I HAR 2 Health Department, Tottenham Town Hall, The Green, High Road, Tottenham, N. 15. To: The Worshipful the Mayor, Aldermen and Councillors of the London Borough of Haringey. Ladies and Gentlemen, I have the honour to present the report to the people of the Borough of Haringey for the year ended 31st December 1966. The second year in the Health Department has seen the opening of a new clinic in Burgoyne Road, and progress has been made in the planning for the future, for a health centre at Stuart Crescent, Wood Green, an adult training centre at Bounds Green Road and a residential hostel for mentally sub-normal men at Linden Road. The Burgoyne Road Clinic houses the Maternity and Child Welfare Clinics together with the Dental Clinics and School Health Services in new premises on the extended site of a church hall formerly used as a clinic, and it will serve a populous area where there are many homes with young families. The statistics obtained in Haringey confirm several of the national trends and show that there is an increase in the number of women under the age of 65 who now die from lung cancer. There is an increase in the number of men who die from coronary thrombosis, and the increase in this disease has been attributed to our increasingly sedentary way of Iife. Too many people, especially men in the middle years of life, are taking less exercise than the equivalent of a one mile walk per day. The most disappointing figure is the recorded total of seven maternal deaths, and at least two of these were directly attributed to attempted abortion. The return made to the Department of Education and Science in January 1966 shows that the Borough has a higher proportion of immigrants in proportion to its population than any other in the country. There were no fewer than 7,726 children of immigrant origin out of a school roll of 33,753. The general impression in the Health Department is that about half the new babies are born to immigrants and about half of these are of African descent. There has been an overall diminution in the total population although there is an increase in the number of dwellings. During the year much work has been done to improve the standard of housing environment with several clearance areas, special attention to the maintenance of reasonable standards in those large houses which have been left in multiple occupation, and the establishment of improvement areas in Uplands Road and Arnold Road. The Department has had a noticeable increase in the demand for the training of a wide variety of professional staff, a demand which must be met in the interest of progress generally and in keeping with our responsibility as a London borough with ready access to a variety of facilities for student training. This has helped to reveal shortages of certain categories of staff:, many of the clinics are now being staffed by part-time medical officers, and few applications are received for vacancies in such posts as public health inspectors, health visitors, nurses, midwives and medical auxiliaries. The shortage of chiropodists was brought to light when the Council took over the voluntary organisations' chiropody services during the year. There is an ever-increasing demand for the services of our Home Helps. In conclusion, I wish to record my thanks to the Chairman and Members of the Health and Welfare Committee for their encouragement and support, to the family doctors, to the hospital services and their staffs, and to the various voluntary organisations and the Chief Officers of the Borough for their help and collaboration in the task of promoting the health of the residents of Haringey. My thanks are due also to the staff of the Health Department for their loyal and efficient service during a busy year. I have the honour to be Your obedient Servant, J.L. PATTON, Medical Officer of Health. HEALTH AND WELFARE COMMITTEE 1966/67 The Mayor Alderman Mrs. A.F. Remington, 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, F.R.S.H. Mrs. D. Cunningham, J.P. Mrs. D.C. Findley B.L. Greenway, M.I.C.M. F.C.V. Hayward F.A. Knight B.D. Lipson, LL.M. Mrs. L.H. Lipson, M.C.S.P., H.T. C.D. Moss (Chairman) Mrs. M.E. Protheroe (Vice-Chairman) Mrs. Brenda S. Remington, B.A. Mrs. J.E. Thexton R.G. Wigley James T. Wilkins Co-opted Members Dr. A.M. Freeman Mr. F.A. Rhodes Mr. D.E. Suffolk STAFF OF HEALTH DEPARTMENT AS AT 31.12.66 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., D.P.M. 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. K.V. Shah, M.B., B.S. (Bombay) 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. Z. Zubrzycki, Med.Dipl., D.P.H., 2 Vacancies 6 Sessional and 4 Part-time Medical Officers 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. A.H. Landsman, L.D.S., R.C.S. 4 sessional dentists : 5 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 8 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: Margaret J. Saywell, S.R.N., H.V. 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 3 vacancies for senior health visitors; 23 health visitor/school nurses: 1 sessional health visitor/ school nurse: 6 vacancies: 3 student health visitors: 1 vacancy: 3 T.B. health visitors: 10 clinic nurses: 2 sessional clinic nurses: 4 day nursery matrons: 4 deputy matrons: 3wardens: 1 part-time warden: 17 staff nursery nurses: 2 part-time staff nursery nurses: 1 nursery assistant: 1 part-time nursery assistant. 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: Dorothy E. Wynn-Jones, S.R.N., S.C.M. 20 midwives: 2 part-time midwives Deputy Superintendent of Home Nurses: Berthe F. Specht, S.R.N., S.C.M., Q.N. 30 home nurses: 4 part-time home nurses: 2 bath unit attendants Chiropodists 1 full-time: 16 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: Barbara Johnson, Dipl. in Sociology., Mental HealthCert. 2 senior mental welfare officers: 5 mental welfare officers: 1 vacancy Home Help Organiser: Vacancy 4 assistants: 210 home helps Red Gables Mother and Baby Home: Matron: Mabel K. Hopkins, S.R.N. Deputy Matron: vacancy 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. Health Education Officer: Sheila M.P. Frost, S.R.N., S.C.M., H.V. 1 assistant 3 Chief Public Health Inspector: W.J. Wilson, D.P.A., M.A.P.H.I., M.R.S.H. Deputy Chief Public Health Inspector: E.S. Glegg, M.A.P.H.I., A.M.I.P.H.E. Senior Public Health Inspectors: F.H. Canton, M.A.P.H.I. E.S. Gray, M.A.P.H.I. A.E. Clarke, M.A.P.H.I.. A.M.I.P.H.E. J.A. Harris, M.A.P.H.I. W.E. Goodfellow, M.A.P.H.I. F. James, M.A.P.H.I. 17 public health inspectors: 3 vacancies: 6 pupil public health inspectors: 4 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: 7 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., M.R.S.H. Accounts, Wages, Supplies, Child Health and Domiciliary Care Division: Buildings and Transport Division: H.J. Dunham, B.A. (Divisional Head) N.P. Child (Divisional Head) S.E. Woodroffe (Section Head) L.E. Wells (Section Head) B.W. Ford (Section Head) J.W. Bailey (Section Head) 28 administrative and clerical assistants: 7 clerical assistants: 1 vacancy 7 part-time clerical assistants Prevention, Care, After care and Environmental Health and Infectious Mental Health Division: Diseases Control Division: P.V. Ingram (Divisional Head) A.W. Lawrence, M.A.P.H.I. (Divisional Head) Hazel Gill (Section Head) H.C.B. Wheal (Section Head) Hetty L. Somers (Section Head) H.P. Bradford (Section Head) 8 clerical assistants 12 administrative and clerical assistants: 1 vacancy Secretariat: A. Balls (Section Head) Anne Gates (Supervisor of Typing Section) Florence Wetherall (M.O.H's Secretary) 5 administrative and clerical assistants: 1 part-time clerical assistant: 5 shorthand-typists: 1 part-time shorthand-typist: 4 copy typists: 2 part-time copy typists: 1 machine operator. 4 VITAL STATISTICS 1965 1966 Area of District (in acres) 7,491 7,491 Population - Mid-year Registrar General's estimate 256,750 254,650 Rateable Value as at 1st April £13,277,781 £13,456,474 Sum represented by penny rate £54,000 £54,200 Approximate Number of Dwellings in District 70,842 71,483 Registered live births: Males 2,848 2,854 Females 2,763 2,750 Total 5,611 5,604 Birth rate per 1,000 estimated population 21.85 22.00 No. of live births which were illegitimate 726 670 (12.94%) (11.96%) Stillbirths: Males 34 42 Females 46 38 Total 80 80 Stillbirth rate per 1,000 total (live and still) births 14.06 14.07 No. of stillbirths which were illegitimate 11 13 (13.75%) (16.25%) Deaths: Males 1,386 1,459 Females 1,479 1,454 2,865 2,913 Death rate per 1,000 estimated population 11.16 11.44 Maternal Mortality: Deaths from Puerperal Causes 3 7 Death rate per 1,000 total (live and stillbirths 0.527 1.232 Deaths of infants under 1 year of age (Infant Mortality) (a) Legitimate Males 40 52 Females 37 32 77 84 Death rate per 1,000 legitimate live births 15.76 17.02 (b) Illegitimate Males 12 9 Females 11 6 Total 23 15 Death rate per 1,000 illegitimate live births 31.68 22.39 (c) Total Males 52 61 Females 48 38 Total 100 99 Death rate per 1,000 total live births 17.82 17.67 Deaths of Infants under 4 weeks (Neo-natal Mortality) 73 61 Rate per 1,000 live births 13.01 11.78 Deaths of Infants under 1 week (Early Neo-natal Mortality) 66 61 Rate per 1,000 live births 11.76 10.89 Stillbirths and deaths under 1 week (Perinatal Mortality) 146 141 Rate per 1,000 live and stillbirths 25.65 24.81 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 1966 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 6 CLASSIFIED DEATHS OF HARINGEY RESIDENTS SHEWING AGE GROUP AND SEX DISTRIBUTION 1966 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 5 2 - - - - - - - - - - - - 1 - 1 - - - 2 - 1 2 Tuberculosis, other - - - - - - - - - - - - - - - - - - - - - - - - Syphilitic disease 4 2 - - - - - - - - - - - - - 1 2 - 1 - 1 1 - - Diphtheria - - - - - - - - - - - - - - - - - - - - - - - - Whooping Cough 1 - - - 1 - - - - - - - - - - - - - - - - - - - Meningococcal infection 1 1 - - 1 - - 1 - - - - - - - - - - - - - - - - Acute poliomyelitis - - - - - - - - - - - - - - - - - - - - - - - - Measles - - - - - - - - - - - - - - - - - - - - - - - - Other infective and parasitic disease 3 7 - - - 2 - 1 1 - - 1 - - - - - 1 2 - - - - 2 Malignant neoplasm, stomach 31 25 - - - - - - - - - - - - - 1 5 1 8 4 8 7 10 12 Malignant neoplasm, lung bronchus 154 42 - - - - - - - - - - - - 1 3 15 7 54 11 47 9 37 12 Malignant neoplasm, breast 1 53 - - - - - - - - - - - - - 8 - 14 - 11 1 9 - 11 Malignant neoplasm, uterus - 27 - - - - - - - - - - - 1 - 4 - 3 - 8 - 5 - - Other malignant and lymphatic neoplasm 147 128 - - - - 2 - 1 2 - - - - 4 5 12 13 33 22 50 41 45 45 Leukaemia, Aleukaemia 7 15 - - - - - 1 - - - - 2 2 - 1 - 2 2 3 1 2 2 4 Diabetes 6 11 - - - - - - - - - - - - - 2 - - 3 2 - 4 3 3 Vascular Lesions of the nervous system 116 229 - - - - - - - - - 1 - - 3 - 6 6 25 8 26 54 56 160 Coronary disease, angina 391 276 - - - - - - 1 - - - 2 - 11 2 35 3 115 23 132 80 95 168 Hypertension, with heart disease 14 24 - - - - - - - - - - - - 1 - - - 3 1 4 8 6 15 Other heart diseases 91 158 - - - 1 - - - 1 1 1 - 1 1 4 3 7 12 15 20 19 54 109 Other circulatory diseases 64 95 - - - - - - - - - - 1 - - 1 - 3 6 9 19 16 38 66 Influenza 2 3 - - - - - - 1 - - - - - - - - - - - 1 - - 3 Pneumonia 79 86 1 2 2 9 1 1 1 - - - 1 - - 1 5 - 9 3 12 8 47 62 Bronchitis 112 44 - - 1 - - - - - - - - - - - 4 2 22 6 42 15 43 21 Other diseases of respiratory system 12 11 - - 2 - - 1 - - - - - - - - 1 - 2 1 1 4 6 5 Ulcer of stomach & duodenum 16 7 - - - - - - - - - - - - - - 2 - 3 1 4 3 7 3 Gastritis, enteritis & diarrhoea 5 10 - - 1 - - - - - - - 1 - 1 - 1 - - - - 2 1 8 Nephritis & nephrosis 10 6 - - - - - - - - - - - - - 1 3 - 2 2 4 - 1 3 Hyperplasia of prostate 10 - - - - - - - - - - - - - - - - - - - 1 - 9 - Pregnancy, childbirth & abortion - 7 - - - - - - - - - 1 - 4 - 2 - - - - - - - - Congenital malformations 13 12 5 6 4 1 1 1 - - 1 - 1 - - - 1 1 - - - 1 - 2 Other defined & ill defined diseases 103 115 35 16 5 1 2 2 3 2 2 1 3 3 3 1 1 4 11 13 20 19 18 53 Motor Vehicle accidents 19 13 - - 1 - 1 - 1 - 1 2 3 1 2 - 3 1 3 1 - 6 4 2 All other accidents 21 26 - - 1 - 2 1 - - 4 3 1 1 2 1 1 1 4 1 1 5 5 13 Suicide 16 16 - - - - - - - - 3 1 1 - 2 2 1 3 7 4 1 4 1 2 Homicide & Operations of War 5 3 1 - - - - - 1 1 1 - - 1 1 1 1 - - - - - - - Total 1,459 1,454 42 24 19 14 9 9 10 6 13 11 16 14 33 41 103 72 327 149 398 322 489 792 L NOTIFICATIONS OF INFECTIOUS DISEASE DURING 1966 BY SEX AND AGE GROUPS Under 1 1 2 3 4 5 - 9 10 - 14 15 - 19 20 - 34 35 - 44 45 - 64 65 + UNK 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 M F Scarlet Fever 1 - 6 2 6 2 7 5 13 6 26 39 3 8 - 3 - 2 - - - - - - - - 129 Measles 37 39 151 169 166 169 155 159 157 128 350 372 11 15 8 7 5 5 - - - - - - 11 16 2130 Whooping Cough 2 6 15 5 8 11 6 9 4 2 15 18 2 2 1 - - 1 - - - - - - - - 107 Pneumonia 2 - - - - - 1 1 3 - 2 - 1 2 3 - 1 5 2 1 8 1 3 6 - - 42 Erysipelas - - - - - - - - - - - 1 - 1 - - 1 1 1 - 3 3 4 1 - 1 17 Food Poisoning 1 2 5 1 2 1 1 - 1 1 5 - - - 1 - 2 8 - 3 1 1 - - 1 1 38 Puerperal Pyrexia - - - - - - - - - - - - - - - 2 - 10 - - - - - - - - 12 Ophthalmia Neonatorum 1 2 - - - - - - - - - - - - - - - - - - - - - - - - 3 A. Encephalitis INF - - - - - - - - - - - - - - - - - - - - - - - - - - - ” -INF - - - - - - - - - - - - 1 - - - - - - - - - - - - - 1 Acute Polio P 1 - - - - - - - - - - - - - - - - - 1 - - - - - - - 2 ” .P. - - - - - - - - - - - - - - - - - - - - - - - - - - - Meningococcal Inf. 1 - - 1 - - - - - - - - - - 1 - - - - - - - - - - - 3 Diphtheria - - - - - - - - - - - - - - - - - - - - - - - - - - - Typhoid - - - - - - - - - - - - - - - - - - - - - - - - - - 1 Para-typhoid - - - - - - - - - - - - - - - - - - - - - - - - - - - Dysentery 1 - 4 5 5 2 2 3 - 3 4 4 2 2 - 3 - 2 3 3 3 2 1 - - 1 55 Scabies (Tottenham) - 1 2 1 - 2 1 1 1 1 2 - 2 1 4 1 2 3 - 1 - 1 - 1 1 1 30 T.B. Resp. - - 1 - 1 - 2 - - 2 3 2 - 1 3 1 20 12 5 9 12 8 8 - - - 90 T.B.M.CNS. - - - - - - - - - - - - - - - - 1 - - - - - - - - - 1 T.B. Others - - - - - - - - - - 1 - - - - - 2 3 6 3 - - 1 3 - - 19 Smallpox - - - - - - - - - - - - - - - - - - - - - - - - - - - Malaria - - - - - - - - - - - - - - - - - - - - - - - - - - 1 INFECTIOUS DISEASES The department maintained a close watch on infectious diseases in the borough. The weekly bulletin produced for general practitioners continued to serve a useful function, especially where the voluntary notification of infective hepatitis was concerned. More use could be made of the bulletin's capacity to disseminate local information on the commoner diseases - influenza, mumps, chicken pox and soon - which are not serious enough to require formal notification, but which yet involve a good deal of day to day work. A step was taken in this direction when discussions were opened with the Education Department regarding the modification of infectious disease returns from schools, so that head teachers and general practitioners could be kept informed of the latest trends at weekly intervals. Food Poisoning The Salmonella group is the commonest cause of this kind of infection. One of these - Salmonella typhimurium - was the cause of a number of troublesome outbreaks in several London hospitals. The Medical Officer of Health was asked to advise on this problem in one in Haringey Sporadic cases also occurred in the borough. Some cases occurred in an old people's home. In another incident a food-handler was excluded from work until clear of the disease. There was a tragic reminder of the sinister potentialities of the organism when a sixteen-month-old child died from this cause. Salmonella derby was responsible for two cases in a family. Foreign travel addedtothe variety of organisms encountered. There was an exceptionally persistent Salmonella muenchen from the Canary Islands, and a Salmonella taksony from Tunisia. A visitor to Guyana returned with a Salmonella litchfield. The tourist visiting warmer countries would be well advised to choose his diet carefully. Salads and cold dishes should be avoided, and fruit should be restricted to the sorts that can be peeled before eating. If uncertain about the safety of the water supplies, one can drink other kinds of fluids. Wine is best taken only in the evenings because of its soporific effect, but the spa waters available cheaply on the continent provide excellent substitutes. There is much to be said in favour of taking regularly one of the preparations intended to prevent gastro-intestinal infections. Meningococcal Meningitis Occasional sporadic cases of this infection are the normal pattern for this disease. It does not tend to be a serious problem nowadays - there were three cases this year as in the last- but it is sad to have to report that one of them, an eight-months-old child, died from a fulminating form of the infection. The source was not known, and no reason could be found for the unusually grave sequence of events in this case. Measles Every alternate year there is an increase in the number of cases of measles. This was one of them. 2,130 were notified to the department, compared with 1,876 in 1965. The Ministry of Health has not yet recommended the widespread use of measles vaccine, though it is being given by general practitioners on a small scale. Poliomyelitis Haringey's freedom from poliomyelitis in 1965 was not repeated in 1966. Two cases occurred, but it would be only fair to say that one of these did not really belong to the borough. This was a seven month-old child who was already suffering from the disease when put on a London-bound plane in Qatar. The diagnosis was made on arrival at the airport, and the child was immediately transferred to Coppett's Wood Hospital in Haringey. For purposes of notification the case was considered to be a resident of this borough. The hospital accepts patients suffering from infectious diseases from a wide area of north-east London, and isolates them so effectively that although it is in Haringey, for practical purposes it is not of it. 8 The summer was a rather anxious one where poliomyelitis was concerned. Vaccination has dramatically reduced incidence, but has not been as extensive as we would like, and it has been necessary to keep on the alert for sporadic cases. In August a case of paralytic poliomyelitis was reported in another borough. He had been in contact the previous month with a man in Haringey who, about that time, had had symptoms suggestive of the disease. Investigation of this man failed to show any evidence of poliomyelitis, and it was eventually concluded that he was probably not the source of the infection. A family elsewhere in this borough had been in contact with the case. They were given oral vaccine by their general practitioner in order to counteract the possible natural infection, and they were kept under close surveillance throughout the incubation period, during which none of them became ill. Later in August, a railway station foreman employed in another part of London was admitted to hospital with paralytic poliomyelitis. This was due to the same kind of virus, type 2, as in the case just mentioned but no connection could be established. The difficulties in tracing the cause of his infection can be appreciated when it is realised that his duties involved ticket collecting, and must have brought him into close proximity to thousands of people. Known contacts were followed up immediately and given the oral vaccine. There were no further cases. The patient, who had not been vaccinated against poliomyelitis, recovered, although there was some residual paralysis. It wasdistressing to learn during the year of the death in Ghana from acute poliomyelitis of a young woman from Haringey. One tends to think only of exotic infections like smallpox, cholera and yellow fever when being inoculated before going overseas, and it is perhaps not surprising that poliomyelitis is overlooked. One can nevertheless pick up heavy doses of the virus, especially in tropical countries, and poliomyelitis vaccination is well worth having in these circumstances. It would be better still if everyone under the age of forty were protected. It is not enough to have stopped the fierce epidemics which used to rage like forest fires, when they are still liable to smoulder underground and burst out in unexpected places. It's safer to be flameproofed. Typhoid The department investigated a number of Haringey residents who were at various times contacts of typhoid cases in other boroughs. These were all negative. Only one person living in Haringey actually had the disease. The evidence suggested that the infection had taken place in a cafe in a neighbouring borough, but intensive follow-up there failed to reveal the source. Similar investigations into family contacts and local shops patronised by the affected individual also proved negative Thepatient made a satisfactory recovery, but the origin of the disease remains a mystery. Dysentery A mild, common form of this infection - that caused by Shigella sonnei - continued to be a problem. An outbreak occurred at a school, and there were cases at two day nurseries. Some children and staff were excluded. Although there was an instance of a grocery shop assistant being excluded from work because of this infection, it is not usually transmitted by food. Contact is the normal mode of spread, frequently among children. Control is difficult because there are many symptomless carriers, but if these are identified and excluded, the institution concerned may be paralysed for weeks or months due to the persistence of the organism, while the victims are usually in excellent health. Hence, considerable nicety of judgement is required from the Medical Officer of Health, who has to bear in mind on the one hand the widespread nature of the disease - each outbreak probably indicating a large reservoir in the local population - and on the other, its occasional tendency to manifest itself in vicious attacks. Since the organism isresistant to most antibiotics, this remains one of the most intractable problems in public health today. Higher standards in toilet hygiene would do much to confine it. Smallpox There was no case in Haringey, though it could be said that the tail of the variola minor outbreak in the early summer in the Midlands and Wales brushed us lightly. A family of five people stayed on a campsite in Dorset where a child from Wales was suffering from the disease, at that time unrecognised. It was difficult to say whether there had been any contact, but the family was vaccinated and examined daily during the incubation period. 9 Malaria There was one case only, a visitor from abroad infected before arrival. People visiting countries overseas where the disease is endemic, including North Africa, should take a suitable prophylactic drug regularly while there, and for a full month after returning to this country. Leprosy Under the Public Health (Leprosy) Regulations 1966, cases ceased to be directly notifiable to the Ministry of Health, and became, like many other infectious diseases are, now notifiable to the Medical Officer of Health. The Health Department keeps a register of all cases known to be in the borough, and informs the Ministry regarding them. Although the word "leprosy" has strong emotional overtones, it is not highly infectious, and the five cases of the disease in Haringey are satisfactorily controlled. Infective Hepatitis Largely due to the enthusiastic co-operation of general practitioners, we learnt of 51 cases of this disease. Apart from a few close contacts who were infected, they were all sporadic cases, and there was no concentrated epidemic. Since early notification is of great value in the control of this insidious, and in many respects obscure, infection,the Ministry of Health was consulted regarding the possibility of making the disease statutorily notifiable. Leptospirosis One case occurred during the year. The disease is associated with contact with dirty water and rats. The patient had not been swimming recently, and inspection of his home and also his place of work in another borough failed to show any cause for the infection. Since this tends to be an occupational disease, discussions were held with the Ministry of Health with a view to its becoming statutorily notifiable in Haringey. Brucellosis Sometimes known as Undulant or Malta Fever, brucellosis usually affects people working with animals, I ike farm workers and veterinary surgeons. The organisms are found in milk from affected cows, ano people who drink the milk are liable to get the disease. This is a fact often not appreciatea by those who believe that milk from a herd tested for tuberculosis is safe. It probably is, but only as far as tuberculosis is concerned, and there is often no way of being sure that it has no brucellosis germs in it. It is safer to keep to pasteurised milk; the process destroys the germs of both diseases. Otherwise it should be boiled. An example of this kind of infection occurred during the year, and demonstrates a possible risk of farmhouse holidays. The patient had developed a remittent fever lasting four months, which developed six weeks after a holiday in Cornwall. When brucellosis was diagnosed the Medical Officer of Health of the area in which the farm was situated was notified. Investigation revealed that the herd was infected with the disease. On veterinary advice, the farmer decided to go out of milk production and dispose of his milking cows. Section 172, Public Health Act 1936 It is occasionally the lot of a public health department to become involved in something which results in little but frustration and waste of time and energy. In June a letter was received from a consultant in a local hospital regarding a man in his early thirties suffering from open pulmonary tuberculosis. This man, although aware that he had an infection which was highly dangerous toothers, had left hospital against medical advice, and was known to frequent public houses. The consultant asked that the utmost rigour of the law be invoked to restrain him until such time as he became non-infectious. It emerged in subsequent discussions that two to three months treatment in hospital would result in the disease becoming quiescent. Since it is the policy of the department not to apply legal sanction until reasonable persuasion has been tried, an officer of the Council visited the patient, who expressed his regret and agreed to return to hospital. He had only been back four days, however, when he left again. Another visit was made, and again the man said he was sorry. The next stay in hospital lasted eleven days. Readmission was once more arranged, and the result was the same. 10 Since the patient had now discharged himself four times on one pretext or another, the Chairman of the Health and Welfare Committee called a meeting of representatives of the hospital and the local authority Legal and Health Departments. The patient himself was invited to attend. It was pointed out to him that he was placing his own health and that of others in considerable danger by refusing to stay in hospital. The patient agreed but said that he could not stand being confined. Although warned of the possibility of legal action, he persisted in his refusal to co-operate. In September an order was made under the above Act committing the man to hospital, but when an officer of the Council visited his home he had disappeared. He was eventually found and an officer of the Council accompanied by police and an ambulance crew entered the house and served the order, when he was escorted to the ambulance and taken to the hospital. Any notions that the local authority's responsibilities in this matter had been fulfilled were quickly dispelled when it was learnt that the patient had on arrival at the hospital become extremely difficult to control. The staff's difficulties in dealing with him were complicated by the reluctance of their legal advisers to accept that the para (7) of the Section stating that "any officer of the hospital or institution may do all acts necessary for giving effect to the Order" could include physical restraint. Later the patient agreed to remain provided he was allowed to keep his clothes. Meanwhile, the Court Order, which was close to its expiry date, was renewed. The man stayed for nine days, then surreptitiously dressed himself ano left. He was discovered a week later and appeared to settle down better, agreeing to hand in his clothes. Bu the became difficult again when a request to be allowed home for Christmas was refused. One evening his pyjamas and dressing gown were found lying on the floor. Once more he had run away and has not been seen since. The difficulties of the hospital should not be underestimated. A hospital is not guarded like a prison, and wards tend to be under-staffed. The moral problems in a case like this are considerable. Even though there is the support of the law, it is difficult to forget that one is hounding a sick man. Yet a patient like this is a constantmenace, especially to children, who may die from fulminant infections if exposed to the heavy doses or organisms coughed up from the lungs. All the time, his own chances of cure, initially good, become progressively less. The liberty of the subject is a jealously guarded privilege in this country, though the law admits that there are situations in which, for the protection of others, it is necessary to restrict the freedom of one person. Since this piece of legislation isclearly insufficient when dealing with a markedly recalcitrant individual, the alternatives are that is should be either strengthened so that hospital facilities are available to contain this kind of situation or abandoned altogether and the risk to the community accepted, or alternatively that some system of enticement is adopted sothat there is a stronger incentive toobtain cure where the prospects are good. A few days before this annual report went to the printers, there was a development which brought the story to a tragic close. During June 1967, a doctor was called urgently to see the patient, who was re-admitted the following day. He died just over a week later. A curiously ironic twist is given to this by the fact that the cause of death was not tuberculosis, but a brain tumour, for which no means of prevention is known. VACCINATION AND IMMUNISATION Vaccination against Smallpox The following table records the number of persons under the 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 80 1,070 347 47 1,544 Number of Re-vaccinations 12 24 65 101 11 It is regrettable that there should have been a fall in the number of primary vaccinations as compared with last year. Vaccination is offered to all children who are attending the clinics between the ages of one and two years, in the absence of any contra-indication, but many parents are reluctant to have it done. 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 doseduring the year by general practitioners or clinic staff. A. The number who completed a full course of Primary Immunisation Age at date of Immunisation Quadruple Triple Dip/WC Dip/Tet Dip WC Tet Salk Sabin Total 0 - 1 year 2 1,446 11 10 - - - 846 2,315 1 - 2 years 9 1,830 1 21 69 - - 6 2,166 4,102 2 - 4 years 10 212 1 31 2 - 1 8 465 730 4 - 6 years - 43 1 58 - 9 2 267 380 6 - 16 years - 8 - 6 - - 19 1 118 152 Totals 21 3,539 3 127 81 - 29 17 3,862 7,679 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 - 79 - - 9 - - 28 116 1 - 2 years - 603 - -16 6 - 1 1 68 695 2 - 4 years 1 1,220 38 62 8 - 2 1 118 1,450 4 - 6 years 4 201 - 195 17 - 3 8 299 727 6 - 16 years 1 45 - 14 5 - 3 1 202 271 Totals 6 2,148 38 287 45 - 9 11 715 3,259 Change in Immunisation Schedule 1. On 1st August 1966 a new Immunisation Schedule was adopted for use in the clinics. In this schedule the primary immunisation against Poliomyelitis by oral vaccine is carried out at the same time as the triple immunisation against Diphtheria, Tetanus and Whooping Cough. This has meant that the number of attendances for immunisation in the child's first year has been cut by half. The combined course is started at the age of three months and has been given to children born since 1st May 1966. Because the oral poliomyelitis vaccine is now given at an earlier age it is necessary for a re-inforcing dose to be given at eighteen months, but this can be combined with the fourth Triple injection, and so no extra visit is required. Further re-inforcing doses of Poliomyelitis and Diphtheria-Tetanus vaccine are given at school entry. 2. The vaccines in use were also modified, and the alum-precipitated toxoids of Diphtheria and Tetanus have now replaced formol toxiods and T.A.F. The vaccines used at the Clinics are now:- 1. Triple Vaccine (Diphtheria, Tetanus, Pertussis) 2. Diphtheria-Tetanus Vaccine (DT/Vacc/P.T.A.H.) 3. Diphtheria Vaccine (D/Vacc/P.T.A.H.) 4. Tetanus Vaccine (T/Vacc/P.T.A.H.) 5. Poliomyelitis Vaccine (O.P.V. Sabin Oral Vaccine) 3. The changes in schedule produced two effects on the numbers completing full courses of Primary Immunisation during 1966. (a) Many more children completed their Poliomyelitis primary course before the age of one year. (b) There was a fall in the total number of children completing their Triple immunisation due in part to starting immunisation a month later at three months instead of at two months which left a short gap in July 1966. 12 Death from Whooping Cough During the year there was unfortunately one death from Whooping Cough in the Borough. A baby of about five weeks was infected and died in hospital ten days later. This was too young to have received immunisation by any recognised scheme, so that the baby could not have been protected directly. However, an increase in the level of immunisation against Whooping Cough throughoutthechildpopulation would decrease the risk of a baby of this age being exposed to the infection. Publicity Campaign From 1st October to 31st December 19P6 there was a Publicity Campaign for Immunisation in London and the Home Counties. The Health Department took part in this campaign. The Deputy Medical Officer of Health wrote an article published in the local press beside an advertisement for available clinic facilities, and posters were exhibited in clinics and other public places. There was an increase in the number of immunisations in the last quarter of 1966 compared with the same quarter of 1965. IMMUNISATION SCHEDULE Visit Approximate Age Vaccine Dose and Site 1st Year 1 3/12 Triple (D.T.P.) + Oral Polio (O.P.V.) 0.5ml by I.M. or S.C. inj.L.U. A. 3 drops by mouth 2 4/12 D.T.P. + O.P.V. ” 3 5/12 D.T.P. + O.P.V. ” 2nd Year 4 Between 1 - 2 yrs. Smallpox Vaccination Multiple Pressure L.U.A. 5 18/12 Booster D.T.P. + O.P.V. 0.5ml by I.M. or S.C. 3 drops by mouth or on sugar 6 School Entry Booster 5 years (approx.) Diph-Tetanus (DT/Vacc/PTAH) (Alum, absorbed Vaccine) + OPV 0.5ml I.M. or S.C. 3 drops on sugar 7 13 yrs.(approx.) B.C.G. (for tuberculin negative children) 0.1ml intradermally NOTES 1. Half volume Triple antigen (D.T.P.) to be used as a routine and it is probably advisable to draw up 0.6ml. In special circumstances when reduced dosage is considered desirable, more accurate volumes can be obtained by using full volume antigen. 2. (a) The intervals between visits 1 and 2, and 2 and 3 should be one month. The minimum acceptable interval should be three weeks and this should only be used in exceptional circumstances. The maximum acceptable interval between visits 1 and 2 is 2/12, and between visits 2 and 3 is 3 12. If these maximum intervals are exceeded then the programme should be started again. (b) If for any reason Oral Polio is being given alone, as in the case of ante-natal patients, the minimum interval between doses should be four weeks and the maximum 4/12. (c) The intervals between visits 3 and 5 should not be less than 1 year. 13 3. If the chiId has had clinical Whooping Cough before Triple Immunisation is started, theprocedure should be:- Visit 1 O.P.V. only 2 DT/Vacc/PTAH + O.P.V. 3 DT/Vacc/PTAH + O.P.V. 5 DT/Vacc/PTAH + O.P.V. 4. The age or Smallpox Vaccination has been left open between 1 - 2 years. In practice, if the other immunisation due in the first year has been completed, it is often desirable to do the Vaccination when the child is seen for the 1 year old R.M.I. at the clinic. At the times of the VA year and 2year old R.M.I.'s the doctor should check to see whether the vaccination has been done. When the chiId attends for the Booster Triple and Polio at eighteen months the doctor or nurse should enquire if the Smallpox Vaccination has been done, if not, on ALL these occasions a definite DATE should be written on the immunisation card for the Smallpox Vaccination appointment. 5. Immunisation against Whooping Cough should not be given after the age of 2 years unless there is a sibling under 1 year of age in the family or the mother is pregnant. (In these circumstances immunisation may be considered justified in order to prevent the child bringing home infection to the infant). This isalsotrueifvisit5takes place after the age of 2 years when DT/Vacc/PTAH should begiven instead of D.T.P. 6. If child at 5 years old has had Diphtheria Immunisation as an infant but not Tetanus, the parents should be strongly advised that the child should be actively immunised against Tetanus, and the child should be given:- (a) 1. T(PTAH) 0.5ml I.M. after 6/52 2. D.T(PTAH) 0.5ml I.M. after 6/12 3. T(PTAH) 0.5ml I.M. (b) If the offer of Tetanus Immunisation is refused D/PTAH 0.5 ml I.M. should be given. T.A.F. should NOT be given due to the risk of subsequent sensitisation to horse serum - in a child who might be given A.T.S. in the absence of active protection against Tetanus. 7. If a child at school age has had NO immunisation e.g. Immigrant Child, Suggested course:- 1. D.T(PTAH) 0.5ml I.M. + O.P.V. (3 drops) after 4/52 2. D.T(PTAH) 0.5ml I.M. + O.P.V. (3 drops) after 4/52 3. O.P.V. (3 drops) after 5/12 4. D.T(PTAH) 0.5ml I.M. 8. A chiId over the age of 12 years who is to have primary immunisation against Diphtheria, should have a SchickTest. If the result ispositiveafter2-4 days the child should be immunised, preferably combined with Tetanus as in 6a. 9. Children who have commenced a course of primary immunisation should complete this, but receive re-inforcing and booster injections according to the revised schedule. CONTRA INDICATIONS 1. To Triple Immunisation - If there is history or family history of convulsions or allergy DT/PTAH should be given instead of D.T.P. If there is a strong reaction to the first injection of D.T.P., the DT/PTAH should be given instead, probably in half dosage. If the reaction to the D.T.P. is really severe, immunisation may have to be discontinued. Minor respiratory infections need NOT be contra-indications to immunisation, but postpone if the temperature is raised. 2. To Polio Immunisation - Diarrhoea is a contra-indication as it may interfere with the desired establishment of "gut immunity". 3. To Smallpox Vaccination - If there is a history of active eczema vaccination should certainly be postponed until the skin is clear, and even then is probably better avoided except in special circumstances. It is also contra-indicated if another child in the household has eczema. 4. Live Virus Vaccines (Oral Polio, B.C. G. or Smallpox) are all contra-indicated in cases receiving Corticosteroid therapy, convalescent from specific fevers, or during the first four months of pregnancy. 14 SANITARY CIRCUMSTANCES OF THE AREA The environmental health functions of the Department have been carried out systematically, but as the number of qualified public health inspectors in post could not be brought up to the approved establishment, careful planning has been necessary to ensure that the most essential work received priority. This has resulted in less time being spent on several facets of the work than the department would have wished. Wherever possible, technical assistants are used to assist the public health inspectors, but until the full establishment of qualified inspectors can be achieved, it will not be possible to cover all aspects of the work as completely as one could wish. The Council recognises the need to provide facilities for the training of new inspectors and at present have six trainees at various stages of the course. Consideration is being given to increasing this number in accordance with the revised recommendations of the Public Health Inspectors Education Board, to one trainee tor every three inspectors in post. Drainage and Sewerage There are separate systems ot drainage for soil and surface water. The former connects into East Middlesex Drainage System and the sewage is treated at Deephams Purification Works, Edmonton. A technical assistant who has the necessary practical experience of plumbing and drainage works is continuously engaged in the inspection ot house plumbing and drainage with a view to the detection of faults by which the pollution of the surface water sewerage system may arise. During the year he inspected 2,631 premises. As a result ot his findings official requests were passed to persons having control of 131 specific premises for the necessary corrections to be carried out. Thepublic health inspectors are responsible † or seeing that this work is done and, where appropriate, recommendations are made to the Council to take formal action under the Public Health Act 1936. The selection of areas in which the technical assistant should work is often decided upon information from the Lee Conservancy Catchment Boardof pollution having been observed by their officers at surfacewater sewer exits. Tracing operations are then carried out along the main sewer until the area from where the pollution arises can be isolated, and individual premises in that area are subjected to detailed examination. This work calls tor systematic and patient examination and the number ot faults found is in no way indicative of the work carried out. Flooding Following the flooding which occurred in 1965, the Council decided to purchase special equipment foruse incaseof any similar emergencies arising in the future. The equipment which is now held by the Department will also be available to assist residents in the event of premises becoming saturated from other causes such as the thawing out of burst pipes following severe winter weather. The machines which the Council have agreed to make available on loan for other purposes, provided that they are readily available for use in an emergency, are as follows:- 1. Three 'Tropical' Heaters. These use paraffin fuel and each has a rating of 320,000 B.T.Us per hour. The hot air is blown out by an electric fan and can be directed by ducting to the points in the premises which are most saturated. 2. Three petrol-driven 1 1/2" portable pumps. These are easily transported pumps which can be used for pumping out flooded cellars and each machine will pump 4,200 gallons per hour. 3. One Trembath Dehumidifier. This machine is designed to work in enclosedplaces and is operated from the main electricity supply. It will abstract eight gallons of water from the atmosphere in the day and it incorporates a 3 kilowatt heater to raise the temperature in cold weather. 15 METROPOLITAN WATER BOARD Water Supplies Dr. Windle Taylor, Director of Water Examination, Metropolitan Water Board, has kindly supplied the following information regarding Haringey's water supplies:- "(a) The supply was satisfactory both as to quality ana quantity through out 1966. (b) (i) The supply was derived from the following works ana pumping stations:- The higher elevation around Muswell Hill is in supply with River Thames derive a water; the remainder is in supply with water from the New River. During the summer months, the locality of Northumberland Park receives well water from Park Pumping Station. No new sources of supply were instituted. (ii) The number of samples collected and the bacteriological and chemical analyses of the supply from the above sources after treatment are shown on the following tables. No fluoride was added, ana where the fluoride content is indicated it represents the naturally occurring fluoride in the water. (c) The supply being hard_ in character is not liable to be plumbosolvent. (a) All new and repaired mains are disinfected with chlorine, after a predetermined period of contact the pipes are flushed out ana refillea; samples of water are then collected from these treated mains; ana the mains are returned to service only after results are found to be satisfactory. The quality control from these laboratories is carried out by means of daily sampling from sources of supply, through the treatment works or we 11 stations, from the distribution system, and through to the consumer. Any sign of contamination or any other abnormality is immediately investigated. (e) (i) The Board has no record of the number of structurally separate dwellings supplied in your area, (ii) No houses were permanently supplied by standpipe. (f) There were no changes to the general scheme of supply in Haringey. (g) There have been no additions to the mains in your area." 16 AVERAGE RESULTS OF THE CHEMICAL AND BACTERIOLOGICAL EXAMINATION OF THE WATER SUPPLIED TO THE LONDON BOROUGH OF HARINGEY FOR THE YEAR 1966 (Milligrams per litre (unless otherwise stated)) Description of the Sample No. of samples Ammoniacal Nitrogen Albuminoid Nitrogen Nitrate Nitrogen Chlorides as C1 Oxygen abs. from Permanganate 4 hrs. at 27°C Turbidity Units Colour (Burgess Units) Hard ness (Total) Ca C03 Hardness (noncar bonate) Ca C03 PH Value Phosphate as P04 Silicate as Si02 Sulphate as so4 Natural Fluoride as F Magnesium as Mg. Sodium as Na Potassium as K Surface Active Material as Manoxol OT Electrical Conductivity (micromhos) New River derived 104 0.027 0.071 5.5 36 0.76 0.1 9 315 83 7.7 1.5 10 64 0.20 4 27.8 4.7 0.01 630 Park well 3 0.145 0.031 0.1 22 0.26 0.2 3 269 58 7.5 14 52 17 520 Thames derived N. of River 207 0.031 0.087 3.9 32 1.26 0.1 15 289 78 7.9 1.6 7 68 0.20 5 24.9 4.9 0.01 570 BACTERIOLOGICAL RESULTS - YEARLY AVERAGES, 1966 BEFORE TREATMENT AFTER TREATMENT Number of samples Agar plate count per ml. Coliform count Escherichia coil count Agar plate count per ml. Coliform count Escherichia coiI 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. Number of samples 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 513 9.6 100.0 100.0 Park well 87 0.4 14 95.40 0.2 100.0 - 87 0.2 14 100.0 100.0 Thames derived N. of River 1,744 17.5 99.71 100.0 17 Lee Valley Water Company A small area of the borough bounded by Aylmer Road and Great North Road is supplied by the Lee Valley Water Company. The Company supplied 106 premises with an estimated population of 329 and an average consumption of 54.6 gallons per head per day with a total daily consumption in the region of 18,000 gallons. A sample representative of this supply was taken in East Finchley. Chemical Results Expressed in Milligrammes per Litre Appearance clear and bright Ammoniacal Nitrogen 0.00 Colour (Burgess) 10 Albuminoid Nitrogen 0.02 Odour/Taste nil Nitrate Nitrogen 3.3 Turbidity 0 Nitrite Nitrogen 0.00 Conductivity 530 Oxygen Absorbed 1.08 Total Solids 360 Fluoride less than 0.2 PH 7.6 Silica 16 Free C02 21 Iron less than 0.02 Alkalinity (CaCo3) 210 Other Metals Copper/Lead/Zinc, absent Carbonate Hardness 210 Phosphate 1.45 Non-Carbonate Hardness 65 Residual Chlorine nil Total Hardness 275 Temperature °C 16.5 CATION Milligrammes per Litre Milliequivalents per Litre ANION Milligrammes per Litre Milliequivalents per Litre Calcium 104 5.04 Carbonate 125 4.16 Magnesium 5.7 0.48 Sulphate 70 1.46 Sodium 22.5 0.98 Chloride 31 0.89 Potassium 5.0 0.13 Nitrate 15 0.24 Total 137.2 6.63 Total 241 6.75 Bacteriological Examination No. of Colonies 1 day at 37°C 2 days at 37°C 3 days at 20°C Developing on Agar 5 per ml 7 per ml 1140 per ml Present in Absent from Probable No. Presumptive Coli-Aerogenes ml 100 ml 0 per 100 ml E. Coli ml 100 ml 0 per 100 ml 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. This is a proper public health responsibility and the procedure supplements the routine control measures taken by the staff of the Baths Department in respect of Council controlled establishments which are available for use to the general public or to special groups, such as school children. There are also a few privately controlled swimming pools in the borough which are subject to the same public health control. 18 Smoke Control Areas The Hornsey No. 7 Order which covers an area of 262 acres containing 5,385 dwellings came into operation on 1st April 1966. Three new areas were made the subjects of Smoke Control Orders in 1966. These were confirmed by the Ministry of Housing and Local Government on 26th May 1966 and came into operation on 1st December 1966. Details of the areas are as follows:- Hornsey No. 8 area - 173 acres, 2,863 dwellings Tottenham No. 6 area - 500 acres, 2,422 dwellings Wood Green No. 9 area - 253 acres, 2,557 dwellings It is expected that the whole of the Borough will become smoke controlled by December 1968. Statistics have become available both at local and national level which confirm the general impression that smoke control orders have contributed enormously to the securing of a cleaner atmosphere and thereby ensuring a positive improvement in the general environment. The statistics indicate that although little specific action has been practicable to reduce significantly the amount of sulphur dioxide in the atmosphere it has been pleasing to note that some diminution has been achieved in spite of a generally increasing fuel consumption. The means of securing further reductions in the amount of sulphur dioxide being discharged in the atmosphere by commercial premises and also of reducing air pollution arising from vehicular traffic now become more urgent problems. The changing pattern of fuel supplies has led the Ministry of Housing and Local Government to advise further modifications of their rules for the assessment of expenditure which may qualify for grant in the adaptation of fireplaces. In a circular letter dated July 1966 the Ministry stated that in the Greater London area gas coke should continue to be available to meet the needs of householders in existing areas, but there was not likely to be sufficient fully to meet increased demands for open tire use resulting from new smoke control orders. The Ministry, therefore, advised that in new smoke control areas grants should be allowed towards the replacement or improved open coke grates by other approved forms of heating such as freestanding or under floor draught stoves, gas or oil room heaters of oft peak electric storage heaters. If, however, a householder should desire to replace a coal grate by an improved open coke grate, grant will continue to be available towards this. Furnace Installations Twenty-five notifications were received in accordance with Section 3 of the Clean Air Act 1956 of proposals to install furnaces and boiler plants. These were carefully examined and where necessary advice was otfered with a view to securing improvements in the proposals. Chimney Heights Nineteen notices were received under Section 10of the Clean Air Act of proposals for new chimneys serving furnace installation. In nine cases the proposed chimney heights were considered to be inadequate and increased heights were subsequently agreed. Investigation of Atmospheric Pollution At the beginning of 1966 there were ten sites in the Borough where instruments were installed and examined daily for the measurement of smoke and sulphur dioxide in the atmosphere. Following discussions with the Divisional Officer and the Ministry of Technology, it was agreed that a reduction could be effected in the number of sites without loss of adequate indication of the pollution present in the various types of development in the Borough. This applied both to the survey for local purposes and the overall national survey in which the Borough was participating. Sites Nos. 2, 3, 5, 8 and 10 shown in Table A were discontinued at the beginning of May and it was agreed that Site No. 7 should be discontinued in April 1967 at the end of the first phase of the national survey. The instrument at the Tottenham Technical College was not satisfactorily sited and was transferred to a suitable position in the nearby Tottenham Town Hall. Two deposit gauges continue to be maintained in the Borough. Although these do not provide any data of national significance, it is considered that they have a local use as indicators of any heavy pollution of dust or grit which may arise as a result of industrial accident or misdemeanour. 19 Table A Average Daily Readings of Smoke and Sulphur Dioxide in the Atmosphere, 1965/6 (Microgrammes per cubic metre) Hornsey Town Hail, N.8. (1) North Hill, N.6. (2) Fortis Green, N. 10. (3) Burghley Road, N.8. (4) Lome House, N.4. (5) Tottenham Tech. College, N.15. (6) Devonshire Hill, N. 17. (7) Mark field School, N.15. (8) Civic Centre, N.22. (9) Woodside School, N.22. (10) Classification A3 X B1 A1 A1 A2 B1 X D2 B3 (a) Smoke April, 1965 40 38 31 38 51 45 52 48 40 N May, 32 35 28 26 45 37 48 36 36 34 June, 29 N 21 25 28 N 27 33 26 22 July, 15 20 15 16 19 N 20 N 17 15 August, " 25 N 24 38 N 46 33 46 28 32 Sept. 39 40 34 49 47 37 60 52 49 44 Oct. 94 72 65 114 123 104 86 108 N 120 Nov. 69 71 44 77 118 N 119 90 53 83 Dec. 59 N 41 95 116 102 112 126 60 78 Jan. 1966 94 91 101 195 166 N 136 139 89 122 Feb. 48 64 58 73 92 77 67 61 29 51 March, " 47 52 49 65 87 N 63 N 20 52 National Winter averages are shewn below) (b) Sulphur Dioxide April, 1965 107 72 57 83 81 140 85 135 110 N May, 92 69 60 74 82 108 85 101 102 67 June, 122 N 93 105 108 N 116 153 138 97 July, " 74 87 71 91 89 N 85 N 88 85 August, " 112 N 82 100 N 128 88 144 109 96 Sept. 155 107 101 120 115 98 119 142 138 104 Oct. 206 119 123 180 191 212 161 176 N 171 Nov. 188 77 97 141 132 N 172 177 166 113 Dec, N N 83 147 144 173 172 220 215 141 Jan. 1966 231 180 189 232 219 N 238 288 275 217 Feb. 146 111 92 128 134 179 154 161 168 110 March, " 143 96 94 140 128 N 153 N 148 122 NOTE: "N" indicates that number of readings insufficient to give accurate average. The following are the provisional national winter smoke averages:- Class of Site A B C D Northern England 240 165 190 190 Southern England 100 65 80 85 20 Classification of Sites The classification of sites indicates the neighbourhood in which the instruments are located as follows:- A1 - residential area with high density housing or with medium density housing in multiple occupation, in either case surrounded by other built-up areas. A2 - predominantly A1, but interspersed with some industrial undertakings. A3 - residential area with high density housing or medium density housing in multiple occupation surrounded by or interspersed with open spaces. B1 - residential area with medium density housing, typically an inner suburb or housing estate, surrounded by other built-up areas. B3 - residential area with medium density housing surrounded by or interspersed with open spaces, or in residential area with low density housing. D2 - Small town centre; limited commercial area mixed with old residential housing and possibly industry. X - Unclassified or mixed area. Table B Monthly Deposit Gauge Readings, 1966 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 1.50 5.89 6.62 12.51 1.57 6.36 7.95 14.31 February 2.99 8.18 6.24 14.42 3.03 8.37 4.04 12.41 March 0.23 3.23 4.66 7.89 0.36 2.92 10.18 13.10 April 3.09 5.77 12.22 17.99 3.66 6.11 14.53 20.64 May 1.87 6.30 21.62 27.92 1. 95 7.37 30.10 37.47 June 3.25 8.33 29.25 37.58 3.16 5.70 17.52 23.22 July 1.66 3.39 5.67 9.06 1.75 3.51 5.90 9.41 August 4.29 6.80 7.48 14.28 4.20 8.60 6.44 15.04 September 2.25 6.67 8.36 15.03 2.19 6.44 6.61 13.05 October 2.21 4.96 3.81 8.77 2.48 5.29 4.91 10.20 November 1.54 3.88 4.94 8.82 1.48 3.81 3.82 7.63 December 2.99 4.71 4.97 9.68 2.80 5.44 4.09 9.53 Total 27.87 68.11 115.84 183.95 28.63 69.92 116.09 186.01 Rodent Control Primary control of rat infestation is undertaken by the regular treatment of sewers where the rat population is the most common reservoir giving rise to sporadic surface outbreaks when drainage defects allow rats to emerge. The routine is to treat the whole of the soil sewerage system in the Borough three times annually, twice with sodium fluoracetate which is a high toxic acute poison, and once with warfarin, which treatment may extend over a period of up to four weeks. The use of the two poisons has distinct advantages in that it may secure the elimination of rodents which have a shyness or resistance to one of the poisons and the warfarin treatment allowsa clearer assessment to be made ofthe number of rats which have been killed by the treatment, and for the areas to be plotted where rodent infestation is greatest. 21 The services of the rodent operatives are available free of charge for the treatment of dwellings infested with rats or mice, but a charge to cover the cost of the operative's time and the materials used is made for the treatment of other premises. Contrary to popular belief, the elimination of mice is more difficult than the destruction of rats, since the former do not have the regular routine feeding habits ofthe latter and have a greater resistance to poison. In order to deal with this problem new poisons are being used for the treatment of premises infested with mice wherever it is suspected that these rodents have developed resistance to the previously successful poisons. The following is a summary of the premises treated for rodent infestation in 1966:- 1. Houses - 1272 2. Shops - 64 3. Factories - 57 4. School Canteens - 38 5. Miscellaneous - 37 6. Total charges for 2 - 5 above - £283. 7s. 10d. 22 23 Details of sewer treatments are set out below: - RODENT CONTROL SEWER TREATMENT - HARINGEY 1966 AREA Total No. of Manholes Sodium Fluoracetate Manholes Baited Warfarin Treatment Manholes Baited Takes - First Visit Takes - Second Visit First Treatment Second Treatment Complete Partial No Take Complete Partial No Take Hornsey 1 (East) 458 331 347 268 59 40 169 25 48 195 „ 2 (Central) 450 307 326 238 38 27 173 11 17 210 „ 3 (West) 442 272 273 223 13 24 186 4 14 205 „ 4 (North) 356 249 246 177 2 15 160 - 9 168 Wood Green 5 (West) 285 261 276 166 1 22 143 13 22 131 „ „ 6 (East) 372 348 357 232 24 23 185 27 24 181 Tottenham 7 (South) 526 516 509 - - - - - - - „ 8 (North) 578 566 565 - - - - - - - TOTALS 3,467 2,850 2,899 1,304 137 151 1,016 80 134 1,090 PERCENTAGES - 82.3% 83.7% 37.6% 10.5% 11.6% 77.9% 6.1% 10.3% 83.5% Cleansing and Disinfecting Station Cleansing, disinfection and disinfestation are carried out at the Department's Depot in Hornsey High Street, N.8. In addition to routine disinfection work bundles of articles are disinfected prior to despatch abroad. Bathing and treatment of verminous persons and scabies patients are carried out at the Station. The Depot is also the place from which the general assistants and rodent operatives work and equipment and poisons are stored there. Services to the public for health matters where other facilities are not available are provided by the Council when the need arises. A recent example of this is the provision of the special equipment referred to earlier in this Report, for dealing with flooding in premises. Laundry Services for the Incontinent During 1966, 1,844 bundles of soiled articles were cleansed and laundered. With the co-operation of the Tottenham Group Hospital Management Committee, the laundering of these articles has now been transferred completely to the St. Ann's Hospital laundry. Collections and deliveries are undertaken by the Department's general assistants. Patients requiring this service are normally referred by general medical practitioners, home nurses or home help organising staff. Insect Pe sts 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 treatments carried out in 1966:- Premises Treated Insect Pest Houses Other Premises Ants 51 10 Beetles and Cockroaches 112 23 Bugs 107 3 Fleas 41 2 Flies and Bluebottles 13 1 Wasps 178 7 Others 62 6 564 52 Total charges for treatment of the other premises - £33. 8s. 8d. Mortuary The Public Mortuary is situated in Myddleton Road, Hornsey, N.8. and is used for the reception of bodies from the whole of the Borough. During 1966, 384 bodies were received into Hornsey mortuary and 380 post-mortem examinations were carried out. Noise Nuisances There has been an appreciable increase in the general background noise in cities during the last twenty years. The continuing increase in mechanisation undoubtedly adds to this volume. It is therefore imperative that all reasonable steps shouldbe taken at all times, particularly by commercial and industrial undertakings, to secure the elimination, reduction or containment of noise arising from the useof mechanical equipment. All complaints of excessive and unreasonablenoisewhicharereceivedarevery closely investigated including, where appropriate, measurement at any hour of the day or night of the offending and intruding noise nuisance. Where reasonably practicable, appropriate action is requestedto secure the elimination, reduction or containment of the noise. It i s considered that this aspect of modern living in towns will need to receive even more attention inthe future with a view to suppressing noise arising from vehicular traffic, structural engineering works and road breaking and demolition operations. 24 Inspections carried out by Public Health Inspectors FIRST RE-INSPECTION Statutory Nuisance 3422 7205 Drainage 932 116 Drain Tests 37 Surface Water Pollution 74 91 Vermin and Pests 82 6 Rodents 261 121 Accumulation of Refuse 144 53 Smoke Observations 50 26 Smoke Control 3569 692 Noise 195 62 Disrepair Certificates 8 3 Housing Surveys 1381 528 Multiple Occupation 1258 1835 Overcrowding 36 6 Other inspections under Housing Acts 548 99 Mortgage Advances 101 Improvement Grants 157 184 Infectious Disease 406 57 Food Poisoning 85 8 Factories with Mechanical Power 266 9 Factories without Mechnaical Power 6 1 Outworkers 51 Offices etc: General Inspection 181 5 Offices etc: Other Visits 208 9 Bakehouses 41 34 Bakers and Flour Confectioners 15 16 Butchers 105 48 Canteens and Kitchens 27 15 Confectioners - Sugar 56 25 Fishmongers 18 11 Fried Fish Shops 48 3 Greengrocers 60 19 Grocers 219 97 Hawkers of Food 9 1 Prepared Food Premises 6 11 Public Houses and Off Licences 32 16 Restaurants and Cafes 283 89 Slaughterhouses 542 Other Food Premises 113 29 Street Traders 35 2 Food Sampling 28 Ice Cream Sampling 40 4 Milk Sampling 1 Surrender of Unsound Food 211 1 Investigation of Food Complaints 191 25 Bacteriological examination of Food 107 7 Hairdressers 67 Old People's Welfare 15 Pet Animals Act 39 3 Other visits 3017 125 No access 2478 5 25 Defects Remedied Drains reconstructed 17 Drains repaired 129 Drains cleared 49 W.C. cisterns repaired or renewed 84 W.C. pans renewed 28 W.C. pans cleansed 50 Waste pipes repaired or renewed 74 Rain water pipes repaired or renewed 142 Roofs repaired or renewed 533 Eaves gutters repaired or renewed 164 Drinking water cisterns renewed 2 Drinking water cisterns covered 7 Water service pipes repaired 32 Water supply reinstated 3 Yards repaired or reconstructed 18 Sinks renewed or provided 61 Floors repaired or renewed 197 Floors ventilated 4 Dampness remedied 459 Window frames and sashes repaired, renewed or painted 340 Fireplaces, stoves and ovens repaired or renewed 23 Flues and chimney stacks repaired 14 Brickwork of walls repaired and walls rebuilt 84 Ventilated food stores provided 65 Rooms cleansed 2 Staircases, passages and landings cleansed 1 Staircases, balconies and steps repaired or renewed 28 Noxious accumulations removed 81 Miscellaneous defects remedied 1453 Statutory Notices Served Housing Act 1957 Section 9 (Repairs) 6 Section 78 (Overcrowding) 24 Housing Act 1961 (Houses in Multiple Occupation) Section 15 (Amenities) 30 Section 16 (Escape in case of fire) 2 Section 19 (Limitation of number of occupants) 8 Housing Act 1964 (Improvements) Section 14 29 Section 16 4 Section 17 12 Section 24 2 26 Statutory Notices Served (Contd.) Public Health Act 1936 Section 39 (Drainage) - 16 Section 45 (Repair of W.Cs.) - 11 Section 79 (Accumulations of refuse) - 9 Section 92/93 (Statutory nuisances) - 279 Public Health Act 1961 Section 17 (Drainage) - 62 Tottenham Corporation Act 1952 Section 43 (Urgent Repairs) - 134 Work executed by the Council Work carried out in default of or by agreement with the owners during 1966:- Housing Act 1957 Section 9 (Repairs) - 3 premises Housing Act 1961 Section 15 (Amenities) - 1 premise Section 16 (Escape in case of fire) - 3 premises Public Health Act 1936 Section 39 (Drainage) - 3 premises Section 45 (Repair of W.Cs.) - 1 premise Section 79 (Removal of refuse accumulations) - 9 premises Section 92and 275 (Repairs) - 5 premises Public Health Act 1961 Section 17 (Drainage) - 29 premises Tottenham Corporation Act 1952 Section 43 (Emergency Repairs) - 53 premises Rag Flock and Other Filling Materials Act 1951 There are no establishments licensed for the manufacture of rag flock, but 24 premises are registered for the use of filling materials. Materials used are subject to sampling as considered necessary. Abatement of Statutory Nuisances An important feature of the work carried out by the Department concerns the abatement of statutory nuisances which may be reported by the public or found by public health inspectors. Complaints of defects in the structure of buildings form the bulk of the work. The remedying of defects in otherwise sound dwellings can be secured in the main by an informal approach, but sometimes it is necessary to resort to statutory action to enforce legal requirements. Dwellings in areas which are obviously coming to the end of their useful life, but must for the time being continue to be occupied, present a difficult problem. Usually in such cases it is the aim of the Department to secure the maintenance of the jdwel lings, at least in a wind and weather-proof condition and with essential services in proper working order. 27 3,422 visits were made to investigate complaints and on 1,088 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. In 279 instances it was necessary to serve statutory notices. Legal proceedings were taken on 22 occasions for failure to comply with the statutory notices and 5 abatement orders were made and fines totalling £21 were imposed together with £82 19s. Od. costs. 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. No emergency arose during 1966 which required any special action under this Act. Pet Shops and Animal Boarding Establishments 23premises are licensed as pet shops and one licence was issued in respect an of animal boarding establishment. The premises were inspected by the public health inspectors, and the Council 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. Cases were reported of scabies occurring in persons who had been in contact with puppies sold from a pet shop in the Borough which were said to be affected with a sarcoptic mange. The Veterinary Officer made a careful examination of the pets remaining on the premises but no infected animals were found.. The proprietor was advised on steps which should be taken to clean and disinfect the premises and arrangements were suggested for the isolation of new litters of puppies arriving at the shop until they had been passed as clear of infection by a veterinary surgeon. Performing Animals One person is registered under the Performing Animals (Regulation) Act 1925. Periodic visits are made by the Veterinary Officer to examine the animal to which the registration relates. HOUSING The inspection of premises and preparation of reports with a view to the clearance of areas of houses unfitfor human habitation has been the main activity of the Housing Section of the Environmental Health Division throughout the year. The Council's clearance area programme had been previously approved. The time schedule for representation of new areas was adhered toduring the year. Three clearance areas, Langham Road, N.15., Brunswick Road, N.15. and The Grove, N.8. were prepared in 1966, but could not be officially represented to the Committee until 5th January, 1967. Work involved in the preparation of clearance area representations included detailed inspection of all houses in the area, a comprehensive report on each dwelling, the preparation of principal grounds of unfitness and the obtaining of particulars of occupancy and information as to ownership. Maps defining clearance areas were also prepared. Housing Act, Section 170 notices were issued requiring details of all persons having interests in houses within areas recommended for action under Part III of the Housing Act. Below is shown the position in regard to clearance areas and Part III Compulsory Purchase Orders as at 31st December, 1966. Numbers of houses and families in confirmed Compulsory Purchase Orders are original figures, but considerable progress was made through the year in the removal of families to new accommodation and the acquiring and boarding up of vacated properties. 28 Clearance of Areas of Unfit Houses 1. Areas demolished and cleared during 1966 Houses Families Willow Walk/Milton Road, N. 15. 77 85 2. Areas confirmed before 1966 and sites awaiting clearance Church Road/King's Road, N.17. 195 239 Tewkesbury Road/Seven Sisters Road, N.15. 92 121 St. Mary's Road, N.8. 128 235 Acacia Road (part), N.22. 7 7 Park Lane/ Waverley Road, N.17. 152 244 Culvert Road/Woodvilie Road, N. 15. 63 94 Clyde Road/Elizabeth Place, N.15. 94 109 Osborne Grove, N.8. 18 30 3. Areas represented before 1966 (awaiting confirmation by Ministry of Housing and Local Government) Northumberland Park/West Road, N.17. 41 95 Hornsey Vale, N.8. 147 113 4. Areas represented during 1966 Lorenco Road/Pretoria Road, N.17. 128 239 Acacia Road/White Hart Lane, N.22. 48 59 Moreton Road, N.15. 8 7 Suf folk/Sutton/St. Ann's Roads, N.15. 156 180 Roslyn Road/Seaford Road, N.15. 90 90 5. Areas acquired for demolition not yet demolished Tottenham Lane/Church Path/Ada Cottages, N.8. 15 16 Individual Unfit Houses The following dwellings were the subject of Closing Orders made during the year:- 68 St. Mary's Road, N.8. 11 Enfield Gardens, N.8. 33 Station Road, N. 17. 172 Stapleton Hall Road, N.4. (Basement) 24 Truro Road, N.22. (part) 120 Stapleton Hall Road, N.4. (Basement) The Council were satisfied that these were houses or parts of houses which were unfit to a degree rendering them unusable as living accommodation and that they could not be made tit tor habitation at reasonable cost. Occupants were rehoused by the Council. Purchase in Advance of Council's Requirements Requests by the Chief Valuation Officer for classification of houses which were ottered for sale to the Council in advance of requirements and which are in areas included in the clearance area programme, were attended to during the year. Over 100 houses were inspected bythe public health inspectors under this heading. Uplands Road Improvement Area As stated in the Annual Reportfor 1965, this area, comprising93 houses, wasdeclared an Improvement Area by the Council on the 26th July, 1965. By the end of the year under review, nearly all the tenanted and improvable dwellings, totalling approximately 30, had been considered by the Committee and appropriate notices had been served. 29 In June, the owner of one dwelling, upon whom had been served an immediate improvement notice requiring the improvement dwelling to the full standard, successfully appealed at the County Court against the notice. The house was leasehold and the tenant paid a controlled rent, and in addition to the improvement works, repairs to a total cost exceeding £200 were necessary. A repairs notice under Section 9 of the Housing Act 1957 was subsequently served on the house, and by the end of the year the owner had completed all the repair works. It was also stated in the Annual Report for 1965 that the Council had successfully negotiated for the purchase of a house in the road and by the end of this year plans for the conversion of the house into two fully self-contained dwellings had been approved by the Ministry for discretionary grants and the works were well in hand. The house should be open for public inspection early in the New Year. Arnold Road Improvement Area This area, compri sing 106 houses and approximately 138 dwel I ings, was declared to be an Improvement Area by the Council on the 9th May 1966. Approximately 78of these dwellings are tenanted and can be improved - 56 to the full standard and 22 to the reduced standard. Bytheend of the year 12 preliminary notices had been served setting out the Council's proposals and progressive steps are scheduled for dealing with the remainder of the area. Improvement of Houses not in an Improvement Area The number of tenants who have approached the Council asking them to use the powers given them under the Housing Act 1964 to require the owner to improve their dwellings continued to be very disappointing. In 1965 only three cases were reported and by the end of 1966 two of these dwellings had been fully improved and steps to improve the third dwelling to the reduced standard were well advanced. During the year three further requests were received. One of these was from a tenant in a block of flats comprising some 65 separate dwell ings. Special provisions are included in the Act for dealing with flats. In this case the owners proved fully co-operative and steps have already been taken to improve some of the flats; negotiations regarding the remainder are continuing. In another case negotiations with the owner have reached an advanced stage; in the third case the possibility of the Council acquiring the property is being pursued because it is included in an area which the Council may deal with as a clearance area within the next fifteen years. Advice has been given informally in some further twenty cases both to owners and tenants. Houses in Multiple Occupation Multiple occupation continues to present many problems but, because of the shortage of staff, work had to be limited mainly to the investigation of new cases coming to light as a result of reports from various sources, the continued supervision of those houses already known to the Department and the inspection of houses in multiple occupation where house purchase loan applications were received by the Council. House to house inspections have had to be limited for the time being. During 1966, 466 houses have been completely inspected and of this number only 42 were found to be satisfactory. Details of the action taken is shown in the table which follows:- Return for 1966 Number of houses completely inspected *466 representing approximately 1,860 lettings Number of houses found satisfactory 42 Number of houses where informal notices relative to S15/S16 sent 294 Number of houses where discussions are in progress 29 Number of houses where Fire Prevention Officer's recommendation or specification of work prepared by Health Department sent 13 (*Note:-Includes 101 houses in multiple occupation where house purchase advances were contemplated.) 30 Number of formal Notices sent under S.15 Housing Act 1961 30 Number of formal Notices sent under S.16 Housing Act 1961 2 Number of formal Notices sent under S.78 Housing Act 1957 18 Other notices served (Public Health Acts and Housing Act Sec. 9) 278 Further visits to houses in multiple occupation 2,745 Completed Works Repairs W.C's provided 34 External 220 Baths provided 31 Internal 220 Sinks provided 92 Penal overcrowding abated 50 Water heaters provided 150 Cooking facilities provided 33 Food stores provided 46 Space heating provided 14 Fire precautions 4 During the year the Greater London Council issued a draft Code of Practice of means of escape in case offire from houses in multiple occupation. Under Section 16 of the Housing Act 1961, the Council have an obligation to consult the Greater London Council as Fire Authority before serving any notice under that Section. It has now been agreed between the Greater London Council and the London Boroughs Association, and adopted by the Council of the London Borough of Haringey, that when the Code of Practice can be applied without variations, consultation is deemed to have been carried out. In consequence thepreparation of schedules of work for adequate means of escape in case of fire now generally falls on the public health inspector who must be fully conversant with the complex Code ot Practice. This additional responsibility only serves to emphasise the urgent need for additional fully qualified staff to deal with the vast problem of houses in multiple occupation in the Borough. "Directions" under Section 19 of the Housing Act 1961 to prevent the over-occupation of houses in multiple occupation were made in respect of six premises in the Borough. These were normally made to stop the reletting of parts of houses where amenities were inadequate and the additional amenities required could only be installed in some of the rooms which were occupied at the time. Procedure ot this kind was found to be useful where it was anticipated that rooms were likely to become vacant as a result of action taken to abate overcrowding or the rehousing ot a family was imminent. Certificates of Disrepair The following statement gives details of applications for Certificates under the Rent Act 1957 which were dealt with during 1966:- No. of applications for Certificates of Disrepair 8 Decision on applications: Approved for some but not all-defects listed 3 Approved for all defects listed 5 No. of landlords' undertakings accepted 4 No. of Certificates issued 4 No. of applications for cancellation of Certificates 1 No. of Certificates cancelled where tenants did not object 1 No. of Certificates issued as to remedying of defects undertaken by landlord: 4 All defects remedied 4 31 Housing Applications - Assessment on Medical Grounds Where housing applicants submit medical evidence supporting their requests for rehousing in Corporation dwellings, their cases are considered by a senior medical officer of the Health Department for medical assessment. During 1966 requests were received for 695 cases to be investigated, and recommendations were made upon medical priorities. This number represented an increased rate of almost 75% over 1965, when only 300 requests were received for the nine months from 1st April to 31st December, 1965. For this reason recommendations were usually made on the basis of the medical evidence submitted and the information regarding the existing accommodation on the Housing Department files. Only in special circumstances was a visit made to the house. Table I gives a summary of the cases coming to the attention of the Department and the sourceof information, and Table II shows the recommendations made where these were appropriate. TABLE I CASES INVESTIGATED Month No. of Cases Source of Request Housing Department Hospital, G.P. or Clinic Tenant, H.V. or P.H.I. January 60 55 3 2 February 55 33 14 8 March 52 32 8 12 April 36 21 5 10 May 57 39 9 9 June 47 30 6 11 July 43 29 6 8 August 78 51 10 17 September 43 31 5 7 October 95 61 13 21 November 70 34 10 26 December 59 26 18 15 Total 695 442 107 146 *200 cases were visited before assessment, and re-visits made in 30 instances. There were also 6 visits made to Council tenants requiring transfer on medical grounds. TABLE II MEDICAL RECOMMENDATIONS MADE DURING 1966 Action recommended No. of cases Special: refer to Committee 41 1st degree priority 161 2nd degree priority 201 3rd degree priority 80 Recommendation for accommodation to be shared 3 Recommendation for transfer 7 Case referred to Welfare Department 1 Not recommended on medical grounds 201 Total 695 32 Greater London Housing Survey In accordance with that Council's responsibilities under the London Government Act, the Director of Planning of the Greater London Council is arranging for a housing survey to be carried out over the whole of Greater London early in 1967. A sample, 4% of the premises on the rating lists, is to be surveyed, and this percentage in the London Borough of Haringey amounts to 2,880 premises. The Council have agreed that the public health inspectors whose familiarity with the field of work involved is of the greatest value, will be responsible for carrying out this survey. The information required will cover a very wide field. In addition to age, type, manner of occupation and numbers and kind of rooms involved, the survey will also require information on maintenance, expected life of the property and parking facilities. Extensive questions regarding possible conversions or improvements and their probable cost must also be answered. The whole survey has been designed so that advantage may betaken of modern computer techniques to assess the existing housing provisions and deficiencies in Greater London against present and future requirements. Although it is anticipated the work will take up a considerable amount of time in the Department, the completed survey should prove of considerable value to the Council, not only in the planning of future clearance and redevelopment schemes, but also in the organisation of other branches of housing work such as improvement areas and house to house inspection for the purpose of enforcing Section 9 of the Housing Act 1957. FOOD HYGIENE 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 continued to receive special attention. This work was further extended during the year by the Food Hygiene (Markets, Stalls and Delivery Vehicles) Regulations 1966. Although these regulations did not come into operation until 1st January 1967 a considerable amount of preliminary work was necessary to bring their requirements to the notice of those affected. Some food businesses carried on by persons from abroad presented particular difficulties. The tendency in some of these shops is for a large variety of goods to be offered for sale, such as groceries, green-groceries, butchers' meat, and cooked meats. In one instance, live chickens are kept in the yard at the rear of the shop where the customer selects the bird, after which it is slaughtered and plucked on the premises andthen handed to thecustomer. In such conditions frequent visitsare necessary to secure and maintain the standard of hygiene required by the Food Hygiene Regulations. The total number of food shops as at 31st December 1966 was as follows:- Bakers 103 Butchers 177 Cafes and dining rooms 235 Confectioners 539 Fishmongers 84 Fruiterers and greengrocers 241 Grocers 483 Off Licences and public houses 257 33 Registered Food Premises At the 31 st December 1966 the following premises were registered under Section 16 of the Food and Drugs Act 1955:- Sale of ice cream 776 Manfr. and sale of ice cream 11 Storage of ice cream 1 Cooking of hams and other meat 64 Fish frying 47 Fish curing (smoking) 3 Sausage manufacturers 99 Preparation of 'Hot Dogs' 1 Preparation of jellied eels 3 Shellfish 2 Prepared foods 14 Pickle making 1 Pickling meat 8 Total 1030 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 124 88 Shellfish 13 4 Fish 8 4 Ice cream 23 2 Light refreshments 16 4 Peanuts 4 2 Eggs 2 - Groceries 4 2 Confectionery 1 1 Totals 195 107 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 255 No. of dairies 6 Milk (Special Designation) Regulations At the 31st December 1966, licences to use the following designations were valid for premises in the Borough:- Pasteurised Milk 190 licences Sterilised Milk 196 „ Untreated Milk 23 „ Ultra-heat treated Milk 33 „ Milk Supplies Samples of miIk for bacteriological examination are submitted to the Central Public Health Laboratory for routine testing for the presence of brucella abortus. During one such examination the presence of rickettsia burnetti, a causal agent of "Q" fever, was found. The Company concerned and the Local Authority from whose district the milk originated were informed and the milk from the particular farm was not sold untreated until affected animals had been isolated by a veterinary surgeon and excluded from the herd. 34 Food Sampling The Public Analyst for Haringey is Mr. W.B. Chapman, B.Sc., F.R.I.C., of the Scientific Division of the Greater London Council and all analyses are carried out at the Greater London Council Laboratories. Similar arrangements exist between the Greater London Council and three other London Boroughs and the four authorities and the Scientific Branch of the Greater London Countil have agreed to carry out a co-ordinated programme whereby duplication of sampling is avoided and each authority is acquainted with the results of the sampling examinations carried out on behalf of all four Boroughs. Informal samples of a wide variety of food and drugs have been submitted to the Public Analyst who reported on each sample in relation to the standards laid down in Orders and Regulations for the commodities including requirements as to labelling and advertisement. Chemical and biological examinations have also been carried out for the presence of penicillin and insecticidal residues. FOOD SAMPLES Article No. of Samples Provided Unsatisfactory Composition Labelling Alcoholic beverages 18 4 8 Baking powder 4 - - Beverages 2 - 1 Bread 1 - 1 Cake 5 - - Cake preparations 8 - - Canned fish 1 - - Canned fruits 106 3 - Canned meats 7 1 1 Canned puddings 14 - - Canned vegetables 21 - - Cereals 28 - 2 Cheese 8 - - Chocolate preparations 18 2 - Cocoa 3 - - Colourings 6 - - Cream 9 1 - Custard powder 5 - - Dried fruit 17 - - Dried herbs 9 - - Drugs 77 4 6 Fats 30 - 1 Fish preparations 1 - - Flavourings 6 - - Fruit preparations 7 - - Gelatine 2 - - Honey 9 - - Ice cream 29 - 8 Meat pies 7 2 - Meat preparations 3 - - Milks 157 2 5 Mi Ik powder 1 - - Nuts 5 - - Oils 15 2 1 Pickles 1 - - Potatoes, etc. 4 - - Preserves 58 - - Puddings 3 - - Salt 7 - - Sauces 4 - - Sausages 2 - - Slimming preparations 4 - - Soft drinks 3 - - Spices 15 - - Suet 4 - - Sugar confectionery 37 - 4 Tea 10 - - Treacle 1 - - Vinegar and non-brewed condiment 9 - 1 TOTALS 801 21 39 35 Details of Unsatisfactory Samples Sample Irregularity Comments and action taken Alcoholic beverages (a) Composition 3 samples of liqueurs contained less alcohol than was claimed on the label Still in correspondence with distributors further samples to be taken 1 sample contained gold leaf, an additive which is not permitted by the Colouring Matter in Food Regulations Although stated by manufacturers that the substance had no effect on the colouring, they were informed that the new Regulations will not permit its use in liqueurs Tomato Puree 3 samples found to contain excessive proportions of tin, due to an attack by the contents on the metal of the can Matter reported to Minister of Agriculture Fisheries & Food, who took this up with Italian Authorities. Manufacturers of this product have not been exporting to Engal and for some years and it is assumed that the tins sampled were very old stock Sausages The drained sausages from a sample of canned frankfurters in brine were found to contain only 60% total meat whereas in the opinion of the Analyst a reasonable minimum would be 65% Further consideration deferred pending publication of new Regulations Chocolate preparations Two boxes of liqueur chocolates had deteriorated and most of the chocolates were devoid of filling On further investigation they were found to be old stock Vendor warned Cream Milk fat in a sample of Ultra Heat Treated Cream was 19.9%, whereas in the opinion of the analyst it is sterilised cream and should contain not less than 23% Awaiting official declaration from Ministry. Drugs (1) A sample of French throat pastilles were coloured with, amongst other colours, Patent Blue V, a colouring matter which is permitted in France but not in England Importers contacted and requested to ensure that future supplies will comply with current legislation (2) The formaldehyde content of Formalin tablets was only about half the minimum prescribed by the B.P.C. due, it was thought to inadequate or over long storage The pharmacist concerned undertook only to supply this product in hermetically sealed containers in the future (3) Two samples of Boric Acid dusting powder were found to contain incorrect amounts of boric acid compared with the requirements of the British Pharmaceutical Codex One sample was very old stock; chemist withdrew remainder. Other may have been of powder no longer on market— difficulty in identifying manufacturer Sausage rolls Two samples from same retailer were considered to contain such a low meat content as to be reasonable cause for objection (8% and 10% total meat respectively). Vendor selling these as "savouries" and was warned regarding adequate labelling and other precautions 36 Untreated Milk The milk fat content in two samples was 2.3% - 23% deficient of the minimum standard of 3% In one case due to failure to mix morning and evening milk and in other case low fat due to altered feeding schedule. Further sample was satisfactory Cooking Oils Samples of groundnut oil and corn oil were both found to be contaminated with small amounts of cotton seed oil Manufacturers are providing separate pipework for each oil Liquers (b) Labelling No address of packer, labeller or importer (2) Alcohol declaration less than 1/12" in height (6) Alcohol declaration in wrong form (1) Alcohol declaration not legible or conspicuous Manufacturers' attention drawn to these facts Vita-cup Generic term "glucose" used in list of ingredients Labels amended by manufacturer Dietary Loaf Not labelled in accordance with Bread and Flour Regulations Labelling amended by manufacturers Frankfurter sausages Generic terms "stock" and "cereals" used in list of ingredients Further consideration deferred pending publication of new Regulations Cereals No name and address on packets of flaked tapioca and pearl barley Properly labelled bags provided for tapioca and pearl barley cartons reprinted by manufacturer Drugs (1) Dusting powders - no cautionary notice (3) One sample should have been labelled "Compound Dusting Powder of Zinc Oxide and Starch" Difficulty in identifying manufacturer. Sample may have been of a powder no longer on the market (1) Stock withdrawn by chemist(1) manufacturer undertook to affix extra label to stock (1). Verbal warning to chemist (2) Cream of Calamine - no cautionary notice On this occasion for sampling purposes it was thought sufficient that there was a notice on larger jar at chemists. Normally cream is dispensed on prescription and is marked "Use as directed" (3) Vitalis hair dressing recommended as a medicine, but label did not show composition or names and proportions of active ingredients Manufacturers requested to amend labels (4) Bio-clear cream - recommended as a medicine but label did not show composition or names and proportions of active ingredients Label amended by manufacturer Corn oil margarine Inadequate size of printing Warning letterre labelling of ½lb. packets packed in 1lb. cartons. Manufacturers gave undertaking to amend labels Ice Lollies Generic term "fruit juice" used in list of ingredients (8) Being discussed by Ministry, Analyst and Ice Cream Alliance. New regulations being issued. 37 Separated Milk Separated milk being sold in bottles marked "sterilised". Matter under discussion with Analyst and Ministry of Agriculture, Fisheries & Food Olive Oil No name and address given Manufacturer undertook to provide proper labels with product Sugar confectionery (1) Chewing gum (3) - Generic terms "gum base" and "softeners" used in list of ingredients Printing on packages amended by manufacturers (2) Bubble Gum (1) - Generic terms "glucose", "gum base" and "softeners" used in list of ingredients Manufacture of this product now ceased Malt Vinegar Incomplete list of ingredients Company notified and they have given an undertaking to rectify the matter Vodka Declaration of alcohol content less than 1/12" in height (2) Manufacturer's attention drawn to this matter and asked to ensure that labels; comply with new regulations when issued Meat Inspection One of the two slaughterhouses in the Borough was severely damaged by a gale in December 1966 and the remnants of the building were subsequently pulled down. It is understood that the proprietors intend to submit proposals for the building of a new slaughterhouse on the same site. The other slaughterhouse undertakes regular slaughtering of pigs, goats, sheep and calves, and a 100 per centinspection of animals slaughtered is carried out by fourteen public health inspectors who work on a rota to cover morning, afternoon and evening sessions. Summary of Carcases Inspected 1966 Horses Cows Calves Sheep and Lambs Pigs excl. Sows Sows Goats No. killed 54 58 543 2683 12046 3522 10 No., inspected 54 58 543 2683 12046 3522 10 All Diseases except Tuberculosis and Cysticercosis Whole carcases condemned 1 9 - 2 15 3 - Carcases of which some part or organ was condemned 19 22 6 408 1814 483 - Percentage of number inspected affected with disease other than tuberculosis and cysticercosis 37.03 53.45 1.10 15.28 15.18 13.80 _ Tuberculosis only Whole carcases condemned - - - - - - - Carcases of which some part or organ was condemned - - - - 126 86 - Percentage of number inspected affected with tuberculosis - - - - 1.04 2.44 - (Note: No case of cysticercosis was reported during the year) 38 Food: Fitness for Human Consumption Frequent samples are taken of cooked meats, pies, cream buns, etc. for bacteriological examinations by the Central Public Health Laboratories at Colindale. The follow up of cases giving less than satisfactory results has often brought about a marked improvement in the equipment provided at the food premises and the attitude of food handlers involved. Specimens of food are submitted to the Department by purchasers who consider that the foodstuffs are unsatisfactory for various reasons. These include the presence of mould, evidence of decomposition and the presence of foreign matter. A thorough investigation is made in each case and if necessary the food is also submitted to the Public Analyst and/or the Central Public Health Laboratories. Reports are prepared and where appropriate legal proceedings instituted. A considerable amount of food, mainly tinned foods, is submitted to the Department by shopkeepers and wholesalers for condemnation. After inspection by the public health inspector the food, if considered unfit for human consumption, is collected and destroyed and a certificate issued to this effect. The following table shows the food complaints which have been received from members of the public during 1966 and the action which was considered necessary. Details of Food Complaints Commodity No. of Complaints Action taken Foreign bodies found Other reasons Official Warning Letters Prosecution No formal action warranted Milk 4 6 7 - 3 Yogurt 2 2 3 - 1 Butter - 1 - - 1 Bread 15 8 17 2 4 Canned meat - 6 2 - 4 Cooked meat - 1 - - 1 Meat pies 1 2 1 - 2 Fish - 2 - • 2 Fruit 1 2 1 - 2 Jam 1 - - - 1 Vegetables - 2 - - 2 Sweets 2 - 1 1 - Confectionery 5 4 4 1 4 Meat - 3 2 - 1 Sausages 2 2 2 - 2 Hamburgers - 1 - - 1 Sausage Rolls - 1 - - 1 Baby Food - 2 1 - 1 Bacon - 1 - 1 - Bacon beans - 1 - - 1 Cough mixture - 1 - - 1 Coffee - 1 - - 1 Dried fruit 1 - 1 - - Fruit pudding - 1 1 - - Margarine - 1 1 - - Orange drink - 1 - - 1 Rice pudding, tinned 1 - 1 - - Soup 1 - - - 1 Cereals 1 - 1 - - Liquid Paraffin - 1 - - 1 Total 37 53 46 5 39 39 Legal proceedings were taken in respect of five offences and the results in fines and costs totalled £91.5s.0d. Unsound Food Surrendered or Condemned Tons Cwts lbs Meat 1 10 74½ Cooked meat and meat products 8 71 Canned meats 14 73 Fish 1 14 + 5 boxes Fruit and vegetables 12 1 20 Tinned food other than meat 3 13 82 Total 18 9 110½ + 5 boxes 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 Alpha-Amylase test cannot be applied satisfactorily to separated yolk or albumen, random samples of the foodstuff consignments are taken for bacteriological examination. All tests proved satisfactory. Imported Foods Quantities of concentrated fruit juices for human consumption are received into the Borough from abroad. These are accompanied by certificates from the country of origin or the Port Authority at the point of entry into the country. Spot checks are made to verify the nature and concentration of the preservatives used. Offices, Shops and Railway Premises Act 1963 Enforcement of this Act is undertaken by the public health inspectors in the food hygiene section. In common with other sections of the Department,this section was affected by the shortage of qualified staff. It was necessary for priority to be given to other work undertake by this section and in consequence the number of general inspections under the Offices, Shops and Railway Premises Act was less than the Department would have desired. Informal notices which have been served as a result of general inspections have however been followed up and the work seen to be carried out. Registrations and General Inspections in 1966 Class of Premises No. of premises registered during 1966 No. of registered premises at end of year No. of registered premises receiving a general inspection in 1966 Offices 13 509 12 Retail shops 22 1,287 149 Wholesale shops, warehouses 3 78 3 Catering establishments open to the public, canteens 4 145 24 Fuel storage depots - 4 - Totals 42 2,023 188 40 Persons employed in Registered Premises Class of Workplace No. Offices 7,038 Retail Shops 7,153 Wholesale departments, warehouses 1,537 Catering establishments open to the public 1,098 Canteens 212 Fuel storage depots 50 Total 17,088 Males 7,942 Females 9,146 Total number of visits of all kinds by Inspectors to registered premises under the Act - 411 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 21 15 Eating facilities 2 5 Overcrowding 2 16 Floors, passage and stairs 13 6 Temperature and thermometers 19 17 Fencing exposed parts machinery - 7 Ventilation 4 8 Lighting 2 18 Protection of young persons from dangerous machinery - 9 Sanitary conveniences 20 10 Washing facilities 20 19 Training of young persons working at dangerous machinery - 11 Supply of drinking water - 12 Clothing accommodation 1 23 Prohibition of heavy work - 13 Sitting facilities 1 24 First aid general provisions 19 14 Seats (sedentary workers) 1 27 Dangerous acts 2 Total 127 Reported Accidents Workplace Number reported Total No. investigated Action taken on cases investigated Prosecution Formal Warning Informal Warning No Action Offices 5 4 - - - 4 Retail Shops 30 14 - - 2 12 Wholesale shops, warehouses 18 6 _ _ 2 4 Catering establishments open to public, canteens 9 4 _ _ 1 3 Fuel Storage Depots 1 1 - - - 1 Totals 63 29 - - 5 24 41 Analysis of Reported Accidents Offices Retail shops Wholesale shops, Warehouses Catering establishments open to public, canteens Fuel Storage depots Machinery - 4 1 1 - Transport - 1 4 - - Falls of persons 4 9 4 3 1 Stepping on or striking object or person - 3 1 - - Handling goods - 10 4 2 - Struck by falling object 1 - 3 2 - Fires and explosions - - - - - Use of hand tools - 3 1 - - Not otherwise specified - - - 1 - TOTALS 5 30 18 9 1 Hairdressers Hairdressing establishments are visited regularly and it has been pleasant to note a general improvement in this type of premises in recent years. Shops Act 1950-1966 A total of 2,006 shops were inspected during the year. The following contraventions were noted:General Sec. 17(2) Assistants weekly half holiday notice not displayed 312 Sec.32(2) Record of hours of employment of young persons notice not displayed 103 Sec.32(3) Abstract of provisions of employment of young persons not displayed 98 Closing hours Sec.2(1) Failed to close at prescribed hour 64 Sec. 1(1) Failed to close at 1 p.m. on early closing day 32 Sec.1(2) Failed to exhibit early closing day notice 539 Sec. 13(1) Failed to exhibit exempted trade notice 114 Sec.24(1) Employment of young persons beyond permitted hours 2 Sunday Trading Sec.22(3) Failed to keep record of hours of employment 11 Sec.57 Failed to exhibit Sunday Trading Notice 115 Registered Jewish Traders Seven Orthodox Jewish Traders were registered under Section 53; no infringements of the conditions were noted. Middlesex County Council Act 1944 Street Trading When the Borough of Haringey was formed Part IX of the Middlesex County Council Act 1944 applied to Hornsey and Tottenham but only to part of Wood Green. The Council have now taken steps for this legislation to apply throughout the Borough and action is being taken to adopt uniform bye-laws throughout the area. The siting of the stalls is also under review particularly having regard to the increase in vehicular traffic in recent years. Forty-nine street trading licences were issued in 1966. Inspection of the sites is carried out by the shops inspectors and a number of verbal warnings were given in respect of obstruction to the highway or footpath. 42 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 all factories requires surveillance and the inspection of other environmental conditions in factories without mechanical power is also the responsibility of the public health inspector. 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 Section 1, 2, 3, 4 and 6 are enforced by local authority 103 7 - - (ii) Factories not included in (i) in which Section 7 is enforced by local authority 1079 275 4 - (iii) Other premises in which Section 7 is enforced by local authority (excluding outworkers premises) 7 - - - Totals 1189 282 4 - Summary of Defects found in Factories Particulars No. of cases in which defects were found Found Remedied Referred to Factories Inspector Referred by Factories Inspector Want of cleanliness (S.1) 1 - - 1 Overcrowding (S.2) - - - - Unreasonable temperature (S.3) 1 1 - 1 Inadequate ventilation (S.4) - - - - Ineffective drainage of floor (S.6) - - - - Sanitary conveniences (S.7) (a) Insufficient 1 1 - 1 (b) Unsuitable or defective 12 12 - 11 (c) Not separate for sexes 1 1 - 1 Other offences against the Act (not including offences relating to outworkers) 2 - 2 - Totals 18 15 2 15 Outworkers Visits were made by public health inspectors to the homes of persons notified to the Department as outworkers in accordance with the requirements on 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. 43 The following is a summary of the types of work undertaken by outworkers in the Borough:- Wearing apparel 357 Household linen 1 Curtains and furniture hangings 3 Umbrellas 5 Artificial flowers 9 Brush making 3 Cardboard boxes 26 Feather sorting 2 Boxing, carding of buttons 85 Christmas crackers and stockings 19 Total 510 RADIOACTIVE SUBSTANCES ACT 1960 Notification is received of all premises within the Borough in respect of which certificates are issued by the Ministry of Housing and Local Government, for the keeping and use therein of radioactive materials. During theyearten visits were made to these premises by a senior public health inspector who has received special additional training in this subject. Information was obtained on the radioactive substances used, their storage and the disposal of any waste products. In one case, this resulted in the return of stocks of strontium 90 and thalium 204 to the United Kingdom Atomic Energy Authority as these items were used very infrequently. In addition, the method of storage of the remaining radioactive substances at these premises was considerably altered. In a further case it was pointed out that adequate warning notices had not been displayed at the site where the radioactive isotope was being used to measure the correct filling of cans. A complaint was received from a lady concerning alleged contamination of her clothing, resulting, it was said, in various skin irritations following her inadvertent opening of a letter from the Radiological Protection Service, not addressed to her but containing a film badge and metal container used to measure radiation. As a precaution and with the assistance of a radiological research laboratory at one ofthe premises registered by the Ministry, various items of clothing belonging to this lady were monitored. It was confirmed that there was no evidence of radiation and that the badge and metal container were not capable of emitting radiation. Lead Poisoning The year produced no less than five cases of lead poisoning with some interesting and unusual features. A six year old girl took ill and was admitted to hospital. She appeared to have an infection, but she had a history of lead poisoning at the age of two, and when a further specimen of blood was taken the lead content was found to be raised. The old records showed that the original cause was considered to be the child's habit of eating soil from the garden, which happened to contain more lead than usual, due to its being near the site of an electric battery company, closed several years before. However, this seemed unlikely to account for the recent incident, since the garden had been cemented over, and as far as could be ascertained - the child had given up the habit. The conclusion was the apparent recurrence was probably the liberation of lead from the bones into the circulation due to an infection. But since so many questions had been raised in the enquiry, it was decided to undertake a long-term investigation. A mother had an exceptionally distressing problem with her three year old daughter who literally ate them out of house and home. Her fondness for eating the plaster from the walls, leaving large holes, resulted in exasperated landlords giving them noticeto quit. When she was found to have lead poisoning, our assumption that it was due to lead in the plaster was shaken somewhat when laboratory tests revealed that the lead content of this was extremely low. Although some of the paintwork contained up to twenty percent of lead, there was no evidence that she ever chewed it. We were inclined to think that the quantity of plaster consumed had made up for the low concentration, but the discovery at a late stage that she had been seen to suck a lead soldier (unfortunately lost) threw doubts on the theory. However, there was unexpected supporting evidence from another part of the Borough. A thirteen year old boy, also fond of eating plaster, was found to have lead poisoning. He varied this diet occasionally with brickdust and fragments of a local newspaper. None of these had a high lead content, so it would seem that, notwithstanding the importance of the concentration of lead in substances consumed, more attention needs to be paid to their total amounts especially if they appear to be comparatively harmless. 44 WINDOW SILL CHEWED BY CHILDREN {See page 45) In view of the tendency of young children to put objects in their mouths, the application of B.S.I.. standards to paint has been a useful contribution to home safety. However, the following example will show that one should not allow oneself to be lulled into a sense of false security because modern paint of low lead content has been used. A twenty-two month old twin was admitted to hospital with convulsions due to leadpoisoning. The other twin was also found to be suffering from the condition. Both had been chewing energetically at the woodwork of their cots and the window sills of their small room. The latter had been painted fairly recently, using a modern paint. The paint of the cots had a low lead content, as had the superficial layer on the window cills; but the children had gnawed right through the paint down to the underlying wood (see photograph). The deeper layers of paint, estimated to have been there thirty to fifty years, contained fifty per cent of lead, and were clearly the cause of the trouble. When one considers the amount of old lead; containing paint concealed in rooms all over the country, the size and difficulty of the problem becomes apparent. The only way to deal with it is to remove it completely before repainting with indoor paints of recent manufacture. This would add considerably to the cost of redecoration, and may well not be thought worthwhile, as accidents like this are extremely rare. It is interesting to reflect, moreover, that the two children would probably have been all right if their cots had been one foot from the wall, and they had had to concentrate their energies on the cots. It is reassuring that there was no death among these five cases, and all have made satisfactory recoveries, but it is obvious that parents must take care to protect theirchildrenfromthis danger, and that more research will be necessary in the future. CARE OF MOTHERS AND YOUIMG CHILDREN Notification of Births The following table shows the births notified during the year- Live Births (a) Domiciliary 858 (b) Hospital or Nursing Home 4824 Still Births (a) Domiciliary 2 (b) Hospital or Nursing Home 76 5760 Maternal Deaths It is regrettable to have to report that there were seven deaths associated with pregnancy and child bearing during the year. This figure is considerably above the national average. Three deaths occurred in early pregnancy; one a ruptured ectopic gestation and two abortions. In both the last two cases large families were left motherless. Of the four cases who died after full term delivery, two were the result of post partum haemorrhage. One died immediately following the birth, and the other although she survived the immediate disaster, had suffered such severe kidney damage that in spite of the most modern medical treatment she died twelve weeks after the birth. Both babies survived in these cases. The other two deaths were associated with severe toxaemia of pregnancy and occurred soon after delivery. In one case the baby was stillborn, but in the other, twins, a boy and a girl, survived. Family Planning In February 1966 the Minister of Health issued a circular urging local authorities to review their present arrangements for family planning advice and treatment and suggesting ways in which local services might be further developed. Considerable discussion ensued within the department and the arrangement for referral by medical officers for family planning advice of mothers in whom further pregnancy would be detrimental to health was revised. These cases are referred to the Family Planning Association clinics and the cost is met by the Council. Increased budgetary provision was made for these cases and increased numbers were referred this year as compared to previous years, viz. 40 cases in 1966 as compared with nine in 1965. In addition further premises were made available to the Family Planning Association. A weekly session was started at Cornwall Road Clinic, N.15. on 26th October 1966, and another has been planned to start at Fortis Green Clinic early in 1967. 45 Consultations were held with other local authorities and with the Family Planning Association concerning the introduction of a domiciliary contraceptive service for selected cases. Ante-natal Clinics The arrangements for ante-natal clinics continued on similar lines to the previous year and the following table gives details of attendances:- Name of Clinic Number of sessions held Total attendances Average attendance per session A.N. P.N. Alexandra Park 1 21 1 22.0 Burgoyne Road 85 1226 38 14.8 Church Road 72 1057 45 15.3 Fortis Green 100 1580 44 16.2 Weston Park 152 2442 125 16.8 Mildura Court 63 1357 57 22.4 Stroud Green 77 1052 50 14.3 The Chestnuts 105 1422 84 14.3 Lordship Lane 103 849 67 8.9 Park Lane 104 943 100 10.3 Gordon Road 75 1150 75 16.3 White Hart Lane 52 401 20 8.9 Totals 989 13500 706 14.3 Midwives Ante-natal Clinics The following table shows the attendances made during the year:- Midwives Clinics Number of sessions held Total number of attendances Average attendance per session Burgoyne Road 10 24 2.4 Fortis Green 14 10 0.7 Weston Park 22 64 2.9 Stroud Green 17 47 2.4 Chestnuts 48 193 4.0 Park Lane 43 116 2.7 Lordship Lane 37 61 1.7 Gordon Road 45 217 4.8 Totals 236 732 3.1 Cervical Cytology In April 1966 the Ministry of Health gave approval under Section 28 of the National Health Service Act 1946 to a proposal by the Council to set up a cervical cancer screening service in the Borough. Arrangements were made with the Whittington Hospital and St. Bartholomew's Hospital for the diagnostic investigation at their laboratories of 18 smears per week, and a weekly session for taking smears was commenced at Mildura Court Welfare Centre, Hornsey, on the 22nd July 1966. The service was limited to applicants who were 25 years of age and over. Up to the end of 1966, cervical smears were taken from 272 patients. In one case the result showed signs of incipient cancer of the cervix and the patient was referred for and received operative treatment. Extension of the service is limited at present because of a shortage of trained laboratory technicians in the hospital service. Nevertheless it is anticipated that during 1967 additional sessions will be arranged at two and possibly three of the Council's clinics, and the number of smears taken per week may be increased from 18 to 48. 46 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 102cases 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. Ten still births were notified with congenital deformity. Mothercraft and Relaxation Classes An average attendance of 6.7 is reasonable because every mother during relaxation instruction requires individual attention if she is to obtain the maximum benefit. The health visitor aims to dispel fears and misapprehension by encouraging group participation in an informal atmosphere. Many members of the staff have in previous years benefited by in-service training under the direction of Mrs. Williams, Physiotherapist, who specialises in this kind of work. New members of staff will need to be given the opportunity of this type of in-service training and we are fortunate that in 1967 six members of staff will join their colleagues in the Borough of Enfield for a specialised course of training. The following table shows attendances at Mothercraft clinics during the year: Clinics Number of sessions held Total number of attendances Average attendance per session Burgoyne Road 33 155 4.7 Church Road 48 266 5.5 Fortis Green 49 418 8.5 Weston Park 21 222 10.5 Mildura Court 45 163 3.6 Stroud Green 46 482 10.5 Chestnuts 49 322 6.6 Lordship Lane 51 330 6.4 Park Lane 46 236 5.1 White Hart Lane 27 194 7.2 Totals 415 2788 6.7 Infant Welfare Clinics There is no sign of a diminishing need for the guidance offered to mothers at infant welfare sessions. Immigrant mothers particularly appreciate the services available, as shown by their continued visits. In spite of language barriers the Cypriot mother seeks help and eagerly accepts advice from doctors and health visitors. It is inevitable, because of language difficulties, that some of the sessions extend beyond the usual hours at clinics where a number of immigrants live in the vicinity. The following table gives attendances during the year at the various clinics:- Name of clinic Number of sessions held Total attendances Average attendance per session Number of cases seen by M.O. Number of cases referred elsewhere Burgoyne Road 137 6475 47.3 1742 13 Church Road 206 4887 23.7 1639 36 Fortis Green 103 4860 47.1 1811 8 Weston Park 149 7019 47.1 2672 28 Mildura Court 104 4537 43.6 1483 16 Stroud Green 103 5418 52.6 1624 20 The Chestnuts 202 8197 40.5 2621 65 Lordship Lane 203 6427 31.1 1664 16 Park Lane 152 5242 34.4 1782 40 Somerset Road 150 3224 21.4 1330 39 Alexandra Park 52 2817 54.1 796 10 Gordon Road 101 5975 59.1 2340 18 White Hart Lane 152 7477 49.1 1913 28 Totals 1814 72555 39.9 23417 337 47 Toddlers Clinics Attendances at these clinics for children between the ages of two and five years are normally arranged by appointment. A friendly and informal atmosphere is created and the children are encouraged to mix and play together. Early detection of minor defects with referral when necessary for specialist opinion is one of the functions of this type of clinic. After the first attendance the majority of mothers continue to bring their children at six-monthly intervals or more frequently if required until the child enters school. The following table gives 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 sessions Burgoyne Road 26 560 560 21.5 Church Road 24 344 321 14.3 Fortis Green 51 492 492 9.6 Weston Park 48 736 734 15.3 Mildura Court 51 786 633 15.4 Stroud Green 27 414 391 15.3 The Chestnuts 53 752 752 14.1 Lordship Lane 52 746 738 14.3 Park Lane 49 651 638 13.2 Somerset Road 52 642 642 12.3 White Hart Lane 20 276 276 13.8 Totals 453 6399 6177 14.1 Day Nurseries The demand for day nursery admission continues to be far greater than the number of places available. The waiting list for priority categories is always extensive and in most instances for long term admission the minimum waiting period is approximately six months. Requests for short term emergency admission can usually be met. There were 191 new admissions during the year. Mothers with a hospital appointment either for themselves or one of their children sometimes are unable to make arrangements for the care of their pre-school children. In these cases, they appreciate being able to leave one, two and sometimes three children for a few hours at the day nursery, while they attend the hospital. The following table shows the attendance at individual nurseries during the year:- Name of Nursery Number of approved places at end of year Number of children on register at end of year Total number of attendances Average daily attendance Under 2 2 - 5 Under 2 2 - 5 Under 2 2-5 Total Stonecroft 15 43 13 40 2427 8811 11238 44.3 Park Lane 20 30 6 32 2979 6336 9315 36.6 Plevna 20 30 11 37 2608 7433 10041 39.5 White Hart Lane 10 30 10 31 1799 7106 8905 35.1 Totals 65 133 40 140 9813 29686 39499 155.5 Student Nursery Nurses All eight students were successful in obtaining the Nursery Nurse Certificate on the completion of the two year training. 48 Daily Guardian Scheme The daily guardian scheme provides an admirable alternative source of day time care for the pre-school child of the working mother, who is either not eligible or does not wish to wait for a day nursery vacancy. The unsupported mother, not infrequently is financially hard pressed to meet the reasonable daily guardian fee. Unsatisfactory daily minding by unregistered minders is continually investigated, but co-operation from the parents is not always forthcoming. No. of daily guardians on register 150 No. of daily guardians minding children 80 No. of children being minded 98 Total No. of children minded during the year 224 Total No. of days minded 21550 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 1966 and April 1967:- Nurseries taking children for the whole of the day Child Minders Play Groups Number Registered places Number Registered places Number Registered places April 1966 2 63 10 87 11 286 April 1967 2 63 16 123 15 387 New registrations April 1966 to April 1967 - - 6 36 4 101 Details of new registrations are as under- Registered places Child Minders - Mrs. Harris, 121 Nightingale Road, N.22 4 Mrs. Haugh, 29 Granville Road, N.22 6 Mrs. G. Landman, 25 Ferme Park Road, N.4 12 Mrs. H.M. Langbridge, 17 Bruce Castle Road, N.17 4 Mrs. D.M. Ross, 5 Lyndhurst Road, N.22 6 Mrs. N. Shields, 247 Alexandra Park Road, N.22 4 Play groups - British Legion Hall, Muswell Hill Road, N.10 24 Mrs. C.B. Hardisty, 33 Dukes Avenue, N..10 13 St. James Church Hall, Birchwood Avenue, N.10 24 Methodist Church Hall, Jacksons Lane, N.6 40 The demand for facilities for under-fives continues to be pressing and most registered premises have waiting lists of entry. There are two different pressures, one from mothers who wish to go out to work and leave the child all day, and the other from mothers seeking nursery education for their children. The second group are really looking for nursery schools and in their absence use playgroups as a substitute. Many, but not all, of the playgroups in the Borough are very well run by fully trained teachers, but the Health Department staff who inspect them are concerned mainly with the health of the children and the hygiene of the premises, and the educational aspect remains unsupervised. 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) 22199 70045 6880 5469 49 Dental Care for the Priority Classes Since the comparable report of last year was made on dental care for the Priority Classes, some change has taken place for the year now under review. This relates both to the total amount of time devoted to these patients being increased by 16.5% and to a redistribution of the time so that greater emphasis is placed upon the pre-school children. This is as planned and was foreseen in the previous report, and has been done without imposing any restrictions on the acceptance of anybody seeking treatment. The reduction in the number of expectant and nursing mothers, and the lesser amount of treatment required by each, is quite by chance. It is to be hoped that this trend reflects the increase in the numbers who regularly attend their own dentists as a routine and who, therefore, do not need to seek treatment from our service solely because they do not already have, or know of, a general dental practitioner. The increase in the number of pre-school children treated has been brought about by closer liaison between the medical and dental services, and by more direct attempts by the dental staff to advise parents of children already attending for treatment that their younger children, not yet at school, might also benefit by attending. We like to have the opportunity of seeing these children before the need for treatment arises, as this makes for a simple and pleasant introductory visit conducive to the later acceptance of treatment without undue difficulty. The association in the mind of a child between severe toothache and a visit to the dentist is the worst possible foundation on which to build acceptance and trust. Neither must it be overlooked that early treatment is likely to be quicker and simpler, and that every dental defect treated before entry to school represents less to be done later, when our duties to the schools may impose delays in treatment not suffered by the priority classes. Where possible, the figures for the preceding year are set beside those for the year under review for comparison, but a change in the keeping of statistics required by the Ministry of Health has not allowed this ineverycase. The change has made possible the giving of some details for the first time this year, but for others has prevented the giving of directly comparable information. It will be seen that we succeed in maintaining a service which conserves rather than removes teeth, and it may be of interest to mention that our ratio for pre-school children's teeth filled to those extracted is 4.0 to 1 against a National average of 1.2 to 1. The table showing the details of work done for priority patients is simple for the small numbers concerned, unlike that for the school dental service reported upon separately elsewhere, so that appreciation is easy and does not call for detailed comment. Expectant and nursing mothers Pre-school children 1966 1965 1966 1965 Number examined 177 207 969 707 Requiring treatment 176 193 727 506 Attendances for treatment 663 1052 2264 1572 Treatments completed 109 108 469 374 Number of fillings 385 639 1586 1053 Number of teeth filled 344 - 1432 - Number of extractions 166 215 361 235 Number of prophylaxes 121 185 57 - Teeth otherwise conserved - - 610 664 Other operations 290 512 744 439 Number of general anaesthetics 22 22 194 119 Number of radiographs 27 24 6 4 Number of crowns and inlays 8 - - - Number of dentures provided: Full - 15 - - Partial - 46 - 2 Method of recording changed for 1966 and dentures for both these categories of patients are combined. Total number of dentures of all types supplied was 38 Number of treatment sessions for priority classes in 1966 was 367 (number in 1965 was 315). 50 MIDWIFERY SERVICE Despite the decline in the national birth rate there were 89 more births notified in Haringey compared with the previous year. The number of bookings for home delivery was 1283. (842 mothers were delivered at home compared with 850 in 1965). Of the remainder, 59 were transferred to hospital during labour, some removed from the Borough, some were transferred to hospital bookings, and the rest miscarried. The Emergency Obstetric Squad was utilised three times and all patients were dealt with satisfactorily. The 'night rota' system continues to be administered effectively by the Whittington Hospital, an average of 67 calls per month being dealt with. Of these calls, 29% were 'false alarms', i.e. the visit did not entail delivery of the baby but was nonetheless necessary to confirm whether or not labour was established and to give a sedative to the patient should the need be there. The number of cases where assessment of social conditions was made in connection with planned early discharges 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 222 Hospitals in North East Metropolitan Region 165 London Teaching Hospitals 25 Total 412 The number of actual planned early discharges was 281. Further early discharges were accepted, though not planned, because of emotional difficulties due to stillbirths, neo-natal deaths or domestic problems. These additional early discharges totalled 204. A further 75 patients discharged themselves. 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 39 Hospitals in North East Metropolitan Region 267 General Practitioner Obstetricians 84 Local Authority Clinics 267 Total 657 The number of requests for assessment received increased by 316 as compared with 1965. Out of 657 cases investigated, 375 were referred to hospital, 240 booked for home confinement, and 42 removed from the area or miscarried. Liaison continues with general practitioner obstetricians, 14 of whom have a midwife in regular attendance at their ante-natal clinics. A table is given below showing the work for the past year- Number of deliveries attended 842 Number of visits made: a) Ante-natal 6950 b) During Labour 1955 c) Nursing 11527 20432 Number of hospital confinements discharged before 10th day 560 Number of visits made 3311 Number of cases in which medical aid was summoned under C.M.B. rules 132 Number of cases in which gas and oxygen analgesia was administered 173 Number of cases in which pethidine was administered 515 Number of cases in which trichloroethylene was administered 327 Number of cases in which gas and oxygen and trichloroethylene were administered 19 51 Student Midwife Training District training for student midwives in association with the Whittington Hospital started on 1st March and also continued as previously in association with the Alexandra Maternity Home. Training lasts for three months in the domiciliary field, the student being attached to a teaching district midwife, having spent nine months prior to this in midwifery training hospital. Of the twenty student midwives from the Whittington Hospital who received district training in Haringey, nineteen were successful. Of the seven student midwives from Alexandra Maternity Home, six were successful.. The failure ratio was 7.4%, comparing favourably with the national average in 1965 of 13.4%. Of the successful candidates, three were recruited to become members of our domiciliary midwifery service and one to the home nursing service. In September the Beacon Lodge Trust, which administers Beacon Lodge Mother and Baby Home, Eastern Avenue, N.2., was placed in difficulties because of a shortage of midwifery staff. Arrangements were made for the Council's domiciliary midwifery service to provide assistance. The Home was placed on the domiciliary midwives' night rota on three nights a week and nursing visits were paid on two days of the week, thus relieving the midwifery Sister for "off-duty". This arrangement has worked very amicably. HEALTH VISITING SERVICE Recruitment of new members of staff to acquire a full establishment during 1966, once again proved impossible. At the end of the year vacancies for one third of the staff establishment remained unfilled. Under these circumstances the health visitor is unable to maintain a close contact with the majority of families on her district. She must of necessity give preference to the more pressing day to day demands of social problems within the family and seek specialist help in a minority of cases. Two parts of the Borough which give cause for special concern are the Stroud Green and Burgoyne districts, both of which have a high percentage of immigrants. At each of these clinics there is only one health visitor. Over recent years the number of babies born for whom they are responsible has increased considerably. In fact they have the highest number of birth notifications of any other individual health visitor district. Office accommodation at Burgoyne Road clinic is available when an additional health visitor can be recruited. This is not the case at Stroud Green and it is not possible to make any structural alterations to these very inadequate premises. 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 1862 Total visits 2805 Children under 1 year of age First visits 6118 Total visits 12977 Children aged 2 - 5 years Total visits 18879 Other cases - Total visits as Health Visitor 1730 - Total visits as School Nurse 141 Student Health Visitors The period of training has now been extended by three months. I am pleased to record that three students commenced training in September, an improvement on the previous year. Regular recruitment of suitable candidates for training over forthcoming years appears to be the only solution in building up a realistic establishment of trained staff and to offset the vacancies that will arise due to the retirement of some of the older members of the staff. 52 Students must receive their practical training under the guidance of field work instructors. These members of the staff are specially qualified for this purpose and arrangements have been made for a fourth health visitor to undergo a special course of instruction early in 1967. The Council for the Training of Health Visitors recommend that a field work instructor should have a case load of 300 families, to enable her to have adequate time to instruct, supervise and guide the student. In addition, the field work instructor must be available to meet the tutors, both at the Training College and clinic to discuss the progress of the student. Due to the shortage of training staff it has not been possible to reduce case loads to the recommended number. Two students sponsored by other local authorities who received practical experience and training in Haringey were successful in obtaining the health visitors certificate. CO-ORDINATING COMMITTEE FOR WORK IN CONNECTION WITH PROBLEM FAMILIES The Chairmanship of the Committee changed by rotation from the Medical Officer of Health to the Children's Officer on 1st April 1966, and the Committee continued to bring together the different officers and their views on the smaII number of families who found life exceptionally difficult. The study of these families and their wants and needs helps to reveal the weak links in the organisation of the Welfare State, and the different officers looked at the problems through various coloured spectacles. A common early sign of family breakdown is the threat of eviction for failure to pay the rent, frequently complicated with additional financial stress, due to hire purchase commitments and resort to money lenders, and the causative factors often noted are mental illness and subnormality. The problems of a family are sometimes solved over a period of many years by varying types of support given to the family through the child-rearing periods. The variety of officers who attend theCo-ordinating Committee is an indication of the variations possible in the approach to these problems, variations from permissive to authoritarian ana from emotional to material depending on how the problem is seen through the eyes of differentdisciplines. In the Health Department some, but not all, of us take a biological approach rather than a sociological approach and we see first the material shortcomings and tend to offer authoritarian aavice gained by past experience, rather than to travel with the family in its wretchedness along the road of trial and error, in the hope that it will find its own road to success. In an environment of deprivation emotional factors may be transferred from one generation to the next and in recent years there has been a noticeable increase in the number of chilaren admitted to the day nurseries from homes where the mother is mentally ill. The child derives considerable benefit from association with other children. Does this mean that we are making progress by breaking some faulty links between mother and child with better prospects for the child's future or, ominously, does it mean that in our new freedom of approach to mental diseases we are encouraging family life in situations where it was formerly impossible? The child of a mentally disturbed mother has a poor start in life. Many families still suffer from the problem of poverty and it is still possible for a man and his family to take the rake's progress so well depicted by Hogarth in the 18th century, and in households where life is aominated by the principle of the "wage stop", the children will meet with real hardship if the parents indulge in excessive smoking, alcoholism or the betting shop. The biological approach to these families sees them living at a marginal level of subsistence and seeks first of all to remedy the material shortcomings, and the following are indications of what takes place. Food. The cost of food is important and food values must be explained so that a family at the subsistence level is encouraged to feed the baby on bottled milk in preference to the more expensive forms of dried tinned milk. Hygiene. Families not only need to understand hygiene, but economies must be explained to them so that instead of acting as did one family using the very convenient but expensive disposable paper nappies for the baby they can be encouraged to use the traditional cheaper towel nappies instead. Heating. Many families fail to appreciate the difference in costs for heating, depending on whether oil, coal, gas or electricity is used, but a family on a low income cannot afford to heat by electricity, and when such a family is housed in a modern all-electric home with an immersion heater the consequential electricity bill strikes like an evil spirit. Fertility. For some families fertility isagreat advantage, but for the family living at marginal subsistence level it is often a handicap for which positive help must be offered. 53 HOME NURSING SERVICE There was an increase of 2694 visits made during the year by the home nurses. Although the number of treatments, injections and dressings increased, the greatest increase was in general nursing care. The age group of the patients treated rose rather more steeply in the over-65 group and in fact there were 30 more men and 200 more women nursed in this age group than in 1965. The number of people in need of daily nursing attention of over one hour's duration increased, but the number of those who required the service of two nurses at the same time increased. This in fact gives a much better nursing service to the patient. Two bath attendants commenced duty in February and March, their duties being to bath, or assist in bathing, the elderly and infirm in the home. They work under the home nursesand attend group discussions to report on their patients' condition. The Whittington Hospital Night Service continued to provide their excel lent communications facilities, an average of twelve per month being referred from this centre. MarieCurie Memorial Foundation again proved invaluable in enabling full-time day or night nursing to be given to the individual patient suffering from terminal cancer. Sixteen patients received this care during the year. Three also received benefit in kind from this fund. The treatment of cases during the year may be classified as follows:- Injections 946 General nursing care 645 Blanket baths 447 Enemas 177 Dressings 477 Preparation for diagnostic investigation 86 Pessaries changed 38 Wash-outs, douches, etc. 46 Other treatments 151 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 44 22 5 - 15 25 25 16 - 39 63 239 40 - 64 211 377 65 and over 543 1318 886 1981 Cases attending during the year were referred from the following sources:- General Practitioners 1809 Hospitals 956 Chest Physicians 7 Public Health Department 36 Direct 59 The following table shows the work of the home nurses during the year- New cases attended 2076 Number of cases on register at end of year 719 Number of visits made 84873 54 DOMESTIC HELP SERVICE The total number of cases provided with home help during the year was 2630. The bulk of the work continued to be among the aged sick, who needed permanent help. The total number of visits made by the Home Help Organiser and her assistants during the year was 4938. Of this number, 1341 were in respect of new cases. The number of home helps in employment at the end of the year was 218 (equivalent to 137 full-time). The following table shows details of 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 1965 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 584 1599 2183 1610 Aged under 65 on first visit during year: Chronic sick and tuberculosis 69 138 207 145 Maternity 94 5 99 1 Others 102 39 141 43 Totals 849 1781 2630 1799 Neighbourly Help Service This service continues to function satisfactorily, but we have not been successful in obtaining the services of many Good Neighbours. At the end of the year only two cases were being helped. ADVISORY CLINICS FOR THE ELDERLY There are two Retirement Advice Clinics in Haringey, both started by previous local authorities. One is held fortnightly in a room in the Old People's Centre at Woodside House, Wood Green; the other, which is confined to men of retirement age, is held weekly at Somerset Road Clinic, Tottenham or at Weston Park Clinic, Hornsey. A medical officer and a clinic nurse are present at each. Advice is provided on health and dietary matters, and medical examinations are carried out as and when the consent of the old 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. During the year there was close consultation with geriatricians in local hospitals regarding improved case notes to be introduced in 1967. Consideration was also given to increasing and widening the sales of the dietary supplement, Complan, which is at present available in one clinic. This is useful in the prevention of deficiency diseases in the elderly. During 1966 there were 24 sessions in Woodside House Clinic, at which nine new cases were seen and 178 who re-attended. 34 sessions were held at Somerset Road and Weston Park Clinics, 34 cases being new and 71 re-attendances. SECTION 47 NATIONAL ASSISTANCE ACT 1948 One of the most distressing duties of a health department is the compulsory removal of a reluctant, infirm old person to a hospital or a home under the powers of this Section. Everything possible is done to encourage the individual to accept help before coercion is employed. Action was considered in a number of cases during the year, but it is pleasant to be able to report that sufficient co-operation was obtained in all of them to render it unnecessary. 55 TUBERCULOSIS REHABILITATION The Council's own Rehabilitation Workshops adjoining the Lido, Lordship Lane, N.17 have continued to function well during the year. At the end of the year 37 journeymen cabinet makers and 3 supervisory staff were employed. Negotiations have been concluded with the Chest Physicians of the various clinics which serve this Borough and the scope has been widened to include persons suffering from other chest complaints such as chronic bronchitis. The number of journeymen will now be increased over a period of time to the maximum of 52. Provision of Extra Nourishment to Tuberculosis Patients On the recommendation of the Chest Physician, the Local Authority provides suitable cases with extra nourishment in the form of high protein food such as milk, dairy produce and eggs for persons on low income suffering from Tuberculosis. During the year there were four patients receiving this extra nourishment. NURSING HOMES There were five private Nursing Homes registered with the Borough during the year. During the period under review there were no further applications received, nor was there the closure of any Homes in existence. Listed below are the names of the Nursing Homes together with the number of patients that they can cater for. All these Homes are regularly visited by Principal Medical Officers. Home Beacon Lodge Trees (Hill Homes Ltd MOUntview 7973) Goldsmith's (Hill Homes Ltd. MOU 7973) Claremont Kenwood Annexe Address Telephone No. 35 Eastern Road, N.2 TUDor 4468 2 Broadlands Road, N.6 MOU 5278 Denewood Road, N.6 FITzroy 4611 108 Colney Hatch Lane, N.10 TUDor 6014 4 Princes Avenue, N.10 TUDor 2940 No. of Beds 17+16 cots 3 maternity 49 (10 Chronic) 15 Chronic 15 Special Nursing Care 9 Medical 15 Chronic RECUPERATIVE HOLIDAYS The Council's scheme for Recuperative Holidays is restricted in the main to those persons who after illness or operation would be most likely to benefit by two weeks convalescent holiday ina suitable home. However, if medical or nursing care would be required, this form of convalescence would be arranged through the Hospital Almoners. Difficulties arise during the normal holiday season in securing sufficient placements and there is a reluctance on the part of some applicants to go away on holiday other than during the summer; this gives rise to a heavy demand in the summer months and under occupation of some convalescent homes during the winter. This year the Council accepted financial responsibility for 142 persons in Recuperative Holiday Homes, of this number 137 were adults and 5 under school age. In addition to this, 54 applicants for Recuperative Holidays were not considered to be eligible under the Council's scheme. 55 children were recommended under Section 48 of the Education Act, 1944, of whom 35 were placed in Recuperative Holiday Homes and the remainder either cancelled or withdrew. Massage and Special Treatment During the year licences were issued for 26 establishments for Massage and Special Treatment, there was no change from the previous year. All these premises have been inspected by the Senior Medical Officer. 56 CHIROPODY SERVICE On 1st April 1966 a unified service was established throughout the Borough. The Council took over the clinics previously operated by the Tottenham Old People's Welfare Committee, Hornsey Old People's Welfare Council and the British Red Cross Society. The Council employed nine chiropodists on domiciliary work, four of whom also do clinic sessions; twelve chiropodists carry out treatment at clinics, one of whom works from his own surgery. As a result of unification, the number of clinic sessions rose from seven per week to 37. This involved a total number of 11,360 treatments for 2,426 patients. Thechiropodist whoworks from his own surgery dealt with a further 139 patients. The total of domiciliary treatments was 5,928 to 1,413 patients. During the year a full-time chiropodist was engaged to replace three part-time chiropodists who had left the employment of this Council, and an additional part-time chiropodist was employed for one session per week and also to do domiciliary work. Clinic sessions were held at:- Fortis Green Clinic 1 session weekly Weston Park Clinic 6 sessions weekly Burgoyne Road Clinic 1 session weekly Stuart Villa Clinic 5 sessions weekly Cornwall Road Clinic 6 sessions weekly Lordship Lane Clinic 5 sessions weekly Park Lane Clinic 3 sessions weekly Clinic sessions for school children:- Lordship Lane Clinic 2 sessions weekly Weston Park Clinic 2 sessions weekly Clinic sessions held at British Red Cross Clinics:- Bruce Grove, Tottenham, N.17 1 session alternate weeks High Cross, Tottenham, N.15 1 session alternate weeks Grove Lodge, Hornsey 1 session alternate weeks River Park Road, Wood Green 2 sessions weekly plus 2 sessions alternate weeks A number of the clinic sessions are still held in the premises of the voluntary societies although they now come under the direct administration of this Authority. When chiropodists have left our employ, difficulty has been experienced in recruiting new suitably qualified staff as it is the general policy of all the London Boroughs to extend this important service. CARE OF UNSUPPORTED MOTHERS AND THEIR BABIES There exists in this Borough, as indeed in all Boroughs, the unhappy problem of the unsupported mother. The majority of such mothers are unmarried, but there occur from time to time a few who are married but for various reasons are homeless. A full-time qualified social worker is employed by the Council, who is responsible for the wellbeing of those who seek help in facing this particular problem. Unhappily, during the past year, the social worker appointed for this purpose sustained a serious road accident and has been off duty for some months. However an acting social worker was detailed to cover the work during this period. Apart from the statutory duties provided by the Health Department, a great amount of social work is occasioned. When a patient first makes application for assistance she often needs reassurance and understanding and the first interview tends to be lengthy. Her story is haltingly told and has to be painstakingly elicited to enable the social worker to assess where the greater need lies and how best to help. The pattern of the help that can be given is fully explained which gives the desired result of hope renewed and dispels the often despairing feeling of being alone in coping with the problem facing the unsupported mother. On many occasions a great deal of time has to be spent in reassuring and encouraging parents of the patient who are shocked and bewildered by the unexpected problem facing their daughter. Invariably, when parents have emerged from the shock and faced the implications of the problem they rally magnificently and become firm supporters of the daughter facing the coming ordeal. 57 The Health Department is well equipped to assist by having its own Mother and Baby Home within the Borough. Recourse may also be had to a number of beds in a Mother and Baby Home run by the London Borough of Barnet. The Council also accepts financial responsibility for eight beds in the Beacon Lodge Home within the Borough run by the London Diocesan Council for Moral Welfare, which especially caters for the very young expectant mother. Frequently patients shrink from accepting the excellent facilities offered. The social worker then renders much service in assisting the patient to cope with the problem through her own, or her family's, resources. The social worker and other officers of the Department fully co-operate with the excellent facilities offered by voluntary societies operating in this field within this Borough and thus the very best service is offered. Help commences in early pregnancy and continues until the post-natal period is over. Where adoption is requested, application is made to the appropriate adoption agency by the social worker, the mother being guided and advised until the adoption is legalised. Applications are only made to established, registered adoption agencies. The trend of the work would appear to be somewhat altering. Where in the past patients have tended to think only in terms of admission to Mother and Baby Homes, it is now found that their families are more understanding and are doing more and more towards keeping the patient in their own homes until the birth of the child. Where the child cannot be accepted into the home environment, and the mother aoes not wish to enter a Mother and Baby Home, being anxious to resume her normal way of life, the social worker assists in obtaining the services of a foster mother for the child pending adoption. Where the mother wishes to keep her child,, the social worker assists in the mother's endeavour towards this end, enlisting the help and co-operation of other sections of the Department, occasionally working in conjunction with the Children's Department, etc. At all times the co-operation of the voluntary societies, organised to assist the unsupported mother towards keeping her child, is enlisted and valuable help given. Other ways in which unsupported mothers are helped are: by the placing of a number of ipatients in working girls' hostels in early pregnancy; by occasionally placing the girls in private households; by obtaining residential nursery care for the baby; by placing the mother in touch with probation officers re obtaining Court consent to marriage where desirable and/or obtaining Maintenance Orders; and last, but not least, by the social worker being available to discuss any problem arising ante- or post-natally. To give some support to my comments, I give below statistical details emerging from the work undertaken by this section. Total number of Cases referred in 1966 Cases cancelled before interview 15 Cases taken 198 Referred by Medical Social Workers 49 Health Visitors 5 General Practitioners 5 Statutory Social Workers 2 Voluntary Social Workers 57 National Council for Unmarried Mother and Child 24 Citizens Advice Bureau 1 Probation Officer 4 Children's Department 6 Education Department 1 British Adoption Project 1 Putative Fathers 1 Self 42 198 58 THE MOTHERS Marital Status Single 172 Married 14 Separated 6 Divorced 4 Widowed 2 Religion Church of England 95 Roman Catholic 79 Free Church 19 Other 4 Atheist 1 Ages 14 years 2 15 years 5 16 years 10 17 years 12 18 years 18 19 years 25 20 years 10 21-30 years 101 31-40 years 15 Countries of origin Great Britain 156 Ireland 15 India 1 Pakistan 1 Italy 3 West Indies 8 Corsica 1 Jamaica 7 Ghana 1 Canada 1 Cyprus 1 Greece 1 Mauritius 1 South Africa 1 Education University 2 Grammar 16 Sec. Modern 126 Convent 5 Technical College 5 Private 2 Education in country of origin 42 Occupation Office Worker 66 Machinist 5 Housewife 3 Laundryhand 1 Student 4 Teacher 3 Demonstrator 1 Engineering 1 Factory 25 Waitress 3 Telephonist 10 Police Official 1 Schoolgirl 6 Cashier 4 Domestic 4 Dressmaker 2 Pharmacist 1 Confectioner 1 Nurse 11 Nanny 1 Shop Assistant 8 Cook 1 Bus Conductress 1 Window Dresser 1 Hairdresser 3 Laboratory Assistant 1 Au Pair 1 House Mother 1 Barmaid 2 No occupation 6 Civil Servant 1 No settled.occupation 19 PUTATIVE FATHERS Marital Status Single 86 Married 20 Divorced 6 Separated 4 Unknown or undisclosed 82 Ages 16 years 3 17 years 3 18 years 7 19 years 13 20 years 14 21-30 years 66 31-40 years 13 40 - 2 Unknown 77 Countries of origin Great Britain 59 Italy 1 Pakistan 1 Ghana 2 Turkey 2 U.S.A. 4 Jamaica 5 British Guiana 1 West Indies 7 India 1 France 1 Canada 1 Ceylon 1 Trinidad 1 Cyprus 5 Australia 1 Ireland (Eire) 15 Unknown 89 Portugal 1 59 Occupation Representatives 2 Apprentice Engineer 1 Carpenter 5 Window Cleaner 2 Police Officer 3 Barman 2 Telephonist 1 Printer 1 Shop Manager 2 Confectioner 1 Office Worker 8 Furniture Remover 1 Machine Operator 2 Draughtsman 1 Butcher 1 Demonstrator 1 Welder 4 Asphalter 1 Driver 10 Porter 2 Mechanic 4 Aeroplane Worker 1 Electrician 3 Commercial Artist 1 Waiter 1 Dustman 1 Contractor 2 Railway Worker 1 R.A.F. 1 Apprentices 2 Merchant Navy 2 Builder-Decorator 11 Student 5 Labourer 13 Catering Manager 1 Shop Assistant 2 Apprentice Printer 1 Silversmith & Civil Servant 1 Goldsmith 1 Self Employed 5 Factory worker 1 Engineer 4 Unknown 79 At the end of 1966 the Mothers who had decided to keep their babies were living in the following way Had returned to parents or relatives 32 Had married putative fathers 9 Were co-habiting 3 Baby to Foster Mother 6 Were living in flatlet house for mother with babies 2 Had returned to living in lodgings 29 Gone to putative father's parents 1 Gone to U.S.A. 1 Moved away before confinement 3 Unknown 31 Incomplete 50 Mothers who parted with babies By Adoption 21 Taken into care 3 Third Party adoption 2 Still births 3 Baby died 1 Miscarried 1 198 60 STAFF MEDICAL ASSESSMENTS, EXAMINATIONS AND SICK PAY REPORTS There was an increased rate of combined medical assessments and examinations during the year 1966. In the last nine months of 1965, there was a total of 1355 assessments and examinations; at the same rate about 1600 would have been expected for the twelve months of 1966, but instead there were 1900. (The very high figure of 910 medical assessments for the Education Department is partly accounted for by the large number of applications for part-time employment in the School Meals Service). The reports on sick pay cases continued at about the same rate as in 1965 when there were 78 in the last nine months. In 1966 just over 100 would have been expected, and there were in fact 109. Medical Assessments of new applicants without medical examination- Architect's Department 19 Baths Department 10 Building Works Department 26 Children's Department 59 Cleansing Department 4 Education Department 910 Engineer's Department 39 Health Department 133 Housing Department 26 Libraries Department 64 Parks Department 4 Town Clerk's Department 62 Town Planning Department 3 Treasurer's Department 35 Welfare Department 76 Total 1470 Medical Examination of New Applicants Architect's Department 2 Building Works Department 2 Cemeteries Department 1 Cleansing Department 3 Engineer's Department 3 Health Department 4 Libraries Department 2 Town Planning Department 1 Welfare Department 1 Total 19 Education Department: Non-teaching 22 Teacher 1st Appointments 168 Teacher Trainees 170 Hornsey College of Art (end of term teachers) 54 Total 414 Total of examinations - 433 Medical Examination of Staff over 70 years of age 9 Reports on Sick Pay Cases 109 Medical Examinations of Sick Pay Cases 20 61 HEALTH EDUCATION Health Education in Schools Health education in schools continues, and is undertaken by a school nurse assisted by the Health Education Officer. Programmes are arranged to include a variety of subjects from personal relations and hygiene to sex education and child management ana development. Great use is made of films and other visual aids concerning health, and up-to-date information is given to teachers on new material in this field. Health education material is often requested by pupils doing health projects for the Certificate of Secondary Education. Duke of Edinburgh Award Scheme Health Department staff assist by giving talks and demonstrations on first aid, mothercraft and personal health to pupils after school hours, and to members of youth organisations. Health Education in Clinics and Other Establishments Visual aids and display materials are made available to clinic staff and day nurseries to further health education. A programme on a wide range of topics concerning healthy living was introduced to the Authority's Mother and Baby home. Speakers from the National Dairy Council and the Home Safety Department joined with us to give a wider programme. This type of health education is very useful in that the persons concerned may never be reached through the usual channels of communication. Staff Training Two day courses on "Health Education and the School Child" were held in the Department for professional members of the staff and teachers. Two lecturers were provided by the Central Council for Health Education. Courses on "Training for Independence" were given by one of the physiotherapists to home nurses. Practical demonstrations and training were given to enable the nurse to give rehabilitation to stroke patients in their homes. Campaigns The Ministry of Health's smoking campaigns were supported by distributing posters and literature to schools, youth organisations, and on public notice boards. Films on smoking have been shown locally arousing interest among all age groups. The Borough participated in the Immunisation Publicity Campaign for London and the Home Counties, whichgotT.V. press and poster coverage. Immunisationstatisticsshowedaslight rise during this period. Many requests for speakers were received from various organisations. Assistance was given in the form of films, and literature at several meetings organised by a voluntary body concerned with cervical cytology publicity. A flannelgraph on the cervical 'smear test' was designed in the Department, and is now being produced by the Central Council for Health Education for national distribution. MENTAL HEALTH SERVICES Consultant Psychiatrists Consultant psychiatrists from the area's Catchment Psychiatric Hospitals and Psychiatric Units at the North Middlesex,Prince of Wales's.Whittington and Halliwick Hospitals provide out-patient psychiatric and domiciliary service for Haringey residents. Dr. U.P. Seidel, M.B.,B.S.,D.P.H.,D.P.M., Principal Medical Officer for Mental Health, has also a seconded joint appointment with Claybury Hospital, Essex. 62 Social Workers The establishment consists of a Chief Mental Welfare Officer, a Deputy Chief Mental Welfare Officer, two Senior Mental Welfare Officers and six Mental Welfare Officers. During the year there was a good deal of staff movement. Mr. E. Inglis retired owing to ill-health and was succeeded as Deputy Chief Mental Welfare Officer by Miss B. Johnson, who is a qualified psychiatric social worker. One of the mental welfare officers was seconded for training for two years in order to qualify for the certificate in social work. Two others left the service of the Borough also to undertake further training in social work. Psychiatric Rehabilitation Association Day Centre The Psychiatric Rehabilitation Association in co-operation with the Mental Health Section have set up a day centre for psychiatric patients in Tottenham. This has proved to be a very successful project, providing not only relief from isolation for selected patients but also a rehabilitative climate through which patients are returning to normal employment. The P.R.A. have been pioneering work of this kind since the introduction of the Mental Health Act 1959, and are attracting national and international interest through their success in a particularly difficult area of social work. Whilst it is a statutory responsibility to provide community care for the mentally ill, it requires psychiatric and sociological skills. This link with the Association helps Haringey to maintain its high quality service in line with progressive thinking. The day centre, using specialised techniques known as Groupwork is providing a work setting through which a number of chronic sick patients have been helped back to full-time employment. As a result of the most satisfactory co-operation existing between the mental hospitals and voluntary organisations it is envisaged that development of this kind of work will enable Haringey to offer the community an exceptionally fine community care programme. Mental Health Social Work Mental welfare officers attend hospital staff and patient group meetings. Each local hospital to which we send patients has a mental welfare officer representative (as also do the mentally subnormal services)attending regularly, who acts as a liaison with the Borough and who provides the co-ordinating link with the hospital service; in addition, the mental welfare officers, where necessary, join the consultant psychiatrists in domiciliary visitation. Complete access to hospital in-patients is granted in all cases so that the necessary links are maintained for continuity of care in the relationship between patient and social worker. Regularcaseconferences are held in the hospitals which are attended by the hospital doctors, nurses and social workers and the Borough's mental welfare officers. In addition, the social workers of the neighbouring hospitals and mental welfare officers of the Boroughs of Enfield and Haringey maintain close liaison by regularly meeting to discuss cases of interest and mutual social work problems. The facilities of our psychiatric social clubs enhance the rehabilitative service. Next year another psychiatric social club will be formed at the Lutheran Church Hall, Tottenham, N.15. This will be in conjunction with the Psychiatric Rehabilitation Association and the mental welfare officers, and various kinds of group therapeutic and social activities will be undertaken. The Oakleaf Psychiatric Social Club continues to increase in membership, the number now stands at 55 and during the past year a wide range of social activities have been successfully arranged by the committee and have been well supported by the members. We are indebted to Ferme Park Baptist Church for their help. During the year, various colleges have sent students to the mental health section to gain insight into aspects of mental healthcare and prevention and to study the services provided -among them medical students, psychiatric social work students, social work students, health visitors and student psychiatric nurses, and trainee probation officers. There is a growing awareness in the community at large of what mental illness means. The importance of early recognition, prompt referral and treatment plus follow-up cannot be over-emphasised. Suitable rehabilitative measures contribute to restitution of social competence and provide social support and increased social toleration and understanding, thus relieving some of the burdens of the family doctors in relation to their patients' mental health problems. 63 Hostels for the Mentally III At 31st December 1966 22 Haringey patients were living in hostels run by other local authorities or voluntary organisations, and two were awaiting admission. It is always difficult for the patient coming out of hospital to find lodgings and we would like to hear from any helpful landladies. Services for the Mentally Subnormal The Hornsey Centre for Handicapped Children continues to provide facilities for Haringey children and it is hoped that in the early part of 1967 the full complement of mentally and physically afflicted children, which amount to twenty youngsters, will be in attendance. The Principal Medical Officer who attends these children whilst at the Centre reports that except for the severely affected mentally and physically handicapped children, great improvements have been brought about in the behaviour and habits of most of these youngsters. Hostels for the Mentally Subnormal It was originally envisaged that a 16-place hostel for subnormal males would be opened during this year. It is now anticipated that this hostel will beopened in the Spring of 1968. At the time of preparing this report work had in fact commenced on this project. Future provision will need to be made for hostels to accommodate mentally subnormal people of both sexes. Adult Training Centre Thisproject will now be opening in the Spring of 1968 to include a laundry and a workshop. Until this, the London Borough of Enfield is providing placements for trainees at the Edmonton Adult Training Centre. At 31st December 1966, there were 72 in attendance and thirteen on the waiting list, which underlines the need for our own adult training centre. Junior Training School I am pleased to report that a site has been secured on the Broadwater Farm Estate, Tottenham, for a proposed junior training school and that work should commence during the financial year 1968/69. This school will accommodate in all, 129 children and there will be placements for 24 special care cases. There will also be two nursery classes for 24 children. This school is being built as part of a complex whichwill includea junior and primary school that will share a communal main kitchen. In the meantime the London Boroughs of Enfield and Barnet continue to provide placements for Haringey children at their respective junior training schools. At Enfield there were at the end of the year 40 Haringey children with a further 17 on the waiting list, and at Barnet there were 24 Haringey children with 23 on the waiting list. Residential Accommodation for Long Term Subnormal Patients In all during the year 34 patients were maintained by this Authority in residential homes. Forthe most part they reside in the Brighton and Hove area where many are boarded out by the Guardianship Society in private households. No new compulsory Guardianship placements have been instituted since the inception of this Borough. Social Clubs There are in being three Clubs catering for the mentally subnormal children. During the year "Roundabout Club" moved into new accommodation at the Muswell Hill Centre for Handicapped Children; this club is perhaps the largest of the three. The Haringey East Society for Mentally Handicapped Children, who are responsible for the "Golden Gate" Club, havealso moved into other premises as it was found that the Art Centre, Lordship Lane, was unsuitable for their requirements. The "Doddy" Club for the educationally subnormal children has widened its admission to take in youngsters of a lower grade. Holiday Camp for Mentally Subnormal Children This Authority undertook to arrange a holiday camp for mentally handicapped children. This camp was held at Suntrap Residential School, Hayling Island; the camp accommodated 32 children for this occasion and it was highly successful. The comments from the parents on the return of the children were very favourable. We are indeed fortunate to have this extremely suitable establishment belonging to this Authority, and I should like to thank the Chief Education Officer and Miss Stout and her staff at Hayling Islandforall they did to make this year's camp so successful. Plans are already well advanced for a similar camp, this time for a larger number of children, to take place during the summer of 1967. 64 Hospital Placement for the Mentally Subnormal Through out the year difficulties have been experienced when the need has arisen to place mentally subnormal persons in permanent care in a catchment area hospital. It was only possible to obtain two placements in South Ockendon and these were both during the first two months of the year. Eight placements were obtained at Harperbury Hospital. It will be seen from the table pertaining to mental health that there were eleven persons in need of urgent hospital care and a further twelve who, although in need of hospital, were not so urgent. This is not a problem restricted to Haringey but is a general one. PUBLICATIONS "Mental Subnormality in Childhood". First abridged version. The Medical Officer, 1965. Vol.CXIV. No.20 pages 269-272 "Autism in Two Brothers" The Medical Officer, 1966. Vol.CXV. No.17 Pages 227-229 "An Appraisal of Mental Health Services of the Local Authority" The Medical Officer, 1966. Vol.CXVI. No.19 Pages 253-255 All above by U.P. Seidel, M.B., B.S., D.P.H., D.P.M. Number of Patients referred to Local Health Authority during year ended 31st December, 1966 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 - 1 85 117 203 - - - - - Hospitals, on discharge from in-patient treatment - - 31 54 85 - - - - - Hospitals, after or during out-patient or day treatment - 1 26 42 69 5 2 1 1 9 Local education authorities - - 1 2 3 2 1 1 7 11 Pol ice and Courts - - 25 13 38 - - - - - Other sources 1 - 82 162 245 11 7 4 4 26 TOTALS 1 2 250 390 643 18 10 6 12 46 Number of Patients under Local Health Authority care at 31st December, 1966 Referred by Mentally III Sub-normaI and severely sub-normaI 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 - - 94 158 252 62 47 187 178 474 (b) (i) attending day training centre. - - 1 - 1 32 25 50 41 148 (ii) awaiting entry thereto - - 1 - 1 23 13 14 6 56 (c) (i) receiving home training - - - - - - - - - - (ii) awaiting home training - - - - - - - - - - (d) (i) resident in L.A. home/hostel - - 2 5 7 - - - - - (ii) awaiting residence in L.A. Home/hostel - - 1 1 2 - - - - - (iii) resident at L.A. expense in other residential homes/hostels - - 9 6 15 1 3 9 5 18 (iv) resident at L.A. expenses by boarding out in private household - - - - - 1 1 6 8 16 (e) receiving home visits and not included under (b) to (d) - - 80 146 226 5 5 108 118 236 65 Number of Patients awaiting entry to hospital or admitted for temporary care during 1966 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 31.12.66 (a) in urgent need of hospital care 5 3 2 1 11 (b) not in urgent need of hospital care 1 2 5 4 12 (c) Total 6 5 7 5 23 Number of admissions for temporary residential care (e.g. to relieve the family) (a) to N.H.S. Hospitals 5 7 12 8 32 (b) to L.A. residential accommodation - 1 - - 1 (c) Elsewhere 2 - 1 1 4 (d) Total 7 8 13 9 37 Work of Mental Welfare Officers (a) Mental Illness Visits made by mental welfare officers 5,372 Compulsory admissions to psychiatric hospitals by mental welfare officers 194 Informal admissions to psychiatric hospitals by mental welfare officers 167 (b) Mental Subnormality Visits to those under community care by mental welfare officers 2,292 66 SCHOOL HEALTH SERVICE REPORT OF THE PRINCIPAL SCHOOL MEDICAL OFFICER FOR THE YEAR 1966 EDUCATION COMMITTEE - 1966/67 The Mayor - Alderman Mrs. A.F. Remington, J.P. (Ex-officio) **Alderman D.F.W. Billingsley (Chairman, Education Committee) **Councillor Mrs. Brenda S. Remington, B.A. (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 Victor Butler, (Vice-Chairman, Special Services Sub-Committee) Councillor Douglas Clark Councillor Mrs. D. Cunningham, J.P. Councillor Mrs. P.M. Dines Councillor D.J. Ding *Councillor B.L. Greenway, M.I.C.M. Council lor V.N. Jary Councillor Frank Lloyd, J.P. Councillor B.J. McBride *Councillor Mrs. Naomi E. Mcintosh, B.A. *Councillor H.A.L. Rossi, LL.B., M.P. Councillor R.L. Singer Councillor M. Skudder, B.Sc., F.S.S., J.P. Councillor L.A. Vitoria *Councillor Mrs. M.E. Warbis Co-opted Members Rev. Prebendary J.S. Aldis Rev. Brian Campbell, L.C.L, Mr. H.R. Cheetham Mr. J.G. EIkington, B.A. Mr. E.H. Fawcett Mrs. J. Sondheimer, M.A., Ph.D. Mr. D.A.T. Williams Members of the Special Services Sub-Committee **Ex-officio members of the Special Services Sub-Committee PRINCIPAL SCHOOL HEALTH STAFF J.L. Patton, M.B., Ch.B., D.P.H. Medical Officer of Health and Principal School Medical Officer W.T. Orton, M.B., B.Ch., B.A.O., D.P.H. Deputy Medical Officer of Health and Deputy Principal School Medical Officer Mary Douglas, M.B., Ch.B., D.P.H. Principal Medical Officer (School Health) G.C.H. Kramer, L.D.S., R.C.S. Chief Dental Officer and Principal School Dental Officer 67 SCHOOL HEALTH SERVICE To: The Worshipful the Mayor, Aldermen and Councillors of Haringey I have the honour to present the second Annual Report on the School Health Service for the year 1966. The general physical condition of the children is excellent and the work of the School Health Service is especially directed towards seeking out those deviations from normality which prevent a child from obtaining the best value from his school life. Defects of vision and hearing and limitations of mental endowment or emotional trauma are of prime importance, and in our assessment of these defects, doctors in the School Health Service are becoming increasingly dependent on the help of the teaching staff, and so there should be an ever-increasing improvement in the liaison between teacher and doctor so that progress can be made towards selective medical examination. The selective medical examination is now being carried out in a number of schools on primary school leavers so that the combined knowledge of head teacher and school doctor is collated and carried forward for use when the child enters a comprehensive school. The small number of children who have a permanent disability would benefit by continued supervision when they have left school to ensure that they are established in life, and for this purpose the appointment of a social worker has been recommended in a report on the co-ordination of Education, Health and Welfare. During the past year the amalgamation and consolidation of the previous year was continued and the progress made and the statistics recorded of the year's work are described in the body of the report. I am grateful for the support of the members of the Committee and for the enthusiasm and interest of the staff, and especially to Dr. Mary C. Douglas, for the part they have played in the development of these services. J.L. PATTON, Principal School Medical Officer 68 SCHOOL HEALTH SERVICE School Population The school population for the Borough on the 19th January, 1967 was 34,314, as shown in the following table:- Primary Schools and Nursery Classes 19,712 Nursery Schools 229 Secondary Modern Schools 9,051 Secondary Grammar Schools 4,990 Special Schools: Physically Handicapped 94 Blanche Nevile School for the Deaf (including classes for the partially hearing) 119 Suntrap Residential Open Air School 119 34,314 Periodic Medical Inspection Periodic medical inspections are at present 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 secondary school and during the last year at school. To cope with the steady influx of children throughout the year, medical officers visit the infant schools each term. The facsimile questionnaire in the Greek language has been a great success, is liked by the parents concerned and has led to a more helpful exchange of information. Experiments with the system of medical examination of pupils by selection have continued. 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 would seem that the most suitable time in the child's school life for "selective" examination is in his or her last year in the primary school. The Head Teacher knows the pupil well and has learned something of the family. We are hoping to expand examination extensively at this age level. This will call for a great deal of re-organisation of the whole system of routine medical examination and will take some time to put into effect. It is our hope that as a result of such examination we will be able to pass on to the new comprehensive schools a fuller account of individual children's health and needs. 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 % 1962 & Later 42 42 100 - - 1961 394 389 98.7 5 1.3 1960 1916 1908 99.6 8 0.4 1959 817 815 99.8 2 0.2 1958 2029 2025 99.8 4 0.2 1957 929 927 99.8 2 0.2 1956 217 217 100 - - 1955 646 644 99.7 2 0.3 1954 683 682 99.9 1 0.1 1953 332 332 100 - - 1952 267 267 100 - - 1951 & earlier 3039 3035 99.9 4 0.1 Total 11311 11283 99.8 28 0.2 In the Appendix to this report will be found an analysis of the defects found to require treatment or observation. 69 Other Medical Inspections The following are the numbers of special inspections and re-inspections carried out during 1966. A special inspection is one which is carried out at the special request of a parent, doctor, nurse or teacher, and is usually carried out at a school advice clinic. Number of special inspections 3685 Number of re-inspections 1205 An analysis of the defects found at special inspections to require treatment or observation will be found in the Appendix to this report. 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 Defects which have been found at periodic medical inspections are further investigated at these clinics to which children are also brought for the treatment of minor ailments, such as slight injuries, certain common infections of the skin, and minor defects of the eye or ear. Parents are able to take their children to these clinics for advice on any condition and much valuable educational and preventive work is carried out at these sessions. , School Advice Clinics are held at 11 clinics in the Borough and during the school holidays, special sessions are held to deal with particular defects, such as hearing and speech, in order to promote close co-operation with Therapists and Technicians. Vision Screening During the year a Keystone apparatus was acquired for vision screening. It is hoped that the introduction of this apparatus will permit the screening of larger numbers of school children, and that operation of the machine by a trained technician will relieve pressure on the school nursing staff. We are at present still in the experimental stage, but the eventual aim is the bi-annual, if not annual, vision testing of all school children. Ophthalmic Clinics There are three school ophthalmic clinics held in the Borough, and T/ 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. Unfortunately it has proved impossible so far to acquire the services of an orthoptist at either Weston Park or Stuart Villa Clinics. This deficiency has seriously hindered the work of the consultant ophthalmologists, and it is to be hoped that the situation will be remedied as soon as possible. Dr. T.G. Kletz, consulting ophthalmologist at Lordship Lane Clinic, reports:- "The work in this clinic is concerned mainly with the investigation and correction ot refractive errors, muscle imbalances and squints. All cases referred are first refracted, the majority under cycloplegia and glasses prescribed as required. Cases of muscle imbalance and strabismus are then referred to the orthoptist for investigation and any required treatment. Cases of unilateral amblyopia, unless of pathological aetiology, are also referred for orthoptic investigation and occlusion carried out if found necessary. A further preliminary ethnic survey was carried out and confirmed the high incidence of myopia in certain immigrant groups attending the clinic ana it is proposed to continue this investigation in the coming year". Mr. E.M.G. Galton, consulting ophthalmologist at Stuart Villa Clinic, reports:- "During this year a new method for screening the vision of school children was introduced. This is experimental and it will be some time before its efficacy can be established. The modern tendency of not prescribing glasses for low refractive errors has been followed even more rigorous with no detriment to the pupil's education. 70 The work has been complicated by the number of immigrant children whose parents are unable to speak English and are unable to appreciate the importance of correcting serious refractive errors to the children's educational future". We have been pleased to welcome during the year Dr. R. Peswani, M.B., B.S., D.O., who took over the appointment of consulting ophthalmologist at the Weston Park Clinic, Hornsey, replacing Dr. Robert Welch, who retired in 1965 through ill-health. Dr. Peswani reports:- "There was considerable arrears of work at the clinic after Dr. Robert Welch retired through ill-health. This was completed with some extra sessions by end of the year. It is now back to normal with 2 sessions a week on Monday and Wednesday afternoons. During the year, there were 1096 total attendances as under:- Under 5 years Over 5 years Total attendances 116 980 New cases 48 182 Errors of Refraction 19 584 Other defects 18 16 Glasses ordered 7 229 As the figures show, most of the work is refractive. Other defects found mostly consisted of squint, amblyopia, conjunctivtis, blepharitis etc. It is unfortunate there is no orthoptist at the clinic, consequently cases with manifest squint, after refraction and correction of error, were referred to some hospital for orthoptic and/or surgical treatment. It will be a really great help if the services of an orthoptist can be obtained even for just 1 session a week". 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. Of the five new cases seen during 1966, three were Haringey children and two were from the London Borough of Enfield. Four of these children were under five years and one was over five years old. The recommendations made in respect of the new cases were as follows:- Recommended admission to Vale Road Special School 1 Recommended admission to a day nursery 1 Referred for further investigation of intellectual ability 2 Referred for re-examination in one year. 1 I am indebted to Dr. William Dunham for the following report:- "During the year, out of the 94 children attending the School, there have been 28 children with Cerebral Palsy, a proportion of 30%. The aim in providing for these children is to make sure that they have the help they need in gaining good habits of posture and movement. The School has a full-time Cerebral Palsy Therapist who works closely with the parents and the teachers to ensure that each child has consistent handling throughout his waking hours. The Consultant. Dr. William Dunham, visits the School each week to discuss with the therapist, the parents and the teachers the requirements of individual children: the School Doctor and Nurse attend on these occasions to deal with any general medical problems which may arise. A new therapy room has been provided during the year and this enables posture and movement training to be carriea out under much improved conditions. The School receives many visitors and plays an important part in the training of many different kinds of worker in the Welfare State. On the Education side, visits have been made during the year by students from the Trent Park Training College, the Staff Training College for House Parents. National Children's Home. Highbury, and the Institute of Education Course for Mature Teachers. London University. 71 On the Medical side, visits were made by Doctors training for the Diplomas of Public Health and Child Health, by Sister Tutors from the Royal College of Nursing and by Student Nurses from the Hospital for Sick Children, Great Ormond Street, the Prince of Wales's Hospital, Tottenham, and St. George's Hospital, Hyde Park Corner, while Student Health Visitors came from the Local Health Authority. All showed a keen interest in the work". 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:- "1966 has been a very busy year in our Orthopaedic Department of the School Medical Service. / am particularly struck by the number of Fathers who now attend my clinic and by the very smart turnout of the children and their parents, the general politeness, and the level of education which the Borough provides. It is a real pleasure to work in the clinic and there is no other out-patients which / enjoy more". Dr. E.G.M. Palser, consultant in physical medicine to the Weston Park Orthopaedic Clinic, reports:"Number of new cases seen:- Under 5 years of age 166 Over 5 years of age 167 Total 333 Total attendances:- Under 5 years of age 328 Over 5 years of age 311 Total 639 Number of attendances for treatment by the physiotherapist:- Urider 5 years of age 158 Over 5 years of age 459 Total 617 The Medical Officers steadily continue to supply the clinic with cases suitable for treatment. In addition cases of two different types are also seen; those whose apparent orthopaedic defects require little more than supervision and reassurance of the parents, and those, of which there have been two this year, whose apparent minor abnormalities were the early signs of a serious condition requiring hospital treatment. Surgical treatment has also been ordered for a small number of patients with minor, mostly congenital, defects ". 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 has continued to attend as consultant to the Ear, Nose and Throat Clinic, Park Lane. 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 weekly clinics at Hornsey and Wood Green continued during the year 1966 as in previous years. The attendances at the clinics, generally, have been satisfactory. Practically all those children for whom a prescribed course of treatment was arranged either at the E.N.T. special clinics or at the treatment sessions during the week continued to attend until the course was completed. During the treatment courses they are seen at regular intervals at the E.N.T. clinics for 'observation' as to their rate of progress, etc. 72 The chief complaints with which we are now concerned are abnormal and diseased affections of the nose and nasal spaces, sinuses, etc, and early symptoms of impaired hearing, the latter in a large number of instances have been a result (secondary) of the former (primary) nasal affections. It is as well to stress here that the first and essential thing to do is to correct the primary exciting cause in the nose in order to relieve the secondary effect in the ear. The chief thing to bear in mind in examining children is a careful look-out for any positive signs or symptoms of nasal obstruction or nasal respiratory insufficiency and any attendant ill-effects present, such as mouth breathing, the most frequent sign, and also any of the potential disabilities which could follow in unrelieved cases. It is very important also to observe and note a certain group of symptoms resulting from nasal obstruction which are more marked and fairly common in young children; they are grouped together and called by the general term, aprosexia, namely, mental depression; disinclination to work; and loss of energy, etc; the children are considered dull and stupid and may be one or more classes below the average child of their age. The urgency of the detection and correction of the underlying cause cannot be too strongly emphasised. A careful examination of the nose and naso-pharynx should always be made before any treatment is advised. It is only by accurately diagnosing the cause of the abnormality that one can expect to remedy the condition. A smalI number of children complained of recurring attacks of 'sore throat', with moderate hypertrophy of the tonsils; these were in most instances secondary to diseased nasal-sinus conditions through the lymphatic drainage of the nasal accessory sinuses, and 'descending infection' which connect directly with the tonsil lymphatic gland. Again we must emphasise here that the correct procedure is, first to relieve the diseased condition in the nasal area and when this is effected, usually the unhealthy state of the tonsils will soon recover. In a small number of instances, however, where the diseased condition has been neglected and allowed to become chronic and the tonsil tissue itself through continuous 'overloading' is now diseased and destroyed and beyond repair or function, removal of the tonsils is indicated, but in any case the nasal defects must always be treated. Hence the importance of the early detection and correction of nasal abnormalities. A smalI number of other 'complaints' included in the E.N.T. group such as 'foreign bodies' viz, pea, beads, bits of toys, impacted pieces of cotton wool, etc, in the ear or nose; epistaxis (nose bleeding); 'external otitis' were seen and treated during the year. In the case of the latter, 'external otitis' fairly common in children, as in adults, a special note is advisable. This condition involves the auditory meatus, the entry passage to the middle ear, not the inner ear itself; it may extend around the meatus to the outer ear, lobe, etc. This can be most intractable and chronic if not correctly treated; it also impairs the hearing owing to the mass of 'debris' being constantly formed in the meatus. It must not be confused with wax in the ear. It is really a form of eczema and is commonly allied to allergic symptoms, which is important to remember in treatment. There have been several of these cases during the year. They all responded satisfactorily in a short time to treatment. The audiometric scheme established by the Local Authorities for some years has been exceedingly helpful in the detection of many cases of impaired hearing which might otherwise be missed". 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. Four 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:- "ln order to keep the list of children waiting for examination as short as possible, additional clinical sessions were introduced. Dr. Douglas, the Principal Medical Officer for School Health is now conducting this additional clinical session, and this helps greatly to reduce the waiting list. She is also assisting Dr. Fisch with his regular clinics and is responsible for the general organisation and administration of the work. Dr. Udall, Senior Lecturer in Paediatrics at St. Bartholomew's Hospital attends a clinical session, and assists Dr. Fisch. This is also a most valuable help. Both Dr. Douglas and Dr. Udall are now fully trained in all aspects of child audiology and are able to conduct clinics independently. 73 Infants "at risk" are tested at a special clinical session by Dr. R.Y. Golder, Principal Medical Officer (Maternity and Child Welfare). She tests these children, and those who are then suspected of being deaf, are referred for further examination by Dr. Fisch. The members of the audiology team work together very well. The team consists of the Consultant Otologist, Medical Officer, Teacher of the Deaf, and Educational Psychologist. Decisions concerning difficult children or children who present special problems are made by a joint consultation of the members of the auaiology team. When the question of placement in the school for the deaf or one of the partially hearing classes arises, the team is joined by the Headmaster of the Blanche Nevile School. Mr. Brown. There was a great improvement concerning help with the psychological assessment of our patients, and Miss Kidgell, Senior Educational Psychologist, frequently attends, and detailed discussion takes place concerning children examined by her. Over the past few years we found that there was a steady increase of children with hearing disorders who also have an additional handicap or have multiple handicaps. Recently we were able to pay closer attention to the problem of emotionally disturbea children. Owing to special interest in the psychological problems of deaf children shown by some psychiatrists, we were able to refer these children to a Department of Psychiatry, and received very valuable help. We hope to increase this work considerably. The two peripatetic teachers of the deaf found that during the past year the numbers of children for training and parent guidance increased to such a degree that they were not able to cope adequately with these numbers, and it seems that a third teacher will have to be appointed. The early training of the pre-school child with hearing difficulty and parent guidance is the most important aspect of our work. The teachers also visit regularly children with hearing difficulties who are in normal schools, special centres, normal nurseries or training centres. Many deaf children are placed in normal day nurseries. This is a great advantage to us, and helps the children to a very great extent. Almost invariably we find that the staff of these nurseries are enthusiastic and most co-operative concerning the special problems of deaf children, and we are most grateful for their help". The following is an analysis of the cases seen during 1966: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 217 30 32 37 26 19 29 25 12 11 13 14 14 5 4 2 - 490 Re-examinations 14 25 20 18 34 14 18 33 15 22 19 18 19 13 18 18 5 323 Total 813 Pre-school children 457 Attending Infant and Junior Schools 253 Attending Senior Schools 103 Reason for referral among New cases:- For diagnosis 237 Known to be deaf, examination before admission to Blanche Nevile School 7 Immigrants to Borough known to be deaf 2 Partially-hearing, advice as to placement 5 Auditory training 1 "At risk" 221 Transfer from hospital out-patients departments 15 Advice as to placement where deafness might be the cause of backwardness 2 Total 490 67 of the above referrals were from other London Boroughs 74 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 partially-hearing children in their homes or day nurseries for supervision and training. Audiometry Routine audiometric testing of school children is carried out by two full-time trained audiometricians. Children who are due for periodic medical inspections at the ages of 5, 8 and 11 first have an audiogram. Those children who fail audiometry have a full audiograph prepared which is made available to the school medical officer when the medical inspection takes place. In this way, the school medical officer is able to discuss with the head teacher-the children's school progress, to arrange a seating. position in class favourable for hearing and to follow-up with any other investigations necessary. During the school holidays, special sessions are held at the school clinics at which the audiometrician is present, for follow-up purposes. The standards for passing audiometry are set purposely high, and of the 452 children who failed first routine tests in 1966, a very high proportion were found to respond to simple measures or not to need treatment. The percentage of children who failed 'special' tests was high, becausethesechildren hadeither been referred specially because deafness was suspected, or were already under treatment. The tables below give the numbers and results of audiometry tests during 1966:- Maintained Primary and Secondary School Population of the Borough 34195 (excluding Suntrap Residential School) Audiometer Tests - Routine Age Group 1st Tests sweep or gramophone Re-tests Failures both ears one ear Total % of Column 1 right left (1) (2) (3) (4) (5) (6) (7) Up to 7 years 2750 254 119 40 37 196 7.1 Intermediate 2590 137 81 41 40 162 6.2 Leavers 2477 151 49 20 25 94 3.8 Totals 7817 542 249 101 102 452 5.8 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 2 - - - 2 2 100.0 5 31 25 13 7 1 21 67.7 6 24 47 10 2 3 15 62.5 7 15 31 4 3 1 8 53.3 8 19 47 6 1 2 9 47.4 9 9 44 - 1 2 3 33.3 10 7 33 3 - 1 4 57.1 11 4 7 - - 2 2 50.0 12 6 32 2 1 - 3 50.0 13 11 17 3 2 1 6 54.5 14 8 22 1 - - 1 12.5 Over 14 3 10 - - - - - Totals 139 315 42 17 15 74 53.2 75 SCHOOL DENTAL SERVICE The Principal School Dental Officer reports for the year 1966 as follows:- Treatment provided by the dental service during 1966 followed the pattern of the preceding year so closely that many detailed comments made in the report of 1965 need not be repeated here. The statistics set out in the table at the end of this report include the year under review with those for the previous year alongside for comparison. It will be seen that in many instances there is no significant difference, although there has been an increase in the overall 'productivity' of the service despite a reduction in the number of treatment sessions. As the figures speak for themselves, detailed comment will be restricted to those showing a significant difference, or where amplification or further interpretation would be informative. Inspection and Treatment In the year under review the number of pupils as at 31st December was 34369, this being an increase of 1213 over the comparable figure the previous year. Routine dental inspections in schools occupied 223 sessions during which 19121 children were examined, while a further 3216 were first examined in the clinics. Together these totalled 22337, which represents 64.9% of our school population. In addition, a further 3367 were re-examined either at the clinics or in schools after a previous course of treatment had been completed earlier in the year. From the total of 25704 first or re-examined, treatment was required by 14,127 representing 54.9% which is a gratifying improvement compared with 62.5% the previous year. Of those found to require treatment, about two-thirds avail themselves of our service and the remainder - apart from the very small hard-core who avoid treatment from any source except for relief of pain - attend a general dental practitioner in the National Health Service. The Executive Council list shows that no less than 87 such practitioners have surgeries in Haringey so there is every opportunity for children to obtain their treatment on a 'family dentist' basis, which would be ideal in ensuring regular attention from someone known and trusted and attended with other members of the family as a normal part of life's routine. In fact, routine attendance is less usual than is desirable, and it is beyond doubt that the findings at school inspections, with the consequent encouragement of persuasion that necessary treatment should be provided, forms a valuable part of our service. Sessions devoted to treatment numbered 3802, during which total attendances for treatment were 28396 and a further 5137 appointments were not kept, which latter figure shows a considerable reduction as compared with the previous year and merits comment. It is inevitable that, from so large a total number of appointments given, there will be a considerable number not kept for good and sufficient reasons which we must accept. We recognise that the natural forgetfulness of children will account for a further number and that a few will seek to avoid treatment by deliberately breaking appointments. The foregoing represent a virtually irreducible number unless we introduce a complicated system far beyond the limits of clerical time possible. We have, however, brought into effect a system which imposes little burden in the way of clerical work and has resulted in a reduction of 20% in the total of appointments broken. At the same time, we are safeguarded against a charge that following a failed appointment we did nothing further to try and ensure the resumption of treatment. In 1965, the fai lures compared with attendances was 22.5% which, looked at in a different way, was 18.4% of the total attendances expected. For the year under review, these figures were reduced to 18.1% and 15.4% respectively. Appointments fai led are not necessarily always wasted, as cancellation even at the last moment may still allow more treatment for the previous patient, or a return to punctuality upset earlier by more lengthy treatment having been found necessary for a previous patient. Thus, the time of the failed appointment is usefully distributed for the benefit of one or more other patients, although still recorded as a failure to attend. 76 Despite the reduction of 213 treatment sessions as compared with the previous year there was a significant increase in the output of conservative work, especially for the temporary teeth which so often in the past have had to be subordinated to the greater demands of the permanent ones. An increase of 935 fillings in the process of conserving 1261 more teeth is a gain of 10.5% and 15.6% respectively, and this not at the expense of the permanent teeth for which there was a small increase. The overall ratio of permanent teeth filled to those extracted was 16.7 to 1, which is outstandingly better than the National average of 5.3 to 1. If the extractions done as an integral part of orthodontic treatment and not because the teeth were unsavable are excluded, the ratio would be 29.6 to 1. The ratio for temporary teeth saved to extracted is 4 to 1 compared to the National average of 0.6 to 1. Part of the foregoing satisfactory trend in the pattern of conservation of temporary teeth results from the use by some of the dental officers of a modern form of treatment, which makes possible the saving of some teeth which previously would have necessitated extractions. This results from the forward-looking policy of the Council in agreeing to the attendance of professional staff at post-graduate courses, which is essential in keeping up-to-date with advances in methods of treatment. An additional benefit we have obtained in the same way is in the saving and restoration of permanent front teeth involved in accidents, which previously would have been removed as beyond repair. It is beyond dispute that attendance at suitable courses will make for a better service and is proving so in our own, and for this I record my appreciation. Reference was made last year to the improved situation in our orthodontic service, but loss of some orthodontic sessions resulting from a part-time officer leaving and the impossibility of obtaining a suitable replacement at the salary we are able to offer has resulted in a worsening in the position, and it is not possible at present to view the future with confidence. The reduction in the figures of work done as shown in the table reflect the reduced treatment possible and, in a branch of the service where we were barely holding our own in the face of increasing demand, can only lead to a deterioration if continued for long. Staffing (as at 31st December, 1966) (The details which follow apply to the whole of the Council's dental staff, although this report is of the school dental service to which we devote approximately 91% of our time. The balance is used for the priority classes reported upon elsewhere). We have been fortunate, at a time when there is a National trend making for difficulties in obtaining and keeping dental officers, in having maintained our position. Indeed, internal reorganisation following upon some staff movements has slightly strengthened our service. In addition to the Chief Dental Officer we had, at the date Nationally used for assessment, 7.9 whole-time equivalent of dental officers and 1.4 orthodontists (although this latter figure represents fewer working sessions than the same figure a year ago). Although we are not in a position to examine all schools each year and offer treatment to all who require it, this is largely a problem of distribution of our dental surgeries in relation to the schools so as to make for short, safe and inexpensive visits by the children concerned. There is too great a burden at some clinics which cannot be eased by any logical redeployment of resources: if the number of surgeries is inadequate, treatment cannot be provided. Nevertheless, the area of greatest difficulty, served by the Weston Park Clinic, is being helped greatly by the transfer of some schools to the new clinic at Burgoyne Road. It is anticipated that the year 1967 will show a marked increase in the percentage of the school population inspected, with some hope of all schools being visited. Within the limitations imposed by the considerations above, our staffing position is satisfactory, except for the orthodontic service where we have the accommodation but not the additional orthodontist needed. Premises Including the surgery in Suntrap Residential School, we have 15 surgeries available in 10 premises, although the treatment demand is not such that all are in full-time use. We have a surplus of accommodation in some places and demand exceeding our resources in others. 77 Investigation of Dental Service As a result of the recommendations made by the Estimates Committee 1962/63, an investigation intoLocal Authority dental services is made by a dental officer on the staffs jointly of the Department of Education and Science and the Ministry of Health. The Borough of Haringey was the first of the London Boroughs to receive such inspection, in the early part of January 1966, and this proved to be a most thorough and searching exercise occupying three full days after having first submitted the full statistical returns for the preceding year and other information which was requested. The visiting officer Mr. J.G. Potter, was favourably impressed by the service we provided and this resulted in a formal report in the names of the Secretary of State for Education and Science and the Minister of Health commending the Authority on the high standard of efficiency achieved for the dental service. The only criticism related to the state of premises and equipment at some clinics, but without exception these were matters of which we were aware and they have been included in the draft estimates for the forthcoming financial year. Some had to be held over for a further year because of the need to reduce expenditure but all have received or will receive attention shortly. It is to be hoped that the standard of decoration and consequent cleanliness of all surgeries where operative procedures are carried out, and the appearance of waiting rooms which give the first impression of the service, may soon be fully up to expectations. The Health and Welfare Committee and the Council recorded their gratification at the successful outcome of the inspection and the commendation which had been received. The following table shows the work undertaken during the year with the figures of the preceding year for comparison:- 1966 1965 Dental Inspections and Treatment Pupils first inspected at school 19121 17760 Pupils first inspected at clinic 3216 3378 Pupils re-inspected 3367 2666 Number found to require treatment 14127 13217 Number of fillings: Permanent teeth 14342 14156 Temporary teeth 8897 7962 Number of teeth filled: Permanent teeth 12408 12104 Temporary teeth 8087 6826 Extractions: Permanent teeth unsavable 419 366 Permanent teeth orthodontia 325 419 Temporary teeth 3435 3451 General anaesthetics 1571 1651 Number of dentures supplied 27 24 Number of crowns and inlays 24 28 Number of teeth root filled 12 22 Number of prophylaxes 1581 1149 Number of teeth otherwise conserved 2456 2464 Other operations 4939 5578 Orthodontic Treatment Cases remaining from previous year 195 175 New cases commenced during year 116 142 Number of appliances fitted: Removable 341 350 Fixed 10 8 Number of impressions, adjustments etc 3700 4486 Number of radiographs 1714 2178 Appointments and Sessions Attendances for treatment 28296 28521 Appointments not kept 5137 6421 Number of half-day sessions devoted to: Inspections in schools 228 204 Treatment 3802 4015 Dental Health Education 9 13 78 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 Dr. Nina Meyer, consultant psychiatrist, who acts as Medical Director. 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, three psychiatric social workers, two social workers, and six clerical assistants who between them work equivalent hours to five full-time officers. Dr. Nina Meyer reports as follows on the work at Lordship Lane Centre:- 'The work of the Tottenham Child Guidance Clinic continues to expand. In the year 1st April 1966 to 31st March 1967, 161 cases were referred: five years ago, 86 cases were referred. It is, perhaps, not surprising that there should be such an increase in a period when social change is rapid. Problems which concern Haringey, in common with other urban areas, include changes in the school structure, a large immigrant population (Greek Cypriot, Turkish Cypriot, Indian, Pakistani, and West Indian) and overcrowding. These factors make serious contributions to disturbance in the child population, exemplified by school phobia, or fear of going to school, an emotional withdrawal, which has recently been described as a kind of autism, and delinquency. New answers are called for, since individual treatment must of necessity be limited, and in many cases is not applicable. To send the child away from his environment to a residential school often constitutes an additional burden on the child's capacity for adjustment. Child Guidance teams are therefore meeting new and challenging problems, for which new answers must be found. With this in view the team at Lordship Lane is increasing its contact with Probation Officers. School Welfare Officers. Child Care Officers and Health Visitors. It is also proposed to have a series of seminars with Health Visitors and Doctors, so that child disturbance can be detected in the earlier stages, when help is most effective. The Clinic for the Under Fives is part of this attempt to give help earlier. Here too numbers have dramatically increased from 26 in 1961 to 60 in 1966/67. It is now proposed to have a clinic for Under Two's, so that priority can be given at this phase of child development, when mothers are most concerned, and involved, and for whom, therefore, help is most effective". Dr. K.A. Graf reports as follows on the work at Tetherdown Clinic:- "As requested. / have pleasure in giving you a brief report on the function and organisation of the Tetherdown Child Guidance Clinic during the year 1966. This is my fifth report since seconded by the North West Metropolitan Regional Hospital Board to services as Consultant Psychiatrist in the area, and my second as Medical Director of the Tetherdown Child Guidance Centre, which was established in its present set-up at the time of the reorganisation of the London Boroughs. The changes of staff and administration which have resulted from this have been described in detail in last year's report, and we enjoyed this year the benefits of a smoothly running service without any particular highlights or new developments. This does not reflect inactivity but, on the contrary, intensive preoccupation with diagnostic and therapeutic work with our clients. We have continued to give advice and practical heIp by therapy and counselling to those who were concerned about the mental health of their own and other people's children. It is one of the prime functions of the Clinic to promote the happiness and to remove the psychological difficulties of the children and young people referred for advice, and they and their parents can be assured that the members of the Clinic are treating them with all modern therapeutic techniques available. The therapeutic methods employed and the whole approach towards emotionally disturbed children who often present behaviour or educational problems differs considerably from the adult psychiatric out-patient clinic because of the following characteristics in the make-up of a child:- 79 1. The immature and inexperienced child finds it very difficult to verbalise his complaints and to express them in an adequate way, while the anxious or depressed adult will make it obvious, by what he says or does, that he has problems, is unhappy or frightened, a child only rarely reveals spontaneously what is troubling him. Even worse for him, he may express his unsettled state by quite inappropriate means, such as mischievous behaviour or telling lies, thus not only misleading the adults who want to help him but even alienating those from whom he would require in his predicament most support. A vicious circle is created which has to be broken by the intervention of the Chila Guidance Clinic by recognising the true nature of the problem and improving the fundamental disturbance. 2. Children have a vivid imagination but lack experience. Even with high intelligence they may be only very vaguely aware of social obligations and lack commonsense to deal with difficult situations. They pay unaue attention to imagined feelings and grievances, are often subject to unreasonable fears and they tend to falsify experience by preoccupations in phantasy. This will create emotional tensions which are difficult to understand for the parents and may cause behaviour problems which cannot be judged by adult standards. 3. As the child is aeveloping his personality he is in a constant state of flux. Even severely disturbed behaviour can improve without residual damage to his future mental stability, if handled expertly, while abnormal mental states in adults are more persistent because their behaviour patterns are strongly fixed. On the other hand, intervention in a child's disturbance is more vital, as it may also grow with advancing age. 4. There is no equivalent in adult life to the relationship of a child with his parents and his experiences in school. Being less independent he has limited opportunity for expressing his own personality and his life is very much influenced by his parents and the codes set by the school. It is for these reasons that no investigation and treatment of a child's problems can be successful if we do not study his home circumstances and take his position at school into consideration. The aid of the educational psychologist and psychiatric social worker is, therefore, indispensable to a children's psychiatrist. This is quite a different approach from the treatment of adults, where mental and emotional problems can and should be only dealt with by the medical psychologist in the seclusion of the psychiatric consulting room with the security of complete professional secrecy. The time at the disposal of the child psychiatrist at the Tetherdown clinic is limitea, but he managed tosee 114 individual cases (including 43 reviews) during the year, compared with 108 (34) in 1965. Seven children were given more regular psychotherapeutic help by him. while the other children from our long treatment waiting list were seen by the psychotherapist. The majority of the 64 referrals dealt with came from the School Health Department and Headteachers, smaller numbers reached us directly from the Children's Officer, General Practitioners and parents. While we had less difficulty in finding places for maladjusted pupils in residential schools we were hampered by the persisting lack of in-patient provisions for autistic children and disturbed adolescents. A readily available unit for short-term observation of disturbed children of all ages would greatly improve our present diagnostic facilities. Enuretic children can, in selected cases, be helped by psychotherapy, but some are more suitable for treatment by medication or deconditioning by the electrical alarm pads which does not require referral to this clinic. Many cases referred to us reveal themselves as being due to social problems which do not really require our more specialised services which are treatment of emotional disturbance and not management of behaviour problems due to vicissitudes in the material environment or unalterable family circumstances. This needs to be stressed as a large number of unpromising referrals prevents the necessary more intensive attention to the urgent psychiatric problems in which we specialise. Fewer parents failed to take advantage of the referral (seven compared with twenty last year) and. on the whole, we found the co-operation of parents, family doctors, hospital specialists, heads of social agencies and other interested departments very encouraging". 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. 80 Originally the clinic was set up to deal with children suffering from acute rheumatism and its after-effects; 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 has supplied the following details of the year's work:- New cases - Haringey patients:- Rheumatic Fever 1 Streptococcal State 1 Congenital Cardiac Lesions:- Coarctation 1 Patent Ductus Arteriosus 4 Fallot's Tetralogy 1 Atrial Septal Defect 4 Ventricular Septal Defect 5 Pulmonary Stenosis 1 Venous Hum 1 Innocent Murmur 7 Total 26 Speech Therapy During 1966 the staff continued to include only three part-time speech therapists, and until the staff can be brought up to the establishment of four full-time therapists the work in this department will be seriously impeded. The three therapists carry out 20 sessions per week and are therefore equivalent to two full time staff. Miss J.D. Came, Senior Therapist, reports:- "Speech Therapy in Hornsey and Wood Green has again been placed on a satisfactory basis, thanks to the efforts of the two young therapists concerned. Owing to staff shortage, only 10 treatment sessions have been available in Tottenham, instead of the recommended 20. This has necessitated drastic curtailment of school and home-visiting, to prevent long waiting-lists. When staffing improves, it is hoped to provide speech therapy at the new Muswell Hill Centre for those mentally handicapped or cerebral-palsied children who need it. Several children with unusual disabilities offered interesting confirmation of present improvement in the medical care of the neonate. Language retardation in these cases was associated with aisorders of metabolism, phenylketonuria, adrenal or thyroid dysfunction, or brain-damage, supra-bulbar paresis, congenital receptive aphasia and possible autism. The rising number of under school-age children referred for speech therapy is of interest and encouragement to therapists, because:- (a) It affords opportunity for early diagnostic assessment ana valuable preventive work. (b) It represents successes in the field of parent education. (c) It is an economic use of the therapist's time". Milk in Schools Scheme Number of pupils supplied with 1/3 pints of milk on an average day in the Autumn Term 1966. Maintained Schools No. Present No. Taking Milk Infant & Nursery 7,205 7,205 Junior Schools 10,614 10,206 Secondary Schools 13,204 6,681 Total 31,023 24,092 Non-Maintained Schools Independent Schools 2,983 2,379 Total 34,006 26,471 81 School Meals were served at 106 schools or departments. Meals consumed by pupils on an average day in the Autumn Term, 1966. No. Present No. taking paid meals No. taking free meals Total Infant & Nursery 7,205 5,132 266 5,398 Junior Schools 10,614 7,787 436 8,223 Secondary 13,204 8,607 389 8,996 Total 31,023 21,526 1,091 22,617 Total number of meals prepared during year ended 31st December 1966, 4,384,800 (including Staff meals). Tuberculosis Prevention of Tuberculosis by B.C.G. Vaccination B.C.G. vaccination isoffered to all school children over the age of 13 years. No further education students availed themselves of the opportunity to have B.C.G. vaccination during the year. Thefollowingtablegives details of the B.C.G. vaccination carried out by the Council during 1966:- School Children Number % Parents approached 3187 Parents accepted 2797 87.8 Number skin tested 2560 Number found positive 254 9.9 Number found negative 2173 84.9 Number failed to attend for Mantoux reading 132 5.2 Number vaccinated (% of those approached) 2173 68.2 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 one instance during 1966, the chest physician recommended epidemiological investigation at the school, which showed that no other members of the school had been infected. Peak Flow Meter Testing Towards the end of 1966 a trial was carried out at a Senior Boys School in conjunction with the staff of Finchley Chest Clinic, who supplied the Peak Flow Meter. The sole object of routine testing was to pick out the children who were below par in ventilatory function. All 275 children on the school roll were tested, and the children who failed (31) were then examined by full spirometry. Those children who failed the later test were examined at the chest clinic and given breathing exercises. Special advice was given about the dangers of smoking and the children will be followed up for a number of years to see if they develop any tendencies to chest disease later in school life, the object of the trial being to prevent this development if possible. 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 1966:- Number of individual examinations of pupils in schools by school nurses 55,613 Number of individual pupils found to be infested 225 82 Ringworm of the scalp During the year 11 cases occurred sporadically in 3 schools throughout the Borough and in conjunction with the Department of Mycology at St. John's Hospital for Diseases of the Skin, screening by Wood's Light was immediately undertaken of all children in the school in order to exclude contact cases. The few contacts found have in all cases been relatives or close friends. It would therefore seem that the condition has been transferred in the home situation rather than the school. Verrucas During the year one medical officer made a study of the problem of plantar warts in school children, under the instruction of the Consultant Dermatologist at the Prince of Wales's Hospital. It is intended that this medical officer will advise on the treatment of intractable cases. While recognising the value of carrying out physical education in bare feet, after taking the advice of dermatologists and having regard to the shortage of school nursing staff, I have reluctantly continued to advise against physical education 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. TheSchool 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 tableshows 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 19th January, 1967. 83 84 RETURN OF ASCERTAINED HANDICAPPED PUPILS REQUIRING SPECIAL EDUCATIONAL FACILITIES CATEGORY IN THE CALENDAR YEAR DISTRIBUTION ON 19TH JANUARY 1967 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 2 - 1 - - - 2 1 - - 4 - 2 - - - 1 - - - - - 9 1 Partially Sighted Pupils 2 2 2 - 4 3 - - - - 2 1 - - - 1 - - - - - - 6 5 Deaf Pupils 2 2 1 2 8 10 2 - - - 1 1 - - - - - - - - - 11 11 11 Partially Hearing Pupils 2 5 - 5 7 12 - - - - - 2 - - - - - - - - - - 7 14 Physically Handicapped Pupils 9 7 8 6 36 24 2 - - - 3 3 1 - - - - - - - - - 42 27 Delicate Pupils 15 6 15 7 16 23 10 4 - - 4 1 1 - 2 - - - - - - - 33 28 Maladjusted Pupils 10 3 10 2 - - 14 - - 1 18 10 14 2 1 - 4 - - - - - 51 13 Educationally Subnormal Pupils 36 18 27 15 101 61 12 6 - - 4 1 3 1 17 7 - - - - - - 137 76 Epileptic Pupils 1 1 1 2 - - - - - - - - - - - - - - 2 1 - - 2 1 Pupils with Speech Defects - - - - - - - - - - 1 - - - - - - - - - - - 1 - Totals 79 44 65 39 172 133 42 11 - 1 37 19 21 3 20 8 55 - 2 1 - - 299 176 Grand Totals 123 104 305 53 1 56 24 28 5 3 - 475 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. The children at these units need special teaching because of their hearing defect, but otherwise participate fully in ordinary school life. Of the 94 children on the roll atVale Road Special School, 59 were Haringey children and 35 children from other Boroughs. Of the 119 children on the roll at Blanche Nevile School (including the Devonshire Hill and Markfield units), 37 were Haringey children and 82 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 48 Haringey children at Durants, 46 at Oak Tree and 57 at Oak Lodge, and it would seem that there is a needfor educational provision for these children within the Borough. The other categories of handicapped pupils requiring day special schooling are placed mainly in the following schools outside the Borough:- Partially Sighted Joseph Clarke School, Walthamstow or Harborough School, Islington Delicate Hazelbury Open-Air School, Edmonton or John Keats School, N.W.8 (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. 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 school accepts boys of primary school age (i.e. 5 to 11 years) and girls of all ages. The number of children placed at Suntrap at the end of the year was 119, of whom 11 were Haringey children and 108 children from other Boroughs. Blind children are placed at special residential schools, mainly at Dorton House School, Sevenoaks or Lindon Lodge School, Wimbledon. Children in 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 inhospital special schools). The only category involving a large number of children is that of maladjusted pupils. Hospital Classes I am indebted to the Chief Education Officer for the following report:- "These classes for in-patients at St. Ann's and Prince of Wales's General Hospitals have continued successfully during the past year, the average number receiving tuition being 38. Many of the children, whose ages range from 5 to 16 years, attend the classroom provided at one of the wards at St. Ann's, the remainder receiving lessons in bed. The work of the teachers is assisted greatly by the ready co-operation of the hospital staff'. 85 A recent study showed that children suffering from the following conditions were pupils in the St. Ann's Hospital School. Boys Girls Chronic nephritis - 1 Heart Defects 2 Fractured Femur 3 2 Fractured Tibia 2 Traffic accident 1 Leg operations - results of polio 2 Infective mononucleosis 1 Infective hepatitis - 2 Rheumatic Fever - 1 Thalassemia - 2 Abdominal pains and pyrexia 1 Abdominal pains 2 1 Suspected appendicitis - 2 Sarcoidosis 1 Burns - 1 Enuresis - 1 Osteomyelitis 1 16 13 Co-ordination of Education, Health and Welfare Services In March, 1966 a joint circular was issued by the Department of Education and Science and the Ministry of Health asking Authorities to review their arrangements for the co-ordination of the Education, Health and Welfare Services for handicapped children and young people. Discussions were held between the departments concerned which showed that the standard of co-operation for Haringey is already high. An observation or 'risk' register for young children, and a register of ascertained handicapped pupils are kept within the Health Department. A medical officer visits Vale Road Special School for handicapped children twice weekly. In each school term a meeting is held between the teaching staff, the senior educational psychologist, the medical officer ana the therapists concerned, to discuss each new entrant to the school. A monthly visit by a medical officer to the Blanche Nevile School for the Deaf is being instituted. School leavers from special schools for educationally subnormal children are reported informally to the Mental Health Department. Leavers from Vale Road School for Physically Handicapped Children are reported to the Welfare Department for further help where necessary. In order to improve arrangements further, it is proposed to maintain a register in this department of all handicapped children and young people between the ages of 13 and 20, and to endeavour to obtain closer liaison and exchange of information with hospitals and general practitioners where existing links are weak. The appointment of a Social Worker (Health Services) to the staff of this department has been agreed in principle, for the purpose of improving knowledge of and contact with families of handicapped children. 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. At the end of 1966 the number of children on the rolls of the Opportunity Classes was 56(36 boys, 20 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, autisticchildren. We are continuing to explore the most effective methods of helping these children, in close association with the child health and mental health services. 86 Home Tuition During the year five children received home tuition for varying periods, under Section 56 of the Education Act 1944. Of these children, three 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 (1) 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. It is intended to make future provision for the attendance of mentally handicapped children up to the age of five years. During 1966, five Haringey children, and four children from other Boroughs were in attendance at day nurseries in the Borough under these arrangements. At the end of the year, two Haringey and two children from other Boroughs were still in attendance. Recuperative Holidays During 1966 twenty nine boys and twenty five girls were recommended for recuperative holidays in order to assist their recovery after illness. Nineteen boys and sixteen girls were placed in suitable homes for periods of varying length. Deaths of School Children It is with regret that I include the following details of 15 local school children who died during 1966:- Sex Age Cause of Death M 9 Malignant tumour F 5 Malignant tumour M 5 Malignant tumour F 12 Acute pericarditis M 15 Heart disease M 14 Acute asthma M 12 Bronchopneumonia, viral M 12 Encephalitis M 10 Tetanus M 13 Cystic fibrosis F 8 Cystic fibrosis M 5 Cerebral palsy F 15 Poisoning M 8 Road accident M 7 Atelectasis following whooping cough Accidents to School Children I am indebted to the Accident Prevention Officer for the following analysis of road accidents involving child pedestrians aged 5 - 15 years during 1966. "A detailed study of the roaa accidents resulting in injury to 193 child pedestrians during 1966 has revealed:- (a) that 5 - 10 years were the most vulnerable ages; (b) that May and November were the most dangerous months; 87 (c) that Wednesday and Saturday were the most dangerous days; (d) that the period 4.30 - 9.0 p.m. was the most dangerous time of day: (e) that the number of boys injured was nearly twice the numbers of girls injured. Fatal Serious Slight Total Girls - 12 57 69 Boys - 30 94 124 (f) that the principal causes were:- Running across or into the road 105 Walking or stepping into the road 46 Crossing road from between or behind stationary vehicles 32 Other causes 10 LIST OF SCHOOL HEALTH CLINICS AS AT 31st DECEMBER, 1966 a - Minor Ailment b - Dental c - Ophthalmic d - Orthoptic e - Orthopaedic f - Physiotherapy g - Cerebral Palsy Unit h - Speech i - Ear, Nose & Throat j - Audiology Unit k - Child Guidance I - Chiropody a All Saints' Church Hall, 11 Church Road, N.6 j Blanche Nevile School for the Deaf, Philip Lane, N.15 abh Burgoyne Road Clinic, 58 Burgoyne Road, N.4 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 h 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 abcdefhi Medical Centre, rear of Hornsey Town Hall, 23a Weston Park, N.8 dfgh Vale Road School for Physically Handicapped Children, N.4 88 APPENDIX SCHOOL HEALTH SERVICE STATISTICS FOR 1966 SCHOOL HEALTH SERVICE STATISTICS 1966 PUPILS FOUND TO REQUIRE TREATMENT AT MEDICAL INSPECTION Number of Individual Pupils found at periodic medical inspections to require treatment (excluding dental diseases and infestation with vermin) Year of Birth For defective vision (excluding squint) For any of the other conditions recorded Total individual Pupils 1962 & Later - 7 7 1961 25 39 61 1960 66 169 207 1959 56 57 108 1958 170 152 296 1957 111 93 185 1956 21 11 25 1955 104 71 133 1954 88 56 137 1953 44 34 69 1952 32 27 53 1951 & earlier 571 237 745 Total 1288 953 2026 Defect Code No. Defect or Disease Periodic Inspections Special inspections Entrants Leavers Total including all other age groups inspected T 0 T O T O T O 4 Skin 27 45 84 60 224 210 529 28 5 Eyes (a) Vision 91 82 603 87 1288 409 285 120 (b) Squint 14 3 1 3 28 15 3 - (c) Other 6 7 9 - 31 15 39 4 6 Ears (a) Hearing 8 27 6 25 42 175 76 82 (b) Otitis Media 2 25 5 2 20 65 8 2 (c) Other 5 14 6 7 18 43 65 8 7 Nose and Throat 39 183 26 56 114 457 71 53 8 Speech 14 36 2 5 47 74 37 11 9 Lymphatic Glands 1 69 - 12 2 161 3 6 10 Heart 3 33 8 29 15 105 15 13 11 Lungs 4 50 4 24 24 171 9 35 12 Developmental: (a) Hernia 1 12 - 1 2 25 1 3 (b) Other 7 20 6 16 23 121 15 32 13 Orthopaedic: (a) Posture 1 5 7 24 17 76 5 8 (b) Feet 48 69 83 46 238 247 45 46 (c) Other 3 8 7 13 16 47 52 13 14 Nervous System: (a) Epilepsy - 7 3 2 13 19 4 4 (b) Other 1 3 5 5 9 24 21 12 15 Psychological: (a) Development 4 14 1 8 13 46 68 25 (b) StabiIity 16 89 4 24 38 245 47 45 16 Abdomen 2 16 2 5 10 59 2 6 17 Other 2 7 2 4 9 23 200 23 T - Requiring Treatment O - Requiring Observation 89 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 58 (b) Errors of refraction, including squint 2070 Total 2128 (c) Number of pupils for whom spectacles were prescribed 870 GROUP 2. Diseases and Defects of Ear, Nose and Throat Received operative treatment for:- (a) Disease of the ear 1 (b) Adenoids ana Chronic Tonsilitis 286 (c) Other nose and throat conditions 7 Received other forms of treatment 401 Total 695 Total number of pupils in schools known to have been provided with hearing aids: (a) During the current year 8 (b) In previous years (excluding any pupils shown at (a) above who were provided with an aid in a previous year) 37 GROUP 3. Orthopaedic and Postural Defects Number of pupils known to have been treated at clinics or at out-patients departments 816 GROUP 4. Diseases of the skin (excluding uncleanliness) Ringworm (i) Scalp 11 (ii) Body - Scabies - Impetigo 3 Other skin diseases 662 Total 676 GROUP 5. Child Guidance Treatment Number of pupils treated at child guidance clinics (including cases sent to the Tavistock and other hospital clinics) 173 GROUP 6. Speech Therapy Number of pupils treated by speech therapists 222 GROUP 7. Other Treatment given (a) Number of miscellaneous minor ailments treated by the Council 51 (b) Treatment other than (a) above and excluding convalescent treatment 268 90 EDUCATION ACT 1944 - SECTION 57 Cases dealt with under Section 57, Education Act 1944 7 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 168 (b) Number of Students examined as to fitness to undertake training course 170 (c) Number of Students examined on completion of training course 54 91 INDEX Page No. Abatement to Statutory Nuisances 27 Accidents to School Children 87 Adult Training Centre 64 Advisory Clinics for the Elderly 55 Analysis of Contraventions found in Offices and Shops 41 Analysis of Reported Accidents in Offices and Shops 42 Ante-Natal Clinics 46 Arnold Road Improvement Area 30 Atmospheric Pollution, Investigation of 19 Audiology Unit 73 Audiometry 75 Autistic Children 86 Births, Notification of 45 Brucellosis 10 Carcases inspected 38 Care of Mothers and Young Children 45 Cerebral Palsy Unit 71 Certificates of Disrepair 31 Cervical Cytology 40 Child Guidance Service 79 Child Minders, Registered 49 Chimney Heights 19 Chiropody Service 57 Clearance of Areas of Unfit Houses 29 Cleansing and Disinfection 24 Clinics, School Health 33 Congenital Malformations 47 Daily Guardian Scheme 49 Day Nurseries 48 Day Nurseries, Admission of Handicapped Children 87 Day Nurseries, Private 49 Deaths of Haringey Residents 6 Deaths of School Children 87 Defects found in factories 43 Defects remedied 26 Dental Care of Priority Classes 50 Dental Inspection and Treatment 76 Dental Premises 77 Dental Staffing 77 Dental Statistics 73 Diseases of Animals Act 1950 28 Disrepair, Certificates of 31 Domestic Help Service 55 Drainage and Sewerage 15 Dysentery 9 Ear, Nose and Throat Clinics 72 Education Committee 67 Education, Health and Welfare Services, Co-ordination of 86 Page No. Factories 43 Factories, Defects found in 43 Family Planning 45 Flooding 15 Food, Fitness for Human Consumption 39 Food Hygiene 33 Food Poisoning 8 Food Premises, Registered 34 Food Sampling 35 Furnace Installations 19 Greater London Housing Survey 33 Handicapped Pupils 83 Health Education 62 Health Visiting Service 52 Health and Welfare Committee 1 Home Nursing Service 54 Home Tuition 87 Hospital Classes 85 Housing 28 Housing Applications, Assessment on medical grounds 32 Houses in Multiple Occupation 30 Immunisation against Diphtheria, Whooping Cough, Tetanus and Poliomyelitis 12 Immunisation Schedule 12 Improvement of Houses not in improvement areas 30 Individual Unfit Houses 29 Infant Welfare Clinics 47 Infectious Diseases 8 Infectious Diseases, Notification of, by sex and age group 7 Infective Hepatitis 10 Insect Pests 24 Inspections carried out by Public Health Inspectors 25 Junior Training School 64 Laundry Services for Incontinent 24 Lead Poisoning 44 Leprosy 10 Leptospirosis 10 Liquid Egg (Pasteurisation) Regulation 1965 40 Malaria 10 Massage and Special Treatment 56 Maternal Deaths 45 Measles 8 Meat Inspection 38 Medical Inspections, Periodic 69 Meningococcal Meningitis 8 Mental Health Services 62 Page No. Mental Health Statistics 65 Mentally III, Hostels for 64 Mentally Sub-normals, Hostels for 64 Midwifery Service 51 Midwives Ante-natal Clinics 46 Milk and Dairies Regulations 34 Milk in Schools Scheme 81 Milk Supplies 34 Mortuary 24 Mothercraft and Relaxation Classes 47 Mothers and Young Children, Care of 45 Multiple Occupation, Houses in 30 National Assistance Act 1948, Section 47 55 Neighbourly Help Service 55 Noise Nuisances 24 Nursing Homes 56 Offices, Shops and Railway Premises Act 1963 40 Ophthalmic Clinics 70 Orthopaedic CIinics 72 Outworkers 43 Periodic Medical Inspections 69 Performing Animals 28 Persons employed in registered premises 41 Pet Shops and Animal Boarding Establishments 28 Poliomyelitis 8 Private Day Nurseries 49 Problem Families, Co-ordinating Committee 53 Psychiatric Rehabilitation Association Day Centre 63 Public Health Act, 1936, Section 172 10 Purchase of Houses in advance of Council's requirements 29 Radioactive Substances Act, 1960 44 Rag Flock and Other Filling Materials Act, 1951 27 Recuperative Holidays 56,87 Registered Child Minders 49 Registered Food Premises 34 Retirement Advice Clinics 55 Rheumatism Supervisory Centre 80 Ringworm 83 Rodent Control 21 Sanitary Circumstances of the Area 15 School Advice Clinics 70 School Dental Service 76 School Health Clinics 88 School Health Service 68 School Health Statistics 89 School Meals 82 School Population 69 Shops Act 1950 - 1966 42 Page No. Sick Pay Reports 61 Smallpox 9 Smallpox,Vaccination against 11 Smoke Control Areas 19 Special Schools 85 Speech Therapy 81 Staff 2,3,4 Staff Medical Assessments and Examinations 61 Statistics, Dental 78 Statistics, School Health 89 Statistics, Vital 5 Statutory Notices Served 26 Statutory Nuisances, Abatement of 27 Street Trading 42 Student Health Visitors 52 Student Midwife Training 52 Student Nursery Nurses 48 Swimming Baths and Paddling Pools 18 Toddlers CI inics 48 Tuberculosis 82 Tuberculous Patients, Extra nourishment for 56 Tuberculosis Rehabilitation 56 Typhoid 9 Uncleanliness and Verminous Conditions 82 Unfit Houses, Clearance of 29 Unfit Houses, Individual 29 Unsound Food surrendered or condemned 40 Uplands Road Improvement Area 29 Unsupported Mothers, Care of 57 Vaccination and Immunisation 11 Vaccination against Smallpox 11 Verrucas 83 Vital Statistics 5 Water Supplies 16 Welfare Foods, Distribution of 49 Whooping Cough - Death from 13 Work executed by the Council 27 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 01-808 1000) Printed by the Libraries Department of the London Borough of Haringey