HARINGEY HEALTH IN 1967 The Annual Report of the Medical Officer of Health & Principal School Medical Officer. HARINGEY HEALTH IN 1967 The Annual Report of the Medical Officer of Health & Principal School Medical Officer. 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, 1967. The work of the public health inspectors to improve the environment continues with regular attention to food hygiene, to offices and shops accommodation and above all to the improvement of housing. Changing conditions bring new problems — food now passes through the ports in containers and so has to be examined inland, and noise presents an ever increasing problem calling for skilled measurement, During the year a major part of their effort was devoted to the London Housing Survey in collaboration with the Greater London Council Research and Intelligence Unit when a total of 4 per cent of the houses in the Borough were assessed in order to arrive at a reliable estimate of the quality of London's housing. The housing situation is changing, because more property is now owner-occupied or Council-owned, so that now only about a quarter is rented to tenants by private landlords. There is, however, an increasing number of houses in multi-occupation. Our experience during the last year has emphasised that these multi-occupied houses have a special fire risk, and the use of fire-proof doors, of "kick through" hatches and the need for special care with paraffin heaters should be fully understood by all who inhabit or visit them. One of the problems that faces Haringey with its substantial population of immigrants from the West Indies is how to care for small children when the mother goes to work. The Council have four day nurseries with 198places but there are 28,000 children under five years of age and several thousand of these are of African descent. The Council's day nurseries can only accommodate a minute fraction of the children whose parents are most hard pressed by social disaster and diseases. The others must be cared for in nursery schools and private nurseries or for the most part by child minders or daily guardians; butthe immigrant community iscrampedfor space, especially for garden space, so necessary for the early experiences of the small child. Somehow we need to organise the environment so that the multi-occupied family can use the ground floor and garden of large old homes for the day care of their small children, and in so doing relieve the tremendous pressure on day nurseries and preventthe development of unsatisfactory patterns of child care. The plea for re-housing on medical grounds often comes from elderly people who live on upper floors and who may be trapped there by their physical incapacity to manage the staircase. One cannot but ask if it is really necessary that so many old people must live in this way. I recently carried out a survey on a small portion of retired local government officers and found that no fewer than 40 per cent of them had retired away from the London area to live in coastal towns or rural areas. If this practice were more generally accepted, the shortage of housing accommodation in the metropolitan area might be considerably relieved. I hope to report next year on the progress which we are expecting to make in the mental health services during 1968. The new approach to mental health is a major social advance, but one of the less fortunate results of it is that a number of young women who in former days would have lived in the sheltered world of a mental hospital are now embarking on family life, sometimes with unhappy consequences for theirchildren. There is probably no more puzzling environment for a small child than a home where the mother is even slightly mentally disturbed. During the year, the department welcomed visitors from many countries to observe our varied activities. Their stream of questions helps to keep us on our mettle. We were honoured by a visit from the Deputy Minister of Health of the U.S.S.R., Mr. Danilov, and from him we were interested to learn that most of the large cities in the U.S.S.R., like those of the U.S.A., have now added fluoride to their drinking water so that their future inhabitants will enjoy better dental health. 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 especially 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 1967/68 Councillor Mrs. L.A. Angell " L. Cohen, F.R.S.H. " Mrs. D. Cunningham, J.P. " Mrs. D.C. Findley " E.V. Garwood " 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. (Vice-Chairman) " C.D. Moss (Chairman) " Mrs. M.E. Protheroe " Mrs. Brenda S. Remington, B.A. " G.H. Stansall " Mrs. J.E. Thexton " James T. Wilkins Co-opted Members Dr. A.M. Freeman Mr. F.A. Rhodes Mr. D.E. Suffolk STAFF OF HEALTH DEPARTMENT AS AT 31.12.67 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 Officers: Elizabeth P. Cloake, M.B., B.S., D.R.C.O.G., D.P.H. Z. Zubrzycki, Med.Dipl., D.P.H. Assistant Medical Officers: Cecilia J.S. Chisholme, M.B., Ch.B., D.R.C.O.G., D.C.H. Avery B. Cooper, M.R.C.S., L.R.C.P. 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) D.P.H. Esther M. Waterhouse, M.D. 2 Vacancies 6 Sessional and 3 Part-time Medical Officers Chief Dental Officer and Principal School Dental Officer: G.C.H. Kramer, L.D.S., R.C.S. Dental Officers: Mary C. Dixon, L.D.S., R.C.S. N. Ansbergs, D.D.D. Alison G. Little, L.D.S., R.C.S. A.H. Landsman, L.D.S., R.C.S. 7 sessional dentists : 6 vacancies Orthodonti sts Joy Maclnerney, L.D.S., D.Orth., R.C.S., B.D.S. 1 vacancy; 1 specialist dental surgery assistant and 1 vacancy 9 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. 2 Deputy Superintendent Health Visitor: Margaret J. Saywell, S.R.N., H.V. 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; 24 health visitor/school nurses; 1 sessional health visitor/ school nurse; 5 vacancies; 2 student health visitors; 2 vacancies; 4T.B. health visitors; 9 clinic nurses; 2 sessional clinic nurses; 2 vacancies; 4 day nursery matrons; 4 deputy matrons; 2 wardens; 1 part-time warden; 1 vacancy; 18 staff nursery nurses; 1 part-time staff nursery nurse; 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. 17 midwives Deputy Superintendent of Home Nurses: Berthe F. Specht, S.R.N., S.C.M., Q.N. 30 home nurses; 5 part-time home nurses: 2 bath unit attendants Chiropodists: 1 full-time: 20 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 Health Cert. 2 senior mental welfare officers: 6 mental welfare officers Home Help Organiser: Judith E. Caplin, D.I.H.H.O. 4 assistants: 232 home helps Red Gables Mother and Baby Home: Matron: Mabel K. Hopkins, S.R.N. Deputy Matron: Irma Lindroos, S.E.N. 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 4 speech therapists (sessional): 1 vacancy 1 orthoptist: 1 vacancy 3 audiometricians: Social Workers: Joyce E.R. Murdoch, S.R.N., S.R.F.N., H.V. Dorothy Myer, A.I.M.S.W. 3 Health Education Officer: Sheila M.P. Frost, S.R.N., S.C.M., H.V. 1 assistant Chief Public Health Inspector W.J. Wilson, D.P.A., M.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. W. Shackcloth, F.A.P.H.I. 19 public health inspectors: 3 vacancies 8 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: 8 public health general assistants: 3 rodent operatives Mortuary Attendant: S.J. Twinn 1 assistant ADMINISTRATIVE STAFF Chief Administrative Officer: W.L.N. Relleen, T.D., D.P.A. Deputy Chief Administrative Officer: D.B. Davies, D.P.A., 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) 29 administrative and clerical assistants: 8 clerical assistants 8 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: 6 shorthand-typists: 1 part-time shorthand-typist: 3 copy typists: 2 part-time copy typists: 1 machine operator. 4 VITAL STATISTICS 1966 1967 Area of District (in acres) 7,491 7,491 Population — Mid-year Registrar General's estimate 254,650 254,120 Rateable Value as at 1st April £13,456,474 £13,572,413 Sum represented by penny rate £54,200 £54,300 Approximate Number of separately rated Dwellings in District 71,483 71,924 Registered live births: Males 2,854 2,762 Females 2,750 2,575 Total 5,604 5,337 Birth rate per 1,000 estimated population 22.00 21.00 No. of live births which were illegitimate 670 (11.96%) 692 (12.97%) Stillbirths: Males 42 30 Females 38 27 Total 80 57 Stillbirth rate per 1,000 total (live and still) births 14.07 10.57 No. of stillbirths which were illegitimate 13 (16.25%) 12 (21,05%) Deaths: Males 1,459 1,391 Females 1,454 1,414 Total 2,913 2,805 Death rate per 1,000 estimated population 11.44 11.04 Maternal Mortality: Deaths from Puerperal Causes 7 2 Death rate per 1,000 total (live and still) births 1.232 0.371 Deaths of infants under 1 year of age (Infant Mortality) (a) Legitimate Males 52 50 Females 32 42 Total 84 92 Death rate per 1,000 legitimate live births 17.02 19.81 (b) Illegitimate Males 9 5 Females Total 6 15 3 8 Death rate per 1,000 illegitimate live births 22.39 11.58 (c) Total Males 61 55 Females 38 45 Total 99 100 Death rate per 1,000 total live births 17.67 18.74 Deaths of Infants under 4 weeks (Neo-natal Mortality) 66 71 Rate per 1,000 live births 11.78 13.30 Deaths of Infants under 1 week (Early Neo-natal Mortality) 61 64 Rate per 1,000 live births 10.89 11.99 Stillbirths and deaths under 1 week (Perinatal Mortality) 141 121 Rate per 1,000 live and stillbirths 24.81 22.43 5 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 England and Wales as a whole. The death rate comparability factor has been adjustedspecifically to take account of the presence of residential institutions in the area. To compare the crude 1967 rates for Haringey with the national rates, Haringey's figures must first be multipliedby the appropriate comparability factors, which are 0.92 for births and 0.97 for deaths. After making these adjustments to the local rates, the birth rate for Haringey is 12% above, and the death rate is 5% below, the national rates. -X 6 7 CLASSIFIED DEATHS OF HARINGEY RESIDENTS SHEWING AGE GROUP AND SEX DISTRIBUTION 1967 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 6 2 - - - - - - - - - - - - 1 — 3 - 2 2 - - Tuberculosis, other 1 - - - - - - - - - - - - - - - - - 1 - - - - - Syphilitic disease 2 3 - - - - - - - - - - - - - - - 1 - 1 2 - - 1 Diphtheria - - - - - - - - - - - - - - - - - - - - - - - - Whooping Cough - - - - - - - - - - - - - - - - - - - - - - - - Meningococcal infection 1 - - - 1 - - - - - - - - - - - - - - - - - - - Acute poliomyelitis - - - - - - - - - - - - - - - - - - - - - - - - Measles - - - - - - - - - - - - - - - - - - - - - - - - Other infective and parasitic disease 5 2 1 - - 1 - - - - - - - - - 1 - - 1 - 2 - 1 - Malignant neoplasm, stomach 46 30 - - - - - - - - - - - - - - 5 2 14 3 12 10 15 15 Malignant neoplasm, lung, bronchus 176 27 - - - - - - - - - - - - 1 - 13 2 65 9 57 11 40 5 Malignant neoplasm, breast - 70 - - - - - - - - - - - - - 2 - 10 - 19 - 20 - 19 Malignant neoplasm, uterus - 31 - - - - - - - - - - - - - 5 - 1 - 5 - 9 - 11 Other malignant and lymphatic neoplasms 147 166 - - - - — 2 — — — 4 1 1 6 2 12 20 42 32 45 46 41 59 Leukaemia, Aleukaemia 10 9 - - - - - - 1 1 - - - - - 1 1 — 4 2 2 2 2 3 Diabetes 11 17 - - - - - - - - - - - - 2 - - - 2 5 2 4 5 8 Vascular Lesions of the nervous system 128 207 - - - - - - - - - - - 2 3 1 7 4 15 14 33 48 70 138 Coronary disease, angina 337 270 - - - - - - - - - - 1 - 7 4 39 6 99 31 107 73 84 1 56 Hypertension, with heart disease 12 22 - - - - - - - - - - - - - - 1 1 3 5 5 8 3 8 Other heart diseases 69 143 - - - - - - - - - - 1 1 4 3 4 4 13 4 10 23 37 108 Other circulatory diseases 58 80 - - - - - - - - - - 1 - - - 4 1 12 7 16 15 25 57 Influenza - - - - - - - - - - - - - - - - - - - - - - - - Pneumonia 75 87 2 2 7 6 1 - - - - - - - - - 2 2 5 3 13 5 45 69 Bronchitis 108 39 - - - - - - - - - - - - 1 - 4 2 20 4 39 8 44 25 Other diseases of respiratory system 8 6 - - - - - 1 - - 1 - - - - - - - 1 1 5 1 1 3 Ulcer of stomach & duodenum 17 7 — — — — - - — — — — 2 — — — 1 1 2 1 4 1 8 4 Gastritis, enteritis & diarrhoea 4 7 — — 2 — — 1 — — — — — - — — — — — — — 1 2 5 Nephritis & nephrosis 8 7 - - - - - - - - - - - - 2 1 - 2 2 - 2 3 2 1 Hyperplasia of prostate 7 — - — — — — — — — — — — — — — — — 1 — 2 — 4 — Pregnancy, childbirth & abortion — 2 - - - - - - - - - 1 - - - 1 - - - - - - - - Congenital malformations 14 11 7 6 6 3 — — 1 — — — — 1 — — - — — 1 — — — — Other defined & ill defined diseases 84 114 28 25 - 2 — — — 1 — 2 - 1 7 2 4 6 10 17 14 16 21 42 Motor vehicle accidents 14 12 - - - - - - - - 5 4 3 - - - 2 — 1 2 1 2 2 4 All other accidents 25 29 — — 1 — - 2 — — 2 1 3 1 2 1 4 2 6 5 4 5 3 12 Suicide 16 13 - - - - - - - - 1 2 2 1 2 1 1 1 5 2 5 4 — 2 Homicide & Operations of War 2 1 - - - - - - - - 1 - - - - - - 1 - - - - 1 - TOTAL 1,391 1,414 38 33 17 12 1 6 2 2 10 14 14 8 37 25 105 69 327 173 384 317 456 755 8 NOTIFICATIONS OF INFECTIOUS DISEASE DURING 1967 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 2 3 5 5 11 8 10 13 9 42 39 3 2 2 4 - 3 - - - - - - - - 162 Measles 56 43 135 117 159 153 108 116 117 115 228 222 11 16 4 9 5 5 - - - - - - 7 1 1627 Whooping Cough 6 6 9 6 13 9 9 10 8 7 20 17 1 6 - 1 1 2 - - - - - - - - 131 Pneumonia 1 1 1 - - - - - - 1 1 1 1 - - - 1 2 1 1 5 3 5 1 - - 26 Erysipelas - - - - - - - - - - - - - - - - - - - 2 1 3 1 3 1 1 12 Food Poisoning 2 _ 2 1 1 1 _ 1 . 1 3 1 1 1 - 1 2 1 - 3 3 3 - - 1 - 29 Puerperal Pyrexia - - - - - - - - - - - - - - - - - - - - - - - - - - 6 Ophthalmia Neonatorum 1 2 - - - - - - - - - - - - - - - - - - - - - - - - 3 A. Encephal itis INF- - - - - - - - - - - - 1 - - - - 1 - - - - - - - - 2 " P-INF - - - - - - - - - - - - - - - - - - - - - - - - - - - Acute Poliomyelitis P - - - - - - - - - - - - - - - - - - - - - - - - - - " N.P. - - - - - - - - - - - - - - - - - - - - - - - - - Meningococcal Infection - - - - - - - - - - - - - - - - - - - - - - - - - - - Diphtheria - - - - - - - - 1 - - - - - - - - - - - - - - - - - 1 Typhoid Fever - - - - - - - - - - 1 1 - - - - - - - 1 - 1 - - - - 4 Para-typhoid Fever - - - - - - - - - - - - 1 - - - - - - - - - - - - - 2 Dysentery 2 1 4 - 3 4 3 - 3 - 3 3 - 1 - 1 1 3 4 1 4 2 - - - - 43 Scabies (Tottenham) _ 1 - - 4 2 - 2 1 2 5 - - - 1 2 3 5 2 1 1 - - - 2 2 36 Tuberculosis Resp. _ _ 3 _ 1 1 - 2 _ - 2 1 - - 2 2 14 12 6 8 16 4 8 3 - - 85 " M & CNS. - - - - - - - - - - - - - - - 1 - - - - - - - - - - 1 " Others - - - - - - - 1 - - 1 - - - - - 2 5 - 1 3 2 2 2 - - 19 Smallpox - - - - - - - - - - - - - - - - - - - - - - - - - - - Malaria - - - - - - - - - - - - - - - - - - - - - - - - - - - INFECTIOUS DISEASES The control of infectious disease is a matter of continual concern to the Health Department and is given priority at all times. Although many of them can now be prevented, we prefer to describe them as being checked, not conquered. We are engaged in an unremitting conflict, fully realizing.that only the utmost vigilance on our part and the co-operation of the general public can ensure that the health of the community is maintained and improved. An increasing proportion of our work is concerned with infection from abroad, and it is therefore not surprising that we view with apprehension the impending appearance in the world's air lines of the jumbo jet. Able to carry nearly 500 passengers at reduced fares, it is likely to give an enormous boost to travel; so that we shall then be encountering a wide range of diseases, from dhobie itch to Rocky Mountain spotted fever. However, there is likely to be at least one good result from this cause; an increase in the smallpox vaccination rate, as many of the countries which will be covered by the spreading tide of tourism, Asia, Africa and the Americas, will be in endemic areas, as a few arealready. A valid international certificate will then become a necessity fora large proportion of travellers. This is another reason why parents should ensure that their children receive their first vaccination in their second year of life. The weekly bulletin to general practitioners has continued to thrive, and has become so much a part of medical life inHaringey that we are often asked to make announcements in it. The exchange of information involved adds a zest to the work of the department, when we sit down on Friday mornings to work out what the Haringey doctor receives on his breakfast table the following day. It is a curious fact that the commonest infectious diseases are the ones we know least about. Conditions like measles, rubella, mumps, chickenpox and influenza do not often cause serious illness, but they certainly result in a large amount of discomfort and absence. 1968 will probably see a great fall in the first of these, when the measles vaccination programme has been completed. A mention should perhaps be made of the problems of publicity in cases of infectious disease. A health department is always on a knife edge where this is concerned. To put the dilemma in a nutshell; while serious infection is of public concern, illness is a private affair. This is complicated by the fact that our idea of the communicability of a disease is often different from that held by the press or the public. For example, there might be a good deal of general alarm about, say, a case of typhoid. But from our point of view, it is rarely dangerous except if transmitted by food or close contact. In other words, you are unlikely to come to harm ifyousitoppositesomebodysufferingfrom typhoid in a tube train. But instances have been recorded elsewhere in which patients or their families have been shunned by others and perhaps suffered financially because it became known that typhoid had occurred, even after all risk of spread had ceased. Similarly, we have to keep information about cases of leprosy at a very confidential level as, though it has a very low grade of infectivity, people have not yet realised this fact and have been frightened of it for centuries. On the other hand, we were surprised to find this year that there was one disease which had evidently lost its terrors for many people. When we made an announcement aboutwhatwas thought at the time to be a case of diphtheria, it was reported only briefly in two newspapers and there seemed to be no public reaction at all. Yet, since this is a disease which is transmissible by air borne spread, it would be a very different thing from typhoid if encountered on a tube train. One wonders, of course, if people have the impression that diphtheria has been conquered by immunisation — a dangerous assumption, since the evidence is that it has only been checked, and may recur if immunisation is not maintained at at least its present level. Our advice is; make sure your children have been immunised against diphtheria, and have yourself protected against typhoid if you mean to go abroad; you will then have little occasion for worry where these are concerned. Infective Hepatitis 73 cases were reported, an increase of 22 on 1966. It is difficult to tell how real this increase might be. The disease was made officially notifiable on 17th June 1968. A difficulty is that many cases do not reach the stage of jaundice and may go unrecognised. We are grateful to doctors for information that has been given to us about this disease. Eighteen of the number occurred at a school over a period of four months. The long duration of the epidemic is typical of the disease which has a lengthy incubation period of between two and six weeks. 76pupils were given injections of gamma globulin to limit the spread, and there were ten more cases extending over two months before the infection died out. There was another outbreak involving five members of a family living in poor circumstances. Other cases later on in the same district may have originated from this source, possibly from contact in school or at play. 9 Smallpox There were no cases in Haringey in 1967, though two were suspected of having the infection in May. Fortunately investigations did not confirm our fears. During the year 24 persons without international certificates entered or re-entered the country and came into Haringey from areas where smallpox is deemed to be endemic. Each was kept under surveillance for 14 days and remained in good health throughout this period. Typhoid Fever This disease has kept us quite busy during the year. Foreign travel has played a large part in its origins. Much of our work involved investigating members of parties who have been abroad, one of whom developed the infection. For example, we took specimens from a Haringey resident who had been on an adventure tour in North Africa. A member of the same party from Scotland had been unfortunate enough to develop both typhoid and malaria. Luckily we found no evidence of either disease. There was also some perplexity over a patient born abroad who showed serological evidenceof typhoid, but from whom no organism could be isolated. It was eventually concluded that there had been an infection in the past from which she had recovered, leaving traces of antibodies in her blood, while the fever for which she was admitted had had another cause. Our most difficult investigation began with a report from another borough that customers at a cafe hadbeen taken ill with typhoid, and that the source of the infection had been shown to be aresidentof Haringey, was a cook in the establishment and had been shown to be a chronic carrier. This individual was admitted to hospital, but it proved impossible to clear up the infection which had evidently been present since an attack of typhoid abroad about twenty years before. A puzzling feature was that the close relatives of this carrier appeared to have escaped the disease, probably owing to the patient's high standards of personal hygiene; but this of course left the question why these standards should suddenly have slipped. No answer to this was ever found, but the patient gave an undertaking never to cook or handle food outside the immediate family circle in the future, and the immediate problem was solved. Not long afterwards the hospital informed us that five months previously they had admitted from yet another borough a patient suffering from typhoid infection of a strain closely resembling that found in our own case. Both had had degraded Vi-strain organisms, a classification meaning that they were impossible to identify exactly; but while we could not be sure they were the same, the coincidence of their appearance in two adjoining boroughs could not be ignored. Enquiry at once revealed that the families were known to one another. An investigation was then undertaken into their movements over the preceding months. Although this may seem a task, there was no shortage of clues. What seemed to be the crucial meeting had taken place a fortnight before the patient intheother borough had taken ill. This fitted in well with the incubation period of the disease; but the curious thing was that there was no evidence that food had passed between them. Their only contact had been a handshake. We reached the conclusion that this had probably been the means by which the infection had been passed on. Paratyphoid Fever A case occurred during the year involving a tourist who had just returned from a car tour to the Levant. The disease was also suspected though not confirmed beyond doubt in a patient in a local hospital. A family, all of whom had been treated in hospital for the disease, moved to this Borough, and the Department completed the investigations which showed they were clear of the infection. Food Poisoning There is a si ightly disenchantedair in the Health Department where summer holidays are concerned. While others plan for days of unalloyed delight on far-off southern European beaches or still remoter strands, we tend to think of the stomach troubles that might plague them there or come back with them; and if we are going in the same directions ourselves we take careful precautions to know what foods to avoid and also put ourselves on courses of tablets to prevent these illnesses. It must be conceded, however, that the majority of the infections that came to our notice this year, Salmonella typhimurium 10 for the most part, appeared to have originated in this country; even a Salmonella brandenburg, a Salmonella indiana and a Salmonella panama. A Salmonella enteritidis infection in a person working in a zoo raised some interesting questions, but no answers were forthcoming. A typhimurium infection was the start of an investigation which extended into other parts of London. The day before taking ill the patient had attended an African wedding, where exotic dishes were served at the reception, but not being an invited guest was rather vague about its location. After several days' work of piecing together the facts and eliminating a number of false trails we were able to locate the church and subsequently the participants. When following up an attack of gastro-enteritis it is desirable to request specimens from food handlers who may have a connection with the disease. They are usually very co-operative, but occasionally we encounter one who feels that this is a sluron his occupational standards and personal hygiene. It then has to be pointed out that this is the only way in which he can be excluded from responsibility for causing the disease, and that if it is not supplied, some doubt must always remain. In fact,duringtheyeara number of cooks and canteen staff were eliminated from suspicion in this way, and a proportion of the outbreaks with which we dealt were identified as epidemic or winter vomiting, a virus infection with airborne spread. Dysentery Where bacilliary dysentery was concerned, shigella sonnei remained by far the commonest offender, occasionally even turning up in the symptomless contacts of people being investigated for other infections. There were two incidents involving its more potent relative, shigella flexner, while there was one case of amoebic dysentery. Psittacosis Psittacosis is an infection of birds which is transmissible to human beings. A single case occurred in which it was found that two pet budgerigars sickened and died shortly before the patient became ill with the pneumonia which is typical of the condition. Examination of one of the birds revealed that psittacosis had indeed been present. Tuberculosis This year witnessed the closure after many years of Finchley Chest Clinic. We are sorry to have come to the end of the happy partnership we had with Dr. B.A. Butterworth and the staff of this clinic, but there was a remarkably smooth changeover of its responsibilities to Islington Chest Clinic, under Dr. J. Wallace Craig, and a high level of service has been maintained. Chest Clinics and Mass Radiography still have a vital role to play in the prevention of the spread of tuberculosis, and everything possible is done to follow up the contacts of open cases of the disease. Here as elsewhere, efficiency and economy go hand in hand, and in order to avoid the unnecessary x-raying of large numbers of people an arrangement has been made with St. Ann's Chest Clinic whereby, if a case occurs in an establishment, i.e. an office or workshop, a chest physician and a Council medical officer visit together, consult with the senior staff, and make a joint estimate of what is required. Unanimity has always been achieved, and whereas in one instance, fortunately a small office, x-ray of all those working there was felt to be necessary, in another it was found to be required for only a few, and in still another, none at all. 11 MASS RADIOGRAPHY Male Female Total Public Sessions Dagmar Arms, N.15. 144 95 239 Scotland Green, N.17 491 502 993 Harringay Stadium, N.4 192 147 339 Bounds Green Station 278 273 551 Rudds Corner, High Road, N.15 579 565 1,144 Spouters Corner, Wood Green 631 785 1,416 Total Number X-rayed 2,315 2,367 4,682 Requiring further investigation 47 35 82 Pulmonary Tuberculosis Requiring immediate treatment - 1 1 Requiring occasional clinic supervision 3 1 4 (1PK) Presumed healed, no further action required 9 5 14 (1PK) Among other abnormalities discovered were:- Bronchial carcinoma 6 1 7 Acquired abnormalities of heart & vessels 1 5 6 Sarcoidosis & collagenous diseases - 1 1 Benign tumours of the lungs and mediastinum 1 1 2 Bacterial & virus infections of the lungs 2 — 2 Emphysema 5 — 5 Pulmonary fibrosis — non T.B. 5 5 10 Pleural thickening or calcification — non T.B. — 1 1 Abnormalities of the diaphragm 2 1 3 Acquired abnormalities of the bony thorax 1 1 2 Miscellaneous abnormalities 1 — 1 Did not attend for further investigation - 1 1 1 case is not yet classified - 1 1 Industrial Surveys, etc. Wonder Bakery, Wood Green 187 33 220 Barratts Ltd. Wood Green 140 366 506 Garman Road, N.17 425 293 718 G.A.S. Club, Willoughby Lane, N.17 1,113 378 1,491 English Abrasives Ltd. N.17. 116 81 197 Ever Ready, Ashley Road, N.17. 276 205 481 Keith Blackman Ltd. N.17. 623 134 757 Marks & Spencer, Wood Green 34 204 238 Gestetner Ltd. (Broad Lane) 783 645 1,428 Gestetner Ltd. (Brantwood Road) 53 67 120 PK — Previously known 12  Male Female Total Harris Lebus, N.17. 735 124 859 Ever Ready, St. Ann's Road, N.15 110 46 156 Williams Bros. Wood Green 82 100 182 Lentheric Ltd. N.15 59 103 162 Maynards Ltd. N.4 488 348 836 Jewish Hospital, N.15 22 67 89 Total Number X-rayed 5,246 3,194 8,440 Requiring further investigation 63 31 94 Pulmonary Tuberculosis Requiring immediate treatment 1 - 1 Requiring occasional clinic supervision 10 2 12 (3PK) Presumed healed, no further action required 8 2 10 (3PK) (2PK) Suspect tuberculosis - not yet confirmed 2 — 2 Among other abnormalities discovered were:- Bronchial carcinoma 2 — 2 Congenital abnormalities of heart & vessels 2 3 5 Acquired abnormalities of heart & vessels 3 6 9 Sarcoidosis & collagenous diseases - 1 1 Benign tumours of the lungs and mediastinum 1 1 2 Bacterial & virus infections of the lungs 3 - 3 Spontaneous pneumothorax 1 - 1 Emphysema 2 - 2 Pulmonary fibrosis - non T.B. 2 4 6 Pleural thickening or calcification - non T.B. 2 - 2 Abnormalities of the diaphragm 4 3 7 Congenital abnormalities of the bony thorax 4 3 7 Acquired abnormalities of the bony thorax 3 1 4 Miscellaneous abnormalities 1 - 1 1 case is not yet classified — 1 1 Number X-rayed - Grand Total of Public Sessions & Industrial Surveys 7,561 5,561 13,122 PK — Previously known Vaccination against Smallpox There was an increase in the number of primary vaccinations as compared with 1966 from 1544 to almost 1900. The increase from 47 to 108 in the age group 5 to 15 years was probably a reflection of increased foreign travel by school children. 13 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. Number of Primary Vaccinations Under 1 year 1 year 2-4 5-15 Total 118 1172 501 108 1899 Number of Re-Vaccinations 4 - 29 154 187 Immunisation against Diphtheria, Whooping Cough, Tetanus and Poliomyelitis 1967 was the first full year of the new Immunisation Schedule in which the primary courses of Triple Vaccine and Oral Poliomyelitis Vaccine were given together. The reduction in the number of attendances for immunisation necessary in the first year has probably helped to increase the number of completed primary courses from 7600 in 1966 to 9350 in 1967. There was a small but promising increase in primary courses of Tetanus immunisation from 29 to 89. Parents whose children have not been immunised against Tetanus in infancy were advised to take the opportunity for this to be done at school-entry age. The large increase in re-inforcing doses from 3250 in 1966 to over 8000 in 1967 was largely due to an increase in the school-entry age boosters of Diphtheria, Tetanus and Poliomyelitis. During 1967 these were brought up to date and a small back-log from 1966 was also completed. The following tables record the number of persons under the age of 16 known to have received a primary course of immunisation or reinforcing dose during the year by general practitioners or clinic staff. A. The number who completed a full course of primary immunisation Age at date of Immuni sation Quadrupl e Triple Dip/WC Dip/Tet Dip WC Tet Salk Sabin Total 0 — 1 year - 1564 12 36 1 1 1 27 1467 3109 1 — 2 years 1 2120 7 73 2 1 - 3 2428 4635 2 — 4 years - 273 - 33 1 - 2 8 577 894 4 — 6 years 1 49 2 102 - - 4 7 277 442 6—16 yea rs - 14 - 34 - - 82 1 145 276 TOTALS 2 4020 21 278 4 2 89 46 4894 9356 3. The number who received a reinforcing dose Age at date of Immunisation Quadruple Triple Dip/WC Dip/Tet Dip WC Tet Salk Sabin Total 0 — 1 year - 41 - 2 - - 1 - 32 76 1—2 years - 629 1 24 - - 1 - 174 829 2—4 years - 1352 5 196 2 - - 4 299 1858 4 — 6 years - 284 28 1858 18 - 7 12 2141 4348 6 — 16 years - 30 - 185 6 1 56 - 632 910 TOTALS - 2336 34 2265 26 1 65 16 3278 8021 14 Venereal Diseases Over recent years these have been increasing nationally and throughout the world,and concern is being expressed regarding them. Figures for Haringey residents at the special clinic at the Prince of Wales's Hospital are as follows:- Year Totals of of Venereal Conditions Syphilis Gonorrhoea Other Venereal Conditions Primary and Secondary Other 1966 896 3 9 96 788 1967 1101 5 15 216 865 Statistics for previous years are not obtainable since the present London Boroughs did not come into existence until April, 1965. ForHaringeytherewasan increase of 22.9 percent in the 1967 figures as compared with the numbers in 1966. Althoughthismustgivesomecausefor alarm, due consideration must be given to the nature of the information. The table supplied refers to Haringey patients attending the clinic in Haringey. It used to be thought, however, that V.D. patients preferred to attend a clinic as far as possible from their home. We receive reports also of numbers of residents who attended hospitals in other parts of London. Notall clinics however, send this information, so the facts we have are of necessity incomplete. There is a possibility, moreover, that although there probably is an increase in Haringey (as elsewhere in London and in the country at large), this might not be as great as the Prince of Wales's figures suggest, and may largely reflect a tendency for a greater proportion of patients to seek treatment locally possibly due to better publicity about the local clinic. A freer attitude towards sexual adventure may well be accompanied by a feeling that there is less need to conceal the consequences. We have evidence of this trend in the reduced demand for Mother and Baby Homes. Unmarried mothers are not as anxious now as they were to have their babies well away from the district where they live, and many now choose or are allowed by their parents to remain at home. It would be wrong to assume thatthe increase in venereal diseases is occurring only in the young. In fact, a wide range of age groups and occupations is involved. Those most at hazard tend to be lonely and mobile; merchant seamen, long-distance lorry drivers, members of pop groups and so on. The young, if anything, are the least promiscuous in the strict sense of the term. Their liaisons,though perhaps unconventional, tend to show that they often remain faithful after their fashion. Illegitimacy is a greater problem with them than venereal disease. There is no other way of preventing venereal disease except avoiding promiscuity. Precautions may help to reduce the risk of catching it, but none of them is wholly effective, even if the individuals concerned are in a fit state to carry them out. 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 inpost continued to be belowthe approved establishment, careful planning has been necessary to ensure that the most essential work received priority. 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 morefully all aspects of the work. The Council recognise the need to provide facilities for the training of new inspectors and has agreed to appoint pupils in accordance with revised recommendations of the Public Health Inspectors Education Board of one trainee for every three inspectors in post. Drainage and Sewerage There are separate systems of drainage for soil and surface water. The former connects into East Middlesex Drainage System and the sewage is treated at Deephams Purification Works,Edmonton. 15 Atechnical assistant who has practical experience of plumbing and drainage works is continuously engaged in the inspection of house plumbing and drainage with a view to the detection of faults by which the pollution of the surface water sewerage system may arise. The selection of areas in which the techical assistant should work is often decided upon information from the Lee Conservancy Catchment Board of pollution having been observed by their officers at surface water 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 inthatareaaresubjectedtodetailed examination. This work calls for systematic and patient examination and the number of faults found is in no way indicative of the amount of work involved. During the year he inspected 3,844 premises. As a result of his findings official requests were passed to persons having control of 100 specific premises for the necessary corrections to be carried out. Thepublic health inspectors are responsible for 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. Water Supplies A small area containing 106 premises between Great North Road and Aylmer Road is supplied with water by the Lee Valley Water Company and the remainder of the Borough receives its water from the Metropolitan Water Board. A report on the water supplied by Lee Valley Water Company was contained in the report for 1966. Dr. Windle Taylor, Director of Water Examination, Metropolitan Water Board, has kindly supplied the following information regarding water supplied by the Board to Haringey during 1967:- 1. (a) The supply was satisfactory both as to quality and quantity throughout 1967. (b) All new and repaired mains are disinfected with chlorine; after a predetermined period of contact the pipes are flushed out and refilled; samples of water are then collected from these treated mains; and the mains are returned to service only after results are found to be satisfactory. The quality control from these laboratories is carried out by means of daily sampling from sources of supply, from the treatment works or well stations, from the distribution system, and through to the consumer. Any sign of contamination or any other abnormality is immediately investigated. (c) (i) The Board has no record of the number of structurally separate dwellings supplied in your area, but the population supplied direct according to the Registrar General's estimates at 30th June, 1967, was 253,455. (ii) No houses were permanently supplied by standpipe. (d) No fluoride was added, and where the fluoride content is indicated in the analyses it represents the naturally occurring fluoride in the water. 2. (a) The higher elevation around Muswell Hill is in supply with River Thames-derived water. The remainder of theBorough is in supply with New River—derived water. The locality of Northumberland Park receives well water from Park Pumping Station. From May to September the supply to the Tottenham area is supplemented by the interim output from the new CoppermilIs Works. There were no changes to the general scheme of supply in your area. The number of samples collected and the bacteriological and chemical analyses of the supply from the above sources after treatment are shown in the following tables. (b) The Board's river and well sources have not been considered to have a plumbo-solvent action, on account of their hardness content and alkaline reaction. It should, however, be appreciated that all types of water pick up varying amounts of metal from piping, particularly when it is newly installed; this applies to copper, zinc, iron and also lead. Tests for lead have been carried out in connection with chemical analyses of samples of runningwater collected from premises in the distribution system and I set out below the information obtained over the period 1st January to 31st December, 1967:- 16 Lead content (mg/I.Pb) water from main taps in consumers' premises Number of Samples Per cent Less than 0.01 64 66.7 0.01 22 22.9 0.02 3 3.1 0.03 4 4.2 0.04 2 2.1 0.05 0 — 0.06 1 1.0 96 100.0 The above figures apply to the whole of the Board's area but it should be pointed out that the general characteristics of the water are similar throughout the area so that the findings are applicable to individual Boroughs. The regular system of examination for lead in water in domestic premises will continue during 1968. 17 18 AVERAGE RESULTS OF THE CHEMICAL AND BACTERIOLOGICAL EXAMINATION OF THE WATER SUPPLIED TO THE LONDON BOROUGH OF HARINGEY FOR THE YEAR 1967 (Milligrams per litre (unless otherwise stated)) Description of the Sampl e 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) Hardness (Total) Ca C03 Hardness (noncar bonate) Ca CO3 PH Val ue Phosphate as P04 Silicate as Si02 Sulphate as S04 Natural Fl uoride as F Magnesi um as Mg. Sodium as Na Potassi um as K Surface Active Material as Manoxol OT Electrical Conductivity (mi cromhos) New River derived 104 0.018 0.068 5.2 35 0.60 0.1 6 309 76 7.8 1.4 10 64 0.30 5 28.9 4.8 0.01 660 Park well 1 0.165 0.038 0.4 20 0.20 0.2 0 268 58 7.4 66 0.70 20 20.0 5.9 540 •Thames derived N. of River 207 0.026 0.090 4.1 30 1.12 0.1 12 289 75 7.9 1.9 10 62 0.30 5 22.3 5.0 0.01 600 Coppermills works 1 0.028 0.123 4.3 41 1.21 0.1 10 319 100 8.3 2.3 7 104 0.35 7 33.4 7.2 0.03 7.30 BACTERIOLOGICAL RESULTS - YEARLY AVERAGES. 1967 BEFORE TREATMENT AFTER TREATMENT Number of samples Agar plate count per mi I. Col iform count Escherichia Coli count Number of samples Agar plate count per mil. Co I iform count Escherichia Coli count 20 -24 hours at 37°C 3 days at 220C Per cent samples negative in 100 ml. Count per 100 ml. Per cent samples negative in 100 ml. Count per 100 ml. 20-24 hours at 37° C 3 days at 22oC Per cent samples ne gati ve in 100 ml. Per cent samples negative in 100 ml. New River derived 510 6.7 99.61 99.80 Park welI 30 0.3 15 96.67 0.1 100.0 — 31 0.0 12 100.0. 100.0 *Thames derived N. of River 1.691 16.0 100.0 100.0 Coppermills works 48 92.4 mn n •Ashford Common. Kempton Park, Hanworth and Barn Elms Swimming Baths and Paddling Pools Frequent sampl ing of water of the swimming baths and paddling pools in the Borough is undertaken on behalf of the Health Department by specialist chemists in water examination on the staff of the Scientific Branch of the Greater London Council. Bacteriological and chemical reports on the samples fromthe swimming pools have been satisfactory and have generally shown a high standard of operation of the chlorination and filtration plants installed at the pools. The Baths Department are advised of the results of the tests in respect of Council controlled establishments so that the reports may be used to supplement the tests undertaken by the staff of that department. The few privately controlled pools in the Borough are subject to the same public health control. Smoke Control Areas Three further smoke control orders were confirmed by the Ministry of Housing and Local Government in April, 1967, andcame intooperation on the 1st December, 1967. Details of the areas are as follows:- Hornsey No.9 area - 167 acres 4970 dwellings Tottenham No.7 area - 188 acres 2059 dwellings Wood Green No.10 area - 128 acres 1671 dwellings The whole of the Wood Green area is now subject to smoke control and the Council in December, 1967, decided to proceed with the making of twofurther smoke control orders which subject to Government confirmation will have the effect of extending control to the whole of the Borough by the end of 1968. Furnace Installations Twenty-one notifications were received in accordance with section 3 of the Clean Air Act, 1956, where it was proposed to install new furnaces and boiler plants. Where necessary, suggestions were made for alterations and improvements in the schemes so as to ensure satisfactory operation. Chimney Heights Nineteen notices were received under section 10 of the Clean Air Act of proposals to construct new chimneys serving furnace installations. The proposed chimney heights were considered to be inadequate in nine instances and in each case it was agreed to extend the height to meet the Council's requirements. Investigation of Atmospheric Pollution There are now four sites in the Borough where instruments are installed for the daily measurement of smoke and sulphur dioxide in the atmosphere. When Haringey was formed there were ten such sites which provided data for use locally and for inclusion in national surveys conducted by the Ministry of Technology. In consultation with the Ministry it was agreed that the number of sites could be reduced without loss of basic information on air pollution in the various types of areas (i.e. residential, commercial, industrial etc.) in the Borough. Five sites were discontinued in 1966 and in May 1967 a further site was closed down upon the ending of the first phase of the national survey. Two deposit gauges are also maintained which provide data of use locally as indicators of any heavy dust or grit pollution which may arise as a result of industrial accident or negligence. 19 Table A Average Daily Readings of Smoke and Sulphur Dioxide in the Atmosphere, 1966/67 (Microgrammes per cubic metre) Hornsey Town Hall, N.8. (1) Burghley Road N.8. (2) Tottenham Town Hall, N.15. (3) Devonshire Hill, N. 17. (4) Civic Centre N.22. (5) Classification A3 A1 A2 B1 D2 (a) Smoke April, 1966 38 65 - 54 N May N 42 - 39 103 June 20 25 N 29 27 July 14 23 19 19 20 August 21 32 34 27 24 Sept. 27 48 55 47 41 Oct. N 63 77 67 59 Nov. 97 90 106 90 82 Dec. 93 90 115 93 80 Jan. 1967 81 92 N 98 85 Feb. 75 80 123 82 69 March 28 29 N N 24 April 37 34 38 38 37 May 37 34 36 38 32 June 21 21 22 - 19 (b) Sulphur Dioxide April, 1966 155 147 - 156 194 May N 105 - 88 N June 107 99 N 97 107 July 65 57 62 50 61 August 100 91 98 82 96 Sept. 123 107 133 102 104 Oct. N 140 204 130 147 Nov. 226 196 258 195 180 Dec. 205 167 241 179 172 Jan. 1967 221 202 N 203 219 Feb. 201 172 352 184 197 March 108 90 N N 91 April 110 102 122 98 98 May N 97 117 82 102 June 56 59 64 - 58 NOTE: "N" indicates that number of readings insufficient to give accurate average. Classification of Sites The classification of sites indicates the neighbourhood in which the instruments are located as follows:- 20 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. D2 — small town centre; limited commercial area mixed with old residential housing and possibly industry. Table B Monthly Deposit Gauge Readings, 1967 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 1.48 4.23 3.77 8.00 1.47 3.57 4.03 7.60 February 2.00 5.41 6.75 12.16 2.14 6.09 5.94 12.03 March 1.18 3.54 4.75 8.29 1.23 3.43 4.49 7.92 April 1.93 4.32 6.12 10.44 2.25 4.70 6.03 10.73 May 3.63 10.63 6.27 16.90 3.56 9.35 11.23 20.58 June 1.85 4.10 8.51 12.61 1.81 4.28 5.76 10.04 July 1.19 3.42 6.26 9.68 0.97 3.66 6.06 9.72 August 1.53 1.97 4.36 6.33 Noresults - sample interfered with on site September 2.21 3.82 5.06 8.88 1.97 4.59 4.60 9.19 October 3.90 7.80 4.55 12.35 4.14 7.21 4.76 11.97 November 1.62 4.26 3.73 7.99 1.50 4.95 2.27 8.63 December 2.25 5.52 4.92 10.44 1.93 4.68 4.13 8.81 Total 24.77 59.02 65.05 124.07 22.97 56.51 59.30 117.22 Rodent Control A continuous programme of sewer baiting using sodium fluoracetamide is carried out which is designed to minimise the rat infestations in the sewers. Once a year an additional control treatment is carried out to ascertain the estimated rat population in each of the sewer systems. A deposit, comprising 6ozs. of oatmeal to which has been added anticoagulant poison (Warfarin), is placed within each of the sewer manholes of the system. One week later the deposit is inspected and, if necessary, made up to the original size of 6ozs. The following week the process is repeated. Results in each case are recorded. Statistics are thus produced which indicate the areas of the sewer system where no bait has been taken or the take has been small indicating slight infestations and areas where there have been large or complete 'takes' which indicate heavy infestations. Areas of heavy infestations are then further treated with sodium fluoracetamide. In 1967 70% of the sewer manholes were checked in this way, and the results are shown in the following table. In addition to the treatment of sewers any surface infestations of rats or mice which may be reported receive immediate attention. The services of the Council's rodent operatives are provided free of charge for the treatment of infestations in domestic premises. A charge to cover the cost of the operator's time and the materials used is made for the treatment of other premises. The following is a summary of dwelling houses and business premises etc., treated during 1967:- 1. Dwelling houses - 1471 2. Factory premises - 63 3. Shops and Cafes - 38 4. School canteens - 42 5. Miscellaneous - 47 6. Total charge for 2 - 5 above - £292.13s.Od. 21 22 RODENT CONTROL - Warfarin Baiting 1967 Area No. Total Manholes Baited Manholes 1st Re-visit after 7 days 2nd Re-visit after further 7 days No take Part take Complete take No take Part take Complete take 1 Hornsey 458 280 265 11 4 273 3 4 2 " 450 256 249 4 3 247 4 5 3 " 442 225 225 - - 225 - - 4 " 356 180 175 5 - 175 5 - 5 Wood Green 229 133 116 14 3 103 18 12 6 " 399 274 236 26 12 237 23 14 7 Tottenham 526 509 368 83 58 370 100 39 8 " 578 551 351 105 95 478 60 13 TOTAL 3438 2408 1985 248 175 2108 213 87 Percentage - 70% 80.2% 11% 8.8% 87% 8.9% 4.1% 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. Laundry Services for the Incontinent During 1967,2,591 bundles of soiled articles were cleansed and laundered. With the co-operation of the Tottenham Group Hospital Management Committee, the laundering of these articles is undertaken by the St. Ann's Hospital laundry. Collections and deliveries are made by the Department's general assistants. Persons requiring this service are normally referred to the Department by general medical practitioners, home nurses or home help organising staff. Insect Pests The Department gives free assistance to householders in securing the elimination of insect pests. Non-domestic premises are also treated on request but a charge is made to cover the cost of the service. The following is a summary of treatments carried out in 1967:- Premises Treated Insect Pest Houses Other Premises Ants 41 4 Beetles and Cockroaches 105 26 Bugs 11 2 Fleas 71 1 Flies and Bluebottles 12 - Wasps and Bees 296 19 Others 47 4 583 56 Total charges for treatment of the other premises - £60.16s.5d. 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 1967, 358 bodies were received into Hornsey mortuary and 355 post-mortem examinations were carried out. 23 Inspections carried out by Public Health Inspectors and Technical Assistants FIRST RE-lNSPECTION Statutory Nuisances 2626 6301 Drainage 4579 985 Drain Tests 49 3 Surface Water Pollution 25 31 Vermin and Pests 126 6 Rodents 189 163 Accumulations of Refuse 197 100 Smoke Observations 16 9 Smoke Control 5320 9 Noise 220 84 Disrepair Certificates 8 1 Housing Surveys 1464 444 Multiple Occupation 869 1461 Overcrowding 45 20 Other inspections under Housing Acts 188 88 Mortgage Advances 94 15 Improvement Grants 357 167 Infectious Disease 775 54 Food Poisoning 85 5 Factories with Mechanical Power 164 15 Factories without Mechanical Power 1 - Outworkers 13 - Offices etc: General Inspection 217 171 Offices etc: Other Visits 172 73 Shops Act 980 1460 Bakehouses 58 52 Bakers and Flour Confectioners 34 14 Butchers 237 67 Canteens and Kitchens 73 13 Confectioners - Sugar 51 21 Fishmongers 56 9 Fried Fi sh Shops 75 7 Greengrocers 165 31 Grocers 378 130 Hawkers of Food 21 1 Prepared Food Premises 23 27 Public Houses and Off Licences 64 19 Restaurants and Cafes 457 159 Slaughterhouses 527 11 Other Food Premises 77 5 Street Traders 485 648 Food Sampling 608 - Drug Sampling 16 - Ice Cream Sampling 45 1 Milk Sampling 43 - Surrender of Unsound Food 361 5 Investigation of Food Complaints 231 8 Bacteriological examination of Food 320 5 Hairdressers 16 4 Old People's Welfare 10 - Pet Animals Act 59 10 Other visits 6994 550 No access 5241 3 24 Defects Remedied following action by District Inspectors Drains repaired 62 Drains cleared 26 W.C. cisterns repaired or renewed 90 W.C. pans renewed 27 Waste pipes repaired or renewed 41 Rain water pipes repaired or renewed 82 Roof s repaired or renewed 331 Eaves gutters repaired or renewed 104 Drinking water cisterns renewed 2 Drinking water cisterns covered 1 Water service pipes repaired 24 Water supply reinstated 3 Yards repaired or reconstructed 14 Floors repaired or renewed 154 Dampness remedied 243 Window frames and sashes repaired, renewed or painted 217 Fireplaces, stoves and ovens repaired or renewed 19 Flues and chimney stacks repaired 13 Brickwork of walls repaired and walls rebuilt 37 Ventilated food stores provided 41 Rooms cleansed 11 Staircases, passages and landings cleansed 2 Staircases, balconies and steps repaired or renewed 27 Noise nuisances abated 84 Noxious accumulations removed 76 Nuisances from animals abated 4 Miscellaneous defects remedied 1041 Statutory Notices Served Housing Act 1957 Section 9 (Repairs) 1 Section 78 (Overcrowding) 12 Housing Act 1961 (Houses in Multiple Occupation) Section 15 (Amenities) 8 Section 19 (Limitation of number of occupants) 10 Housing Act 1964 (Improvements) Section 14 20 Section 16 7 Section 17 13 Public Health Act 1936 Section 39 (Drainage) 4 Section 45 (Repairs of W.Cs.) 1 Section 79 (Accumulations of refuse) 6 Section 83 (Cleansing premises) 1 Part III (Statutory nuisances) 153 25 Statutory Notices Served (contd.) Public Health Act 1961 Section 17 (Drainage) 50 Tottenham Corporation Act 1952 Section 43 (Urgent Repairs) 137 Work executed by the Council Work carried out in default of or by agreement with the owners during 1967 Public Health Act 1936 Section 39 (Drainage) 2 premises Section 79 (Removal of refuse accumulations) 3 premises Section 84 (Destruction of filthy articles) 2 premises Public Health Act 1961 Section 17 (Drainage) 20 premises Tottenham Corporation Act 1952 Section 43 (Emergency Repairs) 45 premises Rag Flock and Other Filling Materials Act 1951 There are no establishments licensed for the manufacture of rag flock. 24 premises are registered for the use of filling materials, but only one of these is known to be using rag flock fillings. 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 dwellings, at least in a wind and weather-proof condition and with essential services in proper working order. 2,626 initial visits were made to investigate complaints and on 870 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 153 instances it was necessary to serve statutory notices. Legal proceedings were taken on 13 occasions for failure to comply with the statutory notices and 7 abatement orders were made and fines totalling £18 were imposed together with £37.14s.0d costs. Noise Several complaints concerning noise were investigated by the public health inspectors during the year. In most cases a satisfactory solution was achieved by informal action resultingfromdiscussions between the inspectors and the persons concerned. Certain types of noise are very difficult to deal with. One of these is the increasing problem of powered sewing machines. Sometimes these are operated for several hours each day and cause distress and annoyance in adjoining premises. The operators of the machines are advised to place thick sponge rubber pads or mats beneath the machines to minimise the effect of the noise or vibration. 26 Another typical complaint concerns launderettes and dry cleaning establishments. These are frequently operated 24 hours a day and the machinery causes annoyance at night. Sound damping and the use of flexible couplings and occasionally re-siting of the machinery has usually been the solution. Noise from factories causes complaint particularly during the summer months when windows are left open. Efforts are made to secure co-operation and good-neighbourly attitudes. Building sites are now equipped with a good deal of machinery and this is frequently noisy. As a result of persuasion noisy machinery has sometimes been exchanged for quieter machines or voluntary restriction on the hours worked has been imposed. All work done under contract to the Council where road breaking machinery is involved is subject to a contract clause that mufflers should be fitted to the drills at all times. 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 local emergency arose during 1967 which required any special action under this Act, but a report on local action in connection with the widespread outbreak of Foot and Mouth Disease is set out in the following paragraph. Foot and Mouth Disease On Saturday 18th November, 1967 we were informed that the whole of the country not in Infected Areas had been declared a 'Controlled Area' under the Foot and Mouth Disease (Controlled Areas Restrictions) General Order of 1938. This made it necessary for movement licences to accompany all animals in transit. In order that animals could be moved into the slaughter-houses on the following Monday morning members of the Health Department staff had to prepare licences and deliver them over the weekend to farms in South Mimms, Barnet and Goffs Oak as the postal collection time for delivery on Monday morning had then passed. Subsequent applications were dealt with as a routine and licences were either collected by the applicants or posted. Strict supervision was carried out at the slaughterhouse to ensure that no animal was kept in lairage or moved to other places after delivery, but slaughtered forthwith. The animal transport vehicles were also required to be thoroughly cleansed before leaving the Borough. No case of suspected Foot and Mouth disease was observed during the period covered by the Order. Article 10 of the Foot and Mouth Disease (Controlled Areas Restrictions) General Order required certificates to be issuedfor slaughterhouse waste and refuse to bebrought into the Borough. Accordingly, certificates were issued and conditions supervised in connection with such materials being brought into other premises in the Borough from various parts of the country. Certificates were also issued for straw and manure to be delivered to the Refuse Disposal Works where these were burned. The conditions were rigidly enforced and the Cleansing Department co-operated in all the preventive measures suggested by this Department. On 5th March, 1968 the Food and Mouth Disease(Controlled Areas) Special Order No.5 of 1968 released existing controlled areas from restrictions. Pet Shops and Animal Boarding Establishments 24 premises are licensed as pet shops and there is one licensed 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. Two complaints were received alleging that puppies already infected with distemper had been sold by a pet shop. The complaints were thoroughly investigated by the Veterinary Officer and the Public Health Inspector. This trader was advised to isolate the remaining puppies at the shop until three weeks had elapsed, then, following their despatch, to cleanse and disinfect the premises and not to bring in any further puppies until a further three weeks had passed. Suggestions were also made to the proprietor for improving his records so as to facilitate the tracing of litters which might have been exposed to infection. 27 HOUSING Unfit Houses Progress continued during the year iri the drive to eradicate the basically unfit properties throughout the Borough. The Schedule of inspections and representations of areas for clearance as contained in the Provisional Clearance Programmepreviously approved by theCouncil was adhered to. One provisional area, St. James's Lane, was found on examination not to be in such an advanced state of deterioration as to warrant clearance of the houses and a recommendation was accepted by the Council that treatment of the area by clearance be postponed, to be taken up again at a later date should conditions in the area justify such action. Work involved in the preparation of clearance areas for representation included detailed inspections and reports, the preparing of principal grounds, obtaining particulars of owners and occupiers, and the defining of areas on ordnance maps. Housing Act, Section 170, notices were sent out in respect of all houses within areas considered suitable for Part III Compulsory Purchase Order procedure. Observations were made of progress in the demolition of houses in previously confirmed clearance areas. Some of these areas were cleared during the year and work proceeded at several others. Six areas containing sixteen clearance areas represented since the advent of the Borough were confirmed during the year and occupiers are presently being re-housed from these areas. The areas include 351 houses housing 481 families. Two areas containing six clearance areas represented in 1966 await confirmation. These cover 212 houses and 228 families. Nine areas containing thirty four clearance areas were represented for clearance during the year. These include 414 houses and 559 families. Public Local Inquiries were held in respect of Orders relating to nine areas containing thirty one clearance areas. The figures given above relate only to houses within clearance areas. Total numbers set out in the statement below also show houses which were not classified as unfit but included in the Compulsory Purchase Orders related to clearance areas. Detailed inspections were also made of these houses before they were so classified. 1. Areas demolished and cleared during 1967 Tottenham Lane/Church Path/Ada Cottages St. Mary's Road Osborne Grove Church Road/King's Road Culvert Road/Woodville Road 2. Areas confirmed before 1967 and not yet cleared Park Lane/Waverley Road Clyde Road/Elizabeth Place Tewkesbury Road/Seven Sisters Road Acacia Road (Part) 28 Total in Area In Clearance Areas of Compulsory Compulsory Purchase Order Clearance Purchase Order No. Of Areas Houses Families Houses Families 3. Areas confirmed during 1967 Northumberland Park/West Road 4 41 95 75 158 HornseyVale 2 147 113 167 142 Lorenco Road/Pretoria Road 2 104 205 128 239 Acacia Road/White Hart Lane 6 42 50 48 59 Moreton Road 1 8 7 8 7 Suffolk Road Clearance Order 1 9 11 9 11 4. Areas represented before 1967 and not yet confirmed Suffolk/Sutton/St. Ann's Road 4 129 145 156 180 Roslyn Road/Seaford Road 2 83 83 90 90 5. Areas represented during 1967 Langham Road/West Green Road 7 31 49 51 76 The Grove, N.8. 3 25 28 35 39 Brunswick Road/West Green Road 6 63 90 110 155 Stanley/Culross/Derby Road 9 163 223 213 291 Western Road, N.22. 2 14 13 15 14 Clyde Road 3 25 26 37 43 Park Lane/High Road 2 24 24 27 26 Station Road/Brograve Road 1 60 79 70 92 Upper Tollington Park 1 9 27 9 27 The list of Provisional Clearance Areas was revised during the year. Areas and houses which have been dealt with by clearance procedure and the sites finally cleared were deleted from the programme and additional areas which appeared to justify detailed examination within a ten year period were added to the list. A new consolidated list was prepared and issued after approval by the Council. A note is kept of deteriorating properties and areas throughout the Borough which, by general observation would appear to warrant consideration for inclusion in the Provisional Programme at a future revision. There are many substantial areas of generally unfit properties remaining within the Borough, and it is confidently expected that these can be put forward as areas for clearance over the next few years. They are areas where disrepair, instability and dampness are prevalent and are most unlikely to be found suitable for treatment other than by clearance. The present Part III procedure would seem appropriate in these cases for some years to come. It would seem that the clearance of houses would properly be held to be the "best method" of dealing with them where the basic structure is unsound, i.e. having regard to extreme disrepair, inherent rising dampness and bad arrangement. The houses within a clearance area however must first be considered to be unfit under terms of Section 4 of the Housing Act before the question of the "best method" arises. There appears to be a trend to place an increasing importance upon the amenities (possibly to be extended) i.e. indoor water closet, foodstore, draining boards to sinks, artificial lighting, baths, hot water supplies, food preparation facilities, etc., when considering fitness or unfitness. This increased importance may lead, particularly if legislation raises the standard in regard to amenities, to a greater ease in proving houses to be unfit, but, where the basic structure of houses is sound, to a greater difficulty in proving that the best method of dealing with the area is by clearance. 29 Thinking in terms of the position say five or six years ahead there is the possibility that there may be many areas of houses considered to be unfit but which are sound enough structurally to merit treatment by other methods than clearance. The question is therefore posed — To repair and modernise now or to allow to stagnate and decay? Inorderto limit the future need for continuing clearance, works of restoration and modernisation should start at the lowest level of structurally sound properties, and fitness of houses worked up from that level rather than down to it. The following dwellings were the subject of closing or demolition orders made during the year. These were houses or parts of houses which could not be made fit for habitation at reasonable expense and were unfit to a degree rendering them no longer tolerable as living accommodation. Occupants were re-housed by the Council:- 69 Western Road, N.22. 10 Sutton Road, N. 15. 5 Canon Road, N.8. 36 Wingmore Road, N.17. 2 St. Joseph's Road, N.8. 91 PelIatt Grove, N.22. 20 Milton Road, N.6. 208 High Road, N. 15. 24 Ennis Road, N.4. 53 Compton Crescent, N.17. 71 Park Road, N.8. 211 High Road, N.15. 5 Ennis Road, N.4. A Closing Order made on the following house in 1966, was determined during the year:- 32 Daleview Road, N.15. Purchase in Advance of Council's Requirements Over 100 detailed examinations of houses were made at the request of the Chief Valuation Officer for informal classification of houses, included in the Council's provisional clearance programme, which were offered to the Council in advance of requirements. Uplands Road Improvement Area In the report for 1966 it was stated that the Council had acquired a house in the area with a view toconverting it into two fully self contained flats and having it open for public inspection. By the end of that year arrangements were well advanced, and during February, 1967 the house was open to viewing for a fortnight. One of the flats had been furnished by a local business house and both flats were attractively decorated. The house was open each day from 9 till 5 and from 9 till 8 on Saturdays and Thursdays. Good publicity was given in the local press and in The Haringey Review. A total of 650 persons visited the house. In addition 2 senior officials from the Ministry of Housing and Local Government visited the house and discussed with the officer on duty the experience which the Council had acquired in using the powers under the Housing Act 1964 to secure the compulsory improvement of houses. It was felt that in view of the wide interest shown, the Council were well justified improviding this demonstration house. Asadirectresultof this show house 3owners in the road approached the Department for assistance in improving their dwellings. This wasgiven and in each casedrawings were prepared by the Department. Oneowner subsequently with drew butan other had completed his job by July the same year by providing a bath, basin and internal water closet where none existed before. The third owner was all set to commence work in the New Year. Two further dwellings in the road were also improved during the year to the full standard by the provision of hot water and satisfactory facilities for storing food. This area was declared in July, 1965, and the Housing Act, 1964 requires the Council to complete the service of all formal notices within 2 years of the declaration of the area. By July, 1967 there had been served and still in operation 13 suspended notices and one immediate notice; and one undertaking had been accepted. The suspended notices have the effect of putting the improvement of a dwelling in abeyance for five years or until such time as there is a change in occupation or the tenant subsequently expresses a wish to have his dwelling improved. Although the Act lays 30 a responsibility on the owner to inform the Council of any change in occupation where a suspended notice is in operation, the Department at the end of year checked on each dwelling to ensure that no change had occurred. The National Building Agency, learning that we had acquired experience in implementing the compulsory improvement powers contained in the Housing Act, 1964 wrote to the Department and asked for information to assist them in some research they were carrying out. A questionnaire from them was completed and an interview given to one of their consultants as well as showing him the Council's two areas. The Agency subsequently wrote expressing their considerable appreciation. Arnold Road Improvement Area As stated in last year's Annual Report this area was declared in May, 1966 and by the end of that year the procedure had commenced to secure improvements in this road. Unfortunately somewhat less progress was made during the year than had been anticipated because effort had to be diverted to assist in the completion of a large general housing survey in conjunction with the G.L.C., mentioned elsewhere inthisreport. However, by the close of the year 5 dwellings had been improved to the full standard by the provision of baths, basins, internal water closets and hot water. A total of 13 suspended notices and 7 immediate notices had also been served. Improvement of Houses not in an Improvement Area During the year 6 written requests were received from tenants living in dwellings not included in improvement areas asking that the Council should assist them in obtaining bathrooms. By the close of the year one of these bathrooms had been provided. The Committee had interviewed the agent acting for the owner of one of the other dwellings and anticipated receiving an official undertaking that the work would be completed within one year. In the remaining 4 cases negotiations were continuing. A case which had been reported to the Committee during the preceding year was satisfactorily concluded by the provision of an internal water closet and bathroom. Advice was also given during the year to some forty enquirers, either owners or tenants, and in every case every assistance was given which in the majority of cases included an inspection of the dwelling. Where the enquirer was an owner no official action is possible and no follow-up was necessarily given, but it is known that in several cases grants were subsequently applied for, and the work satisfactorily completed. Houses in Multiple Occupation Workon multipleoccupation continued throughout the year, but was hampered by the time involved in carrying out 651 visits to houses included in the "Survey of Housing in London" carried out in conjunction with the G.L.C. and the compilation of information required on the questionnaires as well as by the continued shortage of staff engaged upon this work. It was not until the end of the year that the appointment of one public health inspector to a post which had been vacant for a considerable time, was effected, which permitted of one additional inspector being transferred tothis work from other duties. The number of public health inspectors needed todeal adequately with the vast problem of multiple occupation in the Borough is far greater than allowed for within the present establishment. However, 359 houses housing about 1400 families were completely inspected during the year under review, and, of this number, 31 were found to be satisfactory. 65 cases of penal overcrowding were discovered, but it was only found necessary to serve formal notices for overcrowding in 12 cases. Other items calling for attention in houses in multiple occupation necessitated the service of 247 other notices in respect of such things as choked drains, removal of refuse, and matters falling within the scope of the Housing (Management of Houses in Multiple Occupation) Regulation 1962. Progress continues to be made with the installation of amenities as indicated in the schedule, but it must be appreciated that each of the amenities installed involves a considerable amount of work in carrying out the complete inspection of all parts of a house, to which access is frequently very difficult, often lengthy negotiations with an owner, and, quite frequently, his solicitors, long before more practical matters, such as discussions with builders and the supervision of the work can be put in hand. 31 Implementation of the Code of Practice for Means of Escape in Case of Fire at Houses in Multiple Occupation by the public health inspectors engaged upon this work, and the drawing up of the necessary specifications, and discussions with owners to provide an adequate means of escape in case of fire continued; but on a number of occasions, the fire officers were consulted, both informally and formally, in regard to particular problems. Investigations were carried out at several premises in multiple occupation at which fires had occurred, and the owners were informed of the work required to provide an adequate means of escape for the future. In none of these cases was any injury suffered, even though damage was often severe. Inspections of 87 premises, where the Council were contemplating making mortgage advances and where the premises were proposed to be occupied by more than one family were carried out, and full reports upon the facilities, and, in some cases, upon work required to provide an adequate means of escape in case of fire, were provided for the use of the Chief Valuation Officer and the Borough Treasurer under arrangements made with them, so that the conditions of mortgage could be determined. Houses in Multiple Occupation: Summary of Action taken in 1967 Number of houses completely inspected 350 representing approximately 1,400 lettings Number of houses inspected where multiple occupation would exist upon completion of mortgage advances being contemplated by this Council. 87 Number of houses found satisfactory 31 Number of-houses where discussions in progress 10 Number of houses where informal notices relative to S. 15/16 served 222 Number of houses where full specifications of work required for means of escape in case of fire given by Department 13 Number of cases of penal overcrowding 64 Number of cases of penal overcrowding abated 35 Number of cases of non penal overcrowding 27 Number of cases of non penal overcrowding abated 14 Number of premises where formal S.15 Notices served 8 Number of premises where formal S.19 Notices served 10 Number of premises where Directions under S.19 revoked 2 Number of dwellings where Notices under S.78 served 12 Number of other Notices served (P.H. Act 1936, Tottenham Corporation Act 1952, etc.) 247 Number of other visits to houses in multiple occupation 2,734 Completed Works Repairs W.C's. provided 23 External 74 Baths 21 Internal 178 Sinks 46 Water heaters 130 Cooking facilities 17 Food stores 18 Space heating 14 Fire precautions work 11 32 Housing Applications — Assessments 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 1967 requests were received for 647 cases to be investigated, and recommendations were made upon medical priorities. This number represented a slightly decreased rate of approximately 7% below the number of 695 requests in 1966. Most of the recommendations continued to be 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. There was a small increase in the number of requests for visits to Council tenants requiring transfer on medical grounds. Twenty-seven of these were visited compared with 6 in 1966. TABLE 1 REHOUSING [ Month No. of cases Source of Request Housing Department Hospital, G.P. or Clinic Tenant, H.V. or P.H.I. January 77 42 17 18 February 44 31 6 7 March 78 44 13 21 April 52 34 8 10 May 54 37 9 8 June 25 14 5 6 July 52 40 8 4 August 67 47 5 15 September 45 35 5 5 October 52 34 7 11 November 60 39 16 5 December 41 34 3 4 *TOTAL 647 431 102 114 *These figures include second investigations carried out during year. 150 cases were visited before assessment, and re-visits made in 32 cases. TABLE II MEDICAL RECOMMENDATIONS MADE DURING 1967 No. of cases Special: refer to Committee 35 1st degree priority 183 2nd degree priority 200 3rd degree priority 78 Recommendation for accommodation to be shared 7 Recommendation for transfer 28 Not recommended on medical grounds 116 TOTAL 647 During the year 25 of the "special medical" cases were allocated for rehousing. 33 Certificates of Disrepair During the year six applications were received for certificates of disrepair. London Housing Survey Thissurvey, which wascarried out by the public health inspectors in collaboration with the G.L.C. Research and Intelligence Unit during the period February to October 1967 formed part of a sample survey of Greater London housing. Four per cent of all separately rated dwellings were surveyed and in Haringey this entailed the inspection of 2,950 premises. The information obtained has now been analysed by computer by the G.L.C. and the statistics produced show amongst other things, the estimated overall housing conditions in the Borough. In interpreting the figures in the following tables allowance should be made for possible lack of accuracy which can arise from a sample survey. It is generally accepted that in the translation of sample returns the error can be particularly high where the number in a sample is small. It should also be noted that a separately rated dwelling, which was the unit of survey, could be occupied by one, two or more separate households. Theanalysisofthe age and condition of dwellings in the Borough (Table I) indicates that possibly twenty five thousand of the buildings (one-third) can be classified as in only a fair or poor structural condition. 1,794 are more than ninety years old and of these 975 are unfit for human habitation or in a poor structural condition. Over two-thirds of the houses in the Borough (51,167) were built between 1875 and 1919 and in this group a further 3,330 dwellings are classified as unfit or in a structurally poor condition. It is estimated that if nothing is done to improve their present condition 3,329 dwellings have a life of less than seven years and a further 4,088 are unlikely to last for more than fifteen years. This could mean that for the next 15 years after making allowance for the major repair of some of these dwellings an average of 400-500 dwellings will require to be replaced each year. Looking further ahead, the problem is likely to become much greater; it is estimated that, between the years 1983-1992, unless suitable practicable means are found to check deterioration and ensure continuing adequate maintenance, 18,493 dwellings will reach the end of their useful life, representing a necessary replacement rate of 1,850 per annum. Approximately two-fifths of all dwellings are owner-occupied, slightly less are tenanted and belong to private owners and just under one-fifth are owned by the Council or the G.L.C. (Table II). The owneroccupiedgroupcontainsthehighestproportionof premises in good structural condition and the privately owned tenanted dwellings contain the greatest proportion in only a fair or poor structural condition. The number of dwellings owned by the local authorities classified as fair, poor or unfit may largely be accounted for by the acquisition in advance of requirements of houses in areas scheduled for future action in the Council's clearance area programme. Theanalysisof types of dwellings (Table III) discloses that there are 6,392 separately rated flats which are not self-contained. It is probable that these lack the full and exclusive use of the normal amenities of bath, water closet, hot water supply etc. This, of course, takes no account of the very large number of houses which are rated as single units but are let in multiple occupation. 34 35 TABLE 1 CONDITION, AGE AND EXPECTED LIFE OF DWELLINGS Structural Condition Repair State (see note) WHEN BUILT LIFE AS IT STANDS TOTALS PERCENTAGE Pre-1875 1875-1919 1920-1939 Post 1939 Up to 7 years 8-15 years 16-25 years Over 25 years GOOD Good/ Good 175 18,081 8,515 7,400 25 125 4,754 29,267 34,171 46.4 Good/Fair 25 4.372 700 100 25 25 2,133 3,014 5,197 7.1 Good/Poor - - 50 - - - - 50 50 0.1 Fai r/Poor 25 2,917 525 50 - 25 1,240 2,252 3,517 4.8 Poor/Poor - 119 50 - - - 25 144 169 0.2 Unknown 25 3,724 1.300 650 12 25 1,625 4.037 5,699 7.7 TOTAL 250 29,213 11,140 8,200 62 200 9.777 38,764 48,803 66.3 FAIR Good/Fai r 300 4.065 200 25 200 525 1.888 1,977 4,590 6.2 Good/Poor - 204 - - 58 96 50 204 0.3 Fair/Poor 238 11,613 900 100 475 1,308 5,214 5,854 12,851 17.4 Poor/Poor - 587 25 - 125 75 287 125 612 0.8 Unknown 31 2,146 25 25 - 325 994 908 2,227 3.0 TOTAL 569 18,615 1,150 150 800 2,291 8.479 8,914 20,484 27.8 POOR Good/Fair Good/ Poor 25 175 - - 75 125 - - 200 0.3 Fair/Poor 225 1,288 - 25 663 700 137 38 1,538 2.1 Poor/Poor 313 1,092 - 25 658 672 50 50 1,430 1.9 Unknown - 213 - 25 88 100 50 - 238 0.3 TOTAL 563 2,768 - 75 1,484 1.597 237 88 3,406 4.6 UNFIT 412 571 - - 983 - -• - 983 1.3 GRAND TOTALS 1,794 51,167 12,290 8,425 3,329 4.088 18,493 47,766 73,676 - PERCENTAGE 2.4 69.4 16.7 11.4 4.5 5.5 25.1 64.8 - - (Note: REPAIR STATE The two states mentioned indicate a difference between the internal and external maintenance i.e. Good/Fair - Internal maintenance good, external fair or vice-versa) TABLE II CONDITION OF DWELLINGS AND TENURE Structural Condition TENURE Total Owner/ Occupier Borough Tenant s G.L.C. Tenants Private Tenants Not Known Good 23,218 7,783 1,650 13,577 2,575 48,803 Fair 6,775 2,400 600 9,107 1,602 20,484 Poor 475 213 - 2,530 188 3,406 Unfit 25 171 - 775 12 983 TOTAL 30,493 10,567 2,250 25,989 4,377 73,676 PERCENTAGE 41.4 14.3 3.1 35.3 6.0 TABLE III DWELLING TYPES/TENURE - GRAND TOTALS FOR WHOLE OF BOROUGH Dwelling TENURE Total % Owner/ Occupier Borough Tenants G.L.C. Tenants Private Tenants Not Known Detached 700 25 - 100 75 900 1.2 Semi Detached 4,987 550 125 2,200 550 8,412 11.4 Terraced 21,175 4,238 1,825 10,917 2,275 40,430 54.9 Pre-Fab - 125 - - - 125 0.2 Maisonette 75 800' 100 450 75 1,500 2.0 Tenement - - - - - - - Flat - Purpose Bit. 1,575 4,575 200 5,712 775 12,837 17.4 Flat - Converted & self contd. 550 208 - 2,096 225 3,079 4.2 Flat NOT Self contd. 1,430 46 - 4,514 402 6,392 8.7 TOTAL 30,492 10,567 2,250 25,989 4,377 73,675 % 41.4 14.3 3.1 35.3 6.0 36 FOOD HYGIENE In order to utilise our resources to the best advantage and to keep our priorities in order, it is necessary from time to time to have a stock-taking and examine whether we are doing things in accordance with modern thoughts and research or in accordance with ideas which are no longer relevant. In undertaking such an exercise there is a real danger of sacrificing old and tried ideas in favour of new ideas simply because we wish to be considered modern and up to date in our approach. This is just as misguided as retaining old ideas because they have always been used. The answer is to take the best of the new whilst retaining the best of the old. The procedure for the maintenance and improvement of food hygiene in the field is a subject which calls for such a periodic review. As with all preventive measures this work is not spectacular but in fact takes about 80% of the time of public health inspectors in this section. The frequent and informal approach by an inspector relying almost completely on the impact of his own personality on the food handlers continues to achieve a steady improvement in general hygiene. It is an insidious re-education bringing about a change of outlook in the various trades which causes real and permanent improvement by co-operation, rather than the enforcement of a particular regulation which iscarried out unwillingly and with lack of understanding of its fundamental necessity. It is a matter of satisfaction in the Section that formal action is seldom necessary and only occasionally is there any necessity for the institution of proceedings in the courts. Unfortunately a case arises from time to time when even the most patient and tactful approach by the Inspector concerned is ineffective. Becauseofobstinacy, over-concentration on the profit motive or sheer laziness, no impact is possible by informal means and recourse has to be taken to enforce a change by formal means. This procedure is undertaken more in sorrow than in anger, but it can be borne in mind that such action does undoubtedly have a salutary effect on those who may not be familiar with local customs and tend to mistake a friendly informal approach as a sign of weakness and inability to enforce the law when persuasion fails. During the year under review two such cases have arisen, viz:- 1. Cafe — Proceedings taken under the Food Hygiene (General) Regulations 1960 with the result that the proprietor was fined £2 on each of 17 summonses plus 10/6d cost on each. He was also disqualified under Section 14 of the Food and Drugs Act 1955 from using the premises as a cafe for 12 months. 2. Bakehouse — Proceedings taken under the Food Hygiene (General) Regulations 1960. The proprietor was fined £5 on each of 16 summonses and 5 gns. cost. Registered Food Premises At 31.12.67 the following premises were registered under Section 16 of the Food and Drugs Act 1955. Sale of ice cream 784 Mfr. and sale of ice cream 11 Storage of ice cream 1 Cooking of hams and other meat 63 Fish frying 47 37 The total number of food shops as at 31.12.67 was as follows:- Bakers 102 Butchers 173 Cafes and dining rooms 232 Confectioners 532 Fishmongers 85 Fruiterers and greengrocers 241 Grocers 472 Off licences and public houses 258 Fish curing (smoking) 3 Sausage manufacturers 101 Preparation of "Hot Dogs" 1 Preparation of jellied eels 3 Shellfish 2 Prepared foods 15 Pickle making 1 Pickling meat 7 1,039 In addition the following classes of food hawkers and their storage premises are registered under Section 11 of the Middlesex County Council Act 1950:- Article No. of Hawkers registered No. of storage premises Fruit and vegetables 125 90 Shellfish 13 4 Fish 8 4 Ice Cream 26 4 Light refreshments 16 4 Peanuts 4 2 Eggs 3 - Groceries 5 2 Confectionery 1 1 TOTAL 201 111 Milk and Dairies Regulations During the year applications were received for the registration of fourteen more persons as milk distributors. No applications were received for additional dairies. Of the fourteen new registrations, sixwere for new premises and the other eight were in respect of change of proprietorship of previously registered premises Number of distributors 263 Number of dairies 6 Milk (Special Designation) Regulations At 31.12.67 licences to use the following designations were valid for premises in the Borough:- Pasteurised Milk 208 Sterilised Milk 208 Untreated Milk 27 Ultra Heat Treated Milk 45 Sale of Food for immediate consumption from Mobile Units The supervision of traders operating from mobile units in the vicinity of the Tottenham Hotspur Football ground continues to engage the attention of the Health Department, and inspections are made by the public health inspectors on days when the team is playing at home. The difficulties in the past 38 have been mainly due to the inability of inspectors to obtain the true name and address of persons not complying with the law. Discussions have now taken place between members of the Department, representatives of the Town Clerk's legal section and the local police. As a result of this the police have taken a much stronger line with regard to obstruction and have co-operated with the public health Inspectors in obtaining details of identity. The Food Hygiene (Markets, Stalls and Delivery Vehicles) Regulations 1966arebeingrigidly applied and registration of hawkers of food and their storage premises under Section 11 of the Middlesex County Council Act 1950 is required. A dramatic improvement has taken place as a result of warning letters sent to hawkers and compliance has so far been obtained without recourse to prosecution. Sampling for Bacteriological Examination For someconsiderableperiod the Department has taken samplesof cooked meats from shop premises and as a direct result has been able to secure improvements in general hygiene in excess of the standards enforceable by legislation. Discussions have taken place from time to time with Dr. Betty Hobbs of the Central Public Health Laboratory on the results, and guidance received from her as to the measures necessary to remedy conditions which could lead to unsatisfactory bacteriological samples, and also on the desirability of including other foodstuffs in the routine sampling particularly those which are not normally subject to processing by heat before consumption. As a result of these talks, samples are now taken of artificial and dairy cream sold in cartons and contained in cakes or meringues, unwrapped meat pies, chicken barbicue, oysters, escallops and liquid egg. Consideration has been given to the question of the routine sampling of such commodities as watercress, lettuce, celery, etc., but in the light of experience of the laboratory in carrying out pilot projects with these types of foodstuffs, routine sampling would not appear to be justified at present. The routine of food sampling is constantly under review by the Department in the light of experience and advancing knowledge. Advantage is taken of the work done by the Public Health Laboratory Service in thedetection of further hazards and of the experience gained in the improvement of laboratory techniques. Samples of imported whole egg brought in to the Imperial Cold Stores, Tottenham, N.15 are taken for examination to ascertain whether or not the Alpha-amylase test is satisfactory as an indicator of adequate pasteurisation. Other spot check samples of yolk or albumen are taken for bacteriological examination in a specific search for salmonellae organisms. Food and Drugs 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 chemical analyses are carried out by the G.L.C. laboratories. Three other London Boroughs have similar arrangements with the G.L.C. and a co-ordinated programme is carried out by the four boroughs so as to avoid duplication of sampling, each authority being advised of the results of 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 standard laid down in Orders and Regulations including requirements as to labelling and advertisement. Chemical and biological examinations have also been carried out for the presence of penicillin or insecticidal residues. 39 FOOD SAMPLES Article No. of Samples Provided Unsatisfactory Analysis Labelling Alcoholic beverages 12 3 4 Beer and Cider 11 - - Biscuits 3 - - Bread 22 9 - Bread and Butter 13 1 - Butter 1 1 - Cake confectionery 3 1 - Cake mixes 2 - - Canned fish 1 1 - Canned fruit 53 22 - Canned meat 3 2 - Canned soup 9 - - Canned vegetables 4 - - CereaIs 27 - 1 Cheese 7 1 - Chocolate preparations 1 1 - Coffee/chicory 9 - 1 Colourings 1 - - Condensed milk 2 - - Cream 20 2 5 Custard powder 3 - - Dried fruit 9 - - Dried herbs 5 - - Dried milk 3 - • Drugs 80 3 1 Eggs 1 - - Fats 16 - - Fish cakes 4 - - Fish preparations 1 1 - Flavouring powder 4 4 - Flavourings 2 - 1 Food additives 6 - - Foreign bodies 8 8 - Fresh fruit 1 - - Fresh vegetables 1 1 - Fruit juices 1 - - Ice lol 1 ies 18 - - Margarine 1 1 - Meals 2 2 - Meat extract 1 1 - Meat pies 14 3 - Milk 138 2 - Pepper 18 - 1 Pickles 9 - - Preserves 17 - - Puddings 12 - 1 Salad cream, etc. 7 1 1 Sauces 16 - - Sausages 1 1 - Seasoning 6 - - Slimming preparations 1 - - Soft drinks 22 - 3 Spices 5 - - Spirits 5 1 2 Sugar 1 1 - Sugar confectionery 3 1 - Table jelly 33 4 - Table jelly creams 2 - " 681 79 21 40 Details of Unsatisfactory Samples Samples Irregularity Comments and Action Taken Milk (a) Composition Farm bottled milk contained only 2.7% fat which is below presumptive minimum of 3%.3. Probably due to failure to mix morning and evening milk. Notification sent to local authority in whose area farm is situated. Cheese A sample of Canadian Cheddar cheese had a pronounced "catty" odour. Probably associated with ingredient in animal feed. Manufacturer's attention drawn to matter. Sterilised Milk Products (a) 3 samples of canned food similar to sterilised cream were examined. Objection was taken to the labelling of these products which resembled canned cream both in internal and external appearance but failed to meet the minimum fat standard. The Food Standards Committee's report suggests that such products should be referred to as sterilised half cream and the Mini ster's decision is awaited. In correspondence with manufacturers and importers. (b) One of above samples had a bitter taste. Possibly due to contamination by an unusual harmless bacteria. Taken up with importers and notified local authority for area from which product distributed. (c) Two further samples of similar product taken. One had bitter taste. Imported product. Probable cause same as (b). Importers' attention called to matter. Salad Dressing French dressing described as "Salad Dressing" although it did not comply with standards laid down by regulations. Manufacturer agreed to amend terms of advertisement. Canned Loganberries Two samples contained insufficient fruit. One can was 8% below minimum weight but repeat samples were unobtainable. In the other case 20 further cans were examined and on average showed a deficiency of 20%. Local Authority of area in which canning factory situated advised as control of weight of fruit going into cans more readily undertaken at cannery. Table Jellies A sample of instant jelly failed to set when made according to directions. Probably result of faulty blending by manufacturers. Taken up with manufacturers. Pepper A sample of "white pepper" was found to be "black pepper". Warning letter sent to vendor. Spirits and Liqueurs 3 Miniature bottles were found to be deficient of the alcohol content declared on the label. Manufacturer agreed to increase alcohol content to allow for evaporation. Food Additives (a) 3 samples of table jellies contained blue VRS which is not permitted under regulations which came into force on 27th June, 1967. Jellies stated to be old stock. Manufacturers informed that blue VRS no longer used. 41 (b) A sample of Cyprus Rose Water contained a colouring matter, Rhodamine B, which is not in the permitted list. Matter referred to local authority responsible for area in which distributors premises situated. (c) Four flavoured powders contained a sweetener, cyclamate, which was not permitted at time of sale but is now allowed. No action taken. Drugs (a) 2 samples of multivitamins failed to comply with disintegration test. In correspondence with manufacturers. Statement to be included on label that preparation was intended for chewing. (b) A sample of multivitamins contained insufficient vitamin B and calcium to substantiate the claims made on the label. In correspondence with manufacturers. (c) In two samples of drugs one was coloured with Blue VRS and the other with Poncean SX. New regulations prohibit these colouring matters in food and it is considered they should therefore not be used in drugs. Manufacturers requested to use colouring matters which have been approved by Dunlop Committee on Safety of Drugs. (b) Labelling The following labelling irregularities, noted in respect of nineteen samples, were brought to the attention of the manufacturers or distributors responsible. 1. Alcohol declaration not prescribed 1/12" height 6 cases 2. Alcohol declaration not conspicuous or legible 1 case 3. No address on label 3 cases 4. Incorrect or misleading description 10 cases 5. No list of ingredients 1 case 6. Use of generic and meaningless terms 1 case Food Complaints 110 food complaints received in 1967 were fully investigated and, where appropriate, legal proceedings were instituted or warning letters sent. The most common causes of complaint were the presence of foreign bodies in foodstuffs, and the growth of moulds due to improper storage or the sale of perishable foodstuffs after their safe life had expired. Traders are repeatedly advised on the need for the date coding of such foods so that proper stock rotation can be ensured and goods withdrawn from saleat the end of their recommended storage life. Details of the complaints received and action taken are set out below. 42 Details of the complaints received and action taken are set out below. Food No. of Complaints Action taken Baby foods 3 Warning letter Further action not justified 1 Bitter Lemon drink (foreign matter) 1 Legal proceedings 1 Bovril (nodules) 1 Warning letter 1 Bread 1. foreign bodies 15 Legal proceedings Warning letter Further action not justified 1 13 1 2. mould 10 Legal proceedings 3 Warning letter 1 Further action not justified 6 3. taste 1 Further action not justified 1 Butter 3 Warning letter Further action not justified 1 Cheese (maggots) 2 Warning letter Further action not justified 1 1 Chestnuts (maggoty) 1 Warning letter 1 Chicken (smell) 1 Further action not justified 1 Chicken pie (composition) 1 Further action not justified 1 Cream (taste) 1 Warning letter 1 Crisps (foreign body) 1 Further action not justified 1 Eggs (1 worm, 1 bad) 2 Further action not justified Extract of malt and cod liver oil 1 Further action not justified 1 Fish (tinned) (crystals) 1 Further action not justified 1 Flour confectionery 7 Legal proceedings Warning letter Further action not justified 1 Fruit (foreign body) 1 Further action not justified 1 Fruit (tinned) 1 Further action not justified 1 Fruit juice powder (smell) 1 Further action not justified 1 Fruit and nuts (foreign body) 1 Warning letter 1 Jelly (bitter taste) 1 Further action not justified 1 Jelly crystals (smell and taste) 1 Further action not justified 1 Margarine (foreign object) 1 Legal proceedings 1 Meat 4 Legal proceedings Further action not justified 1 3 Meats (cooked) 4 Warning letter Further action not justified 3 1 Meat (tinned) 6 Warning letter Further action not justified 2 4 43 Food No. of complaints Action taken Meat pies 13 Warning letter 7 Legal proceedings 3 Further action not justified 3 Milk 1. dirty bottle 1 Warning letter 1 2. foreign body 5 Legal proceedings 2 Warning letter 2 Further action not justified 1 3. taste 1 Further action not justified 1 Rose Hip Syrup (exploded) 1 Further action not justified 1 Sausages (foreign object) 1 Legal proceedings 1 Sausage rolls 2 Legal proceedings 1 Warning letter 1 Shrimps (unfit for human consumption) 1 Legal proceedings 1 Sugar confectionery 6 Legal proceedings 1 Warning letter Vegetables (tinned) 3 Warning letter Further action not justified 1 Yoghourt (foreign object) 1 Warning letter 1 Sugar (demerara)(dark substance) 1 Further action not justified 1 Cider 1 Further action not justified 1 110 Legal proceedings were taken in respect of 14 offences and the results in fines and costs totalled £248. 4s. Od. Unsound Food Surrendered or Condemned 1967 Tons Cwts lbs Meat 1 3 51/4 Cooked meat and meat products 2 - 104 Canned meats 1 10 87% Fish - 3 0% Fruit and vegetables - 1 8 Tinned food other than meat 5 11 46% 10 10 28% 44 Meat Inspections Regular slaughtering took place throughout theyear at the licensed slaughterhouse and the carcases of all animals slaughtered were inspected in accordance with the Meat Inspection Regulations. Summary of Carcases Inspected 1967 Horses Cows Calves Sheep and Lambs Pigs exclud. Sows Sows Goats Number killed 708 1442 10165 1673 10 Number inspected - - 708 1442 10165 1673 10 All Diseases except Tuberculosis Whole carcases condemned 5 19 Carcases of which some part or organ was condemned 3 217 1421 189 1 Percentage of number inspected affected with disease other than tuberculosis - - 0.42 15.39 14.16 11.29 10.0 Tuberculosis only Whole carcases condemned - - - - 1 - - Carcases of which some part of organ was condemned — 126 35 Percentage of number inspected affected with disease other than tuberculosis - - - - 1.25 2.09 - Note: No case of cysticercosis was reported during the year Offices, Shops and Railway Premises Act, 1963 General inspections were made of 217 premises registered under this Act. Although this is a small increase over the number inspected in the previous year, it falls short of our aim and consideration is being given to methods of securing a greater increase in 1968. Although experience has shown that working conditions in offices and shops are reasonably good and the contraventions found are often of a minor character the Department is working toward the complete inspection of all registered premises by the earliest possible date. However, it is our policy that when defects are found there should be follow-up visits to check that these have been remedied and any necessary enforcement procedure taken to this end. It would not be proper or wise to sacrifice this enforcement action in order to secure a greater number of initial inspections. Notifications were received in accordance with section 48 of the Act of the occurrence of 74 accidents, of which 29 were considered to require investigation. No major contravention was noted but informal warnings and advice were given on 11 occasions, principally in respect of care in the cleaning and use of cutting instruments and in respect of hazards in connection with the storage and handling of goods. 45 Registrations and General Inspections in 1967 Class of Premises No. of premises registered during 1967 No. of registered premises at end of year No. of registered premises receiving a general inspection in 1967 Offices 14 500 59 Retail shops 31 1,270 139 Wholesale shops, warehouses 1 78 6 Catering establishments open to the public, canteens 10 152 12 Fuel storage depots - 4 1 TOTAL 56 2,004 217 Persons employed in Registered Premises Class of workplace No. Offices 7,073 Retail shops 7,094 Wholesale shops, warehouses 1,532 Catering establ i shments open to the publ ic 1,135 Canteens 234 Fuel Storage Depots 50 TOTAL 17,118 Males 7,926 Females 9,192 Total number of visits of all kinds by inspectors to premises under the Act - 633 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." 46 Analysis of contraventions found Section Type of Contravention No. found Section Type of Contravention No. found 4 Cleanliness 4 15 Eating facilities - 5 Overcrowding - 16 Floors, passages and stairs 2 6 Temperature 15 17 Fencing exposed parts machinery - 7 Ventilation 1 18 Protection of young persons from dangerous machinery — 8 Lighting 1 9 Sanitary conveniences 7 19 Training of young persons working at dangerous machinery - 10 Washing facilities 14 11 Supply of drinking water 1 12 Clothing accommodation - 23 Prohibition of heavy work - 13 Sitting facilities - 24 First aid general provision 15 14 Seats (sedentaryworkers) - 50 No abstract 32 TOTAL 90 Reported Accidents Workplace Number reported Total No. investigated Prosecution Formal warning Informal warning No Action Offices 11 5 - - 1 4 Retail Shops 47 16 - - 6 10 Wholesale shops, warehouses 11 6 - - 3 3 Catering establishments open to the public, canteens 4 1 - - - 1 Fuel storage depots 1 1 — - 1 - TOTALS 74 29 — — 11 18 47 Analysis of Reported Accidents Offices Retail Shops Wholesale Shops Warehouses Catering establishments open to the public, canteens Fuel Storage Depots Machinery - 4 - - 1 Transport - - 2 - - Falls of persons 5 5 1 - - Stepping or striking against object or person 1 3 — - - Handling goods 3 21 7 3 - Struck by a falling object - - 1 - - Use of hand tools 1 13 - - - Not otherwise specified 1 1 - 1 - TOTALS 11 47 11 4 1 Hairdressers Section 21 of the Greater London Council (General Powers) Act 1967 enables the Councils of London Boroughs to require the registration of persons carrying on businesses as hairdressers or barbers at premises in the Borough. It was decided by the Haringey Council that the section should come into force in the Borough on the 1st January, 1968. Byelaws for the proper management of hairdressers and barbers premises made by the former Boroughs of Hornsey and Tottenham continue to apply to those parts of Haringey which formerly constituted those boroughs, but no similar byelaws apply to Wood Green. The Haringey Council accordingly decided to make new byelaws applicable to the whole Borough and to revoke the Hornsey and Tottenham byelaws. Shops Act 1950-1966 A total of 2,440 shops were inspected during the year. The following contraventions were noted:General Sec.17(2) Assistants weekly half holiday notice not displayed 261 Sec.32(3) Record of hours of employment of young persons not displayed 93 Sec.32(3) Abstract of provisions of employment of young persons not displayed 79 Closing Hours Sec.2(1) Failed to close at prescribed hour 38 Sec.1(1) Failed to close at 1 p.m. on early closing day 27 Sec.1(2) Failed to exhibit early closing day notice 382 Sec.13(1) Failed to exhibit exempted trade notice 179 Sec.24(1) Employment of young persons beyond permitted hours 3 Sunday Trading Sec.22(3) Failed to keep record of hours of employment 26 Sec.57 Failed to exhibit Sunday Trading Notice 93 48 Registered Jewish Traders Seven Orthodox Jewish Traders were registered under Section 53; no infringements of the conditions were noted. Legal Proceedings Two prosecutions were taken in respect of failure to close at the prescribed hour and one in respect of a Sunday trading offence. Fines were imposed totalling £35 and £11.11s. costs. Street Trading Street trading is controlled under Part IX of the Middlesex County Council Act 1944. The Council license trading from 33 sites principally in roads off West Green Road, N.15 and the Tottenham and Wood Green High Roads. In addition, 19 small sites on the footpath are licensed to newsvendors in the vicinity of Underground and British Rail stations. New byelaws for the management of street trading came into force on 1st May, 1967. The supervision and control of street trading is carried out by the shops inspectors, but the siting of the pitches is a matter upon which the Borough Engineer and the Police are asked to advise because the maintenance of safe and unimpeded traffic conditions is the principal factor to be taken into consideration. Acting on advice from these services the Council decided that wherever possible trading sites should not be on parts of the highway which were subject to "No Waiting" restrictions so as to minimise any interference with the flow of traffic. Certain traders appealed against this decision and the Courts' decision on the appeals is awaited. One un-licensed street trader who was prosecuted in 1967 was fined £2 with £1.1s. costs. FACTORIES The general supervision of factories is the responsibility of H.M. Inspectors of Factories, but this Authority has the duty of enforcing the sanitary accommodation regulations in all factories and is also responsibleforthe inspection of other environmental conditions in factories without mechanical power. Premises No. on Register No. of Inspections Written Notices Occupier Prosecuted (i) Factories in which sections 1,2,3,4 and 6 are enforced by local authority 101 1 - - (ii) Factories not included in (i) in which Section 7 is enforced by local authority 1102 179 - - (iii) Other premises in which Section 7 is enforced by local authority (excluding outworkers premises) 10 3 - - TOTALS 1213 183 3 - 49 Summary of defects found in factories Particulars Number of cases in which defects were found Found Remedied Referred to Factories Inspector Referred by Factories Inspector Want of cleanliness (S.1) - - - - Overcrowding (S.2) - - - - Unreasonable temperature (S.3) - - - - Inadequate ventilation (S.4) - - - - Ineffective drainage of floor (S.6) - - - - Sanitary Conveniences (S.7) (a) Insufficient 1 1 - 1 (b) Unsuitable or defective 4 3 - 2 (c) Not separate for sexes 1 - - 1 Other offences against the Act (not including offences relating to outworkers) - - - - 6 4 - 4 Outworkers Employers of outworkers in certain specified trades arerequired to make half-yearly returns showing the home addresses of such workers and the class of work upon which they are engaged so that action can be taken to prevent work being undertaken in unwholesome premises, or to stop the spread of infectious disease. However, no action was required in respect of these matters, but the use of power machines in private houses has given rise to complaints from neighbours of noise and vibration and this aspect is dealt with elsewhere in this report (see page 26). Outworkers Making of wearing apparel 338 Household linen 17 Making of curtains and furniture hangings 2 Umbrellas 3 Artificial flowers 11 Cardboard boxes 18 Making of brushes 1 Feather sorting 2 Button carding 33 Christmas crackers 12 437 50 RADIOACTIVE SUBSTANCES ACT, 1960 The Council continued to be notified of premises within the Borough where radioactive materials were held and where certificates in respect of their storage and use were issued by the Minister of Housing and Local Government. Eight visits were made during the year by the Senior Public Health Inspector concerned with this work in connection with notifications received under this Act. One firm, who are concerned with the installation and testing of pipelines, although authorised to hold a large number of radio-isotopes, were found to have only a few held at their premises in Haringey. The large majority of their stocks were found to be distributed throughout the country at various building sites which are covered by the Certificate issued, which relates to "mobile radio-active apparatus". This particular firm hold their own courses to instruct their personnel in the correct and safe methods of handling radioactive materials. Insufficient security appeared to be maintained at one firm handling a small amount of radioactive material and the Radiochemical Inspectorate were informed and took appropriate action. CARE OF MOTHERS AND YOUNG CHILDREN Notification of Births The following table shows the births notified during the year:- Live Births (a) Domiciliary 706 (b) Hospital or Nursing Home 4,656 Still Births (c) Domiciliary — (d) Hospital or Nursing Home 58 5,420 Family Planning The National Health Service (Family Planning) Act 1967 received the Royal Assent on 28th June 1967 giving local health authorities power to make arrangements for the giving of advice on contraception to persons seeking it. For many years they have been able to provide contraceptive advice to persons who require it on medical grounds free of charge and they are now able to provide it on social grounds, making a charge considered reasonable having regard to the means of the recipient. Before the Act was passed the department was consideringthe introduction of adomiciliary family planning service for persons unable to attend clinics and during the year arrangements for this were completed with the Family Planning Association and the scheme was ready for introduction in early 1968. Unfortunately, there were some unfavourable Press comments when the arrangements became known. These inferred that contraceptive advice was to be forced on families in social difficulties and with too many children. But, of course, this was a misinterpretation and the service is only for persons accepting it. The Council decided to provide family planning services entirely through the agency of the Family Planning Association and discussions have been proceeding in order to implement fully the powers conferred inthe Act throughout the Borough. These were not completed at the end of the year. Further sessions were opened, however, in Fortis Green Clinic and at Weston Park Clinic and plans were made to open others in Gordon Road and Burgoyne Road. Sixty-four cases were referred for family planning advice on medical grounds during the year. Ante-natal Clinics There has been a falI in the number of sessions held and in the total number of women who attended during the year. The drop in pressure is most noticeable. In the period of a year the whole picture has changed from one where hospital beds were hard to find, mothers had to travel in ambulances, in labour, to hospitals at a distance from their homes, and in both hospitals and Council clinics antenatal sessions were crowded and busy, to the present situation where hospital bookings are relatively easy, even allowing the patients some choice and, although hospital clinics are still busy, Council sessions in general are quieter. This is due partly to a reduced birth rate and partly to progress in cooperation and organisation on the part of hospitals, councils and general practitioners. 51 The attendances during the year are shown in the following table:- Name of CIinic Number of sessions held Total attendances ge attendance per session A.N. P.N. Burgoyne Road 95 1,041 42 11.0 Church Road 64 886 43 14.5 Fortis Green 97 1,292 57 13.9 Weston Park 151 2,007 80 13.8 Mildura Court 64 1,382 47 22.3 Stroud Green 61 870 37 14.8 Chestnuts 102 1,068 83 11.2 Lordship Lane 102 859 63 9.0 Park Lane 104 954 80 9.9 Gordon Road 74 1,011 97 14.9 White Hart Lane 51 429 16 8.7 Total 965 11,799 645 12.8 Midwives Ante-natal Clinics The following table shows the attendances made during the year:- Midwives CIinics Number of sessions held Total number of attendances Average attendance per session Burgoyne Road 8 32 4.0 Weston Park 3 5 1.6 Stroud Green 1 2 2.0 Chestnuts 49 44 0.9 Park Lane 47 104 2.2 Gordon Road 48 140 2.9 Total 156 327 2.1 Cervical Cytology Clinics were held throughout the year at four centres in the Borough, as shown in the table below:- Name of Clinic 1st visits Attendances Sessions Gordon Road 120 123 34 Lordship Lane 301 301 71 Weston Park 169 170 20 Mildura Court 338 341 41 Total 928 935 166 At first waiting lists were long and there was a heavy demand for the test. However, as the initial backlog was dealt with the number of applicants gradually fell and towards the end of the year there were occasional weeks when the full number of slides which the laboratories would accept were not sent. Valuable assistance in interesting women in the scheme was given by the Haringey Cancer Control Committee, a voluntary organisation which ran several public meetings where speakers showed slides 52 and films to explain the purpose of the procedure. A great deal more remains to be done in this field as, at present, only a minority of eligible women are coming forward for the test. Thetwo positive cases that were found received immediate hospital appointments for investigation and treatment. It is not possible to prove locally that this scheme is reducing cancer of the cervix in the population. This can only be shown on a national scale over a long period of years. Mothercraft and Relaxation Classes Associated with the ante-natal clinics the eleven centres offer Mothercraft instruction and exercises to expectant mothers. Towards the latter part of the year an additional session was introduced at the Somerset Road clinic. Although the space facilities at this clinic are very limited it is hoped that it will prove to be worthwhile. In an informal atmosphere the health visitor in co-operation with the midwife aims to dispel fears and misapprehension by encouraging group participation. This type of health education is considered to be one of the most important. 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 38 118 3.1 Church Road 42 213 5.1 Fortis Green 47 299 6.3 Weston Park 18 165 9.1 Mildura Court 45 158 3.5 Stroud Green 41 332 8.1 Chestnuts 51 387 7.5 Lordship Lane 51 328 6.4 Park Lane 48 270 5.6 White Hart Lane 26 166 6.3 Alexandra Park Road 1 3 3.0 Gordon Road 30 153 5.1 Somerset Road 5 11 2.2 Totals 443 2,603 5.8 Child Health Centres Baby and toddler clinics have continued to be well attended this year. The following table gives attendances during the year at infant welfare clinics:- Name of CIinic Number of sessions held Total attendances Average attendance per session Number of cases seen by M.O. Number of cases referred elsewhere Burgoyne Road 153 7,198 47.0 2,051 15 Church Road 206 4,404 21.3 1,623 21 Fortis Green 103 4,888 46.6 1,877 16 Weston Park 149 7,365 49,4 2,531 37 Mildura Court 104 4,501 43.2 1,534 53 Stroud Green 102 5,122 50.2 1,660 20 Chestnuts 202 7,995 39.5 2,660 94 Lordship Lane 204 6,377 31.5 1,819 35 Park Lane 154 5,130 33.3 1,931 115 Somerset Road 150 3,437 22.9 1,285 54 Alexandra Park 52 2,636 50.6 867 27 Gordon Road 103 5,861 56.9 2,276 38 White Hart Lane 152 6,820 44.8 1,972 16 Totals 1,834 71,734 39.1 24,086 541 53 The following table gives details of attendances at toddlers clinics:- Name of CIinic Number of sessions held Total attendances Number of cases seen by M.O. Average attendance per session Burgoyne Road 30 661 661 22.0 Church Road 25 372 340 14.8 Fortis Green 51 471 431 9.2 Weston Park 52 818 817 15.7 Mildura Court 50 799 630 15.9 Stroud Green 32 563 480 17.5 Chestnuts 53 841 836 15.8 Lordship Lane 52 845 845 16.2 Park Lane 51 691 691 13.5 Somerset Road 53 691 688 13.0 White Hart Lane 23 321 320 13.9 Total 472 7,073 6,739 14.9 Throughout this branch of public health work there has been increasing interest in the assessment of babies' development and the techniques for doing this have spread steadily during the year. With training and experience it is possible for medical officers to predict a child's capabilities earlier than was usual in the past and where these appear to be abnormal early action may help to give the child better opportunities to reach his best potential. All children are examined at regular intervals but special attention is given to those whose type of birth or early life suggest that they are liable to have defects. The following table shows the conditions where special observation is made:- Analysis of Children on Observation Register Categories of Observation Deafness of genetic origin in parents or siblings 40 History of maternal rubella in first four months of pregnancy 8 Gestation 36 weeks or less 181 Birth Weight under 4lbs 21 Moderate or severe birth asphyxia 321 Difficulty in sucking or swallowing 24 Failure to thrive not explained by simple feeding problems 44 Convulsions 4 Cyanotic attacks or severe apnoeic spells 9 Abnormal neurological signs in neonatal period 27 Haemolytic disease of the newborn or hyperbilirubinaemia 160 Any congenital abnormalities 144 Late 85 Late intake 1 Total number of defects on the Observation Register 1.069 Changes were made in the conditions in July 1967 as too many children were added to the list. Since July the following figures apply:- Number of children born 2,788 Number placed on observation register i.e. 30% approx. 860 This figure is still too high and further reduction is planned. In some conditions there is a particular risk of deafness and as we are fortunate in the Borough to have a fully equipped audiology unit children suffering from these conditions were tested there. 231 children were examined at the audiology unit as well as at the normal child health sessions. 54 Children placed on the observation register at birth can be removed from it at any time at the discretion of the medical officer. It is usual for most of them to be removed from it by the age of two years or else transferred to a register of handicapped children if a defect is confirmed. An analysis of the register of handicapped children under five is shown in the following table: Analysis of Children on Handicapped Register On Handicapped Register from 1966 or earlier 118 Transferred from Observation Register during 1967 16 Added to Handicapped Register during 1967 late 42 Total number of cases on Handicapped Register 176 Categories of Handicap Mental Handicap 85 Cerebral Palsy 9 Congenital Cardiac Defects 12 Blind or Partially Sighted 8 Deaf or Partially Deaf 12 Orthopaedic 27 Miscellaneous Defects 29 Total number of Defects 182 Day Nurseries The demand for day nursery admission shows no sign of diminishing. The waiting list for the special categories who are eligible for admission continue to be extensive with a waiting period of at least 6 months. Short term emergency admission is always arranged. Babies are not admitted before the age of three months but exceptions need to be made at times, for the mother of school age or the mother suffering from mental illness. Prospective student nursery nurses are always encouraged to spend time at one of the nurseries, usually during school holidays. This arrangement helps them to decide if nursery nursing is a career they wish to follow. Requests to work in the day nursery during the long vacation from trainee infant teachers is becoming a new and welcome feature. This kind of arrangement, when vacancies exist, helps to ease the strain on the trained nursery staff at a time when colleagues are on annual leave. In addition it gives opportunities for exchange of knowledge and experience which is of benefit to all concerned. 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 41 1,912 8,745 10,657 42.0 Park Lane 20 30 8 40 1,775 7,729 9,504 37.4 Plevna 20 30 11 36 2,308 7,170 9,478 37.3 White Hart Lane 10 30 6 30 1,663 6,973 8,636 34.0 Totals 65 133 38 147 7,658 30,617 38,275 150.7 55 Daily Guardian Scheme The daily guardian scheme is continuing to provide a satisfactory alternative source of day time care for pre-school children of working mothers. Details of the service for the year are set out below:- No. of daily guardians on register 175 No. of daily guardians minding children 82 No. of children being minded 107 Total No. of children minded during the year 225 Total No. of days minded 24,605 Private Day Nurseries and Child Minders The provision made by private individuals for day care of chiIdren is required to be registered under the Nurseries and Child Minders Regulation Act 1948. Child minders and day nursery premises are inspected prior to registration and regularly thereafter and they make a valuable addition to facilities for children in the Borough. As in the Council's own nurseries, places in private establishments are eagerly sought and are in short supply. There has been much activity in this field in 1967 with fresh registrations, particularly of play groups. Day Nurseries Child Minders Play Groups Number Registered Places Number Registered Places Number Registered Places 1st January 1967 2 82 13 97 12 301 New Registrations 1 32 3 15 8 180 Discontinued — — 2 16 — — 31st December 1967 3 114 14 96 20 481 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) 18,327 63,914 6,010 4,652 DENTAL CARE FOR THE PRIORITY CLASSES Reference was made in the report of last year to measures being taken to attract larger numbers of priority class patients, especially pre-school children, and the increase already becoming apparent at that time. In the year under review, sessions devoted to this part of the dental service were increased by 28.9% and we have at last attained the proportions as between school and priority services recommended by the Ministry of Health. Expectant and nursing mothers are easily able to make their arrangements for treatment from dental practitioners within the National Health Service and the majority choose to do so, so that the increased treatment we have been able to provide has largely been for the benefit of the pre-school children. These latter have been the most difficult to attract, largely because of lack of appreciation by the parents of the need and importance of treatment at this early age and the difficulty of making the facts known to them. The present improvement is noteworthy and results from the team-work of several different categories of Health Department staff, to whom I record my appreciation. It is to be regretted that the combined efforts both of our service and the general dental practitioners can only touch the fringe of the problem, and it is to be hoped that the introduction of fluoridation of the public water supplies will not be long delayed for the benefit of future generations. Apart from the greater time devoted to the priority classes and the resulting greater amount of treatment provided, the general pattern of the service has followed exactly that described in detail in previous reports, so that repetition is unnecessary on this occasion. The statistics for the year are as follows:- 56 Visit of Mr. Danilor, Deputy Minister of Health of the U.S.S.R. to Plevna Day Nursery, with Chairman and Members of the Health and Welfare Committee Expectant and nursing mothers Pre-school children Number examined 199 1081 Requiring treatment 197 857 Attendances for treatment 779 2965 Treatments completed 91 647 Number of fillings 366 2466 Teeth filled 345 2193 Number of extractions 182 483 General anaesthetics 20 211 Number of prophylaxes 199 159 Teeth otherwise conserved - 181 Other operations 352 919 Number of radiographs 40 24 Number of crowns and inlays 3 — Total number of dentures of all types 62 Total number of treatment sessions 473 MIDWIFERY SERVICE There has been a lower birth rate and a consequent fall in the number of domiciliary births with a drop of 215 in the number of home bookings and of 136 deliveries when compared with 1966. A total of 706 mothers were delivered at home by midwives and the general practitioner was present for the delivery in 110 cases. 97 mothers who had hoped for a home confinement were transferred to hospital in late pregnancy for various reasons, including postmaturity, mild pre-eclamptic toxaemia, breech presentation, or early in labour where complications had occurred. Of these women 88 were discharged after delivery to the care of the district midwife. Four mothers were delivered at home having had no ante-natal care and no preparations made. This number has decreased most satisfactorily since the catchment areas were organised. The emergency squad gave assistance on several occasions to patients in labour, and on one to a patient on the 5th day of the puerperium where the patient had a secondary post partum haemorrhage. All the results were satisfactory and in most cases blood or dextrose were given intravenously. Some of the mothers were transferred to hospital with the flying squad accompanying the patient. In no instance was there a maternal death when the case was being dealt with by the domiciliary midwives. A 'night rota' system for midwives night calls continues to be effectively administered by the Whittington Hospital, an average of 50 calls a month were dealt with. Relaxation classes were started by the Deputy Supervisor of Midwives at Beacon Lodge Mother and Baby Home, Eastern Avenue, N.2. Great interest was shown by the potential mothers, all of whom co-operated in the movements and breathing exercises to their advantage. The Council's domiciliary midwifery service gives relief to the Beacon Lodge staff for 2 days and 3 nights each week. Planned Early Discharge There was a fall in the number of assessments for planned early discharge. No. of requests received Requested by Hospitals in N.W. Met. B.Region 187 Requested by Hospitals in N.E. Met. B.Region 143 Requested by London Teaching Hospital 39 369 Number Accepted 331 Actual Number attended 287 57 Selection of cases for hospital confinement for social reasons. Source of Request No. of requests received 1965 1966 1967 Hospital in N.W. Met. Region 3 39 50 Hospital in N.E. Met. Region 174 267 303 Gen. Prac. Obst. 48 84 97 Local Auth. Clinics 116 267 158 London Teaching Hosp. - — - Totals 341 657 610 Of the 610 investigated 395 were referred to hospital, 194 booked for home confinement and 21 moved out of the area. Midwives continue to work in the ante-natal surgeries of 15 general practitioner obstetricians. Student Midwife Training Progress was made in training midwives when the Council in co-operation with the Tottenham Hospital Management Committee altered, decorated and furnished the top floor of a former nurses' home in St. Ann's Hospital. The student midwives' hostel was opened on 1.3.67 with 6 students and at the June term was able to accommodate 12 students. Students are taken from the Alexandra Maternity Home, the North Middlesex Hospital, and the Whittington Hospital, each student being attached to a teaching midwife. There are 4 terms in the year aseach district training period is the last 3 months of the one year's midwifery training. Each student has already obtained her S.R.N. There were 47 students trained, 11 are still in training. 43 were successful in obtaining the S.C.M. The remaining 4 were re-sitting the examination in 1968. HEALTH VISITING SERVICE Recruitment of experienced members of staff to fill the vacancies within the establishment during the year, again proved to be unsuccessful. This failure of recruitment is a matter of grave concern, especially as four health visitors have reached retirement age, whilst others are approaching the age of retirement. In spite of the heavy case loads and the day-to-day ever increasing demands made upon health visitors' time, requests for students from other agencies, who are anxious to observe and learn something of the local authority health services are constantly being made and met. In conjunction with the EnfieldTechnical College, child care officer students spent three days with the health visitors, visiting families and observing the services provided in the clinics. This new venture proved successful and it is anticipated wiII be repeated in future years. Child care officers and health visitors frequently need to consult and this kind of co-operation during training is of value to both. Student nurses from the Prince of Wales's and Middlesex Hospitals also spent three days observing the various services provided by the local authority. The student nurse gains an insight into the Personal Health Service and because of this experience may decide to enter the health visiting service in the future. The actual number of visits made by 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 1524 Total visits 2351 Children under 1 year of age First visits 6090 Total visits 12449 Children aged 1 - 2 years Total visits 11063 Children aged 2-5 years Total visits 17838 Other cases - Total visits as Health Visitor 2787 - Total visits as School Nurse 103 58 Student Health Visitors I am pleased to record that the three students who completed their one year's training in September were successful in obtaining the health visitors certificate. Unfortunately instead of the anticipated four students only two suitable candidates were recruited to commence training in September 1967. The Council for the Training of Health Visitors recommend that field work instructors 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 tutors, both at the Training College and clinic to discuss the progress of the student. Due to the shortage of staff it has not been possible to reduce case loads to the recommended number. Four members of the health visiting staff have attended a special course of instruction to qualify as instructors. CO-ORDINATING COMMITTEE FOR WORK IN CONNECTION WITH PROBLEM FAMILIES The Chairmanship of the Committee changed by rotation in the first three years of the Council's existence from Medical Officer of Health to Children's Officer and Chief Welfare Officer. The work of the Committee continued on the lines described in previous reports. Much of the information exchanged is very confidential but a useful degree of trust has been a variety of social workers and so there is now less risk of multiple visiting and more care is taken to ensure that the most suitable agency is left to cope with the problem. HOME NURSING SERVICE There was a slight fall in the number of new cases dealt with during the year by the staff who continue to give advice and support as well as nursing treatment in the home. The number of visits which required attention for a period exceeding one hour increased by about 50% which indicates a rise in the number of very ill patients now being cared for at home. The two bath attendants, by specializing in their duties, were able to know their patients and so follow a regular timetable. During the year they treated 58 people and in addition carried out treatment for scabies either in the patients' homes or in the Cleansing Centre in Hornsey. Full time day or night nursing for terminal cancer patients was provided for 23 people by the Marie Curie Memorial Foundation. Treatment of cases during the year may be classified as follows:- Injections 848 General Nursing Care 628 Blanket Baths 442 Enemata 163 Dressings 369 Preparation for diagnostic investigation 106 Pessaries changed 26 Washouts douches 54 Other treatment 223 2,859 Sex and age of patients at the time of the nurse's first visit may be classified as follows:- Age Males Females 0 - 4 35 40 5 - 15 24 24 16 - 39 57 276 40 - 64 210 369 65 and over 547 1,273 873 1,982 59 Cases attended during the year were referred from the following sources. G.P.'s 1876 Hospitals 902 Chest Physicians 9 P.H. Dept. 25 Direct 43 2855 The following table shows the work of the home nurses during the yean:- New cases attended 1956 No. of cases on register at end of the year 776 Total No. of visits made 84618 No. of visits of over one hour duration 2844 The general efficiency of nursing in the home will be improved by the gradual introduction of more sophisticated equipment. Nursing services are improved when such expensive equipment as hoists and special beds are made available and these represent a sound capital investment in labour saving equipment. The gradual substitution of the traditional sickroom commode by the Elsan type of toilet is a welcome innovation for those whose incapacity restricts them to life in one room. DOMESTIC HELP SERVICE The total number of cases provided with home help during the year was 2774. The number of new cases is still increasing and the bulk of the work continues to be among the aged sick, who need permanent help. The total number of visits made by the Home Help Organiser and her assistants during the year was 5745. Of this number 1491 were in respect of new cases. The number of home helps in employment at the end of the year was 232 (equivalent to 144 full- time). The following table shows details of the cases served during the year:- Cases provided with help during the year Number of new cases provided with help Number of old cases for which help was continued from 1966 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 737 1610 2347 1691 Aged under 65 on first visit during year Chronic sick and tuberculosis 88 145 233 151 Maternity 48 1 49 1 Others 102 43 145 36 Totals 975 1799 2774 1879 Neighbourly Help Service This service continues to function satisfactorily, but we have not been successful in obtaining the services of many Good Neighbours, and at the end of the year there were only 5 cases being served. 60 ADVICE CLINICS FOR THE ELDERLY The two retirement advice clinics in Haringey have functioned regularly throughout the year. The one situated at Woodside House in the Old People's Centre was for a while transferred to the School Clinic at Stuart Villa. The other, which is confined to men of retirement age, was held weekly at Somerset Road Clinic, Tottenham or at Weston Park, Hornsey. On all occasions the clinics were attended by a medical officer assisted by a clinic nurse. 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. A good liaison exists with the Ministry of Labour with regard to obtaining part-time employment for men who have passed retirement age and other agencies for help with social problems or recreational needs and with G.P.s, chiropodists, etc., should any treatment be required. During 1967 there were 25 sessions in Woodside House/Stuart Villa Clinicat which 8 new cases were seen and 184 re-attendances. 34 sessions were held at Somerset Road and Weston Park clinics, 27 cases being new and 106 reattendances. SECTION 47, NATIONAL ASSISTANCE ACT, 1948 Although a number of elderly people presented difficult problems, fortunately all were capable of some kind of improvement through the provision of additional services, and it has not been necessary to apply for any compulsory removals. TUBERCULOSIS REHABILITATION Rehabilitation Workshops The number admitted for training during the year under review was 9. During the same period 6 of the trainees became sufficiently competent to be placed on the permanent establishment. This was a very difficult year from the point of view of the workshops' trading. Of the 34 cabinet makers at the workshops, 8 have been assessed by the chest physicians of being capable of working only four hours a day. In some cases, the number of hours worked are reduced as a precautionary measure at the beginning of the winter. It was found that the amount of orders coming in had fallen off so an illustrated booklet was prepared and distributed to potential customers and I am pleased to be able to report that the volume of orders now being received has materially increased. Discussions have taken place with representatives from the Ministry of Labour regarding ways of improving the output from the workshops and as a result of advice offered, two additional machines have been installed which have already proved themselves to be a great asset. The workshops always create a great interest in people connected with treatment of chest and heart diseases and visitors are received from many parts of the world who always express a very keen interest and admiration for the work which is taking place here in Haringey. Provision of Extra Nourishment for Tubercular 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 products and eggs for persons on low income suffering from tuberculosis. During the year there were 7 patients receiving this extra nourishment. RECUPERATIVE HOLIDAYS The Council's scheme for recuperative holidays is restricted to those persons who, after illness or operation, would be most likely to derive benefit by two weeks convalescent holiday in a suitable home. However, if medical or nursing care is required then this would become a convalescent holiday and would be arranged through the hospital almoners. It always proves more difficult during the normal holiday season to secure sufficient suitable placements and there is a natural reluctance on the part of some patients to go away on holiday other than during the summer. This creates a problem of a heavy demand in the summer months and under-occupation of some convalescent homes during the winter. The Council this year accepted financial responsibility for 123 persons in recuperative holiday homes. Of this number 114 were adults and 9 under school age. In addition to this 37 applicants for recuperative holidays were not considered eligible under the Council's scheme. 37 children were recommended under Section 48 of the Education Act 1944 of whom 29 were placed in recuperative holiday homes and the remainder either cancelled or withdrew. 61 MASSAGE AND SPECIAL TREATMENT During the year there were 26 establishments licensed for massage and special treatment. Applications are made for the renewal of licences annually and the premises are inspected by a Senior Medical Officer. It was not found necessary to cancel or revoke any licences. CHIROPODY SERVICE During the year 19 Chiropodists were employed on a part time basis and one full time. Unfortunately due to a motor accident in the early part of the year, the services of the full time chiropodist were lost to the Department. In all 39 clinic sessions are held each week in various parts of the Borough. During the yeara total of 1,705 people received treatment at the Local Authority Clinics, a further 183 in the surgeries of chiropodists and 486 at the British Red Cross Clinics. In addition to these, 1,150 patients have received domiciliary treatment. This form of treatment has shown a marked increase during the past 12 months. In all, 3,525 persons have received chiropody treatment through the Local Authority Service. During the year 552 applications were received from persons requiring clinic appointments and a further 380 for domiciliary treatment. At the end of the year there were 245 patients waiting for re-appointments for clinics and 96 new cases waiting for their first appointment at clinics and 17 for domiciliary treatment. During the year the Council decided to waive all charges as from 1st April, 1968. CARE OF UNSUPPORTED MOTHERS AND THEIR BABIES Thecareofthe unmarried mother and her child is an obligation on a local authority as they belong to one of the groups specially 'at risk'. The child's health is at risk from the time of conception, and later the child's emotional and mental health is at risk because the mother is socially at risk. She often receives little sympathy and help, and people feel that such difficulties as she may meet are of her own seeking. There may be a decrease in the number of illegitimate births because of the greater knowledge of contraception, but it is likely that there will continue to be a need for help. The demand for Mother and Baby Homes in the Greater London Area has decreased but homes are still needed for special categories. The schoolgirl mother with her dual needs of care and education will almost certainly gain by admission to a special home; many girls in lodgings as well as those with family conflicts still find a mother and baby home a haven. Post-natally the homes provide an opportunity for the mother to care for her child in a place where no one will press her into a decision which she may regret. For the increasing number who do not seek admission to a mother and baby home there is a need for skilled help, often over a long period. This is particularly true of the mother keeping her baby. Some will need practical help, help with accommodation, equipment to set up a home, and help to obtain care for their baby if they return to work. The shortage of day nursery accommodation may well mean that the mother may live on supplementary benefits rather than embark on precarious arrangements with daily minders and with broken periods of employment if her child is sick. However, such a decision may mean that she both loses skills and becomes isolated. If she is fortunate enough to be with her parents other problems may occur; it is notoriously difficult for two women to share a kitchen, it is often even more difficult to share a baby. It is still a momentous decision to part with a baby however the mother may have prepared for it. Returning home means for both her and her parents a period of anxiety. The parents may well feel anxious about her new friendships, but the girl herself, though not wanting to hurt her parents, may find a greater need for the companionship of others. 245 cases were referred to the Social Worker during the year. Of these 15 were not interviewed, mainly referral from other agencies in the belief that the mothers might become homeless. A total of 122 were admitted to mother and baby homes during 1967. The following are relevant details of the 230 to whom help was given:- 62 Marital Status Age Single 216 Under 16 15 Married with husband 1 16 — 25 181 Married and apart 7 25 — 30 21 Divorced 6 30 — 35 8 36 and over 5 Countries of Origin Occupation U.K. 147 Students 27 Eire 47 Domestic 23 West Indies 27 Factory 44 Commonwealth 7 Clerical 76 Europe 1 Professional 9 Other 1 Other 51 Of the 230 cases seen for the first time in 1967 arrangements for 56 were incomplete at the end of 1967, but 50 completed 1966 cases are included. Marriage 14 Baby living with mother who is unmarried 91 Baby in care of voluntary society 1 In care of Children's Department 5 Foster parents 8 Adoption 67 Mother moved away before delivery 20 Mother repatriated 4 Miscarriage 7 Stillbirths 5 Baby died 1 Not pregnant 1 STAFF MEDICAL ASSESSMENTS, EXAMINATIONS AND SICK PAY REPORTS There was little change in the number of combined medical assessments during the year 1967 as compared with 1966. A slightly increased proportion of the new applicants were medically examined in 1967, 25% as compared with 22.5% in 1966. There was an increase in the number of sick pay reports from 109 in 1966 to 130 in 1967. Medical Assessment of new applicants without medical examination Architect's Department 13 Baths Department 4 Catering Department 10 Cemeteries Department 7 Children's Department 56 Cleansing Department 3 Education Department 797 Engineer's Department 48 Building Works Department 6 Entertainments Department 2 Health Department 127 Housing Department 18 Libraries Department 48 Parks Department 4 Town Clerk's Department 73 Town Planning Department 13 Treasurer's Department 30 Welfare Department 50 Tottenham Technical College 55 Hornsey College of Art 26 1,390 63 Medical Examination of New Applicants Cemeteries Department 5 Children's Department 7 Cleansing Department 1 Health Department 6 Housing Department 1 Libraries Department 3 Town Clerk's Department 1 Treasurer's Department 4 Welfare Department 1 Tottenham Technical College 1 30 Education Department Non-Teaching 40 1st Appointment Teachers 164 Teacher Trainees 195 Hornsey College of Art (end of term teachers) 46 445 Total of examinations 475 Reports on Sick Pay Cases 130 Medical Examination of Sick Pay Cases 21 Medical Examination of Staff over 70 years of age 2 HEALTH EDUCATION Health Education in Schools Talks to groups of 13 to 15 year old girls were given in the first half of the year by a school nurse. When she left the Borough, a health visitor continued the series. Programmes are arranged to combine sex education, personal relationships and hygiene, together with child development. With this type of syllabus such subjects as venereal disease and drugs are introduced naturally. The Health Education Officer assists by providing audio-visual aids etc. and up-to-date information on health matters. School teachers, students and pupils request such information and material especially in connection with projects for the Certificate of Secondary Education. School medical officers are attached to specific schools, and have been requested to talk on health problems to the pupils. It is hoped that the demand for such talks will increase. At one school a doctor regularly sits in on the sixth form discussions on health topics. Lectures have also been given to All Saints Teacher Training College on the School Health Service. The Duke of Edinburgh Award Scheme continues to run in the Borough, and requests from schools and youth organisations for staff to teach and examine on such subjects as first aid, mothercraft and personal health are met. This involves talks after schools hours and in the evenings. Health education to other establishments and outside organisations The health education section assists and gives support to other sections and personnel in the Department where health education is concerned, especially when display material and health education publicity are employed. The section co-ordinated closely with the mental health staff during Mental Health Week, providing the publicity material and organising the exhibition on mental health mentioned in greater detail in that section's report. Later the exhibition was broken up into smaller displays and exhibited in the foyer of Tottenham Town Hall and some of the larger health centres. 64 A programme on healthy living, commenced last year, was continued at the Authority's Mother and Baby Home. This is a useful and worthwhile channel of communication. Speakers were requested and provided for various outside organisations. Co-operation continues with a voluntary organisation concerned with cervical cytology, providing speakers, audio-visual aids, leaflets and other publicity material. Advanced first-aid lectures were given to the Red Cross, and lectures on childbirth to St. John's ambulance drivers. Visual Aids Two useful leaflets concerning deaf children and their parents were produced by the health education section in co-operation with Dr. Fisch of the audiology unit. These were printed by the Libraries Department. Other authorities have shown interest in the leaflets and are purchasing these from the Borough. The Section has produced a set of slideson the various services provided by the Health Department; these are extensively used for trainees in the Borough and pupil midwives. In the latter part of the year the Health Education Officer was seconded to do a special course of Advanced Study in Content and Method of Health Education at the Institute of Education, London University. In her absence her assistant took over the day-to-day running of the section. MENTAL HEALTH SERVICES Psychiatric services have continued to develop in the Borough, with extended out-patients clinics and facilities at the North Middlesex Hospital, the Prince of Wales's Hospital and a small in-patient unit at St. Ann's Hospital. These additional services facilitate keeping the patients in the area in which they live when they become ill. Access by the patient to out-patient departments for psychiatric medicine is therefore much easier ana advice can be more readily sought, and it, of course, means that families can visit their relations more conveniently and with less expense when the unit is actually in theBorough. Dr. Seidel, Principal Medical Officer for Mental Health is attached to these three hospitals in the capacity of Assistant Physician in Psychiatric Medicine. Publications A detailed edition by Dr. U.P. Seidel of Mental Subnormality in Childhood was published in the International Journal of Social Psychiatry Volume 13 No. 1 1966/67. The 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 again a good deal of staff movement. Two of the Mental Welfare Officers were seconded to the training course for a period of two years, one by this Authority and one by the Authority in whose area he lives. The volume of work increases, this is due not so much to increased incidence, but to recognition of the value of the Community Care Service. Psychiatric Rehabilitation Day Centre The Psychiatric Rehabilitation Association's Day Centre at Mitchley Road has proved most successful during the year, providing not only relief from isolation for selective patients, but also a climate conducive to rehabilitation which assists patients to return to normal employment. At the end of the year there were 20 Haringey patients attending this Centre. Through the efforts of the organisers a number of patients have successfully returned to take up their places in the community and have returned to full employment. 65 The Psychiatric Rehabilitation Association has had links with Haringey Mental Health Section for some time prior to this project in Tottenham. Before the Centre at Mitchley Road was started a number of Haringey patients attended one or other of the P.R.A. Day Centres in East London. Arising out of the success of these placements and in close association with the Department, the P.R.A. were encouraged to open a Day Centre at Mitchley Road in September 1966, and at the time of preparing this reportthere were 34 patients on the register of whom 26 are residents of Haringey. The importance of the Centre and the need it fulfils is evident by the great demand for places at the Centre; even in the most inclement weather the patients make the effort to attend. Including those currently attending, 73 Haringey residents have been referred since the Centre opened of whom 21 returned to employment, 12 were re-admitted to psychiatric hospitals, one was admitted to general hospital, 7 stopped attending, 3 attendances discontinued at the organiser's request, 2 were referred to P.R.A. Industrial Unit and one moved to another area, a total of 47. The Work: Whilst work is the basis for the group interaction it is not the main purpose of the centre. The objective is to enable patients in a group situation to interact constructively with each other and thereby regain self confidence to participate effectively in normal society. The availability of appropriate work is governed by the amount of space available, and this in turn isaffected by the availability of transport. Notwithstanding these difficulties the work situation is improving due to the recent appointment of a P.R.A. Contracts Organiser and a cultivatedrelationship with local industrialists. The Future: Day Centres are a means by which chronic patients can be helped towards greater self-expression and are a preparation for more realistic work situations. From experience, it is unlikely that the majority of participants will be able to return to full-time employment without the availability of additional rehabilitative situations. In this connection, the next stage after the Day Centre must be more demanding but nevertheless sheltered work situation Iike the P.R.A. Industrial Education Unit at Bethnal Green, and special sheltered employment in industry, similar to the P.R.A. recent experiment at Maynards in Haringey. The diagnosis and severity of illness of individual patients also varies greatly. The average period of stay at the Centre of those returning to full-time employment was just under five months. Selection for attendance at the Centre has, hitherto, been left largely to the discretion of the Mental Health Section and the P.R.A. Selection on this basis has usually been more successful than those referred through other sources. Of the few patients that we were able to follow up who were re-admitted to hospital, there were usually domestic difficulties. This inevitably led to the patient refusing to co-operate in the taking of medication and therefore resulted in the return of the symptoms. The few patients who were found unsuitable for the Centre were either violent or too disruptive and, therefore, diminished the benefit of attendance for the majority. The expenses of the Day Centre at Mitchley Road are shared with Enfield on a per capita basis. During the period January to December 1967 the 73 places mentioned above represented 2,610 attendances. Those attending can take advantage of the other P.R.A. facilities, for instance, some have moved on to the Industrial Educational Unit at Bethnal Green and five of the patients lived at the residential centre, Nicholas House. Four of the members took part in the group holiday at Margate and nine joined in a day trip to France. The P.R.A. Evening Centre, meets at the Lutheran Church Hall, Antill Road and has proved a valuable function in the rehabilitation of the patient or ex-patient at work. The high standard of the groupwork and the success already evident emphasises the need for the Health Department to establish a workshop of our own for the mentally ill as allowed for in the 10 year plan. The Association together with the University of Surrey is currently studying the incidence of mental illness in North London with a view to revealing its geographical distribution and sociological factors prevailing. This will no doubt reveal some interesting material for the further development of the mental health services within the Borough. 66 Mental Health Social Work The local catchment hospitals which take patients from the Borough have a Mental Welfare Officer Representative attend hospital staff and patient group meetings. This provides a close liaison between the Mental Health Section and the hospital service and creates the co-ordinating link necessary to ensure that the patients receive the optimum support from this Department. We are fortunate that the hospitals which serve this area allow complete access to in-patients so that these necessary links for continuity of care in the relationship between the patient and the social worker can be maintained. Mental welfare officers attend regular case conferences inthe hospitals. These conferences are attended by the hospital doctors, nurses, social workers, and students from many other disciplines. Mental Health Year This was an eventful year being the middle one of the three-year programme organised by the National Association for Mental Health to publicise the need of the mentally disordered for greater tolerance, understanding and acceptance, with special reference to the community, to remind everyone how necessary it is to try and appreciate the difficulties experienced by those who have had a spell in hospital, or under treatment, and for us all to play our part in smoothing the path of rehabilitation. Haringey's contribution to Mental Health Week was marked by articles in the Press by Dr. Orton and in the local papers by their own correspondents. A poster competition was organised and very well supported, and very many interesting entries were submitted. Prizes were awarded to the winners by the Mayor, Alderman Gellay. The main feature of the week was a Symposium on Mental Health held in the Council Chamber atthe Civic Centre. Council lor C.D. Moss the Chairman of the Health and Welfare Committee gave a preliminary introductory talk to the meeting. Mr. David Hobman, Director of the Social Work Advisory Service, took the chair. The speakers were Dr. Moran, Consultant Psychiatrist, Claybury Hospital Dr. Bruce, Consultant Psychiatrist, Friern Hospital: Dr. Shapiro, Physician Superintendent, Harperbury Hospital: Mr. John Wilder, Director of the Psychiatric Rehabilitation Association: Mrs. Joan Meigh representing the Samaritans: Mr. Phillips of the National Society for Mentally Handicapped Children and Miss J. Sherlock of the National Institute of Social Work Training, each of whom spoke on their own organisation's role in the mental health field. This was followed by lively, thoughtful questions from the audience and gave rise to some very interesting discussion. Throughout the entire week an exhibition on mental health was open to the public in the foyer of the Civic Centre. This showed the various facets of the work being done. The stand supplied by the Borough Architect on which plans and models of current projects were displayed created an immense amount of interest. There was a display of handiwork contributed by the mentally ill and the mentally subnormal. The winning posters were also on display. The week ended with a garden fete in aid of the Haringey East Society for Mentally Handicapped Children in the grounds of the Civic Centre. This was attended by the Mayor and Mayoress who awarded prizes donated by the Society for the best handicraft entries submitted by handicapped children. Many of the Borough Council's members and staff and general public attended the function. As a result of these activities in connection with Mental Health Year there have been offers of help from people in connection with existing and future services, and a number of volunteers are now assisting in mental health community care especially in the social clubs and allied projects. One grammar school in particular has followed up a number of ideas for voluntary help in the mental health field. Re-organisation of Hospital Board Facilities There has been a re-organisation by the North West Metropolitan Regional Hospital Board of the facilities to be provided by Friern Hospital, New Southgate, N.11. This hospital covers the Hornsey and Wood Green part of the Borough. Under the new arrangements, one psychiatric team at the hospital take over in-patient and out-patient treatment for the Borough residents. This is particularly welcome as it is hoped that this will secure a consequent improvement in the overall service and continuity of care in the service we give. SERVICES FOR THE MENTALLY ILL Boarding out Scheme During the year inquiries have been pursued as to the most efficient way of running a boarding out scheme for patients recently recovered from mental illness or suffering from mental handicap. A discussion took place with the Borough's Housing Manager to clarify the position of any Council tenants who wish to participate in this scheme and health visitors and old people's welfare workers were circulated about this scheme. Advertisements were placed in the five IocaI papers and posters displayed 67 throughout the Borough asking for potential landladies to come and discuss the scheme with the Health Department staff. A similar scheme has been run in the London Borough of Croydon for some time and advice was obtained from that Borough and from other Boroughs that have had experience in running such schemes. A limited response was received to the advertisements but so far no patients have been placed with landladies. Financial restrictions have hindered the development of this scheme but it is hoped to implement it more fully in the future. On 31 December 1967 21 Haringey patients were living in hostels run by other local authorities or voluntary organisations. Psychiatric Social Clubs The Oakleaf Club (Psychiatric Social Club) at Ferme Park Baptist Church holds regular meetings on a Monday night. These are always well attended. The Psychiatric Rehabilitation Association have now opened their own club for patients on Tuesday evenings at the Lutheran Church Hall, Tottenham, N.15. Membership of both clubs continues to expand and as their approach is different the appeal is therefore wider. Services for the Mentally Subnormal The Hornsey Centre for Handicapped Children continues to provide facilities for handicapped children. During the year the number of children that could be accepted there for two days per week was increased to thirty. The Principal Medical Officer who provides medical care for these children while they are at the Centre, reports that except in the cases of the severely affected mental and physically handicapped children, marked improvements have been brought about in the habits and behaviour of these youngsters. Hostels for the Mentally Subnormal Work commenced this year on the conversion of Linden House, 10. Linden Road as a hostel for sixteen adult male subnormals. This hostel is due to open in March 1968. Adult Training Centre The Hamilton Hogben Adult Training Centre is due to open in 1968. This will provide training facilities for eighty subnormals both male and female. Work on this establishment commenced in June of this year. The Centre will soon include a laundry and workshop facilities, domestic training, and further education. The Manager, Mr. Green, was appointed on 1 November 1967. At the present time the London Borough of Enfield is providing placements for trainees from this Borough at the Edmonton Adult Training Centre. On 31 December 1967 there were 67 in attendance and 20 on the waiting list. There arealsochildren suitablefor transfer to the Adult Training Centre attending the Junior Training Schools at Friern Barnet and Waverley Road, Enfield. Junior Training Schools As set out in my last year's report, a site has been secured on the Broadwater Farm Estate, Tottenham, for a proposed Junior Training School and work should commence during the financial year 1968/9. Plans have been submitted to the Ministry of Health and have been accepted with certain slight modifications. Holiday Camp for Mentally Subnormal Children Again this Authority undertook to arrange a holiday camp at Suntrap Residential School, Hayling Island for mentally handicapped children. This year forty-three children attended compared with thirtytwo last year. The children enjoyed a very good holiday if one can judge from favourable comments of the parents on the return of the children. We should count ourselves extremely fortunate to have this eminently suitable establishment belonging to this Authority and I should like to thank the Chief Education Officer and Miss Stout, the Headmistress of the School, and all her staff for alI they did again this year to make the holiday so successful. Unfortunately, due to the additional work involved in the setting up and opening of new establishments in the early part of 1968 it will, regrettably be impossible for this Authority to make the necessary arrangements for next year's camp. However, the Enfield Health Department have indicated that next year they will be prepared to organise a camp on similar lines at St. Mary's Bay, Dymchurch. 68 Psychogeriatric Day Centre The search for suitable accommodation for this project has at last met with success. Various properties have been looked at with a view to establishing the pilot scheme and it will now be possible with the co-operation of the Wood Green Old People's Welfare Committee to start such a scheme at Woodside House with a small unit catering for twelve psychogeriatric patients. It is hoped that this club for the senior citizens who are, or have been, mentally ill will be opened in April 1968. Residential Accommodation for Longterm Subnormal Patients 35 patients were maintained by this Authority in residential homes during the year, the greater number of whom are placed in the Brighton and Hove area where they are boarded out by the Guardianship Society in private households. It has not been necessary for this Authority to make any compulsory Guardianship placements; indeed, none has been made since the formation of the Borough. Social Clubs for the Mentally Handicapped The three clubs catering for mentally subnormal children are still very active. The "Roundabout Club" has now settled into its new meeting place at the Hornsey Centre for Handicapped Children as has the Golden Gate Club in their new premises at Lancastrian School. The "Doddy" Club for the Educationally Subnormal Children has been accepting members of the subnormal range. Hospital Placements for the Mentally Subnormal Difficulties have again been experienced in the placing of mentally subnormal persons for permanent care in the Catchment Area Hospitals. It was only possible for 1 placement at South Ockendon. 6 placements were obtained at Harperbury Hospital. It will be seen from the tables set out below that there were 9 persons in need of hospital care and a further 29 who, although in need of hospital placements, were not considered to be so urgent. This has been a year of great activity in the Mental Health field, work having commenced on the Adult Training Centre, Hostel for Adult Subnormal Working Males, the finding of suitable accommodation for Psychogeriatric Day Centre, the initial preparations of work for our Junior Training School, a year in which we justifiably look back on the progress we have made but we must also look forward with challenge to the future as the needs for mental health within the community will increase to growas the policy of keeping people at home rather than in hospital becomes morewidely accepted. Number of patients referred to Local Health Authority during year ended 31st December, 1967 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 - - 59 109 168 - 1 - 1 2 Hospitals, on discharge from in-patient treatment — - 25 77 102 — 1 — 1 2 Hospitals, after or during out-patient or day treatment 1 — 38 46 85 5 3 1 1 10 Local education authorities - - - - - 4 1 1 1 7 Police and Courts - - 15 19 34 - - - - - Other sources 2 6 98 192 298 19 20 3 - 42 TOTALS 3 6 235 443 687 28 26 5 4 63 69 Number of Patients under Local Health Authority care at 31st December, 1967 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 1. TotaI number - 1 60 180 241 68 64 199 181 512 2. Attending workshops/occupation training centres — — — - - 37 38 50 40 165 3. Awaiting entry to workshops/ occupation training centres - - 1 - 1 28 24 8 13 73 4. Receiving home training - - - - - - - - - - 5. Awaiting home training - - - - - - - - - - 6. Resident in L.A. Home/hostel - - 1 2 3 - - - - - 7. Awaiting residence in L.A. home/hostel - - - - - - - 24 - 24 8. Resident at L.A. expense in other homes/hostel s - - 8 10 18 - 4 8 7 19 9. Resident at L.A. expense by boarding out in private household - - - - - - 1 5 10 16 10. Attending day hospitals 11. Receiving home visits and not included in Iines 2-10 a) suitable to attend a training centre - - - - - - - - - - b) others - 1 50 168 219 4 4 104 111 223 Number of Patients awaiting entry to hospital or admitted for temporary care during 1967 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 31.12.67 a) in urgent need of hospital care 1 5 2 1 9 b) not in urgent need of hospital care 9 6 8 6 29 c) Total 10 11 10 7 38 Number of admissions for temporary residential care (e.g. to relieve the family) a) to N.H.S. Hospitals 11 7 10 5 33 b) to L.A. residential accommodation - - — - — c) Elsewhere 4 1 - 1 6 d) Total 15 8 10 6 39 Work of Mental Welfare Officers (a) Mental Illness Visits made by mental welfare officers 5,841 Compulsory admissions to psychiatric hospitals by mental welfare officers 166 Informal admissions to psychiatric hospitals by mental welfare officers 133 (b) Mental subnormality Visits to those under community care by mental welfare officers 2,083 70 SCHOOL HEALTH SERVICE REPORT OF THE PRINCIPAL SCHOOL MEDICAL OFFICER FOR THE YEAR 1967 EDUCATION COMMITTEE - 1967/68 **Alderman Mrs. A.F. Remington (Chairman, Education Committee) **Councillor Mrs. Brenda S. Remington, B.A., (Vice-Chairman, Education Committee) * Alderman D.F.W. Billingsley (Chairman, Special Services Sub-Committee) Alderman J. Watkins Councillor Mrs. L.A. Angell Councillor Victor Butler Councillor Douglas Clark Councillor Mrs. D. Cunningham, J.P. Councillor Mrs. P.M. Dines * Councillor D.J. Ding (Vice-Chairman, Special Services Sub-Committee) * Councillor B.L. Greenway, M.I.C.M. Councillor V.N. Jary * Councillor Bryan D. Lipson, LL.M. Councillor Frank Lloyd, J.P. Councillor Brian James McBride * Councillor Mrs. Naomi E. Mcintosh, B.A. * Councillor Peter P. Rigby, J.P. Councillor R.L. Singer Councillor M. Skudder, B.Sc., F.S.S., J.P. Councillor L.A. Vitoria Co-opted Members Rev. R.J. Avent * Rev. J. Brian Campbell, L.C.L. Mr. H.R. Cheetham Mr. J.G. Elkington, 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 71 SCHOOL HEALTH SERVICE To: The Worshipful The Mayor, Aldermen and Councillors of Haringey I have the honour to present the third Annual Report of the School Health Service for the year 1967. The advances of medicine and surgery, especially with organ transplants, have been immense, but would it not be better to check our own state of maintenance before we start looking for spare parts? In former days our ill-health was attributed to witchcraft or acts of God or the Devil. In due course we learned about the germ theory of disease and how to prevent it, but today much of our illhealth is due to defects in our own behaviour. The heavy toll of traffic accidents, lung cancer caused by the cigarette, obesity caused by over-eating, coronary thrombosis due to the sedentary life spent before the T.V. screen or in cars, and above all the new threat of unknown magnitude from the increasing pace of drug addiction. We should be concerned about the frequent allegations of drug taking amongst "pop" singers who areso often the objects of hero worship by the young and who, like the Pied Piper of Hamelin, may lead them to unknown disaster. Their youthful hero-worshippers have a life time before them and a national tradition to maintain. I can see nothing in the recent history of the marijuana, cannabisor hashish smoking nations which suggests that it is in our interests to join them in that habit. Even if cannabis smoking is to be tolerated in adults, we should not allow children to learn the habit in school, and therefore in the interests of the normal healthy children in our schools, a child who is still at school but who is over compulsory school age and who boasts about taking drugs or if found to be doing so, should be asked to leave, and a child under 15 who is dependent on drugs should be removed to the disciplined environment of a residential school. The more permissive will argue that severe measures will drive the problem under ground. It is my contention, however, that drug addiction should be driven under ground, where it properly belongs, and it should not be encouraged to establish itself on the stage of society for all to contemplate. 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 during the past year. J.L. PATTON, Principal School Medical Officer. 72 SCHOOL HEALTH SERVICE School Population The school population for the Borough on the 18th January 1968 was 34,391, as shown in the following table:- Primary Schools and Nursery Classes 20,654 Nursery Schools 241 Secondary Comprehensive Schools 11,579 Secondary Modern Schools 1,215 Secondary Grammar Schools 394 Special Schools: Vale Road School for Physically Handicapped 88 Blanche Nevile School for the Deaf (including classes for partially hearing) 129 Suntrap Residential Open-air School) 91 34,391 Medical Inspections in Schools Medical examinations in schools are at present under reorganisation which, it is hoped, will be completed by September, 1969. As from the school year commencing on that date there will be a full medical examination of each child on school entry and during the child's last year at school, with examination by selection in the last year in the primary school. Selection for examination at this age will be made by a school medical officer as a result of answers to questionnaires sent to the parents and after consultation with the head teachers of the schools concerned. This will lead to a fuller account of the individual child's health and needs being passed on to the head teachers of comprehensive schools. During the year at the invitation of the Head Teacher of Drayton Comprehensive School a new idea was explored with a view to establishing closer and more continuous links between the school health service and the school. It is proposed that a school medical officer should visit the school each week on a regular afternoon during term time to carry out medical examinations and to be available to give advice to pastoral heads on particular problems. The school is fortunate in obtaining the services of a distinguished authority on the problems of young people. Thefollowing 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 % 1963 & later 235 235 100 — — 1962 1,708 1,706 99.9 2 0.1 1961 2,449 2,444 99.8 5 0.2 1960 1,505 1,503 99.9 2 0.1 1959 1,766 1,764 99.9 2 0.1 1958 1,082 1,082 100 — - 1957 399 399 100 — - 1956 218 218 100 — - 1955 1,117 1,114 99.7 3 0.3 1954 669 667 99.7 2 0.3 1953 175 175 100 - - 1952 & earlier 2,635 2,631 99.9 4 0.1 Total 13,958 13,938 99.86 20 0.14 In the Appendix to this report will be found an analysis of the defects found to require treatment or observation. 73 Other Medical Inspections The following are the numbers of special inspections and re-inspections carried out during 1967. 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 3170 Number of re-inspections 1658 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 These clinics, which have replaced the former minor ailment clinics, continued throughout the year to deal with the follow-up of defects found at routine medical inspections together with some minor ailments and parental problems. It is hoped to develop the work at these clinics further in order to make a selective approach to certain population groups. Ophthalmic Clinics There are three school ophthalmic clinics held in the Borough and 7¼ sessions are held each week. At Lordship Lane Clinic, an orthoptist is employed for nine sessions a week at the Clinic and on the remaining session each week visits Vale Road school for Physically Handicapped Children. We were long unable to obtain the services of an orthoptist for the Hornsey and Wood Green areas, but we look forward to providing a more comprehensive ophthalmic service in these districts in future. Dr. T.G. Kletz, Consulting Ophthalmologist at Lordship Lane Clinic, reports:- "The work in this clinic continues to be the investigation and correction of refractive errors, muscle imbalances and squints. Continued investigation of the incidence of myopia and the further ethnic survey has confirmed the high incidence of myopia, in some cases very high myopia, in very young children of certain immigrant groups. The results so far show that most of the ethnic groups have a much higher incidence of myopia than the Anglo-Saxon. The incidence of very high myopia, especially in the very young children, is most marked in the West Indian group, there being cases of over 10D of myopia and even 15D in children of three years of age. The survey is being continued during 1968." Mr. E.M.G. Galton, Consulting Ophthalmologist at Stuart Villa Clinic, reports:- "During the year 200 new cases were seen of which 114 were under five years old. New and old cases accounted for 1403 attendances. 101 pairs of glasses were ordered during the year. It is gratifying to note the proportion of 'under fives' who were referred as it has always been the aim to get cases at as early an age as possible." Dr. R. Peswani, Consulting Ophthalmologist at Weston Park Clinic, reports:- "The ophthalmic clinic at Weston Park continued during 1967. as in the previous year, with two weekly sessions. The attendances have been very satisfying as the following figures will show:- 74 Year Sessions Total Attendances New Cases Under 5 years Over 5 years Under 5 years Over 5 years 1966 75 116 980 48 182 1967 97 158 1,275 66 226 The work as before has been correction of refractive error and investigation of unilateral amblyopia, muscle imbalances and squints. A very large number of children under five years of age brought in as convergent squint were found to have uni- or bilateral epicanthus and no true squint. We are lucky to have appointed an orthoptist recently and it is hoped that from January 1968 most of the cases of muscle imbalance and squint will be investigated and treated at the clinic." Medical Services at Vale Road School for Physically Handicapped Children The Cerebral Palsy Unit associated with the School 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 and a full time cerebral palsy therapist gives treatment to these children under his direction. A speech therapist and an educational psychologist are available to give advice and treatment in suitable cases. A medical officer attends at the school twice a week and there is also a full time school nurse, and a full time physiotherapist who is in constant touch with the hospital consultants concerned. Once again I am grateful to Mr. A.J. Ives, the headmaster of the school and his staff for their continued co-operation with the medical staff. Of the seven new cases seen at the Cerebral Palsy Unit during 1967, three were Haringey children and four were from the London Borough of Enfield. Three of these children were under five years of age and four over five. The recommendations made in respect of new cases were as follows:- Recommended admission to Vale Road Special School. 6 Referred for further investigation of intellectual ability. 1 Orthopaedic Clinics There are two orthopaedic clinics in the Borough, at each of which fortnightly sessions are held. I am indebted to Mr. E.H. Hambly, consulting orthopaedic surgeon to Lordship Lane Clinic, for the following report:- "The Orthopaedic Clinics have been well attended during the last year. The number of new cases in the year was 347, and the total attendances were 911. The Clinic is fortunate in having excellent administrative help and physiotherapy is still under the excellent charge of Mrs. N. Allardice. This is particularly important as we have such considerable numbers of teenage boys and girls who have poor posture which is partly due to very rapid growth as they are all likely to be taller than their parents. I am very encouraged by the superb responses from the boys and girls and their parents to these exercises. Our liaison with Mr. Ives and his staff at the Vale Road Physically Handicapped School is as close as ever and Miss Marcus, the physiotherapist, exerts great efforts in dealing with the wide and numerous cases of progressive muscular atrophy. All the operations arising from patients seen in these clinics are performed by me at the Prince of Wales's Hospital and include such operations as triple arthrodesis, elongation of tendo-Achilles and leg shortening of the good leg in cases where anterior poliomyelitis has resulted in shortening of the affected leg." 75 Dr. E.G.M. Palser, consultant in orthopaedic and traumatic surgery to the Weston Park Orthopaedic Clinic, reports:- "During the year attendances were as follows — Number of new cases seen:- Under 5 years of age 201 Over 5 years of age 173 Total 374 Total attendances:- Under 5 years of age 380 Over 5 years of age 330 Total 710 Number of cases attended for treatment by the physiotherapist:- Old cases New cases Total Under 5 years of age 140 44 184 Over 5 years of age 430 110 540 Totals 570 154 724 The clinic continues to deal with children mostly under the age of 12 who are sent by the Medical Officer of Health at an early age and do not usually require treatment up to school leaving age. A small number of traumatic cases and a small number of cases requiring surgical treatment have been seen." Ear, Nose and Throat Clinics There are three ear, nose and throat clinics in the Borough, at two of which weekly sessions are held, and at the other monthly sessions. Mr. W. McKenzie, Consultant to the Ear, Nose and Throat Clinic, Park Lane, reports:- "The incidence of chronic suppurative otitis media has shown a striking fall and we seldom see a case of chronic discharging ears nor do we see untreated otitis media. Perforations of the drum have also become scarce and all this must be considered to be a tribute to the improved standard of living in Tottenham. he have a steady number of children referred for removal of tonsils and adenoids and we also have some cases of middle ear deafness. There is no doubt about the value of the sweep audiograms in schools and the only difficulty / have at the Park Lane Clinic or at the Prince of Wales's Hospital is when I see a child who attends a school outside the audiometrician's service." When the North West Regional Hospital Board suspended the School Ear, Nose and Throat Clinics in Hornsey and Wood Green early in 1968, we had reason to regret not only the cessation of a valuable service to the children of this Borough but also the termination of the employment of Dr. F.P.M. Clarke, who has nobly fulfilled this responsibility for over a quarter of a century. Dr. Clarke belongs to an older school in the treatment of ear, nose and throat conditions, one in which precise diagnosis and conservative treatment hold pride of place. Proetz nasal displacement, zinc ionisation,diastolization, etc. continued to be used in his clinic with highly satisfactory results. Events may well show that an approach such as this, requiring skill and careful technique but avoiding the more spectacular methods commonly used nowadays, is of greater benefit in the long run. But for us the closing of these clinics signals the end of a long and happy relationship, and we wish Dr. Clarke many years in which to enjoy his well-earned retirement. Audiology Unit The Audiology Unit is held within the precincts of Blanche Nevile School for the Deaf, and there is a 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. 76 Dr. L. Fisch, Consultant Otologist, reports:- "No major change occurred during the past year, he managed to keep the waiting list down and there was some improvement. Regular meetings with our parents of pre-school children were held throughout the year. These meetings are very important as part of parent guidance. We tried as much as possible to place our preschool deaf children into normal day nurseries or play groups. Excellent co-operation has been obtained from the staff of these nurseries. Members of the staff in our area attended a day conference on "The deaf child in a normal nursery", which was held at Heston. Our peripatetic teachers and many matrons and other staff from various day nurseries made an important contribution during the discussion. We find that there is an increasing number of children who have additional difficulties, apart from deafness. This is creating serious problems concerning placement of these children with multiple handicaps. In several cases we had great difficulty in finding satisfactory placing. The number of young children who require home training and parent guidance has increased. Also the number of more difficult children, with additional problems, is increasing and we found that an additional peripatetic teacher of the deaf was required to cover this work. Research: he are conducting an investigation on screening tests for babies by recorded test sounds. This investigation is supported by the Medical Research Council and the special equipment which was built for this purpose is used by Dr. Golder during her screening clinic for infants. Good co-operation with the School for the Deaf and the Partially Hearing Units continued, Wen a recommendation is made for admission of a child either to a school for the deaf or one of the classes for partially hearing children, this is discussed in detail with the Headmaster and a suitable time for admission is arranged. Dr. Udall continued to co-operate closely with our clinic and his contact with St. Bartholomew's Hospital is a very useful one. Several of our patients had special X-rays (by tomography) carried out at St. Bartholomew's Hospital and Dr. Udall is conducting an investigation into the various syndromes connected with deafness with the help of tomography. Our new premises which were added proved to be very useful. There are still some urgent needs as regards additions to the building. One of the most important is an observation room, with facilities for one-way observation. Also a larger waiting room is urgently required and a covered passage from the clinic into the audiometry clinic." The following is an analysis of the cases seen during 1967: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 in year 244 17 20 37 42 31 27 7 9 11 11 6 4 3 1 1 1 472 Cases brought forward from previous year 5 27 28 25 43 34 22 27 28 20 33 17 27 16 8 15 10 385 Re-examinations of old and new cases 8 91915 22 15 9 4 5 5 7 7 5 2 —- — 1 133 Total attendances 990 Pre-school children 536 Attending Infant and Junior Schools 225 Attending Senior Schools 96 Reason for referral among New cases:- For diagnosis 183 Known to be deaf, examination before admission to Blanche Nevile School 15 Immigrants to Borough known to be deaf 5 Partially-hearing, advice as to placement 3 Auditory training 6 "At risk" 243 Transfer from hospital out-patients departments 11 Advice as to placement where deafness might be the cause of backwardness 6 Total 472 66 of the above referrals were from other London Boroughs. 77 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 full-time and one part-time peripatetic teachers of the deaf who work incloseco-operation with Dr. Fisch, covering the London Borough of Haringey and 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 three full-time trained audiometricians, the third of whom commenced duties towards the end of the year. The audiometricians now combine vision screening in schools with audiometric duties. Children who are due for medical inspection in school have a hearing test beforehand and the audiographs of those who fail are made available to the school medical officer at the time of inspection so that he or she can discuss the hearing-loss with the head teacher and follow-up with any further investigation necessary. During school holidays special sessions are held at school clinics at which an audiometrician is present with the medical officer. The standards for passing audiometry are set purposely high, and of the 368 children who failed first routine tests in 1967, a very high proportion were found to respond to simple measures or not to need treatment. The percentage of children who fail 'special' tests was high, because these children had either been referred specially because deafness was suspected or were already under treatment. It is hoped that in future audiometry as well as vision screening will be carried out in schools every two years independently of school medical inspections, and children who fail these screening tests will be referred for further investigation. Tables below give the numbers and results of audiometry tests during 1967:- Audiometer Tests - Routine Age Group 1st Tests sweep or gramophone Re-tests Failures % of Column 1 both one ear Total ears right left (1) (2) (3) (4) (5) (6) (7) Up to 7 years 2233 102 67 30 30 127 5.6 Intermediate 4406 175 108 45 72 225 5.1 Leavers 201 23 12 2 2 16 7.9 Totals 6840 300 187 77 104 368 5.3 Audiometer Tests - Specials Age 1st Tests Re-tests Failures % of Column 1 both ears one ear Total right left (1) (2) (3) (4) (5) (6) (7) Under 5 — - - - - - - 5 18 12 5 2 2 9 50.0 6 32 19 10 5 8 23 71.8 7 21 18 6 — 8 14 66.6 8 22 17 8 4 6 18 81.8 9 19 14 8 4 4 16 84.2 10 7 6 5 — 1 6 85.7 11 8 10 3 2 1 6 75.0 12 4 5 3 1 — 4 100.0 13 8 4 4 1 — 5 62.5 14 5 3 — 1 1 2 40.0 Over 14 7 2 - - 1 1 14.2 Totals 151 110 52 20 32 104 68.8 78 SCHOOL DENTAL SERVICE The Principal School Dental Officer reports for the year 1967 as follows:- The general pattern of the dental service as detailed in the reports of the two previous years has been maintained. Any direct comparison of the numbers of items of treatment set out at the end of this report with those of the previous years must be made taking full account of the fact that the number of treatment sessions was 670 fewer than in 1966 and 883 less than in 1965. Further explanation of this will be found later, but it is worthy of note that the 'productivity' of sessions again showed an advance. Inspection and Treatment The number of pupils on the school rolls on 31st December was 34391, just 22 more than in 1966. Routine dental inspections in schools occupied 211 sessions, as a result of which 18089 were inspected for the first time in the year, and a further 3759 were first inspected in the clinics. Together these total 21848, which is 63.5% of the total possible and is virtually the same as in the previous year. An additional 2880 were re-examined either at school or in clinics after having been inspected or treated earlier in the year. Of the total of 24728 first or re-examined, treatment was required by 15367 or 62.5%. This was exactly the same percentage as in the year 1965 and was higher than in 1966, when it seems likely thatthepercentage was lowered by the inspection in their due turn of a high proportion of schools with a better standard of dental health. The deplorably high incidence of dental decay is unlikely ever to be reduced to manageable proportions without the introduction of fluoridation, for which the Council have expressed their approval but which can not be implemented while contrary views are held in a minority of other places. Sessions devoted to treatment numbered 3132, during which total attendances were 26491 with a further 5131 appointments not kept. This latter figure was almost the same as in the previous year when a large reduction had been achieved from the introduction of a new system with that end in view, and appears to confirm the value of the change as a continuing benefit and not merely by chance in its first year of operation. It will be seen from the table at the end of this report that the large numbers of teeth fiIled— both permanent and temporary — and the even larger numbers of separate fillings done, heavily outweigh the numbers extracted, and that these latter are predominantly temporary teeth. Of the permanent teeth removed as unsavable, a pleasingly small total for so many patients treated in the year, a high proportion were for children recently resident in the Borough and mostly from other countries. Staffing (as at 31st December, 1967) (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 88% of our time. The balance is used for the priority classes reported upon elsewhere). We have again been fortunate in maintaining a relatively stable staffing position although, when recruitment to the public dental service has become more difficult than for some years past, there have been delays in filling posts which became vacant. Part of the reduction of sessions worked, as referred to in the opening paragraphs of this report resulted from this fact, and there have been occasions when one or more surgeries have been lying idle for some weeks before suitable appointments could be made. A further loss of sessions resulted from the lengthy illness of a dental officer who, it was hoped, would eventually return to duty. The greatest single loss of sessions as compared with the previous year resulted from our parttime orthodontist leaving England in the middle of January and our inability to find a replacement for the whole remainder of the year. 79 The report for 1966 made reference to the difficulties of the orthodontic service already becoming apparent in the face of increasing demand and expressed misgivings for the future, and the forecast was borne out by events. Our one orthodontist could not possibly cope with the demand, so that waiting lists for this form of treatment have become very long. Fortunately, a decision of the Council late in the year should now make it possible to fill the vacant post, so that the future again looks encouraging. Premises and Equipment Progress has been made towards the high standard of decoration and cleanliness appropriate to premises in which operative procedures are carried out and, together with work due to be done in the first three months of 1968, we should be beyond criticism in this respect. The resulting good impression made upon the children and parents who attend the clinic makes for better appreciation of the quality of the service available and encourages acceptance of very necessary, but not always popular, treatment. Our facilities and equipment are of a high standard and, although one must be realistic and not over ambitious when items are costly, we have been able to keep up to date in this respect. Investigation of Dental Service Following the full-scale routine investigation made by a dental officer of the Department of Education and Science and Ministry of Health in 1966, resulting in the highly successful report referred to last year, the same dental officer made a shorter and less formal visit early in 1967. Mr. Potter expressed himself as being welI satisfied with the findings and no official communication from the Department and Ministry was received. Details are given of the main items of treatment as follows:- Dental Inspections and Treatment Pupils first inspected at school 18,089 Pupils first inspected at clinic 3,759 Pupils re-inspected 2,880 Number found to require treatment 15,367 Number of fillings Permanent teeth 13,318 Temporary teeth 9,286 Number of teeth filled Permanent teeth 11,612 Temporary teeth 8,525 Extractions Permanent teeth unsavable 418 Permanent teeth orthodontia 227 Temporary teeth 3,623 General anaesthetics 1,347 Number of dentures supplied 21 Number of crowns and inlays 24 Number of teeth root filled 18 Number of prophylaxes 1,804 Number of teeth otherwise conserved 626 Other operations 5,087 Orthodontic Treatment Cases remaining from previous year 208 New cases commenced during year 82 Number of appliances fitted Removable 255 Fixed 15 Number of impressions, adjustments etc. 2,859 Number of radiographs 2,534 Appointments and Sessions Attendances for treatment 26,491 Appointments not kept 5,131 Number of half-day sessions devoted to Inspections in schools 211 Treatment 3,132 80 Child Guidance Service The Borough is served by two Child Guidance Centres - at Lordship Lane, Tottenham and at Tetherdown, Muswell Hill. Dr. Nina Meyer is consultant psychiatrist and medical director at Lordship Lane, and Dr. K.A. Graf at Tetherdown. Miss Gwen Kidgell is senior educational psychologist with overall responsibility for the administration of the child guidance and school psychological services. The staff of the service also includes two full-time and one part-time educational psychologists, three part-time psychotherapists, four part-time psychiatric social workers, two part-time social workers and six clerical assistants who between them work the equivalent hours of five full-time officers. Dr. Meyer reports as follows on the work at Lordship Lane:- "How to make the best use of the resources available for help for the disturbed child has been the chief concern of this Clinic during the past year. Perhaps because of increasing awareness of disturbance and its consequences, and the beneficial results of timely help, the number of referrals have increased greatly — the present average is 4 — 5 a week, over 200 new referrals a year. From 1st January 1968 to 29th February 1968, 54 cases have been referred compared with 35 in the same period of 1967. Preventive psychiatry as with all preventive medicine is, we feel, the most economic way of using our resources. The Clinic therefore, is tending to the approach of the Child Health Department and is dealing with childhood disturbance from birth to school leaving age, giving priority to the very young child. We hope in this way to modify patterns of disturbed reaction between mother and child before they are firmly established. Much malaise of the young infant stems from the mother's disturbance, of which depression is a frequent feature. To give help to the mother together with suggestions for the well being of her infant is often dramatically rewarding. Managing the anxieties of the very young mother is another rewarding measure. Two such mothers referred to the Clinic were under fourteen. Early discussion when making decisions for these girls might have been helpful in averting the later disturbance for which they were eventually referred. With the aim of using early psychiatric help to the greatest advantage, discussion groups this year have included Health Visitors, Nursery Matrons and Assistant Medical Officers. For the first time it is proposed to include a group of School Welfare Officers, since enlarging the scope of school welfare has been found to be a great help in averting delinquency and school refusal. The end result of such interactions at home and at school can be seen in the frequent gravity of the problems with which older children are referred for psychiatric help — attempted suicide (3), exclusion from school for dangerous violence (5). inability to go out of the house because of intense fear of the outside world (4), truanting (6). Together with preventive work aimed at the emotional aspects of disturbance, there has been in this Clinic an increasing awareness of the part played by unrecognised physical causes in many symptoms referred to the Psychiatrist; for example, pica, the eating of abnormal substances — dirt, sand or grit, has been frequently found associated with anaemia, behaviour problems in epileptic children have on occasion responded to change in medication which has affected metabolism. A child referred for hysterical symptoms was found to be suffering from hypoglycemia; abdominal pain with no organic cause, has responded to a non-purgative regime aimed at dealing with constipation. The agreement of the Hospital Management Committee to prescribing by the present writer has been of great assistance. The enthusiastic co-operation of co-workers in the field of Child Health, Child Care Officers. Probation Officers. School Welfare Officers. Nursery Matrons, Health Visitors, and our own Assistant Medical Officers, has greatly helped us; our team continues unchanged in personnel, but matured by another year of rich clinical experience." Dr. Graf reports as follows on the year's work at Tetherdown:- "This is my third report as Medical Director of the Tetherdown Child Guidance Centre, which was established at the time of the reorganisation of the London Boroughs. We can justly claim that this was a further year full of activity for the team of experts who have been co-operating and pooling their experience in the interest of the referred children and their parents and elders. The problems on which we are consulted are becoming increasingly more complex. The old pattern of family cohesion and parental authority has been loosened and modified by contemporary social trends, the increasing influence 81 of the mass media and the prosperity and tolerated independence of youth, who also challenge established codes and question traditions, Broken homes, irresponsible or mentally disturbed parents, housing shortage, communication difficulties between the generations, prejudices associated with migration, the reorganisation of education and lack of private or public funds can create difficulties for children, who will vent their feelings and express their insecurity through behaviour problems in home or school. These difficulties lead to their referral to our Clinic, but they are not always easily treated by the traditional child guidance methods because we have no control over social factors and the shortcomings of the responsible adults. It is for this reason, more than ever before, necessary for all referring parties to consider the competence of a child guidance clinic and not to expect a quick solution of problems which are produced by factors which can be dealt with more appropriately by other social agencies. Child Guidance is a highly specialised service which diagnoses and treats emotional disturbances of children who are creating problems in the family or at school. While many behaviour problems are caused by emotional maladjustment, not every difficult child is disturbed, and even when psychological factors are clearly operating in the causation of problems they are not always amenable to treatment. As I have tried to show in my report to you last year, / consider that the child is influenced in his behaviour by so many factors that only very careful investigation by several experts in different spheres of competence will be able to arrive at a reliable diagnosis. It is for this reason that our investigations seem to take a long time and our waiting lists are long. It occurs that referring bodies get impatient at the slowness of our procedure and the production of results. However, shortcut methods have been tried and were found to be unreliable, if not actually dangerous, because it must not be forgotten that the mental constitution of children is sensitive and highly delicate. It also happens that children are not usually referred to us before other well established methods of handling have been unsuccessfully tried. Added to this difficulty there is a perpetual shortage of staff which is not only caused by the limitations of public funds, but even more due to the extreme care that is necessary in selecting staff for appointment at the clinic, as certain minimal requirements of training and personality are essential and the second best will not do for children. The Child Psychiatrist (and his locum) saw 108 new cases and 15 reviews. He saw four children more regularly for treatment, while many more were seen at weekly intervals or more often by the psychotherapists who provide fairly intensive and deeper therapy. Apart from seeing the children and parents who were referred to us from the usual sources, as described in more detail previously, we spent some time in discussion of cases in interviews with Child Care Officers, Probation Officers, Wardens of Children's Homes and other experts in child and community care". Rheumatism Supervisory Centre The Rheumatism Supervisory Centre is held at the Prince of Wales's Hospital under the direction of Dr. I.M. Anderson, consultant paediatrician, with the close co-operation of the Health Department. One session is held each week. Originally the clinic was set up to deal with children suffering from acute rheumatism and its aftereffects, but its scope has widened to include the investigation of symptomless heart murmurs and cases of congenital heart disease. Dr. Anderson has supplied the following details of the year's work:- "During 1967 there were no new recorded cases of rheumatic fever. There were thirty-two new cases of cardiac murmurs referred from Welfare Clinics and General Practitioners. These cases are classified as follows — Patent Ductus Arteriosus 2 Aortic lesions 4 Ventricular septal defects 2 Auricular septal defects 5 Mitral stenosis 1 Innocent murmurs 18 Total 32 Of these thirty-two new cases, twenty-six are from the Borough of Haringey — eighteen male and eight female. Six came from other areas — two male and four female. 82 Three cases have been transferred to the Westminster Hospital to attend Dr. Anderson's Cardiac Clinic there for full investigation. Two patients have been discharged (innocent murmurs no longer audible)". Speech Therapy Miss J.D. Came, Senior Therapist, reports:- "One part-time therapist resigned in June. A full-time therapist was appointed in September. The appointment of a fourth part-time therapist in February 1968 makes 31 sessions now available. This represents a considerable improvement on the previous year. More treatment sessions were undertaken in 1967, and school visiting was resumed. This is much appreciated by school staff who, in turn, offer invaluable help. An increasing number of children of immigrants is seen. In such children it is important to differentiate a true language disorder from normal lack of skill in language acquisition. Stammering has been frequently found in children with histories of long separation from their parents, and language retardation is not unusual in children left with disinterested "minders". It has finally proved possible to start the pioneer project at Muswell Hill Training Centre for Handicapped Children. It is hoped much will be learnt about the development of communication skills in the mentally handicapped or cerebral palsied child." Milk In Schools Scheme Number of pupils supplied with 1/3rd pints of milk on an average day in the Autumn Term, 1967. Maintained Schools No. Present No. Taking Milk Infant & Nursery 7,755 7,735 Junior Schools 11,271 10,505 Secondary Schools 12,996 6,644 Total 32,022 24,884 Non-Maintained Schools Independent Schools 2,641 2,362 School Meals were served at 104 schools or departments Meals consumed by pupils on an average day in the Autumn Term, 1967. No. Present No. taking Paid Meals No. taking Free Meals Total Infant & Nursery 7,755 5,468 352 5,820 Junior Schools 11,271 8,196 610 8,806 Secondary 12,996 8,683 486 9,169 Total 32,022 22,347 1,448 23,795 Total number of meals prepared during year ended 31st December 1967, 4,677,700. (Including staff meals). Tuberculosis Prevention of Tuberculosis by B.C.G. vaccination. B.C.G. vaccination is offered to all school children over thirteen years. No further education students took advantage of the opportunity to have B.C.G. vaccination during the year. 83 The following table gives details of B.C.G. vaccinations carried out by the Council during 1967:- School Children Number %[#/##] Parents approached 2,961 Parents accepted 2,449 82.7 Number skin tested 2,313 Number found positive 257 11.1 Number found negative 1,958 84.7 Number failed to attend for Mantoux reading 98 4.2 Number vaccinated (% of those approached) 1,958 66.1 Cases of Tuberculosis occurring in Teachers or Pupils When a member of 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 infectious, but where it is steps are taken by a skin test and X-rays to determine whether any contacts are affected. During 1967 one investigation at a school was carried out. Children in five classes affected were skin tested; 106 tests were carried out in all and one child with a positive reaction was referred to the chest physician for further investigation. Infective Hepatitis An outbreak of infective hepatitis during the year enabled an experiment to be conducted in the usefulness of gamma globulin as a means of ending the outbreak. This investigation was carried out under the direction of the Public Health Laboratories at Colindale. Gamma globulin was offered to all members of the teaching staff and was given to the children born on odd dates in the four classes concerned - children born on even dates being used as "controls". All children with gastro-enteric symptoms were excluded from school for at least a week. No child given gamma globulin subsequently developed infective hepatitis. The height of the outbreak occurred in February and following the administration of gamma globulin the infection at the school died out by the Easter vacation. Details of the outbreak are as follows:- Number of cases 16 children, 3 adults Number given gamma globulin 76 children, 18 staff, 57 controls Uncleanliness and Verminous Conditions Regular hygiene inspections of schools are carried out by school nurses. While verminous heads are now rather the exception than the rule, careful watch is kept to prevent the spread of infection. The following details are submitted concerning hygiene inspections carried out in 1967:- Number of individual examinations of pupils in schools by school nurses 62,051 Number of individual pupils found to be infested 190 Ringworm of the scalp During the year 19 cases occurred sporadically in six 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 affected school in order to exclude contact cases. All doubtful cases were referred to the consultant dermatologist at the Prince of Wales's Hospital for further investigation. Verrucas During the year a special clinic was set up at Weston Park Medical Centre to deal with intractable cases. The medical officer who conducts the clinic has made a study of plantar warts in school children under the supervision of the consultant dermatologist at the Prince of Wales's Hosp.ital. Where necessary, diathermy under local anaesthetic is carried out. The object of this special clinic is to provide treatment which is usually only available at hospital out-patient departments where waiting lists are long. Children will therefore obtain treatment more quickly and will be absent from school for shorter periods. 84 The carrying out of physical education in bare feet is still a matter of controversy. At the moment one of the school medical officers is carrying out a controlled survey in four schools in the Borough in an attempt to decide the relative merits of bare feet versus gym shoes. Handicapped Pupils The Education Act 1944 places on local education authorities the duty of ascertaining handicapped pupils in their areas and of providing special educational treatment for such children. Though it is the duty of the local authority to ascertain these children from the age of two years, it is often desirable, especially in the case of blind, deaf or cerebral palsied children, that the defect be discovered before this age, so that steps may be taken to help the child to develop as normally as possible despite his handicap. The School Health Service and Handicapped Pupils Regulations 1959 defined the various categories of handicapped pupils as follows:- Blind Epileptic Partially Sighted Maladjusted Deaf Physically Handicapped Partially Hearing Delicate Educationally Subnormal Children suffering from speech defects Pupils handicapped by severe blindness or deafness are normally educated in special schools. Special educational treatment may be provided for other categories in an ordinary school with special consideration appropriate to the disability. Where this is not appropriate arrangements are made for handicapped children to attend day or residential special schools. There are increasing numbers of handicapped children with more than one disability who do not fal I clearly in one category. There is increasing need for facilities to assess the needs of these children and to supply the appropriate education and treatment. An example is the physically handicapped deaf child. Home tuition may be arranged on a temporary or permanent basis for children unsuitable for education at school. The following table shows the number of pupils newly ascertained as handicapped, and newly placed in special schools during the year, and the distribution of ascertained handicapped children on 18th January 1968:- 85 86 RETURN OF ASCERTAINED HANDICAPPED PUPILS REQUIRING SPECIAL EDUCATIONAL FACILITIES CATEGORY IN THE CALENDAR YEAR DISTRIBUTION ON 18TH JANUARY 1968 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 Indepen- Day Boarding Day Boarding Schools Day Boarding Boys Girls Boys Girls B G B G B G B G B G B G B G B G B G B G Blind Pupils 1 - 2 - - - 3 1 - - 3 - - 1 - - - - - - - - 6 2 Partially Sighted Pupils 3 2 2 1 7 3 - - - - 1 2 - - 3 1 - - - - - - 11 6 Deaf Pupils - 4 1 1 6 10 2 - - - 2 3 - - - 1 - - - - - - 10 14 Partially Hearing Pupils 2 3 1 5 9 15 - - - - - - - - - - - - - - - - 9 15 Physically Handicapped Pupils 13 6 13 4 33 23 1 - - - 5 3 - - 3 2 - - - - - - 42 28 Delicate Pupils 12 12 9 5 15 19 13 8 - - 2 - 1 - - 1 1 - - - - - 32 28 Maladjusted Pupils 18 4 16 4 - - 9 - - - 23 7 12 2 1 - 5 1 - - 1 - 51 10 Educationally Subnormal Pupils 42 25 31 19 112 67 7 4 3 1 3 2 1 - 23 13 - 1 - - - - 149 88 Epileptic Pupils - - - - - - - - - - 1 - - - - - - - 1 - - - 2 - Pupils with Speech Defects — 1 - - - - - - - - - - - - - - - - - - - - - - Totals 91 57 75 39 182 137 35 13 3 1 40 17 14 3 30 18 6 2 1 - 1 - 312 191 Grand Totals 148 114 319 48 4 57 17 48 8 1 1 503 Special School Provision (a) Day Special Schools There are two day special schools in the Borough - Vale Road School for Physically Handicapped Children, and the Blanche Nevile School for the Deaf. Units for partially hearing children at Devonshire Hill Infants, Risley Avenue Junior and Drayton Comprehensive Schools are attached to the Blanche Nevile School. The children at these units need special teaching because of their hearing difficulty but are otherwise fully integrated with ordinary school life. Of the 88 children on the roll at Vale Road Special School 54 were Haringey children and 34 children from other boroughs. Of the 129 children on the roll at Blanche Nevile School (including the partially hearing units), 40 were Haringey children and 89 from other boroughs. Day special school facilities for children in other categories have to be sought outside the Borough. It is a matter of some concern that places must be sought for educationally subnormal children at either Durants School or Oaktree School in Enfield or Oak Lodge School, Finchley. At present there are 42 Haringey children at Durants, 41 at Oaktree and 80 at Oak Lodge. There are 36 Haringey children at present on the waiting list for admission to these schools. There is thus an acute shortage of places available for children ascertained as educationally subnormal and an urgent need for 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 New River School, Islington Delicate Hazelbury Open Air School, Edmonton (b) Residential Special Schools The one residential special school belonging to the Borough is Suntrap Open Air School at Hayling Island, Hants. This 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 disability. There is a resident staff including a night nurse. A medical practitioner attends twice a week and a dental officer once a week. The school accepts boys at 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 1967 was 91, of whom 18 were Haringey children and 73 from other boroughs. The following were the defects for which the Haringey children required placement:Asthma 9; Bronchitis 3; physical and nervous debility 3; Recurrent respiratory infections 2; Cystitis 1. Blindchildren areplaced at special residential schools, mainly at Dorton House School, Sevenoaks, or Linden 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 in hospital 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:- "Tuition is provided for children who are in-patients at St. Ann's and Prince of Wales's General Hospitals under Section 56 of the Education Act 1944. At St. Ann's Hospital a classroom is established in one of the children's wards, and individual teaching takes place in other wards and at the Prince of Wales's Hospital. The average number of children receiving tuition at any one time is 36". 87 Co-ordination of Education, Health and Welfare Services In continuation of the policy set forth in my report last year, a register is maintained of all handicapped children and young people between the ages of 13 and 20. Efforts have been made further to improve liaison with hospitalsand general practitioners. The appointment of a social worker (Health Services) to this Department has been agreed and it is hoped that she will be appointed early in the New Year.. The aim of this appointment is to improve knowledge of and contact with the families of handicapped children. Every effort is made to pass on information concerning handicapped pupils to the Chief Careers Officer as early as possible after the child's fourteenth birthday. Special Classes attached to Ordinary Schools Inaddition 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 1967, the number of children attending full-time 'Opportunity' classes was 58. There are also five peripatetic remedial teachers who take children either individually or in small groups for specific help with reading. Home Tuition During the year seven children received home tuition for varying periods under Section 56 of the Education Act 1944 when they were not well enough to attend school for a prolonged period. 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, partially-sighted, physically handicapped, maladjusted. (ii) Mentally handicapped children under five years of age. (iii) Children over one year of age of deaf or deaf/mute mothers. No charge is made to the parents of these children. For children in category (i) over the age of two years the cost of attendance is borne by the Education Committee, under Section 56 of the Education Act 1944. Other cases are dealt with under Section 22 of the National Health Service Act 1946. Admission may be for the whole or part of the day. During 1967 thirteen Haringey children and two children from other boroughs were in attendance at day nurseries in the Borough under these arrangements. At the end of the year ten Haringey children were still in attendance. Recuperative Holidays During 1967 18 boys and 25 girls were recommended for recuperative holidays in order to assist their recovery after illness. 13 boys and 16 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 five local school children who died during 1967:- Sex Age Cause of Death M 6 Leukaemia F 5 Leukaemia M 14 Congenital Heart Defect F 15 Road Accident F 11 Cystic Fibrosis 88 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 and 1967:- "The continuing rise in the number of accidents involving child pedestrians — 134 in 1965, 193 in 1966 and 216 in 1967 — is the one black spot in an otherwise encouraging picture over this period when the total number of road accidents in the Borough decreased by 12%. A detailed study of these accidents to child pedestrians shows: (a) that 5-10 years were the ages most involved (b) that Saturday was the most dangerous day (c) that the period 4.30—9.0 p.m. was the most dangerous time of the day (d) that boys are nearly twice as vulnerable as girls:- Fatal Serious Slight Total 1966 1967 1966 1967 1966 1967 1966 1967 Girls nil nil 12 19 57 58 69 77 Boys nil nil 30 30 94 109 124 139 nil nil 42 49 151 167 193 216 (e) that the principal causes were 1966 1967 Running across or into the road 105 130 Walking or stepping into the road 46 26 Crossing road from between or behind stationary vehicles 32 30 Other causes 10 30 Conclusion It is apparent that road safety education is most necessary in the primary schools, 21 of which were completely free from accident during the school year 1965/66 and only 14 in 1966/67. The teaching of Kerb Drill is of vital importance and its strict application would result in a substantial reduction in the number of accidents to child pedestrians. As most accidents occur after 4.30 p.m. when children are at play or running errands, parents must recognise and accept their responsibility for the safety of their children outside school hours." LIST OF SCHOOL HEALTH CLINICS AS AT 31st DECEMBER, 1967 a - School Advice e - Orthopaedic i - Ear, Nose & Throat b - Dental f - Physiotherapy j - Audiology Unit c - Ophthalmic g - Cerebral Palsy Unit k - Child Guidance d - Orthoptic h - Speech I - Chiropody a All Saints' Church Hall, 11 Church Road, N.6. j Blanche Nevile School for the Deaf, Philip Lane, N.15. 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. abcdefhil Medical Centre, rear of Hornsey Town Hall, 23a Weston Park, N.8. dfgh Vale Road School for Physically Handicapped Children, N.4. 89 APPENDIX SCHOOL HEALTH SERVICE STATISTICS FOR 1967 SCHOOL HEALTH SERVICE STATISTICS 1967 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 1963 & Later 7 32 34 1962 71 223 258 1961 109 281 363 1960 105 182 263 1959 163 196 315 1958 74 119 171 1957 50 51 88 1956 13 25 35 1955 138 145 241 1954 82 68 131 1953 18 25 36 1952 & earlier 485 209 633 Total 1,315 1,556 2,568 Defect Code No. Defect or Disease Periodic Inspections Special inspections Entrants Leavers Total including all other age groups inspected T O T O T O T O 4 Skin 54 123 84 99 294 484 730 29 5 Eyes (a) Vision 149 155 494 90 1315 596 375 142 (b) Squint 30 19 3 2 77 44 7 3 (c) Other 6 14 3 7 42 59 45 2 6 Ears (a) Hearing 17 56 14 16 88 209 69 51 (b) Otitis Media 6 44 6 10 25 107 1 6 (c) Other 3 12 3 3 21 55 76 11 7 Nose and Throat 68 320 10 47 201 775 99 75 8 Speech 35 76 2 10 6 156 30 23 9 Lymphatic Glands 1 96 1 7 5 240 - 11 10 Heart 2 56 4 39 18 179 13 16 11 Lungs 27 105 4 39 68 298 34 38 12 Developmental: (a) Hernia 7 27 1 3 19 94 2 6 (b) Other 1 61 1 14 13 199 17 67 13 Orthopaedic: (a) Posture 9 19 12 32 59 122 10 16 (b) Feet 93 115 65 92 449 465 48 28 (c)Other 14 48 11 22 77 156 64 8 14 Nervous System (a) Epilepsy 3 14 3 4 22 34 4 3 (b) Other 4 10 4 10 17 45 13 10 15 Psychological: (a) Development 4 58 6 18 27 121 85 58 (b) Stability 16 207 5 36 98 545 96 52 16 Abdomen 3 22 - 13 9 103 4 9 17 Other 3 16 2 2 27 50 171 56 T - Requiring Treatment O - Requiring Observation 90 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 81 (b) Errors of refraction, including squint 2,780 Total 2,861 (c) Number of pupils for whom spectacles were prescribed 842 GROUP 2. Diseases and Defects of Ear, Nose and Throat Received operative treatment for:- (a) Diseases of the ear 2 (b) Adenoids and Chronic Tonsilitis 324 (c) Other nose and throat conditions 12 Received other forms of treatment 358 Total 696 Total number of pupils still on the register of schools at 31st December, 1967 provided with hearing aids: (a) During the current year 29 (b) In previous years (excluding any pupils shown at (a) above who were provided with an aid in a previous year) 36 GROUP 3. Orthopaedic and Postural Defects Number of pupils known to have been treated at clinics or at out-patients departments 1,094 GROUP 4. Diseases of the skin (excluding uncleanliness) Ringworm (i) Scalp 19 (ii) Body - Scabies 1 Impetigo 2 Other skin diseases 791 Total 813 GROUP 5. Child Guidance Treatment Number of pupils treated at child guidance clinics (Including cases sent to the Tavistock and other hospital clinics) 247 GROUP 6. Speech Therapy Number of pupils treated by speech therapists 230 GROUP 7. Other Treatment given (a) Number of miscellaneous minor ailments treated by the Council 42 (b) Pupils who received convalescent treatment under School Health Service arrangements 29 (c) Pupils who received B.C.G. vaccination 1,958 (d) Treatment other than (a), (b), and (c) above 218 91 EDUCATION ACT 1944 - SECTION 57 Cases dealt with under Section 57, Education Act 1944 9 Cases de-notified under Section 8, Education (Miscellaneous Provisions) Act 1948 - MEDICAL EXAMINATION OF TEACHERS (a) Number of Teachers examined as to fitness for first appointment 164 (b) Number of Students examined as to fitness to undertake training course 195 (c) Number of Students examined on completion of training course at Hornsey College of Art 46 92 INDEX Page No. Abatement of Statutory Nuisances 26 Accidents to School Children 89 Adult Training Centre 68 Advice Clinics for the Elderly 61 Analysis of Contraventions found in Offices and Shops 47 Analysis of Reported Accidents in Offices and Shops 48 Ante-Natal Clinics 51 Arnold Road Improvement Area 31 Atmospheric Pollution, Investigation of 19 Audiology Unit 76 Audiometry 78 Bacteriological Examination, Sampling for 39 Births, Notification of 51 Carcases inspected 45 Care of Mothers and Young Children 51 Cerebral Palsy Unit 75 Certificates of Disrepair 34 Cervical Cytology 52 Child Health Centres 53 Child Guidance Service 81 Child Minders 56 Chimney Heights 19 Chiropody Service 62 Clearance of Areas of Unfit Houses 28 Cleansing and Disinfection 23 Clinics, School Health 89 Daily Guardian Scheme 56 Day Nurseries 55 Day Nurseries, Admission of Handicapped Children 88 Day Nurseries, Private 56 Deaths of Haringey Residents 7 Deaths of School Children 88 Defects found in factories 50 Defects remedied 25 Dental Care of Priority Classes 56 Dental Inspection and Treatment 79 Dental Statistics 57,80 Diseases of Animals Act 1950 27 Disrepair, Certificates of 34 Domestic Help Service 60 Drainage and Sewerage 15 Dysentery 11 Ear, Nose and Throat Clinics 76 Education Committee 71 Education, Health and Welfare Services, Co-ordination of 88 Page No. Factories 49 Factories, Defects found in 50 Family Planning 51 Food Complaints 42 Food Hygiene 37 Food Poisoning 10 Food Premises, Registered 37 Food, Sale of from Mobile Units 38 Food and Drug Sampling 39 Foot and Mouth Disease 27 Furnace Installations 19 Hairdressers 48 Handicapped Pupils 85 Handicapped Register, chiIdren on 55 Health Education 64 Health Visiting Service 58 Health and Welfare Committee 1 Home Nursing Service 59 Home Tuition 88 Hospital Classes 87 Housing 28 Housing Applications, Assessment on medical grounds 33 Houses in Multiple Occupation 31 Immunisation against Diphtheria, Whooping Cough, Tetanus and Poliomyelitis 14 Improvement of Houses not in an Improvement Area 31 Infant Welfare Clinics 53 Infectious Diseases 9 Infectious Diseases, Notification of, sex and age group 8 Infective Hepatitis 9,84 Insect Pests 23 Inspections carried out by Public Health Inspectors 24 Laundry Services for Incontinent 23 London Housing Survey 34 Malaria 10 Mass Radiography 12 Massage and Special Treatment 62 Meat Inspections 45 Medical Inspections in Schools 73 Mental Health Services 65 Mental Health Year 67 Mental Health Statistics 69 Midwifery Service 57 Midwives Ante-natal Clinics 52 Milk and Dairies Regulations 38 Milk in Schools Scheme 83 Mortuary 23 Mothercraft and Relaxation Classes 53 Mothers and Young ChiIdren, Care of 51 Multiple Occupation, Houses in 31 National Assistance Act 1948, Section 47 61 Neighbourly Help Service 60 Noise 26 Page No. Observation Register, Children on 54 Offices, Shops and Railway Premises Act 1963 45 Ophthalmic Clinics 74 Orthopaedic Clinics 75 Outworkers 50 Paratyphoid Fever 10 Pet Shops and Animal Boarding Establishments 27 Play Groups 56 Problem Families, Co-ordinating Committee 59 Psittacosis 11 Psychiatric Rehabilitation Association Day Centre 65 Purchase of Houses ih advance of Council's requirements 30 Radioactive Substances Act, 1960 51 Rag Flock and Other Filling Materials Act, 1951 26 Recuperative Holidays 61 Registered Food Premises 37 Rheumatism Supervisory Centre 82 Ringworm 84 Rodent Control 21 Sanitary Circumstances of the Area 15 School Dental Service 79 School Health Service 73 School Meals 83 School Population 73 Shops Act 1950 — 1966 48 Sick Pay Reports 63 Smallpox 10 SmalIpox, Vaccination against 13 Smoke Control Areas 19 Special School Provision 87 Speech Therapy 83 Staff 2,3,4 Staff Medical Assessments and Examinations 63 Statistics, Dental 57,80 Statistics, School Health 90 Statistics, Vital 5 Statutory Notices Served 25 Statutory Nusiances, Abatement of 26 Street Trading 49 Swimming Baths and Paddling Pools 19 Toddlers Clinics 54 Tuberculosis 11,83 Tuberculosis Patients, Extra nourishment for 61 Tuberculosis Rehabilitation 61 Typhoid Fever 10 Uncleanliness and Verminous Conditions 84 Unfit Houses, 28 Unsound Food surrendered or condemned 44 Uplands Road Improvement Area 30 Unsupported Mothers, Care of 62 Page No. Vaccination against Smallpox 13 Venereal Diseases 15 Verrucas 84 Vital Statistics 5 Water Supplies 16 Welfare Foods, Distribution of 56 Work executed by the Council 26 Printed by the Haringey Libraries Department