HAR 5 HARINGEY HEALTH IN 1969 The Annual Report of the Medical Officer of Health & Principal School Medical Officer. LONDON BOROUGH OF HARINGEY of the Medical Officer of Health TOTTENHAM TOWN HALL, THE GREEN, N.I5 TELFPHONE: 01-808 1000 HARINGEY HEALTH IN 1969 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 on the health of the Borough of Haringey for the year ended 31 st December 1969. During the year considerable thought and energy has been spent in the development of the Council's new management structure, which brings the former Health Department under the co-ordination of the Director of Social Services in accordance with the recommendations of the Maud Report, although this arrangement may have to be modified in view of the Social Services Act which requires the separation of Social Services from Health. The report has been divided into four sections: Environmental Health and Infectious Disease; Personal Health Service; School Health Service; and Social Services; which brings it into^line with recent thinking "about the future of Health Departments. The Social Services and the Junior Training School will transfer from Health to Social Services and Education respectively by 1971 and if the second green paper is accepted the Personal and School Health Services will eventually transfer to an Area Health Board. The local authorities will, however, retain responsibility for the very important control of the Environment. An important event in 1969 was the opening of a Health Centre at Stuart Crescent, Wood Green. The new Health Centre replaces the former school clinic and it provides a comprehensive service to include the personal health services of the Local Authority and the general medical services offered by nine general practitioners. The Stuart Crescent Health Centre is the Council's first Health Centre. The immediate advantage is the provision of new premises for the health services, but long-term advantages should bring a better and more productive co-operation between the general practitioners and the various services now provided by the Local Authority. In 1965 the Council considered the fluoridation of drinking water in the interest of better dental health and decided to support the idea. The Ministry of Health took no action and at a subsequent debate on the same subject in 1969 the Council reversed the previous decision. Fluoridation is not likely to be achieved at this rate of progress which now compares unfavourably with the long debate on the pasteurisation of milk or the protracted history of smallpox vaccination, so well described by Dr. Orton later in this report. In the meantime a small number of parents now give fluoride tablets to their children with beneficial results to their dental health. The Council has given encouragement to the Family Planning Association by way of increased financial assistance and the use of clinic premises, so that in addition to the customary services, there are now facilities for unmarried women and an effective domiciliary family planning team has passed its pilot scheme phase. The Council has been selected as an authority eligible for Urban Aid and progress has been made with the upgrading of pavilions in Markfield and Down Lane Parks so that they can be used by play groups during the week. In the evenings and at weekends the same premises are used for recreational purposes by adults. This is a valuable use of the Urban Aid scheme and helps the public to make even better use of the Council's parks. In conclusion I wish to record my thanks to Councillors Mrs. Cooper and Mrs. Levinson, Chairmen of the Social Services Committee and the Health Services Panel, and to the members, for their encouragement and support. My thanks are especially due 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 SOCIAL SERVICES COMMITTEE Alderman C.C. Chalker, B.A. (Cantab) Councillor Mrs. L.A. Angell S.M. Ayres Mrs. H.M. Bavin D. Beale Mrs. J. Cooper (Chairman) Mrs. E.M. Donno Mrs. D.C. Findley E.C. Godfrey Mrs. C.J. Levinson D.J. Patrick (Until December 1969) Mrs. Brenda S. Remington, B.A. A.E. Roy, M.lnst.Pkg. S.A. Shrank C.W. Ware Sir Robin Williams, Bt., M.A. (Vice Chairman) HEALTH SERVICES PANEL Councillor S.M. Ayres E.C. Godfrey Mrs. C.J. Levinson (Chairman) Mrs. Brenda S. Remington, B.A. Miss J.R. Tarris (Vice Chairman) STAFF OF HEALTH DEPARTMENT AS AT 31.12.69 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. Departmental Medical Officers Manju Chakrabarti, M.B., B.S., M.Sc., (Calcutta) 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. K.G. Ghattas, M.B., B.Ch.(Cairo) in M.S.S.A., D.P.A., D.T.M.a.H. Joan F. NicholIs, M.B., B.S., D.C.H., D.P.H. K.V. Shah, M.B., B.S. (Bombay) D.P.H. Part Time:- Elizabeth A.S. Carrington, M.B., B.S., M.R.C.S., L.R.C.P. Margaret Kirk, M.B., B.S., D.C.H. Anne W. Birt, M.B., B.S., D.R.C.O.G. Mavis M. Conway, M.B., B.Ch., D.R.C.O.G., D.C.H. 7 sessional Chief Dental Officer and Principal School Dental Officer G.C.H. Kramer, L.D.S., R.C.S. Dental Officers N. Ansbergs, D.D.D. Alison G. Little, L.D.S., R.C.S. A.H. Landsman, L.D.S., R.C.S. Part Time:- Mrs. M.P. Antonieviez, B.D.S. Miss D. Saxon, L.D.S., R.C.S. R.P. Bacon, B.D.S. 7 sessional dentists Orthodontists T.J. Combes, B.D.S., D.Orth., R.C.S. Joy Maclnerney, L.D.S., D.Orth., R.C.S., B.D.S. 1 specialist dental surgery assistant 12 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 Renee Boyd, S.R.N., S.R.F.H., H.V. Dulcie Carlow, S.R.N., S.R.F.N., S.C.M., H.V. Elsie T. Clarke, S.R.N., S.R.F.N., T.A., H.V. Mary A. Grimm, S.R.N., S.R.F.N., S.C.M., H.V. Ruth A.H. Jones, S.R.N., S.C.M., H.V. Jeanette Hendon, S.R.N., H.V. Betty M. Mclver, R.G.N., S.C.M., H.V. Kathleen Noolan, S.R.N., S.C.M., H.V. Vacancy for senior Health visitor; 13 health visitor/school nurses; 3 sessional health visitor/school nurse; 3 vacancies; 5 student health visitor; 3 T.B. health visitors/1 vacancy clinic nurses; 1 sessional clinic nurse; 1 vacancy; 4 day nursery matrons; 3 deputy matrons; 1 vacancy wardens; 3 vacancies; 16 staff nursery nurses; 2 part-time staff nursery nurses; 6 vacancies; 1 nursery assistant; 1 part-time nursery assistant. IMon-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. 15 midwives Deputy Superintendent of Home Nurses Berthe F. Specht, S.R.N., S.C.M., Q.N. 27 home nurses; 4 part-time home nurses: 3 bath unit attendants. 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 S.A. Cundale, S.R.N. 2 senior mental welfare officers: 6 mental welfare officers: 2 vacancies. Home Help Organiser Judith E. Caplin, D.I.H.H.O. 4 assistants: 237 home helps: 12 neighbourly helps. Sheltered Workshops Manager/Instructor: C.A. Towner 1 assistant Manager/Instructor Hamilton Hogben Adult Training Centre Supervisor/Instructor: N. Green, Dip. N.A.M.H. 1 Senior Instructor, 1 vacancy, 6 Instructors 3 Linden House Hostel Warden: C.H. Knowlden Day Centre for Aged Mentally III Supervisor: Miss M. Dubos, R.M.N. Medical Auxiliaries 2 physiotherapists 1 occupational therapist 3 speech therapists (sessional): 2 vacancies 2 orthoptists 3 screening technicians 20 chiropodists (sessional) 1 play therapist. Social Workers Avril I.C. Duthie, A.I.M.S.W. Joyce E.R. Murdoch, S.R.N., S.R.F.N., H.V. Mercy N. Kalu, S.R.N., S.C.M., Q.N., H.V. Ruth Wainwright (part-time) N.S.C.P. Frances J. Lassalle, R.M.N., R.G.N., S.C.M. Playgroup Supervisor Muriel H. Henderson Health Education Officer Sheila M.P. Frost, S.R.N., S.C.M., H.V., D.H.E. 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. 20 public health inspectors: 3 vacancies: 9 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 4 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 Building and Transport Division: N.P. Child (Divisional Head) L.E. Wells (Section Head) J.W. Bailey (Section Head) 8 clerical assistants: Prevention, Care, After care and Mental Health Division: P.V. Ingram (Divisional Head) Hazel Gill (Section Head) Hetty L. Somers (Section Head) 8 clerical assistants: 1 vacancy. Child Health and Domiciliary Care Division: H.J. Dunham, B.A. (Divisional Head) S.E. Woodroffe (Section Head) J.C. Day (Section Head) 29 administrative and clerical assistants: 9 part-time clerical assistants: Environmental Health and Infectious Diseases Control Division: A.W. Lawrence, M.A.P.H.I. (Divisional Head) H.C.B. Wheal (Section Head) H.P. Bradford (Section Head) 11 administrative and clerical assistants: 1 vacancy. Secretariat A. Balls (Section Head) Mrs. F. Morfill (Supervisor of Typing Section) Florence Wetherall (M.O.H's Secretary) 5 administrative and clerical assistants: 8 shorthand-typists: 1 part-time shorthand-typist: 2 copy-typists: 1 part-time copy typist: 1 vacancy: 1 machine operator. VITAL STATISTICS 1968 1969 Area of District (in acres) 7,491 7,491 Population - Mid-year: Registrar General's estimate 245,270 242,300 Rateable Value as at 1st April £13,658,588 £13,696,189 Sum represented by penny rate £54,600 £54,500 Approximate number of separately rated dwellings in district 72,279 72,395 Registered live births: Males 2,663 2,436 Females 2,457 2,317 Total 5,120 4,753 Birth Rate per 1,000 estimated population 20.87(16.9)* 19,62(16 3)* No of live births which were illegitimate 694 645 (13.75%) (13 57%)(8%) Stillbirths: Males 45 41 Females 41 18 Total 86 59 Stillbirth rate per 1,000 total (live and still) births 16.52(14)* 12.26(13)* No. of stillbirths which were illegitimate 16 10 (18.60%) (16.95%) Deaths: Males 1,456 1,484 Females 1,511 1,436 Total 2,967 2,920 Death rate per 1,000 estimated population 12.10(11.9)* 12.05(11.9)* Maternal Mortality: Deaths from Puerperal Causes 2 2 Death rate per 1,000 total (live and still) births 0.384 0.416 Deaths of infants under 1 year of age (Infant Mortality) (a) Legitimate: Males 60 44 Females 38 34 Total 98 78 Death rate per 1,000 legitimate live births 22.14 18 99 (b) Illegitimate: Males 12 10 Females 4 11 Total 16 21 Death rate per 1,000 illegitimate live births 23.05 32.56 (c) Total: Males 72 54 Females 42 45 Total 114 99 Death rate per 1,000 total live births 22.27(18)* 20 83(18)* Deaths of Infants under 4 weeks (Neo-natal Mortality) 80 62 Rate per 1,000 live births 15.62(12.3)* 13.04(12)* Deaths of Infants under 1 week (Early Neo-natal Mortality) 71 50 Rate per 1,000 live-births 13.87(10.5)* 10.52(10)* Stillbirths and deaths under 1 week (Perinatal Mortality) 157 109 Rate per 1,000 live and still births 30.16(25)* 22 65(23)* NOTE: The figures in parenthesis marked * indicate the rates for England and Wales, 6 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 adjusted specifically to take account of the presenceof residental institutions in the area. To compare the crude 1969 rates for Haringey with the national rates, Haringey's figures must first be multiplied by the appropriate comparability factors, which are 0.92 for births and 0.96 for deaths. After making these adjustments to the local rates, the birth rate for Haringey is 11% above, and the death rate is 2% below, the national rates. Classification of Deaths The Registrar General has analysed the 1969 deaths by causes which are classified according to the International Abbreviated List of 50 causes (B.List) of the Eighth Revision of the International Classification of Diseases but with some sub-divisions, to improve comparability with the classification used before 1968. 7 8 CLASSIFIED DEATHS OF HARINGEY RESIDENTS SHEWING AGE GROUP AND SEX DISTRIBUTION 1969 DISEASE TOTAL Under 4 weeks 4 Weeks & under 1 year 1-4 5-14 15-24 25-35 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 B2 Typhoid Fever 1 - - - - - - - - - - - - - - - - - - - - - - - B4 Enteritis and Other Diarrhoeal Diseases 2 4 - 1 1 - 1 1 - - - - - - - - - - - - - 1 - 1 B5 Tuberculosis of Respiratory System 10 1 - - - - - 1 - - - - - - - - 2 - 4 - 1 - 3 - B6 Other Tuberculosis, including Late Effects 3 1 - - - - - - - - - - - - - - 1 - 1 - - 1 1 — B14 Measl es 2 - - - - - - - - - - - - - - - - - - - - - - - B18 Other Infective and Parasitic Diseases 1 4 - 1 - - - - - - - - - 1 - 1 - - - 1 - - 1 - B19(1) Malignant Neoplasm, Buccal Cavity etc. 7 6 - - - - - - - - - - - - - - 1 - 2 - 1 1 3 5 B19(2) Malignant Neoplasm Oesophagus 6 2 - - - - - - - - - - - - - - - - 2 1 2 1 2 - B19(3) Malignant Neoplasm, Stomach 50 29 - - - - - - - - - - - 1 - - 2 2 21 6 15 7 12 13 B19(4) Malignant Neoplasm, Intestine 37 54 - - - - - - - - - - - - 3 - 2 - 8 12 9 20 15 22 B19(5) Malignant Neoplasm, Larynx 4 - - - - - - - - - - - - - - - - - - - 2 - 2 - B19(6) Malignant Neoplasm, Lung, Bronchus 141 25 - - - - - - - - - - - 1 - - 11 4 46 8 60 6 24 6 B19(7) Malignant Neoplasm, Breast 1 70 - - - - - - - - - - - 2 - 3 - 16 - 18 1 17 - 14 B19(8) Malignant Neoplasm, Uterus - 17 - - - - - - - — - 1 - 1 - - - 4 - 5 - 4 - 2 B19(9) Malignant Neoplasm, Prostrate 18 - - - - - - - - - - - - - - - - - 2 - 4 - 12 - B19(10) Leukaemia 8 9 - - - - - - - 1 - 1 - - - 1 1 1 3 2 1 2 3 1 B19(11) Other Malignant Neoplasms 81 78 - - - - - 1 - 1 - 2 - 1 3 3 9 6 21 15 32 17 16 32 B20 Benign and Unspecified Neoplasms 2 1 - - - - - - - - - - - - - 1 1 - - - - - 1 - B21 Diabetes Mellitus 7 20 - - - - - - - - - - - - - - 1 1 - 3 3 4 3 12 B46(1) Other Endocrine etc. Diseases 3 7 1 - 1 - - - - - - - - - - - 1 - - 1 - 3 - 3 B23 Anaemias 2 10 - - - - - - - - - - - 2 - - - - - - - 1 2 7 B46(2) Other Diseases of Blood etc. 1 1 - - - 1 — - - - - - - - - - 1 - - - - - - - B46(3) Mental Disorders 4 5 - - - - - - - - 2 - - - - - - - - - - - 2 5 B24 Meningitis 2 - 1 - - - 1 - - - - - - - - - - - - - - - - - B46(4) Other Diseases of Nervous System, etc. 30 24 - - 1 2 - - - - - - 1 - - 1 1 3 5 3 9 6 13 9 B26 Chronic Rheumatic Heart Disease 15 21 - - - - - - - - - - - - - - 4 3 7 5 3 10 1 3 B27 Hypertensive Disease 23 31 - - - - - - - - - - - - 2 - 4 1 3 3 6 8 8 19 B28 Ischaemic Heart Disease 397 269 - - - - - - - - - - 2 - 12 - 40 6 114 19 124 77 105 167 B29 Other forms of Heart Disease 57 99 - - - - - - - - - - 2 - 2 1 2 2 5 4 12 12 34 80 B30 Cerebrovascular Disease 125 222 - - 1 - - - - - - 1 1 2 2 3 5 4 19 18 38 55 59 139 B46(5) Other Diseases of Circulatory System 42 76 1 - - - - - - - - - 1 - - 1 3 3 5 4 9 12 23 56 B31 Influenza 8 12 - - - - - - - - - 1 - - - - - 3 4 2 2 2 2 4 B32 Pneumonia 91 106 3 3 5 4 2 - 1 - 1 - 1 - 1 - 2 2 11 3 12 18 52 76 B33(1) Bronchitis and Emphysema 126 47 - - 1 - - - - - - - - - 1 2 3 - 30 8 47 15 44 22 B33(2) Asthma 2 2 - - - - - - - - - - - - - - 1 - 1 2 - - - - B46(6) Other Diseases of Respiratory System 13 13 - - 3 1 - - - 1 - - - - 1 - 1 - 2 1 2 3 4 7 B34 Peptic Ulcer 9 11 - - - - - - - - - - 1 - - - 1 - 2 1 2 1 3 9 B35 Appendicitis 1 2 - - - - - - - - - - - - - - - 1 - - 1 1 - - B36 Intestinal Obstruction and Hernia 4 11 - - 1 - - - - - - - - - 1 - - - - 2 1 3 1 6 B37 Cirrhosis of Liver 1 4 - - - - - - - - - - - - - - - 1 - - - 1 1 2 B46(7) Other Diseases of Digestive System 10 21 - - - - - - - - 1 - - - 1 - - - 3 1 3 4 2 16 B38 Nephritis and Nephrosis 8 6 - - - - - - - 1 1 - - - - - 3 - 2 2 1 1 1 2 B39 Hyperplasia of Prostrate 4 - - - - - - - - - - - - - - - - - - - 2 - 2 - B46(8) Other Diseases, Genito-Urinary System 7 11 - - - 1 - - - - - - - - - - 1 1 1 2 - 2 5 5 B41 Other Complications of Pregnancy etc. - 2 - - - - - - - - - - - 2 - - - - - - - - - - B46(9) Diseases of Skin, Subcutaneous Tissue - 1 - - - - - - - - - - - - - - - - - - - 1 - - B46(10) Diseases of Musculo-Skeletal System 3 9 - - - - - - - - - - - - - - - - - 1 - 1 3 7 B42 Congenital Anomalies 13 15 5 3 4 7 2 1 - 1 1 - - 1 - - 1 - - 1 - - - 1 B43 Birth Injury, Difficult Labour, etc. 13 7 13 7 - - - - - - - - - - - - - - - - - - - - B44 Other Causes of Perinatal Mortality 12 11 11 11 1 - - - - - - - - - - - - - - - - - - - B45 Symptoms and III Defined Conditions 3 10 - 1 - - - - - - - - - - 1 - - - 1 - 1 1 - 8 BE47 Motor Vehicle Accidents 20 10 - - - - 2 1 2 2 1 4 1 1 - 3 - 3 2 2 3 1 2 BE48 All Other Accidents 17 23 - - - 1 - 2 1 - 1 1 1 2 3 - 2 2 1 2 4 2 4 11 BE49 Suicide and Self-inflicted Injuries 30 11 - - - - - - - - 6 1 2 1 4 - 5 3 7 2 3 3 3 1 BE50 All Other External Causes 7 5 - - - 1 - - - - - 1 2 2 2 - 1 - 2 - - 1 - - TOTAL ALL CAUSES 1,484 1,436 35 27 19 18 8 7 5 5 16 10 19 20 40 17 1 16 69 338 160 415 328 473 775 9 10 NOTIFICATIONS OF INFECTIOUS DISEASE DURING 1969 BY SEX AND AGE GROUPS Under 1 1 2 3 4 5-9 10-14 15-19 20 - 34 35 - 44 45 - 64 65 + Unknown DISEASE 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 2 - 5 3 2 3 8 10 3 13 27 37 4 1 - 2 - 1 — — — — — — - — 121 Measles 45 19 84 101 99 91 88 86 10 92 173 188 8 16 2 2 8 11 1 - 1 1 1 1 4 1212 Whooping Cough 4 1 2 - 1 - 1 3 1 1 3 - - - - - - - - - - - - - - - 17 Food Poisoning 5 1 1 1 4 - 1 1 - - 2 2 2 2 2 - 2 7 3 2 2 3 1 1 - - 45 Ophthalmia Neonatorum 1 - - - - - - - - - - - - - - - - - - - - - - - - — 1 Acute Encephalitis, Infective - - - - - - - - - - - - - - - - - - - - - - - - - - 3 Acute Encephalitis, Post Infectious - - - - - - - - - - - - - - - - 1 - - - - - - - - - 1 Acute Poliomyelitis, Paralytic - - - - - - - - - - - - - - - - - - - - - - - - - - - Acute Poliomyelitis, Non-Paralytic - - - - - - - - - - - - - - - - - - - - - - - - - - - Acute Meningitis 2 2 - - - 1 - - - - 3 3 2 - - - 7 1 - - - - 1 — — 22 Diphtheria - - - - - - - - - - - - - - - - - - - - - - - - - - - Typhoid Fever - - - - - - - - - - - - - - - - - - - - - - - - - - 3 Para-Typhoid Fever - - - - - - - - - - - - - - - - - - - - - - - - - - - Dysentery 5 2 2 2 4 3 2 - 4 5 7 8 - 2 - 2 6 5 5 1 3 2 2 - — 72 Scabies* - 1 5 - 7 1 5 8 1 3 18 12 9 10 2 10 15 25 5 2 4 3 1 - 5 3 155 Tuberculosis, Respiratory - - - - - 1 - 1 - 1 4 - 1 - - 2 16 15 5 2 13 3 11 2 - - 77 Tuberculosis, Meninges and C.N.S. - - - - - - - - - - - - - - - - - - - - - - - - - - - Tuberculosis, Other - - - - - - - - - - - - - - - - 4 7 2 3 1 3 — 1 — 1 22 Small pox - - - - - - - - - - - - - - - - - - - - - - - - - - - Malaria - - - - - - - - - - - - - - - - - - - - - - - - - - 3 Infective Jaundice - - 2 - - 2 2 1 1 1 7 10 5 5 1 9 21 14 4 6 7 4 1 1 1 - 105 NOTE * Scabies became notifiable in whole of Haringey on 1st April 1970 for three years. PART 1 ENVIRONMENTAL HEALTH AND INFECTIOUS DISEASE INFECTIOUS DISEASES IV. T. Orton, Deputy Medical Officer of Health 1969 proved to be a quieter year than usual for infectious diseases, though it began with a tragic outbreak of typhoid fever. There is certainly no reason to assume that vigilance should be relaxed. The increase in foreign travel in large aircraft can bring dangerous infectious disease to our doorstep in a few hours. One can only regard with growing concern the cynical endeavours of travel agents to increase their business without giving their customers any inkling of the health hazards they face when visiting many countries overseas. It is especially alarming to notice that in the year of the jumbo jet the government's second green paper should propose a reorganisation of the health services in which infectious disease control is divided between area health boards and local authority public health inspectorates. It is strange to think that ideas like this can result from an intention to unify! Perhaps it is thought that it does not matter because infectious disease is not as important as it used to be. There may be a rude awakening from this, for there is every likelihood that the jumbo jet is well able to convey every infection we have had to face in the past, plus quite a few more than will be new to us. Measles In spite of the frustrations over delays in obtaining vaccine, the Health Department was able to complete its programme of measles vaccination, though the public response was rather disappointing. The results were awaited with interest. Measles is normally a biennial affair, that is, there are large epidemics every two years. So we have to compare 1969 with 1967. The figures of notifications were 1212 and 1627 respectively, meaning that the 1969 figures were 74 per cent of those for the last "measles year" during which there had been no vaccination. These are not as good as we had hoped, but it seems likely that the vaccination had an effect on the incidence. The 1967 epidemic reached a peak of 221 in the weekly notifications in January of that year: but the peak for 1969 was only 73 and took place in April. The results therefore suggest that vaccination may also have had a delaying effect. If measles is to be wiped out in this country there will have to be a greater response from the public. This has not been helped by the withdrawal of one of the vaccines from use; and as supplies return to normal the department will be hard-pressed to complete the programme of vaccination before the autumn of 1970 - and the next measles year. Enteric There were seven cases of typhoid altogether. Three occurred in Haringey residents on holiday in Wales, and unfortunately one of them was fatal. The same type of organism was discovered in a woman who had been caring for a baby of two of the victims, and the evidence suggested that the infection had been passed through the child to the parents, though without causing any serious illness in the infant. The woman turned out to be a chronic typhoid carrier, the result of an attack many years before. She agreed to an operation which removed the source of the infection. In another incident a woman developed the disease, and her husband was found to be excreting the organism, although he was in good health. Both were admitted to hospital and treated successfully. Here it seems likely that the man was infected at about the same time as his wife. The source appears to have been in another borough, There was also the case of a boy born in this country of Cypriot parents who caught the infection while visiting the ancestral island. The Department co-operated with the staff of a hospital in Haringey in investigating contacts of a child from another borough who was suffering from typhoid while a patient in a ward. Fortunately none of the other children had caught the disease, and similarly investigations of other Haringey residents who had been contacts of cases of typhoid in this country or abroad during the year showed them to be free of infection. 11 One case of paratyphoid was notified. The organism was found incidentally during investigations of a patient in hospital who was suffering from another complaint. It was not detected again, and appears to have played an insignificant part in the illness. Dysentery Sonnei dysentery continued its role as a generally mild infection, often symptom-free, with occasional acute exacerbations. Food Poisoning As ever, outbreaks of food poisoning kept the department busy. The commonest organism encountered was Salmonella typhimurium, which affected a number of hospitals in the London area. There was great anxiety over a visitor to Haringey who apparently got the infection in a hotel in another borough and subsequently became gravely ill. Fortunately he recovered, but here was a reminder that food poisoning is not just a brief comical episode which just happens to people, but a dangerous infection causing acute suffering, and which can and ought to be prevented. A Salmonella reading infection was responsible for several cases of food poisoning who were infected during a wedding reception in Haringey. The source of the outbreak, which may have been pre-cooked chicken, was impossible to locate because most of the guests had brought food with them. Other salmonella infections occurring during the year were enteritidis, tennessee, infantis, bovis morbificans, munster, oranienberg, panama and heidelberg. Infective Hepatitis This is the first full year in which the disease has been statutorily notifiable. We were informed of 105 cases. Surveillance of the geographical distribution of the infection was continued. An apparent clustering of cases was found in the north-east of the borough in the latter half of the year, but enquiries did not reveal any connection between them. A particularly severe case occurred in an individual recently returned from Mexico: a reminder to travellers that the revenge of Montezuma can take more than one form — and is not limited to his own borders. Scabies Scabies has been making a small comeback in this country, and was made notifiable in the whole of Haringey (previously it was just Tottenham) since 1st April 1969. The actual number notified was 155, but if one projects the figures from the known rates this would be equivalent to 137 in the whole borough for the second, third and fourth quarters of the year, or 182 for the full year. Extensive use has been made of the treatment facilities provided by the Health Department. Influenza The Hong Kong 'flu which so unexpectedly wilted before the expected epidemic in late 1968 came back with a vengeance at the end of 1969. Thousands fell before it, even those who had been given the appropriate vaccine and subsequently lost their immunity in the course of time. Obviously there is a long way to go before this hydra-headed disease can be adequately understood and brought under control. Smallpox The fact that there was no smallpox in 1969 will probably arouse little interest. It may even be thought that such a state of affairs is in the natural order of things, but this is not a view which would have been held at the beginning of the century. Recently, during the examination of old records in the department, there came to light a copy of the Report of the 1901-2 epidemic of smallpox in Tottenham written by Dr. J.F. Butler-Hogan, the then Medical Officer of Health. It proved to be such a fascinating document, combining a remarkable grasp of the subject and lucidity of expression, "that it is well worth bringing to the attention of 12 modern Haringey, not only as a reminder of what has occurred in the past but as a warning of what of what could happen in the future. We have also studied back copies of 'The Tottenham Herald' of that time, and are grateful to the editor of 'The Tottenham and Edmonton Herald' for allowing us access to his files. The period covered was that of the closing months of the Boer War, and mention is also made in the press of incidents like the illness and the coronation of Edward VII, and a murder on Tottenham Marshes with a subsequent trial and conviction. The Tottenham of those days was in some ways very different from what it is now — quieter, with a slower, more relaxed tempo of life. Mother Siegal's Curative Syrup was widely acclaimed the panacea of all ills. But tragedy was never far away, and almost every issue of the newspaper had its sad chronicle of inquests, mainly concerned with the deaths of young children. And yet a feeling of great vitality rises from the pages, and the fortunes of Tottenham Hotspurs were as great a focus of interest and enthusiasm then as now. For the readers of the 'Tottenham Herald' the great smallpox epidemic stole quietly on to the scene. A letter published on 18th October 1901, requested cast-off clothes for victims of smallpox whose clothes had had to be destroyed. Dr. Butler-Hogan's report stated that the first patient was diagnosed on 28th August. By 8th November there had been a generous response to the appeal for clothing. The number of cases must by then have exceeded 25. A ratepayer protested that the Council was being charged 7/6 per head for the vaccination of paupers while local doctors would do it for between 2/6 and 5/-. When the year ended there had been 53 cases and 7 deaths. On 10th January 1902, the newspaper reported a poignant court case. A labourer had been charged for being drunk and disorderly. It was stated in his defence .that he had just been discharged from the smallpox hospital, but his two children who went in with him had died. Some friends sympathised and gave him a drink, which in his weak state soon overcame him. The magistrate could see no friendship in giving a man too much to drink, and fined him a shilling plus seven shillings for a doctor's fee, but gave him a week in which to pay. "I am much obliged to you sir", said the man. Hopes that the epidemic was declining were disappointed. While the numbers were climbing towards a January total of 40, the Council decided to erect a temporary smallpox hospital on the Down's Lane site, to be paid for out of the rates. In spite of protests from local people it was erected within a fortnight and was ready for use in the middle of February. Opinion in the Council was divided. It discussed a proposal that the Beckenham Local Government Board should repeal the clause which allowed conscientious objectors to avoid the operation of the vaccination laws, and decided not to support it. Anti-vaccinationists on the Council claimed that vaccination was a lot of rubbish and ruined thousands of lives by putting poison into the blood of children. One said that he would rather go to prison than have his children vaccinated. At about this time the Finance Committee authorised the payment of £111 and £81 in vaccination fees to a local doctor. By the end of the month the Medical Officer of Health, probably a predecessor of Dr. Butler-Hogan, had taken successful legal action against an un-named medical practitioner, who had notified a patient with smallpox by sending him to the health department with a letter. It was evidently felt that there were less hazardous methods of informing the authority. A total for February was 44 cases, but controversy was still raging. An editorial on 7th March advised the public to take the trouble to think. Much attention was focused on schools. The School Board had issued a circular letter to head teachers at the end of the previous year, counselling them to be vaccinated themselves and advising that as far as possible the school staff and children should be recommended to have it. A councillor now strenuously opposed a proposal to allow the Medical Officer of Health to inspect children to see if they were vaccinated, and to issue pamphlets recommending vaccination. "This fad of vaccination is getting abominable", he said. "We cannot move without having it thrust down our throats". Nevertheless the Council agreed the proposal, and made a ruling that children kept away from school as smallpox contacts would not lose their silver medals for good attendance. But some adult contacts were proving to be difficult, one of them being found in a public house. 13 By the middle of March an alarming increase in the disease was evident. Tents were erected beside the hospital. The Vice Chairman of the Council became a victim, but fortunately recovered. The jury at an inquest were excused from kissing the Bible by the Coroner in deference to their fears of infection. The March total was 115 cases. In April it fell to 81. A tent at the smallpox hospital used for drying was burnt down. A local clergyman said that he had been practically boycotted by his parishioners because he had visited the smallpox hospital. Parents had threatened to withdraw their children. He was determined not to cease attending the hospital, and had taken rooms away from his house in order to avoid a risk of infection. At the end of April it was thought that the epidemic was abating, but May was the worst month, reaching 129 cases. The Council agreed a shilling rate to pay for the cost of the outbreak. In June the number fell to only 39, but there were 11 deaths in the same period. Presumably many of these had taken ill the month before. After this the incidence declined rapidly. The total number of cases in the epidemic was 525, 74 of whom (14 per cent) had died. The editorial of 1st August stated that there was little room to carp at what the local authority had done in the face of the ordeal. The Health Department had worked under great difficulties, not the least of which had been a series of changes at the top. The former Medical Officer of Health had been succeeded by a temporary one, who had unfortunately died a few weeks after. His successor had been young and inexperienced; but then came the appointment of Dr. Butler-Hogan. By July it was clear to the readers of 'The Tottenham Herald' that he was a man of strong personality who did not hesitate to express his views. He wanted an infectious diseases hospital for Tottenham. In September he criticised the general public health provision for the area. Indeed, his appointment signalled the beginning of a series of striking advances in the health of Tottenham, which were to become evident over his tenure of office during the next ten years. His Report on the epidemic, unlike many medical documents, stands the test of time well. A modern reader who is experienced in the subject cannot but be filled with admiration for the author, most of whose statements could be transferred wholesale to a modern textbook without seeming out of place. The Report was written with one definite object: to place the facts about smallpox and vaccination firmly before the Council, dealing with the controversial points one by one, in sufficient detail to make his arguments clear. "I can well believe", he wrote, "that with all the conflicting and inaccurate statements which are made about vaccination, you must find it difficult to arrive at any sound conclusion on the subject". He went on to prove by the use of statistics on hospital staff that vaccination conferred a very high level of protection, even for those in direct contact with patients. As for the community in general, he showed that claims that it was ineffective were not confirmed by the evidence. Smallpox could occur in adults who had been vaccinated in infancy, but this was because their immunity had been allowed to decline. Revaccination would have given them considerable protection. "in the case of Small Pox", he said, "there is no substitute, and if you discard Vaccination, you are left defenceless and without any protection but flight in the presence of a relentless foe". This is almost as true today as it was then. He went on to say: "...it might be expected that those who wish to learn about Smallpox and its prevention would be wise to go to those likely to possess the most accurate knowledge of the disease, namely, those who have spent their lives in the practical study of Small Pox. You will find that the unanimity of opinion expressed by those (who have so spent their lives) as to the effect of Vaccination is very striking, and those who have been opposed to Vaccination are either those who have no very practical acquaintance with Small Pox, or whose eyes have been so completely blinded by preconceived prejudice as to be incapable of seeing aright. There are, unfortunately, armchair generals even in medicine, who prefer to sit at home and deal out what they consider destructive criticism to those who are in the midst of the fight, rather than be up and doing something for the good of the individual and the welfare of the community". "The fight against ignorance and prejudice is not over", he said in his concluding paragraphs, a statement that could be echoed nowadays. The anti-vaccinationists are still with us, and producing the same arguments as before. But in spite of their opposition great progress has been made. This country has probably benefited most from the massive vaccination campaigns run by the World Health Organisation in under-developed countries, so reducing the dangers from foci of infection abroad. But these are far from complete and present appalling difficulties to those who have to organise them. The development of fast air travel has brought the problem much closer to us, but this has to some extent been controlled by strict enforcement of vaccination regulations for travellers. In Haringey this involved Health Department staff in the surveillance of 34 insufficiently protected 14 individuals from smallpox endemic areas in 1969. Revaccination of school children has become routine practice. But there is still room for concern since many children were not eligible because they had not been vaccinated in infancy, In fact in 1969 less than a half of Haringey children aged up to and including five years of age had been vaccinated. This is likely to be improved, however, by the new computerised schedules. It would seem therefore that another smallpox outbreak of over 500 cases is not a likely event, but recent experience has shown that even only one case can cause a tremendous amount of alarm and anxiety in the general population, and we may have to face something considerably worse than this. The opponents of vaccination had a heavier responsibility than they realised. One wonders how many of the victims of the Tottenham outbreak would have been spared if they had not refused the opportunity of vaccination because eminent local people, some in responsible positions, had declared against it, or it had been made to appear that the experts disagreed among themselves. Indeed, in the history of public health it is disturbing to contemplate the amount of unnecessary suffering and death that has resulted from the activities of dedicated, sincere, but misguided groups who, on what seemed to them to be the highest principles, succeeded only in leading others to disaster. It is rarely that the anti-vaccinationists have to face the consequences themselves or among their own supporters. The 'Tottenham Herald' of 17th January 1902, however, mentioned two individuals who paid the price of their principles: a widow and a daughter of a man who died of the disease, who refused vaccination, and became cases themselves. It is to be hoped that history will not repeat itself. HOUSING APPLICATIONS - ASSESSMENTS ON MEDICAL GROUNDS Where housing applicants submit medical evidence supporting their requests for re-housing in Council accommodation, their cases are assessed by senior medical officers of the Health Department. During 1969 requests were received for 722 cases to be investigated and recommendations made upon medical priorities. This was a considerable increase of over 14% above the 630 requests in 1968. This extra demand was also reflected in an increase in the number of visits made from 202 in 1968 to 250 in 1969. Visits were still made only in special circumstances to housing applicants, the majority of recommendations being made on the basis of medical evidence submitted, and the information regarding the existing accommodation on the Housing Department files. However, all cases where the Housing Manager requested advice on the medical circumstances of Council tenants were visited. There was again an increase in the number of requests for visits to Council tenants from 45 in 1968 to 67 in 1969. During 1969 65 of "special medical" cases were recommended for consideration by the Housing Tenancy Selection Panel. These were dealt with in the following way: Allocated during the year 54 Consideration pending at end of year 6 Rehoused by the G.L.C. 1 Deferred until the property had been acquired by the Council 1 Applied for Residential Accommodation as house was in a Clearance Area 1 Died before allocation could be considered 2 44 of the special medical cases concerned applicants over 60 years of age and 29 of these were over 70 years of age. This illustrates the increasing need for suitable housing for the elderly. 15 Housing Assessment on Medical Grounds Month No. of cases Source of Request Housing Dept. Hospital, G.P. or Clinic Tenant, H.V. or P.H.I. etc. January 58 37 10 11 February 33 14 12 7 March 52 22 16 14 April 62 44 9 9 May 39 21 11 7 June 42 25 10 7 July 100 81 12 7 August 78 605 10 8 September 56 36 11 9 October 91 73 9 9 November 57 45 5 7 December 54 43 6 5 TOTAL * 722 501 121 100 *These figures include second investigations carried out during year. Housing Visits by Medical Officer 1. To Housing Applicants 1st visits 164 Re-assessments 19 2. To Council Tenants 67 TOTAL 250 Medical Priorities recommended during 1969 Recommendation * No. of cases Special: Refer to Committee 65 1 st degree 188 2nd degree 184 3rd degree 108 Recommendation for transfer 63 Council tenants Recommendation for accommodation to be shared 8 Recommendation for priority when Clearance Area is being rehoused 11 Recommendation for hostel accommodation 1 Council tenant Recommendation to be referred to other sections - TOTAL 628 20 cases were investigated where no medical recommendation was made. * These figures include second assessments made during the year. 16 SANITARY CIRCUMSTANCES OF THE AREA W.H. Wilson, Chief Public Health Inspector The responsibilities of the Environmental Health Division continue to expand as new legislation widens the functions of the Council in this field. Of particular significance was the Housing Act 1969 with its emphasis on the improvement and repair of older dwellings. The Public Health Department became responsible to the Council for the approval of applications for Improvement Grants and for the investigation of applications for Qualification Certificates to enable landlords of controlled dwellings to apply to the Rent Officer for fair rents to be fixed. The Council approved the addition to the establishment of two Public Health Inspectors and one Technical Assistant as a consequence of the extra work arising in this connection and in respect of General Improvement Area schemes. The rebuilding of a slaughterhouse in the Borough is likely to lead to an increase in the amount of meat inspection work and the Council have authorised the appointment of a Meat Inspector later in 1970 to relieve the Public Health Inspector of the routine work. Drainage and Sewerage There are separate soil and surface water drainage systems in the greater part of the Borough. Most of the soil system drains to the G.L.C. works at Deephams Purification Works, Edmonton and the surface water is discharged into the local streams and the River Lee. Pollution, particularly with detergent scum and soap solution, of the watercourses, may arise if unauthorised soil drainage connections are made to the surface water system or industrial processes may lead to contaminants from floors or yards being washed down into the surface water drains. Considerable investigation is required to trace and stop such pollution whenever it arises and to this end a close liaison is maintained with enforcement officers of the Lee Conservancy Catchment Board, and with the Department of Public Health Engineering of the Greater London Council. A technical assistant experienced in plumbing and drainage work is continuously engaged in the inspection of house drainage with a view to the detection of faults which may result in surface water pollution, special attention being given to those areas where surface water samples indicate that infringements may be occurring. During the year 2,515 premises were inspected in this way and drainage corrections were requested in 47 instances. The Public Health Inspectors took any necessary action to ensure that the required works were carried out and, where appropriate, formal action was taken under the Public Health Act 1936. Water Supplies A small area on the Borough boundary containing 106 premises between Great North Road and Aylmer Road, N.2. 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 the Lee Valley Water Company was contained in the report of 1966. Dr. Windle Taylor, Director of Water Examinations, Metropolitan Water Board, has kindly supplied the following information regarding water supplied by the Board to Haringey during 1969:- 1. (a) The supply was satisfactory both as to (i) quality, and (ii) quantity throughout 1969. (b)AII 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 1969, was 241,666. (ii) No houses were permanently supplied by standpipe. 17 (d) No artificial 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 supply was derived from the following works and pumping stations:- The higher ground around Muswell Hill is supplied from the River Thames Group via Fortis Green pumping station. The remainder of the borough is supplied from the New River Stations. No new sources of supply were instituted and there were no changes to the general scheme of supply in your area. The number of samples collected and the bacteriological and chemical analyses of the supply from the above sources after treatment are shown on the attached sheets. (b) On account of their hardness content and alkaline reaction the Board's river and well water supplies are not considered to be plumbo-solvent. It should however, be appreciated that all types of water pick up varying amounts of metal from the material of water piping particularly when it is newly installed; this applies to copper, zinc, iron and also to lead. Surveys carried out between 1966 and 1968 on analyses of water from consumers' premises confirmed this statement. 18 AVERAGE RESULTS OF THE CHEMICAL AND BACTERIOLOGICAL EXAMINATION OF THE WATER SUPPLIED TO THE LONDON BOROUGH OF HARINGEY FOR THE YEAR 1969 (Milligrams per litre (unless otherwise stated)) Description of the Sample No. of samples Ammoniacal Nitrogen Albuminoid Nitrogen Nitrate Nitrogen Chlorides as CI Oxygen abs. from Permanganate 4 hrs. at 27° C Turbidity Units Colour (Burgess Units) Hardness (Total) Ca C03 Hardness (noncar bonate) Ca C03 PH Value Phosphate as P04 Silicate as Si02 Sul phate as S04 Natural Fluoride as F Magnesium as Mg. Sodium as Na Potassium as K Surface Active Material as Manoxol OT Electri cal Conductivity (micromhos) New River derived 106 0.012 0.061 4.7 41 0.60 0.1 7 310 83 7.9 1.6 10 68 0.25 5 30.8 5.3 0.02 620 Thames derived 371 0.024 0.083 4.4 32 1.05 0.1 11 282 79 7.9 2.1 9 58 0.25 5 24.0 5.4 0.02 550 BACTERIOLOGICAL RESULTS - YEARLY AVERAGES 1969 BEFORE TREATMENT AFTER TREATMENT Number of samples Agar plate count per mil. Coliform count Escherichia Coli count Number of samples Agar plate count per miI. Coliform count Escherichia Coli count 20-24 hours at 37°C 3 days at 22°C Per cent samples negative in 100 ml. Count per 100 ml. Per cent samples negative in 100 ml. Count per 100 ml. 20-24 hours at 37°C 3 days at 22°C Per cent samples negative in 100 ml. Per cent samples negative in 100 ml. New River derived 1,502 77.6 45.27 10.0 61.78 2.7 514 13.1 100.0 100.0 Thames derived 8,196 66.5 39.79 19.0 53.97 7.0 3,698 12.9 99.89 100.0 Swimming Baths and Paddling Pools Public health control of the public and privately owned pools is maintained by regular sampling on behalf of the Health Department of water for bacteriological and chemical examination from the swimming pools in the Borough by special chemists on the staff of the Scientific Branch of the Greater London Council. Samples are similarly taken from paddling pools in the parks when these are in use during the summer months. The filtration and chlorination equipment at the swimming baths is highly efficient and the analyses generally give very good results but the paddling pools which lack efficient dosing installations present a problem during school holidays when, in hot weather, they may be heavily used. The Baths Department are advised of the results of the tests in respect of Counci I controlled establishments so that they may be used to supplement the tests undertaken by the staff of that Department. Smoke Control Areas The whole of the Borough became smoke controlled on 1st December 1968 and other boroughs in Greater London continue to expand their areas of smoke control which must have a beneficial effect on the atmosphere in Haringey since the prevailing south-westerly winds must carry air across other London Boroughs to this area. The steady conversion from coal gas to North Sea gas is leading to the closing of coal gas works with the consequential loss of gas coke. Some concern must be felt at the elimination of this source of solid smokeless fuel, particularly for approved open fires and it is hoped that alternative supplies at comparable cost will be available to meet this deficiency. Furnace Installations 41 notifications were received in accordance with Section 3 of the Clean Air Act 1956 where it was proposed to install new furnances. These were examined and where necessary discussed with the installation engineers. The Department was satisfied that the final proposals provided for installations which would meet the requirements of the Act that they should as far as practicable be capable of being operated continuously without emitting smoke when burning the fuel for which they were designed. Chimney Heights 30 notices were received of proposals to construct new chimneys. Where appropriate these were discussed with the applicants and agreement was reached in each case by which chimney terminal heights were fixed that should provide for adequate dissipation of the exhaust gases so avoiding the risk of harmful local concentrations of air pollutants. Trade Emissions During the summer of 1968 a well-known firm in the Borough erected a large new plant for the purpose of recovering volatile solvent used in the process of manufacture. The plant contains several tons of activated carbon granules used for absorbing the gases drawn from machines in the factory and when operations commenced some carbon dust was emitted continuously from the plant and was blown into a neighbouring street. The company were already aware of this matter along with other initial problems, and when visited by representatives of the department they initimated that remedial work was already in hand. Besides taking immediate action which greatly reduced the emission they asked the makers to design a filtration apparatus to trap the dust emitted which, having regard to the nature of the plant, was a difficult and costly project. The process of design, manufacture and erection lasted several months but the plant is now working successfully without dust emission. The department has been in touch with the firm throughout this period and the incident is chosen to illustrate the fact that where some form of nuisance is caused by a manufacturing process, many local firms go to great lengths to provide remedial measures, and co-operate very fully with the department in matters of public health without any necessity for formal proceedings. 20 Investigation of Atmospheric Pollution Haringey continued to co-operate with the Ministry of Technology by operating four instruments at suitable sites in the Borough for recording the daily level of smoke and sulphur dioxide in the atmosphere. In addition to giving information on local trends, the data forms part of information collected by the Ministry to show national distribution and trends in atmospheric pollution. The readings obtained depend to some extent on varying local meteological conditions and at times these may give rise to deviations from the general trend. TABLE A Average Daily Readings of Smoke and Suplhur Dioxide in the Atmosphere 1968/69 (Microgrammes per cubic metre) Hornsey Town Hall N.8. (1) Burghley Road N.8. (2) Tottenham Town Hall N.15. (3) Civic Centre N.22. (4) Classification A.3 A. 1 A.2 D.2 (a) Smoke July 1968 N 21 23 21 August N 19 22 19 September 33 45 48 45 October 68 88 70 66 November 86 73 102 89 December 91 81 108 124 January 1969 71 69 79 71 February 64 67 70 66 March 54 50 N 53 April 31 28 31 N May 31 30 34 114 June 19 16 20 18 (b) Sulphur Dioxide July 1968 N 56 76 65 August N 56 68 58 September 110 93 84 69 October 120 159 141 144 November 199 132 207 171 December 319 221 292 274 January 1969 262 192 249 237 February 227 187 214 200 March 179 174 N 195 April 131 116 129 N May 122 128 134 138 June 73 65 79 83 NOTE: 'N' indicates that number of readings insufficient to give accurate average. 21 Classification of Sites The following classification of sites indicates the neighbourhood in which the instruments are located as follows: A.1. — residential area with high density housing or with medium density housing in multiple occupation, in either case surrounded by other built-up areas. A.2. - predominantly A.1 but interspersed with some industrial undertakings. A.3. — residential area with high density housing or medium density housing in multiple occupation surrounded by, or interspersed with open spaces. D.2. - small town centre; limited commercial area mixed with old residential housing and possibly i ndustry. TABLE B Monthly Deposit Gauge Readings 1969 MONTH HORNSEY TOWN HALL SITE HAMPDEN ROAD, N.8. SITE Rainfall (litres) Deposits - Mgs per M2 Rainfall (litres) Deposits - Mgs per M2 Dissolved Undissolved Total Dissolved Undissolved Total January 4.49 51 87 138 4.78 57 66 123 February 3.10 74 78 152 2.90 67 60 127 March 4.21 63 69 132 4.18 64 37 101 April 1.51 83 77 160 1.48 67 34 101 May 3.41 65 93 158 3.67 90 85 175 June 2.19 38 94 132 2.13 37 69 106 July 5.37 65 86 151 4.69 77 104 181 August 4.06 33 62 95 4.21 34 16 50 September 0.48 42 131 173 0.31 42 65 107 October 0.45 49 119 168 0.5 75 114 189 November 5.90 83 129 212 5.5 84 145 229 December 4.20 49 95 144 4.2 63 141 204 TOTAL 39.37 695 1120 1815 38.55 757 936 1693 Rodent Control Details of the rodent control measures in the sewers are shown in the table. In addition to the sewer baiting programme, control of rats and mice is implemented wherever they are found. An aspect of this work which has accelerated during the past year has been the spread of strains of rats and mice resistant to the poisons which have previously been successful. New poisons have been developed and have proved successful in many cases. People no longer keep cats in anything like the numbers previously experienced and this has made the control measures more difficult. Close liaison is maintained with the Pest Control Unit, Ministry of Agriculture, Fisheries and Food and with the rodent officers in adjoining Boroughs. 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 1969. 1. Dwelling houses - 2,695 2. Factory premises - 98 3. Shops and Cafes - 75 4. School canteens - 73 5. Miscellaneous - 37 6. Total charge for 2 - 5 above - £587.7s.4d. 22 RODENT CONTROL - SEWER BAITING 1969 AREA Total manholes WARFARIN SODIUM FLUORACETAMIDE Baited manholes 1st revisit after 7 days 2nd revisit after further 7 days 1st treatment 2nd treatment No take Part take Complete take No take Part take Complete take West 2141 2116 1905 164 47 2040 63 13 2141 2141 East 1256 1256 839 399 18 1139 104 13 1256 – TOTAL 3397 3372 2744 563 65 3179 167 26 3397 2141 PERCENTAGE 99.3 81.4 16.6 1.9 94.9 4.6 0.5 100 63.0 Cleansing and Disinfecting Station Cleansing, disinfection and disinfestation was carried out at the Department's Depot in Hornsey High Street, N.8. In addition to routine disinfection work, bundles of articles were disinfected prior to despatch abroad. Bathing and treatment of verminous persons and scabies patients was carried out at the Station. As part of the general reorganisation of Council depots plans were made for the unification of the Public Health Department stations at Wightman Road, N.8. This necessitated alterations to existing buildings and the installation of apparatus moved from the former Tottenham and Hornsey establishments. Cleansing facilities were also to be provided for male and female persons. Work was well advanced by the end of the year so that the transfer could take place early in 1970. Laundry Service for the Incontinent During the year 2,447 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 Free assistance is given to householders to eradicate insect pests, DDT continuing to be the most effective insecticide in dealing with the majority of these insects. Premises Treated in 1969 Insect Pest Houses Premises Ants 52 7 Beetles and Cockroaches 114 29 Bugs 87 – Fleas 125 1 Flies and Bluebottles 8 – Wasps and Bees 131 6 Others 157 10 TOTAL 674 53 Where requests for assistance are received in respect of non-domestic premises a charge is made to cover the cost of the service. During 1969 £59.11s.0d. was received in this connection. 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 1969, 437 bodies were received into Hornsey mortuary and a post-mortem examination was carried out in every case. Agreement has been reached with the Greater London Council for the utilisation of the upper part of the building housing the mortuary to be used as a Coroner's Court. The building was originally designed for this purpose but certain modifications and extensions are required before establishing the Court in the premises. 24 Inspections and Re-inspections carried out by Public Health Inspector and Technical Assistants Statutory Nuisances 7,050 Drainage 2,194 Drain Tests 43 Surface Water Pollution 2,515 Vermin and Pests 386 Rodents 524 Accumulation of Refuse 707 Smoke Observations 191 Smoke Control 2,000 Noise 698 Disrepair Certificates 25 Housing Surveys 1,801 Multiple Occupation 13,457 Overcrowding 274 Other inspections under Housing Acts 1,465 Mortgage Advance 13 Improvement Grants 736 Infectious Disease (Not food borne) 669 Food Poisoning and food borne disease 697 Factories with Mechanical Power 361 Factories without Mechanical Power 9 Outworkers 190 Offices etc: General Inspection 682 Offices etc: Other visits 447 Shops Act 3,764 Employment of Young Persons 119 Bakehouses 134 Bakers and Flour Confectioners 231 Butchers 740 Canteens and Kitchens 276 Confectioners — Sugar 198 Fishmongers 87 Fried Fish Shops 133 Greengrocers and Fruiterers 397 Grocers 967 Hawkers of Food 26 Prepared Food Premises 87 Public Houses and Off Licences 215 Restaurants and Cafes 964 Slaughterhouses 86 Other Food Premises 190 Street Traders 2,756 Food and Drugs Sampling 833 Ice Cream Sampling 37 Milk Sampling 82 Surrender of Unsound Food 334 Investigation of Food Complaints 290 Bacteriological examination of Food 265 Hairdressers 200 Old People's Welfare 44 Pet Animals Act 84 Other visits 4,753 No access 5,381 25 Defects remedied following action by District Public Health Inspectors Drains repaired 27 premises Drains cleared 20 W.C. cisterns repaired or renewed 105 W.C. pans renewed or cleansed 39 Flush pipes repaired 23 Waste pipes repaired or renewed 142 Rain water pipes repaired or renewed 100 Roofs repaired or renewed 518 Eaves gutters repaired or renewed 215 Drinking water cisterns renewed or covered 3 Water service pipes repaired 24 Yards repaired or reconstructed 12 Floors repaired or renewed 189 Dampness remedied 473 Window frames and sashes repaired, renewed or painted 498 Fire places, stoves and ovens repaired or renewed 6 Flues and chimney stacks repaired 6 Brickwork of walls repaired and walls rebuilt 99 Wallpaster repaired 395 Ceiling plaster repaired 251 Rooms cleansed 1 Staircases, balconies and steps repaired or renewed 27 Noxious accumulations removed 100 Nuisances from animals abated 2 Miscellaneous defects remedied 256 Statutory Notices Served Housing Act 1957 Section 9 (Repairs) 1 Section 78 (Overcrowding) 12 Housing Act 1961 (Houses in Multiple Occupation) Section 12 (Management Orders) 2 Section 14 (Neglect of Management) 2 Section 15 (Amenities) 15 Section 16 (Means of Escape in case of Fire) 16 Section 19 (Limitation of number of occupants) 4 Housing Act 1964 (Improvements) Section 16 (Immediate Improvement Notice) 1 Section 17 (Suspended Improvement Notice) 1 Public Health Act 1936 Section 39 (Drainage) 43 Section 45 (Repairs of W.C.'s) 11 Section 79 (Accumulations of refuse) 7 Part III (Statutory nuisances) 263 Public Health Act 1961 Section 17 (Drainage) 49 Tottenham Corporation Act 1952 Section 43 (Urgent Repairs) 144 G.L.C. (General Powers) Act 1967 Section 23 (Water supply) 1 26 Work Executed by the Council Work carried out in default of or by agreement with the owners during 1969 Public Health Act 1936 Section 39 (Drainage) 4 premises Section 45 (Water closets) 1 Section 79 (Removal of refuse accumulations) 4 Part III (Statutory Nuisances) 1 Public Health Act 1961 Section 17 (Drainage) 18 Tottenham Corporation Act 1952 Section 43 (Emergency Repairs) 45 Housing Act 1961 Section 14 (Houses in Multiple Occupation: Management) 1 Sections 15 and 16 (Houses in Multiple Occupation: Amenities) 5 G.L.C. (General Powers) Act 1967 Section 23 (Defective water fittings or pipes) 1 Rag Flock and Other Filling Materials Act 1951 Rag flock is not manufactured in any premises in the Borough. 18 premises are registered for the use of filling materials in upholstery work or the stuffing of bedding, toys etc., but the use of rag flock as a filler is not common. Abatement of Statutory Nuisances The wide scope of the work tackled by the district public health inspectors means that their services are always in demand by the public. Primarily the work involves the inspection of premises which have been reported to be in a state which is in any way prejudicial to health or a nuisance. Investigations are also made following observation by the inspectors during the normal course of their duties. Where defects are found the attention of the persons responsible is drawn to the matter informally. Frequently this suffices to secure the abatement of the nuisances but, if not, a statutory notice is served specifying the works necessary. If this too fails to achieve the desired result then the matter is referred to the magistrate's court. During 1969, 7050 visits were made to investigate complaints and 831 informal notices were sent requesting action to remedy unsatisfactory conditions. In 263 instances it was necessary for this informal approach to be followed by the service of statutory abatement notices. Legal proceedings were taken against defaulters on 13 occasions resulting in fines totalling £265 and costs £108.10.0. In 144 cases where the normal procedure for securing the abatement of statutory nuisances would have been unduly lengthy having regard to the defective conditions arising, urgent notices were served under the provisions of section 43 of the Tottenham Corporation Act 1952 and repairs were carried out by the Council in the owners' default at 45 premises. Noise 698 visits were made in connection with complaints of noise. Usually the noise nuisances fall into one of two categories. Firstly noise emanating from business premises. Informal approaches to the managements usually achieve the desired co-operation. Frequently a good deal of technical research and experiment is necessary to satisfy the legal requirement that the "best practicable means shall be used to minimise the effect of the noise or vibration". The second category involves noises which originate in private homes and most frequently arise from the use of power sewing machines by people working as outworkers for the clothing trade. Practical suggestions are made to reduce the transmission of noise and vibration and if these measures fail, the Complainants are advised to take legal advice with a view to taking civil action in the Courts. Local bye-laws concerning noisy instruments and also noisy animals are a great help in dealing with other appropriate cases. 27 Drain Stoppages Where complaints are received of obstructed drains the Public Health Department first investigates to see if the obstruction can be cleared by some simple action such as plunging. If so, this is carried out by the general assistants free of charge. In the event of the stoppage being more serious, the owner is notified that immediate action is necessary to clear the drain and is invited to sign a form requesting the Borough Engineer's staff which has the use of heavier equipment to deal with the matter. The person responsible must undertake to meet the Council's charge. If agreement cannot be reached statutory action is taken under section 17 of the Public Health Act 1961. During the year 848 drains were cleared by the Public Health Department and 381 jobs were passed to the Borough Engineer's Department. It was also necessary to serve 49 notices under Section 17, Public Health Act. 1961 and in 18 of these cases to carry out the clearance in the owners' default. House Drying Assistance is given when premises have been saturated, caused possibly by burst water pipes or tanks or major roof defects. Powerful hot air blowers and dehumidifiers are taken to the premises and greatly speed up the drying out process. Accumulations of Refuse An unfortunate trend towards indiscriminate dumping of rubbish on any available site has continued throughout the year. The practice is conducive to the harbourage of vermin and causes a great deal of work for the department. Diseases of Animals Act 1950 The Council is the responsible local authority under this Act, but no local emergency arose during the year which required special action in this respect. Pet Shops and Animal Boarding Establishments 19 premises are licensed as pet shops and there is one licensed animal boarding establishment in the Borough. Regular inspections are made by the public health inspectors to ensure compliance with the Council's licensing conditions. In addition arrangements have been made for veterinary supervision of the premises and animals to be carried by Mr. F.G. Buxton, F.R.C.V.S. Performing Animals The owner of the performing dog registered until 1968 died in 1968 and no performing animals are now registered by this Council. HOUSING Unfit Houses The investigation of houses in areas where there was reason to believe that the houses were generally unfit for habitation and might best be dealt with by clearance of the sites was continued during the year, and areas were inspected in accordance with the Council's Inspection Area Programme. Procedure in preparation for representation of areas recommended for clearance followed similar lines to those of previous years. A programme and target dates for the year were agreed after consultation with other Departments concerned, but progress fell short of that anticipated and the programme for the year and target dates were not fully achieved. The work involved, which forms the greatest part of the work of the Section, includes the detailed examination of each house in the provisional area, the preparation of reports, principal grounds of unfitness and maps and the compiling of lists of owners, occupiers and other interested parties in regard to all the houses which require to be dealt with. 28 Observations were made during the year of progress in the clearing of sites of confirmed clearance areas. Two areas were completely cleared and clearance of the sites proceeded at eight other confirmed areas. Four areas were confirmed by the Ministry during the year and occupiers are presently being re-housed from these areas. The areas comprise 444 houses involving 761 families. Three areas represented in 1968 still await confirmation. These include 217 houses and 286 families. Three areas were represented for clearance during the year. These include 345 houses and 399 families. Public Local Inquiries were held in respect of five areas for clearance under Compulsory Purchase Orders. The figures above relate to houses within clearance areas. The numbers set out in the tables below are of houses in Compulsory Purchase Orders and therefore include clearance area houses and added houses. 1. Areas demolished and sites cleared during 1969 Lorenco Road/Pretoria Road, N.17. Roslyn Road/Seaford Road, N.15. 2. Areas confirmed before 1969 and not yet cleared Suffolk Road/Sutton Road, N.15. The Grove, Hornsey, N.8. Langham Road/West Green Road, N.15. Brunswick Road (part) N.15. West Green Road/Stanley Road (part) N.15. Clyde Road/Lawrence Road, N.15. Western Road, N.22. Upper Tollington Park, N.4. 3. Areas confirmed during 1969 In Clearance Areas In Compulsory Purchase Orders Houses Families Houses Families Station Road/Brograve Road, N.17. 60 80 69 91 Park Lane, N. 17. 23 24 26 26 Chestnut Road/Col sterworth Road, N.15& 17 356 652 483 844 High Cross Court, N.17. 5 5 5 5 444 761 583 966 4. Areas represented before 1969 and not yet confirmed Paxton Road, N.17. 11 12 15 14 Kings Road, N.22. 21 24 28 31 Birkbeck/Lightfoot/St.Joseph's Road, N.8. 185 250 249 299 217 286 292 344 5. Areas represented during 1969 Russell Road/Victoria Crescent, N.15. 186 240 196 250 Craven Park Road, N.15. 5 5 5 5 Beaufoy Road/Tenterden Road, N.17. 154 154 202 200 345 399 403 455 Four Compulsory Purchase Orders were confirmed during the year in full except for three buildings at Park Lane which were held to be shops and were excluded from the Compulsory Purchase Order and the clearance area. 29 In other confirmed areas there was a small number of re-classifications from "unfit" to "not unfit". These were mostly owner/occupied houses and almost all were the subjects of intense repair operations immediately before the Public Inquiry. Many objections were received in respect of properties in the Compulsory Purchase Orders, but it is noteworthy that although objections to classification continued as in former years, the proportion of objections to the Compulsory Purchase Orders was at a reduced level. Indeed, at the Public Inquiry in respect of High Cross Court all the properties were the subject of objection against classification but, perhaps through experience, there were no objections to purchase by the Council. In the event, no objectors appeared at the Public Inquiry and all the houses were confirmed as "unfit". The list of areas of houses where there was reason to believe that they might require to be dealt with by clearance and which formed the Provisional Clearance Area Programme commencing April 1965 has been revised and brought up to date. The Provisional Programme now shows areas which have been represented but not yet confirmed and the remaining areas which warrant detailed examination. Areas which have been dealt with by clearance and other areas which on examination were found not to be clearance area subjects have been deleted. A few areas of houses which are known to have deteriorated have been added. The year saw the advent of the Housing Act 1969 which came into operation on 25th August 1969. This is an Act which amongst its provisions recognises the need for strenuous activityjn maintaining and improving the stock of houses throughout the country where and when it is reasonable to do so and lays down procedure for that purpose. So far as the unfitness of houses and their clearance is concerned there are two important new matters to be taken into consideration. One is an alteration and increase in the amounts of compensation to be made in certain cases where houses are acquired under Part III of the Housing Act 1957, and the other is the inclusion in Section 4 of the Housing Act 1957 of "internal arrangement" as one of the matters to be taken into account when considering the fitness or unfitness for habitation of a dwelIing house. The standard of fitness, which is a minimum standard, remains the same as formerly with the exception of the above-mentioned important additional feature. It was perhaps recognised that a higher minimum standard which would inevitably bring many more houses into an "unfit" category would create a burden at the present time, which would over-strech remedial resources available. Poor internal arrangement is a feature which is now taken into account in deciding whether or not a house is unfit for habitation. In theory a house, otherwise in good condition, could be so far defective in respect of internal arrangement that it would be unfit. Few instances are Iikely to be met where the above circumstances obtain, but this matter, added to the others in Section 4 of the 1957 Act, is a recognition of an important factor in the assessment of a dwelling as reasonably fit fot habitation. Unfit houses are not necessarily houses which would best be dealt with by demolition. Individually, demolition of unfit houses is becoming increasingly rare. Groups or areas of unfit houses, however, pose a more serious question in regard to demolition. The Public Health Inspector has to reach his findings and recommendations upon the condition of each house individually and then upon the houses collectively within an area under examination. The items (a) to (h) of Section 4 of the 1957 Act may be divided into two parts. (1). Repair, stability, dampness, internal arrangement, natural light and ventilation and (2) water supply, drainage and sanitary conveniences and facilities for the preparation and cooking of food. Items at (2) above, while causing or adding to unfitness, in a built-up area like Haringey, could be rectified without great difficulty at nearly all houses. Defective matters at (1) above may involve, where indeed possible, major alteration and repair depending upon the degree of defectiveness. It will be appreciated from the foregoing the significance and importance of the introduction of internal arrangement into Section 4 of the 1957 Act. The rectification of bad internal arrangement may be a major factor in deciding whether a house or houses would best be dealt with by clearance. Bad design, though perhaps not by itself making a house unfit, may add to the unfitness of a house and render it obsolete by present day standards. 30 The Act of 1969 largely deals with matters relating to the repair and improvement where rehabilitation is thought to be the best method of dealing with unsatisfactory houses either individually or in areas. Inducement to owners to carry out the work is provided by financial reward in proportion to the degree of neglect and deficiences at the houses. Difficulty remains in deciding upon a standard of conditions under which clearance of houses may be the best method of dealing with them and above which the repair and improvement of the buildings may be more appropriate. The Ministry apparently have found it necessary to state that rehabilitation is not a substitute for clearance, perhaps realizing the possibility of the acceptance of large twilight areas where rehabilitation would be extensive, difficult and expensive but where clearance procedure would not be a clearly obvious solution. The rehabilitation of fit or unfit houses which are in reasonably sound structural condition is more easily achieved than in the case of houses which are structurally less sound and it is hoped that houses which fall between the obviously clearance category and the obviously rehabilitation category will not be allowed to continue to exist as unfit or unsatisfactory dwellings indefinitely. There is a widespread need for the repair and improvement of ageing but reasonably sound properties and the arrest of deterioration and the raising of the standard of the stock of houses can be attained by intensive programmes of rehabilitation provided always that rehabilitation is in fact carried out. The following dwellings were the subject of closing or demolition orders made during the year. These were houses or parts of houses which were unfit for habitation and could not be made fit at reasonable expense. 73 Park Road, N.8. 1 & 2 Cleveland Villas, N.15. 83 Victoria Road, N.22. 5 & 7 Victoria Crescent, N.15. 209 High Road, N.15. 51 Truro Road, N.22. 42 Park Road, N.8. 44 Park Road, N.8. 80 Milton Park, N.6. 30 Milton Road, N.6. 37 Stanley Road, N.15. 66 Highgate High St., N.6. 68 Milton Park, N.6. 18 Victoria Crescent, N.15. Closing Orders on houses as under-noted were determined during the year — 4 Heybourne Road, N.17. 55 North Grove, N.15. Routine matters such as replies to "searches", interviewing members of the public and office administration, and special investigations and reports and memoranda from other Departments were attended to throughout the year. Housing Improvement and Conversion The Housing Act 1969 which came into force on 25th August 1969 offers considerable additional incentive to house owners to take action to bring their property up to modern standards. Many older substantial dwellings lack amenities now considered to be a necessity and may have defects such as rising dampness, due to omissions in the original design and construction of the premises. Generous grants are now available to owners to assist them in improving their property and if at the same time essential repairs to the premises are needed, the cost of this may also qualify for grant up to an amount equal to the approved cost of the improvements. Certain older houses are now too large for present day families and are capable of conversion into two or more self contained units of accommodation. Here too owners may be assisted by grants from the Council which may also be paid as described above towards essential repairs carried out at the same time. The Council has agreed that the fullest possible use should be made of the new provisions and every encouragement and assistance given to owners to take advantage of the enhanced grant provisions. In this way it is felt that the steady deterioration of property in wide areas of the borough may be arrested and reversed with a probable consequent reduction in the need for clearance and redevelopment. The revised maximum grants which are free of the 3-year conditions applying under previous legislation, are summarised below:- Maximum Grant 1. Improvement to 12 point standard of house normally having a life expectancy of at least 30 years. £1,000 (Half of approved estimated expenditure on improvement and repairs) 31 Maximum Grant 2. Conversion of premises into two or more self-contained dwellings normally with 30 years life (Half of approved estimated expenditure on improvements and repairs) £1,000 per dwelling 3. As (2) above but building has 3 or more floors £1,200 per dwelling 4. Installation of standard amenities only in dwelling normally having a further life of at least 15 years. (a) Fixed bath or shower in bathroom £30 (b) Wash hand basin £10 (c) Sink £15 (d) Hot and cold water supply for (a) £45 (e) Hot and cold water supply for (b) £20 (f) Hot and cold water supply for (c) £30 (g) Internal water closet £50 Total maximum grant £200 5. As (4) but where necessary to construct a bathroom extension £450 Standard grants may not exceed 50% of the actual approved cost of the works. The Housing Act 1969 came into force on 25th August and between that date and the end of this year applications for grant were received in respect of 121 dwellings, as follows:- Standard Grant 44 Improvement Grant 54 Conversion Grant 23 TOTAL 121 Grants approved under the 1969 Act in that period amounted to £15,218. Of necessity, approvals must lag behind the applications since a considerable amount of investigation must be undertaken in respect of the property and the specification of works and prices submitted by the applicant. The applicant's title to the property must also be checked by the legal department. Improvements and Rents The Housing Act 1969 has linked the improvement of properties with the decontrol of controlled tenancies and the re-assessment for rent purposes of "regulated" tenancies and this is an additional incentive to owners to modernise their properties. If, when the Act came into operation on 25th August 1969, a dwelling let at a controlled rent, was provided with all the standard amenities and these amenities continue to be available, the owner may apply to the Council for a Qualification Certificate to enable him to request the Rent Officer to fix, and register a fair rent for the dwelling and this rent can be brought into operation, the increase being phased over a period of five years. Before issuing the Qualification Certificate the Council must be satisfied that, in addition to having all the standard amenities, the dwelling is fit for human habitation and is in good repair having regard to its age, character and locality. 264 applications of this type were received in 1969. Where a controlled dwelling lacked some of the standard amenities in August 1969, the owner may submit proposals for installing these amenities, with or without the aid of a grant from the Council and apply for a Certificate of Provisional Approval. This will enable him to request the Rent Officer to fix a fair rent for the improved dwelling. When the fair rent has been fixed and the tenant advised, the owner may then request the tenant to consent to the improvements being carried out: if this consent is given the owner is then entitled to a Qualification Certificate upon the satisfactory completion of the work to enable him to request the Rent Officer to register the fair rent. 14 applications were received in 1969. 32 General Improvement Areas Under the Housing Act 1969 the Council may declare general improvement areas where it is considered that special efforts are warranted to secure the improvement of dwellings in the areas. Parallel with this work action can be taken to make environment improvements to the area to make it a more pleasant part in which to live. Consultation and collaboration with the residents and owners is an essential feature of any scheme of this nature as its success must rest upon their co-operation and active participation. The Council has welcomed these provisions and has called for surveys to be undertaken with a view to initiating general improvement areas in 1970. Housing Act 1964 Improvement Areas The 1969 Act prevents the declaration of any new areas under the 1964 Act procedure but action may continue to be taken in respect of those areas already declared. Haringey have declared four Improvement Areas but action in respect of the last two had been suspended because of the impending new legislation. The Council has decided that no further action should be taken in respect of these two areas. The remaining two areas, however, have already reached an advanced stage and it is likely that it will be necessary to carry these through to a conclusion. Further consideration will be given to this by the Council in 1970. Houses in Multiple Occupation The coming into operation of the Housing Act 1969 has caused many headaches; the problem of staff being not the least. It became necessary in order to implement effectively the improvement provisions of the Act to transfer two of the team of inspectors concerned with houses in multiple occupation to other duties in this connection. Whilst day to day work progresses, therefore, it is stiIl not possible to institute house to house inspections whereby known areas of multiple occupation can be dealt methodically. Due to a recent adverse High Court decision upon the definition of "family" in regard to houses in multiple occupation, the new act gave a fresh definition, using the word "household" instead of "family". Unfortunately, the act did not define "household", but the term is at present interpreted according to the definition used for Census purposes. Changes were made in regard to the procedure for making Management Orders, so that it became no longer necessary to give 21 days notice of the Council's intention to make the order. It was, however, still necessary to make a Management Order before the provisions of the Housing (Management of Houses in Multiple Occupation) Regulations 1962 could be legally enforced by action under Sections 13 or 14 of the Housing Act 1961. It is, to say the least, rather mystifying as to why it should still be considered necessary to make a Management Order before being able to implement the provision of regulations which should automatically be applicable to every house in multiple occupation. With regard to means of escape in case of fire, certain amendments were made by the 1969 Housing Act to enable the local authority to make a Closing Order on a part of a house, if, by doing so, it was considered that adequate means of escape could be provided at reasonable" expense for the rest of the house whereas this could not have been done at reasonable cost if that part of the house remained in occupation. A similar procedure to that laid down in Part II of the Act of 1957 for the making of Closing Orders for unfit houses must be followed. However, in view of the income from many houses in multiple occupation, particularly the larger ones with which the Department is primarily concerned, it appears unlikely that even the provision of an external staircase would be an 'unreasonable expense'. The use of this power would, therefore, seem to be extremely limited. However, there is provision for the authority to accept an undertaking that part of a house would not be used for human habitation if the owner was able to provide adequate means of escape if thatpartofthehousewasclosed, since the Council's requirements in this respect may be considerably reduced in these circumstances. He would of course suffer a loss of income and would, therefore, wish to consider this when deciding whether to carry out the work required in full or execute less extensive work by virtue of hisgivinganundertakingnottouse part of the house. Use of the part of the house subject to an undertaking would constitute a contravention and the Council may also make a Closing Order when these circumstances have arisen. 33 A slight amendment is made to the penalty clauses under Section 65 of the Housing Act 1964 in that the obligation to execute works required continues after the notice expires and after any conviction which may be secured under Section 65. Maximum penalities under Section 19 of the Housing Act 1961 and Section 90 of the Housing Act 1957 are increased from £20 to £100 for the first offence. Certain other amendments are made to Section 19 so that it is possible to specify the number of households as well as the number of individuals when making Directions. The complex procedure of making Control Orders is further amended if a local authority make a Compulsory Purchase Order within 28 days of making the Control Order. The already difficult financial processes are then further amended and provision made for the service of notices to secure the carrying out of urgent works prior to the Minister's decision as to whether or not he confirms the Compulsory Purchase Order. There is now a choice of three types of Registration Schemes for houses in multiple occupation which may be made, instead of the single scheme laid down in Section 22 of the Housing Act 1961, as follows:- 1. A scheme of notification by owners or other interested persons that a house appears to be registrable (as under Section 22 of the Housing Act 1961) (i.e. is occupied by 3 or more households as the local authority may determine). 2. A scheme containing control provisions for preventing multiple occupation of a house to a greater extent than at the time the provisions came into force, unless the house was registered. There is power to refuse to register. (a) if the house is unsuitable and incapable of being made suitable for occupation in present circumstances; and (b) if the person having control of the house is considered to be not a fit and proper person; and the Council can require as a condition of registration that work is carried out to put the house into such condition that it would be accepted for registration. 3. A scheme combining both the above schemes. Schemes can be made to apply to the whole or any part of a Borough, and consideration may be given to the making of a scheme in Haringey. With the emphasis now on the improvement of dwellings with the aid of grant, this is yet another aspect to be considered when dealing with houses in multiple occupation and, of course, involves considering the potentialities of a house as well as its shortcomings, and then discussing these with the owner as alternatives to bringing the house up to multiple occupation standards. The "multiple occupation" standards are merely a palliative and it is far better for a house to be improved to a higher standard and to achieve full amenities for the exclusive use of each household and, if possible, self contained flats, than merely to increase the number of shared amenities. Full "improvement" should be the aim of the future. Many of the properties in multiple occupation do not lend themselves to conversion without displacement of a number of households and it may not be an economic proposition for an owner to convert a house to, say, 3 flats as against perhaps having six separate lettings. After the expense of conversion the financial return may be less than before, and there is the additional problem of finding accommodation for the displaced households, so that even with the encouragement of substantial grants, the problem of multiple occupation is likely to remain with us for many years to come. House in Multiple Occupation — Summary of Action taken in 1969 Number of separately occupied parts of houses visited for first time 1,831 Number of revisits to above 11,626 Number of inspections where multiple occupation would exist upon completion of mortgage advances being contemplated by this Council 30 Number of houses completely inspected 367 Number of houses where informal notices sent relative to S15 217 Number of houses where informal notices sent relative to S16 292 Number of houses where items of inadequate management notified to owners 176 Number of cases of penal overcrowding 79 Number of cases of penal overcrowding abated 69 Number of cases of non-penal overcrowding 19 34 Number of cases of non-penal overcrowding abated 17 Number of formal S14 notices 2 Number of formal S15 notices 15 Number of formal S16 notices 16 Number of formal S78 notices 12 Number of houses where S19 Directions made 4 Number of houses where S12 Management Orders made 2 Other notices served 345 Other visits, including discussions with owners, builders etc., at premises 1,248 Completed works W.C's. provided 18 Baths/Showers provided 25 Sinks/lavatory basins provided 32 Water heaters provided 103 Cooking facilities provided 20 Food stores provided 12 Space Heating provided 7 Fire precautions work 88 Repairs External 107 Internal 228 Certificate of Disrepair - Rents Act 1968 During the year five applications were received for certificates of disrepair, but in two cases certificates were not considered to be justified. One certificate was cancelled in 1969. Searches: Local Land Charges and Mortgage Advances 5,515 searches were reported upon in relation to Public Health functions which may have had a bearing on the properties concerned. Reports were also furnished in respect of 198 houses where applications were under consideration for mortgage advances by the Council. The regular inspection of all places where food is stored, sold or prepared, retains a position of of top priority as far as the work of the Food Hygiene Section is concerned. The number of people with little knowledge of the English language in charge of food establishments appears to be still on the increase. This makes general communication difficult and increases the chanctes of misunderstanding, deliberate or otherwise, of requirements of Regulations. The Public Health Inspectors of the Department were pleased to receive an invitation to serve on the Food Hygiene Sub-Committee of a local Hospital Group Control of Infection Committee and thereby contribute to discussions between the staff of the Bacteriological Laboratory, Catering Department and the general administration responsible for the food storage, preparation and general food handling arrangements in all the premises under the control of the Committee. The Hospital Authorities have expressed appreciation of the contribution which the Department has been able to make towards securing and maintaining the highest practicable standards of food hygiene in the local hospital establishments. FOOD HYGIENE 35 The total number of food shops at the end of the year was as follows:- No. of Shops No. of Inspections Bakers and Flour Confectioners 98 231 Butchers 116 740 Cafes and restaurants 236 964 Confectioners, Sugar 375 198 Fishmongers 34 87 Fruiterers and greengrocers 169 397 Grocers 423 967 Off licences and public houses 200 215 Registered Food Premises At the end of the year the following premises were registered under Section 16 of the Food and Drugs Act 1955. Sale of ice cream 805 Manufacture and sale of ice cream 11 Storage of ice cream 1 Cooking of hams and other meat 64 Fish frying 56 Fish curing (smoking) 3 Sausage manufacturer 101 Preparation of "Hot Dogs" 1 Preparation of jellied eels 3 Shell fish 2 Prepared foods 17 Pickling meat 3 Total 1,067 In addition the following classes of food hawkers and their storage premises are registered under Section 11 of the Middlesex County Council Act 1950:- Articles No. of Hawkers registered No. of storage premises Fruit and vegetables 127 91 Shellfish 13 4 Fish 12 4 Ice cream 28 4 Light refreshments 19 5 Peanuts 4 2 Eggs 3 - Groceries 6 2 Confectionery 1 1 Total 213 113 Milk and Dairies Regulations The number of distributers and dairies registered at the end of 1969 was as follows;- Distributors 269 Dairies 6 36 Meat Inspection in progress at new Abattoir Milk (Special Designation) Regulations At the end of the year the following licences to use special designations were valid for premises in the Borough:- Imported Food Regulations The revised regulations with respect to imported food permit the release of food cargoes at the ports on the receipt of an undertaking by the Port Health Authorities from the importer that the foodstuff will be forwarded undisturbed to a named Inland Reception Centre where it will be subject to public health inspection by the receiving Local Authority Officers. Partly due to the increase in "container" traffic, Haringey receives increasing quantities of imported foodstuff which are delivered to the local Cold Stores and are there subject to official examination. On occasions, this examination must include chemical and bacteriological sampling, and if the present indications of a large scale expansion in the "container" transport of imported foods are fulfilled, it appears likely that a material increase in official surveillance by the Public Health Inspectors will be necessary in this sphere. New Food Premises (1) Ice Cream Factory During 1969, a long standing local ice cream manufacturer commenced production in a newly constructed building in South Tottenham. For many years this family business had been trading from very restricted premises in an area which has now been redeveloped by the Council. The factory, now demolished, was a random development of severely limited proportions. It speaks volumes for the hygienic standards observed by proprietor and his staff that the product was consistently of a high bacteriological standard. The new building consists of two blocks, of which one is a workshop for the mobile sales vans. The factory is modern in concept and is the result of not only advice from all interested parties but also the proprietor's own considerable experience. The machinery in the factory, which produces a variety of lines, includes three 30/60 Vogt Cherry Burrell freezers and a C.P. 30/60 freezer, six 100 gallon ageing vats by C.P. and Alfred, and C.P. fruit feeder and ripple pump, two 100 gallon pasteurisers, and an Oldham lollie machine capable of producing 35 gross/hour. Recently a modern automatic Carousel Rotary freezer lollie plant has been installed capable of producing 25 gross/hour. There is also a 10,000 cu. ft. cold room. (2) New Abattoir The slaughterhouse on the site in Markfield Road, N.15. went out of use three years ago following severe damage to the structure during a storm. The proprietors decided to demolish the existing building and construct a modern abattoir on approximately the same site. Expert advice was obtained from all available sources including the Ministry of Agriculture, Fisheries and Food. This Department was consulted and kept informed of all developments during the planning of the scheme and as a result we now have what we consider to be a model abattoir. Full production has not yet been achieved and a few teething troubles have yet to be remedied. The abattoir is using a "line system" which in effect means that the carcase does not again touch the floor after being hoisted immediately after slaughter. This is in contrast to the method of dressing on cradles on the floor. Apart from the standard equipment found in any modern abattoir, items of interest include — (a) compressed air flaying knives and apparatus for removing hides with the minimum of handling and in such a manner that the hide is removed and deposited in the hide room without touching the floor. (b) A pneumatic blower unit is used to convey all waste material through pipes which discharge into collection hoppers in the yard, thus reducing to a minimum the time which such material remains within the building. Pasteurised Milk 219 Sterilised Milk 216 Untreated Milk 30 Ultra Heat Treated Milk 52 37 The site which incorporates the actual abattoir is being developed with extensions to the existing pet food plant, and new cold stores and office blocks. Data of interest is as follows — Total area of land (including buildings) 1.8 acres. Floor areas in square feet- Covered lairage — 5358 Slaughterhall — 2146 Hanging space —768 ChiIl-room, cold air store or refrigerated room — 856 Mess rooms, toilets, showers, locker area and offices — 429 Potential number of animals to be killed per week — 300/350 (mainly bovines and horses) The Company, expect eventually to transfer to the new abattoir the whole of their business from the present site in central London. Food sampling for bacteriological examination The Department continues to submit to the Central Public Health Laboratory samples of food as sold to the public which are considered most likely to be vehicles of food poisoning organisms. These include cooked meats, artificial and dairy cream, meat pies (particularly those sold from hot cabinets) and chicken barbecue. The relative number of samples of any particular type of food is constantly under review and emphasis is changed in the light of our own experience and the advice so freely given by Miss Betty Hobbs, D.Sc., F.R.C.Path., Dip.Bact. the Director of the Food Hygiene Laboratory, and her colleagues at Colindale. The results of the examination are found frequently to be either a pointer to poor hygiene practices which cannot be observed during routine inspection or strong reinforcements to persuasion to secure improvements often beyond the standard which can be demanded by the Food Hygiene Regulations. Food and Drugs Act The work of sampling a wide variety of foodstuffs has continued smoothly and in no case was it necessary to resort to legal proceedings to enforce the provisions of the Act and the numerous regulations made thereunder. In a number of instances, where minor contraventions have been found, the manufacturers have not only taken immediate action to rectify the matter but have in most cases expressed their appreciation of the advice given. Depending on pressures of other work, the visits to food manufacturing premises by members of the Section accompanied by the Council's Deputy Public Analyst have continued on the basis of about one a month. The visits are welcomed by the manufacturers and samples of raw materials as well as finished products were freely submitted for analytical examination. In some instances matters of constituents and/or labelling have been taken up with suppliers of raw materials. A large number of samples are also submitted to the Council's Public Analyst which arise from complaints of alleged unsound foodstuff made to the Department by members of the public. These fall into two main categories, (a) the presence of foreign matter in the foodstuff and (b) the deterioration of the foodstuff owing to decomposition or attack by parasites. The opinion of the Public Analyst is particularly valuable in cases where foreign objects, especially insects, are found in food. In these cases he can often say with certainty whether or not the insect has gained access to the food before, during or after manufacture. 38 Needles in Coconut Mallows X-ray photographs of coconut mallows showing complete hand sewing needle embedded in a mallow. Above-mallows remaining in tray, below-side view of mallow containing needle. Examination followed complaint that another mallow from same packet was found to contain part of a needle when bitten by purchaser. Suppliers prosecuted under Food and Drugs Act; were fined £40 and £10 costs. FOOD SAMPLES Articles No. of Samples provided Unsatisfactory Analysis Labelling Alcoholic Beverages 16 1 2 Biscuits 4 - - Bread 8 7 - Cereal and Starch Products 3 - - Cheese and Cheese preparations 3 3 3 Cocoa and chocolate preparations 13 1 - Colourings 6 1 1 Confectionery (Flour) 2 2 - Drugs 59 7 - Eggs and egg products 1 - - Fish and fish preparations 2 - - Flavourings 2 - 1 Flour and flour products 7 1 - Food additives 26 - 1 Foods - miscellaneous 1 1 - Fruit and fruit preparations 35 - - Gravy preparations 4 - - Herbs and herb preparations 5 - 2 Jam and preserves 9 - - Margarine 5 - - Meat and meat preparations 15 3 - Milk 180 8 - Milk, Dried and condensed 2 - - Milk preparations 51 20 9 Oils, fats and fatty foods 29 4 - Pickles and sauces 2 1 - Sausages 4 1 - Soft Drinks 7 - 3 Soup and soup mixes 3 - - Spices and condiments 3 - - Sugar confectionery 4 - - Sugar and Syrups 4 - - Table Jelly Preparations 23 1 - Tea 2 1 - Vegetables and Veg. preparations 38 4 - 578 67 22 39 Details of Unsatisfactory Samples Sample Irregularity Comments and Action taken Butterfat Samples of butterfat taken from two food factories showed abnormally low Reichert, Polenske and Kirschner values Investigations are still proceeding, but preliminary conclusions suggest that when stored under warm conditions butterfat can separate into high and low melting point fractions, and these fractions may have different Reichert values. Chocolate Vermicelli Routine examination of a sample of chocolate vermicelli showed the presence of a live lavae of a bread beetle (Stegobium Paniceum). The retail shop was inspected and was found to be satisfactory. Further samples were taken and found to be satisfactory. No further action taken. Colouring Matter (a) Blue VRS found in a packet of lime jelly Blue VRS colouring matter prohibited in this country since 1967. Alleged to be old stock. Further samples to be taken for examination. (b) 'Bismarck Brown Substitute used for colouring the casings of slicing sausages, found to contain Blue VRS. The carton of colour was withdrawn from use. (c) A sample of Conovid was found to contain Ponceau SX, a nonpermitted food colouring matter. No regulations control the addition of colouring matter to drugs, but it is considered that drugs for internal administration should not contain colouring matter prohibited in food. A further sample showed that the manufacturer was now using permitted colouring. The previous sample was thought to be old stock. Drugs (a) Four samples of soluble aspirin tablets were found to contain excessive salicylic acid Withdrawn from sale. Soluble aspirin tablets are particularly liable to decompose to form the more toxic salicylic acid. (b) Two samples of A.P.C. tablets were found to contain excessive amount of free salicylic acid Withdrawn from sale. The use of these analgesics has been discouraged because of the possibility of toxic effect from phenacetin, therefore stocks are likely to be old and liable to decomposition caused by overlong storage. Flour A sample of flour was found to contain 470mg. chalk per 100gm. of flour Difficulty is experienced in maintaining an even distribution of added chalk to flour as required by the Bread and Flour regulations under which the legal maximum is 390mg. chalk to 100gm. flour. Milk (a) Samples of pasteurised milk were taken from a school which had complained that the milk rapidly went sour. All samples failed the methylene blue test and the phosphaste test. Investigations at the dairy showed that the pasteurisation plant was not functioning properly. A warning letter was sent to the company and defects have now been remedied. Palm Oil (a) A sample to palm oil was found to contain 24 parts per million lead. The Lead in Food Regulations limit the amount of lead in edible oils and fats to 0.5 parts per million of lead. The oil contained a number of flakes of paint. Another sample was taken which also contained excessive lead. The stock was seized and destroyed. 40 Sample Irregularity Comments and Action taken Palm Oil (contd.) (b) A further sample of palm oil from the same source was taken, and was found to contain 7 parts per million lead which is also considerably in excess of the legal maximum. The lead again was mainly associated with flakes of paint in the oil. Legal proceedings were taken against the retailer who was fined £15 with 10 gns. costs. Yoghourt Objection was taken to samples of yoghurt that contained either sorbic acid or benzoic acid added to the fruit puree as preservative. The regulations relating to the use of preservatives in food do not permit the direct addition of preservatives to yoghurt, and sulphur dixoide is the only preservative which may be included in the fruit puree used to flavour such preparations. The regulations are at present under review, and it is possible that a relaxation may be recommended, as the addition of such preservatives are permitted on the continent. Labelling The following labelling irregularities, noted in respect of 26 samples, were brought to the attention of the manufacturers or distributors responsible. Statutory declaration absent or incorrect 6 cases Misleading Description 6 „ Incorrect Designation 6 „ No common or usual name 5 „ No list of ingredients 4 „ Incorrect list of ingredients 2 „ No name and address 3 „ Alcohol declaration not prescribed 1/12" in height 2 „ Food Complaints 103complaints of unsound foodstuffs were investigated and, where appropriate, legal proceedings were instituted or warning letters sent. Details are shown in the following table. 41 Details of Food Complaints Commodity No. of Complaints Action taken Foreign bodies found Other Reasons Official warning letter Prosecution No formal action justified Baby Food 1 - - 1 - Bacon - 3 - 3 - Biscuits 2 1 2 - 1 Bread 11 11 12 8 2 Butter - 1 - 1 - Cereal 1 - 1 - - Cheese 1 - - - 1 Chicken - 3 1 - 2 Confectionery (Flour) 8 3 3 6 2 Confectionery (Sugar) - 2 2 - - Corned Beef 1 1 1 1 - Crisps - 1 - - 1 Custard Powder 1 - 1 - - Fish 2 2 2 - 2 Fruit (Fresh) - 1 - - 1 Fruit (Tinned) 2 3 4 - 1 Jelly 1 - - - 1 Meat - 1 - - 1 Meat(Cooked) 2 3 2 - 3 Meat (Tinned) - 2 1 - 1 Meat Pies - 6 2 2 2 Milk 3 3 3 1 2 Peanuts 1 - 1 - - Pickle 1 1 - 1 1 Prepared Food 3 2 4 - 1 Sausages 1 4 1 3 1 Tablets - 1 - - 1 Tea 1 - 1 - - Vegetables (Tinned & Frozen) 3 1 3 1 - Yoghurt 1 - 1 - - Total 47 56 48 28 27 Surrender of Unsound Food 712 certificates were issued in 1969 in respect of unsound foodstuffs which were surrendered by wholesale and retail distributors. Meat Inspection There was very little slaughtering in the borough in 1969as the rebuilt slaughterhouse was at only the early stages of operation by the end of the year. The details given below relate to trial slaughtering which was undertaken towards the end of 1969. 42 Summary of Carcases Inspected 1969 (3 months only - started October 69) Bovines Horses Calves Sheep & Lambs Cows Number killed 10 8 12 1 170 Number inspected 10 8 12 1 170 All Diseases except Tuberculosis Whole carcases condemned 1 - - - 8 Carcases of which some part or organ was condemned 3 5 1 - 121 Percentage of number inspected affected with disease other than tuberculosis 40.0 62.5 8.3 - 75.8 Note: No case of cysticercosis or tuberculosis was reported during the year. There are no registered poultry slaughterers in the borough. Offices, Shops and Railway Premises Act 1963 The amount of work arising from the provisions of this Act, which can be carried out by the Department is limited, not only by the personnel available but by the priority which other aspects of public health demand. In spite of this, every effort has been made to increase the number of general inspections during the year. All accident reports are carefully scrutinised and wherever the circumstances suggest that further investigation is needed visits are made to the premises and detailed examinations are made and advice given on preventive measures which should be taken. Some difficulty has been experienced in translating to particular circumstances the provisions of the Offices, Shops and Railway Premises (Hoists and Lifts) Regulations 1968 and the Deputy Superintending Inspector of Factories has been consulted. He has, on one occasion, visited the Borough to see for himself a type of lift used by a particular company who are using numerous similarly constructed lifts throughout the country. The legal and physical aspects of the matter had not been resolved at the end of the period under report. Registrations and General Inspections in 1969 Class of Premises No. of Premises Registered during 1969 No. of Registered premises at end of year No. of Registered premises receiving a general inspection 1969 Offices 22 463 220 Retail Shops 83 1,098 453 Catering establishments and canteens 8 67 32 Wholesale shops and warehouses 6 152 42 Fuel Storage Depots - 3 2 119 1,783 749 43 Analysis of Contraventions Found Section Type of Contravention No. found Section Type of Contravention No. found 4 Cleanliness 33 12 Clothing Accommodation 4 5 Overcrowding 2 15 Eating Facilities 2 6 Temperature 51 16 Floors, passages and stairs 54 7 Ventilation 8 17 Fencing machines 12 8 Lighting 15 23 Heavy work 1 9 Sanitary Conveniences 63 24 Provision of first aid 63 10 Washing facilities 42 50 Abstract 88 11 Supply of drinking water 1 Persons Employed in Registered Premises Class of Workplace No. Offices 6,796 Retail Shops 6,268 Wholesale Shops, Warehouses 1,542 Catering establishments 1,078 Canteens 238 Fuel Storage Depots 35 Total 15,957 Males 7,236 Females 8,721 Reported Accidents Work place No. Reported Total No. Investigated Prosecution Formal Warni ng Informal Warning No Action Offices 10 3 - - - 3 Shops, Retail 25 16 - 1 3 12 Wholesale shops, warehouses 39 18 - - 5 13 Catering establishments and Canteens 6 5 - - - 5 Fuel Storage Depots - - - - - - Total 80 42 - 1 8 33 44 Analysis of Reported Accidents Offices Retail Shops Wholesale Shops, Warehouses Catering establishments and canteens Machinery 1 1 3 1 Transport - - 3 - Hand Tools - 3 - - Falls of Persons 5 12 7 3 Stepping or striking against objects - 3 4 - Handling Goods 2 5 9 2 Struck by falling object 2 1 10 - Not otherwise specified - - 3 - 10 25 39 6 Hairdressers Section 21 of the Greater London Council (General Powers) Act 1967 was applied to Haringey with effect from 1st January 1968. This requires all persons carrying on business as hairdressers or barbers at premises in the Borough to be registered by the Council. New byelaws in respect of such establishments in Haringey were approved and came into force on 1st October 1968. These prescribed standards of hygiene in relation to the premises, equipment and persons working on the premises. 179 premises were registered at the end of the year and all were inspected during the year. Shops Act 1950 — 1966 A total of 3,764 shops inspections were made during the year. The following contraventions were noted:- General Section 17(2) Assistants weekly half holiday notice not displayed 268 Section 32(2) Notice of hours of employment of young persons not displayed 79 Section 32(3) Abstract of provisions of employment of young persons not displayed 41 Closing Hours Section 2(1) Failed to close at prescribed hour 14 Section 1(1) Failed to close at 1 p.m. on early closing day 27 Section 1(2) Failed to exhibit early closing day notice 196 Section 13(1) Failed to exhibit exempted trade notice 248 Sunday Trading Section 22(3) Failed to keep record of hours of employment 6 Section 57 Failed to exhibit Sunday Trading Notice 53 Street Trading Although there is no street market in the Borough, 30 sites on the public highway are licensed for street trading. The majority of these are in side roads off the Tottenham and Wood Green High Roads and off West Green Road, N.15. Following a review of traffic problems, the resiting of many of the stalls further back from the main roads was considered necessary. Appeals to the Courts by some traders against the Council's decision were still pending at the end of 1969. The Council also license 19 small sites on the footpaths for trading. These are mainly occupied by newsvendors and are situated in the vicinity of British Rail and Underground Stations. 45 FACTORIES The local authority has responsibilities to inspect the sanitary accommodation and water supplies, in all factories and business premises. In factories where no mechanical power is used, the other welfare provisions of the Factories Acts are also the responsibility of the local authority. Frequent visits are made to factories for a variety of reasons and it is the usual practice to check all the conditions whilst on the premises. Premises No. on Register No. of Inspections Written Notices Occupier Prosecuted (1) Factories in which sections 1, 2, 3, 4 and 6 are enforced by the local authority 59 9 - - (2) Factories not included in (1) in which Section 7 is enforced by local authority 1024 284 47 - (3) Other premises in which section 7 is enforced by local authority (excluding Outworkers premises) 17 17 - - 1100 310 47 - 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 Sanitary Conveniences (S.7) (a) Want of cleanliness 1 1 - 1 (b) Unsuitable or defective 12 11 - 12 (c) Not separate for sexes 4 4 - 2 Total 17 16 - 15 Outworkers Employers of outworkers in certain specified trades are required 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. No action was required in respect of these matters, but the use of power machines in private houses continues to give rise to complaints from neighbours of nuisance by noise and vibration. This aspect is mentioned elsewhere in this report. 46 Outworkers' Trades No. employed Making of Wearing Apparel 251 Making of Curtains and furniture hangings 1 Making of articles from brass 4 Fur pulling 7 Making of cart gear 1 Umbrellas 1 Artificial Flowers 12 Cardboard Boxes 10 Making of brushes 6 Button Carding 56 Making of stuffed toys 1 Christmas Crackers 9 Total 359 190 visits were made to outworkers' premises Radioactive Substances Act 1960 The Council is notified of all premises within the Borough in respect of which certificates are issued by the Ministry of Housing and Local Government for the keeping and use therein of radioactive materials. During the year, the Council were notified of a slight increase in the number and strength of sources of radioactivity held at 3 of the premises in the borough already holding radioactive materials. New certificates were issued by the Ministry of Housing and Local Government in respect of 2 premises. Visits to premises using radioactive materials continue to be carried out by one of the Senior Public Health Inspectors so that the department can be kept informed of the levels and use of these materials within the Borough. Student Public Health Inspectors The Department has eight student public health inspectors, with two pupils on each year of the four-year course. They attend the Education Board Diploma day-release course at the Tottenham Technical College. The in-service training is directly supervised by a Senior Public Health Inspector who has steadily expanded and developed their programme of practical work, to ensure that, when qualified, the officer has had a very full experience of the best methods of dealing with the problems he is likely to meet with as a public health inspector. 47 PART 2 PERSONAL HEALTH SERVICES Stuart Crescent Health Centre In 1965 when the Borough of Haringey was established one of the first recommendations of the Health Committee was to replace the 100-year-old Victorian mansion which had been used as a school clinic with a purpose-built health centre. The family doctors in practice within convenient distance of this centre were consulted and eventually all the doctors practising within half a mile of the Stuart Crescent area agreed to work in the new Health Centre. Many exploratory talks were carried out with the assistance of Mr. Madden of the Middlesex Executive Council and the staff of the Department of Health and Social Security, who were most helpful with their guidance in the early planning stage. The crescentic site faces the Civic Centre across the Wood Green High Road and a small park. A single-storey building would have been out of keeping with the taller buildings around it and and would also have been wasteful of building land and so it was decided to build on four floors and to provide a basement car park. The ground floor of the Centre accommodates ten general practitioner suites as well as rooms for the maternal and child health services of the borough and for the sale of welfare foods. On the same floor there are facilities for the chiropodists together with a treatment room and small operating theatre. The first floor includes two dental suites for the school dental service and normal facilities for the school health service together with a soundproof room for audiology and speech therapy. The same floor has administrative office accommodation for the administrative officer, district nurses and the health visitors and a small kitchenette is located between a small common room for use of the staff. The two upper floors comprise eleven maisonettes and two flatlets for residential purposes. The Centre is so designed that the services of the local health authority share some facilities like waiting space and reception in common so that in the course of time and with the evolution of the new medical service envisaged in the second green paper there should be a better liaison in the health services. The clinic was eventually opened in the last few days of 1969 and since then progress has been made with the attachment of home nurses and midwives to individual general practitioners for the almost certain benefit of their patients. The Centre facilitates an improvement in primary medical care which must follow with the increasing team work by doctors, nurses and other health service workers a gradual progress with an inevitable improvement in health services. CARE OF MOTHERS AND YOUNG CHILDREN Notification of Births Live Births (a) Domiciliary 463 (b) Hospital or Nursing Home 4328 Still Births (a) Domiciliary 2 (b) Hospital or Nursing Home 54 Total 4847 Family Planning The family planning service in the Borough continued to be provided by the Family Planning Association, acting as the Council's agents, the Council accepting financial responsibility for cases dealt with at family planning clinics who came within certain medical and social priority categories. The number of cases for whom responsibility was accepted during the year was 214. Ten-and-a-half weekly sessions were held at clinics, including a weekly evening session at which contraceptive advice was given to the unmarried, and a weekly session at the Prince of Wales's Hospital for the insertion of the intra-uterine device. 48 Stuart Crescent Health Centre The Domiciliary Planning Service continued to be held for women who need contraceptive advice but are unable for various reasons to attend the clinic. During 1969, the Domiciliary Service dealt with 104 patients, for all of whom the Council accepted financial responsibility. Dr. E. Christopher reports as follows on work of the Domiciliary Service and the Clinic for the Unmarried:- ACCOUNT OF TWO YEARS OF HARINGEY DOMICILIARY FAMILY PLANNING SERVICE February 1968 to February 1970 (An abstract from a Report by Dr. E. Christopher) The London Borough of Haringey (population 245,700) uses the Family Planning Association as its agent to operate a Domiciliary Family Planning Service, using one Doctor (myself) and one nurse (Mrs. Hinshelwood). In 1968 there were 5,120 births. 694 of these were illegitimate. Number of cases referred - 145 (average 6 per month). Referring Agents 1. Health Visitors: Referred 89 cases (a) Somerset Road 13 (b) Park Lane 25 (c) Lordship Lane 27 (d) Chestnuts 18 (e) White Lane Lane (now Stuart Crescent) 2 (f) Fortis Green 1 (g) Church Road 1 (h) Weston Park 1 (i) Gordon Road 1 There were no referra Is from: I. Mildura Court II. Stroud Green III. Burgoyne Road 2. Medical Officers in Health Department 9 3. Family Case Worker with special responsibility for homeless 18 4. Chi Idren's Department 11 5. Child Guidance 1 6. Probation Officer 1 7. Mental Welfare 7 8. District Midwife 2 9. General Practitioner 3 10. Hospital Consultant 1 11. Medical Social Worker (Prince of Wales's) 2 Country of Origin Religion Cyprus 7 Church of England 61 England 55 Roman Catholic 33 Gibraltar 1 Baptist 18 India 3 Methodist 14 Ireland 17 Church of God 8 West Indies 62 Greek Orthodox 7 Jehovah's Witnesses 2 Salvationist 1 Jewish 1 Number of patients unmarried - 11 49 Methods of Contraception chosen (by the 145 visited) Methods are discussed fully with the patient by the Doctor, and provided there are no medical contraindications to the method decided upon the decision of what to use is left to the patient and her husband. 1. Oral contraceptive 41 (2 patients transferred to Clinic, pay for themselves) (2 patients transferred to Clinic, Local Authority pay) 2. I.U.C.D. 32 (8 transferred to IUD Clinic at Prince of Wales's. No pregnancies so far with coil. 2 coils spent, expelled. 1 coil removed because of menorrhagia). 3. Sheaths and pessaries 19 (3 supply own sheaths, off list) 4. Sterilisation Female 21 (5 terminated and sterilised) 4 male Waiting sterilisation 5 Of the 21 sterilised: 13 West Indian 5 English 2 Irish 1 Greek Cypriot 3 patients left the area. 8 patients refused advice (despite the assurance by the referring agent that this had been requested by the patient):- (a) Mother of 1 patient (unmarried mother) is prostitute, refused to let daughter be seen. (b) 2 patients objected on religious grounds - 1 R.C., 1 Jehovah's Witness. (c) 2 unmarried mothers were immature West Indian girls with poor motivation. (d) 1 patient wanted 10 children (she had 9) despite being advised by Royal Free Hospital not to, as she is Rhesus negative and has antibodies. (e) 2 patients not allowed to accept advice by husband. 1 subnormal girl came to Clinic for discussion - she had no children. Of the remaining 8 patients:- 4 pregnant — 1 sheath failure - 1 forgetting Pill — 2 pregnant before visited 2 have just had badies and are still to be visited 2 unmarried girls, pregnancy terminated (for both it was 3rd illegitimate pregnancy) Thus 1. Numbers being visited 86 2. Numbers of sterilisations, male + female, therefore off list 25 Those awaiting sterilisation 8 3. Patients transferred to Clinic, therefore off list 12 4. Those supplying own contraceptives, therefore off list 3 5. Left area, therefore off list 3 6. Refused advice 8 145 Discussion and comment 1. The number of referrals has continued to increase, many coming from Health Visitors. Referrals can, of course, originate from many different sources, in fact from anyone in close contact with the patient (some patients try to refer their friends!). The Children's Department, with their detailed knowledge of the family, can be especially important. It may be mentioned here that the role of the Domiciliary Doctor is not primarily concerned with the social problems of a family (though it is inevitable that they do affect the doctor/patient relationship to a certain extent). A special point is made to keep the Social Worker or other referring person informed of what is happening with regard to family planning. 50 Under no circumstances is advice and help on family planning given unless the patient actively requests it. Those patients who want the IUD (which is not fitted at home) go by themselves to the Prince of Wales's IUD Clinic. Those wanting sterilisation similarly attend hospital by themselves. General Practitioners have co-operated (closely in some cases) with the domiciliary service and no Practitioner has withheld his consent to my visiting his patients. 2. Again (as in my report of a year ago) it will be seen that the majority of referrals concern mothers between the ages of 20 and 34 with 3—6 children, i.e. many potential problem families. Those patients who refuse advice often give religion as the reason. It is my impression that some of the husbands exert considerable pressure on their wives not to accept family planning because this would lessen their control over their wives. They may fear that their wives wilI become promiscuous once free of the fear of pregnancy. Some wives do appear to be the victims (sometimes willing ones) of their husbands' determination to make them pregnant every year only in order to keep control of them. These husbands will not themselves take precautions. 3. The oral contraceptive is the most popular method of birth control because of its effectiveness and ease of usage. There was much anxiety at the time of the Dunlop Committee Report in December 1969, and this entailed extra work in attempting to allay fears and give reassurance. It is interesting to note that there have been increasing requests for information about male sterilisation, possibly related to the uncertainties surrounding the Pill. There are no requests for diaphragms. The homes I visit often have no bathroom and there is usually very little privacy for the mother to use this kind of method. 4. Some of these patients request sterilisation. They may have already tried various methods of contraception unsuccessfully; they may be intolerant to the IUD because of resulting heavy periods, or be afraid of the Pill because of the controversy surrounding it: husbands cannot be relied on to use the sheaths all the time, and caps are not requested because of the reasons stated above. With their families complete, sterilisation is often seen by the patient as the only effective answer to their problem. The request is usually made to the North Middlesex Hospital after the last confinement as this hospital (with 3,000 deliveries per year) serves the Tottenham area where most of the patients I see live. These requests unfortunately are sometimes refused. In June 1969 I met the Consultant Obstetricians of the North Middlesex Hospital and asked them about this situation. I was told that sterilisation was done only on medical grounds and not as a method of contraception. It seems regrettable that provision for sterilisation for contraceptive purposes cannot be made under the N.H.S. Acts. A mother with many successive pregnancies under poor social conditions usually suffers from chronic ill-health (anaemia, various gynaecological complaints and severe varicose veins), and often is unable (with the best will in the world) to cope with her family. Indeed the children of such families have frequently been in hospital for illnesses such as gastro-enteritis and bronchopneumonia, and in a few cases meningitis. The psychological damage to children is incalculable. 2 families have all their children in care (10 in all): 5 other families have respectively 1, 4, 1, 2, 1 children in care. Thus the total number of children in care is 19. THE FIRST YEAR'S WORK OF A CLINIC FOR UNMARRIED GIRLS December 1968 — December 1969 (Report by Dr. E. Christopher) In December 1968, it was decided to start a fortnightly evening clinic to give contraceptive advice and counselling (when needed) to unmarried girls in the London Borough of Haringey. Unmarried girls seen at other F.P.A. Clinics in the Borough were to be directed to this clinic. The clinic started with 3 lay workers, a nurse and a doctor (myself). After one month the clinic was held every week because of increased demand. Since July 1969 it has been necessary to call on the services of an additional doctor and nurse, usually at fortnightly intervals. It is held on an appointment system which works reasonably well. Occasionally appointments are not kept and the patients tend to come the following week, and of course, they must be seen. At this kind of clinic patients must be free to come when they want to. 51 This paper gives a summary of our work and findings during the year December 1968 - December 1969. 222 cases were seen during the year. They come to us from the following sources. (1) Reading about us in (i) local papers (ii) Honey magazine and then contacting Central Office 70 (2) Friends 64 (3) Other doctors, G.P.'s etc. 43 (4) Transferred from another clinic 15 (5) Home for Unmarried Mothers 15 (6) Local hospitals 8 (7) Local Authority Social Workers, etc. 7 222 Points from these figures deserve comment: (1) The importance of private information: the article in Honey magazine which the Editor wrote after visiting the Brook Advisory Clinic was particularly important. It discussed illegitimacy and how to avoid it, giving common-sense advice. This led a lot of girls to ask for further information from Central Office. (2) The importance of a happy clinic atmosphere encouraging the girls to recommend it to their friends. (3) During the first 7 months only 4 girls came from the nearby Home for Unmarried Mothers, despite the fact that it is 5 minutes walk from the clinic and that we had informed the Home of our existence. It seemed worthwhile to give a talk to the girls on contraception and tell them about the clinic. I started doing this in September and since then more girls have come. Age Distribution of Girls Attending is shown below Employment of Girls Office Workers (clerks, typists, etc.) 104 Students 30 Nurses 22 Teachers 20 Factory Workers 16 Hairdressers and Shopgirls 9 Schoolgirls 8 Au pairs 2 Model 1 Musician 1 Studio Manager 1 Unemployed 8 222 52 Nearly all the girls had had intercourse before coming to the clinic and the methods of birth control most commonly used were withdrawal or sheaths. The methods used after attending the clinic were: Only 25 patients out of 222 failed to attend for a second appointment. Most of these had chosen the Pill and so should have returned after 6 weeks but in the event, failed to keep their appointment. 44 patients had had unwanted pregnancies. Of these 36 had illegitimate children (4 had 2 illegitimate children). 8 had had therapeutic or back-street abortions. (1 had had 2 abortions. 10 of these girls attended once only. (This number is included in the 25 previously mentioned). Only 4 of these girls were going to marry the father of the child. 24 had their babies adopted and 12 were keeping their babies. All but 7 of these girls were office workers. It may be of interest to record some assessment of the number needing counselling. (It is of course recognised that this assessment is necessarily subjective). (1) Girls who had a stable, mature relationship most probably leading to marriage 107 (+4) (2) Girls who got married while attending the clinic. (Most aged between 19-22 years) 16 (3) Good relationships not necessarily leading to marriage 20 (+13) (4) Sexual problems. Immature relationships 35 (+27) The figures in brackets are those with unwanted pregnancies. Thus, just under one third of the patients seen needed counselling. Comments The girls with unwanted pregnancies present a depressingly consistent picture of ignorance about sex and immature relationships. This is where education and counselling are necessary. They often have unhappy home backgrounds, are unable to communicate with their parents and have looked for affection elsewhere. They usually know their boyfriends for only a short time before they have intercourse and are surprised when they become pregnant and think their boyfriend will marry them. They become disappointed and humiliated when their boyfriends no longer "want to know". Some quickly find another boyfriend who may take care of them during pregnancy, but is not necessarily a more satisfactory relationship than the previous one. Others reject the whole of the opposite sex, at least for the time being. "I've gone off men" is a common statement. But nevertheless they may come for advice because they cannot trust themselves in a similar situation. These girls mostly come from other London Boroughs to have their babies, then leave Haringey 6 weeks after the baby is born so that there is little time for confidence to be established. They tend to be very sensitive to criticism and fear they may be given a lecture on morals. The girls at the Home seemed surprised that only a straightforward talk on contraception was given. This suggests that a shortcoming of this type of clinic is that, (as judged from my experience with the Unmarried Mothers' Home), there are girls who need contraceptive advice but who are reluctant because of their personal problems, to come along. I feel it is essential that those with immature relationships should have both counselling as well as contraceptive advice, to avoid unwanted pregnancies. I know that it is feared by some that less patients will therefore be seen because of the time needed to do this, but it takes courage for these girls to come to a clinic. Their motivation is often poor. Pregnancy may mean showing their parents that they too are grown up and it reassures them about their femininity. It often seems it is the pregnant state that they desire rather than a baby. There seems to be a fear that clinics of this kind encourage promiscuity. I believe that this is not so. Most of the girls seem to have mature relationships and often mention that they would get married but for the time needed to save for a home. Another feature is that boyfriends and fiances very often accompany the girls. They also want information and the decision of what to use is then made by both partners. (I see far fewer husbands at an ordinary F.P. Clinic). Oral contraceptive 186 Diaphragm 25 I.U.C.D. 4 Sheaths and pessaries 3 Foam 2 Nil 2 (2 mentally retarded girls who had been referred for counselling). 53 Mrs. Brooks (of the Brook Advisory Clinics) once said that she wondered whether some of today's girls were being used as prostitutes were in former times. A small number do seem to be exploited in this way. I feel uneasy when a girl comes saying "my boyfriend said I should get the Pill" not "I want advice about birth control" or "my boyfriend thought it would be a good idea to live together". Quite a few do live together. Some appear to be using it as a testing period for possible marriage, others are unhappy about living together but are unable to extricate themselves for one reason or another. This is where counselling may be helpful. The results of this first year's work are encouraging and the work is certainly rewarding. Ante-natal Clinics The attendances during the year are shown in the following table:— Clinic Sessions held Total Attendances Average Attendance per session Ante-natal Post-natal Burgoyne Road 77 829 38 11.3 Chestnuts 100 1081 76 11.6 Church Road 47 361 12 7.9 Fortis Green 94 888 41 9.8 Gordon Road 50 716 60 15.5 Lordship Lane 102 510 49 5.5 Mildura Court 61 912 41 15.6 Park Lane 104 529 66 5.7 Stroud Green 52 676 37 13.7 Weston Park 154 1247 49 8.5 White Hart Lane/ Stuart Crescent 52 284 15 5.8 TOTAL 893 8033 484 9.5 A Midwive's Ante-Clinic was held at Park Lane Centre on 37 occasions. 83 attendances were made for ante-natal consultations. There were no post-natal attendances. Cervical Cytology Clinics continued to be held at centres in the Borough throughout the year, part of the routine ante-natal clinic sessions being reserved for the taking of "smears". A separate evening cytology session continued at Mildura Court Centre, Hornsey, where 47 sessions were held during the year. Attendances at clinic sessions were as follows: — Clinic Attendance Burgoyne Road 35 Chestnuts 119 Church Road 30 Fortis Green 78 Gordon Road 110 Lordship Lane 160 Mildura Court 348 Park Lane 85 Stroud Green 25 Weston Park 118 White Hart Lane/ Stuart Crescent 79 Total 1187 54 Six additional sessions were carried out at local factories and one in a department store. 105 "smears" were taken at these sessions. In all, 4 "positive" cases were found during the year of which 2 proved to be cancer. There is now almost no waiting time for clinic appointments. At local hospitals, the position regarding technicians has improved, and it would still be possible for them to accept more slides for investigation if the demand were to increase. I am grateful for the valuable work which the Haringey Cancer Control Committee continue to arrange in the form of regular public meetings and local publicity displays where leaflets and application forms are available. Clinic for the early detection of Breast Cancer The Department continued to co-operate with St. Ann's General Hospital in conducting a clinic for the early detection of cancer of the breast which was initiated in 1968 at the request of Mr. Keith Abel, F.R.C.S., Consultant Surgeon to the Prince of Wales's and St. Ann's General Hospitals. The women volunteers who attend this Clinic will be kept under surveillance by Mr. Abel for a number of years. The following figures give the results of a second year's examination:— Number of women examined 720 Number of cases referred for further investigations 18 Child Health Clinics The following table gives attendances during the year at child health clinics. Clinic Sessions Attendances Average Attendance per Session No. of Cases seen by M.O. No. of Cases Referred Elsewhere Alexandra Park Road 51 2,055 40.3 570 43 Burgoyne Road 154 5,484 35.5 1,343 4 Chestnuts 205 6,031 29.4 2,276 47 Church Road 161 3,035 18.9 1,212 10 Fortis Green 103 4,015 39.0 1,601 8 Gordon Road 105 3,215 30.6 1,135 99 Lordship Lane 207 4,938 23.9 1,771 68 Mildura Court 103 4,324 42.0 1,353 46 Park Lane 153 4,730 30.9 2,000 85 Somerset Road 149 2,757 18.4 1,235 130 Stroud Green 104 4,787 46.0 1,405 30 Weston Park 154 6,426 41.7 2,130 25 White Hart Lane/ Stuart Crescent 152 5,518 36.3 1,586 29 TOTAL 1,801 57,315 31.8 19,617 624 55 Mothercraft and Relaxation Classes The following table shows attendance at Mothercraft clinics during the year- Clinic Sessions Attendances Average Attendance per Session Burgoyne Road 35 142 4.0 Chestnuts 46 231 5.0 Church Road 44 170 3.9 Fortis Green 45 335 7.4 Gordon Road 38 175 4.6 Lordship Lane 50 324 6.5 Mildura Court 38 92 2.4 Park Lane 44 180 4.1 Somerset Road 32 79 2.5 Stroud Green 38 199 5.2 Weston Park 42 198 4.7 TOTAL 452 2,125 4.7 Toddlers Clinics (2-5 years age group) Children attending toddlers session do so by special appointment at six to twelve month intervals. The following table gives details of attendance at toddlers sessions. Clinic Sessions Attendances Average Attendance per session No. of Cases seen by M.O. No. of Cases Referred Elsewhere Burgoyne Road 51 753 14.8 753 19 Chestnuts 50 659 13.2 659 27 Church Road 24 267 11.1 261 4 Fortis Green 53 576 10.9 574 33 Gordon Road 23 234 10.2 233 41 Lordship Lane 51 687 13.5 687 35 Mildura Court 50 729 14.6 586 46 Park Lane 50 587 11.7 587 52 Somerset Road 53 691 13.0 684 54 Stroud Green 29 461 15.9 461 17 Weston Park 49 695 14.2 682 55 White Hart Lane/ Stuart Crescent 51 552 10.8 552 16 TOTAL 534 6,892 12.9 6,719 399 HEALTH VISITING SERVICE In spite of a continued shortage of staff (9.4 out of an establishment of 36) health visitors are making an increasing contribution to the alleviation of psycho-social problems. The responsibility for the health assessment and skill involved in its carrying out, by working with the family is not always given due recognition. Early detection of ill health and survellience of high risk groups, require a great deal of time and effort. The staff are acutely aware that their function in the prevention of mental physical and emotional ill-health falls below the desired level, because of the high case load placed upon them. Nevertheless referrals from general practitioners and hospitals where social or marital problems are suspected are always welcomed. 56 After assessment of a situation the health visitor may require the help of other specialist agencies. The actual number of visits made by health visitors are:- NUMBER OF VISITS PAID BY HEALTH VISITORS WORKING IN THE BOROUGH Expectant Mothers — First Visits 1,217 - Total Visits 1,826 Chi Idren under 1 year of age - First Visits 5,296 - Total Visits 11,203 Children aged 1 - 2 years 9,878 Chi Idren aged 2 — 5 years 17,001 Other Cases 2,325 Total Visits as Health Visitors 42,233 Student Health Visitors The one student health visitor who completed her training in September was successful in obtaining the health visitors certificate. She has proved to be a welcome and useful addition to the staff. We were fortunate in recruiting 4 sponsored student health visitors to commence the one year training in September 1969. Analysis of Pre-School Children on Observation Register at 31st December 1969 Categories of Observations Deafness of genetic origin in parents or siblings 49 History of maternal rubella in first four months of pregnancy 12 Gestation 36 weeks or less 268 Birth Weight under 4lbs. 20 Moderate or severe birth asphyxia 312 Difficulty in sucking or swallowing 11 Failure to thrive not explained by simple feeding problems 63 Convulsions 7 Cyanotic attacks or severe apnoeic spells 20 Abnormal neurological signs in neonatal period 34 Haemolytic disease of the newborn or hyperbilirubinaemia 157 Any congenital abnormalities 177 Late or late intake 136 Mother in care of Mental Health 29 Total 1,295 Number of children bom during the year 4,847 Number placed on observation register i.e. 23% approx. 1,124 Where there is a particular risk of deafness children are examined at the audiology unit as well as at the normal child health sessions. 124 children were seen at the unit during the year. Analysis of Pre-School Children on Handicapped Register at 31st December 1969 Categories of Handicap Physically handicapped 60 Partially sighted 2 Deaf 4 Delicate 2 Partially hearing 8 Speech defect 5 Educationally subnormal 1 Mental handicap 90 Epileptic 9 Miscellaneous 35 Maladjusted 5 Total 221 57 Distribution of Welfare Foods The following table gives details of the distribution of these foods during the year:- National Dried Milk (packets) Orange Juice (bottles) Cod Liver Oil (bottles) Vit. A & D Tabs (packets) 11,254 61,926 5,255 3,600 DENTAL CARE FOR THE PRIORITY CLASSES Mr. G.C.H. Kramer, Chief Dental Officer, reports as follows:— We have been able to maintain the service of previous years, whereby the priority classes who seek treatment in our clinics are genuinely accorded priority and receive-necessary attention with virtually no delay. However, an imbalance in the proportion of our total time allocated to this aspect of our duties at the expense of the severely overloaded school dental service, needed to be adjusted in spite of the undoubted value in treating pre-school children early and regularly. A reasonable allocation of time available has been regarded as up to 10% for the priority service and this we attained three or four years ago, but in 1967 this had risen to 12% and showed signs of going higher when we were failing by a large margin to deal adequately with school children. By deliberately making less attempt to recruit new patients, the percentage in 1968 was at the desired level of 10%, but in the year now under review the pendulum has swung rather too far and the percentage is down to 8.7. At no time, however, have we failed to accept patients who wanted us to treat them. The total number of sessions employed in the priority service was lower by 32 than the previous year, although the amount of treatment fell by rather less than could have been expected. For expectant and nursing mothers there was virtually no change apart from a welcome further reduction in the number of teeth extracted, and there now seems to be a stable level of demand for this section of the community. For pre-school children there is a large unsatisfied need, although not demand, for treatment, and this is the section of the population who most need to be helped by fluoridation of the water supplies so that, without any effort at all, their dental needs would be drastically reduced. We would, as a result, have a school entry bringing with them a less utterly unmanageable need for treatment. The statistics are as follows:— Expectant and nursing mothers Pre-school children Number examined 157 876 Requiring treatment 153 669 Attendance for treatment 554 2,200 Treatments completed 72 435 Number of fill ings 378 1,902 Teeth filled 336 1,666 Number of extractions 60 491 General anaesthetics 5 163 Number of prophylaxes 122 131 Teeth otherwise conserved - 180 Other operations 211 641 Number of radiographs 40 36 Number of crowns and inlays 1 - Total number of dentures 25 Number of treatment sessions 380 58 MIDWIFERY SERVICE There was a further drop in domiciliary deliveries as also a total reduction of 269 births in the borough compared with 1968. The number of domiciliary bookings was 565, and 450 were successfully delivered at home. 50 mothers were transferred to hospital for varying reasons during labour and returned home to be nursed by the district midwife following delivery. The remainder either removed from the area or were booked for a hospital delivery. The emergency obstetric squad was called from the North Middlesex Hospital on 4 occasions. One patient had a blood transfusion and remained at home. Three mothers and babies were transferred to hospital accompanied by the squad. All conditions were eventually satisfactory. Selection of Cases for Hospital Confinements for Social Reasons Source of Request Number of requests received 1965 1966 1967 1968 1969 Hospitals in N.W. Metropolitan Region 3 39 50 6 8 Hospitals in N.E. Metropolitan Region 174 267 303 262 155 General Practitioner Obstetricians 48 84 97 105 96 Local Authority Clinics 116 267 158 65 45 Midwi ves - - - 3 - TOTAL 341 657 608 441 304 Of the 304 investigated 160 were referred to hospital, 137 were booked for home confinement and 7 moved out of the area. The number of referrals was considerably less, indicating that hospital beds were more easily obtainable in the North East Metropolitan Board Region. Planned Early Discharges Source of Request Number of requests recei ved 1967 1968 1969 Requested by hospitals in N.W. Metropolitan Region 187 267 233 Requested by hospitals in N.E. Metropolitan Region 143 137 201 Requested by London Teaching Hospitals 39 44 50 TOTAL 369 448 484 Number accepted: 402 Actual Number discharged and attended: 327 Unplanned discharges: 120 Self discharges: 116 Here we see an increase in the number of requests from the North East Metropolitan Board notably the North Middlesex Hospital and the Bearsted Hospital both of which almost doubled the number compared with the previous year. Unplanned discharges increased to 120 from 96 in 1968, 15 due to shortage of beds in the City of London Maternity Hospital and 9 in the North Middlesex Hospital, both hospitals having had to close a ward because of infection in August and October respectively. Other reasons for unplanned discharges being mothers delivered of stillbirths and neonatal deaths and/or domestic crises that arose during the puerperium. 59 Self-discharges rose to 116 compared with 79 in 1968. The number of visits, i.e. ante natal, labour calls and post natal visits during the year was 17,787. All midwives were instructed in the technique of taking blood from babies on the 7th day of life for the Guthrie test for the early detection of Phenylketonuria. The scheme started for all domiciliary deliveries and hospital re-tests on 8th December 1969. Student midwives training 59 students were in training during the year, 14 from the Alexander Maternity Home, 17 from the North Middlesex Hospital, and 28 from the Whittington Hospital. 47 students completed their training and 12 are stiII in training. Obstetric nurse training There were 39 students from the City of London Hospital and 31 students from the Whittington Hospital given an insight into the work of the district midwife. HOME NURSING SERVICES The work load for district nursing continued to increase with a remarkable jump in the number of patients over 65 years of age. Pilot schemes for district nurse attachment to general practitioners were started in varying situations with a view to complete attachment at a later date, e.g. one nurse was completely attached to a group practice, attending a surgery for one hour twice a week; one nurse attached to a two-doctor practice, calling at the surgery each day at a stated time; one nurse attached to a single-doctor practice plus a geographical area, and attending his surgery for one hour twice a week. Four district nurses obtained the National Certificate for district nurses. Two attended the course at Chiswick Polytechnic and two at the North Western Polytechnic. These are day release courses over a period of 13 weeks with a two week block at the beginning. The Marie Curie Memorial Foundation gave day and night full time nursing aid for 12 patients suffering from terminal carcinoma and one person requiring financial aid toward special nutrition. During the year, the Prince of Wales's Hospital sent 25 student nurses for instruction on community nursing, which took the practical form of visiting with a district nurse, and the Middlesex Hospital sent 20 student nurses for similar instruction. Cases attended during the year were referred from the following sources: — Source 1967 1968 1969 General Practitioners 1876 1907 2055 Hospitals 902 846 627 Chest Physicians 9 8 8 Direct 43 72 101 Health Department 25 23 107 Welfare Department and Old Peoples Welfare - - 31 TOTAL 2855 2856 2929 The following tables show the work of the nurses during the year:— 1967 1968 1969 New cases attended 1,956 2,004 2,280 Total number of visits made 84,618 88,112 92,053 Number of visits of over one hour duration 2,844 2,371 3,533 60 Treatments followed:- Injections 28,455 General nursing care 20,507 Blanket baths 14,277 Enemota 873 Dressings 18,775 Preparation for diagnostic treatment 53 Scabies treatment 211 Washouts, douches 121 Other treatment 3,854 Maternity complications 135 TOTAL 87,261 Age of patients at time of nurses first visit may be classified as follows:- AGE 1967 1968 1969 0-4 75 35 108 5-64 840 971 211 65 and over 1820 1885 3416 GERIATRIC SERVICES The problems of the elderly in Haringey give increasing cause for anxiety. Owing to shortage of staff the Health Visiting Service is barely able to cope with its commitments regarding young children, and has great difficulty in fitting in visits to needy elderly people. Although well-equipped to look after sick old people in their homes, district nurses are being forced more and more to engage in preventive care, which although desirable in itself, is not the most effective way of using already hard-pressed staff. Organisation has been employed to a growing extent to compensate for the deficiencies in provision. A Geriatric Co-ordinating Committee has been formed to deal more effectively with the problems of old people in crisis situations, or on the verge of becoming so. Under the chairmanship of the Deputy Medical Officer of Health, it includes in its membership the Superintendent Health Visitor, the Supervisor of Home Nurses, the Deputy Chief Mental Welfare Officer and a representative of the Welfare Department. This group has often proved successful in ameliorating the problems of older people when an officer working alone might have found himself baffled. "Problem" is perhaps the most appropriate word that could be applied to a high proportion of the individuals who are discussed at its monthly meetings. Thirty-seven were referred during the year, of which five went into homes and three into hospital. One died and no further action was taken in the case of three. Often living in squalor, under-nourished and in poor health, they have little insight into the gravity of their positions and refuse most or all of the help offered. Often the best that can be done is to maintain friendly contact until the old person recognises the truth himself. One hopes that this will not come too late; but this Committee is reluctant to force any of them to do anything against their will. People have a right to live their own lives, even if others may not approve of the way they do it; and the fact has to be faced that even if the conditions are so filthy as to seem repulsive to neighbours and relatives, such old people often manage to live lives which are quite satisfying (to themselves if not to others) for many years. Only in the most extreme circumstances would action be taken to remove an individual from home against his or her will. This was considered necessary only once during the year, when, after months of fruitless persuasion it was decided to recommend action under Section 47 of the National Assistance Act 1948, against an old lady who was incontinent and living in indescribably filthy conditions. Members of the Health Services Panel visited the premises and agreed that the Council should bring the matter to court. However before this could be done the old lady had a fall and had to be admitted to hospital, where she has remained since. 61 The Health Department is represented on the North West Metropolitan Region Geriatric Liaison Committee in which hospitals, general practitioners and local authorities meet and exchange views on the care of the elderly. It has fully supported the Committee in its proposals for a psychogeriatric assessment unit to assist doctors and social workers in the correct placement of sick old people, whether in geriatric wards in general hospitals, in psychiatric hospitals, in old people's homes or their own homes. These are difficult decisions which need to be made with the expert advice of a number of different disciplines, and are of life or death importance. It has also been useful to learn the opinions and the methods of work of other bodies. It is significant, for example, that several neighbouring local authorities have appointed Geriatric Visitors to look after the elderly, and that the Committee has commented on the fact that Haringey has not yet done so. Retirement Advice Clinics continued to operate, each clinic being run by a medical officer assisted by a clinic nurse, advice being given on health and diet, with medical examinations when the clients were willing. Family doctors were informed of any significant findings, and other agencies such as the Welfare Department,Old People's Welfare Organisers etc. were contacted when necessary. The Department of Employment and Productivity kindly referred a large proportion of the clients, but they are regrettably unable to provide much in the way of employment for this age group. Retirement at 60 or 65 is an arbitrary arrangement, and the community loses thereby many skilled and devoted workers. Yet industry and business generally do not seem to be able to provide the employment exchanges with vacancies, even at a time when it is difficult to find workers for many essential services. One suspects that a kind of age prejudice is responsible. Nevertheless, the voluntary employment agency service provided by the Hornsey Old People's Welfare Committee is continuing to put employers and older people in contact with one another to their mutual benefit. It is encouraging to learn that the Wood Green Old People's Welfare Committee is undertaking a similar project. But although the work of the Retirement Advice Clinics goes on, and indeed in some respects advances — as for example the case note forms were improved further during the year — they are still far from fulfilling their true function, and attendances have fallen slightly. A total of 64 sessions were held (as compared with 70 in 1968). Forty of these were in Tottenham, 10 in Wood Green and 14 in Hornsey. There were 30 first attendances in Tottenham and 175 re-attendances; 4 first attendances in Wood Green and 49 re-attendances; and 8 first attendances in 43 re-attendances in Hornsey. The totals of new cases were 42 (compared with 40 in 1968) and of re-attendances, 267 (compared with 293 in 1968). The ultimate aim of these clinics is to hold sessions not unlike child health clinics in pattern. The Geriatric Visitor would have a greatly increased role because of her increased knowledge of of the background of the clients. The medical officer would concentrate more on the health of the individual and would maintain contact with the general practitioner. More older people in need of help would be found and offered assistance before their problems became desperate. But until greater resources are made available to this and the other parts of the preventive geriatric services, the care of old people in Haringey must continue to be a source of anxiety. CHIROPODY SERVICES During the year two part time chiropodists ceased to work for the London Borough of Haringey and one chriopodist was compelled to give up some of his sessional work. Owing to a general shortage of chiropodists and to the heavy demands on the service it was decided to ask private chiropodists to participate in a scheme to treat Local Authority patients at their own surgeries. Seven chiropodists agreed to do so. As a result of this the case load of patients waiting for first appointments at clinics was considerably reduced. Later two more chiropodists joined the scheme. The number of patients who were receiving treatment at private surgeries at the end of the year was 941 compared with 175 in 1968. 62 The demand for domiciliary treatment was so heavy that it was decided that departmental medical officers should visit and assess all new applicants. Investigation revealed that in some cases patients would be able to attend private surgeries or clinics in the summer and only required domiciliary treatment in the winter months. In other instances patients were sufficiently mobile to attend clinics. A number of cases did not warrant the specialised services of a chiropodist, and toenail cutting by home nurses was organised. During the year it was found necessary to reassess some of the cases because of deterioration of physical condition or changing circumstances. While assessing the need for domiciliary chiropody, departmental medical officers also reported other social factors and made recommendations. As a result of these other Health and Welfare Services were provided. Applications received: - 1968 1969 Clinic: New Cases 742 802 Domiciliary: New Cases 262 419 Transfer from clinics 97 43 Waiting for assessments 28 Assessments made for domiciliary treatment during the year- Domiciliary treatment all the year 234 Domiciliary treatment winter months only 38 Referred to Home Nursing Department for nail cutting only 81 Clinic treatment only 28 To be dealt with by relatives and friends 24 No action 57 TOTAL 462 1713 clinic sessions were held during the year, including sessions for school children. 22 Chiropodists were employed on a part time basis on 31st December 1969. 13 at clinic sessions 3 of whom also treat patients at their private surgeries 9 private surgeries 3 of whom attend clinic sessions 8 domiciliary 5 of whom attend clinic sessions One domiciliary chiropodist commenced working for the borough in November 1969. Chiropody Service: Patients on lists 1968 1969 Receiving treatment at clinics 1807 1768 Receiving treatment at private surgeries 175 941 Receiving Domiciliary treatment 1109 1116 Waiting for clinic appointments 370 235* Waiting List: Clinic cases 241 61 Waiting List: Domiciliary cases 61 15X Waiting List: Domicil iaries (transfer from clinics) 17 12X *This number is high because one of the part-time chiropodists has not been working owing to illness. XWaiting for assessments. Number of patients treated 3,995 (including 282 school children) Number of treatments given:- New patients treated in 1969 In clinics 10,841 272 In private surgeries 4,230 469 Domiciliary 5,345 190 School Children in clinics 1,330 282 TOTAL 21,746 1,213 63 Staff Medical Assessments, Examinations and Sick Pay Reports There was an increase in the number of combined medical assessments during the year 1969, from 1806 in 1968 to 2095 in 1969. This was partly due to a further increase in the number of medical • assessments for the Education Department. These came to a total of 982 which reflected the rapid turnover of employees as supervising assistants in the School Meals Service. There were also more requests by the Department for Special Medical Assessments, including those of employees who had resigned from work on grounds of ill-health, and some manual employees whose short term sick leave appeared excessive. Medical Assessment of New Applicants without Medical Examination Architects 5 Baths Department 10 Catering Department 3 Cemeteries Department 0 Chief Executive's Department 59 Children's Department 65 Cleansing and Transport Department 8 Education Department 982 Engineer and Surveyor's Department 88 Health Department 125 Housing Department 18 Libraries Department 19 Park's Department 2 Town Planning Department 8 Treasurer's Department 18 Welfare Department 36 Tottenham Technical College 42 Hornsey College of Art 46 1,534 Medical Examination of New Applicants Children's Department 1 Engineer and Surveyor's Department 5 Treasurer's Department 1 Welfare Department 1 Tottenham Technical College 3 11 Education Department Non-Teachning 10 First Appointment Teachers 98 Teacher Trainees 183 Hornsey College of Art (end of term teachers) 47 338 Reports on Sick Pay Cases without medical examination 78 Reports on Sick Pay cases with medical examination 46 Special Assessments of employees without medical examination 40 Special Assessments of employees with medical examination 43 Medical Examination of Staff over 70 years of age 5 Employee returned to work or resigned before report completed 76 64 THE DRUG EPIDEMIC AND ITS EFFECT ON THE COMMUNITY (Dr. U.P. Seidel, Principal Medical Officer, Mental Health) The usual classification of addictive drugs into "soft" and "hard" has led many people into false security by believing that "soft" drugs are almost harmless and that only the "hard" ones need be carefully controlled. This point of view is, of course, completely falacious. "Soft" as well as "hard" drugs can cause severe physical, mental and socio-economic disabilities. The former drugs being of even greater danger because they are more easily obtainable and consumed in far greater quantities by more people than the "hard" varieties. Treatment of all types of addiction has not been as successful, I am sorry to say, as was originally hoped for. The reason for this is not difficult to find if one considers that there are no legal powers compelling a drug dependant person to seek treatment. He is quite happy and contented in his deviant ways as long as he can get his regular supplies. Only when something goes amiss either with the source of his supply or he gets himself into physical or legal trouble, will he come to the attention of a Doctor. If his ailments have been treated successfully and he does not then wish to submit himself for treatment of his addiction, the whole episode unfortunately ends here, unless he has to seek medical advice again. Drug taking, has assumed epidemic proportions and its contagious nature is felt, especially amongst young people who, at first, perhaps quite innocently, accept a tablet for either experiencing the thrill of its effect or not be left out and considered "odd", or merely to experiment in the company of other youngsters and "to be with it". We know only too well how often this constitutes the beginning of a downward path towards stronger drugs and in increasing quantities, until the end of the road is reached when self-administration of "hard" drugs by injection might well become a necessity. Once this final stage has been entered the person is truly "hooked" for the rest of his very often shortened, disabled and ruined life. One should not imagine that only adolescent and young people fall for this vice. There are far more elderly and old folk who have become habituated to a different kind of a drug-taking scourge and I refer to the inevitable sleeping tablets, which are being prescribed in enormous quantities, and sometimes for many years, to individual patients. The dangers of this practice have been pointed out repeatedly on many occasions but seem to have made little impression on people using this type of hypnotic. These sedatives, in my opinion, can be equally as dangerous and harmful as other "soft" drugs or even "hard" ones, for they also may adversely affect both body and mind. Community hostels for addicts have been championed recently by a number of people, but I consider their establishment highly dangerous to the surrounding community, especially to young people. Believing as I do, that in most cases "once an addict always an addict", the vicious cycle cannot be broken as the law will not permit compulsive treatment at present. We expose the surrounding population to the very real risk of becoming "infected" by this scourge as addicts might well peddle their surplus wares to outsiders in order to derive an income for obtaining further illicit supplies for their own deleterious use. What can be done to curb the present and ever increasing drug curse? Firstly, circularise all General Practitioners, and suggest that all addictive drugs should be very cautiously prescribed whilst the amphetamine type should be banned altogether, and further, all sleeping tablet prescriptions, greatly curtailed. It would then naturally follow, that Chemists would have to cease stocking the more undesirable drugs. Secondly, more intensive health education in schools pointing out the dangers of even the very first "trial" tablet. Talks should be directed, not only at the children, but also at the teachers and parents acquainting them with the nature and adverse effects of habit forming drugs. Thirdly, create powers by legislation whereby all drug addicts, whether on "hard" or "soft" drugs, must submit themselves compulsorily to treatment and that treatment must finally aim at weaning off these people from their addictive habits. 65 IMMUNISATION AND VACCINATION Vaccination against Smallpox There was a considerable increase in re-vaccinations during the year from 299 in 1968 to 645 in 1969. This was mainly due to the introduction into the routine Immunisation Schedule of the Re-vaccination of School Children, at School Entry and School Leaving Ages. (Primary Vaccination is not recommended as a routine at these times). The following table records the number of persons under the age of 16, known to have been vaccinated or re-vaccinated during the year by general practitioners and clinic medical officers. Under 1 year 1 year 2-4 5-15 Total Number of Primary Vaccinations 22 907 793 181 1903 Number of Re-Vaccinations 8 91 546 645 Vaccination against Diphtheria, Whooping Cough, Tetanus, Poliomyelitis and Measles Primary Immunisation The revised immunisation schedule which was introduced for babies born after January 1968, results in their completing their primary immunisation with Triple Vaccine and Oral Poliomyelitis Vaccine at about fourteen months. This is the reason for the fall in completed Triple and Polio immunisation in the 0 - 1 year age group, and the increase in the 1 - 2 year age group. The fall in Measles Vaccination as compared with the very high figure of 5963 in 1968 is due to the ending of the special Measles campaign and the severe shortage of Measles Vaccine for a considerable part of 1969. Re-lnforcing Doses The new schedule of Triple and Polio Immunisation does away with the need for a booster dose at eighteen months of age, which accounts for the difference in the total of Triple and Polio boosters in the 1 — 2 year age group. The increase in Tetanus and Polio booster doses in the 6-16 age group is accounted for by the start which has been made in giving Booster doses to the School Leavers. The following tables record the number of persons under the age of 16 known to have received a primary course of 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 Immunisation Triple Dip/W.C. Dip/Tet. Dip. W.C. Tet Sabin Measles Total 0 — 1 year 79 - - - 77 - 156 1 — 2 years 2643 2 149 1 - 2 2993 354 6144 2 — 4 years 151 1 95 1 — 1 325 1008 1583 4 — 6 years 45 - 127 - - 25 307 382 ' 886 6 — 16 years 8 - 37 — — 88 132 64 329 TOTALS 2927 3 408 2 - 116 3834 1808 9098 66 B. The number who received a reinforcing dose Age at date of Immunisation Triple Dip/W.C. Dip/Tet. Dip. W.C. Tet. Sabin Total 0 — 1 year — — — — — — — — 1 — 2 years 279 - 19 - - 1 283 582 2-4 years 1667 2 290 - - 1 1793 3753 4-6 years 111 2 1384 10 - 57 1756 3320 6-16 years 27 147 2 — 106 401 683 TOTALS 2084 4 1840 12 - ' 165 4233 8338 Venereal Disease Information about this is, as before, incomplete, since a proportion of the London hospitals undertaking treatment do not submit reports on the number of cases from different boroughs. This seems a pity, as other hospitals apparently have no difficulty in supplying this information. We are therefore dependent upon our local clinic for any significant figures we have. New Haringey Cases attending Prince of Wales's Hospital Clinic 1969 Year Totals of Venereal Conditions SYPHILIS Gonorrhoea Other Venereal Conditions Primary and Secondary Other 1966 896 3 9 96 788 1967 1101 5 15 216 865 1968 1090 4 10 259 817 1969 1316 4 8 255 1049 The totals of sexually transmitted diseases treated at the Prince of Wales's Hospital, which remained relatively static in 1967 and 68, increased by 226 in 1969. It is of interest that the figures for syphilis and gonorrhoea were about the same, and that the increase occurred under the heading of other venereal conditions. This is to some extent a vaguely defined group merging into the wider field of non-venereal infections, but the figure is largely accounted for by non-specific urethritis, a disease associated with promiscuity; so it can only be assumed that V.D. is continuing to increase in the borough. Venereal disease can be so insidious in origin that anyone who has run the risk would be well advised to seek advice at a V.D. Clinic, where the staff would feel it well worth their while to carry out a check. It is always difficult to write about venereal disease, especially if one is a doctor. One is always liable to be accused of being a spoilsport. This is not necessarily an unfair criticism. It depends on one's definition of sport. But the greatest problem is over the word "love", and often one wishes that the English language had as many words to denote its subtle varieties as, say, Greek. Take the slogan, for example, "Make Love, Not War". Basically, one would not wish to quarrel with it, but while it is obvious that it is better to love than to kill people, it would be wrong to assume that we are necessarily dealing with opposites. Love that includes the whole individual, thinking only of his or her wellbeing, and gladly accepting its consequences, is one of the highest emotions of which we are capable. But this is not the same as the casual sleeping-around that often passes for it which deliberately avoids any deep emotional involvement, cynically exposing the other to the risk of infection, unwanted pregnancy, or the anquish of unrequited love. This kind of "love* engenders misery and confNct, and has been well described by Ambrose King as the exploitation of the weaker personality. Those who have to deal with the problems of V.D. Cases, unmarried mothers and illegitimate children are only too well aware of the wretchedness it can create. It is merely the substitution of one form of cruelty for another, and indeed bears a striking resemblance to war in that it is the weak and helpless who invariably come off worst. 67 Recuperative Holidays Applications recommending recuperative care are received from doctors and hospitals on behalf of patients recovering from a recent illness and do not require medical or nursing care. These recommendations are only considered in respect of those patients who have recently been ill and require only rest, fresh air and good food to complete treatment. The greatest number of applications for a period of recuperation are received during the summer months because of a natural reluctance on the part of patients to go away during the winter months. Difficulties have sometimes arisen in placing patients in a recuperative home because of age limit restrictions and the nature of their recent illness. In some instances owing to lack of patients in the winter months, some homes have closed for a short period. The following table gives details of applications received during 1969:— Appl ications Accepted Arranged Cancelled Outstanding Ineligible Adults (including 8 chi Idren under school age who accompanied their mothers) 125 86 60 26 - 39 School Children 45 36 30 6 - 9 Provision of Extra Nourishment for Tuberculous Patients During the year there were 12 patients receiving Extra Nourishment. Hostels for Tuberculous Patients During the year arrangements were made for the admittance of a patient to a residential Tuberculosis Hostel, making two patients for whom the London Borough of Haringey was financially responsible. Massage and Special Treatment Establishments One new application for a licence was received in 1969 and 20 licences were renewed. HEALTH EDUCATION Health Education in Schools The school doctors continued the health education sessions which had commenced at the beginning of the 1968-69 school year. Due to staff turnover these sessions, 45 in number, were sparodic and unfortunately had to be discontinued in October. It is hoped to continue the sessions when staffing conditions are more favourable. These sessions in schools have proved beneficial. Contact with schools has improved. Although the number of talks by the Departments personnel has decreased, it is encouraging that teachers are taking a greater interest in health education and introducing it, however indirectly, into the curriculum. Since the introduction of the section's health education audio-visual aid catalogue, there has been an increased use of equipment, leaflets etc., and use of the section in an advisory capacity. The health education officer continues to give short series of talks, mainly to girls on sex education and parentcraft. Talks on drugs and related problems such as smoking and alcohol are given to mixed groups mainly to 15 year olds and over. It would be preferable to start these talks earlier especially as many boys and girls are smoking as much as ten cigarettes daily. During the year a total of 109 talks was given in 25 primary and 11 secondary schools, to a total of 3,564 school children. 68 The section has represented the Department at meetings of the infant and junior head teachers, and the pastoral association at the Teachers Centre, and mounted displays in the Centre of play material for the under fives, and literature and visual aids of dental health and sex education. The Inter-Services Standing Committee on Youtlv and the Inter-Services Working Party was formed early in 1968 following a wider consideration of facilities for disturbed adolescents in the Greater London Area. Bodies represented include the whole range of statutory social services in the Borough and voluntary services working with youth and representatives from the Police Force. The health education section plays an active part in the working party, and arranged two screenings of the Canadian film "Warrendale" for members of the various Bodies represented on the Committee. "Warrendale" is a film dealing with the treatment of severely disturbed children. The film was introduced by Dr. J. Parfitt, Principal Medical Officer of ILEA. The section will also be responsible for arranging a Symposium on "The Adolescent in Society" early in 1970 for this same Committee. The Duke of Edinburgh Awards Panel - The section continues to be represented on this panel, which works closely with schools and youth organisations in the Borough, and arranges for examiners and lecturers concerning health education topics. Health education to organisations - Talks were given to various organisations, usually outside normal working hours, to such groups as parent teachers associations, teacher training colleges and voluntary bodies on such topics as sex education, drugs and related problems, cervical cytology and the health and welfare services. Though the number of talks, 27 is relatively small, the audiences amounted to 883 persons, who are in a position to influence others. Food Hygiene Courses Talks on personal and food hygiene were requested by the North London Groups Hospital Management Committee for catering staff at the Prince of Wales's Hospital. A series of talks was given to two groups of catering staff, and a second course was arranged for two groups of domestic orderlies. The health education officer and a public health officer during the series worked in co-operation with a sister tutor, the catering manager, domestic supervisor and pathologist. It is difficult to estimate the success of such talks, although they have enabled the public health inspector to make certain recommendations and suggestions to improve food hygiene in this establishment, and it is proposed to introduce a similar programme to the catering and domestic staff at St. Ann's Hospital. It is envisaged that these talks will be repeated at regular intervals to cover the turn-over of staff. Cervical Cytology The section continues to work closely with the Haringey Women's Cancer Campaign. A display was mounted at the Wood Green Show, theme 'Cancer can be cured'. The Tottenham Co-operative Store and Wilsons of Crouch End allowed a display on cervical cytology to be erected on their premises during the Saturday shopping period. On all these occasions members of the Campaign manned the displays, distributing leaflets and application forms. Cervical cytology tests showed a slight rise following the displays. Child-Minders Meeting - This was held in September at the Moselle Room, Tottenham Town Hall, and attended by child-minders and members of the Health Department staff (80 persons). The objectives of the meeting were to explain the Council's plans for the increase of child-minding facilities, the new regulations regarding registration of child-minders, and to emphasise home safety. Displays on home safety were exhibited, and the divisional fire officer lectured on and demonstrated fire prevention. 69 It was proposed that child-minders should meet at regular intervals to discuss problems, have talks and demonstrations, while the children in their care were occupied in an organised play session. Questionnaires were sent to the child-minders, and as a result of these it was decided to set up a child-minders group meeting at Park Lane Health Centre in 1970. Detection of Hearing Defects in the Infant and Pre-school child - A 2 day course for health visitors This course was organised by the health education section, under the direction of Dr. L. Fisch, the Consultant Otologist at the Audiology Unit. The course was mainly designed to give health visitors an insight into the detection of hearing loss in infants and young children. 39 health visitors attended from Local Authorities in and near London, in addition to two visitors from Holland. The course was financially self-supporting as fees were charged to other Local Authorities seconding staff. The venues were the Moselle Rooms at Tottenham Town Hall, and the Audiology Unit at Blanche Neville School. Dr. Fisch, and Health Department staff including two peripatetic teachers gave lectures and demonstration. The course was considered a great success and it is proposed to run a similar one in November 1970. "Notes on High Frequency Hearing Loss in Children" — This booklet produced by the Audiology Team in co-operation with the Health education section is in its second edition. Other booklets in the series "Talking to the Elderly Deaf" and "Uni-lateral Deafness" will be printed in 1970. Objectives of the health education section - In general to communicate current knowledge of ways in which to promote and maintain health in the individual and the community, and to encourage the effective use of social services within the community. In particular to enlist the support of the professionals within the Authority and others in authority in the community as potential health educators, and to assist them with advice, aids, equipment, plans, projects and syllabuses. To participate, if appropriate locally, in national campaigns and projects mounted by central departments, voluntary and charitable organisations. Publications An article entitled "Lead Poisoning among Children in Haringey" by Dr. W.T. Orton, Deputy Medical Officer of Health, was published in "The Medical Officer" (1970, 123, 1470). It deals with a series of four incidents of lead poisoning among five children in 1966. Their ages ranged from 22 months to 13 years. All suffered from a tendency to eat substances such as earth, paint and wall plaster. Modern paints with low lead content were shown to give only apparent protection if applied over old paints containing high proportions of lead. There was evidence suggesting that wall plaster could be a cause of poisoning despite its low lead content if consumed in large amounts. Very high lead contamination was found in soil over a wide area which appeared to come from a number of sources including dust from a battery factory, exhaust smoke from petrol motor engines, and builders' rubble. 70 PART III SCHOOL HEALTH SERVICE REPORT OF THE PRINCIPAL SCHOOL MEDICAL OFFICER FOR THE YEAR 1969 EDUCATION COMMITTEE 1969/70 Councillor G. Murphy (Chairman) Alderman A.J.F. Doulton (Vice-Chairman) O.B.E., T.D., M.A. Alderman V.P. Gellay, B.Sc., A.lnst.P., A.R.I.C. Council lor Miss L.A. Angel I Council lor S.R. Gaubert, B.A. Councillor Miss A. Harris, T.D. Councillor P.E. Hitchens, M.Sc. Councillor Miss C.D. Jackson Councillor V.N. Jary Councillor Miss S.A. Jones Council lor A.C. Perry, B.A. Councillor Peter P. Rigby, J.P. Council lor D.F.P. Rosa Councillor Mrs. P.A. Spratt Co-opted Members Rev. R.J. Avent Mr. J.G. Elkington, B.A. Mr. R.E. Grout Mrs. J. Sondheimer, M.A., Ph.D. Schools Sub Committee Councillor Miss A. Harris T.D. (Chairman) Councillor A.C. Perry, B.A. (Vice-Chairman) Alderman V.P. Gellay, B.Sc., A.lnst.P., A.R.I.C. Councillor Mrs. L.A. Angell Councillor Mrs. J. Cooper Councillor S.R. Gaubert, B.A. Councillor D.J. Patrick Councillor Sir Robin Williams, Bt., M.A. Co-opted Members Mrs. J. MacGregor Mr. P.A. Moon 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 Dr. Mary Douglas, Principal Medical Officer School Population The school population of the Borough on 22nd January 1970 was 36,703 as shown in the following tabl e: — Primary Schools and Nursery Classes 22,492 Nursery Schools 329 Secondary Comprehensive Schools 12,456 Other Secondary Schools 1,091 Special Schools Vale Road School forPhysical ly Handicapped 95 Blanche Nevile School for theDeaf (including classes for partially-hearing) 137 Suntrap Residential Open-Air School 103 Total 36,703 Medical Examinations in Schools The re-organisation of the system of medical examinations in school has now been completed. There is a full medical inspection of each child on school entry. The maximum number of children sent for at each session does not exceed 15. There is also a full medical inspection of each child during the final statutory year at school, with an examination by selection during the child's last year in the primary school. The selection of children for examination at this age is made by the school medical officer as the result of questionnaires sent to parents, and after consultation with the head teachers of the schools concerned. The hearing and vision of the children in the group are screened, whether or not the children are eventually selected for medical examination. We continue to develop closer relations between the school health service and the schools. Drayton Comprehensive School continues to have a weekly visit by the school doctor to carry out medical inspections and to be available to discuss problems with pastoral heads. This scheme was extended to Wood Green Comprehensive School during the year and it is hoped that eventually all comprehensive schools will have the same service. Similarly, in infants schools, the medical officer visits where possible once a month throughout the school year, particularly to meet the needs of new entrants. The Blanche Nevile School, including the Partially Hearing Units, is visited by a medical officer once a month, and the School for Physically Handicapped Children has bi-weekly visits. It is hoped that the reduced number of routine medical inspections will leave more time for regular review of children with handicaps. The following table shows the number of children inspected by years of birth and the classification of their physical condition:- 72 Year of Birth Number of pupils Inspected Physical Condition of Pupils Inspected Satisfactory Unsatisfactory Number % Number % 1965 & later 159 157 98.7 2 1.3 1964 1,158 1,156 99.8 2 0.2 1963 1,944 1,943 99.9 1 0.1 1962 458 458 100.0 - - 1961 199 197 98.9 2 1.1 1960 216 215 99.6 1 0.4 +1959 +570 568 99.6 2 0.4 +1958 +896 895 99.4 1 0.6 1957 1,732 1,729 99.8 3 0.2 1956 958 957 99.8 1 0.2 1955 1,004 1,001 99.7 3 0.3 1954 & earlier 1,211 1,210 99.9 1 0.1 TOTALS 10.505 10.486 99.8 19 0.2 + Signifies Selective Medical Examinations In the Appendix to this report will be found an analysis of the defects found to require treatment or observation. Other Medical Inspections The following are the numbers of special inspections and re-inspections carried out during 1969. A special inspection is one which is carried out at the special request of a parent, doctor, nurse or a teacher, and is usually carried out at a school advice clinic. Number of special inspections 3,810 Number of re-inspections 1,429 Total 5,239 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 Details are given in the Appendix to this report of treatment (excluding uncleanliness and dental defects) of pupils attending maintained primary and secondary schools (including nursery and special schools), whether provided directly by the Council or arranged through other agencies. School Advice Clinics These clinics continue to deal with minor ailments, and problems brought by parents and with the follow-up of defects found at periodic and other medical inspections. Full medical examination is now offered to all school children who are new entrants to the country, including any who have been out of the country for a year or more and have returned. This gives an opportunity to have the children's immunisation and vaccination state brought into line with other children in the borough as well as affording an opportunity to the parents to discuss any health problem with the school doctor. 484 children who were new entrants to the country were examined during the year under these arrangements. Orthopaedic Clinics The orthopaedic clinic at0 Weston Park, Hornsey, has continued to function as in previous years, fortnightly sessions being held. 73 I have to record, with regret, the prolonged illness of Mr. E.H. Hambly, who has been the consulting orthopaedic surgeon to the Lordship Lane Clinic, Tottenham, for the past 20 years. It is hoped that it will not be long before he is restored to health.. Dr. E.G.M. Palser, Consultant in Orthopaedic and Traumatic Surgery to the Weston Park Clinic, reports: - "There is an overall increase in the attendance both for examination and treatment. The increased proportion of children under 5 years of age which was noted in 1967 was not maintained. The 1967 figures were probably due to some non-recurrent factor. The proportion of children under 5 who have come for treatment and carried it out satisfactorily has increased a little. Selection of these cases and the care they receive in congenial surroundings has been fully justified. During the year attendances were as follows:- Number of new cases seen:— Under 5 years of age 175 Over 5 years of age 220 Total 395 Total attendances: — Under 5 years of age 292 Over 5 years of age 382 Total 674 Number of cases attended for treatment by the physiotherapist: — Old cases New cases Total  Under 5 years of age 67 29 96 Over 5 years of age 457 131 588 TOTALS 524 160 684 Medical Services at Vale Road School for Physically Handicapped Children This school offers day education to physically handicapped children from the London Boroughs of Enfield and (part of) Barnet as well asHaringey. A medical officer attends at the school twice a week and there is a full-time school nurse, and a full-time physiotherapist. I once again express my appreciation to Mr. A.J. Ives, Headmaster of the school and his staff, for their continued co-operation with the medical staff. 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 cerebral palsy is diagnosed. Dr. William Dunham, Consultant in Physical Medicine to the Unit, attends weekly and a full-time cerebral palsy therapist gives treatment to the children under his direction. A speech therapist and an educational psychologist are available to give advice and treatment in suitable cases. Of the 8 new cases seen at the Unit during 1969, 5 were Haringey children, and 3 from outside the Borough. 3 of these children were under five years of age and 5 over five. The recommendations made for the new cases were as follows; — Recommended admission to Vale Road Special School 7 Recommended admission to an ordinary school 1 Dr. Dunham reports as follows on the year's work: — "Of the 95 children attending the Vale Road School for Physically Handicapped Children, 32 were children with cerebral palsy — "spastics". The proportion has remained fairly constant for several years. 74 Some of the children attending the school offer special educational problems. This is especially the case where a child has more than one handicap. At present the Vale Road School has two special tuition groups for such children and if more children with multiple handicaps are admitted additional special tuition groups may well be required. So far as the children with cerebral palsy are concerned all offer special problems for medical treatment - "therapy". Planning for them would be easy if the desired effect of therapy, like that of some medicines, lasted for several hours. If it did. therapy given three times a day would be ideal: its effect would be continuous. It would be better still if its effect, like those of some injections, lasted for several days. For the best possible results therapy would then be required only two or three times a week. But therapy, though it can add to the number of things the child can do well, is a complete success only if some means can be found of ensuring that he in fact does them well until this becomes a habit. For this, three times a day would be inadequate: three times a week is obviously more so. What is needed, in addition to intermittent therapy, is informed interim supervision. In the school we attempt to achieve this through collaboration between parents, teachers, school nurse, therapist, school medical officer and consultant. The earlier in his life a child comes under such supervision the better he is likely to respond, and we encourage the bringing of children of under school age by their parents to the school for advice on management. We attempt to provide as wide a range of supervised activities as possible. It is hoped that the construction of a therapy pool may be started next year: the Rotary Club of Haringey has already raised about half the anticipated cost. Since last year, facilities have been made available by the Highgate Wood Comprehensive School in woodwork (one session) and metal work (two sessions), but it has not, unfortunately, proved possible to arrange any needlework sessions. Thanks to the initiative of Miss L. Powell and Mr. Coates of the Tottenham Technical College, instruction in wigmaking has been added to the range of forms of technical training available: school leavers can now obtain whole-time training. We keep up with the times too!" Audiology Unit The Audiology Unit is within the curtilage of BlancheNevile School for the Deaf and there is excellent co-operation between the medical and teaching staff. Three sessions are held each week and in addition, there are two screening sessions a month for babies who are "at risk". There is regular supervision of pre-school children with hearing defects and school children with hearing loss who attend ordinary schools. Pre-school children with hearing loss are admitted where possible to day nurseries, playgroups, and when necessary to the nursery class at the Blanche Nevile School. Many of these children wear hearing aids and those not attending BlancheNevile School are supervised by two full-time peripatetic teachers of the deaf who work inclose co-operation with Dr. L. Fisch, the Consultant Otologist. Dr. Fisch reports as follows upon the year's work at the Unit:- "No major changes occurred at the Audiology Unit during 1969. Unfortunately / cannot report any progress in meeting the added requirements or rectifying deficiencies at the clinic. In spite of repeated requests there is still no satisfactory accommodation for a waiting room, no observation facilities and no toilet facilities for patients or staff. Plans were worked out in detail for these requirements a long time ago and in spite of various assurances no steps have been taken to provide these improvements. The most urgent need is still for better waiting facilities and an observation room for the many visitors to the Audiology Unit. Peripatetic Teachers Our two peripatetic teachers are overworked. Each teacher has a case load far above the number which can be dealt with satisfactorily. All attempts to obtain the services of a third peripatetic teacher have failed but attempts continue to be made. During 1969 regular meetings with the parents continued and at some of these films were shown. We hope to develop film showing at future meetings. These meetings are a very important part of parent guidance. 75 Teaching A considerable amount of teaching has been carried out at the clinic, teachers of the deaf who were attending the course at the Institute of Education visited in small groups, and were also attached for further guidance to our peripatetic teachers and attended our parent meetings. Medical Officers, Health Visitors and other Student Nurses attended individually at the clinic for teaching and demonstrations. A two-day course for Health Visitors was held in October and 39 Health Visitors attended from various Boroughs in the Greater London Area. This was very successful and very ably organised by Miss Frost, the Health Education Officer. Booklet on High Frequency Hearing Loss In co-operation with Miss Frost, a Pamphlet was printed entitled "Notes on High Frequency Hearing Loss". This pamphlet explained the difficulties encountered with this type of hearing loss and suggestions were given to help overcome them. The booklet is meant for teachers, speech therapists and other personnel who have contact with these children. It has been highly successful and soon after publication a thousand copies had been distributed and another thousand had to be re-printed. Educational Placement of Deaf and Partially-Hearing Children Difficulty in placement continues. The number of places for children under 5 is extremely limited and many children have to wait a long time for admission. There is no nursery for the partiallyhearing and there are serious deficiencies in the pre-school training programme. There is also great difficulty in placing children in special classes for the partially hearing. Two new classes for partially hearing children are being established in the Borough of Brent and / hope this will relieve the pressure on the partial hearing units at Tottenham. Hearing Aids Considerable improvement can be reported in the range of hearing aids distributed by the National Health Service. The small post-aural aid is now available and all children who needed one were issued with it. There is also a more powerful body-worn aid available and this meant that we did not have to ask the local authority for such large funds to provide commercial hearing aids as we have had to do in the past. It will be only in an exceptional case that a commercial aid will be required for our children in future. Waiting List for the Clinic Improvement has occurred as regards our waiting list and all children who need urgent examination can be examined within a reasonable time. Attendances at the sessions are quite good and the average number seen is 6 or 7. On the average each child needs about half an hour for examination including discussion with parents and advice to them. Children are examined in the presence of the whole team. Otologist, Medical Officer and Teacher of the deaf and, when placement for special education is being considered, the Headmaster of the school. The Educational Psychologist is also frequently present and on special occasions a Psychiatrist attends for special discussion". The following is an analysis of the cases seen during 1969: — 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 131 7 24 41 25 21 25 20 10 9 14 18 10 1 3 - - 359 Cases brought forward from previous year 6 13 20 30 35 37 48 40 20 29 23 19 27 18 19 16 9 409 Re-examinations of old and new cases 3 1 7 15 4 11 7 10 5 8 3 4 2 - 3 1 - 84 Total attendances 852 76 Pre-school children 561 Attending Infant and Junior Schools 141 Attending Senior Schools 150 Total 852 Reason for referral of new cases:- For diagnosis 195 Known to be deaf, examination before admission to Blanche Nevile School 5 Immigrants to Borough known to be deaf 2 Partially hearing, advice as to placement 7 Auditory training 10 "At risk" 127 Transfer from hospital out-patients departments 8 Advice as to placement where deafness might be the cause of backwardness 5 Total 359 62 of the above referrals were from other boroughs. Audiometric and Vision Screening Audiometry Routine audiometric screening is carried out by three full-time trained audiometrician/vision testers. Vision screening in schools by the Keystone apparatus is now combined with audiometric screening from junior school upwards. Combined testing has not been found to be practicable or time saving at infant school level. The audiometricians are also closely associated with the Audiology Unit. Audiometric screening is carried out twice in infants schools - in the first and last year; once in junior school and twice in secondary schools - in the first and last years. The standard for passing screening tests is set purposely high, and a high proportion of those who fail are found to respond to simple corrective measures. The percentage of children who failed in "special" tests continued to be high because these children had either been referred especially because deafness was suspected or were already under treatment. Special sessions continued to be held during the school holidays at school clinics at which an audiometrician was present with the medical officer, for the further investigation of these failures. Technique of Audiometry A senior audiometrician reports:- "Routine hearing tests in schools are carried out by means of a portable audiometer (AmplivoxJ. This gives pure tones from 125 cycles per second to 8,000 c.p.s.. the range of speech frequencies. A sweep test at 20 decibels in all frequencies is carried out separately in both ears, the child indicating only when he/she has heard the noise. If all frequencies at this level are not heard, the child concerned is re-visited at the school between 7 and 10 days later. This waiting period gives a child whose hearing loss is due to a cold, time to improve. If. however, the loss persists, a graph is completed and the child is recorded for further investigation. A further hearing test is then given at a local clinic with a medical officer present to examine the child and obtain family history. Children with a persistent hearing loss are then referred to the Audiology Unit where more stringent and technical tests are carried out on a Peters Clinical Audiometer in a sound proof room". 77 The tables below give the numbers and results of audiometry tests during 1969;Audiometer Tests - Routine Age Group 1st Tests sweep Fai lures Re-tests both ears one ear Total % of Column 1 ri ght left (1) (2) (3) (4) (5) (6) (7) Up to 7 years 4261 38 150 69 86 305 7.2% Intermediate 3006 71 103 38 54 195 6.5% Leavers 1734 57 51 15 18 84 4.9% TOTALS 9001 166 304 122 158 584 6.5% Audiometer Tests - Specials Age 1st Tests Re-tests Fai lures both ears one ear Total %of Column 1 right left (1) (2) (3) (4) (5) (6) (7) Under 5 3 — — — — — — 5 34 23 12 3 5 20 58.8% 6 27 28 12 3 7 22 81.5% 7 13 21 3 3 2 8 38.1% 8 1 12 - - 1 1 100.0% 9 8 8 — 2 3 5 62.5% 10 7 18 4 1 1 6 33.3% 11 4 5 2 2 4 80.0% 12 — 4 - - - - 13 2 4 1 1 - 2 50.0% 14 2 - - - - - - Over 14 1 - - - — — — TOTALS 102 123 34 13 21 68 67.7% Vision Screening Keystone vision screening is carried out in the same age groups in the junior and secondary schools. Itmaybe that the frequency of audiometric screening could be reduced,and it is desirable to increase vision screening so that children's eyes are examined every second year of their school life. Screening procedures are carried out independently of the school medical examination, but every effort is made to have the results available for the school doctor at the medical examination. Keystone failures are followed up by the orthoptists before referral to the school medical officer. In the infant schools, vision testing of children is carried out by the school nurse at routine medical inspections, the orthoptist carrying out screening procedures for latent squints. A special investigation was carried out at two comprehensive schools by the technician and the orthoptist together, the purpose of which was to assess the efficiency of the Keystone method-of vision screening. 78 Of 583 children who were tested on the Keystone apparatus, 291 failed (50%). Of these failures 119 (41%) were either already under treatment or had received treatment previously. A further 74 (25%) were re-tested by the orthoptist and passed as normal. 66 (23%) were confirmed by the orthoptist as having defects but were not referred for further investigations for various reasons, e.g. colour vision only involved, cosmetically good, due to leave school. 32 children (11%) were referred by the orthoptist for investigation by the ophthalmologist. Ear, Nose and Throat Clinics There is now only one Ear, Nose and Throat Clinic at which a consultant attends, which is held at Park Lane Medical Centre, Tottenham, once a month. As the number of referrals continues to decrease, it is likely that this session will be discontinued in 1970 and that Mr. W. McKenzie, the Consultant, will see cases referred to him at the Prince of Wales's Hospital. Mr. McKenzie reports as follows on the work of the Park Lane Clinic:- "The striking feature of my clinic is the progressive reduction of patients and / notice that this is confirmed by the closure of similar clinics elsewhere in the borough. It is astonishing to record that there has been no case of chronic suppurative otitis media seen during the last six months". Ophthalmic Clinics There are three school ophthalmic clinics held in the Borough, at which 7 weekly sessions are held. During 1969 the Wood Green School Ophthalmic Clinic continued to be held at the Lordship Lane Medical Centre, Tottenham. The new Stuart Crescent Health Centre opened at the end of the year and Wood Green cases will be seen in 1970 at the new Health Centre. Two full-time orthoptists work in conjunction with and under the direction of the consultant ophthalmologists. Dr. T.G. Kletz, Consulting Ophthalmologist for Lordship Lane Clinic,Tottenham, reports as follows:- "The work at this clinic is. in the main, the examination of children referred on account of defective vision and defects of ocular muscles. The children are first refracted and glasses prescribed when required. Cases of squint or muscle imbalance, also cases of amblyopia are referred for orthoptic investigation and treatment where necessary. In view of the comparatively high incidence of myopia in different nationalities, an ethnic survey has been carried out during the past few years and was continued during 1969 with the following results: - 1. Of the children attending the clinic. 51.7% were native. 48.3% immigrant or of immigrant origin. 2. Of the children attending for the first time, the comparative figures are: Native 40.6% Immigrant 59.4% The immigrant section consisted of approximately 49% West Indian 16% Cypriot 16% Irish 3. The figures for myopia were Native 33.7% of cases seen were myopic Immigrant 46% of cases seen were myopic (West Indian 48%) 4. The incidence of high myopia in young children was almost totally in the West Indians. West Indians - Under 3 years 3 cases over 7 dioptres, including 1 of over 14 dioptres. Age 3—7 years 7 cases over 7 dioptres, including 4 of over 10 dioptres. West Africans — 1 case age 7 with 16 dioptres of myopia." 79 Mr. E.M.G. Galton, Consulting Ophthalmologist for the Wood Green children attending Lordship Lane Clinic, reports:- "During the year parents became more familiar with the Lordship Lane Clinic, and attendances improved by 8% to 1,308. New cases likewise increased by 55% to 208. Of these 46 were under 5 years of age. At the end of the year the new Clinic at Stuart Crescent was opened and already attendances are improving. I feel those responsible for this fine new Health Centre should be congratulated; for layout and amenities leave little to be desired. " Dr. R. Peswani, Consulting Ophthalmologist at Weston Park Clinic, Hornsey, reports:- "The work at this clinic has progressed smoothly during the past year. There are two sessions weekly and attendances have been fairly good. Any cases requiring orthoptic investigation and treatment were referred to the orthoptist after refraction, and her presence on the same day as the ophthalmic sessions are held, has proved a great help. / would ask for early referral of children with defective vision since incidence of amblyopia discovered when it is too late is still high. The statistics for the year are as follows:- Under 5 years Over 5 years Total attendances 147 1232 No. of new cases 54 343 Errors of refraction (including squint) 33 641 Speech Therapy Miss J.D. Came, Speech Therapist, reports:- "Practical and administrative difficulties have been evident during the year. Part-time speech therapists have been hard pressed to cover full programmes of treatment and school visiting and yet prevent mounting waiting lists. At present, we are still six speech therapy sessions short of our entitlement. Young therapists move to fields of wider opportunity. Two left during the year for Canada and Australia. On the positive side, the opening of the Health Centre at Stuart Crescent will better serve children in that area. An interesting and worthwhile development has been the increased use made of speech therapists by clinic doctors for the purpose of counselling and reassuring parents of children with speech handicaps. In Haringey an unique opportunity presents itself for the study of the speech and language problems of the various ethnic groups. We are finding that the work of the speech clinic is appreciated by people from widely varying cultural and linguistic backgrounds. This has surely most encouraging significance for the future." 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 medical director of the Tottenham Centre, and Dr. K. Graf medical director of the Hornsey Centre. The administrative director of the child guidance and school psychological service is Mr. B.J. Watkins, Senior Educational Psychologist. 80 Dr. Nina Meyer reports as follows on the year's work at the Lordship Lane Centre:- "Increasingly the pattern of Child Guidance must be that the people in contact with the child should be helped to understand and respond to the child's difficulties. Many children are responding to the abnormal circumstances of their lives and the demands of a society in a state of flux and change. Understanding gives appropriate solutions which apply to whole classes of children in similar circumstances. The child who has real psychiatric illness can then hope to be able to be given individual psychiatric attention. The recruitment of additional Educational Psychologists to the team has facilitated the new orientation of this Clinic towards Psychiatric support in the form of intervention in schools by discussion and conference, rather than direct contact of the team with the child. Our current case load is 287 of which 24 are under intensive treatment by the Psychotherapist. Of the 227 cases we have dosed, 147 improved with help, 40 were over school leaving age, 24 moved away, and in 16 cases there was no response to offered appointments. 81 cases are awaiting a school report or Health Visitor's assessment with a view to closure. We have begun to integrate a policy by which referrals are also screened; only those most likely to benefit from Child Guidance are seen, leaving others to be referred to agents which can be of most help to them. 179 new referrals were accepted of which 94 have been seen for diagnostic assessment; 19 children were seen for review while on leave from boarding school. Among workers in the field there appears to be a greater consciousness of the psychiatric need of their population. This perhaps is the important advance in the field of Child Guidance this year". Dr. K. Graf reports as follows on the year's work at the Tetherdown Centre:- "As requested. / have pleasure in presenting a brief report on the function and the organisation of the Tetherdown Child Guidance Clinic during the year 1969. This is my eighth Annual Report since / was seconded by the North-West Metropolitan Regional Hospital Board to serve in this area as Consultant Child Psychiatrist, and my fifth report as Medical Director of the Tetherdown Child Guidance Clinic, which was established in its present set-up at the time of the re-organisation of the London Boroughs in 1965. The Tetherdown Clinic is the direct successor of the Hornsey Child Guidance Clinic which began with the appointment by the Education Committee in September 1944 of an Educational Psychologist who two years later, in 1946, was assisted by the appointment of a Psychiatric Social Worker. The work was extended in December 1947 by the appointment of a Psychiatrist by the Local Authority for two sessions per week. In April 1948 this establishment was increased to four sessions but again reduced to two sessions in April 1951, when the Psychiatrist came into the service of the North-West Metropolitan Regional Hospital Board. While the establishment of the other team members and the demands made on our service have progressively increased since then, the psychiatric sessions have remained for nearly 20 years unaltered and our plea for the appointment of an assistant to the Consultant Psychiatrist has remained unheeded. We are still hoping to get the services of a switchboard operator-cum-receptionist who is badly needed for the running of this clinic which also houses a remedial teaching unit. Mrs. Benjamin and Dr. Azevedo continued their sessional services as child therapists and we also now have help with treatment from a fourth year student from the Hampstead Child Therapy Clinic who is supervised by Miss Anna Freud. The present establishment shows an unbalance of the different types of professional staff. We are now short of approximately two full-time psychiatric social workers according to the Ministry recommendation. As a consequence the present psychiatric social worker has to spend too much of her time on clinical administration and intake interviews at the expense of other very much needed activities, such as therapeutic case work with the parents. The Consultant Psychiatrist has to undertake much routine work and diagnosis which could easily be done by a less experienced colleague and this prevents him from giving more of his valuable time to consultative work and therapy of his patients. There has been a total of 250 referrals to the Clinic of which 132 came from Head Teachers. 61 from Medical Officers. 27 from parents. 12 from the Children's Department. 11 from General Practitioners, 4 from hospital consultants, 2 from Probation Officers and 1 from the Family Service Unit. Of the 250 who were seen by the Psychiatric Social Worker and the Educational Psychologist, 83 proceeded for full psychiatric investigation which is an increase of diagnostic psychiatric interviews compared with last year. During the earlier part of the year we were able to follow up all cases on the diagnostic waiting list which in consequence was reduced from 106 patients in December 1968 to 20 in December 1969. The reason for this big drop was that some children had made spontaneous 81 recoveries which is not unusual in dealing with children referred for psychological difficulties, other families had moved out of the Borough and some children had improved in the meantime through the special educational or other measures which had been instituted in the interim period by clinic staff. The traditional field of competence of the Child Guidance Clinic and of its psychiatrist, in particular, is the diagnosis and the treatment of emotional disturbance in children and adolescents. Soon after Child Guidance Clinics were established in this country some 40 years ago it became obvious to everybody concerned that one had to help the whole family in order to treat the child and that nearly every unsettled child reflected a disturbed family situation. But it took a further 20 years to recognise that child psychiatry meant family psychiatry and more recently still through insight gained by sociological studies we have learned that children in their narrow and extended family settings are also being influenced by forces prevalent in the wider environment and that therefore child psychiatry forms an integral part, if not actually the driving force, in any form of community psychiatry. Apart from a relatively few cases, such as children suffering from inherent personality limitations, or exclusively maladjusted through the school situation, or where the problem has arisen as the result of a temporary emotional crisis, as is not infrequent in adolescence, the parents have to be involved in case work with a psychiatric social worker while the child receives treatment. In fact, many of our failures are due to the parents' lack of co-operation or inability to get involved. Delinquent children have been of very special interest to child guidance teams ever since Healey and Bronner. as far back as 1915 at the Psychopathic Clinic in Boston. U.S.A.. where they had introduced the now still practised tripartite team approach of psychiatrist, educational psychologist and psychiatric social worker, first investigated young people who appeared before the Courts. However, our chances of treating and helping them are limited as it is not sufficient to unravel the underlying psychopathology or criminal behaviour but one requires in treatment also the co-operation of the client and there are many socially determined factors beyond the competence of psychiatry which promote delinquent tendencies. Hence the statements one occasionally hears that a hardened and mature criminal might have been salvaged if he had only had psychiatric attention as a child is not always true. Quite apart from delinquency, contemporary youth manifests other disturbing expressions of behaviour which appear to be rooted in social maladjustment and for which the help of the child psychiatrist is being sought, but where his chances of achieving a cure are very limited. / am referring to young people involved in the socially paralysing effects of the contemporary drug scene, the often very disturbing precocious sexual behaviour of others and to those anti-authoritarian militant youths who carry their neurotically determined need for forceful self-expression to extremes of violence which are not acceptable to the community. Such admittedly rarely referred expressions of youthful emotionality may in the individual case require psychological help but when they are the result of misguided submission of young people to social pressures beyond the influence of the child guidance clinics they can only be dealt with on a national or even international scale by those who rule human fortunes by maintaining law and order, as they are expressions of the so-called permissive society, which in spite of its many social blessings for the mature person, appears occasionally too threatening for young people of weaker moral constitution, who then succumb to the inconsistencies, hypocrisies and materialistic influences that impinge upon them." Tuberculosis Prevention of tuberculosis by B.C.G. vaccination B.C.G. vaccination is offered to all school children over 13 years of age. No students of Further Education took advantage of the opportunity to have B.C.G. vaccination during 1969. 82 The following table gives details of B.C.G. vaccinations carried out by the Council during the year- School Children Number % Parents approached 2688 — Parents accepted 2481 92.2 Number skin tested 2413 - Number found positive 176 7.3 Number found negative 2084 86.4 Number failed to attend for Mantoux reading 153 6.3 Number vaccinated (% of those approached) 2084 77.5 Dr. Z. Zubrzycki reports as follows on the use of the Dermo-jet:- "A new method of tuberculin testing and BCG vaccination was introduced in June 1969. Instead of a syringe and needle a jet-injection apparatus (demo-jet) is used which makes intradermal injection by means of a pressurised jet. It is rapid in use and by elimination of syringes and needles less costly. After a period of trial certain short-comings of this technique became apparent, among them the under-dosage of the vaccine delivered by demo-jet. For this reason the BCG vaccination is at present carried out by the old method of syringe and needle, whereas the demo-jet is used for skin testing. The jet-injection is a new invention and provided its technical efficiency is guaranteed it will be valuable as an instrument in immunisation programmes." Cases of Tuberculosis occurring in Teachers or Pupils During 1969, an investigation was carried out on the advice of the Chest Physician at one school where a case of tuberculosis had occurred amongst the pupils. The results were as follows:- Heaf Tests of immediate contacts 31 Referred to Chest Clinic for further investigation 5 No additional case was discovered at the school. Verrucas There are now two special clinic sessions held each week at Weston Park and Lordship Lane Medical Centres to deal with plantar warts, conducted by Dr. Shah, a medical officer who has had special training in their treatment. Dr. Shah reports as follows on the work at these clinics during the year:- "Special clinics for the treatment of warts amongst school children started in the year 1969. Two sessions in a week at two different clinics are allocated for the treatment. Almost all kinds of warts except the facial and those that are situated on difficult and dangerous areas are treated in these wart clinics. The line of treatment depends on the size, situation and the number of warts. Treatment of choice is by electrocautery as it gives satisfactory results and complete healing takes place usually in a week. The area around the wart is cleaned and painted with acriflavin. Local anaesthetic 2% Xylocain is infiltrated. The wart is then either cut off with sterilised scissors or excised with knife. After scooping the area with a scoop to remove the indurated tissue, it is cauterised. It is kept covered with a dressing for one week, during which time complete healing takes place. The warts of small and unco¬operative children are treated with either chlorosal paste or collodion salicylic acid. For the treatment with electrocautery, the presence of a parent or guardian is essential." 83 The number of cases treated at the two clinics, i.e. Lordship Lane and Weston Park during the year 1969 are as follows:- Name of Clinic Total Attendances First Attendance of the Year (New cases) Number treated with electrocautery Number of Sessions Lordship Lane 597 241 91 35 Weston Park 467 144 65 38 Ringworm of the Scalp During the year 24 cases of ringworm of the scalp occurred in 8 schools throughout the Borough. We continue to be grateful to St. John's Hospital for Diseases of the Skin, who carried out screening procedure in the schools involved. No evidence of spread of infection was discovered. As in previous years, all doubtful cases were referred to the Consultant Dermatologist at the Prince of Wales's Hospital for further investigation. The great majority of cases continues to occur in immigrant children. Weight Watching Clinics The problems of nutrition continue to highlight the overweight rather than the underweight chiId. The weight watching clinic which was started with such success during 1968, ran into difficulties during 1969 when the medical officer who was conducting the clinic left the Borough. The clinic will be resumed as soon as possible. Co¬operation with the Prince of Wales's Hospital The department continues to maintain a close link with the Prince of Wales's Hospital. The Rheumatism Supervisory Clinic continues to be held at the Hospital under the direction of Dr. Ian M. Anderson, Consultant Paediatrician. A weekly session is held at which a senior medical officer from the department attends; and another senior medical officer attends at a weekly general paediatric session. I am grateful to Dr. Anderson for the following report on the work of the rheumatism clinic during 1969:- "During 1969 there was only one new case of Rheumatic Fever admitted to the Paediatric Unit in St. Ann's General Hospital. There were 19 new cases of Congenital Cardiac Lesions seen during 1969 in the Paediatric Clinics at the Prince of Wales's General Hospital. Total number of NEW CASES in 1969 -20 (in Haringey - 13; from other areas - 7) (Male -11 Female - 9) 50% were referred from Child Health Clinics. The 20 new cases are classified as follows:- Total In Haringey From other areas Male Female Rheumatic Fever 1 1 — — 1 Patent Ductus Arteriosus 1 1 - - 1 Aortic Stenosis 2 2 - 2 - Ventricular Septal Defect 2 1 1 - 2 Atrial Septal Defect 6 3 3 3 3 Venous Hum 1 1 - 1 - Innocent Murmur 7 4 3 5 2 TOTALS 20 13 7 11 9 84 Five of the new cases have been transferred to Westminster Hospital to attend Dr. I.M. Anderson's Cardiac Clinic there for further investigations and follow-up." There also continues to be close co-operation between the school health service and the children's ear, nose and throat clinic at the Hospital. Mr. William McKenzie, the hospital consultant, also acts as consultant to the school ear, nose and throat clinic at Park Lane Medical Centre. An assistant medical officer from this department attends the consultant's weekly hospital session, where he acts as registrar. Uncleanliness and Verminous Conditions School nurses carried out regular hygiene inspections in the schools. Verminous heads are now the exception rather than the rule, but careful watch still needs to be kept to prevent the spread of infection. The following are details of the hygiene inspections carried out during 1969:- Numberof individual examinations of pupiIs in schools 55,632 Number of individual pupils found to be infested 269 Milk in School Scheme Number of pupils supplied with 1/3rd pints of milk on an average day in the Autumn Term 1969:- Maintained Schools No. Present No. taking Milk Infant and Nursery 8,811 8,807 Junior Schools 11,892 11,137 Secondary Schools 12,460 63* TOTALS 33,163 20,007 *The supply of milk to senior pupils' (other than those in Special Schools) has been discontinued as the result of a directive from the Department of Education and Science. School Meals were served at 103 schools or departments. Meals consumed by pupils on an average day in the Autumn Term 1969:- No. Present No. taking Paid Meals No. taking Free Meals Total Infant and Nursery 8,811 5,843 595 6,438 Junior Schools 11,892 8,257 1,208 9,465 Secondary Schools 12,460 6,053 923 6,976 TOTALS 33,163 20,153 2,726 22,879 Total number of meals prepared during year ended 31st December 1969 , 4,538,980 (including staff meals). Handicapped Pupils The Education Act 1944 places upon 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 defects 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 85 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 fall clearly in one category, and an 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 chi Id. Home tuition may be arranged on a temporary or permanent basis for children unfit 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 22nd January 1970:- 86 RETURN OF ASCERTAINED HANDICAPPED PUPILS REQUIRING SPECIAL EDUCATIONAL FACILITIES IN THE CALENDAR YEAR DISTRIBUTION ON 22ND JANUARY 1970 Number newly ascertained as Number newly Number on register of — Number placed in Boarding Homes 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 Total CATEGORY requiring education in a Special School (other than hospital Special Schools) placed in Special Schools (other than hospital Special Schools) Maintained Special Schools Non-Maintained Special Schools Independent Schools Day Boarding Day Boarding Day Boarding Act 1 944 Boys Girls Boys Girls B G B G B G B G B G B G B G B G B G B G B G Blind Pupils 1 — 1 1 — — 3 1 — — 3 1 1 - - - - - - - - - - - 7 2 Partially Sighted Pupils 1 3 2 3 7 5 _ _ — 1 1 _ _ - _ 2 - - _ - - 8 8 Deaf Pupils 2 2 1 2 9 9 2 - - - 2 2 - - - - 2 3 - - - - - - 15 14 Partially Hearing PupiIs 5 _ 2 - 9 13 1 - - - - - - - - - 1 - - - - - - - 11 13 Physically handicapped Pupils 6 4 6 5 35 28 1 - _ _ 6 3 - _ __ _ - - 1 — - - 43 31 Delicate Pupils 16 16 16 12 18 16 10 8 - - 2 2 - - - 2 1 2 - - - - 32 29 Maladjusted Pupils 20 7 19 7 4 1 6 - - - 20 7 15 10 8 1 - - 1 1 - - - - 63 20 Educationally Subnormal Pupils 29 20 26 18 94 73 9 2 3 6 3 2 1 1 2 — 38 21 1 - - 1 - 152 105 Epileptic Pupils - 1 - 1 - - - - - - 1 - - - - - - - - - - - - - 1 - Pupils with Speech Defects - - - - - - - - - - - - - 1 - - - - 1 - - - - - 1 1 TOTALS 80 53 73 49 176 145 32 11 3 6 38 18 17 12 10 1 43 27 12 3 1 - 1 - 333 223 GRAND TOTALS 133 122 321 43 9 56 29 11 70 15 1 1 556 87 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 Risley Avenue Junior and Infants 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 95 children on the roll at Vale Road Special School, 61 were Haringey children and 34 children from other boroughs. Of the 137 children on the roll at Blanche Nevile School(including the partially hearing units), 39 were Haringey children and 98 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 for educationally subnormal children must be sought at either Durants School or Oaktree School in Enfield or Oak Lodge School, Finchley. At present there are 29 Haringey children at Durants, 28 at Oaktree and 85 at Oak Lodge. There are 59 Haringey children 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:- PartiaIly 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 Islana, Hants. This school accepts delicate and physically handicapped children—boys of primary school age, i.e. 5 to 11 years, and girls of all ages. There is a resident staff including a night nurse. A medical practitioner attends twice a week and a dental officer once a week. Dr. A.J. May, who has been part-time medical officer to Suntrap School for some 40 years, retired in September 1969. The Haringey Authority and its predecessors, the Middlesex and Tottenham Authorities, are most grateful to Dr. May for his excellent care of the children over this very long period. He has been succeeded by Dr. A.H.W. Brenan. The number of children placed at Suntrap at the end of 1969 was 103, of whom 13 were Haringey children and 90 from other boroughs. The following were the defects for which the Haringey children required placement- Asthma 4; Bronchitis 2; Nervous Debility 1; Osteomyelitis 1; Hirschsprung's Disease 1; Recurrent Respiratory Infections 1; Lead Poisoning 1; Emotional Disturbance 2. Blind children are placed at special residential schools, mainly at Dorton House School at Sevenoaks and at Linden Lodge School, Wimbledon. Children in other handicapped categories who require residential schooling, for whom Suntrap cannot provide suitable care and education, are placed in schools administered by other local authorities or independent bodies, apart from epileptic children with severe epilepsy, who are placed in hospital special schools. The only category involving a large number of children is that of maladjusted pupiIs. Hospital Classes I am indebted to the Chief Education Officer for the following report::- "The tuition of children who have been in-patients at St. Ann's and the Prince of Wa/es's Hospitals, has continued during the past year under the direction of two full-time teachers. The ages of the pupils range from 4½A - 15 years and wherever possible the school curriculum is followed. Some children attend school in the classroom in one of the wards at St. Ann's whilst others have bedside tuition. When weather permits, some lessons are taken in the extensive hospital grounds. 88 The individual attention given to pupils proves very beneficial, particularly to those needing additional help in some subjects and to those preparing for examinations. The smooth running of the classes is ensured by the co-operation of the hospital staff and the ready help of the Haringey Library Service is much appreciated." Special Classes attached to Ordinary Schools In addition to the units for partially hearing children already mentioned, there are seven '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 1969, the number of children attending full-time 'Opportunity classes' was 55. 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 eight 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 1969 thirteen Haringey children and one child from another borough were in attendance at day nurseries under these arrangements. At the end of the year nine Haringey children were still in attendance. In addition, one handicapped child was placed with a private child minder and one in a private playgroup, without charge to the parents. Both children were still in attendance at the end of the year. Recuperative Holidays During 1969 18 boys and 18 girls were recommended for recuperative holidays in order to assist their recovery after illness. 14 boys and 16 girls were placed in suitable homes for periods of varying length. 89 Deaths of School Children It is with regret that I include the following details of local school children who died during 1969:- Sex Age Cause of Death Years Months M 8 1 Road accident M 5 11 Road accident M 6 8 Other accident F 5 8 Malignant disease F 10 6 Malignant disease F 7 2 Broncho-pneumonia M 5 5 Broncho-pneumonia F 14 9 Nephritis F 7 10 Congenital Deformity of Internal Organ M 13 8 Congenital Neurological Defect Road Accidents to School Children I am indebted to the Accident Prevention Officer for the following details of road accidents involving school children during 1969:- Fatal Serious Slight Total Pedestrians 2 36 180 218 Cyclists 4 43 47 TOTALS 2 40 223 265 LIST OF SCHOOL HEALTH CLINICS AS AT 31ST DECEMBER 1969 a - School Advice b - Dental c - Ophthalmic d — Orthoptic e - Orthopaedic f - Physiotherapy g — Cerebral Palsy Unit h - Speech i — Ear, Nose and Throat j - Audiology Unit k - Child Guidance I - Chiropody a All Saints' Church Hall, 11 Church Road, N.6. j Blanche Nevile School for the Deaf, Philip Lane, N.15. abh Burgoyne Road Clinic, 58 Burgoyne Road, N.4. 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. acd Health Centre, 8 Stuart Crescent, N.22. abcdefhl Medical Centre, rear of Hornsey Town Hall, 23a Weston Park, N.8. dfgh Vale Road School for Physically Handicapped Children, N.4. 90 SCHOOL DENTAL SERVICE Mr. G.C.H. Kramer, Principal School Dental Officer, reports as follows:- "The year has brought both disappointment regarding the level of routine inspections in schools and satisfaction that it at last became possible to introduce the precautionary blood-testing of certain groups of patients before the administration of general anaesthetics. The general pattern of the service provided again followed that of previous years and. staffing difficulties notwithstanding, the average and total 'productivity' were well maintained, with a small but pleasing increase in teeth saved and reduction in those extracted. The relevant figures are set out in full at the end of this report, but comment on certain aspects is necessary. Inspection and Treatment The number of pupils on the school rolls as at 31st December was 35,952, a mere 140 more than a year ago. Routine dental inspections in schools occupied 144 sessions, 40 fewer than in 1968, during which 12,452 children were examined for the first time in the year, and a further 3,849 were first examined in the clinics. Together, these 16,301 on whom a check on the dental status was possible represent only 45.3% of the school population: worse even than the low level of 53% the previous year which was itself unsatisfactory. However the more recent figure does include a higher proportion of children in primary schools who, because of their age. are more at risk of dental decay and less likely to have established routine treatment with the 'family dentist'. Being unable to meet the whole of our duty, to inspect, we have used inadequate resources quite deliberately for those in greatest need. In addition to the insufficient number of surgeries and/or dental officers in some parts of the Borough where the demand is heaviest, we have had the continuing mal-distribution of schools-to-clinics necessitated by the building of the new Stuart Crescent health centre in Wood Green. Of the total of 18,498 children first or re-examined in the year, treatment was required by 11,305 or 61.1% — as compared with 64.4% in the previous year. / am afraid that the reduction is by chance and not statistically meaningful, but should very much like succeeding years to show that this was the beginning of a trend towards a better level of dental health among our child population. One thing which figures of the past several years have convinced me is being achieved, albeit very slowly, is that we are arousing greater interest in obtaining treatment. The numbers rendered dentally fit who then, at the usual sort of interval such as six months approach their clinic for re-inspection and necessary treatment, is increasing. In some ways we are making a rod for our own backs in creating an even greater demand, but perhaps / can be forgiven for feeling pleased if our message is getting over. Whatever slight improvement may have occurred, it does little to reduce the appalling amount of treatment needed by our children, and only in future fluoridation of the water supplies can / foresee a real answer to the problem. Blood Testing of Certain Ethnic Groups Recent years have brought increasing awareness that blood abnormalities found among people from certain overseas countries, of whom there are many resident in the Borough, may present a threat to life or health when a general anaesthetic needs to be administered for any purpose. As well over one thousand are administered each year in our dental service, it would be less than reasonably careful if no account was taken of the risk and steps taken to avoid danger to our patients. Children suffering from the most severe types of these abnormalities may be expected already to be known to us, unless they have very recently arrived in England, because of the effect on health already having been recorded. If any such information came to the notice of the Health Department, it would be passed to the dental clinic responsible for that particular patient through the 'Dental At Risk' register which contains details of patients with any defect needing to be noted on the dental record card as a permanent warning. However, it is always possible that a small number of even serious abnormalities remain unknown, and it was certain that less serious and obvious conditions were to be found deserving of particular care, and use of a modified technique if general anaesthesia was necessary. 91 The size and extent of the problem was unknown, but it could not reasonably be ignored: the fact that serious results were rare in this country was not sufficient guarantee for the future. \Ne have been able to enlist the help of Dr. J. Reeve. Consultant Pathologist at the Prince of Wales's Hospital, who agreed to examine and report upon blood samples which we take from the patients and deliver to the hospital. These samples are taken at sessions arranged for the purpose at the clinic usually attended by the child concerned, so as to avoid both travelling and being seen in unfamiliar surroundings, and the small specimen required is obtained from a finger¬prick, which simple procedure is well accepted by the children without upset in almost all instances. The level of haemoglobin is measured for all samples, and the test appropriate to the abnormality which might be found for that particular patient is carried out. In cases of doubt, a more sophisticated test follows the first, to make doubly sure that the essential information is obtained. Also, although not of concern as regards dental treatment, the opportunity is taken to make an additional test which might prove of value to the medical service in ensuring a good standard of general health. After being under consideration for some long time, it became possible to start this routine testing in March 1969 for all patients concerned and, up to the end of the year under review, 448 such tests had been carried out with findings of interest and value for 98 of these, which seems abundantly to justify the work involved. It is not, of course, possible to know or even theorise as to whether or not any serious difficulties associated with general anaesthesia have been avoided by possession of knowledge derived, but certainly we have been enabled to take particular care and use a modified technique in appropriate cases for the greater safety of the patients concerned." Dental Inspections and Treatment Pupils first inspected at school 12,452 Pupils first inspected at clinic 3,849 Pupils re-inspected 2,197 Number found to require treatment 11,305 Number of fillings: Permanent teeth 12,834 Temporary teeth 8,865 Number of teeth filled: Permanent teeth 10,893 Temporary teeth 8,072 Extractions: Permanent teeth unsavable 361 Permanent teeth orthodontia 388 Temporary Teeth 3,518 General anaesthetics 1,191 Number of dentures supplied 28 Number of crowns and inlays 35 Number of teeth root filled 27 Number of prophylaxes 1,549 Number of teeth otherwise conserved 708 Other operations 4,350 Orthodontic Treatment Cases remaining from previous year 192 New cases commenced during year 127 Number of appliances fitted: Removable 328 Fixed 27 Number of impressions, adjustments etc. 4,277 Number of radiographs 2,545 92 Appointments and Sessions 93 Attendances for treatment 25,592 Appointments not kept 6,118 Number of half-day sessions devoted to: Inspections in schools 144 Treatment 3,977 APPENDIX SCHOOL HEALTH SERVICE STATISTICS FOR 1969 SCHOOL HEALTH SERVICE STATISTICS 1969 Pupils found to require treatment at Medical Inspections 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 1965 & later 7 32 33 1964 54 252 279 1963 98 374 440 1962 33 96 122 1961 27 48 68 1960 23 61 75 1959 95* 161* 227* 1958 131* 285* 352* 1957 277 373 582 1956 133 198 292 1955 214 246 404 1954 & earl ier 224 240 404 TOTALS 1,316 2,366 3,278 *Signifies "Selective" medical examinations 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 76 127 94 75 416 390 923 83 5 Eyes (a) Vision 152 180 379 61 1291 484 182 138 (b) Squint 68 26 19 8 159 69 5 9 (c) Other 13 16 4 14 53 62 32 22 6 Ears (a) Hearing 60 30 32 19 199 110 67 45 (b) Otitis Media 22 46 5 5 55 109 4 6 (c) Other 4 13 19 7 42 36 101 25 7 Nose and Throat 113 231 12 36 222 471 71 78 8 Speech 39 29 3 10 71 81 23 12 9 Lymphatic Glands 4 76 2 4 7 157 - 12 10 Heart 7 62 8 13 41 114 21 43 11 Lungs 56 83 10 28 132 212 49 60 12 Developmental: (a) Hernia 6 26 4 4 28 62 9 15 (b) Other 19 88 69 43 301 282 79 184 13 Orthopaedic: (a) Posture 15 8 30 14 105 47 2 7 (b) Feet 120 94 68 34 420 252 50 29 (c) Other 20 23 22 23 128 106 87 23 14 Nervous System: (a) Epilepsy 4 14 6 8 20 32 8 10 (b) Other 5 8 3 1 20 27 14 41 15 Psychological: (a) Development 10 55 4 3 34 105 117 57 (b) Stability 44 180 21 55 156 444 155 119 16 Abdomen 9 16 4 6 29 56 20 22 17 Other 20 5 33 5 100 34 192 54 T - Requiring Treatment 0 - Requiring Observation 94 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 80 (b) Errors of refraction, including squint 3,036 Total 3,116 (c) Number of pupils for whom spectacles were prescribed 945 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 147 (c) Other nose and throat conditions 8 Received other forms of treatment 157 Total 314 Total number of pupils still on the register of schools at 31 st December 1969 provided with hearing aids: (a) During the current year 12 (b) In previous years (excluding any pupils shown at (a) above who were provided with an aid in a previous year) 72 GROUP 3. Orthopaedic and Postural Defects Number of pupils known to have been treated at clinics or at out-patients departments 1,220 GROUP 4. Diseases of the skin (excluding uncleanliness) Ringworm (i) Scalp 24 (ii) Body 1 Scabies - Impetigo 4 Other skin diseases 832 Total 861 GROUP 5. Child Guidance Treatment Number of pupils treated at child guidance clinics (including cases sent to the Tavistock and other hospital clinics) 640 GROUP 6. Speech Therapy Number of pupils treated by speech therapists 331 GROUP 7„ Other Treatment given (a) Number of miscellaneous minor ailments treated by the Council 107 (b) Pupils who received convalescent treatment under School Health Service arrangements 30 (c) Pupils who received B.C.G. vaccination 2,084 (d) Treatment other than (a), (b) and (c) above 253 95 EDUCATION ACT 1944 - Section 57 Cases dealt with under Section 57, Education Act 1944 6 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 98 (b) Number of Students examined as to fitness to undertake training course 183 (c) Number of Students examined on completion of training course at Hornsey College of Art 47 96 PART IV SOCIAL SERVICES OF HEALTH DEPARTMENT MENTAL HEALTH SERVICES During the year the Principal Medical Officer for Mental Health has brought closer together the care of the patients seen in the hospital setting and then transferred to the community. His time has been increasingly called upon to give advice on psychiatric problems, especially by the School Health and Children's Departments. Nationally the spotlight of attention continues to be focussed on the services for the mentally disordered. In Haringey the Mental Health Services continue to develop and expand and important work has been done in consolidating the progress already made and in strengthening the existing links with the other associated services. Staff movement has made its own contribution to our difficulties in making progress at the rate to be desired less easy of attainment and in order to combat those difficulties a rising from too little money, I have increasingly encouraged the voluntary services in the area to help wherever possible. I am grateful to the Psychiatric Rehabilitation Association, the Red Cross Society and all those other volunteers who make a valuable contribution to the on-going social work inHaringey, nevertheless volunteers however willing and able, still do not entirely take the place of the fieldworker and statutory officer, whose volume of work constantly increases. Our endeavours to provide adequate community care for those in need have been maintained, and special effort has been directed to the improvement of the facilities associated with the Woodside Club which has now been rehoused at White Hart Lane, in the old clinic, where patients can recuperate and rehabilitate in a friendly atmosphere, while spending some time in suitably interesting and occupational activities. It will be appreciated that this work is a valuable preventive measure and often obviates hospital admission as well as reducing social stress and isolation. Social Work The full range of social work for all classes of mentally disordered persons is given, and the duties vary from making arrangements for the specialists to assess these people, or to assist in admitting them to hospital, into residential care, or in the provision of domiciliary visits, or getting them to join in the activities of the Psychiatric Social Clubs. As close a contact as possible is kept with the hospitals and other statutory and social agencies serving the area. This has been a difficult year in the social work field owing to the general increase in mental health community care and the fact that there has been a considerable changeover in staff during this period, at one time the total number of Mental Welfare Officers was reduced to four, however, at the time of this report the general position looks rather more hopeful, fresh recruits are coming in, although mostly in¬service trainees, which adds to the burden of the existing staff while they are being instructed in their new role. There have been the usual professional visits of observation to the Mental Health Section and the associated borough services, and among those welcomed have been an Assistant to the Professor of Psychiatry Istanboul University, Probation, Child Care and other Social Workers, teaching, midwifery and nursing students. In order to give those in training some experience of the community care services, our local catchment hospitals both Claybury and Friern now regularly send student nurses to the section for a short placement. Psychiatric Rehabilitation Association I am indebted to Mr. John Wilder of the Psychiatric Rehabilitation Association, for the following report:- "1969 saw steady consolidation of community care for the mentally ill. The Mental Welfare Department, the psychiatric hospitals, and the P.Ft. A. have continued to work closely together developing the rehabilitation facilities in the Borough. 97 The P.R.A. Day Centre at Mitchley Road has had another successful year providing relief from isolation for selected patients and also a climate conducive to rehabilitation. During the year there were 49 referrals from Haringey and 11 from Enfield. As in the past, the cost has been shared between the User Authorities on a per capita basis. 14 patients moved on to full time employment during the year, one moved out of the area, and one moved on to a sheltered employment scheme; some returned to work direct from the Day Centre and some went via the Industrial Education Unit — an extension of the Day Centre. Bearing in mind the chronicity of the illness of most of the patients, this was no mean achievement. The importance of the Centre and the need that it fills is evidenced by the excellent attendance record, even in the most inclement weather. The Work Whilst the work is the basis for 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, thereby regaining self¬confidence to participate effectively in normal society. The availability of appropriate work is governed by the amount of space available. However, in spite of these difficulties, the situation is improving since the appointment of a Supervisor who has introduced toy design and manufacture. The developing relationships with local industrialists have enabled two sheltered employment schemes to provide short periods of employment in real factory conditions, as preparation for full time employment in industry. This particular scheme is being carefully watched by many interested bodies. 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 dear that a large number of participants will be unable to return to full time employment, without the availability of additional rehabilitative situations or protective environments such as sheltered workshops. In this connection, the Psychiatric Rehabilitation Association is experimenting with thermoplastic welding equipment, and will shortly be venturing into the plastics industry through their Industrial Education Unit. Selection for attendance at the P.R.A. Centres has been largely at the discretion of the Mental Health Section, Psychiatrists at CI ay bury Hospital, and at the North Middlesex Hospital. Community Housing Association The Group Home in Tottenham completed its first year very successfully. Here again, dose links with Clay bury Hospital and with the Mental Welfare Department have been of vital importance to the scheme. The G.P. who looks after the residents has also been invaluable. The four original residents are still living there, and have been joined by two more. This highly successful project is proving to be an effective way of providing residential care with rehabilitative value at an economic cost. The Evening Centre Situated at the Lutheran Church Hall, Antill Road, this centre reinforces the will of the ex-patient intent on re-integration into society, and stimulates constructive self-assertion. Annual Holiday The P.R.A. booked a hotel at CIacton-on-Sea enabling eight Haringey patients to enjoy a holiday at the seaside. This included a range of additional activities and outings, and was largely paid for by the patients themselves - partly subsidised by the Mayor's Fund and P.R.A. projects. There is much that can be done, and will be done, as financial resources become available." 98 Psychiatric Social Club The Oakleaf Club in N.8. and the Psychiatric Rehabilitation Association's evening club in N.15. have both continued to function very well throughout the year offering social activities to their members covering a wide range. The attendance at both these clubs is very good. The Oakleaf Club draws its membership in the main from the western side of the borough and from patients at Friern and Halliwick Hospitals. The Psychiatric Rehabilitation Association Club caters for all the eastern side of the borough and those patients who have been in Claybury, although all are free to go to either or both. These Clubs perform a very useful service in supplying a link between those patients in hospital and the community as patients while still in hospital may attend the Clubsand groups are at times conveyed there and in giving support to those who are in the community and thereby helping to reduce the re-admission factor. Hamilton Hogben Adult Training Centre Now in its second full year the Adult Training Centre continues to function in a most satisfactory manner and progress is such that a further extension is proposed for the year 1970/71 when an extra forty trainees will be admitted. Plans are going ahead to establish an horticultural unit on a piece of waste land recently acquired from the Council's Estates Department Other than providing a most valuable training facility, it is intended that the site will provide an excellent "fair weather" recreational area for the benefit of the trainees not actively engaged in horticulture. Close co-operation is maintained with local industry and accordingly the light industrial work carried out in the Centre covers a very wide field from roller skates to motor car components, and from television components to plastic toys. The type of work accepted for processing is kept as varied, as possible in order that the maximum benefit is available to all the trainees irrespective of their mental ability and/or dexterity. The laundry still continues to expand and has recently accepted a contract to launder the blankets for the North Eastern and North Western Divisions of the London Ambulance Service. The increased volume of work necessitated a re-deployment of machinery and space within the laundry. This has now been started and we look forward to further expansion in the future. A more direct approach is being made to the medical, social and educational aspects of the day to day life of the Centre, commencing with a complete assessment of all trainees in the light of past, present and future training requirements. The annual Christmas concert was held in December in which some thirty per cent of the trainees took part. The show was very well patronised by parents and other interested parties. It is anticipated that the concert wi II become firmly established as an important annual fixture. The Centre athletic team won the Inter Training Centre sports trophy and medals; they intend to win again in 1970. Six trainees have been placed in open employment and several others are under consideration. Services for the mentally subnormal The Authority sponsors 30 children at the Hornsey Centre for Handicapped Children on two days per week. In most of these children a marked improvement has been noted and they are becoming more socially competent The Hornsey Centre fills a serious gap in the Borough's services until the new Special Care unit at the Junior Training School is open. Linden House Hostel This hostel is for 16 adult male working subnormals, now it has had some time to settle down, there are very few changes taking place in the residency of the Home, six men are working in open employment, one is employed at the T.B. Workshop and the rest attend the Adult Training Centre. In the summer the Warden and his deputy took the residents on a holiday for one week to Walmer in Kent Junior Training School and Special Care Unit Work on the building of the JuniorTrainingSchool commenced this year, and the school will be opened at the beginning of the September 1970 term. This means thatevery child at present attending a Junior Training School in either Enfield or Barnet will now be able to attend a Junior Training School within the borough. 99 Holiday Camp for the Mentally Subnormal The Enfield Health Department undertook the organisation of the Junior Camp and children from Enfield and Haringey attended this holiday at St. Mary's Bay, Dymchurch. This Authority made the necessary arrangements for the adult holiday for the two boroughs. The venue chosen was a private hotel at Walmer in Kent, both of these holidays were most successful. Residential Long Term Accommodation for Mentally Subnormal Patients This Authority maintained 38 patients in residential Homes during the year, the majority are placed in the Brighton and Hove area where the Guardianship Society boards them out in private households. It was not necessary to make any compulsory guardianship placements during the year. Social Clubs for the Mentally Handicapped I regret to say that during the period under review the Golden Gateway Club had through force of circumstances to close its doors, the leader having left the district and the secretary was unable to carry on owing to personal ill health,however,the Roundabout Club still meets on Monday evenings at the Hornsey Centre for Handicapped Children and is supported by the Haringey West Society for Mentally Handicapped Children. The Doddy Club meets on Tuesday evenings at Earlsmead School, Broad Lane, and serves the eastern side of the borough and receives the support of the Haringey East Society. Both of these clubs put on a full social programme for their members, organising a number of outside visits and interests throughout the year. Hospital Placements for the Mentally Subnormal As in previous years the difficulties in placing mentally subnormal persons in permanent care in catchment hospitals still exists, and this situation has shown no signs whatsoever of improving during the year. Conclusion Work in the mental health field has progressed quite rapidly over the past two or three years, in the first five years since the borough was formed, community facilities will have been provided for 80 adult subnormals in Training Centres, Junior Training School placements for 108 children, this of course includes special care and nursery placements; a hostel for 15 adult male subnormals; a psycho-geriatric Day Centre for 12 elderly mentally ill persons. The establishment in liaison with theP.R.A. of a Day Centre for the mentally ill and the setting up of the various Clubs for the mentally ill. At times requests are made for preventive work to be undertaken where the person has not yet needed hospital treatment but without casework and psychiatric aid may well break down. The provision of mental health community care for these people, illustrates how positive preventive work may be done, but to develop this aspect of service more staff are required. NUMBER OF PATIENTS REFERRED TO LOCAL HEALTH AUTHORITY DURING YEAR ENDED 31ST DECEMBER 1969 Referred by MENTALLY ILL SUBNORMAL ANO SEVERELY SUBNORMAL Under age 16 Aged 16 and over TOTAL Under age 16 Aged 16 and over TOTAL M F M F M F M F General practitioners 1 - 59 86 146 2 - 1 _ 3 Hospitals, on discharge from inpatient treatment _ 1 31 37 69 - - 4 - 4 Hospitals, after or during outpatient or day treatment _ 2 22 43 67 - - - 1 1 Local education authorities - 1 3 3 7 2 1 6 3 12 Police and courts - - 21 18 39 - - - - - Other sources 1 1 110 154 266 14 15 6 5 40 TOTALS 2 5 246 341 594 18 16 17 9 60 100 NUMBER OF PATIENTS UNDER LOCAL HEALTH AUTHORITY CARE AT 31 ST DECEMBER 1969 Referred by MENTALLY ILL SUBNORMAL AND SEVERLY SUBNORMAL 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. Total Number - 1 48 152 201 73 68 190 167 498 2. Attending workshops, day centres or training centres (including special units) - - 3 8 11 55 49 55 51 210 3. Awaiting entry to workshops, day centres, or training centres -(including special units) - - - - - 25 22 6 8 - 4. Receiving home training - - - - - - - - - - 5. Awaiting home training - - - - - - - - - - 6. Resident in L.A. home/hostel - - 3 5 8 - - 9 - 9 7. Awaiting Residence in L.A. home/hostel _ _ 2 1 3 - - - - - 8. Resident in other home/hostel - - 12 13 25 2 4 9 9 24 9. Boarded out in private household - - - - - 1 1 4 8 14 10. Attending day hospital - - - - - - - - - - 11. Receiving home visits and not included in lines 2-10 (a) suitable to attend a training centre - - - - - - - - - - (b) Others - 1 28 125 154 2 2 107 91 202 NUMBER OF PATIENTS AWAITING ENTRY TO HOSPITAL ADMITTED FOR TEMPORARY CARE DURING 1969 SEVERELY SUBNORMAL OR SUBNORMAL 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 31.12.69 (a) In urgent need of hospital care 2 8 1 1 12 (b) Not in urgent need of hospital care 8 6 8 7 29 (c) Total 10 14 9 8 41 Number of admissions for temporary residential care (e.g. to relieve the family (a) To N.H.S. hospitals 7 18 9 8 42 (b) To L.A. residential accommodation - - 1 - 1 (c) Elsewhere 4 4 2 4 14 (d) Total 11 22 12 12 57 Work of Mental Welfare Officers (1969) (a) Mental Illness Visits made by mental welfare officers Compulsory admissions to psychiatric hospital by mental welfare officers Informal admissions to psychiatric hospitals by mental welfare officers 5,757 167 132 (b) Mental Subnormality Visits to those under community care by mental welfare officers 2,271 Rehabilitation Workshops On the 31st December 1969, 31 men were employed at the workshops, excluding the manager and the instructor. Of the three men who entered for training during the year, one was transferred to the staff upon completion of the training, one left before completing the course and the training was terminated in the third case. Two high grade mentally subnormal adults were employed as porters in the workshops and one of these later left to take up employment in open industry. Although there was a falling off of orders received during 1969 the goods supplied during the year showed an increase due to outstanding orders at the beginning of the year. Orders received in 1969 amounted to £9,547 compared with £13,413 for 1968, and the value of goods delivered was £16,246 compared with £12,619 the previous year. DOMESTIC HELP SERVICE The total number of cases provided with home help during the year was 2,689. 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 6,052. Of this number 1,374 were in respect of new cases. The number of home helps in employment at the end of the year was 212(equivalent to 124.3 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 1968 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 615 1,717 2,332 1,762 Aged under 65 on first visit during year- Chronic sick and tuberculosis 45 151 196 141 Maternity 41 1 42 3 Others 89 30 119 41 TOTALS 790 1,899 2,689 1,947 The following cases still continue to make heavy demands on the service. Case 1 Problem Family, mother, father and 9 children aged 11, 10, 9, 7, 6, 5, 3, 2 and 1 year. Family continues to get into debt and have to be guided along by Health Department Social Worker. Home Help attends three hours daily. Case 2 Widowed mother who had disseminated sclerosis. She has three sons, the eldest aged 20 years by her first marriage and two other aged 6 and 7 years. Home help attends four hours daily. Case 3 Case referred by G.L.C. Housing Welfare Officer. Case commenced 17th March 1961 when the family were rehoused by G.L.C. Mother left home prior to the move. The children are now aged 17, 15, 13, 12, 10 and 9 years. Father is' in regular employment but is more often than not in debt. Rent, electricity and gas bills outstanding (gas meter has been broken into on various occasions). Two of the children are at present in care. The accommodation comprises three bedrooms — one occupied by the father, one by the two eldest boys and the third by the other children, a living room and a sitting room. There is no bathroom. The only washing facility is a sink which stands in a small area approximately four feet square which includes the gas stove. There is an outside toilet. Home help attends three hours each morning. Case 4 Triplets aged 2 years and two other children aged 5 and 31/2 years. Home help attends three times a week, two hours each time. 102 Neighbourly Help Service This service continues to function satisfactorily and during the year 12 cases were served. Six cases were still receiving service at the end of year. DAY NURSERIES The pressing needs and demands for day nursery placement continue. It is a matter of some concern thatplaces are not immediately availablewhen children are exposed to the risk of traumatic experience, because of extreme stress and crisis within the home. Although during the year there has been an unusual number of staff shortage and changes the level of admission has been fairly constant. Nursery nurses are trained at an early age, usually between 16 and 18 years. It is understandable that at times it is difficult for them to appreciate the problems of some of the parents and at the same time take full responsibility for a group of young children immediately after completion of their two year training. 8 students who commenced training in September 1967 were successful in obtaining the N.N.E.B. certificate. Many children admitted to a day nursery are emotionally disturbed - the demand for admission of these children is continually increasing. Help for emotionally disturbed children, requiring specialised attention, became possible, when Mrs. Phillips, Play Therapist, commenced her appointment in May 1969. It is appropriate to include some of the comments made by Mrs. Phillips in an article written by her for the Nursery Journal. Play therapy as a treatment for emotionally disturbed children has long been accepted in hospitals and child guidance clinics. Since the war the Day Nursery has been used to fill the growing needs for placement of under-fives whose parents are unable to care for them during the day because of social, financial or medical reasons. It is therefore not surprising that there is a higher percentage of emotional disturbance among Day Nursery children than among those coming. from a more stable home background. The Medical Officer of Health for the London Borough of Haringey and his staff had long been aware of this increasing intake of emotionally disturbed children into their Day Nurseries. As an Occupational Therapist who has specialised in the treatment of psychiatric patients and worked in a Children's Unit in a Psychiatric hospital it was a great challenge to take up the newly appointed post of Play Therapist with the Borough of Haringey. There are four Day Nurseries in this Borough and two more will be opening in the not too distant future. With no predecessor in whose steps to follow, it was necessary to find myself a place in the nursery setting in which to dsicover my role as the Play Therapist. The first month was spent learning the details of the nursery routine and getting to know the staff and children. The Matrons were most helpful as regards providing details of the children's behaviour in the nursery and their family backgrounds. With two hundred children to observe and make friends with / was and still am grateful for their continued suppoit. I work under the guidance of the Consultant Psychiatrist at the Tottenham Child Guidance Clinic who sees some of the more severely disturbed children herself and is always ready with expert advice concerning the other children. / divide my time between the four nurseries so that / can spend at least a day a week at each. After discussions with the Matrons and their staff at each nursery we were able to agree upon the particular children that we considered to be in need of help. Insecurity is a big problem with children of this age and some become withdrawn perhaps refusing to eat. play or even speak. Others less severely affected are nevertheless timid, anxious or lacking in self confidence. The rather 'flat' expressionless child often proves depressed either at being parted from its mother at the nursery or for some deeper cause. 103 All these children it was thought would benefit from attending a weekly, or more often, a twice weekly play group of five children. The first stage in starting these small play groups was to develop a good relationship with the children and create an atmosphere in which they would feel free to express themselves as they were not previously able to do. Some of these children develop a strong dependence upon the therapist which when managed correctly can provide a basis for developing their emotional stability and later for gaining more confidence and independence in their everyday dealing with adult and children alike. Another type of child who will be known to all whose work is with children is the aggressive child. These children may or may not benefit from a play group. Sometimes unable to cope with sharing the therapist's attention they become too disruptive to be contained beneficially within the group. They may however benefit from regular individual play therapy sessions when a one-to-one relationship can be built up more quickly. They choose their own toys or play equipment or act out their troubles through the medium of their play. This type of treatment can take a lot of time and patience, and having worked in the nurseries for 8 months now I am conscious that the job is still in its early stages. The percentage of children in need of some sort of attention to a greater or lesser extent is high and makes it impossible for me to cope with them all. However. / feel encouraged by the results even at this early stage and / am hopeful for the future of play therapy for the under-fives. The following table shows the attendance at individual nurseries:- NURSERY Approved Places at end of year Number 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 15 43 2,403 8,524 10,927 42.8 Park Lane 20 30 10 37 1,651 8,521 10,178 39.9 Plevna 20 30 10 43 2,593 8,309 10,902 42.8 White Hart Lane 10 30 10 30 1,330 7,602 8,932 35.0 TOTALS 65 133 45 154 7,977 32,956 40,939 160.5 In addition a large number of children were permitted to attend on a casual basis for half or a full day to enable the mother to keep appointments at hospital, family planning clinic or court. Private Day Nurseries and Child Minders Consequent upon the Health Services and Public Health Act 1968, two part-time child minder visitors were appointed early in 1969 to deal with the increased number of registrations necessary, until a full-time visitor could be appointed. In June 1969", Mrs. F. Lassalle was appointed as fulI time child minder visitor, and the following is her report of the work carried out during the rest of the year:- "The number of visits by the child minder visitor has averaged 75 a week, the purpose of visits being as follows:- (a) Initial visits to assess the suitability of the prospective child minder for registration. (b) Subsequent visits in the course of registration - necessitating in most cases three visits, in some four or five visits. (c) Inspections of registered minders. (d) Investigations of allegations of child minding by unregistered persons. (e) Visits to health centres to consult with health visitors. There are of course a number of "no access" visits, particularly in the summer months. 158 persons applied for registration but withdrew their applications before registration was completed, in most cases either because the applicant was leaving the district or being rehoused; or because the child minder visitor's recommendations were not acceptable to the applicant. In 25 cases the child minder ceased to mind after registration, either because she left the area or because she decided that she would be financially better off working". 104 The following is an analysis of the registrations made in 1969;- Day Nurseries Child Minders Play Groups Number Registered Places Number Registered Places Number Registered Places 1st January 1969 3 114 21 158 23 551 New Registrations 2 40 313 824 4 71 Discontinued - - 25 61 1 40 31 st December 1969 5 154 309 921 26 582 105 INDEX Page No. Abatement of Statutory Nuisances 27 Abattoir 37 Advice Clinics for the Elderly 62 Adult Training Centre 99 Ante-natal Clinics 54 Atmospheric Pollution 21 Audiology Unit 75 Audiometry 77 Births, Notification of 48 Breast Cancer, Clinics for early detection 55 Cancer of the breast, early detection of 55 Care of Mothers and Young Children 48 Certificates of Disrepair 35 Cervical Cytology 54 Child Guidance Service 80 Child Health Clinics 55 Child Minders 104 Chimney Heights 20 Chiropody Services 62 Cleansing and Disinfection 24 Clearance Areas 28 Comparability Factors 7 Day Nurseries, Local Authority 103 Private 104 Admission of Handicapped ChiIdren 89,103 Deaths of Haringey Residents 8 Deaths of School Children 90 Defects remedied 26 Dental Care: Priority Classes 58 School 91 Disease of Animals Act 1950 28 Domestic Help Service 102 Drain stoppages 28 Drainage and Sewerage 17 Drug Epidemic and its effect on Community 65 Dysentery 12 Ear, Nose and Throat Clinics 79 Education Committee 71 Enteric 11 Factories 46 Family Planning 48 Food and Drugs Act 38 Food Complaints 41 Food Hygiene 35 Food Poisoning 12 Food Premises 36 Food Samples 38 Furnace Installations 20 General Improvement Areas 33 Geriatric Services 61 Page No. Hairdressers 45 Handicapped Pupils 85 Handicapped Register, Children on 57 Health Education 68 Health Services Panel 1 Health Visiting Service 56 Home Nursing Services 60 House Drying 28 Houses in Multiple Occupation 33 Housing applications, assessment on medical grounds 15 Ice cream factory 37 Immunisation against diphtheria, whooping cough, tetanus, poliomyelitis and measles 66 Imported Food Regulations 37 Improvement Areas 33 Improvement of dwellings 31 Infectious Diseases 11 Infectious Diseases, Notification of 10 Infective Hepatitis 12 Influenza 12 Insect Pests 24 Inspections carried out by Public Health Inspectors 25 Junior Training School 99 Laundry services for the incontinent 24 Linden House Hostel 99 Massage and Special Treatment 68 Measles Meat Inspection 42 Medical examinations in schools 72 Mental Health Services 97 Mental Health Statistics 100 Mentally Sub-normal, Services for 99 Midwives Ante-natal Clinics 54 Midwifery Service 59 Mi Ik and Dairies Regulations 36 Milk in Schools Scheme 85 Mortuary 24 Mothercraft and Relaxation Classes 56 Multiple occupation, Houses in 33 Neighbourly Help Service 103 Noise 27 Observation Register, Children on 57 Offices, Shops and Railway Premises Act 1963 43 Ophthalmic Clinics 79 Orthopaedic Clinics 73 Outworkers 46 Performing Animals 28 Pet Shops and Animal Boarding Establishments 28 Psychiatric Rehabilitation Association 97 Psychiatric Social Clubs 99 Publications 70 Page No. Radioactive Substances Act 1960 47 Rag Flock and Other Filling Materials Act 1951 27 Recuperative Holidays 68, 89 Refuse, Accumulation of 28 Rheumatism Supervisory Centre 84 Ringworm 84 Road accidents to School Children 90 Rodent Control 22 Sanitary Circumstances of the Area 17 Scabies 12 School Advice Clinics 73 School Dental Services 91 School Health Clinics 90 School Health Service 72 School Health Service Statistics 94 School Meals 85 School Population 72 Shops Acts 1950-1966 45 Smallpox 12 Smallpox, Vaccination against 66 Smoke Control Areas 20 Social Services Committee 1 Special Schools Provision 88 Speech Therapy 80 Staff 2 Staff Medical Assessments 64 Statistics, Dental 92 Statistics, School Health 94 Statistics, Vital 6 Statutory Notices Served 26 Statutory Nuisances, Abatement of 27 Street Trading 45 Stuart Crescent Health Centre 48 Student Public Health Inspectors 47 Swimming Baths and Paddling Pools 20 Toddler CIinics 56 Trade Emissions 20 Tuberculosis in Schools 83 Tuberculosis Patients, Extra nourishment for 68 Tuberculosis, Prevention by B.C.G. vaccination 82 Tuberculosis Rehabilitation 101 Typhoid 11 Uncleanliness and verminous conditions 85 Unfit houses 28 Unsound Food, Surrender of 42 Vaccination against Smallpox 66 Venereal Disease 67 Verrucas 83 Vision Screening 78 Vital Statistics 6 Water Supplies 17 Weight Watching Clinics 84 Welfare Foods, Distribution of 58