospital confinements. The number of cases who were booked for domiciliary confinement but who were transferred to hospital during labour as emergency admissions was 98. The Obstetric Emergency Service ('Flying Squad') was used eight times during the year, and all the cases were dealt with satisfactorily. The number of cases where assessment of social conditions was made in connection with plannedearly discharge from hospital continued to increase:- During the year requests for investigation were received as follows:- Source of Request No. of requests received Hospitals in North West Metropolitan Region 177 Hospitals in North East Metropolitan Region 135 London Teaching Hospitals 17 Total 329 The number of actual planned early discharges was 252. Further early discharges were accepted, although not planned, because of emotional difficulties due to stillbirths, neo-natal deaths, or domestic problems. These additional early discharges totalled 197. 42 Continuing the policy of selection for hospital confinements, social assessments for suitable cases were carried out on request as follows:- Source of Request No. of requests received Hospitals in North West Metropolitan Region 3 Hospitals in North East Metropolitan Region 174 General Practitioner Obstetricians 48 Local Authority Clinics 116 Total 341 During the year nine pupil midwives obtained their training in the Borough in association with the Alexandra Maternity Home. Of these, eight were successful in passing their examinations. Negotiations for Part II training of pupil midwives, in which hospital and district training play equal parts, were instituted by the Whittington, North Middlesex and Bearstead Maternity Hospitals. Approval was given to the Whittington Hospital by the Central Midwives Board for Part II training, and six pupil midwives started hospital training on the 1st December 1965, and are due to commence district training on the 1st March 1966. Arrangements were made for a further five general practitioner obstetricians to have a midwife in regular attendance at their ante-natal clinics, bringing the total number of clinics attended to thirteen. A table is given below showing the work for the past year:- Number of deliveries attended 850 Number of visits made 19277 Number of hospital confinements discharged before 10th Day 354 Number of visits made 2465 Number of cases in which medical aid was summoned 111 Number of cases in which gas and air analgesia was administered 182 Number of cases in which pethidine was administered 497 Number of cases in which trichloroethylene was administered 386 Number of cases in which gas and air and trichloroethylene were administered 25 HEALTH VISITING SERVICE Recruitment of new members of staff toacquire a full establishment proved impossible during 1965, with the inevitable result that the health visitors had larger case loads than could be adequately covered. Shortage of staff can seriously undermine the work of the health visitor, which is basically the teaching of the principles of health and well-being. She must be constantly on the look out for early signs of breakdown and deviation from the normal whether mental or physical. With eight unfilled posts at the end of last year, it is reasonable to expect that the preventive aspect of the health visitor work cannot be fully maintained. The great value of the health visitor has always been her knowledge of her area andfamilies, buttoo largeaworkablearearesults in more pressing responsibilities and less opportunities of fulfilling her role as the only family worker whose concern is preventing ill-health. The actual number of visits made by the health visitors this year was as shown in the following table:- Number of visits paid by Health Visitors working in the Borough Expectant Mothers First Visits 2074 Total Visits 3177 Children under 1 year of age First Visits 5705 Total Visits 13274 Children aged 1-2 years Total Visits 11157 Children aged 2-5 years Total Visits 18174 Other cases - Total Visits as Health Visitor 3293 - Total Visits as School Nurse 666 43 Research 1965 was an exceptional year by the request from four different research teams for health visitor participation. 1. The National Survey of Health and Development This involved personal interviews as far as possible with the young people born in 1946 who had reached the age of nineteen years. 2. Medical Research Council - Measles Vaccine Trial Children whose parents participated inthe initial investigationduring the latter part of 1964 required follow-up visits at three, six and nine monthly intervals. 3. Investigation of Childhood Cancer - Department of Social Medicine Some parents of children who had died in recent years from childhood cancer were visited to obtain their co-operation and willingness to be interviewed by a member of the research team. It was necessary once these parents had indicated a convenient time to be interviewed, to approach the parents of a live child of approximately the same date of birth, to act as a control group. Six children in the control groups were selected for every death and in some instances an approach was made to all the parents in these groups before their resistance was finally overcome. 4. National Child Development Study This survey was acontinuation of a national survey carried out on every baby born during one week in March 1958. For each child included in the survey a detailed questionnaire was completed by personal interview with a parent. Each interview required a minimum of 45 minutes, sometimes much longer if there were language difficulties. Special medical examinations were subsequently arranged, as well as participation by the Education Department. It will be seen that participation in any form of research is time-consuming, requiring special effort on the staff concerned. As well as additional pressure on health visitors, there is increasing administrative work. Student Health Visitors Practical training of students must be undertaken by selected experienced members of staff, who have undergoneaspecial Field Work Instructors course. Two health visitors have attended the special course and arrangements have been made for a third health visitor to attend early in 1966. It may prove in the light of experience that additional Field Work Instructors will be required in the future, depending upon the demand for Training Centres. Two student health visitors were accepted from the Institute of Education (University of London) and commenced their practical training in Haringey during the latter part of the year. It is regretted that of the many inquiries during 1965 from potential students desiring training, none came to fruition. This may have been due to the reduction in the number of available training places due to the shortage of tutors. It is anticipated that some students may be referred through the London Boroughs Training Committee in the future. Problem Families Miss Howse, Social Worker, reports:- "During the year I have had to deal more than ever before with the mentally ill for whom complete rehabilitation is impossible. A great deal of support is necessary if the family is to be kept as stable as possible when the mother or father has to spend two or three months in a psychiatric hospital each year. There is mental sub-normality or mental illness needing treatment in twelve of the families under supervision. In two other instances the husbands are in and out of prison, which imposes a great strain on the wife. 44 Psychiatric treatment is becoming more readily available In prison and efforts are being made to provide employment for prisoners on discharge, both of which help to ease their return to the community. It is essential that these families should have advice on family planning and fortunately some of the new methods are more suitable for mothers who are of sub-normal intelligence. One mother who has been specially grateful for family planning advice has had seven babies in five years. It Is anticipated that this family will soon be out of their difficulties and that the parents will be able to manage their own affairs. I would like to express my appreciation to so many who have helped during the year by providing furniture, clothing, holidays and toys, etc. Also to voluntary agencies and colleagues who co-operate so closely with me in this work". Co-ordinating Committee for Work in Connection with Problem Families The Joint Committee of Chairmen of the Health and Welfare, Housing and Children's Committees asked that a Committee be set up to co-ordinate work in connection with problem families in order to reduce the overlap of visiting by officers from different organisations who might not be aware of the work carried out by their colleagues and, in addition, to allocate responsibility for dealing with problem families to the officer principally concerned. The Co-ordinating Committee meets at monthly intervals and after a short formal discussion on policy matters the different members of the Committee meet for case conferences. During the year 80 cases were considered. During the first year the Medical Officer of Health was Chairman of the Co-ordinating Committee and the undermentioned were members or represented:- Family Service Unit National Assistance Board Senior Probation Officers N.S.P.C.C. Children's Officer Housing Manager Chief Welfare Officer Superintendent Health Visitor Chief Mental Welfare Officer Health Department Social Worker HOME NURSING SERVICE In May, the Authority became agents for the Marie Curie Memorial Foundation, which is a voluntary society enabling service to be given to needy patients either in kind, that is, clothing, equipment, materials, or day or night nursing for people suffering from terminal carcinoma. It is found to be invaluable in aiding the patient immediately the need arises. In June, all the district nurses attended a one-day visit to the rehabilitation medical centre at Camden, in the interest of extending their knowledge of physiotherapy for the housebound patient. Areorganisation of the home nurses' areas took place in October 1965, when the home nurses were put on a five-day week. This gave them every other weekend off and a day off during the week. They work in groups of four, having discussion groups weekly at centres within their area of practice. Late night visits continue to be made to very ill patients requiring general nursing care and/or sedatives. This system was reorganised into a rota, thus giving each nurse one late night per week instead of leaving the nurse in whose area the ill patient was living, the full burden of the late night call. Requests for home nursing visits out of office hours, that is, 5 p.m. to 9 p.m. and weekend from Saturday midday until Monday morning at 9 a.m., were taken over by the Whittington Hospital night service. If urgent, they were passed on to the senior nurse on duty and if not urgent, retained until the following morning. This service works very well and we are grateful to the Whittington Hospital for their cooperation. 45 The number of cases who require a visit by two nurses Is increasing. More bedridden patients require a daily visit by two nurses and increasing use is made of hydraulic hoists for this class of patient. The department now has two such hoists which are invaluable for lifting the heavy patient and in sodoing help to obviate the risk of "slipped disc" in nurses and relatives. During the year it has been necessary to borrow additional hoists from the Welfare Department. The treatment of cases during the year may be classified as follows:- Injections 879 General nursing care 503 Blanket baths 458 Enemas 171 Dressings 418 Preparation for diagnostic investigation 125 Pessaries changed 38 Wash-outs, douches, etc. 131 Other treatments 297 The sex and age of patients at the time of the nurse's first visit may be classified as follows:- Age Males Females 0 - 4 27 24 5 - 15 25 29 16 - 39 65 184 40 - 64 211 354 65 and over 513 1140 841 1731 Cases attended during the year were referred from the following sources:- General Practitioners 1592 Hospitals 911 Chest Physicians 11 Public Health Department 12 Direct 46 The following table shows the work of the home nurses during the year- New cases attended 2030 Number of cases on register at end of year 786 Number of visits made 82129 Incontinence Pads Service Incontinence pads are provided free of charge to all patients in the 3orough requiring them in accordance with the suggestions in Circular 14/63. They are stored at three centres, namely:- 357 High Road, Tottenham, N.15 Weston Park Clinic, Hornsey, N.8. White Hart Lane Clinic, Wood Green, N.22. and on receipt of a note from either doctor or nurse packets of twelve are issued. During the year 129 patients were supplied. Arrangements for disposal of soiled pads are not as yet ideal, as they are wrapped and placed in a dustbin or burnt. It is hoped to provide a collection service at a later date. 46 DOMESTIC HELP SERVICE The total number of cases provided with home help during the year was 2,624. The number of new cases are still increasing and the bulk of the work continues to be among the aged sick, who need permanent help. The total number of visits made by the Home Help Organiser and her assistants during the year was 5,597. Of this number 1,243 were in respect of new cases. The number of home helps in employment at the end of the year was 216 (equivalent to 127 full- time). Neighbourly Help Service This service continues to function satisfactorily, but we have not been successful in obtaining the services of many Good Neighbours,and at the end of the year there were only two cases, although at one period there were five, being serviced. The following table shows details of the cases served during the year- Cases provided with help during the year Number of new cases provided with help Number of old cases for which help was continued from 1964 Total number of cases provided with help Total number of cases still being provided with help at end of year Aged 65 or over at time of first visit during year 638 1529 2167 1599 Aged under 65 on first visit during year: Chronic sick and tuberculous 82 111 193 138 Mentally disordered - - - - Maternity 100 3 103 5 Others 113 48 161 39 Totals 933 1691 2624 1781 RETIREMENT ADVICE CLINIC There are twoclinics in Haringey, both started by previous local authorities. One is held fortnightly in a room in the Old People's Centre at Woodside House in Wood Green; the other, which is confined to men of retirement age, is held weekly in Somerset Road Clinic, Tottenham, or Weston Park Clinic, Hornsey. A medical officer and aclinicnurse are presentat each. Advice is provided on health and dietary matters, and medical examinations are carried out as often as the consent of the older people is obtained. There is frequent contact with the Ministry of Labour with regard to part-time employment, other agencies for help with social problems or recreational needs,and with general practitioners,chiropodists,etc. should any treatment be required. A study is in progress to determine how the work of these clinics might be co-ordinated and expanded. During 1965 there were27sessions at the Woodside House Clinic, at which 14 new cases were seen and 208 who re-attended. 33 sessions were held at Somerset Road Clinic and Weston Park Clinic, 32 cases being new and 48 re-attendances. 47 SECTION 47, NATIONAL ASSISTANCE ACT 1948 It is occasionally necessary, when a serious degree of senile change is reached, to compel a person to enter a home or a hospital. Such a removal is only possible if the individual is infirm or suffering from grave chronic disease, and is not able to give himself sufficient care, nor is receiving it from others, and it is in his own interest or for the protection of others. Since this involves taking away the liberty of the subject, the Department is reluctant to take action except in the worst circumstances. Everything possible is done to improvehis domestic arrangements, and if this should prove insufficient for his needs, attempts are made to persuade him to change his mind. In spite of the numerous cases in which the extreme measure of compulsory removal to hospitals or welfare accommodation had to be considered, it was only necessary to apply Section 47 in one instance, the case of aparalysed woman who refused to enter hospital in spite of her rapidly deteriorating condition. She was compulsorily removed to a hospital where she improved sufficiently to be transferred to a welfare home some months afterwards. TUBERCULOSIS - REHABILITATION The need of patients suffering from tuberculosis is met in three ways:- (a) Full-time training provided by the Ministry of Labour at their training centres; (b) By the admission of selected patients to colonies such as Preston Hall. There was only one patient maintained by this Council during 1965; (c) By providing training and subsequent employment under sheltered conditions at the Council's own Workshops, (Tottenham Rehabilitation Workshops, adjoining The Lido, Lordship Lane, N.17.). At the end of the year 35 journeyman cabinet makers and three supervisory staff were employed. The total capacity at the Workshop is for 52 journeyman cabinet makers and I am at present in consultation with the Chest Physicians of the various clinics which serve this Borough with a view to widening the scope of persons acceptable, as the decline in the number of tuberculous patients being recommended by the chest clinics for sheltered employment should free facilities for sufferers from other forms of chest complaints such as chronic bronchitis. Provision of Extra Nourishment to Tuberculous Patients On the recommendation of the chest physicians the local authority provides in suitable cases extra nourishment in the form of high protein foods such as milk, dairy produce and eggs for persons of low income suffering from tuberculosis. During the year there were four patients receiving this extra nourishment. NURSING HOMES There were six private nursing homes registered with the former Middlesex County Council which were passed over to this Borough on the 1st April 1965. During the period under review one of these nursing homes has closed down. An application was received for the opening of a nursing home, but following discussion, the applicant withdrew his application. Listed below are the names of the nursing homes together with the number of patients that they can cater for. All of these homes are regularly visited by principal medical officers. Home Address Telephone No. No. of Beds Beacon Lodge 35 Eastern Road, N.2. TUDor 4468 17 + 16 cots, 3 Maternity Trees (Hill Homes Ltd. MOUntview 7973) 2 Broadlands Road, N.6 MOUntview 5278 49 (10 chronic) Goldsmith's (Hill Homes Ltd. MOUntview 7973) Denewood Road, N.6 FITzroy 4611 15 Chronic 15 Special Nursing Care Claremont 108 Colney Hatch Lane, N.10 TUDor 6014 9 Medical Kenwood Annexe 4 Princes Avenue, N.10 TUDor 2940 15 Chronic Strath lene 79 Creighton Avenue, N.10 TUDor 1259 20 (Closed Nov.1965) 48 RECUPERATIVE HOLIDAYS All holidays are normally looked on as being recuperative to a greater or lesser extent, but the Council's scheme is in the main restricted to those persons who after illness or operation would be most likely to benefit by two weeks convalescent holiday in a suitable home. If medical or nursing care is necessary this form of convalescence is arranged through the aimoners at the hospitals. As a natural course of events the demand for holidays under this scheme for elderly persons is on the increase, but the demand on holiday homes is such that it is not possible to accommodate them all during the accepted holiday season. Not unnaturally, too, there is a reluctance on the part of some applicants to go away on holiday other than during the summer and this gives rise to a heavy demand in the summer months and under-occupancy of some convalescent homes during the rest of the year. During the year the Council accepted financial responsibility for 201 persons in recuperative holiday homes. 139 were admitted to such homes and of the remainder, 56 were cancelled or withdrew and six were outstanding on the 31st December 1965. Of the 201 cases accepted, 197 were adults and four children under school age. In addition there were 12 applicants for recuperative holidays who were not eligible for holidays under the Council's scheme. 24 children were recommended under Section 48 of the Education Act 1944, 17 of whom were placed in recuperative holiday homes and the remainder were either cancelled or withdrawn. THE CARE OF THE UNSUPPORTED MOTHER Referred to Department 203 Admitted to Red Gables 24 Admitted to other Local Authority homes 38 Admitted to voluntary homes 57 Not admitted 84 (These figures include those admitted to homes before 1st April 1965 and still in on that date) Admission to Red Gables from other Boroughs 53 Thereasonswhygirlsseekadmissiontomother and baby homes are varied. Girls living in lodgings orthose whoserelationshipwith their parents is poor and made impossible by the disclosure of pregnancy, are obvious candidates. As well as these, whom one might class as homeless, are those who leave home tosave their families and particularly younger members embarrassment; in this 3orough the proportion who deliberately come into the area because of pregnancy are few. There are always a certain number who make no arrangements at all for their babies and need immediate post-hospital arrangements. As well as these, there are girls who would consider themselves members of a happy home who seek admission and who benefit from removal from the emotional tensions of home. Bitter words are not easily forgotten and admission gives an opportunity for tempers to simmer down and for the family to sort things out; this is particularly true when the boy concerned is known to, and disapproved of by the family. Mostly in such cases the girl wil leventually return home grateful and surprised at the consideration her family later give her. A girl who wishes to keep her baby and who has no home or none prepared to accept her, will probably require longer in a home before she can make satisfactory arrangements; hostel vacancies are few and private accommodation difficult to obtain. It will be seen that more than a third of referrals do not require admission. The great majority of these stay at home and subsequently keep their babies; what at first seemed an impossible situation is later accepted. Others will marry and these are by no means always forced marriages. There has been an increase in the numbers demanding fostering straight from hospital prior to adoption. These give much work and anxiety to the case worker as it is often difficult to obtain a vacancy with a temporary foster mother suitable for a baby straight from hospital. Though a good number of these girls will at the eleventh hour decide to take their babies home, they would feel let down if the foster mother was not available if they wished for one. 49 STAFF MEDICAL ASSESSMENTS, EXAMINATIONS AND SICK PAY REPORTS 1st April 1965 to 31st December, 1965 1. Medical Assessments of New Applicants without Medical Examination Architect's Department 34 Baths „ 4 Building Works „ 21 Catering „ 3 Children's „ 46 Cleansing „ 10 Education „ 547 Engineer's „ 32 Entertainments „ 1 Health „ 96 Housing „ 30 Libraries „ 29 Parks „ 2 Town Clerk's „ 65 Town Planning „ 14 Treasurer's „ 45 Welfare „ 45 Total 1024 2. Medical Examination of New Applicants Architect's Department 5 Building Works " 3 Children's " 2 Cleansing " 2 Education Department: Engineer's " 6 Non-teaching 7 Entertainments „ 1 Teacher trainees 124 Health„ 2 Teacher 1st appointments 119 Libraries„ 1 Hornsey College of Art 49 Parks„ 1 299 Town Clerk's " 3 Treasurer's " 5 Welfare " 1 32 Total 331 3. Medical Examination of Staff over 70 years of age Total 5 4. Reports on Sick Pay Cases 78 Medical Examination of Sick Pay Cases 8 50 HEALTH EDUCATION A Health Education Off icer was appointed and commenced duties in August. This new appointment includes the organisation and co-ordination of health education throughout the Department, and supply and maintenance of visual aids. Health Education in Schools As in previous years, this has been undertaken by a school nurse. Potential school leavers are given the opportunity to take part in informal group discussions, assisted by demonstrations, films and other visual aids on the principles of healthy living. It is hoped that in the future school medical officers will also be able to participate in health education in schools. Health Education in Clinics Clinic staff were advised and assisted in their health education projects. Poster Campaign In the latter half of the year posters were distributed on public notice boards and in welfare centres to help increase polio immunisation. Anti-smoking posters were distributed throughout the Borough to tie-up with the Ministry of Health's National Campaign on smoking. Venereal disease posters were displayed in all local authority public conveniences givingdetails about treatment facilities. Staff Training Instruction films were shown to medical officers, health visitors, school nurses, home nurses, midwives and mental health staff. Home Safety The Health Education Officer co-operated in the work of the Home Safety Sub-Committee of the Town Safety Committee; as part of this, clinic facilities were afforded for the National Fire Prevention Campaign. CHIROPODY SERVICE The arrangement during 1965 for chiropody treatment in the Borough may be summarised as follows:- L Directly-provided service (a) Clinic sessions were held at the under-mentioned Centres:- For elderly persons (12 sessions):- Weston Park Hornsey 4 sessions a week Stroud Green, Hornsey 2 „ „ „ Mi Idura Court, Hornsey 1„ „ „ Fortis Green, Hornsey 1 „ „ „ Stuart Villa, Wood Green 4 „ „ „ For schoolchildren, expectant and nursing mothers and children under school age (4 sessions): Lordship Lane, Tottenham 2 sessions a week Weston Park, Hornsey 2 „ „ „ 51 (b) Domiciliary treatment was carried out for elderly persons who were unable by reason of ill-health or infirmity to attend aclinic. Three chiropodists were employed for this purpose, one of whom also did clinic sessions. 2. Treatment arranged by Voluntary Organisations Arrangements existed with voluntary organisations as follows:- (a) Tottenham Old People's Welfare Committee This organisation arranged clinic sessions, for which they were re-imbursed up to a maximum of 141 sessions a quarter; and were also re-imbursed for up to a maximum of 42 domiciliary treatments a week. 11 clinic sessions a week were held at the Borough Council's centres and in the organisation's premises. (b) Hornsey Old People's Welfare Council This organisation was re-imbursed for up to 420 treatments a quarter, which were carried out at the chiropodists' surgeries. The number of domiciliary treatments arranged by the organisation was about 300 a quarter. (c) British Red Cross Society This organisation was re-imbursed for up to a maximum of 4,400 treatments a quarter in the area of the former Middlesex County Council. The Society's arrangements in the Borough were as follows:Clinic Treatment Regular clinics were held at the following centres:- Grove Lodge, Muswell Hill, Hornsey BRCS Hut, River Park Road, Wood Green 13b Bruce Grove, Tottenham High Cross Congregational Church Hall, Tottenham The following tables show treatment given during 1965:- Treatment in Clinics by Local Authority Category of Patient New cases first attendances Old cases first attendances Re-attendances Total Elderly persons 161 358 2765 3284 Physically handicapped - - 3 3 Expectant and nursing mothers 8 - 15 23 School children 247 59 1339 1645 Pre-school children 1 - 8 9 Others 1 - - 1 Totals 418 417 4130 4965 Domiciliary Treatment by Local Authority New cases Old cases Category of Patient first first Re-attendances Total attendances attendances Elderly persons 174 87 924 1185 Physically handicapped 9 1 44 54 T otals 183 88 968 1239 52 Treatment of elderly persons by voluntary organisations British Red Cross Society Hornsey and Wood Green Division Clinics Hornsey - 93 patients received 169 treatments Wood Green - 776 patients received 1470 treatments Domiciliary Wood Green - 676 patients received 1496 treatments There is no domiciliary chiropody service provided by the British Red Cross for the Hornsey area. Tottenham Division Clinics 311 patients Domiciliary 47 patients Hornsey Old People's Welfare Clinics 1965 patients Domiciliary 1002 patients Tottenham Old People's Welfare Clinics 4793 treatments Domiciliary 2184 treatments 53 The Development of the Mental Health Services Particularly the Training of the Sub-normal This service covers the whole range of mental disorders; the pre-care, care and after-care of the mentally ill, the mentally sub-normal and psychopathic, and the support of the patient and his family will continue for as long as it is considered necessary. This support in the community helps the patient to function more effectively. The mental welfare officer carrying out this task has to use his discretion and to ensure confidentiality in offering such personal service. The Borough has established theclosestco-operation with the four mental hospitals which serve the area and the Principal Medical Officer for Mental Health works as a part-time member of the medical team at Claybury and North Middlesex Hospitals, which receive patients from Tottenham. The mental welfare officers also attend at the various hospitals serving the Borough for case conferences and to see referrals for after-care. One useful function of co-operation which has been formed is the monthly meeting of the mental welfare officers from this and other adjoining authorities, together with other welfare and social workers from the catchment area hospitals for the mentally ill. A 24-hour rota of mental welfare officers is maintained at all times throughout the year for emergency calls. The Borough is, unfortunately, divided between two Hospital Boards areas so that links have to be established with twice the number of hospitals. Hostels for Mentally III Although at this juncture we have no hostel of our own, indeed, no premises at all in the mental health field, we do, nevertheless, find placements in hostelsrun by other local authorities and by voluntary organisations. Hostels for Mentally Sub-normal It is hoped to open a hostel for 16 sub-normal males during 1966. Adult Training Centre Although we have no Adult Training Centre at present, plans are well advanced for establishing such a centre at 3ounds Green Trading Estate. This will include a laundry and workshop facilities for 80 trainees and should be ready for occupation in 1967. Meanwhile we use the Enfield Adult Training Centre at which 69 Haringey residents attend. Junior Training School Again we have no premises of our own, but included in our first ten years' plans is the building of a Junior Training School on the Broadwater Farm Estate, Tottenham. By arrangement with the London Boroughs of Barnet and Enfield atotal of 75 Haringey children are trained in their Junior Training Schools. Residential Accommodation - Long Term In all - during the year 47 cases were maintained by this Authority in residential homes. For the most part they reside in the Brighton and Hove area, where many are boarded out by the Guardianship Society in private households, although we have children placed asfar away as Norfolk. These placements are, in the main, for sub-normals, although, if necessary, the mentally ill could be similarly placed. Social Club During the year a Psychiatric Social Club was formed with the co-operation of Ferme Park Baptist Church, in whose premises the club meets - by hospital social workers and Health Department staff. It is hoped that during 1966 it may be possible to establish another similar club within the Borough. 54 The long-established Roundabouts Club for sub-normals which is run by the Hornsey Society for Mentally Handicapped Children hopes to be moving into new premises early in the new year. Late in the year, the newly formed Haringey East Society for Mentally Handicapped Children opened its first Youth Club, the Golden Gate Club, at the Arts Centre, Lordship Lane. There is, inaddition, aclubfor Educationally Sub-normal Children functioning at Earlsmead School, Broad Lane. Number of Patients referred to Local Health Authority during year ended 31st December, 1965 Referred by Mentally III Sub-normal and severely sub-normal Under age 16 Aged 16 and over Total Under age 16 Aged 16 and over Total M F M F M F M F General practitioners - - 90 152 242 - 1 1 3 5 Hospitals, on discharge from in-patient treatment - - 25 46 71 2 1 1 2 6 Hospitals, after or during outpatient or day treatment - - 33 48 81 7 4 1 2 14 Local education authorities 1 - - - 1 1 - 3 2 6 Police and courts 1 - 30 16 47 1 - 1 - 2 Other sources - - 95 126 221 9 8 4 5 26 TOTALS 2 - 273 388 663 20 14 11 14 59 Number of Patients under Local Health Authority care at 31st December, 1965 Referred by Mentally III Sub-normal and severely sub-normal Under age 16 .Aged 16 and over Total Under age 16 Aged 16 and over Total M F M F M F M F (a) Total Number - - 113 157 270 49 68 209 169 495 (b) (1) attending day training centre _ - - _ _ 26 49 44 25 144 (II) awaiting entry thereto - - - - - 11 5 3 4 23 (c) (1) resident in residential training care - - - - - 1 2 - 1 4 (li) awaiting residence therein - - - - - 1 - - - 1 (d) (i) receiving home training - - - - - - - - - - (II) awaiting home training - - - - - 1 - - - 1 (e) (1) resident In L.A. home/ hostel _ _ _ 2 2 - - 1 - 1 (li) awaiting residence in L.A. home/hostel _ _ 1 - 1 - - - - - (Ili) resident at L.A. expense In other residential homes/ hostels - - 10 7 17 3 1 5 3 12 (iv) resident at L.A. expense by boarding out in private household - - - - - 1 2 4 7 14 (f) receiving home visits and not Included under (b) to (e) - - 102 148 250 5 9 152 129 295 55 Number of Patients awaiting entry to hospital or admitted for temporary residential care during 1965 Sub-normal or severely sub-normal Total Under age 16 Aged 16 and over M F M F Number of patients in L.H.A. area on waiting list for admission to hospital at 31.12.65 (a) in urgent need of hospital care 4 2 1 1 8 (b) not in urgent need of hospital care 1 3 5 4 13 (c) Total 5 5 6 5 21 Number of admissions for temporary residential care (e.g. to relieve the family) (a) to N.H.S. Hospitals 11 4 6 3 24 (b) to L.A. residential accommodation _ _ . . . (c) Elsewhere 1 - 1 1 3 (d) Total 12 4 7 4 27 56 SCHOOL HEALTH SERVICE REPORT OF THE PRINCIPAL SCHOOL MEDICAL OFFICER FOR THE YEAR 19 6 5 EDUCATION COMMITTEE - 1965/66 The Mayor - Councillor Victor Butler, J.P. (ex-officio) * *Alderman Mrs. A.F. Remington (Chairman, Education Committee) * *Alderman D.F.W. Billings ley (Vice-Chairman, Education Committee) *Alderman V.P. Gellay, B.Sc., A.Inst.P., A.R.I.C. (Chairman, Special Services Sub-Committee) Alderman J. Watkins Councillor Mrs. L.A. Angell Councillor Douglas Clark *Councillor Mrs. D. Cunningham (Vice-Chairman, Special Services Sub-Committee) Councillor Mrs. P.M. Dines Councillor D.J. Ding *Councillor B.L. Greenway, M.I.C.M. Councillor V.N. Jary Councillor Frank Lloyd, J.P. Councillor B.J. McBride *Councillor Mrs. N.E. Mcintosh, B.A. *Councillor Neil Muldoon, O.B.E., J.P. Councillor Mrs. Brenda S. Remington, B.A. Councillor R.L. Singer Councillor M. Skudder, 3.Sc., F.S.S., J.P. Councillor L.A. Vitoria *Councillor Mrs. M.E. Warbis Co-opted Members *Rev. G.J. Groves Rev. Prebendary J.S. Aid is Mr. J.G. Elkington, B.A. Mr. D.A.T. Williams Mrs. J. Sondheimer, M.A., Ph.D. Mr. H.R. Cheetham Mr. E.H. Fawcett *Members of the Special Services Sub-Committee * *Ex-officio members of the Special Services Sub-Committee 57 SCHOOL HEALTH SERVICE The London Borough of Haringey took over the School Health Services of the former Middlesex County Council on the 1st April 1965. Under theCounty Council'sdirection and since the National Health Service Act of 1946 there has been an agreement between the Education and Health Departments for the integration of the School Health Service with the former Council's health services so that the best use could be made of medical, dental, nursing and other staff as we 11 as clinic premises and the day-to-day services were managed bythe AreaHealth Department from the off ices in Somerset Road. The London Borough of Haringey moved the school health, environmental, personal health and mental health services into office accommodation at Tottenham Town Hal I. The re-organisation of the service and the change of office accommodation was a complex manoeuvre, but after an initial period of disturbance the advantages of the re-organisation are becoming apparent and there is good contact between the officers of these departments and the Education Department, which should lead to further progress. Tottenham had a long association with advances in the School Health Service, and as a result Haringey has the good fortune to inherit from Middlesex two special schools - theBlancheNevile School for the Deaf and the Vale Road School for Physically Handicapped Children - both of which are situated in the Borough. The new London Borough is fortunate, too, in inheriting from Middlesex the "Suntrap" Residential School for delicate children at Hayling Island, a school which had been associated with the Borough of Tottenham before it was transferred to Middlesex in 1945. The past year's work in the School Health Service has been one of amalgamation and consolidation of services in the new environment, and the progress made and the statistical record of the year's work are described in the body of the report. I am grateful for the support and tolerance of the members of the Committees concerned during this difficult period and I am grateful, too, for the enthusiasm and interest of the staff and especially to Dr. Mary C. Douglas, the Principal Medical Officer for the School Health Services, for the part they have played during the difficult first year. J.L. PATTON, Principal School Medical Officer. 58 Periodic Medical Inspections Periodic medical inspections are carried out four times during the pupils' school life - on school entry; during the first year in the primary junior school; during the first year in the secondary school; and during the last year at school. The changing population and the number of school children arriving from overseas will make it necessary toreconsider the method of examination of school entrants, with possible screening for diseases such as tuberculosis. It would also seem that the questionnaire issued to parents before school medical inspection is inadequate, andthis is in process of revision. Already, in areaswitha heavy Greek-speaking population, and where the language barrier has led to difficulty, the situation has been improved by the issue of a facsimile questionnaire in the Greek language. An experiment was carried out during the year in selective school medical examination. In this system, children are selected for examination by the medical officer as a result of answers to questionnaires sent to the parents, teachers and school nurses. It is intended to continue such experiments in order to determine the most efficient way of carrying out school medical examinations. As a further experiment, routine weighing and measuring of school children has been abandoned, except in sample schools for statistical purposes. The following table shows the number of children inspected by years of birth and the classification of their physical condition:- Year of Birth Number of pupils inspected Physical condition of Pupils inspected Satisfactory Unsatisfactory Number % Number % 1961 & Later 45 45 100 - - 1960 1535 1533 99.8 2 0.2 1959 1687 1684 99.8 3 0.2 1958 445 442 99.3 3 0.7 1957 1233 1232 99.9 1 0.1 1956 702 701 99.8 1 0.2 1955 214 211 98.6 3 1.4 1954 1347 1346 99.9 1 0.1 1953 1711 1708 99.8 3 0.2 1952 714 712 99.7 2 0.3 1951 863 859 99.5 4 0.5 1950 & earlier 2402 2399 99.8 3 0.2 Total 12898 12872 99.8 26 0.2 59 SCHOOL HEALTH SERVICE School Population The school population for the Borough on the 20th January 1966 was 33,156, as shown in the following table:- Primary Schools and Nursery Classes 18,489 Nursery Schools 220 Secondary Modern Schools 8,890 Secondary Grammar Schools 5,258 Special Schools: Physically Handicapped 90 Blanche Nevile School for the Deaf (including classes for the partially hearing) 113 Suntrap Residential Open Air School 96 33,156 In the Appendix to this report will be found an analysis of the defects found to require treatment or observation. Medical Treatment In the Appendix to this report details are given of treatment (excluding uncleanliness and dental defects) of pupils attending maintained primary and secondary schools (including nursery and special schools), whether provided direct by the Council or arranged through other agencies. School Advice Clinics The term 'minor ailment clinic' no longer describes adequately the work carried out at these clinics. Here are treated the minor ailments such as slight injuries which are of frequent occurrence during childhood, together with certain common infections of the skin and minor defects of the eye>or ear. However, parents are free to take their children to these clinics for advice on any condition and much valuable health education and other work is carried out at these sessions. School Advice Clinics are held at eleven clinics in the Borough and 10½ sessions are held per week. Ophthalmic Clinics There are three school ophthalmic clinics held in the Borough, and 7½ sessions are held each week. At Lordship Lane Clinic, an orthoptist is employed who works nine sessions a week at the Clinic, and in addition visits Vale Road School for Physically Handicapped Children one session a week. A second orthoptist is normally employed at the Hornsey Town Hall Clinic for four sessions a week, but this post is vacant at present. There is no Orthoptic Clinic at Stuart Villa, Wood Green, though it is hoped to establish one there in the future. Meantime, it is intended to meet this deficiency to some extent by the appointment of an orthoptist to work six sessions a week at the Hornsey Clinic, devoting two of these sessions to Wood Green children. Dr. T.G. Kletz, consulting ophthalmologist at Lordship Lane Clinic, reports:- "The work at this clinic is mainly investigation and correction of refractive errors, and investigation and orthoptic treatment of squints, muscle imbalance and amblyopia. While most of the children are aged between five years and school leaving age, about 10% of the children seen are under the age of five years. Following refraction and correction of errors by glasses cases of manifest or suspected squints and cases of amblyopia are referred for orthoptic investigation and treatment if required. During the year, 40% of cases treated in the orthoptic clinic were complete successes and a further 30% are improving but still under treatment. 15% failed to improve. Of the cases of amblyopia treated by occlusion, 70% improved to 6/9 or 6/6, whilst a further 10% improved to 6/18 or 6/12. During the year there has been a noticeable increase in the number of immigrant children attending the clinic and amongst these children there is a high incidence of myopia and a number of young children with very high myopia who may not be able to cope under normal educational facilities." Mr. E.M.G. Galton, consulting ophthalmologist at Stuart Villa Clinic, reports:- "The work at the Eye Clinic continues smoothly. I should, however, very much like the work to concern itself even more with the early detection of slight cases of squint in children of pre-school age.". It is most unfortunate that Dr. Robert Welch, consulting ophthalmologist at the Hornsey Town Hall Clinic, has recently suffered a serious illness and consequently had to resign from his appointment during the early part of 1966. The Authority and its predecessors owe a debt of gratitude to Dr. Welch for the devoted work he had put in at the Hornsey Ophthalmic Clinic since 1955. The loss of his services has already been keenly felt, and considerable arrears of work have accrued at the clinic owing to difficulty experienced by the Regional Hospital Board in the appointment of a successor. 60 Cerebral Palsy Unit The Cerebral Palsy Unit associated with Vale Road School for Physically Handicapped Children Is a centre to which mothers are referred for advice and children for treatment, as soon as a diagnosis of cerebral palsy has been made. Dr. William Dunham, the consultant in charge of the Unit, attends once a week. A physiotherapist and an occupational therapist are attached to the School, and give treatment under the direction of the visiting consultant. A speech therapist is also available to give treatment in suitable cases. I am grateful to Mr. A.J. Ives, the headmaster of the school, and to his staff, for their continued co-operation during the year with the medical staff. It is no easy task to reconcile the educational needs of the children with their need for medical treatment, particularly when accommodation Is so inadequate. Of theelght new cases seenduring 1965, six were Haringey children and two were from the London Borough of Enfield. Five of these children were under five years and three were over five years old. The recommendations made in respect of the new cases were as follows:- Recommended admission to Vale Road Special School 3 Recommended admission to an ordinary school 1 Referred for further investigation of intellectual ability 4 I am indebted to Dr. William Dunham for the following report:- "Life at a normal school can be strenuous, and to bring the benefits of a school education- social as well as educational - to physically handicapped children, special arrangements are necessary. It is one of the advantages offered by the Schools for Physically Handicapped Children that, in them, demands are reduced so as to be within the capability of most of the children concerned. Other advantages are the increased medical and nursing provision, reduction In the sizes of classes, and, in many cases, the availability where required of physiotherapy, occupational therapy and speech therapy. Orthoptics may also be available. These schools can thus serve children with a variety of handicaps. Of those who attend schools for physically handicapped children,children with cerebral palsy-the so-called "spastics"-form a considerable proportion. These children find itabnormally difficult to learn todoeven the ordinary activities of every-day life, and they find it even more difficult to do these things properly. Training byatherapist is therefore usually provided in order tohelp overcome these difficulties. At the Vale Road P.H. School, Harringay, where these children at present account for 28 of the total of 90 pupils, they have for a number of years received particular attention, being provided with their own visiting Consultant and their own specially trained Therapist. As the Therapist works actually in the school, she isabletoprovidethis treatment without causing the child to waste valuable time in travelling to and from a treatment clinic. But, as well as finding it abnormally difficult to learn to do things properly, these children inevitably find that their first successful attempts are slow and of short duration, calling for their close attention, and it is obviously unlikely that they will practise the things they have learned in their therapy sessions at other times unless they are adequately supervised. Yet unless they practise their therapy is largely wasted, for it is constant practise which develops ease of performance and endurance, and it is only the habitual adoption of normal postures which can prevent the development of deformity. For this reason it is essential that the furniture they use shall be chosen so as to make it as easy as possible for them to achieve normal posture and activity. And for this reason the collaboration of everyone concerned with the children is required. At the Vale Road School teachers and attendants combine with the parents to help the therapist guide the child into establishing normal habits of posture and movement. The system is not one of restriction of the child's activity, but of helping him to do the best of which he is capable. It should obviously be adopted as soon as the child's difficulties are realised. For this reason an Advice Clinic for the parents of children with cerebral palsy of under school age is held at the school, and through this the child can receive much useful training even before he reaches school age. The school receives many visitors, and plays a valuable part in the training of personnel in many branches of the Welfare State. On the Education side, organised visits have been made during the past year by Students from the Trent Park Training College, the Staff Training College for House Parents (Highbury) National Children's Home and the Maria Grey Training College. On the medical side, visits were made by sister Tutors from the Royal College of Nursing, by Student Nurses from the Hospital for Sick Children, Great Ormond Street, W.C.1., the Prince of Wales's Hospital, Tottenham, and St. George's Hospital, Hyde ParkCorner, while Student Health Visitors came from the Local Health Authority. Visits were aIso made by Occupational Therapists in training and by Doctors attending the Course in the Diploma of Public Health, as well as by a number of individuals. 61 62 At the time of writing, an extension to the school premises Is being built. At present, shortage of space makes organisation both of the Educational and of the Medical aspects of the school's activities difficult. Despite the difficulties, morale is high. When the extension is complete it may well be even higher". Orthopaedic Clinics There are two orthopaedic clinics in the Borough, at each of which fortnightly sessions are held. Mr. E.H. Hambly, consulting orthopaedic surgeon to Lordship Lane Clinic, reports:- "The Clinics are slightly larger because Wood Green children now attend. I have been struck during the past year by the quality from the medical point of view of the patients sent to the Orthopaedic Clinic. The Medical Officers do an extremely good job of work in sending the right type of patient who can benefit from the physiotherapy under the guidance of the physiotherapist. Liaison with Mr. Ives, the Head Teacher of Vale Road School for Physically Handicapped Children, and with Dr. William Dunham, who is in charge of the Spastic Unit at Vale Road School, continues to be as close as ever". Dr. E.G.M. Palser, consultant in physical medicine to the Weston Park Orthopaedic Clinic, reports:- "The number of new cases seen during the year was:- Under 5 years of age 167 Over 5 years of age 208 375 Number of attendances during the yean- Under 5 years of age 303 Over 5 years of age 362 665 Number of attendances for treatment by physiotherapist:- Under 5 years of age 102 Over 5 years of age 609 711 It appears that more cases are being taken early and their treatment being completed before teenage. During the year, in addition to routine school orthopaedic cases, two cases deserve comment; one was an autistic child, also a patient at the Royal National Orthopaedic Hospital, whose calipers, boots and walking sticks have been designed and supplied by us and who has been receiving treatment at the clinic during holiday time from a special school for autistic children. The other was a quadriplegia due to head injury in infancy who is receiving treatment who a view to assessment and improvement". Ear, Nose and Throat Clinics There are three ear, nose and throat clinics in the Borough, at two of which weekly sessions are held, and at the other monthly sessions. Mr. W. McKenzie, consultant Ear, Nose and Throat Surgeon to Park Lane Clinic, reports:- "I have usually commented on the steady decrease of children needing specialist treatment, and it is striking that we only have to work once a month, whereas my predecessor worked twice a week. A discharging ear in a child is now a rarity and all the other diseases of childhood affecting the nose and throat are becoming scarcer. I think this is due to the improved conditions of general health, and I do not think that it is due to any change in treatment in my Department. I expect that this decrease will continue, and it is likely that the need for a clinic may become less in future years. I do not think the clinic should disappear, because the children and their parents like it, and it is a pleasant way of examining them in their own world". Dr. F.P.M. Clarke, Consultant Ear, Nose and Throat Surgeon to the Hornsey Town Hall and Stuart Villa Clinics, reports:- "The ear, nose and throat clinics at Weston Park and Stuart Villa were carried on during the year 1965 along similar lines to those of previous years. The nature of the complaints for which patients were referred to the clinics followed much the same pattern as those in preceding years. There has been a very noticeable decline in recent years in the incidence of chronic otorrhoea (chronicdischarging ears). During the earlier period of these clinics and up to the last few years chronic suppurative otitis formed a very considerable part of the work of the clinics and has been found one of the most intractable conditions todeal with, requiring a very specialised technique of treatment to correct this potentially very serious septic affection, and its equally serious sequelae. The decline in the incidence of chronic otorrhoea can, I think, be fairly explained by the great advance in modern treatment, in the suppression, and prevention of those 'fevers' which were the chief exciting causes of ear affections, and also by the use of suitable antibiotic and sulphanilamide drugs given in the very early stages and first symptoms of ear infections. The chief 'complaints' with which the clinics are now concerned are diseased and abnormal conditions of the nose and naso-pharyngeal areas, nasal obstruction, nasal respiratory insufficiency, rhinitis, sinus affections, etc. and their consequent effects in the causation of many local and also widespread,defects, some far removed from the existing cause in the nasal area. Among the commonest ill effects are those affecting the ears, and hearing, many eye affections, mouth breathing, and lung affections, disorders of digestion, tonsillitis, and laryngeal and pharyngeal defects, aprosexia etc. During the year a number of these nasal conditions were met with at the clinics, and with suitable treatment the results have been very satisfactory. Proetz technique of 'sinus displacement* - using certain medicaments, such as albucic solution, lipiodol, etc. as indicated has been regularly employed in suitable cases and has given, as usual, excellent results. Other special treatments, Dowling's nasal argyrol packs, 'Gautier's; (French) diastolisation for nasal obstruction, nasal Zinc ionization,'drops', etc. have been used in the appropriate cases. 'Hay-fever' cases have, in the main, responded very favourably to nasal zinc ionization- one or two applications relieve all symptoms for the remainder of the season. The early detection and prompt correction of any abnormal conditions in the nose and naso-pharyngeal areascannot be too strongly emphasised because the removal of these defects is one of the most important factors in the prevention of otitis media and impaired hearing in young children. It is equally essential by the correction of nasal obstruction - in restoring and maintaining a normal nasal respiration which is fundamentally requisite for the function of normal breathing and a healthy condition of the lungs and, indeed the general health. It is the first principle in the recovery of the hearing in a very large number of cases of deafness in children,due mainly to eustachian tube obstruction and deficient aeration in the middle ear - an extension from that in the nose. The present systematic audiometric screening of school children for any impairment in hearing has been found very helpful in picking out these children with minor degrees of deafness who might easily be missed inthe ordinary school routine medical examinations. It is in these instances that prompt treatment is so essential and effective in restoring normal hearing and in preventing any further advance in the deafness. At this stage the response to treatment is usually the most favourable". Audiology Unit The Audiology Unit is held within the precincts of Blanche Nevile School for the Deaf, and there is close co-operation between the medical and teaching staff. Three sessions are held each week, and the Unit continues to serve the whole of the London Borough of Haringey, and also the London Boroughs of Enfield and (part of) Barnet. Dr. L. Fisch, Consultant Otologist, reports:- "The most urgent aspect of the work during the past year was to keep the list of children waiting for examination within reasonable limits. It is important to examine children as soon as possible when deafness is suspected. 63 When the list became very long we had to make special arrangements for clinical sessions during which we could see a very large number of children with more moderate degrees of hearing loss, or onesided hearing loss, in order to see the more serious cases of children, who need detailed examination, as soon as possible. We receive now many requests to test babies "at risk", that is those who may be affected because of some unfavourable history during pregnancy, birth, or a family history of deafness. We arranged a special clinical session for this purpose and this is successfully conducted by the Principal Medical Officer (M. & C.W.). Screening tests are carried out first, and those who do not pass the test are then referred for full examination. The number of children seen per session by the consultant had to be temporarily increased as well, but we hope that this is only a temporary measure, otherwise the quality of work may suffer. A serious deficiency has arisen because of the inadequate facilities for psychological examination of the children. This deficiency affected our work quite seriously. We hope things will improve. The great improvement during the year consisted of the addition of three new rooms gained by adapting the adjoining war time shelter. These are first class rooms (for teachers, psychologists and audiometricians) and make the work of our staff very much easier and more effective. Regular meetings of parents of our pre-school age children were held, and these proved to be a very important aspect of parent guidance. The success of these meetings is largely due to the enthusiasm of our two peripatetic teachers of the deaf". Special Classes for Partially-Hearing Children There are special classes for partially-hearing children at Devonshire Hill Junior School and Markfield Secondary Modern School which form an annexe to Blanche Nevile School. The children admitted need special teaching because of their hearing defect, but otherwise are able fully to take part in ordinary school life, and the closest integration of these pupils with the school is encouraged at all levels. 64 The following is an analysis of the cases seen during 1965:- Number of cases seen:- Age -1 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16- Total New cases 204 25 25 24 12 9 9 14 18 8 4 5 5 7 2 3 1 375 Re-examinations 6 38 28 22 15 21 34 22 40 35 29 25 18 32 23 8 10 406 Total 781 Pre-school children 409 Attending Infant and Junior Schools 251 Attending Senior Schools 121 Reason for referral among New cases:- For diagnosis 127 Immigrants to Borough known to be deaf 5 Partially-hearing, advice as to placement 1 Auditory training 3 "At risk" 218 Transfer from hospital out-patients departments 19 Advice as to placement where deafness might be the cause of backwardness 2 Total 375 56 of the above referrals were from other London Boroughs Children with hearing defects attending ordinary schools and partially-hearing pre-school children Arrangements are made for the regular supervision of these children, many of whom wear hearing aids. For this purpose, there are two peripatetic teachers of the deaf who work in close co-operation with Dr. Fisch-one covering the London Borough of Haringey, the other the area outside Haringey served by the Audiology Unit. The peripatetic teachers also pay regular visits to pre-school age deaf and partiallyhearing children in their homes, for supervision and training. Audiometry Routineaudiometric testing of school children iscarried out by two full-time trained audiometricians. Children who are due for periodic medical inspections at the ages of five, eight and eleven, first have an audiogram. Those children who fail audiometry have a full audiograph prepared whi"ch is made available to the school medical officer when the inspection is made. In this way the school medical officer is able to discuss with the head teacher the child's school progress, to arrange a seating position in class favourable for hearing and to follow up with any other investigations necessary. The standards for passing audiometry are set purposely high, and of the 595 children failing first routine tests in 1965, a very high proportion were found to respond to simple measures or not to need treatment. As would be expected, the percentage failing 'special'tests was high, because these children had either been referred specially because deafness was suspected or were already under treatment. The tables below give the numbers and results of audiometry tests during 1965:- Maintained Primary and Secondary School Population of the Borough 33060 (excluding Suntrap Residential School) Audiometer Tests - Routine Age Group 1st Tests sweep or gramophone Re-tests Failures both ears one ear % of Column 1 right left Total (1) (2) (3) (4) (5) (6) (7) Up to 7 years 2907 239 152 43 54 249 8.6 Intermediate 2771 105 84 39 78 201 7.3 Leavers 2955 142 71 33 41 145 4.9 Totals 8633 486 307 115 173 595 6.9 Audiometer Tests - Specials Age Group 1st Tests Re-tests Failures both ears one ear Total % of Column 1 right left (1) (2) (3) (4) (5) (6) (7) Under 5 4 9 1 - 1 2 50.0 5 23 47 5 3 11 19 82.6 6 35 68 9 4 4 17 48.6 7 25 86 8 2 1 11 44.0 8 27 63 6 4 2 12 44.4 9- 10 43 1 7 2 10 100.0 10 16 32 7 3 1 11 68.7 11 10 24 1 1 1 3 30.0 12 23 44 4 5 3 12 52.2 13 2 34 2 - - 2 100.0 14 9 32 2 1 1 4 44.4 Over 14 6 10 - 1 1 2 33.3 Totals 190 492 46 31 28 105 55.0 65 SCHOOL DENTAL SERVICE The following is the Principal School Dehtal Officer's report for the year 1965:-. The transition from the former County of Middlesex to the autonomous London Borough of Haringey took place on the 1st April 1965, and the smoothness with which the change was effected was a tribute to careful planning during the final six months of the existence of Middlesex. The former Health Area No.3 consisting of the Boroughs of Tottenham and Hornsey, had added to them the Borough of Wood Green from the former Health Area No.2, and statistics which follow in the appropriate parts of this report, being for the whole calendar year, include those for the first quarter which at that time were attributable to the County of Middlesex. Inspection and Treatment Routine dental inspections at schools occupied 204 half-day sessions. The number of school pupils examined at least once in any given year, with the expectation that necessary treatment will subsequently be provided either by our service or by the General Dental Practitioner, whichever may be the preference of the child or parent concerned, gives some measure of how far we fall short of the ideal of 100% examination. During the year under review the total number on the school rolls as at the 31st December was 33,156. Of these, 17,760 were first examined at school and a further 3,378 were first examined in the clinics, making a total of 21,138 which represents 63.7%. In addition, a further 2,666 were re-examined duringtheyear,either at schools or in the clinics,after a previous course of treatment had been completed. From the total number of those examined and re-examined, treatment was required by 13,217 (62.5%). Total attendances for treatment were 28,521, while a further 6,421 appointments were not kept (22.5%), which together accounted for 4,015 sessions. The greater part of the treatment we provide is conservative in nature as befits a dental service for young patients, and it is gratifying that we have long passed the days when the school dental service was able only toextract vast numbers of teeth for relief of pain and sepsis, with little conservation of permanent teeth and virtually none for the temporary dentition. During 1965 we completed 14,156 fillings in 12,104 permanent teeth and 7,962 in 6,826 temporary teeth, while the number of permanent teeth extracted was 761 and temporary teeth extracted 3,451. The overall ratio of permanent teeth filled to those extracted was 15.9 to 1, but as the permanent extraction total includes 395 teeth removed as an essential part of orthodontic treatment and not because of decay or infection, the more realistic ratio would be 33 to 1. The ratio of temporary teeth filled to extracted is 1.9 to 1. Compared with the National average of 5.1 : 1 and 0.6 : 1 for permanent and temporary teeth respectively, our figures give some cause for satisfaction. When extract ions are necessary it is general ly preferable for young patients that these be done under general anaesthesia. For this purpose we employ qualified anaesthetists on asessional basis, when sufficient appointments are given to justify this system. 1,651 general anaesthetics were administered during the year,the majority at these routine sessions, but some for immediate relief of pain were given by dental and medical officers. Teeth conserved by means other than filling, such as application of silver nitrate and stoning, total 2,464, whilst scaling and polishingwerecarried out for 1,149 patients. "Other operations" are necessary but usually minor items of assorted treatment whichdonot fal I logically under any other descriptive heading and these amounted to 5,578. Despite all our attempts toconserve permanent teeth whenever possible, we still found it necessary to supply 24 dentures during the year, but these were almost wholly for replacement of front teeth, either broken beyond repair or knocked out by the sort of accidents which are all too common among young and active children. 66 Despite our pre-occupation with meeting the very heavy demand for routine types of treatment, we were still able to provide some advanced conservation and preserve teeth which could not have been saved in any other way, by the provision of 7 gold inlays, 21 permanent crowns and root-filling of 22 anterior teeth. 2,178 diagnostic X-rays were taken for 676 separate patients, the majority of these being in connection with orthodontic treatment. The Orthodontic service, itself, was being hard-pressed in the earlier part of the year with a backlog of patients on the waiting lists, together with those newly being referred. A policy of reserving reference of new patients to those who would be likely to require such treatment within the near future, rather than as hitherto all such patients even when treatment clearly would not be appropriate for some considerable length of time, has allowed the artificially inflated waiting lists to be vastly reduced and, althouoh still heavily engaged, we feel ourselves in command of the situation. Patients wearing corrective appliances carried forward from the previous year numbered 175 and were added to by 142 new appliance cases during the year under review, and of these 71 were finally completed and a further 39 discontinued because of the impossibility of our obtaining the necessary patient co-operation. Many patients referred to the Orthodontists were found to require treatment which could be provided solely by carefully planned extractions at the appropriate times, and these cases do not contribute to the figures which appear above. For those patients requiring active treatment, 350 removable and 8 fixed appliances were supplied. Staffing (as at the 31st December, 1965) (Approximately 92% of our service is devoted to school children and the remainder to the priority classes reported upon elsewhere). In addition to the Chief Dental Officer, we had a whole-time equivalent of 6.4 dental officers, together with whole-time equivalent of 1.4 orthodontists and a dental auxiliary giving 0.8 whole-time equivalent. The professional officers are aided by ten whole-time surgery assistants. This complement of dental off icers, with afurther full-time off icer due tostart three days later, although below establishment, seems sufficient for the time being in meeting the demand for treatment in our present clinics,which are proving not to be situated wholly as we would wish for the dental services in relation to the schools concerned. During 1965 we had eight dental clinics in operation having a total of 13 surgeries, plus one dental surgery maintained in Suntrap Residential Special School on Hayling Island, Hants, for the treatment there of the physically delicate children residing at that school. The opening in November of the new Fortis Green Clinic brought together under one roof the Health Services, previously divided in the Muswell Hill area, and replaced the former unsatisfactory Coldfall Avenue Dental Clinic by a new two-surgery unit, which is fully up to modern standards. During the year the demand for treatment alone at the Weston Park Clinic has been such as to overwhelm the dental officer and dental auxiliary working in the two surgeries there, but it is anticipated that the opening of the additional dental clinic in Burgoyne Road, N.4. will relieve the pressure at Weston Park sufficiently to per mit routine dental inspections in schools being held at shorter intervals than within the past few years. Premises ind Equipment In the main our premises and equipment are satisfactory. It is necessary to be realistic with the very heavy cost of modernisation and a desire to replace obsolete items has to be a restrained and phased programme embarked upon so as to spread the cost over a reasonable length of time. All surgeries where routine treatment is provided are fitted with high speed air turbines; most of the obsolescent anaesthetic apparatus is being replaced by recent and more reliable models and it is hoped that within the not too distant future X-ray facilities will be available at each clinic. 67 Any plan regarding major items of equipment has to be related to the 3orough's plans for the replacement of unsuitable premises, with new equipment for the new premises provided at the appropriate time, even though this requires the use of older equipment until that day arrives. The following table shows the work undertaken during the year:- Dental Inspections and Treatment Pupils first inspected at school 17760 Pupils first inspected at clinic 3378 Pupils re-inspected 2666 Number found to require treatment 13217 Number of fillings: Permanent teeth 14156 Temporary teeth 7962 Number of teeth filled: Permanent teeth 12104 Temporary teeth 6826 Extractions: Permanent teeth unsavable 366 Permanent teeth for orthodontia 395 Temporary teeth 3451 General anaesthetics 1651 Number of dentures supplied 24 Number of crowns and inlays 28 Number of teeth root filled 22 Number of prophylaxes 1149 Number of teeth otherwise conserved 2464 Other operations 5578 Orthodontic Treatment Cases remaining from previous year 175 New cases commenced during year 142 Number of appliances fitted: Removable 350 Fixed 8 Number of impressions, adjustments etc. 4486 Number of radiographs 2178 Appointments and Sessions Attendances for treatment 28521 Appointments not kept 6421 Number of half-day sessions devoted to: Inspections in schools 204 Treatment 4015 Dental Health Education 13 68 Child Guidance Service The Borough is served by two Child Guidance Centres - at Lordship Lane, Tottenham, and at Tetherdown, Hornsey. The Lordship Lane Centre is attended by two consultants - Dr. Nina Meyer, who acts as Medical Director, and Dr. Jack Waldman. At the Tetherdown Centre, the consultant psychiatrist and Medical Director is Dr. K.A. Graf. Miss Gwen Kidgell is the Senior Educational Psychologist with overall responsibility for the administration of the child guidance and school psychological service. The staff of the service also includes three educational psychologists, two psychotherapists, four psychiatric social workers, and four clerical assistants who between them work equivalent hours to three full-time officers. It is hoped to increase the clerical establishment to five in the future. Dr. Nina Meyer reports as follows on the work at Lordship Lane Centre:- "The work of the Clinic continues to expand. The number of referrals for the Child Guidance Clinic is now in the region of 130 per year which, allowing for annual leave, means three referrals per week. Unfortunately, owing to the illness of Dr. Nina Meyer, the waiting lists have extended, and work is now mainly concerned with priority cases of urgent need. Some children present with incipient schizophrenia; others with symptoms suggestive of organic illness; school refusal and gross behaviour disorders, where children become a danger to themselves or others, are a frequent pattern in children we are now seeing. Recently the Regional Hospital Board asked for a list of adolescents for whom inpatient treatment might be helpful. We found that of our adolescents, 80% were such cases. TheClinicfor the under-fives continues to grow, with a total number of 145 referrals since the clinic started in August 1961. Although these children need a great deal of care, the response is most rewarding, since many have an above average potential for healthy development, although reacting to difficulties in their environment with symptoms of grave disturbance. Help now can be crucial for their future wellbeing, but we need more facilities. Nursery schools, where attendance mornings or afternoons can hehp the child to emancipate from a too close mother/child relationship, and initiate him into healthy social andgroupactivity. Phobias, difficulties with eating and sleeping, breakdown in toilet training, physical disability, emotional and even intellectual retardation, respond to simple therapeutic measures. We are getting an increasing number of referrals from outside agents, such as paediatric departments and hospitals, general practitioners, and frequently mothers themselves. For this age group, an increase in psychiatric time is a primary need". Dr. K.A. Graf reports as follows on the work at Tetherdown Clinic:- "This is my fourth report since seconded by North West Metropolitan Regional Hospital Board to services as consultant psychiatrist in the area, but my first as Medical Director of newly-named Tetherdown Child Guidance Centre of the London Borough of Haringey. The child psychiatrist holds clinical responsibility, being mainly concerned with diagnosis and treatment of the young clients, while he also maintains as a specialist in the health service contact with his medical colleagues in the school health service, general practice and hospitals, acting frequently as a co-ordinating officer between the many agencies interested in children's welfare. The time he has at his disposal during his two sessions is limited, but the weekly evening session has been found particularly useful for those children and parents who would miss work or school when attending during the day. The psychiatrist managed to see 108 individual cases (including 34 reviews) during the year and has given 2-3 children more regular psychotherapeutic help, while all the other children from our ever increasing diagnostic and treatment waiting lists, are seen after assessment, if regarded suitable for regular therapy, by Mrs. Benjamin. The majority of referrals have come through the educational psychologists from head teachers, with the co-operation of the parents who, themselves, referred some children. Next in frequency were referrals from school medical officers, and other cases reached us from general practitioners, hospital doctors, child care, probation and school welfare officers. The majority of cases could be described as behaviour problems related to environmental factors, including parental problems. School phobia, a child's neurotic disability to attend school was again quite frequent and always most difficult to deal with, while we had a variety of personality problems and neurotic disorders of more or less serious nature. Psychoses of childhood, including autistic children, were fortunately relatively few, but their disposal and management created each time a big problem because of the scarcity of places available nationally for their treatment. Equally, have we remained handicapped by the difficulty of getting places for maladjusted pupils into boarding schools, there being so much competition from ail over the country for the few available places that head masters can select the most promising cases, while children who have shortcomings in personality and intelligence or are less likely to respond favourably, yet would require residential treatment all the more to rehabilitate them to society, cannot be found places and frequently deteriorate. The increasing immigrant population form special problems which are often not really within the scope of the child guidance service, although we are approached by frustrated teachers who notice the disturbing influence or unhappiness of a child. 69 All cases are assessed by the traditional three experts of the child guidance team before treatment or other therapeutic measures are decided upon. I am rather disappointed that, in 20 cases suggested for a psychiatric opinion, the parents failed to come and see me,which seems to reflect the unnecessary awe of the psychiatrist and fear of stigma of psychiatric examination in spite of all efforts to stress the prophylactic value of psychiatric services to mental health and the enlightenment of the public on the role of the psychiatrist as adviser on normal emotional problems rather than the therapist of mental patients. Especially in the child guidance service would he prefer to be consulted whenever a child seems unhappy about a personal problem in home or school and not only to exclude mental disturbance. On the other hand, we appreciate very much that there are limitations to our competence and we are acutely aware that we can be of little avail if a child's difficulties are not promoted by personal problems or tensions within the family setting, but theresult of unalterableenvironmental circumstances, social conditions or complete insightlessness of parents and lack of co-operation of the young person. Such cases, if presenting serious social problems are frequently better dealt with by agencies who can apply a degree of coercion which we must never apply. Rheumatism Supervisory Centre The Rheumatism Supervisory Centre operates at the Prince of Wales's Hospital under the overall direction of Dr. I.M. Anderson, consultant paediatrician, with the close co-operation of the Health Department. Weekly sessions are held. Originallytheclinicwas set up to deal with children suffering from acute rheumatism and its aftereffects; but its scope has widened to include the investigation of symptomless heart murmurs found at routine medical inspections and of cases of congenital heart defects. Dr. Anderson reports:- "Rheumatic Fever is now becoming uncommon, but congenital heart disease still occurs as one would expect. I think it is stll important to have a centre to which to refer cardiac problems, although they do not appear to be of great magnitude. I would like to say that there is still a close link between your department and mine in relationship to many paediatric problems from infancy to late childhood and I appreciate considerably the help that I obtain from your medical officers and your health visitors". The following is a summary of the new cases seen at the clinic during 1965:- There were three new cases of rheumatic fever-two male and one female - all of whom were admitted to hospital. 20 new cases with cardiac murmurs were seen - 13 male and seven female, and these cases were classified as follows:- Patent Ductus Arteriosus 1 Aortic Stenosis 2 Ventricular Septal Defect 3 Atrial Septal Defect 6 Innocent Murmur 8 Everyeffort is made to ensure that adequate information concerning diseases which may affect the administration of anaesthetics for dental extractions is entered on the child's dental record card. Speech Therapy There are three part-time speech therapists, who carry out 20 sessions per week and are therefore equivalentto two full-time staff. This is two below the establishment of four full-time therapists. Miss J.D. Came, Senior Therapist, reports:- "Without further staff, thefull needs of theBorough including those of the mentally handicapped child, cannot be met. The speech therapist in Hornsey reports increased interest and better attendances. The attractive new clinic at Fortis Green is appreciated. The interesting collaboration with Mr. Brown, Headmaster of Blanche Nevile School, in the treatment of a few partially-hearing children, with unusual voice and speech disorders has continued". 70 Tuberculosis Prevention of Tuberculosis by B.C.G. Vaccination B.C.G. vaccination is offered to all school children over the age of 13 years. As the B.C.G. scheme is operated under Section 28 of the National Health Service Act, it is not confined to children attending maintained schools, but is available to all children of the appropriate age. B.C.G. vaccination is also available to further education students up to the age of 21. The following table gives details of the B.C.G. vaccination carried out by the Council during 1965:- School Children Students* Total Number % Number % Number % Parents approached 2705 19 2724 Parents accepted 2262 83.6 19 100.0 2281 83.7 Number skin tested 2213 15 2228 Number found positive 199 9.0 11* 73.3 210 9.4 Number found negative 1880 84.9 4 26.7 1884 84.6 Number failed to attend for Mantoux reading 134 6.1 - - 134 6.0 Number vaccinated (% of those approached) 1880 69.5 4 21.0 1884 69.2 *Of the 11 students with positive results, 9 were found to have already had B.C.G. vaccination. Cases of tuberculosis occurring in teachers or pupils Where a member of the staff or pupil at any school in the Borough is found to be suffering from tuberculosis, investigations into all school contacts are undertaken, where these are necessary, under the supervision of the chest physician. A case of tuberculosis is not necessarily always infectious, but where it is, steps are taken by skin testing and X-rays, to determine whether any contacts are affected. In two instances during 1965, the chest physician recommended epidemiological investigation at the school. One case was a teacher, the other a pupil whose case was brought to light during routine B.C.G. vaccination at the school. In both cases, investigations showed that no other members of the school had been infected. Testing of school entrants for susceptibility to tuberculosis At this age, skin testing by the multiple puncture (Heaf Gun) method is used more for family case finding than for individual disease in the children. However, because of the changing population and the very large number of children entering school direct from overseas, screening of school entrants by this method is under consideration. Uncleanliness and Verminous Conditions School nurses visit the schools regularly to carry out hygiene inspections. While verminous heads are now the exception rather than the rule, vigilant watch is kept to prevent the spread of infection. The following details are submitted concerning hygiene inspections carried out in 1965:- Number of individual examinations of pupils in schools by school nurses 61260 Number of individual pupils found to be infested 284 Ringworm of the scalp There were 15 cases of ringworm of the scalp found sporadically in schools throughout the year. This is a fungal infection of the scalp, mildly contagious, but serious if undiagnosed and untreated. The children concerned were excluded from school. The rest of the children in the school were examined by means of a Wood's fluorescent lamp, and there was no spread from the original cases. 71 Verrucas The steady increase in the incidence of verruca (plantar wart) continues to cause concern. Investigations are proceeding into the most effective methods of treatment. It is necessary ruthlessly to exclude from swimming all children with foot ailments of any kind until they have been examined by a school doctor or school nurse. I would stress the need for even greater attention to hygiene in the swimming baths, including more frequent sluicing of the baths precincts. In addition, physical education should never be carried out in bare feet. Handicapped Pupils The Education Act 1944 places on local education authorities the duty of ascertaining handicapped pupils in their areas and of providing special educational treatment for such children. Though it is the duty of the local authority to ascertain these children from the age of two years, it is often desirable, especially in the case of blind, deaf or cerebral palsied children, that the defect be discovered before this age, so that steps may be taken to help the child to develop as normally as possible despite his handicap. The School Health Service and Handicapped Pupils Regulations 1959 defined the various categories of handicapped pupils as follows:- Blind Epileptic Partially Sighted Maladjusted Deaf Physically Handicapped Partially Hearing Delicate Educationally Subnormal Children suffering from speech defects Pupils handicapped by severe blindness or deafness are normally educated in special schools. Special educational treatment may be provided for other categories in an ordinary school with special considerations appropriate to the disability. Where this is not appropriate, arrangements are made for handicapped children to attend day or residential special schools. Home tuition may be arranged on a temporary or permanent basis for children unsuitable for education at school. The following table shows the number of pupils newly ascertained as handicapped, and newly placed in special schools during the year, and the distribution of ascertained handicapped children on the 20th January, 1966:- 72 73 RETURN OF ASCERTAINED HANDICAPPED PUPILS REQUIRING SPECIAL EDUCATIONAL FACILITIES CATEGORY IN THE CALENDAR YEAR DISTRIBUTION ON 20TH JANUARY 1966 Number newly ascertained as requiring education in a Special School (other than hospital Special Schools) Number newly placed in Special Schools (other than hospital Special Schools) Number on register of - Number requiring places in Special Schools Number on register of hospital Special Schools Number being educated at home under arrangements made under Sec.56 Education Act 1944 Total Maintained Special Schools Non-maintained Special Schools Independent Schools Day Boarding Day Boarding Day Boarding Boys Girls Boys Girls B G B G B G B G B G B G B G B G B G B G Blind Pupils - - - - - - 1 1 - - 4 1 2 1 - - - - - - - - 7 3 Partially Sighted Pupils 2 2 1 2 5 2 1 1 - - 1 - - - - - 1 - - - - - 8 3 Deaf Pupils 2 1 2 1 8 8 2 - - - 1 - - - - 1 - - - - - - 11 9 Partially Hearing Pupils 5 3 5 3 7 5 - - - - - 2 - - - 1 - - - - - - 7 8 Physically Handicapped Pupils 12 3 14 4 30 21 1 - - - 4 2 - - 1 1 - - - - - - 36 24 Delicate Pupils 9 10 10 12 19 23 9 3 - - 4 1 1 - - 1 1 1 - - - - 34 29 Maladjusted Pupils 9 2 5 2 - - 11 - - 1 7 7 23 6 - - 1 - - - 1 - 43 14 Educationally Subnormal Pupils 31 11 28 9 96 58 13 7 - - 2 - 2 - 2 2 - 1 - - - " 115 68 Epileptic Pupils 1 - 2 - - - - - - - - - - - - - - - 4 - - - 4 - Pupils with Speech Defects - - - - - - - - - - 1 - - - - - - - - - - - 1 - Totals 71 32 67 33 165 117 38 12 - 1 24 13 28 7 3 6 3 2 4 - 1 - 266 158 Grand Totals 103 100 282 50 1 37 35 9 5 4 1 424 Special School Provision (a) Day Special Schools There are two day special schools situated in the Borough - Vale Road School for Physically Handicapped Children and Blanche Nevile School for the Deaf, which includes units for partially-hearing children at Devonshire Hill Junior and Markfield Senior Schools. Of the 90children on the roll at Vale Road Special School, 49 were Haringey children and 41 children from other Boroughs. Of the 113 children on the roll at Blanche Nevile School (including the Devonshire Hill and Markfield units), 29 were Haringey children and 84 from other Boroughs. Day special school facilities for children in other categories have to be sought outside the Borough. It is a matter of particular concern that places must be sought for educationally subnormal children at either Durants or Oak Tree Schools, Enfield, or Oak Lodge, Finchley. At present there are 43 Haringey children at Durants, 56 at Oak Tree and 55 at Oak Lodge, and it would seem that there is a need for educational provision for these children within the Borough. The other categories of handicapped pupils requiring day special schooling are placed in the following schools outside the Borough:- Blind Dorton House School, Sevenoaks or Lindon Lodge School, Wimbledon Partially-sighted Joseph Clarke School, Walthamstow or Harborough School, Islington Delicate Hazelbury Open-Air School, Edmonton The number of children placed in these schools is quite small in each case. (b) Residential Special Schools The one residential special school belonging to the Borough is Suntrap Residential Open-Air School, Hayling Island, Hants. The School accepts delicate and physically handicapped children, most of whom are cases of asthma, rheumatic heart, minor degrees of emotional disturbance, and varying degrees of nervous and physical debility. Suntrap School belonged to the former Borough of Tottenham until 1945,when as the result of the Education Act 1944 ownership was transferred to the former Middlesex County Council. The re-organisation of London Government resulted in the transfer of the School to the London Borough of Haringey on 1st April 1965. Suntrap School offers a very wide range of educational facilities and is situated in very pleasant surroundings which are extremely conducive to the improvement of the health and well-being of the children. There is a residential fully-trained nursing staff, including a night nurse. A medical practitioner attends twice a week as a routine, and a dental officer once a week. The number of children placed at Suntrap at the end of the year was 96, of whom six were Haringey children and 90 children from other Boroughs. In future preference will be given to Haringey pupils who will not have to be sent to other authorities' schools. Children in the other handicapped categories who require residential schooling are placed in schools administered by other local authorities or independent bodies (apart from epileptic children who are placed in hospital special schools). The only category involving a large number of children is that of maladjusted pupils. Hospital Classes These classes are provided at St. Ann's and the Prince of Wales's Hospitals, under Section 56 of the Education Act 1944. At the end of the year 33 children were receiving tuition in the classes. Special Classes attached to ordinary schools In addition to the units for partially-hearing children already mentioned, there are five 'Opportunity' (or Remedial) inter-school Classes, for children with a normal range of ability but with learning difficulties. Placement in these classes is temporary. 74 At the end of 1965 the number of children on the rolls of the Opportunity Classes was 63(44boys, 19 girls). There are also five peripatetic teachers who take children either individually or in small groups for specific help with reading. Autistic Children Among handicapped children are some who do not seem to fall within any of the classified categories for example, autistic children. There would appear to be a case for considering the establishment of a special care unit, in close co-operation with the mental health services, for such children. Home Tuition During the year six children received home tuition for varying periods, under Section 56 of the Education Act 1944. Of these children, four suffered from physical handicap and two from maladjustment. Day Nurseries - Admission of Handicapped Children The Council's Day Nursery Scheme provides for the attendance at day nurseries of handicapped children who are recommended for admission, in the following categories:- (i) Deaf, partially-hearing, physically handicapped, maladjusted, partially-sighted children (ii) Mentally handicapped children under three years of age. (iii) Children over one year of age of deaf or deaf/mute mothers. No charge is made to the parents of these children. For children in category (i) over the age of two years, the cost of attendance is borne by the Education Committee under Section 56 of the Education Act 1944. Other cases are dealt with under Section 22 of the National Health Service Act 1946. Admission may be for the whole or part of the day. During 1965, five Haringey children, one child from Enfield and one from Hackney were in attendance at day nurseries in the Borough under these arrangements. At the end of the year, three Haringey, one Enfield and one Hackney child were still in attendance. Recuperative Holidays During 1965, thirteen boys and eleven girls were recommended for recuperative holidays in order toassist their recovery after illness. Eleven boys and six girls were placed in suitable homes for periods of varying length. Special Investigations National Child Development Study The school health service continued to co-operate in this study, which is a national survey being carried out on every baby born during one week in March 1958. For each child included in the survey a detailed questionnaire was completed at personal interviews by health visitors with the parents, and subsequently special medical examinations were arranged, and the results reported to the Study. 75 LIST OF SCHOOL HEALTH CLINICS AS AT 31st DECEMBER, 1965 a - Minor Ailment e - Orthopaedic i - Ear, Nose & Throat b - Dental f - Physiotherapy j - Audiology Unit c - Ophthalmic g - Cerebral Palsy Unit k - Child Guidance d - Orthoptic h - Speech I - Chiropody a All Saints' Church Hall, 11 Church Road, N.6 j Blanche Nevile School for the Deaf, Philip Lane, N.15 a Campsbourne School Clinic, Boyton Road, N.8 b Chestnuts Clinic, 268 St. Ann's Road, N.15 k Child Guidance Centre, Tetherdown, N.10 abh School Clinic, 128 Cornwall Road, N.15 abh Medical Centre, 150 Fortis Green, N.10 ah Gordon Road Clinic, 1a Gordon Road, N.11 b Dental Clinic, 334 High Road, N.15 abcdefhkl Medical Centre, 239 Lordship Lane, N.17 ah Mildura Court Clinic, 18 Gisburn Road, N.8 abhi Medical Centre, 131 Park Lane, N.17 a Somerset Road Clinic, 370 High Road, N.17 abci Stuart Villa Clinic, 11 Stuart Crescent, N.22 abcdefhil Medical Centre, rear of Hornsey Town Hall, 23a Weston Park, N.8 dfgh Vale Road School for Physically Handicapped Children, N.4 76 APPENDIX SCHOOL HEALTH SERVICE STATISTICS FOR 1965 SCHOOL HEALTH SERVICE STATISTICS 1965 PUPILS FOUND TO REQUIRE TREATMENT AT MEDICAL INSPECTION Number of individual Pupils found at periodic medical inspections to require treatment (excluding dental disease and infestation with vermin) Year of Birth For defective vision (excluding squint) For any of the other conditions recorded Total individual Pupils 1961 & Later 1 11 11 1960 63 185 230 1959 99 228 298 1958 32 55 77 1957 114 118 208 1956 77 66 142 1955 27 22 44 1954 191 128 293 1953 278 208 434 1952 117 108 190 1951 161 95 226 1950 & earlier 467 211 628 Total 1627 1435 2781 Periodic Inspections Defect Code No. Defect or Disease Entrants Leavers Total including all other age groups inspected Special inspections T O T O T O T O 4 Skin 45 65 66 52 337 268 599 9 5 Eyes (a) Vision 163 159 531 69 1627 550 228 52 (b) Squint 23 6 9 6 60 19 6 1 (c) Other 15 8 15 6 76 39 72 5 6 Ears (a) Hearing 11 43 6 23 55 176 139 37 (b) Otitis Media 9 59 5 13 27 137 3 3 (c) Other 10 20 3 7 16 64 60 10 7 Nose and Throat 108 258 13 36 183 581 88 40 8 Speech 29 48 3 8 58 100 93 33 9 Lymphatic Glands 3 77 - 4 4 149 10 6 10 Heart 8 32 3 46 21 156 6 12 11 Lungs 22 78 4 44 57 226 13 8 12 Developmental: (a) Hernia 6 20 - 3 16 39 2 1 (b) Other 3 37 1 16 20 148 14 30 13 Orthopaedic: (a) Posture 7 8 7 34 28 96 12 5 (b) Feet 78 118 60 60 308 399 26 23 (c) Other 14 31 18 35 66 143 72 10 14 Nervous System: (a) Epilepsy 2 10 2 1 12 24 3 2 (b) Other 1 11 4 7 12 56 11 3 15 Psychological: (a) Development 5 35 - 5 9 66 55 10 (b) Stability 18 152 8 42 49 444 52 28 16 Abdomen 3 20 3 7 16 66 3 2 17 Other 10 35 7 9 25 88 184 41 T - Requiring Treatment O - Requiring Observation 77 TREATMENT OF PUPILS ATTENDING MAINTAINED PRIMARY AND SECONDARY SCHOOLS (INCLUDING NURSERY AND SPECIAL SCHOOLS) Number of cases known to have been treated GROUP 1. Eye Diseases (e.g. blepharitis, conjunctivitis) Defective vision and Squint (a) External and other, excluding errors of refraction and squint 46 (b) Errors of refraction, including squint 2150 Total 2196 (c) Number of pupils for whom spectacles were prescribed 941 GROUP 2. Diseases and Defects of Ear, Nose and Throat Received operative treatment for:- (a) Diseases of the ear 1 (b) Adenoids and Chronic Tonsilitis 276 (c) Other nose and throat conditions 5 Received other forms of treatment 253 Total 535 Total number of pupils in schools known to have been provided with hearing aids: (a) During the current year 6 (b) In previous years (excluding any pupils shown at (a) above who were provided with an aid in a previous year 46 GROUP 3. Orthopaedic and Postural Defects Number of pupils known to have been treated at clinics or at out-patients departments 811 GROUP 4. Diseases of the skin (excluding uncleanliness) Ringworm (i) Scalp 15 (ii) Body - Scabies 3 Impetigo 4 Other skin diseases 422 Total 444 GROUP 5. Child Guidance Treatment Number of pupils treated at child guidance clinics (including cases sent to the Tavistock and other hospital clinics) 137 GROUP 6. Speech Therapy Number of pupils treated by speech therapists 198 GROUP 7. Other Treatment given (a) Number of miscellaneous minor ailments treated by the Council 87 (b) Treatment ether than (a) above and excluding convalescent treatment 132 78 EDUCATION ACT 1944 - SECTION 57 Cases dealt with under Section 57, Education Act 1944 9 Cases de-notified under Section 8, Education (Miscellaneous Provisions) Act 1948 - MEDICAL EXAMINATION OF TEACHERS (a) Number of Teachers examined as to fitness for appointment 70 (b) Number of Students examined as to fitness for first appointment 168 (c) Number of Students examined as to fitness to undertake training course 205 (d) Number of Students examined on completion of training course 49 79 INDEX Page No. Abatement of Statutory Nuisances 22 Adult Training Centre 54 Analysis of Contraventions found in Offices and Shops 33 Analysis of Reported Accidents in Offices and Shops 34 Ante-Natal Clinics 36 Audiology Unit 63 Audiometry 65 Autistic Children 75 Births, Notification of 36 Carcases inspected 29 Care of Mothers and Young Children 36 Cerebral Palsy Unit 61 Certificate of Disrepair 27 Child Guidance Service 69 Child Minders, Registered 40 Chimney Heights 15 Chiropody Service 51 Clearance of Areas of Unfit Houses 23 Clinics, School Health 76 Congenital Malformations 37 Daily Guardian Scheme 39 Day Nurseries 39 Day Nurseries, Admission of Handicapped Children 75 Day Nurseries, Private 40 Deaths of Haringey Residents 6 Defects found in factories 35 Defects remedied 21 Dental Care for Priority Classes 41 Dental Inspection and Treatment 66 Dental Premises and Equipment 67 Dental Staffing 67 Dental Statistics 68 Diseases of Animals Act 1950 22 Disrepair, Certificate of 27 Domestic Help Service 47 Drainage and Sewerage 12 Dysentery 9 Ear, Nose and Throat Clinics 62 Education Committee 57 Factories 34 Factories, Defects found in 35 Flooding 12 Fluoridation in interests of Dental Health 42 Food, Fitness for Human Consumption 29 Food Hygiene 28 Food Poisoning 8 Food Premises, Registered 28 Food Sampling 30 Furnace Installations 15 Page No. Handicapped Pupils 72, 73 Health Education 51 Health Visiting Service 43 Health and Welfare Committee 1 Home Nursing Service 45 Hospital Classes 74 Housing 23 Housing Applications, assessment on medical grounds 27 Houses in Multiple Occupation 24, 26 Immigrants, long stay, medical arrangements for 11 Immunisation against Diphtheria, Whooping Cough, Tetanus and Poliomyelitis 11 Improvement of Houses not in improvement areas 24 Incontinent Pads Service 46 Individual Unfit Houses 24 Infant Welfare Clinics 38 Infectious Diseases 8 Infectious Diseases, Notification of, by sex and age group 7 Infective Hepatitis 10 Insect Pests 19 Inspections carried out by Public Health Inspectors 20 Junior Training School 54 Leprosy 10 Liquid Egg (Pasteurisation) Regulation 1965 30 Malaria 9 Measles 8 Meat Inspection 29 Medical Arrangements for Long Stay Immigrants 11 Medical Inspections, Periodic 59 Meningococcal Meningitis 8 Mental Health Services, Development of 54 Mental Health Statistics 55, 56 Mentally III, Hostels for 54 Mentally Sub-normals, Hostels for 54 Midwifery Service 42 Midwives Ante-natal Clinics 37 Milk and Dairies Regulations 29 Milk Supplies, Brucella Abortus 30 Mortuary 19 Mothercraft and Relaxation Classes 38 Mothers and Young Children, Care of 36 Multiple Occupation, Houses in 24, 26 National Assistance Act 1948,Section 47 48 Neighbourly Help Service 47 Noise Nuisance 19 Nursing Homes 48 Offices, Shops and Railway Premises Act 1963 32 Ophthalmic Clinics 60 Orthopaedic Clinics 62 Outworkers 35 Partially-Hearing Children, Special Classes for 64 Periodic Medical Inspections 59 Persons employed in registered premises 33 Pet Shops and Animal Boarding Establishments 23 Poliomyelitis 8 Private Day Nurseries 40 Problem Families 44 Problem Families, Co-ordinating Committee 45 Purchase of Houses in advance of Council's requirements 24 Page No. Rag Flock and Other Filling Materials Act 1951 22 Recuperative Holidays 49, 75 Registered Child Minders 40 Registered Food Premises 28 Research 44 Retirement Advice Clinics 47 Rheumatism Supervisory Centre 70 Ringworm 71 Rubella 10 Sanitary Circumstances of the Area 12 School Advice Clinics 60 School. Dental Service 66 School Health Clinics 76 School Health Service 58 School Health Statistics 77 School Population 59 Shops Act 1950 - 1965 34 Sick Pay Reports 50 Smallpox 9 Smallpox, Vaccination against 11 Smoke Control Areas 15 Special Investigations 75 Special Schools 74 Speech Therapy 70 Staff 2, 3, 4 Staff Medical Assessments and Examinations 50 Staphylococcal Infection 8 Statistics, Dental 68 Statistics, School Health 77 Statistics, Vital 5 Statutory Notices Served 21 Statutory Nuisances, Abatement of 22 Street Trading 34 Student Health Visitors 43 Swimming Baths and Paddling Pools 15 Toddlers Clinics 39 Tuberculosis 71 Tuberculous Patients, Extra nourishment for 48 Tuberculosis Rehabilitation 48 Typhoid 8 Uncleanliness and Verminous Conditions 71 Unfit Houses, Clearance of 23 Unfit Houses, Individual 24 Unsound Food surrendered or condemned 30 Uplands Road Improvement Area 24 Unsupported Mothers, Care of 49 Vaccination and Immunisation 11 Vaccination against Smallpox 11 Verrucas 72 Vital Statistics 5 Water Supplies 13 Welfare Foods, Distribution of 41 Work executed by the Council 22 Produced by the Health Department of the London Borough of Haringey: Medical Officer of Health, Tottenham Town Hall, The Green, High Road, Tottenham, N.15 (Telephone TOT 1000) Printed by the Libraries Department of the London Borough of Haringey