HARINGEY HEALTH IN 1971 The Annual Report of the Medical Officer of Health & Principal School Medical Officer. HAR 7 HARINGEY HEALTH IN 1971 The Annual Report of the Medical Officer of Health & Principal School Medical Officer. To: The Worshipful The Mayor, Aldermen and Councillors of the London Borough of Haringey Ladies and Gentlemen, I have the honour to present the report on the health of the Borough of Haringey for the year ended 31 December, 1971. In 1971 the Haringey electorate once again changed course so that during the year we moved from a policy of retrenchment in the early months to expansion in the latter months and although the routine work of the Department was carried on with its usual efficiency, the Health Department had to prove its flexibility in meeting the new situation. We adapted to the departure of our Social Services element. The brief period of retrenchment early in the year allowed the Chief Nursing Officer to prepare a new Nursing Staff structure on the lines advocated in the Mayston report. Dr. Orton, the Deputy Medical Officer of Health, completed his paper on "The Infected Terrapin" which was published in Community Medicine on 18th February, 1972, and the Medical Officer of Health himself was given a period of study leave so that he might view the current field of general medical practice in an attempt to visualise the future evolution of the Health Service. The new Health Committee adopted an expansive approach towards Health Services and reintroduced a policy for the building of Health Centres. They also introduced the vaccination of 13 year old schoolgirls against Rubella in order to free them from the risk of producing a deformed child during their reproductive lives. The Committee continued to expand the Family Planning Services through the agency of the Family Planning Association and new clinics were opened at Stroud Green and Park Lane. The Committee supported the view of the Family Planning Association that every woman should have a wanted baby. During the year the Council was seriously concerned about the future of St. Ann's Hospital, which has been omitted from the North East Metropolitan Regional Hospital Board's future plans for District General Hospitals. The Council is satisfied that this hospital should retain its present status which is equivalent to that of a general district hospital in the best interests of the Health service provided to Haringey residents. In conclusion, I wish to record my thanks to Councillor Mrs. Levinson and Councillor Mrs. Lipson, Chairmen of the Health Committee during the year and to the members of both Committees for their encouragement and support. My thanks are specially due to the staff of the Health Department for their loyal and efficient service during a year of considerable change. I have the honour to be your obedient servant, J.L. PATTON Medical Officer of Health HARINGEY'S HAPPY HEALTH COMMITTEE Photograph by kind permission of the Hornsey Journal HEALTH COMMITTEE Councillor Mrs. D. Cunningham, JP Councillor Mrs. J. Cooper Councillor Mrs. Maureen F. Dewar, MCSP JP (Vice-Chairman) Councillor Mrs. C.J. Levinson Councillor Bryan D. Lipson, LLM Councillor Mrs. L.H. Lipson, MCSP (Chairman) Councillor Mrs. Joan Smith Councillor Ulric Thompson Councillor Mrs. Sally Whitby SENIOR STAFF OF THE DEPARTMENT Medical Officer of Health and Principal School Medical Officer J.L. PATTON, MB ChB MFCM(RCP) DPH Deputy Medical Officer of Health and D.P.S.M.O. W.T. ORTON, MB BCh BAO MFCM(RCP) DPH Principal Medical Officers School Health Mary C. Douglas, MB ChB MFCM(RCP) DPH Maternity and Child Welfare Ruth V. Golder, MB ChB DRCOG DPH Mental Health U.P. Seidel, MB BSc MFCM(RCP) DPH DPM Senior Medical Officers Joan F. Nicholls, MB BS DCH DPH Z. Zubrzycki, Med Dipl DPH Departmental Medical Officers Manju Chakrabarti, MB BS MSc(Culcutta) Kyvelie Papas, Med Dip MD(Athens) LAH Avery B. Cooper, MRCS LRCP T.H. Elias, MB BS MRCS LRCP DPH W.G. Griffiths, MRCS LRCP S.R. Lund, MB BS(Pakistan) Isobel M. Pine, MB BS DPH K.V. Shah, MB BS(Bombay) DPH Part-Time:— Lorna Baker, MB BS MRCS LRCP Jean Dickson, MB ChB Margaret Kirk, MB BS DCH Chief Dental Officer and Principal School Dental Officer G.C.H. Kramer, LDS RCS Dental Officers N. Ansbergs, DDD Rosemary Jackson, BDS Alison G. Little, LDS RCS Gitanjali H. Liyanage, LDS UBrist A.H. Landsman, LDS RCS Part-Time:— Mrs. M.P. Antoniewicz, BDS Miss D. Saxon, LDS RCS 2 Orthodontists T.J. Combes, BDS DOrth RCS Joy Maclnerney, LDS DOrth RCS BDS Public Analyst W.B. Chapman, BSc FRIC Principal Nursing Officer Mary Smith, SRN SCM HV Deputy Superintendent Health Visitor Margaret J. Saywell, SRN HV Senior Health Visitors Joan Beese, SRN HV Edith N. Gibbon, SRN SCM HV Irene E.G. Marriott, SRN SCM HV Diploma in Social Studies Renee Boyd, SRN SRFN HV Dulcie Carlow, SRN SRFN SCM HV Elsie T. Clarke, SRN SRFN TA HV Mary A. Grimm, SRN SRFN SCM HV Ruth A.H. Jones, SRN SCM HV Jeannette Hendon, SRN HV Betty M. Mclver, RGN SCM HV Kathleen Noolan, SRN SCM HV Doreen Witton, SRN HV Acting Non-Medical Supervisor of Midwives Dorothy E. Wynn-Jones, SRN SCM Acting Superintendent of Home Nurses Berthe F. Specht, SRN SCM ON Medical Auxiliaries Physiotherapists Nancy W. Allardice, MCSP SRN Elizabeth Marcus Gudrun Trowbridge DP 3 Occupational Therapist Judith Hunt, MAOT Senior Speech Therapist Eleanor R.P. McKeown, LCST Speech Therapists Joan D. Came, LCST Alison Courtile, LCST Sally D'Souza, LCST Jane C. Froud, LCST Lindy V. Peacey, LCST Ruby Sewell, LCST Orthoptists Diana R. Kiverstein, DBO Senga Conn, DBO Screening Technicians Hilda M. Bristow Frances M. Jenner Philomena C. Ward Health Education Officer Sheila M.P. Frost, SRN SCM HV DHE Chief Public Health Inspector W.J. Wilson, DPA MAPHI MRSH Deputy Chief Public Health Inspector E.S. Glegg, MAPHI AMIPHE Senior Public Health Inspectors F.H. Canton, MAPHI A.E. Clarke, MAPHI AMIPHE W.E. Goodfellow E.S. Gray, MAPHI J.A. Harris, MAPHI F. James, MAPHI W. Shackcloth, FAPHI Senior Shops Inspector T.E. Goodwin 4 ADMINISTRATIVE STAFF Chief Administrative Officer D.B. Davies, DPA MRSH Principal Assistant H.J. Dunham, BA A.W. Lawrence, MAPHI F.R. Reeves, DMA Section Heads Hilda Battley H.P. Bradford R. Newman K.J. Walker L.E.Wells H.C.B. Wheal S.E. Woodroffe 5 VITAL STATISTICS 1970 1971 Area of District (in acres) 7,491 7,491 Population—Registrar General's Estimate at 30 June 238,410 238,200 Rateable Value at 1 April £13,733,152 £13,816,991 Product of penny rate (n.p.) £131,400 £134,000 Approximate number of separately rated dwellings 72,170 72,500 LIVE BIRTHS Total registered: Male 2,188 2,162 Female 2,154 2,043 Total 4,342 4,205 Birth Rate per 1,000 population 18.21 (16.0) 17.65 (16.0) Total illegitimate live births 611 597 Illegitimate as percentage of all live births 14.07% (8%) 14.20% (8%) STILL BIRTHS Total registered: Male 33 24 Female 18 23 Total 51 47 Stillbirth rate per 1,000 live and still births 11.61 (13) 11.05 (12) Total illegitimate still births 4 10 Illegitimate stillbirths as percentage of all stillbirths 7.84% 21.28% DEATHS FROM ALL CAUSES Male 1,356 1,312 Female 1,428 1,425 Total 2,784 2,737 Death rate per 1,000 population 11.68 (11.7) 11.49 (11.6) MATERNAL MORTALITY: Number of deaths 4 2 Rate per 1,000 total live and still births 0.915 0.470 INFANT MORTALITY (Deaths of infants under 1 year of age) (a) Legitimate: Male 51 51 Female 33 36 Total 84 87 Rate per 1,000 legitimate live births 22.51 24.11 (b) Illegitimate: Male 9 9 Female 8 8 Total 17 17 Rate per 1,000 illegitimate live births 27.82 28.48 (c) Totals: Male 60 60 Female 41 44 Total 101 104 Rate per 1,000 total live births 23.05 (18) 24.73 (18) NEO NATAL MORTALITY (Deaths of infants under 4 weeks) 72 67 Rate per 1,000 live births 16.58 (12) 15.93 (12) EARLY NEO NATAL MORTALITY (Deaths of infants under 1 week) 58 57 Rate per 1,000 live births 13.36 (11) 13.56 (10) 6  1970 1971 PERI-NATAL MORTALITY (Total stillbirths and deaths under 1 week) 109 104 Rate per 1,000 live and still births 24.81 (23) 24.44 (22) NOTE: The figures in parenthesis indicate the rates for England and Wales 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 presence of residential institutions in the area. To compare the crude 1971 rates for Haringey with the national rates, Haringey's figures must be multiplied by the appropriate comparability factors, which are 0.92 for births and 0.95 for deaths. The adjusted birth rate for Haringey is 16.3, and the death rate 10.9, compared with national rates of 16.0 and 11.6. 7 8 DEATHS OF HARINGEY RESIDENTS SHEWING AGE GROUP ANDSEX DISTRIBUTION 1971 DISEASE TOTAL Under 4 weeks 4 weeks & under 1 year 1-4 5-14 15-24 25-34 35-44 45-54 55-64 65-74 75 and over M F M F M F M F M F M F M F M F M F M F M F M F B4 Enteritis and Other Diarrhoeal Diseases 1 3 — — 1 1 — 1 — — — — — — — — — — — — — 1 — — B5 Tuberculosis of Respiratory System 2 5 — — — — — — — — — — — — 1 — 1 — — 1 — 1 — 3 B6(1) Late effects of respiratory T.B. 3 — — — -— — — — — — — — — — — — — — — — 1 — 2 — B6(2) Other Tuberculosis — 3 — — — — — — — — — — — — — — — — — 1 — 1 — 1 B11 Meningococcal Infection — 2 — — — 1 — 1 — — — — — — — — — — — — — — — — B18 Other Infective and Parasitic Diseases 3 4 — 2 — — — — — — — — — — — — 1 1 2 1 — — — — B19(1) Malignant Neoplasm, Buccal Cavity etc. — 1 — — — — — — — — — — — — — 1 — — — — — — — — B19(2) Malignant Neoplasm Oesephagus 14 5 — — — — — — — — — — — — — — 1 1 2 2 6 — 5 2 B19(3) Malignant Neoplasm, Stomach 25 28 — — — — — — — — — — — — — — 1 — 3 6 13 8 8 14 B19(4) Malignant Neoplasm, Intestine 26 49 — — — — — — — — — — — — 1 2 -— 1 5 6 14 12 6 28 B19(5) Malignant Neoplasm, Larynx 7 2 — — — — — — — — — — — — — — — — 4 — 2 2 1 — B19(6) Malignant Neoplasm, Lung, Bronchus 133 36 — — — — — — — — — — — — 1 1 7 4 51 10 50 10 24 11 B19(7) Malignant Neoplasm, Breast — 57 — — — — — — — — — — — — — — — 11 — 14 — 18 — 14 B19(8) Malignant Neoplasm, Uterus — 21 — — — — — — — — — — — 1 — — — 4 — 5 — 3 — 8 B19(9) Malignant Neoplasm, Prostate 20 — — — — — — — — — — — — — — — — — 4 — 7 — 9 — B19(10) Leukaemia 4 10 — — — — — — — — — — — — — — — 2 2 1 1 4 1 3 B19(11) Other Malignant Neoplasms 79 85 — — — 1 3 1 1 — 1 — 1 — 3 4 9 4 18 13 30 30 13 32 B20 Benign and Unspecified Neoplasms 4 4 — — — — — — — — — — — — — — 2 1 — 1 1 2 1 — B21 Diabetes Mellitus 5 15 — — — — — — 1 — — — — 1 1 — — — — 1 3 4 — 9 B46(1) Other Endocrine etc. Diseases 2 8 — — — 1 — — — — — — — — — — — — 1 2 1 2 — 3 B23 Anaemias 2 4 — — — — — — — — — — — — — — — — — 2 2 1 — 1 B46(3) Mental Disorders — 4 — — — — — — — — — — — — — — — — — — — — — 3 B24 Meningitis 1 1 — — — — — — — — — — — 1 — — — — 1 — — — — — B46(4) Multiple Sclerosis 1 4 — — — — — — — — — 1 — — — 1 1 — — 1 — — — 1 B46(5) Other Diseases of Nervous System, etc. 10 7 — — — — — 1 1 — — — 2 — — — — — 2 — 2 2 3 4 B26 Chronic Rheumatic Heart Disease 11 18 — — — — — — — — — — — — 2 — 1 3 2 3 4 5 2 7 B27 Hypertensive Disease 23 37 — — — — — — — — — — — — 1 — 2 — 4 5 9 8 7 24 B28 Ischaemic Heart Disease 345 289 — — — — — — — — — — 1 — 4 1 24 3 81 27 124 74 111 184 B29 Other forms of Heart Disease 39 90 — — — — — — -— — — — — 1 1 — 2 — 5 2 9 22 22 77 B30 Cerebrovascular Disease 90 209 — — — — 1 — — — — — — — — 2 5 6 17 15 23 47 44 139 9 B46(6) Other Diseases of Circulatory System 49 58 — — — — — — — — — 1 1 1 2 — 4 4 7 2 13 7 22 43 B31 Influenza 1 — — — — — — — — — — — — — — — — — 1 — — — — — B32 Pneumonia 116 152 3 — 7 6 — — 1 — — — — 1 1 1 2 1 7 4 26 16 69 123 B33(1) Bronchitis and Emphysema 101 51 — — — — — 1 — — — — — — — — 2 — 20 1 35 16 44 33 B33(2) Asthma 2 1 — — — — — — — — — — — — — — — 1 1 — 1 — — — B46 Other Diseases of Respiratory System 10 5 — — 3 1 — — 1 — — — — — — — — — 2 — 2 3 2 1 B34 Peptic Ulcer 10 8 — — — — — — — — — — — — 1 — — — 1 — 4 3 4 5 B35 Appendicitis 1 — — — — — — — — — — — — — — — — — — — — — 1 — B36 Intestinal Obstruction and Hernia 8 8 1 — 1 1 1 — — — — — — — — — — 1 — — 1 — 4 6 B37 Cirrhosis of Liver 7 3 — — — — — — — — — — — — 4 — — — 2 2 — — 1 1 B46(8) Other Diseases of Digestive System 13 19 — — — 1 — — — — — — — — — — 1 — 1 3 5 4 6 11 B38 Nephritis and Nephrosis 11 8 — — — — — — — — — — 1 — 1 — 1 1 3 — 2 1 3 6 B39 Hyperplasia of Prostate 5 — — — — — — — — — — — — — — — — — — — — — 5 — B46(9) Other Diseases, Genito-Urinary System 11 12 — — — — — — — — 1 — — 1 1 1 — 1 3 1 3 4 3 4 B40 Abortion — 1 — — — — — — — — — — — — — — — — — — — — — — B41 Other Complications of Pregnancy etc. — 1 — — — — — — — — — — — — — — — — — — — — — — B46(10) Diseases of Skin, Subcutaneous Tissue 1 2 — — — — — — — — — — — — — — — — — — — — — 2 B46(11) Diseases of Musculo-Skeletal System 2 3 — — — — — — — — — — — — — — — — — 1 — — 2 2 B42 Congenital Anomalies 16 11 7 5 3 3 2 — 1 1 1 — — — — — — — — 1 1 — 1 1 B43 Birth Injury, Difficult Labour, etc. 17 9 17 7 — 2 — — — — — — — — — — — — — — — — — - B44 Other Causes of Perinatal Mortality 15 11 14 11 1 — — — — — — — — — — — — — — — — — — - B45 Symptoms and III Defined Conditions 2 7 — — — — — — — — — — — — — — — — — 1 — — 2 6 BE47 Motor Vehicle Accidents 18 9 — — — — 1 — 2 — 3 2 3 — 1 1 3 — 1 1 1 2 3 3 BE48 All Other Accidents 30 27 — — 2 1 3 2 1 — 7 — 3 1 — 2 2 3 2 1 — 4 10 13 BE49 Suicide and Self-inflicted Injuries 11 18 — — — — — — — — 2 2 — 3 3 2 2 3 4 1 — 4 — 3 BE50 All Other External Causes 5 — — — — — — — — — 1 — 2 — — — — — 2 1 — — — - TOTAL ALL CAUSES 1,312 1,425 42 25 18 19 10 7 10 2 16 6 14 12 30 20 74 56 261 138 396 309 441 831 10 HARINGEY STATISTICS SINCE THE CREATION OF THE LONDON BOROUGH IN 1965 Year Population (R.G. Est.) BIRTHS DEATHS COMPARABILITY FACTORS DEATH RATE OF INFANTS PER 1000 LIVE BIRTHS Still Birth Rate per 1000 live and still births Peri-Natal Mortality Rate per 1000 live and still births Percentage of Births Illegitimate No. Rate per 1000 Population No. Rate per 1000 Population Births Deaths Under 1 year Under 4 week Under 1 week 1965 256,750 5,611 21.85 2,865 11.16 .92 .97 17.82 13.01 11.76 14.06 25.65 13.75 1966 254,650 5,604 22.00 2,913 11.44 .92 .97 17.67 11.78 10.89 14.07 24.81 11.96 1967 254,120 5,337 21.00 2,805 11.04 .92 .97 18.74 13.30 11.99 10.57 22.43 12.97 1968 245,270 5,120 20.87 2,967 12.10 .92 .96 22.27 15.62 13.87 16.52 30.16 13.75 1969 242,300 4,753 19.62 2,920 12.05 .92 .96 20.83 13.04 10.52 12.26 22.65 13.57 1970 238,410 4,342 18.21 2,784 11.68 .92 .95 23.05 16.58 13.36 11.61 24.81 14.07 1971 238,200 4,205 17.65 2,737 11.49 .92 .95 24.73 15.93 13.56 11.05 24.44 14.20 11 NOTIFICATIONS OF INFECTIOUS DISEASES DURING 1971 BY SEX AND AGE GROUPS Disease Under 1 1 2 3 4 5-9 10-14 15-19 20-34 35-44 45-64 65+ UNK TOTAL M F M F M F M F M F M F M F M F M F M F M F M F M F Scarlet Fever 2 1 1 — 2 2 5 6 7 5 15 18 3 5 1 1 3 3 — — — 1 — — 1 — 82 Measles 35 18 55 56 47 41 78 53 64 65 156 159 11 8 2 7 8 6 2 — — — — — 8 3 882 Whooping Cough 5 7 3 1 4 8 3 2 4 4 9 16 2 2 — — — — — — — — — — — — 70 Food Poisoning 2 — — — 1 — — — — — 2 — — — — — 4 6 2 1 3 1 — — — — 22 Ophthalmia Neonatorum 2 1 — — — — — — — — — — — — — — — — — — — — — — — — 3 A. Encephalitis Infective — — — — — — — — — — — — — — — — — — — — — — — — — — — A. Encephalitis Post Infectious — — — — — — — — — — — — — — — — — — — — — — — — — — — Acute Poliomyelitis Paralytic — — — — — — — — — — — — — — — — — — — — — — — — — — — Acute Poliomyelitis Non-Paralytic — — — — — — — — — — — — — — — — — — — — — — — — — — — Acute Meningitis 2 1 — — — 1 — — — — 3 1 1 — 1 — 3 5 2 — 1 1 — 1 — — 23 Diphtheria — — — — — — — — — — — — — — — — — — — — — — — — — — — Typhoid — — 1 — — — — — 1 — — 1 — — — — 2 2 — — — — — — — — 7 Para-Typhoid — — — — — — — — — — — — — — — — — — — — — — — — — — 1 Dysentery 1 — 1 — — 1 1 — — — 1 — 1 — — — 1 2 — — — — — — — — 9 Scabies 1 2 2 6 5 4 9 5 7 5 21 18 5 10 6 13 29 48 5 5 1 4 2 5 2 3 223 Tuberculosis Respiratory 1 — — — — — — — — — 1 — 2 — 3 2 10 5 8 4 13 3 6 4 — — 62 Tuberculosis Mehinges & Central Nervous System — — — — — — — — — — — — — — — — — — — — — — — — — — 1 Tuberculosis Others — — — — — — — — 1 — 1 — — — — — 6 5 1 3 — 2 — — — — 19 Smallpox — — — — — — — — — — — — — — — — — — — — — — — — — — — Malaria — — — — — — — — — — — — — — — — 2 2 3 — 1 — — — — — 8 Infective Jaundice — — — — — — — 1 2 2 3 7 4 7 7 3 16 20 6 3 2 3 1 2 2 1 92 PART I ENVIRONMENTAL HEALTH W.J. Wilson, Chief Public Health Inspector Surface Water Pollution Present day publicity for Environmental Pollution has spotlighted work which has been in progress within the Borough for several years. There are two systems of sewerage operative in the Borough. Surface Water is collected and conveyed to the water courses, rivers etc. Soil sewage is conveyed to the sewage treatment works. Occasionally it is found that the water courses are being polluted, particularly with detergent scum and soap solution. A continuous programme of investigation is carried out by a technical assistant who reports all contraventions to the public health inspectors. Close co-operation with the Greater London Council (Department of Engineering) is maintained. During the year 1,146 premises were inspected in this way and drainage corrections were requested in 87 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 full report on the water supplied by the Lee Valley Water Company was contained in the report of 1966. Dr. Windle Taylor, Director of Water Examination, Metropolitan Water Board has kindly supplied the following information regarding water supplied by the Board to Haringey during 1971 I refer to the Department of Health and Social Security Circular No. 1/72 and have pleasure in giving below and on the attached sheets the required information as far as it relates to the Board's direct supply to your administrative area and its several parts. You will understand that this information does not relate to private supplies derived from or through other Water Undertakings (if any). 1. (a) The supply was satisfactory both as to (i) quality and (ii) quantity throughout 1971. (b) All new and repaired mains are disinfected with chlorine; after a predetermined period of contact the pipes are flushed out and refilled; samples of water are then collected from these treated mains; and the mains are returned to service only after the analytical results are found to be satisfactory. The quality control from these laboratories is carried out by means of daily sampling from sources of supply, from the treatment works or well stations, from the distribution system, and through to the co???sumer. 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, 1971, was 236, 336. (ii) No houses were permanently supplied by standpipe. (d) No artificial fluoride is being added, and where the fluoride content is indicated in the analyses it represents the naturally occurring fluoride in the water. 2. (a) The supply was derived from the following works and pumping stations:— The higher ground around Muswell Hill is supplied with River Thames derived water from the Thames Valley group. The remainder of the area receives New River-derived water from the Hornsey and Stoke Newington Works. In addition during the summer months, the area around Northumberland Park area received well water from Park pumping station. 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 shown to be not plumbo-solvent. It should, however, be appreciated that all types of water pick up varying amounts of metal from the material of water piping particularly when it is newly installed; this applies to copper, zinc, iron and also to lead. 12 13 AVERAGE RESULTS OF THE CHEMICAL AND BACTERIOLOGICAL EXAMINATION OF THE WATER SUPPLIED TO THE LONDON BOROUGH OF HARINGEY FOR THE YEAR 1971 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) CaCO3 Hardness (non carbonate) CaCO3 PH Value Phosphate as po4 Silicate as Sio2 Sulphate so4 Natural Fluoride as F Magnes ium as Mg. Sodium as Na Potassium as K Surface Active Material as Manoxol OT Electrical Conductivity (micrompos) New River derived 104 0.017 0.063 6.4 42 0.60 0.1 9 302 84 7.8 1.8 9 62 0.20 5 30.3 5.2 0.02 630 Thames derived 364 0.029 0.084 6.1 34 1.04 0.1 13 281 90 7.8 2.3 10 64 0.15 5 23.5 5.1 0.02 580 Park Well 6 0.162 0.020 Nil 28 0.20 0.1 4 276 71 7.5 — — — 0.70 — — — — 560 BACTERIOLOGICAL RESULTS - YEARLY AVERAGES 1971 Description of the Sample BEFORE TREATMENT AFTER TREATMENT Number of samples Agar plate count per ml. Coliform count Escherichia Coli count Number of samples Agar plate count per ml. 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 1,504 82.8 — 40.69 14.2 60.31 2.5 515 14.7 — 100.0 100.0 Thames derived 8,154 53.9 — 40.37 12.2 54.91 5.1 3,901 8.4 — 99.51 99.97 Park Well 100 0.1 100 96.00 0.1 99.00 — 101 0.5 14 99.01 100.0 Swimming Baths and Paddling Pools Public health control of the public and privately owned pools is maintained on behalf of the Public Health Department by regular sampling of water for bacteriological and chemical examination from the swimming pools in the Borough by specialist 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 Borough Council's swimming baths is highly efficient and the analyses generally give very good results. The Baths Department is advised of the results of the tests in respect of the Council controlled establishments and these results are supplementary to the tests undertaken by the staff of the Department. Furnace Installations In accordance with Section 3 of the Clean Air Act 1956 notifications were received in respect of 28 premises where it was proposed to install new furnaces. Chimney Heights Nineteen applications were received under Section 6 of the Clean Air Act 1968. In four instances the proposed heights were not acceptable and revised proposals were agreed after discussion with the engineers. Of nine cases not controlled by Section 6 two chimneys proposed were considered to be of insufficient height and the plans were subsequently modified to the satisfaction of the department. Control of Atmospheric Pollution Informal action was taken in respect of 16 cases where it was observed that excessive smoke was being emitted from chimneys of industrual premises. The faults were remedied in each case. Seven contraventions were noted of Section 1 of the Clean Air Act 1968 where the burning of timber on building sites or of trade waste gave rise to the emission of dark smoke. These were speedily dealt with and the nuisances stopped. Smoke Control Orders The temporary suspension of the smoke control orders relating to the eastern part of the Borough because of the fuel shortage in the winter of 1970/71 ended on the 31 March 1971. Because of the mildness of the winter little bituminous coal was needed to supplement the solid smokeless fuels and the effect of suspending the orders was minimal. In seven instances it was found that in contravention of Section 9 of the Clean Air Act 1968 merchants had delivered bituminous coal to premises within smoke control areas. The offending parties quickly substituted coalite for the bituminous coal when the matter was drawn to their attention. In two cases it was found that householders in contravention of smoke control orders were causing the emission of smoke by burning bituminous coal which they had purchased ready bagged from local shops. Investigation of Atmospheric Pollution Haringey maintains three daily recording instruments for the collection of data regarding the smoke and sulphur dioxide content of the atmosphere. It was necessary to close down a fourth station at the Hornsey Town Hall because of the change of use of the office in which it was situated. In addition to giving information on local trends, the data forms part of information collected by the Warren Spring Laboratory to show national distribution and trends in atmospheric pollution. The readings obtained depend to some extent on varying local meteorological conditions which at times may give rise to deviations from the general trend. 14 TABLE A Average Daily Readings of Smoke and Sulphur Dioxide in the Atmosphere 1970/71 (Microgrammes per cubic metre) Burghley Road N.8 (1) Tottenham Town Hall N.15 (2) Civic Centre N.22 (3) Classification A.1 A.2 D.2 (a) Smoke July 1970 14 16 13 August 19 25 21 September 33 37 34 October 43 49 47 November 54 58 65 December 72 80 72 January 1971 72 82 76 February 56 66 57 March 33 118 32 April N N N May 26 35 34 June 25 24 25 (b) Sulphur Dioxide July 1970 68 65 69 August 74 87 95 September 72 96 90 October 106 135 129 November 142 171 181 December 170 227 219 January 1971 179 237 234 February 173 208 176 March 128 149 138 April N N N May 102 118 111 June 105 103 118 NOTE: "N" indicates that number of readings insufficient to give accurate average 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. D.2.—small town centre; limited commercial area mixed with old residential housing and possibly industry. 15 TABLE B Monthly Deposit Gauge Readings 1970 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 5.2 54 75 129 5.8 69 73 142 February 1.3 38 48 86 1.1 86 51 137 March 3.6 10 78 88 3.7 53 63 116 April 3.3 65 137 202 2.9 67 123 190 May 5.2 73 87 160 4.8 82 107 189 June 8.9 55 78 133 7.9 46 73 119 July 2.1 33 99 132 2.3 41 102 143 August 6.5 154 105 259 7.1 148 114 262 September 2.2 62 73 135 1.6 45 81 126 October 2.3 47 67 114 2.2 42 76 118 November 10.8 259 72 331 11.0 365 119 484 December 2.2 66 62 128 2.6 58 64 122 TOTAL 53.6 916 981 1,897 53.0 1,102 1,046 2,148 Rodent Control Details of the rodent control measures in the sewers are shown in the table below. In addition to the sewer baiting programme, control of rats and mice is carried out wherever they are found. This work is made more difficult since strains resistant to poisons which have previously been effective have now become established in the London area. Close co-operation is maintained with the Pest Control Unit, Ministry of Agriculture, Fisheries and Food and with the Pest Control 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 treatments carried out during 1971:— 1. Dwelling houses 1,205 2. Factory premises 74 3. Shops and Cafes 191 4. Schools 75 5. Miscellaneous 64 6. Total charge for 2-5 above £758.00 Rodent Control - Sewer Baiting 1971 AREA Total manholes WARFARIN SODIUM FLUORACE TAMIDE 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 2,141 2,141 2,024 88 29 2,123 17 1 2,141 2,141 East 1,256 1,256 1,137 101 18 1,186 57 13 1,256 1,256 TOTAL 3,397 3,397 3,161 189 47 3,309 74 14 3,397 3,397 PERCENTAGE 100.0 93.1 5.6 1.3 97.4 2.2 0.4 100 100 16 Cleansing and Disinfecting Station The treatment of affected materials by cleansing, disinfection and/or disinfestation was carried out at the Department's Depot in Wightman Road, N.8. In addition to routine disinfection work to infected bedding or soft furnishings, bundles of articles were disinfected prior to despatch abroad. Supervised bathing and treatment of verminous persons and scabies patients were also carried out at the Station. Laundry Service for the Incontinent During the year 2,903 bundles of soiled articles were cleaned and laundered at the Council's laundry in the Hamilton Hogben Training Centre. Care is taken to ensure that the laundry is treated separately from the normal work undertaken at the Centre. Collections and deliveries are made twice weekly by the Department's general assistants. The names of persons requiring this service are normally referred to the Department by general medical practitioners, home nurses or home help organising staff. Sixty-one people were helped by this service in 1971: the average number on the "active list" at any one time is about twenty-five. 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. Insect Pest Houses Other Premises Ants 25 4 Beetles and Cockroaches 139 21 Bugs 158 — Fleas 156 2 Flies, Bluebottles and Maggots 16 — Wasps and Bees 120 8 Other pests or precautionary treatments 118 4 TOTAL 732 39 Where requests for assistance are received in respect of non-domestic premises a charge is made to cover the cost of the service. During 1971 £39.00 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 1971 380 bodies were received into Hornsey Mortuary and a post-mortem examination was carried out in every case. Inspections and Re-inspections carried out by Public Health Inspectors and Technical Assistants Statutory Nuisances 7,671 Drainage 1,104 Drain Tests 24 Surface Water Pollution 1,610 Vermin and Pests 299 Rodents 519 Accumulation of Refuse 847 Smoke Observations 367 Smoke Control 681 Atmospheric Pollution (Fumes) 10 Noise 400 Disrepair Certificates 11 Housing Surveys 941 Multiple Occupation 10,949 Overcrowding 92 Other inspections under Housing Acts 3,714 Mortgage Advance 6 Improvements Grants 4,130 Infectious Disease (Not food borne) 489 17 Food Poisoning and food borne disease 140 Factories with Mechanical Power 225 Factories without Mechanical Power 3 Outworkers 100 Offices etc: General Inspection 198 Offices etc: Other visits 466 Shops Act 2,504 Employment of Young Persons 338 Bakehouses 92 Bakers and Flour Confectioners 325 Butchers 458 Canteens and Kitchens 263 Confectioners—Sugar 363 Fishmongers 82 Fried Fish Shops 126 Greengrocers and Fruiterers 618 Grocers 1,133 Hawkers of Food 50 Prepared Food Premises 51 Public Houses and Off Licences 224 Restaurants and Cafes 903 Slaughterhouses 173 Other Food Premises 68 Street Traders 1,026 Food and Drugs Sampling 909 Ice Cream Sampling 60 Milk Sampling 61 Surrender of Unsound Food 221 Investigation of Food Complaints 325 Bacteriological examination of Food 193 Hairdressers 65 Old People's Welfare 15 Pet Animals Act 60 Other Visits 2,707 No access 3,434 Defects remedied as a result of action by District Public Health Inspectors Drains repaired 17 W.C. cisterns repaired or renewed 81 W.C. pans renewed or cleansed 29 Flush pipes repaired 26 Waste pipes repaired or renewed 90 Rain water pipes repaired or renewed 65 Roofs repaired or renewed 377 Eaves gutters repaired or renewed 156 Water service pipes repaired 15 Yards repaired or reconstructed 9 Floors repaired or renewed 121 Dampness remedied 425 Window frames and sashes repaired, renewed or painted 405 Fire places, stoves and ovens repaired or renewed 1 Flues and chimney stacks repaired 2 Brickwork of walls repaired and walls rebuilt 91 Wallplaster repaired 315 Ceiling plaster repaired 211 Staircase, balconies and steps repaired or renewed 26 Noxious accumulations removed 105 Nuisances from animals abated 1 Miscellaneous defects remedied 284 18 Statutory Notices Served Housing Act 1957 Section 9 (Repair of Unfit Houses) 1 Section 78 (Overcrowding) 4 Housing Act 1961 (Houses in Multiple Occupation) Section 12 (Management Orders) 6 Section 14 (Neglect of Management) 4 Section 15 (Amenities) 25 Section 16 (Means of Escape in case of Fire) 38 Section 19 (Limitation of number of occupants) 1 Public Health Act 1936 Section 39 (Drainage) 43 Section 45 (Repair of W.C.'s) 15 Section 79 (Accumulation of refuse) 1 Section 83 (Cleansing Premises) 1 Part III (Statutory nuisances) 181 Public Health Act 1961 Section 17 (Drainage) 22 Tottenham Corporation Act 1952 Section 43 (Urgent Repairs) 102 Work Executed by the Council in default of or by agreement with the owners during 1971 Public Health Act 1936 Section 39 (Drainage) Part III (Statutory nuisances) 3 5 Public Health Act 1971 Section 17 (Drain Clearance) 14 Tottenham Corporation Act 1952 Section 43 (Emergency Repairs) 42 Housing Act 1961 Section 14 (Houses in Multiple Occupation: Management) 1 Section 15 (Houses in Multiple Occupation: Amenities) 8 Section 16 (Houses in Multiple Occupation: Fire Precautions) 7 Rag Flock and Other Filling Materials Act 1951 No rag flock is 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 now very common. District Public Health Inspection It is the duty of the Local Authority to cause the district to be inspected from time to time in order to detect matters requiring to be dealt with as specified in the Public Health Acts. The district Public Health Inspectors cover a very wide range of subjects to achieve this objective and the changing patterns in the lives of the community are reflected in the work of the section. 19 As life becomes increasingly more complex and the general standard of living rises there will always be a number of people who, either from choice or by necessity will opt out of the standards of the community as a whole. Such people sometimes by their actions or omissions cause nuisance to their neighbours and the neighbourhood and it is necessary for action to be taken to remedy the situation. The inspectors investigate all complaints and they also initiate action following their own observations. The attention of the person responsible is drawn to the existence of a nuisance and that person is invited to remedy the matter. If this is not done a statutory notice is sent specifying the works required and setting out a time limit for the work to be carried out. If this is not done then the matter is referred to the Magistrate's Court. Increasing use is made of scientific instruments and frequent consultations with the Council's specialist advisers are made. National publicity has made the community more pollution conscious and more people nowadays have a much greater knowledge of their rights and of the services available to them. The investigations necessary in this regard is increased because of the unfortunately large numbers of people who need help, guidance and advice to enable them to cope with modern living conditions. During 1971 7,459 visits were made to investigate complaints and 699 informal notices were sent requesting action to remedy unsatisfactory conditions. In 181 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 14 occasions resulting in fines totalling £85.00 and costs £96.00. In 102 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 42 premises. Noise Many complaints concerning noise are received and each is investigated. Usually the noise comes into two categories. Firstly noise emanating from business premises where informal approaches to the management usually achieve the desired co-operation. Frequently a good deal of technical research and experiment is necessary to satisfy the legal requirements that the best practicable means shall be used to minimise the effect of the noise or vibration. The second category concerns noise in private homes caused by machinery and electrical equipment sometimes in conjunction with work carried out on the premises. If necessary the co-operation of the Town Planning Department is sought to ascertain whether the use is appropriate to domestic premises. Local Bye-laws concerning noisy instruments and also noisy animals are a great help in appropriate cases. Sometimes complainants are advised that the proper course of action would be to take legal advice with a view to taking a civil action in the Courts. Drainage 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 Public Health general assistants free of charge. In the event of the stoppage being more resistant, 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. In these cases 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 whereby the Council does any necessary works and recovers the cost thereof from the owners of the premises. During the year 1,114 drains were cleared by the Public Health Department and 550 jobs were passed to the Borough Engineer's Department. It was also necessary to serve 22 notices under Section 17, Public Health Act, 1961 and in 14 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 Once again there has been a good deal of dumping of refuse matter on open spaces throughout the Borough. This practice is conducive to the harbourage of vermin and causes a great deal of work for the inspectorate. 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. 20 Pet Animals All pet shops and animal boarding establishments are inspected with particular reference to cleanliness, temperature, ventilation and fire precautions. The Councils vetinerary advisor also visits these premises to ensure that the welfare of the animals or birds is reasonably safeguarded. HOUSING The main work of the Section, as in previous years, centred round the Council's Inspection Area Programme. The examination of the houses and dwellings within the defined areas in the Programme for 1971 continued throughout the year and reports and recommendations as to conditions found in the Areas have been presented to the appropriate Committee. Procedural changes during the year have ended the previous practice of a formal representation of clearance areas to the Health Committee and substituted the reporting of the fact of houses being unfit anywhere throughout the whole of the defined Inspection Area without guide as to their condition in relation to the question of clearance. Decisions as to the best method of dealing with the unfit houses in an Inspection Area now rests with the Area Renewal Panel. It remains, however, that procedure under Part III of the Housing Act 1957 requires the agreement and supporting evidence of the Public Health Inspector. Duties in addition to inspection of possible clearance areas included inspection of individual houses in respect of demolition and closing orders, opinions as to quality of houses, the answering of telephone calls, visits by the public and letters of enquiry regarding the condition of houses and the interest of the Council in properties variously situated, answering official searches, preparing inter-departmental memoranda, preparing for and giving evidence at Public Local Inquiries, the conducting of Ministry Inspectors to the properties in Part III Compulsory Purchase Orders, the keeping of records and general office administration. Confirmed clearance areas were visited from time to time to observe progress in the work of demolition. Four areas were completely cleared during the year and work proceeded at four other areas. Nine clearance areas and compulsory purchase orders were confirmed by the Ministry during the year. These comprise a total of 616 houses which were occupied by 780 families. One clearance area represented before 1971 has yet to be confirmed. This is a small area totalling 16 houses and occupied by 18 families. Six areas have been inspected and reported upon during the year. Four are to be dealt with by clearance, one is at present under consideration and one is to be dealt with by rehabilitation. Public Local Inquiries were held in respect of eight areas for clearance under Part III compulsory purchase orders. One of these compulsory purchase orders awaits confirmation. No modifications were made to any of the confirmed C.P.O.'sand the very few reclassifications were the result of repair works being carried out immediately before the Public Inquiries. A large proportion of claims for good maintenance were sustained by the Ministry. The following is a summary of progress made in respect of clearance areas and compulsory purchase orders under Part III of the Housing Act 1957. 1. Area Demolished and Sites Cleared during 1971 The Grove, N.8 Brunswick Road, N.15 Upper Tollington Park, N.4 West Green Road/Derby Road, N.15 2. Areas Confirmed before 1971 and not yet cleared High Cross Court, N.15 Chesnut/Welbourne/Somerset Roads, N.15 Park Lane, N.17 Craven Park Road, N.15 Birkbeck Road/St. Joseph's Road, N.8 King's Road, N.22 Paxton Road, N.17 21 3. Areas Confirmed during 1971 Houses Families. Russell Road/Victoria Crescent, N.15 196 250 Beaufoy Road/Tenterden Road, N.17 202 200 Eade Road/Vale Road, N.15 40 88 Boyton Road/Eastfield Road, N.8 48 66 Tebworth Road, N.17 10 9 Summerhill Road, N.15 21 24 Clarendon Road, N.8 60 84 Lealand Road, N.15 11 24 Westerfield Road, N.15 28 35 616 780 4. Areas Represented before 1971 and not yet confirmed Philip Lane, N.15 16 houses 18 families 5. Areas Represented or Reported during 1971 Houses Estimated No. of Families. Stonebridge Road/lpplepen Road, N.15 176 250 Plevna Crescent, N.15 58 76 Middle Lane, N.8 63 65 Park Road, N.8 13 10 The Crescent, N.15 157 190 Fortis Green Cotts, N.10 4 4 Recent years have seen the clearance of large areas of houses where conditions for too long had been extremely poor and squalid. Many hundreds of old, neglected properties where dilapidation, dampness and only the rudest of basic amenities abounded have been cleared and the sites used for the provision of new dwellings. The successful outcome of the Housing Act 1957 Part III representations and compulsory purchase orders continues to result in the elimination of areas of unfit and unsound houses where Ministry opinion confirmed the assessment that the houses had reached the end of their useful lives and that clearance was the best method of dealing with them. The present programme of detailed examination of houses in areas where clearance might be found to be warranted is, however, nearing its end and it is anticipated that completion will be achieved in the year 1972. It has been the practice over the years to deal first with areas of houses which appeared to be in poorest condition, leaving the less markedly deteriorated to be investigated later in the Inspection Programme. Progress in the treatment of the poorer areas brings us to a point where making a decision as to the best method of dealing with areas of unfit houses requires deep and careful study. Investigations towards the end of the year, 1971, reveal that areas within the Inspection Programme, although mainly consisting of unfit houses are not necessarily wholly clearance area material. It will be remembered that two circumstances must obtain before a clearance area under Part III of the Housing Act 1957 can be made, (1) the houses must be unfit under terms of Section 4 of the Act and (2) the best method of dealing with the conditions in the area is clearance of the site. In connection with the former of the above circumstances there is no doubt that although the wording of Section 4 has been little amended, the standard encompassed by Section 4 has risen to a new understanding of what is acceptable as a fit house. A simple example is the fact that a water closet which is external and not readily accessible now weighs more heavily against the fitness of a house. Likewise, the condition of repair demands a higher level of acceptance than in past years. The most significant features in considering the clearance of unfit houses under Part III of the Act are the stability of walls and roofs and the adequacy of natural light and ventilation. Groups of houses are now being encountered, even within the Inspection Area Programme, where many or most of the buildings are unfit in terms of Section 4, but are in fair condition as to stability though with varying adequacy as to light and ventilation. These houses are not necessarily best dealt with by clearance under Part III and many may have their useful lives prolonged for say 30-40 years by thorough repair and improvement. A decision not to demolish these unfit houses still leaves them to be dealt with, presumably by a better method. 22 Now that clearance under Part III of the Act is reaching the end of its appropriateness, we are confronted with many areas of unfit and/or sub-standard older-type houses, both within and without the Inspection Area Programme, and totalling into the thousands of properties. These require attention. The Housing Act 1969 makes possible the declaration and treatment of General Improvement Areas. Several such Areas have been formed within the Borough, all, however, in areas of good substantial properties where unfitness under Section 4 is the exception rather than the rule. The repair and modernisation of these houses will substantially improve the general housing stock within the Borough as will the favourable consideration of random Improvement Grant applications. There remains the "twilight" band. Clearance of houses under Part III of the Act of 1957 being near the end of its course the formidable exercise of dealing with the many remaining houses which are old and unfit or sub-standard becomes increasingly a confrontation requiring urgent solution. Alternatives of a positive nature, and on the same scale, are rehabilitation or urban renewal. Whereas until the present, the alternative methods have been Part III clearance or rehabilitation, the time is approaching when satisfactory housing standards will be achieved by a choice between Part V clearance and the highest quality of rehabilitation. Under-noted are houses or parts of houses upon which demolition orders or closing orders were made. These dwellings were unfit for human habitation and could not be made fit at reasonable cost. 5 Cavendish Road, N.4 28 Woodstock Road, N.4 26 Elizabeth Road, N.15 2 Chapel Place, N.17 2 Kemble Road, N.17 597 Seven Sisters Road, N.15 9 Tancred Road, N.4 22 Avenue Road, N.6 56 Woodstock Road, N.4 205 Ferme Park Road, N.4 Closing Orders on the following were determined during the year, extensive works of repair having been satisfactorily carried out. 48 Endymion Road, N.4 81 West Green Road, N.15 24 Truro Road, N.22 4 Northwood Road, N.6 667 Seven Sisters Road, N.15 An Order revoking a closing-order and substituting a demolition order was made on the under-noted property. 87 St. James Lane, N.10 General Improvement Areas During the year a further two areas containing 2,997 dwellings were surveyed and declared General Improvement Areas in 1971 these areas were respectively Noel Park, N.22 (2,733 dwellings) and Clarendon Road, N.15 (264 dwellings). Owing to a continuing shortage of public health inspectors and technical assistants the Council decided for the first of these areas to employ the services of local estate agents and surveyors. The Council were influenced in making this decision by the fact that in this area there was a 10 year programme to improve a substantial number of properties which the Council acquired from the Artizan and General Properties Co. Limited in 1966. Further, there was already an active residents association, and advantage could be taken of this to enable the Planning Department to formulate environmental improvements in the area. The use of private surveyors was not an unqualified success on three accounts: the surveyors were not experienced in this specialised field; the public relations aspect of the exercise as between the Council and the local residents was necessarily completely missed; and the organisation and supervision of the exercise by the Council's officers reduced the saving of the Council's officers' time. The total number of areas now declared by the Council stands at four as follows: — Durban Road 115 dwellings, declared July 1970 Clonmell Road 289 dwellings, declared November 1970 Noel Park 2,733 dwellings, declared March 1971 Clarendon Road 264 dwellings, declared July 1971 23 At the end of the year a further area, Coleraine Park (610 dwellings) was under survey with a view to declaration as a General Improvement Area. Owing to continuous pressure of work the inspectors have not been able to undertake any specific work to encourage owners within these areas to improve their dwellings. However by the provision of demonstration houses in both the Durban and Clonmell Road areas and by the example which an improved dwelling sets for adjoining properties some success has been achieved. Improvement Grants The upsurge in the number of applications noted in last year's report has continued as follows:— 1970 1971. Standard Grants 213 162 Improvement Grants 194 416 Conversion Grants 140 326 TOTAL 550 904 The aim of the department is to process each application with the minimum delay, but it must be reported that in line with the increasing flow of applications, the number of outstanding cases has already increased. Which means that the time required to issue the grant approvals is lengthening. The policy of the department has always been to give all enquirers maximum assistance and in the majority of cases this entails a visit to the premises with specific advice on site. In this way the best service is given to the public but it necessarily entails a lot of professional time. Grants approved during the year amounted to £348,476 in respect of 628 dwellings. There has been no let-up in the burden mentioned last year on the technical and administrative staff. In the last quarter of the year the Management Services O. & M. section commenced a survey of the Environmental Health Division and an interim report on the Improvement Grant Section recommended an additional 4 inspectors to cope with the present work load in that section. There has been no improvement in the very inconvenient and limited office accommodation. Out of a total of approximately 90,000 dwellings in the Borough it is estimated that there are about 30,000 which are lacking in the exclusive use of one or more of the basic amenities. In pursuance of the objective of securing to each household a self-contained dwelling in good repair and provided with all the basic amenities for the exclusive use of the occupants, the department is encouraged by the number and quality of the improvements and conversions which are being carried out. A significant start has been achieved and all the signs are that there will be an ever increasing rate of improvements particularly with the aid of grant. Especially heartening is the conversion and repair of properties previously either in serious disrepair or manifesting the worst conditions associated with some houses in multiple occupation. The task facing the Council and this department is enormous but if the Council are able to provide adequate staff resources, the financial inducements of the grant scheme are expected to make considerable in-roads into the housing deficiencies. Table I shows the grants approved in Haringey by the Public Health Department during the year ended 31 March 1971 under sections 2 and 8 of the Housing Act 1969, but does not include improvements and conversions carried out by or under arrangements with housing associations under Section 121 of the Housing Act 1957 which responsibility rests with the Borough Valuer and Estates Surveyor. Table IV at the end of this report gives details provided by the Borough Valuer and Estates Surveyor of conversions completed during the year 1971/72 by housing associations under arrangements with Haringey Council. Some housing associations have also carried out conversions in Haringey in co-operation with the G.L.C. but details of them are not available. 24 TABLE 1 Grant Approvals Year Ended 31 March 1972 Type of Applicant No. of Dwellings Grant £. (a) Owner/Occupiers: Conversion 69 45,305 Improvement 137 67,732 Standard Improvement 67 11,833 All groups 273 124,870 (b) Housing Associations and Societies Conversion 11 8,706 Improvement 12 9,277 Standard Improvement 23 17,983 All groups 23 17,983 (c) Others Conversion 193 177,622 Improvement 166 112,125 Standard Improvement 58 5,865 All groups 417 295,612 (d) Totals Conversion 273 231,633 Improvement 315 189,134 Standard Improvement 125 17,698 All groups 713 438,465 The following table analyses the total cost of the works where conversions were proposed. It shows that the grant sum payable is about 35% of this total cost. It also shows the number of premises to be converted and the resultant number of self-contained dwellings to be provided. TABLE II Overall Estimated Costs of Conversions Approved During Year Ended 31 March 1972 No. of Premises No. of Dwellings to be provided Improvement Repair Other Works Total Cost Grant Approved. £ £ £ £ £ Owner/Occupier 33 69 90,047 12,927 40,847 143,821 45,305 Housing Associations 3 11 16,608 803 2,806 20,217 8,706 Other 68 193 282,102 68,645 164,947 515,694 177,622 TOTAL 104 273 388,757 82,375 208,600 679,732 231,633 25 TABLE III Distribution throughout Borough of the conversions approved for year ended 31 March, 1972 and break-down o1 dwelling units per building Postal District Ownership No. of Premises No. of Dwellings Dwellings/Building 1 2 3 4 5 6 N2 Owner/occupier 1 3 — —- 1 — — — N4 Owner/occuper 2 5 — 1 1 Other 2 7 — 1 — — 1 — N6 Owner/occupier 4 11 1 1 — 2 — — Housing Association 1 4 — — — 1 — — Other 14 50 2 1 2 5 4 — N8 Owner/occupier 7 13 1 6 — — — — Housing Association 2 7 — — 1 1 — — Other 25 73 4 5 7 8 — 1 N10 Owner/occupier 11 20 3 7 1 — — — Other 8 24 — 1 6 1 — — N11 Owner/occupier — — — — — — — — Other 1 2 — 1 — — — — N15 Owner/occupier 2 4 — 2 — — — — Other 9 15 5 3 — 1 — — N17 Owner/occupier 2 3 1 1 — — — — Other 2 5 — 1 1 — — — N22 Owner/occupier 4 10 — 2 2 — _ — Other 7 17 — 5 1 1 — — Whole Borough Owner/occupier 33 69 6 20 5 2 — — Housing Association 3 11 — — 1 2 — — Other 68 193 11 18 17 16 5 — TOTAL 104 273 17 38 23 20 5 1 It will be noted that most of the owner/occupier applications concern either the self-containing of one part of a house or its division into two dwellings. With three exceptions all the conversions of buildings to 4 or more dwellings relate to houses in the western part of the Borough in the N6, N8 and N10 districts where the larger properties are otherwise more likely to be in multiple occupation with shared facilities and other attendant problems. 26 TABLE IV Conversions completed by Housing Associations under arrangements with Haringey Borough Council during year ended 31 March, 1972 (Details provided by the Borough Valuer and Estates Surveyor) Postal District No. of Premises No. of Dwellings. N4 16 38 N6 1 3 N8 26 59 N15 19 38 N17 24 50 N22 1 3 Total 87 191 Rehousing of Tenants of Houses requiring Improvement When in February 1970 the Council formulated its policy with regard to house improvement grants under the Housing Act 1969 it decided that, where necessary in order to allow for the repair and modernisation of dwellings existing tenants would be offered alternative accommodation providing the owners entered into agreements to accept nominees from the Council's housing list for the tenancy of premises improved in this way. This decision was subject to review when the operational implications could be assessed. Since the adoption of this policy a few cases have arisen where rehousing was necessary and no special difficulty has been met. Nomination agreements have been entered into in nine cases and in three of these the improvements had been completed at the end of 1971. Two of the premises have been reoccupied by nominated tenants and in the other case the remaining tenant was allowed to occupy the whole of the improved house which was too small for sub-division. Housing Acts 1957-1969 Repair and Improvement of Dwellings From time to time this Council receive requests from tenants for assistance in securing the installation of the standard amenities in their dwellings. Although there are statutory powers which can be invoked to require the landlord to install the missing amenities, these are involved and the legal processes extend over a considerable period of time. The landlord also has the right, as an alternative to carrying out the works, to require the Council to purchase the property. Every endeavour, therefore is made to persuade the landlord informally to meet the tenant's wishes with the aid of an improvement grant. However, on occasions it is not possible to secure the installation by these informal methods either because the owner is unwilling or unable to incur the expenditure involved and not prepared to borrow the money from the Council or elsewhere for that purpose. This leaves two possible courses open to the Council:— (a) Take statutory action to require the landlord to carry out repairs and improvements in the knowledge that the landlord may require the Council to purchase the premises; or (b) Negotiate for the sale of the property to the Council and the Council carry out the necessary works (with or without a change of tenant). Compulsory purchase orders are also available. 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 can 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. 27 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. 282 applications for Certificates were received in 1971. Applications for Qualification Certificates Dwellings having amenities at 25th August 1969 No. of Applications outstanding at 1.1.71 562 No. of Applications received in 1971 282 844 No. of Qualification Certificates Granted 183 No. of Qualification Certificates Refused 159 No. of Applications withdrawn 22 No. of Applications where owners notified of repairs needed 403 767 No. of Applications under investigation at 31 December, 1971 77 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 indicate the fair rent for the improved dwelling if and when the improvements and repairs have been completed. When the fair rent has been fixed and the tenant advised, the owner must then request the tenant to consent in writing to the improvements being carried out: and only if this consent is given can the owner be entitled to a Qualification Certificate upon the satisfactory completion of the work. This enables him to request the Rent Officer to register the fair rent. 227 applications were received in 1971. Application for Qualification Certificates Missing Amenities to be provided No. of Applications outstanding at 1.1.71 77 No. of Applications received in 1971 227 304 No. of Certificates of Provisional Approved issued 177 No. of Certificates refused 17 194 No. of Applications under investigation or negotiation at 31 December, 1971 110 Houses in Multiple Occupation Consideration was again given during the year to the question of the registration of houses in multiple occupation, and a questionnaire was sent to all the boroughs in Greater London concerning this. The results of this survey indicated that 7 of the 31 London Boroughs had made schemes of registration and 3 were proposing to have schemes. Of the remaining 21 authorities, only three were considering schemes, the other 18 having either decided against a scheme of registration or considered that a scheme was not warranted in their area. These results were studied by the Health Committee, who decided to reconsider the matter at a future date in 1972. Should it be decided to implement a scheme of registration it would most certainly be necessary to increase substantially the staff engaged upon multiple occupation work, in order for the scheme to be administered properly, so that the information it revealed could be followed up quickly by inspection and remedial action when necessary. It is no good merely to collect information and not make use of it speedily, because the details provided, even when correct, can rapidly become out of date due to the not infrequent changes which occur in the 28 occupation of houses of this type. Alternatively, of course, an increase in the staff allocated to these duties at present would enable what are considered to be the worst areas of multiple occupation to be dealt with on a house to house basis, instead of having to give priority to notifications received from, what may well be, the better type of house occupied in this way which had been notified voluntarily under a scheme of registration. The staff situation did not improve during the last year. One Public Health Inspector had to retire before the anticipated time, due to a prolonged period of ill health and another, who only joined the section during the latter part of the year, obtained a position elsewhere and has resigned. The net result was that the section was below strength for a considerable part of the year and only able to be allocated the services of one of the Public Health Inspectors who were appointed during the year, these appointments being mainly from our own students who qualified as inspectors during 1970, few suitable applicants having applied to join the Council's service. The Haringey Corporation Act 1971 passed through all its stages during the year and became law on 27 July 1971. So far as is known, Haringey were the only authority to acquire the power to deal expeditiously with premises where the supply of gas or electricity had been withdrawn due to some act or omission of the owner (i.e. failure to pay his account, or to have essential repairs carried out to a gas or electricity installation where, because these had not been done, there was no longer an adequate supply of gas or electricity available for the tenants). The provisions of this act enable the Council to pay such sum to the statutory undertaker as may be necessary to secure the reinstatement of the gas or electricity supply, as appropriate. Until this expenditure has been recovered it is made a charge upon the property. It has only been necessary to actually make payments under these provisions upon two occasions in the five months since the act came into force, but these powers have been invoked upon a total of five other occasions, which have resulted in owners taking the necessary measures to reinstate the gas or electricity supplies either by payment of the outstanding account, or carrying out work to put the gas or electrical installations into working order where a fault has developed. HOUSES IN MULTIPLE OCCUPATION Summary of action taken in 1971 No. of separately occupied parts of houses visited for first time 1,535 No. of revists to above 9,414 No. of inspections where multiple occupation would exist upon completion of mortgage advances being contemplated by this Council 79 No. of houses where informal notices sent relative to S.15 (Amenities) 189 No. of houses where informal notices sent relative to S.16 (Fire Precautions) 174 No. of houses where items of inadequate management notified to owners 81 No. of cases of penal overcrowding 37 No. of cases of penal overcrowding abated 39 No. of cases of non-penal overcrowding 18 No. of cases of non-penal overcrowding abated 10 No. of formal S.14 Notices (Management) 4 No. of formal S.15 Notices (Amenities) 25 No. of formal S.16 Notices (Fire Precautions) 38 No. of formal S.78 Notices (overcrowding) 4 No. of houses where S.19 Directions made 1 No. of houses where S.12 Management Orders made 6 Other Notices served 246 Other visits including discussions with owners, builders etc. at premises 1,872 29 FOOD HYGIENE Food shops appear to be changing hands more frequently than in the past. Sometimes the new occupant has had no experience in the particular trade. The fact that these people are often of foreign origin with limited understanding of the language and are completely unaware of the requirements of legislation affecting their business, does not help matters. There Is still a tendency for certain shops to sell a very wide range of goods so that the risk of contamination and cross-infection must always be borne in mind. The remedy for this state of affairs is, in the opinion of the Department, repeated visits by the Public Health Inspectors in order that the shopkeeper may not only know the Food Hygiene (General) Regulations 1970, but will understand the true significance and principles upon which the regulations are based. This leads to a much better state of hygiene than if the owner of the business is expected to obey the rules blindly. A number of complaints of unsatisfactory foodstuffs have been due to the carelessness of shopkeepers in allowing goods which are well over the manufacturer's "expiry date" for sale and in fact considerably over their normal shelf life, to remain on display. Public Health Inspectors are calling the attention of such shopkeepers to this point and have found several instances of goods being on display where the manufacturer's recommended date has been ignored. Whether this is due to the goods being kept in shop too long i.e. lack of stock rotation or, as it is sometimes alleged, the goods being "uplifted" from one shop and delivered to another, is difficult to decide. All that we suggest is that the shopkeepers familiarise themselves with the manufacturer's codes, use their own coding system where goods are not coded and above all practise careful stock rotation. The total number of food shops at the end of the year was as follows:— Trade No. of Shops No. of Inspections. Bakers and Flour Confectioners 97 325 Butchers 109 458 Cafes and Restaurants 236 903 Confectioners, Sugar 379 363 Fishmongers 34 82 Fruiters and greengrocers 169 618 Grocers 401 1,133 Off licences and public houses 203 224 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 835 Manufacture and sale of ice cream 1 Cooking of hams and other meat 64 Fish frying 56 Fish curing (smoking) 3 Sausage manufacturer 91 Preparation of jellied eels 3 Shell fish 2 Prepared foods 27 Pickling meat 3 Total 1,085 In addition the following classes of food hawkers and their storage premises are registed under Section 11 of the Middlesex County Council Act 1950 — 30 Trade No. of Hawkers registered No. of storage premises. Fruit and vegetables 131 94 Shellfish 14 5 Fish 13 4 Ice cream 35 9 Light refreshments 24 7 Peanuts 4 2 Eggs 3 - Groceries 12 5 Confectionery 1 1 TOTAL 237 127 Milk and Dairies Regulations The number of distributors registered at the end of 1971 was 323. There are no dairies in the Borough where loose milk is bottled. Milk (Special Designation) Regulations At the end of the year the following licences to use special designations were valid for premises in the Borough:— Pasteurised Milk 157 Sterilised Milk 143 Untreated Milk 29 Ultra Heat Treated Milk 61 Imported Food Regulations 1968 The amount of food imported in sealed containers direct to the warehouses in the Borough without prior examination by the Port Health Authority has continued to increase. During 1971, a large cold store in the eastern part of the Borough commenced the construction of a substantial extension to their premises. Fortunately, the relations between the Company and this Department have always been very good and we have no doubt that full co-operation will be maintained in the future. When this large new store is completed it is likely that the rate of increase in the enforcement work under these regulations will accelerate. The additional demands on the time of the Food Inspectors will present a problem since all this work was undertaken by the Port Health Authorities prior to the 1968 regulations and was not therefore allowed for when the Food Hygiene Section was established. Consignments of Imported Food examined under Imported Food Regulations Type of Food No. of consignments. Egg, Frozen or dried 30 Cheese 56 Confectionery, Sugar 10 Meat and offal 23 Tinned milk or Fruit Juices 17 Frozen prawns and shrimps 18 Tinned fruit 10 Butter 1 Beans A TOTAL 166 Food Sampling The Department continues to sample a wide range of foodstuffs for chemical and bacteriological examination. The whole question of sampling is reviewed from time to time and the emphasis is shifted in the light of our own experience, and the advice given us from time to time by Mr. W.B. Chapman, the Council's Public Analyst and Dr. Betty Hobbs, Director of the Food Hygiene Laboratory at the Central Public Health Laboratory. 31 Monthly samples of all designations of milk were submitted to the Analyst for chemical and bacteriological examination. Some samples were found to be deficient in the percentage of milk fat or percentage of solids not fat but there was no evidence of added water. These results were sent to the dairy concerned and also to the Chief Public Health Inspectors of the Boroughs in which the milk was bottled for their information and any action they considered necessary. Food samples were also collected regularly for submission to the Central Public Health Laboratory at Colindale for bacteriological investigation. These were mainly in respect of foodstuffs which are normally intended for consumption without further cooking where bad handling or storage might give rise to the risk of food poisoning. None of the irregularities in the samples were considered so serious as to warrant formal action. Where appropriate warnings and advice were given to the suppliers who were generally anxious to comply with the statutory requirements and promptly withdrew any articles which were found to be defective and corrected any labelling irregularities. Food Samples Articles No. of Samples Unsatisfactory Analysis Labelling Alcoholic Beverages 16 - 4 Bread and Butter 4 1 - Butter 2 - - Cereal and Starch Products 1 - - Cocoa and Chocolate Preparations 13 • - Coffee and Coffee Preparations 6 • - Cream 7 1 - Drugs on prescription only 22 - - Drugs: Miscellaneous 58 1 - Fish and Fish Preparations 7 2 - Flour and Flour Products 9 - - Flour Confectionery 13 - - Food Additives 5 3 2 Foods Miscellaneous 1 - Fruit and Fruit Preparations 31 - - Gravy Preparations; 2 - - Home Brew Beer Packs 5 - - Jam and Preserves 12 - - Meat and Meat Preparations 1 - - Meat Products, Canned 4 - - Milk 179 4 - Milk, dried and Condensed 2 - - Milk Preparations 3 - - Nuts and Nut Preparations 1 1 - Oils, Fats and Fatty Foods 3 - - Sausages and other Meat Products 2 1 - Soft Drinks 28 2 - Soups and Soup mixes 7 - - Spices and Condiments 3 - - Sugar and Confectionery 14 - - Table Jelly Preparations 5 • - Vegetables and Vegetable Preparations 11 1 - - TOTAL 477 18 15* NOTE: "One sample had irregularities in respect of analysis and labelling 32 Details of Unsatisfactory Samples Sample Irregularity Comment. Bread and Butter The spread described as "Butter/Margarine mixture" contains only 2% butter. Vendor warned Double Cream Fat content below minimum required (46.8% - Minimum 48%) Warning letter sent Drugs Tablets in pack broken Further sample found to be satisfactory Fish and fish preparations Two samples of potted pastes contained unauthorised colouring agent: PONCEAU MX Old stock: withdrawn by manufacturer Food additives Three samples of Finings contained sulphur dioxide contrary to Preservatives in Food Regs. In correspondence with manufacturers Gravy preparations Gravy browning contained 5.9% fuel oil Warning letter sent to manufacturer. Remainder of stock withdrawn by them Milk Four samples contained less than the minimum of 3.0% fat which genuine milk is presumed to contain No evidence of adulteration. Deficiencies may have been in morning milkings. Producers and local authorities for their areas advised. Nuts and Nut Preparations Creamed coconut had lost oil Probably stored under warm conditions allowing loss of oil. Shop keeper warned. Stock withdrawn Sausages etc. Sausages said to contain 90% meat had only 82% Retailer advised. No confirmation of alleged statement as to content Soft drinks 1) Low calorie lemonade contained cyclamate which is no longer a permitted sweetener Manufacturer notified. Remainder of stock including similar products withdrawn by manufacturer 2) Almond flavour drink fermenting Warning letter sent. Remainder of stock surrendered Vegetables and Veg. Preparations Rhubarb in syrup contained insect larva Warning sent to manufacturer Labelling Irregularities List of ingredients incomplete or absent 8 List of ingredients included generic terms 5 Alcoholic declaration incorrect or less than minimum height 4 No name and address given 1 Food Complaints 91 complaints of unsound foodstuffs were investigated and, where appropriate, legal proceedings were instituted or warning letters sent. Details are shown in the following table:— 33 Commodity No. of Complaints Action Taken Foreign bodies found Other Reasons Official warning letter Prosecution Formal action not justified. Baby Food 2 - 1 1 . Bacon 3 2 1 1 3 Biscuits 1 - - 1 . Bread 5 8 7 4 2 Butter - 3 2 - 1 Cereal 2 3 5 - - Cheese 1 . 1 - - Chicken - 3 1 - 2 Confectionery (Flour) 4 3 3 2 2 Confectionery (Sugar) 3 3 2 4 Cream 1 - - 1 - Fish 2 4 2 4 Fruit (Tinned) 2 - 1 1 - Honey 1 - 1 - Jam 1 - - 1 - Meat (Cooked) - 3 - 1 2 Meat Pies - 5 1 3 1 Meat (Tinned) 2 - 2 - - Milk 7 5 5 2 5 Potato Crisps 1 - 1 - - Prepared Food 1 - 1 - - Soft Drinks 3 - 1 2 - Starch Products 2 - 2 - - Vegetables (Tinned) 4 1 5 - - Total 48 43 45 20 26 A number of these articles were submitted to the Public Analyst and his reports assisted when assessing what action should be taken in respect of offences. Prosecutions were instituted in twenty cases where it was judged that the circumstances warranted such action, but only fourteen of these were brought before the Magistrates for a final decision during the year under review. The results of the fourteen cases are shown in the following table: — Fine Costs. £ £ Sachet of Sun Pop Drink containing foreign matter 25 2 Mother's Pride Take and Bake Loaf - Mouldy 30 5 Part of cigarette embedded in cake 10 5 Sausage roll completely hard 30 10 Foreign body on interior of bottle of orange crush 25 5 Whole wheat sultana biscuits - insect infested 40 20 Apple strudel with insects 15 15 Foreign matter in jar of baby food 15 5 Mouldy sausages 20 5 Packet of unsmoked bacon - mould growth 60 5 Country Bake Chicken & Ham Pie - mould growth 20 5 Home Bake bread completely covered with mould 20 5 Cigarette tip in part of Banbury Cake 15 10 325 97 Mouldy pork pie Case dismissed with £10 costs against Council. 34 Surrender of Unsound Food 1,306 Certificates were issued in 1971 in respect of unsound foodstuffs which were surrendered by wholesale and retail distributors. These are itemised as follows:— Tinned meat 334 2 tons 6 cwt 33 lbs Tinned fruit 317 1 ton 62 lbs Meat 205 3 tons 8 cwt 80 lbs Tinned vegetables 154 1 ton 11 cwt 60 lbs Tinned cereal 133 2 tons 5 cwt 57 lbs Tinned fish 62 1 cwt 56 lbs Bottled condiments 51 3 cwt 26 lbs Tinned milk 31 2 cwt 73 lbs Miscellaneous 19 5 cwt 9 lbs Total no. of certificates issued 1,306 11 tons 5 cwt 8 lbs Meat Inspection An authorised meat inspector assists in the inspection services which the Public Health Inspector is statutorily required to provide at the Markfield Road abattoir. His total daily attendances for the year was 218. The abattoir is constructed to deal with many types of animals where the flesh is intended for human consumption but the bulk of the work covers bovines and horses, the flesh of some of which is intended for export. The Company is approved by the Ministry of Agriculture, Fisheries and Food to export to countries within the European Economic Community and such an approval is only granted to an abattoir which complies with the stringent requirements of the European Economic Community. The whole or parts of carcases which are rejected as unsuitable for human consumption are passed directly for processing, sterilization and manufacture into pet food within a separate building in the same complex. This arrangement is regarded by the Public Health Department as eminently satisfactory since the rejected meat is not removed from the direct supervision and control of this department. SUMMARY OF CARCASES INSPECTED 1971 Goats Donkeys Bovines Horses Calves Sheep and Lambs Cows. Number killed 11 4 980 1,115 240 18 2,329 Number inspected 11 4 980 1,115 240 18 2,329 All diseases except Tuberculosis and Cysticercosis Whole carcases condemned - - 29 3 5 3 131 Carcases of which some part or organ was condemned _ _ 281 611 67 2 1,781 Percentage of number inspected affected with disease other than tuberculosis or cysticercosis 25 32 55 30 28 82 Cysticercosis only Whole carcases condemned - - 13 5 - - 29 Carcases of which some part or organ was condemned - - 6 - - - 9 Percentage of number inspected affected with cysticercosis - - 1.9 - - - 1.6 NOTE: There were no cases of tuberculosis reported during the year 35 The Food Hygiene (Markets, Stalls and Delivery Vehicles) Regulations 1966 The Middlesex County Council Act 1950 — Section 11 Itinerant hawkers of hot dogs, hamburgers etc. in the vicinity of the Tottenham Hotspur Football Club on match days continues to receive the attention of the Department. With the assistance of the Police, we have reached the stage where the only traders who could be a danger to Public Health are those who appear for the first, and quite often the only, time. The majority of the regular hawkers are well known to the Food Hygiene Section and generally achieve good standards of cleanliness, but difficulty has been experienced in persuading them to comply fully with the Regulations. After issuing a large number of warnings, the situation was still found to be unsatisfactory, and summonses were issued against seven offenders. Fines and costs ranging from £7 to £169 were imposed by the Magistrates. It is hoped that this action will have a salutory effect on the hawkers generally, and further inspections will reveal whether the improvement has been sustained. Offices, Shops and Railway Premises Act 1963 The implementation of the Offices, Shops and Railway Premises (Hoists and Lifts) Regulations 1968, is still causing some difficulty with regard to hand-operated lifts such as those used in Public Houses. The advice of the Deputy Superintending Inspector of Factories was sought and it is understood that considerable discussion has taken place between the Factory Inspectorate and the Brewers' Society and an advisory circular is promised in the near future. Class of Premises No. of Premises Registered during 1971 No. of Registered premises at end of year No. of Registered premises receiving a general inspection 1971. Offices 11 486 14 Retail Shops 22 1,120 138 Catering establishments and canteens 3 156 56 Wholesale shops and warehouses 5 74 32 Fuel Storage Depots - 3 - TOTAL 41 1,839 240 Analysis of Contraventions Found Section Type of contravention No. found Section Type of contravention No. found 4 Cleanliness 2 12 Clothing accommodation 2 6 Temperature 9 16 Floors, Passages, Stairs 7 8 Lighting 2 17 Fencing machines 1 9 Sanitary conveniences 12 19 Training etc: Dangerous 10 Washing facilities 7 24 Machines 1 11 Supply of drinking First Aid 15 water 1 50 Abstract 33 Persons employed in registered premises Class of workplace No. Offices 7,052 Retail Shops 6,659 Wholesale Shops, Warehouses 1,533 Catering establishments 1,095 Canteens 238 Fuel Storage Depots 35 Total 16,612 Males 7,400 Females 9,212 36 Reported Accidents Workplace No. Reported Total No. investigated Prosecutions Formal warning Informal warning No Action. Offices 4 2 - - 2 - Shops, Retail 48 19 - 1 9 9 Wholesale Shops 11 2 - - 1 1 Catering establishments 6 2 - - 1 1 Fuel Storage depots 1 - - - - - TOTAL 70 25 — 1 13 11 Analysis of Reported Accidents Offices Retail Shops Wholesale Warehouses Catering Establishments Centeens Fuel Storage Depots. Machinery 1 2 1 1 - Transport - 4 1 - - Falls of persons - 15 1 - 1 Stepping on or striking against object or person 1 3 1 1 Handling goods 1 17 6 3 1 Struck by falling objects 2 - - - - Fires and explosions - - - 1 - Electricity - - - - - Use of hand tools - 6 - - - Not otherwise specified 2 - - - TOTAL 4 49 10 6 1 Hairdressers Section 21 of the Greater London Council (General Powers) Act 1967 was applied to Haringey with effect from 1 January 1968. This requires all persons carrying on business as hairdressers or barbers at premises in the Borough to be registered with the Council. Byelaws in respect of such establishments in Haringey prescribe 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. All are inspected from time to time based on an assessment of conditions found at the time of previous inspection. Shops Acts 1950—1965 A total of 2,504 shops inspections were made during the year. The following contraventions were noted:— General Section 17(2) Assistants weekly half holiday notice not displayed 212 Section 32(2) Notice of hours of employment of young persons not displayed 50 Section 32(2) Abstract of provisions of employment of young persons not displayed 62 Closing Hours Section 2(1) Failed to close at prescribed hour 37 Section 1(1) Failed to close at 1 p.m. on early closing day 49 Section 1(2) Failed to exhibit early closing day notice 258 Section 13(1) Failed to exhibit exempted trade notice 119 Sunday Trading Section 22(3) Failed to keep record of hours of employment 9 Section 57 Failed to exhibit Sunday Trading Notices 103 37 Street Trading Although there is no street market in the Borough, 27 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. The Council also license 19 small sites on the public footpath for trading. These are occupied mainly by newsvendors and are situated in the vicinity of British Rail and Underground Stations. 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 Prosecutions. (1) Factories in which sections 1, 2, 3, 4 and 6 are enforced by the local authority 58 3 - - (2) Factories not included in (1) in which section 7 is enforced by local authority 997 225 7 - (3) Other premises in which section 7 is enforced by local authority excluding outworkers 17 - - - TOTAL 1,072 228 7 - Summary of defects found in factories Particulars No. of cases in which defects were found Found Remedied Referred to Factories Inspector Referred by Factories Inspector. Sanitary conveniences (S7) - - - (a) want of cleanliness 8 1 - - (b) unsuitable o'r defective 9 - - . (c) not separate for sexes 2 - - 1 (d) no. intervening lobby 4 - • 4 (e) w.c.'s not labelled 3 1 - - Abstract 31 14 - - 57 16 . 5 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 any necessary steps can be taken to prevent work being undertaken in unwholesome premises, or to stop the spread of infectious disease. 38 Outworkers' Trades No. Employed. Making of wearing apparal 170 Making of curtains and furniture hangings 12 Making of handbags 1 Making of sacks 1 Umbrellas 4 Making brass articles 1 Artifical flowers 7 Cardboard boxes 12 Brushes 4 Button carding 1 Textile weaving 1 Christmas crackers 9 TOTAL 223 100 visits were made to outworkers premises. Radioactive Substances Act 1960 During the year, the Council received, from the Department of the Environment, details of Certificates issued under Section 1 of the above act in respect of three premises. These premises were visited by one of the Senior Public Health Inspectors, in order that the department may continue to be kept informed of the levels and uses of radioactive materials within the Borough. It is interesting to record that these materials are used in many ways, some uses being purely experimental and others of very practical application. An example of the latter is in the use of radioactive materials, in minute quantities, which form the basis of fire detectors. These can detect the presence of smoke and, in consequence, set off fire alarm systems within buildings and operate relays so that doors, normally required to be left open in the course of business, can be closed automatically to prevent the spread of a fire; and so leave a safe exist route for those persons left within the building. STUDENT PUBLIC HEALTH INSPECTORS The Department has an establishment of 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. Two students completed their training during the year and passed their final examination for the Public Health Inspector's Diploma, and two new pupils were recruited. It is pleasing to record that the educational standard of applicants for appointment is steadily improving. 39 PART II PERSONAL HEALTH SERVICES AND INFECTIOUS DISEASE CONTROL Co-ordination and co-operation with Hospital and Family Doctor Services The Department of Health has asked for information about co-ordination and co-operation in the tripartite service. Hospital Services The Medical Officer of Health is represented on the Medical Executive Committee of the Tottenham Group Hospital Management Committee and he serves on the Investigational Department Committee and the Medical Library Sub-Committee and the Deputy Medical Officer of Health serves on the Group Control of Infection Committee and the Geriatric Liaison Committee. Medical Officers employed by the Council have an effective liaison with this hospital and with the North Middlesex and Bearsted Hospitals, especially with the paediatric, obstetric and audiology departments. In addition, there are special links between the Consultant Dermatologists and the "Warts Clinic"; with the Consultant Haematologist for the detection of genetic blood dyscrasias in the interests of safer anaesthesia by the Dental Officers; and links between the Consultant Bacteriologist and the Chief Public Health Inspector in the best interest of hospital kitchen hygiene. The Chest Physicians are ready to advise us when tuberculosis is diagnosed in schools; and the V.D. Contact Tracer is in daily contact with the Consultant Venereologist. Dr. Seidel, the Principal Medical Officer Mental Health, spends more of his time in hospital since the passing of the Seebohm Legislation. Arrangements have been made for the Council's Midwives to conduct deliveries of their patients in several Maternity Hospitals which serve the Borough. General Practitioners' Service The programme described in the Annual Report in previous years for the attachment of midwives and home nurses to General Practitioners has been maintained. A Weekly Bulletin is distributed to all General Practitioners and it carries basic information about infectious disease notifications and about lectures at Hospital Academic Centres and changes in services, and it is also a useful medium for the communication of a wide variety of ideas between different agencies of the Health Service and doctors in general practice. The improvements most likely to follow the abolition of the tripartite service and the unification of the Health Service will include better communication between the different branches. Although a Bulletin is not the only solution, it has an important part to play. The community physician of the future will have to learn as much as he can about the problems of other doctors and their patients and improved contact between the different groups of clinicians must take place. The problems of general practice are not static in time and as I wished to revitalise my personal experience of general practice I was most grateful to the Chairmen of the Health and Personnel & Management Committees, Councillor Mrs. Levinson and Councillor Douglas Smith, who agreed that I should take some study leave for this purpose. Report on a Period of Leave to Study the likely Relationship between General Medical Practice and the Future Health Authorities. I was fortunate in making arrangements with a firm of general practitioners who allowed me to study their practice and then employed me as a part-time assistant for two days a week in February and March of 1971, and I was also very glad to spend some time with the duty doctor of the G.P. Relief Service. There have been considerable changes in general practice since I worked as an assistant in Lancashire about thirty years ago. In general, diagnosis remains much the same, drug therapy is completely different, the liaison with the local authority staff is developing slowly and the attitudes and expectations of the public have changed beyond belief. General medical practice can be considered from the viewpoint of the patient whose needs may be divided into three main groups. 1. The doctor as an apothecary Since the development of the National Health Service the patient has learned to make extensive demands on his doctor for diagnosis, reassurance and advice, and although diagnosis is often elementary it cannot readily be delegated. In treating a variety of minor conditions the doctor works in conjunction with the pharmacist and must 40 rely for much of his clinical knowledge on the capacity for communication by the Pharmaceutical Industry through their "reps" or numerous news magazines. Much of the minor illness treated is readily remediable or self limiting. The public attitudes and expectations in regard to medical treatment have changed remarkably and people happily take risks with their bodies and when they are unlucky they expect the doctor to restore their functions to order. I refer to minor disasters which often pass unrecorded - the septic ear lobe which can follow unskilled surgery by an ear piercing jeweller, the face rash in an allergic subject who has been given a hair dye by her hairdresser or the allergic rash which can follow the application of an adhesive plaster by a chiropodist or again a rash which follows a bubble bath. These conditions are usually mild and remediable but there is perhaps a need for more communication between the different professions and some redirection of health education by the future area health authorities. There is scope, too, for more effective links with the present school health service and the care of the school child - asthma in children may call for an environmental report and the relationship between dampness and the house dust mite directed towards the elimination of the latter. Ear infections are frequent and usually treated with success but one feels that the effective and well tried follow up organisation of the School Health Service could be applied by subsequent audiometry to exclude and deal with any residual hearing defect. Nowhere is the change in public attitude more readily seen than in the field of minor throat infections. Here rapid cure is expected and if the child's mother is in full employment she does not wish the child to remain at home a moment longer than necessary. The possibility of ambulant treatment from the earliest date possible may in future have to be considered jointly by general practitioner and school medical officer so that the child may return to school without risk of the spread of infection, with the minimal delay. 2. The doctor and the chronic sick In these circumstances the patient looks for support from the most effective agencies and here one can see the value of a generic social worker to assess the Local Authority contribution by way of services, i.e. home help, meals on wheels, mental health and welfare support together with advice on rehousing or re-adaptation of present home. The excessive demands made by the staircase on so many physically handicapped people become apparent and the question arises should retired people not be given more encouragement to live in the spacious environment of a rural or seaside area as is a fairly common practice in Social Classes I and II. There is scope for difficulty in communication between doctors and social workers and for misunderstanding because of their different approach. The doctor is generally prompt in his attendance and brief with his visit and the social worker commonly reverses this pattern of action to take his more comprehensive case history. A doctor may see sixty cases a day in contrast with the social worker's six and both parties will have to accept the difference in approach which is a consequence of their different working patterns. 3. The accident and emergency service The patient needs to have competent professional help instantly available at any hour of the day or night and as can be seen from frequent press criticisms of hospital casualty departments such provision is not always easy to arrange. The services of the Ambulance and Casualty Departments are required both in a supportive capacity for the general practitioner and as an agency of primary medical care. The general practitioner is by tradition "busy" and an important reason for this attitude is that he must constantly be prepared for emergency action and so the well-prepared doctor is constantly "clearing his decks for action". There is always scope for improvement in this kind of service by the professional staff responsible, but other authorities could help by insisting on well-maintained public telephone boxes and on an efficient system of address finding, i.e. streets named and numbered so that they can be seen by a vehicle driver. I was appalled at the contrasting standards of numbering and naming in many blocks of modern flats in different London boroughs. The experience so far gained has been valuable not so much in obtaining new knowledge as in confirming views and ideas. There is no doubt that the assessment of local health requirements is most necessary to the efficient deployment of resources. The assessment of need can only be gained by better links between the community physician and doctors engaged in various forms of medical care in general practice and in the various specialities. In my opinion the future should see more direction and guidance of preventive action from other medical disciplines and direction of this type will have to be sought by a continuous series of exploratory projects between now and 1974. 41 Health Centres Stuart Crescent The well established Health Centre at Stuart Crescent, which serves most of the Wood Green area, has proved invaluable as a model for the Council's plans for future Health Centres. The Borough Planning Officer has given special consideration to the location of future Health Centres in the Borough and he carried out an informative but confidential survey to find out the patients' views on Health Centre practice. Bounds Green The proposals for a Health Centre at the Wood Green and Southgate Hospital to replace the existing Gordon Road Clinic and to offer shared facilities for Outpatients had been shelved in 1969. The plans were revived and progress is now being made with the development of a comprehensive Health Centre at Bounds Green. Crouch End The enthusiasm and interest of local general practitioners for a Health Centre has encouraged the Council to allocate a site for this purpose at the junction of Middle Lane and New Road, and planning is now in progress. CARE OF MOTHERS AND YOUNG CHILDREN Notification of Births Live Births (a) Domiciliary 229 (b) Hospital or Nursing Home 4,017 Still Births (a) Domiciliary — (b) Hospital or Nursing Home 46 Total 4,292 knte-Natal Clinics Attendances during the year are shown in the following table:— Clinic Total Attendances Sessions held Ante-natal Post-natal Average Attendance per session. Burgoyne Road 49 349 33 7.8 Chestnuts 75 612 50 8.8 Church Road 46 169 18 4.1 Fortis Green 51 744 22 15.0 Gordon Road 52 342 37 7.3 Lordship Lane 50 323 30 7.1 Mildura Court 51 454 24 9.4 Park Lane 52 508 64 11.0 Stroud Green 51 282 24 6.0 Weston Park 100 749 45 7.9 Stuart Crescent 52 277 20 5.7 Total 629 4,809 367 8.2 Cervical Cytology Routine screening for cancer of the neck of the womb continued to be carried out as part of the normal work of the ante-natal clinics. The special weekly evening sessions at Mildura Court Clinic also continued throughout the year. Attendances at clinic sessions were as follows:— 42 Clinic Attendances. Burgoyne Road 44 Chestnuts 137 Church Road 57 Fortis Green 91 Gordon Road 109 Lordship Lane 107 Mildura Court 228 Park Lane 163 Stroud Green 56 Stuart Crescent 97 Weston Park 98 Total 1,187 Screening sessions were also held at three local factories and a telephone exchange, at which 138 smears were taken. Hospitals are now able to accept more slides than in previous years and the service has expanded during the past year. There is a need for further expansion in cervical cytology and I am indebted to the work of the Haringey Cancer Control Committee for their generous help by means of public meetings and publicity, because this service is so very dependant upon publicity and information. It has been estimated from the 1961 census that there are 47,530 women aged 35-64 in Haringey and if smears are taken once in five years the annual total should be one-fifth or 9,505. A number of authorities now consider that smears should be taken before the age of 35 and this service is provided at the Council's clinics. Although the Department of Health has not yet agreed to pay a fee to general practitioners who offer this service to women under age 35 there may be scope for an expansion of the service by lowering this age. It is not possible to know the exact number of smears taken in Haringey in 1971 but the following figures have been arrived at by estimation. Estimated number of smears done in 1971: — in L.A. Clinics — 1,421 in F.P.A. Clinics — 2,350 by G.Ps. — 908 Total — 4,679 + number from hospital not possible to estimate from available figures. These women were not necessarily aged 35 - 64 — many were under 35 years. During the year, 5 "positive" cases were found, of which 2 were subsequently diagnosed as cancer and 3 are still under investigation. Distribution of Welfare Foods National Dried Milk (Packets) Orange Juice (Bottles) Cod Liver Oil (Bottles) Vit A & D Tablets Vit Drops (Bottles) 7,187 50,152 2,139 2,438 5,132 'Supply of Cod Liver Oil was discontinued during the second Quarter and replaced by Vitamin drops. 43 Child Health Clinics The following table of attendances during the year indicates the continuing need and use of the service: — Clinic Sessions Attendances Average attendance per session Number of cases seen by M.O. Number of cases referred elsewhere. Alexandra Park Road 52 1,639 31.5 477 23 Burgoyne Road 153 4,607 30.1 879 9 Chestnuts 198 5,212 26.3 2,069 53 Church Road 153 2,502 16.4 1,046 4 Fortis Green 101 3,467 34.3 1,421 21 Gordon Road 103 2,305 22.4 792 29 Lordship Lane 204 4,620 22.6 1,610 25 Mildura Court 102 2,919 28.6 1,162 47 Park Lane 154 4,916 31.9 2,049 52 Somerset Road 146 1,953 13.4 997 40 Stroud Green 104 3,781 36.4 1,120 31 Weston Park 155 5,196 33.5 1,793 54 Stuart Crescent 152 5,661 37.2 1,821 29 TOTAL 1,777 48,778 27.8 17,236 417 Mothercraft and Relaxation Classes These classes are considered to be one of the important branches of health education, health visitors and midwives co-operating together in the weekly courses of instruction and discussion. Attendances during the year:— Clinic Sessions Attendances Average attendance per session. Burgoyne Road 28 92 3.3 Chestnuts 46 144 3.1 Church Road 29 133 4.6 Fortis Green 29 212 7.3 Gordon Road 29 90 3.1 Lordship Lane 48 217 4.5 Mildura Court 17 36 2.1 Park Lane 48 283 5.9 Somerset Road - - - Stroud Green 41 219 5.3 Weston Park 48 290 6.0 Stuart Crescent 45 256 5.7 TOTAL 408 1,972 4.8 44 Toddlers' Clinics (2-5 years age group) Children attending toddlers sessions do so by special appointment at six to twelve month intervals. The following table gives details of attendance:— Clinic Sessions Attendances Average attendance per session No. of cases seen by M.O. No. of cases referred elsewhere Burgoyne Road 52 544 10.5 544 38 Chestnuts 96 1,027 10.7 1,026 61 Church Road 24 286 12.0 281 3 Fortis Green 52 512 5.0 499 12 Gordon Road 52 449 8.6 447 24 Lordship Lane 103 986 9.6 985 24 Mildura Court 51 745 14.6 630 39 Park Lane 100 1,029 10.3 1,029 56 Somerset Road 52 484 9.3 483 25 Stroud Green 52 512 9.9 501 35 Weston Park 86 943 11.0 936 55 Stuart Crescent 50 541 10.8 541 41 TOTAL 770 8,058 10.5 7,902 413 Congenital Malformations Details of children born with a congenital abnormality continued to be passed to the Registrar General. During he year 89 cases were notified, suffering from abnormalities as listed below:— Diagnostic Group Congenital Malformation No. 0.1 Anencephalus 4 0.4 Hydrocephalus 6 0.8 Spina bifida 9 0.6 Other specified malformations of brain or spinal cord 1 1.1 Anophthalmos and microphthalmos 1 1.9 Other specified malformations of ear 1 1.6 Unspecified malformations of ear 2 2.1 Cleft lip 5 2.2 Cleft palate 6 2.3 Hiatus hernia 1 2.7 Rectal and anal stresia and stenosis 2 2.9 Other special malformations of alimentary system 1 5.2 Undescended testicle 2 5.3 Hydrocele 3 5.4 Malformations of male external genitalia 1 5.7 Hypospadias, epispadias 4 5.9 Other specified malformations of urino-genital organs (includes pseudohermaphroditism) 1 5.0 Unspecified malformations of urino-genital organs 1 6.0 Polydactyly 11 6.2 Reduction deformity hand or arm 1 6.3 Reduction deformity leg or foot 1 6.5 Talipes 20 6.6 Congenital dislocation of hip 4 6.7 Other specified malformation of upper limb or shoulder 1 6.8 Other specified malformations of leg or pelvis 2 6.9 Unspecified limb malformations 4 7.1 Malformations of skull or face bones 1 8.1 Other malformations of face or neck 1 8.3 Pigmented naevus 2 8.4 Other specified malformations of skin including ichthyosis congenita 1 8.6 Unspecified malformations of hair, nails or teeth 1 9.6 Down's syndrome (mongolism) 2 9.8 Other specified syndromes 2 9.9 Multiple congenital malformations not specified 1 TOTAL 106 45 Analysis of Pre-School children on Observation Register as at 31st December, 1971 Categories of Observation Deafness of genetic orgin in parents or siblings 47 History of maternal rubella in the first four months of pregnancy 18 Gestation 36 weeks or less 231 Birthweight under 4 lbs 39 Moderate or severe birth asphyxia 350 Difficulty in sucking or swallowing 4 Failure to thrive not explained by simple feeding problem 80 Convulsions 7 Cyanotic attacks or severe apnoeaic spells 25 Abnormal neurological signs in neo-natal period 36 Haemolytic disease of the newborn 183 Congenital abnormalities 201 "Late" or "Late Intake" 202 Mother in care of mental health service 19 TOTAL 1,442 Number of children born during the year 4,292 Number placed on observation register 713 (16.6%) Where there is a particular risk of deafness, children are examined at the audiology unit as well as at the routine child health sessions. 124 such young children were seen at the unit during 1971. Analysis of Pre-School Children on Handicapped Register at 31st December, 1971 Categories of Handicap Partially-sighted 5 Physically handicapped 44 Deaf 1 Mental handicap 52 Partially-hearing 3 Miscellaneous 12 Total 117 Nursing Services Miss M. Smith — Director of Nursing Services Health Visiting As in previous years, the full establishment of health visitors could not be achieved. Vacancies at the end of the year were 5.6 compared with 6.4 at the end of 1970. The one additional member of staff resulted in increased home visits, an essential part of this preventive service. Home visits made by Health Visitors:— 1970 1971 Expectant Mothers 1,824 2,234 Children under 1 year 10,346 11,937 Children aged 1 -2 9,718 11,600 Children aged 2-5 16,102 17,474 Other cases 2,654 2,969 TOTAL 40,644 46,214 Student Health Visitors The two sponsored student health visitors, on completion of their training in September, were successful in obtaining the Health Visitors Certificate and were appointed to the staff. Four students commenced the year's training in September 1971. Training of student Health Visitors and their subsequent recruitment unfortunately 46 does not result in achieving full establishment but helps to fill the gaps left by Health Visitors reaching retirement age and those leaving the service to start their own family. Some real incentive to attract the younger Health Visitors back to the service is required. Student Nurses Twenty-five student nurses from the Prince of Wales's Hospital and twenty from the Middlesex Hospital were given the opportunity of three days observing the Health Visiting, District Nursing and School Health Services. Midwifery Service Following the pattern of recent years, domiciliary deliveries again showed a decrease, 229 patients being successfully delivered at home in 1971. Domiciliary midwives delivered at the North Middlesex Hospital 25 patients who were considered suitable by the consultants for early discharge. It is anticipated that a similar arrangement will be introduced during 1972 for domiciliary midwives to travel to the Whittington Hospital with their own booked personal early discharge patients, deliver them and accompany them home by ambulance. Planned Early Discharge Source of Request Number of requests received 1969 1970 1971 Hospitals in N.W. Metropolitan Region 233 268 149 Hospitals in N.E. Metropolitan Region 201 254 145 Teaching Hospitals 50 63 43 TOTAL 484 585 337 Patients nursed at home under the planned early discharge scheme 314 Patients whose discharge was unplanned or who discharged earlier than planned 371 Phenylketonuria First and repeat Guthrie tests on the early detection of phenylketonuria numbered 955. All were found to be normal. Student Midwives Training Forty-eight students were in training during the year, eight from the Alexandra Maternity Home, sixteen from the North Middlesex Hospital and twenty-four from the Whittington Hospital. Obstetric Nurse Training Thirty students from the City of London Hospital and twenty-eight from the Whittington Hospital were given an introduction into the work of the district midwife. Home Nursing Service Group attachment of district nurses commenced in May 1970 and some minor adjustments to the original scheme proved necessary to avoid excessive travelling on the part of individual nurses. As the number of general practitioners greatly exceeds the number of nurses, individual nurses were attached to group practices and groups of doctors. Nurses endeavour to visit the doctor once weekly. Where doctors are working alone and there are few referrals, patients are visited and treated by the district nurse whose practice area is nearest. Inevitably, in these circumstances, frequent and regular visits to individual doctors are impossible to achieve. Patients attended were referred from the following sources:— 47 Source 1970 1971[/$$$] General Practitioners 1,467 1,437 Hospital 748 762 Chest Physician 8 8 Health and Social Services Departments 113 112 Old People's Welfare 28 26 TOTAL 2,364 2,345 The following table shows the work of the nurses: — 1970 1971 New patients attended 2,364 2,318 Total number of visits made 104,286 109,375 Number of visits of over 1 hour duration 1,781 2,317 The need for district nursing service shows a steady and continued increase. In 1968, 2,004 new patients were treated as against 2,318 in 1971. Total visits paid in 1968 were 84,618 while the total for 1971 was 109,375. There appears to be a continuing increase in the demand for home nursing service, as hospitals follow the trend for earlier discharge of patients to the care of general practitioners and the home nurses. The following gives an indication of the type of treatment provided:— Injections 27,079 Dressings 25,445 General Nursing Care 21,812 Enemata 127 Blanket Baths 13,989 Scabies 245 Maternity Complication 26 The Marie Curie Memorial Foundation gave night and day nursing care to twelve patients in the terminal stage of cancer. Family Planning The service provided by the Family Planning Association continued as in previous years, the Council paying the consultation and advice fees for all cases, and in addition the cost of contraceptive supplies for cases in the priority medico/social categories. The number of cases paid for during the year were — priority cases 664; non-priority cases 3,927. During the year an additional weekly clinic session was established at Stroud Green Clinic, and at the end of the year 12 weekly and 1 fortnightly sessions were being held in the Borough. The domiciliary scheme continued as previously, and 300 cases were dealt with during the year. I am indebted to Dr. E. Christopher for the following report on the work of the domiciliary service since its inception in 1968: — Domiciliary Family Planning Service February 1968 - February 1972 Dr. E. Christopher The domiciliary service was started in order to provide family planning advice for those families who find it difficult to attend clinics. Total No. of referrals 555 No. being visited — 346 No. referred in first year 54 4/month No. referred in second year 90 7/month No. referred in third year 177 14/month No. referred in fourth year 234 19/month 48 Characteristics of family Total No. of children of 555 families 2,109 3.8 children/family No. of children dead 69 No. of stillbirths 34 No. of spontaneous abortions 114 No. of terminations 53 2,379 4.2 pregnancies/family Marital Status Married 432 123 one parent families Single 81 Divorced 27 Separated— 15 Ages 13 years 1 15 years 5 16 —20 years 52 21 -25 years 57 26 - 30 years 172 30 + years 168 Nationalities U.K. 237 W.I. 204 Eire 62 Gr. Cyp. 18 Turk. Cyp. 6 Indian 14 Italy 7 Ghana 3 Spain 1 Iraq 1 Chinese 2 Number living on social security — 160 (30 men unemployed 9 men in prison). This may not be an accurate figure as women are not specifically asked about their social circumstances. Number of children in care — 50. No. of children 0 1 2 3 4 5 6 7 8 9 10 No. of families 3 43 87 130 122 79 41 26 17 5 2 Referring Agents Health Visitors Park Lane 165 Social Services 33 Lordship Lane 141 Homeless Families Unit 28 Chestnuts 41 Hospital Whittington 16 North Middlesex Somerset Road 33 Assistant Medical Officer 16 Stuart Crescent 21 General Practitioner 10 Gordon Road 11 Probation Officer 2 Weston Park 5 District Midwife 1 Fortis Green 3 N.S.P.C.C. 1 Church Road 3 Other Domiciliary Services 3 423 F.P.A. Clinic 3 Self Referral 19 132 There were no referrals from: — Mildura Court Burgoyne Road Stroud Green 49 Method chosen (numbers) Male sterilisation 61 Female sterilisation 77 Awaiting female sterilisation 2 Awaiting male sterilisation 5 Using sheath 43 Using cap 9 Using pessaries and coitus interruptus 11 Using IUD 108 (69 attend clinic on their own) (11 taken regularly by nurse) (28 visited at home by doctor) Using oral contraceptive 152 Pregnant at present 10 (2 awaiting termination) Not yet settled 7 Deciding to use own method sheaths or coitus interruptus 26 Moved away 26 (17 of these established on contraception) Died 1 Refused advice 18 Of the 18 women who failed to accept advice 4 did so for religious reasons. 2 — were West Indian Jehovah's Witness 1 — was Iraqi Jew 1 — was Irish Roman Catholic 3 were subnormal unmarried mothers (one was West Indian, two were British). 1 was chronic schizophrenic (West Indian). 1 was chronic alcoholic (Irish). Of the other 9 — 6 were unmarried (3 of these were West Indian, 3 were British). These 18 women had a total of 73 children: average 4 children/family. The women who refuse advice are often apathetic and lonely with deep feelings of inadequacy. They feel that they are worthless. The only thing that they can do is have babies and this gives them self-esteem. They become solely concerned with their reproductive function; they may have many different partners; sex is unimportant, it is a means to an end. For them to accept contraception means denying themselves of their most precious possession— their fecundity. These women are so often rejected by their own mothers and do not grow up with a sense of their own uniqueness and worth. They are thus unable to give this to their own children and may reject them in turn as they cease to be babies and become toddlers with their own wishes and demands. Intensive individual care and interest must be given to such women to give them a sense of their own personal value. The social services usually become involved with the secondary problems of such families — the bad housing, debts, neglected children and these are often so overwhelming and absorbing that it is not surprising that the primary psychological problems may be shelved. Some of the unmarried mothers with perhaps 2 — 3 children also come into the above category and an awareness of the above factors may enable early recognition and help to be given to such women before they become overburdened. Number of pregnancies occurring after domiciliary visit 49 (a) of these the number going to term and having babies 28 5 of these pregnancies were planned and wanted 16 were unplanned and result of method failure Sheath failure 6 Failure of women to take O.C. properly 7 IUD expelled 2 Vasectomy failure 1 7 became pregnant because of failure to become established on any method. (6 are now using reliable method of contraception). 15 women were pregnant at time of referral and went to term and had their babies. 8 of these were sterilised postpartum at hospital outside the Borough. 50 (b) number requesting termination who got pregnant as result of method failure 21 Sheath failure 7 Failure of women to take O.C. properly 4 IUD expelled 2 IUD failure 1 Pessary failure and coitus interruptus 7 7 of these were sterilised at the same time. (c) 18 women were referred to the service for termination and sterilisation 3 women were referred for termination only at hospital outside Borough 3 women who were pregnant at time of referral obtained back street abortion — one of whom died. Female Sterilisation 77 Nationality English 26 Eire 5 Gr. Cyp. 2 Italian 1 W.I. 43 77 Ages 20-24 11 25 -29 25 30 - 34 19 35 + 22 77 Total number of children — 392 5.1 children/family Number of children 123 456 789 10 Number of families 1 7 9 15 16 9 10 5 2 2 Reasons for requesting sterilisation — Medical=25 Women with subnormal intelligence unable to cope with family 3 Mental Illness 12 Hypertension 2 Disseminated sclerosis 1 Child with retinoblastoma 1 Child with osteogenesis imperfecta 1 Epilepsy 1 Children physically handicapped 4 25 6 women not married 52 Social and Medical Reasons Male Sterilisation 61 Nationality Ages English 47 Eire 6 W.I. 7 Ind. 1 20-24 1 25 - 30 27 31-34 13 35 -39 12 40 + 8 61 Total number of children — 253 4.1 children/family Number of children 2 3 4 5 6 7 8 9 Number of families 7 15 17 13 5 3 - 1 51 Reasons for request — Medical = 13 Muscular dystrophy 1 Wife had disseminated sclerosis 1 Wife had rheumatic heart disease 2 Wife had deep vein thrombosis 2 Wife had rheumatoid arthritis 1 Husband epileptic 2 Mental Illness 4 13 Medical and Social 48 Male sterilisations performed at Marie Stopes Clinic 1. The number of referrals to the domiciliary service have continued to increase mainly from health visitors. However, there has only been one referral for February 1971—February 1972 from the social services possibly due to the reorganisation that has taken place this year. There has been an increased number of unmarried mothers referred to the service. A gratifying affirmation of the success of the domiciliary service has been the "self-referral" by women who have heard of the domiciliary service from relatives and friends. This may look like "sex on the rates" but these women were all in need; many of them were unmarried mothers living in welfare accommodation. One woman who referred herself had 2 children and her husband was in prison and due for release. She told me that she went to her G.P. for advice but found that he wanted her to pay £3 for a prescription for the pill. Her sister-in-law was receiving the pill through the domiciliary service and so we were contacted as she could not afford £3. It has been encouraging to have had a number of patients referred from the North Middlesex Hospital mainly by one of the Medical Social Workers. 2. Since my last report when the need for clerical help was shown this has been provided at the Town Hall. It has proved a great boon to the domiciliary service having this additional help because it forms a focal point where messages can be left and addresses checked etc., freeing the doctor's and nurse's time for visiting. With the number of referrals increasing each month the time has probably come for the appointment of a second nurse to share the visiting load. Mrs. Hinshelwood the domiciliary nurse (without whose hard work the service would not function) not only does home visits but also ferries women to the IUD clinic on Tuesday and Thursday evenings where necessary and there is no one to fall back on should a crisis develop. 3. Since September 1971 a student social worker from Hatfield Polytechnic College has come to work with the domiciliary service and has been allocated 4 cases. The domiciliary service could in fact act as a referring agent to the social services. A special report will be written about this at the end of the student's year. 4. The domiciliary service continues to function as a pregnancy advisory service (despite the fact that this was not its intention). Women who have terminations are followed up at home and contraceptive advice is given. So often women who have had a termination fail to keep appointments made for them at Family Planning Clinics and so do not get advice and may get pregnant and request termination again. This has not occurred with women referred to the domiciliary service for termination. The terminations and sterilisations were done at a hospital outside the Borough. The reasons for this were given in a previous report. General practitioners have continued to be helpful and co-operative. Many of the women referred for termination are referred by their general practitioners. 5. Medical Problems (a) There has been one case of pulmonary embolus, fortunately not fatal, with the pill in a 19 year old unmarried West Indian girl who already had 3 children. She now has been fitted with an IUD. (b) There have been 3 suspicious smears that were negative when repeated. All pill and IUD patients have smears performed. 52 (c) Vaginal infection with trichomonas is almost endemic among the women seen probably giving rise to one of the myths held about the IUD that "it gives you V.D.". (d) There have been a total of 37 method failures resulting in unplanned pregnancies:— Sheath 13 Oral contraceptive (patient failure) 11 IUD 1 IUD being expelled and patient being unaware that it has happened 4 Pessaries 2 There has been one vasectomy failure. A man who had vasectomy operation did not take his semen for analysis and his wife got pregnant for the seventh time. 8 men developed severe haematomas after vasectomy requiring a week off work. One man required 6/52 off work. (e) One woman who requested termination and was refused later obtained a back street abortion and died as a result in a South London Hospital. 6. Characteristics of Women referred to the domiciliary service The book "Family Intentions" by Myra Woolf published by Her Majesty's Stationery Office 1971 showed that most couples want only 2-3 children. The women seen by the domiciliary team had an average of 3.8 children. The majority of couples referred to the service have attempted some sort of family planning usually withdrawal and/or Rendells pessaries or Gynomin or Sheaths. Where couples are happy with these methods and have made them work for them (possibly because the couples are not so fertile) then no attempt is made by the domiciliary doctor or nurse to persuade them to use more reliable methods. Thus there were 26 couples who after learning about the other methods decided to go on with their own method used prior to the domiciliary visit, and did not have further visits. It is when these methods have failed resulting in a fourth or fifth child that the couple want to use a more reliable method but may fail to go to a clinic. The reasons for this may be multiple and complex. As mentioned in previous reports ignorance and embarrassment may prevent women going to clinics; the clinics may be held at awkward times and there are anxieties about the methods themselves especially the pill. There are now as many old wives tales about the methods as there are about pregnancy and labour. Then there are the attitudes to sex and the roles of men and women. Women are often angry when their husbands fail or refuse to use birth control, they feel it is "up to the man", he may not be "man enough" in other ways e.g. not earning an adequate wage, not giving her enough money for housekeeping so that the sexual relationship and the question of who uses contraception may become a focus for discontent with the relationship itself. The women may resent taking the pill with its risks when it is the man "who gets all the pleasure". The couples requesting vasectomy usually have used predominantly male methods of contraception. The couples requesting female sterilisation usually have used pessaries or no method at all. This is especially true of West Indian women requesting sterilisation. When men are unemployed or have low status at work they often need to demonstrate their virility by keeping their wives pregnant. They may resent the freedom contraception gives to women or be critical of side effects. One man whose wife is taking the pill has chronic osteomyelitis that has caused facial disfigurement — he is also unemployed. He became very annoyed when his wife got breakthrough bleeding with the pill and complained that it was "interfering with our sex life" and said she should get sterilised. This may also account for some of the complaints by husbands against the IUD which often results in 7 - 8 day periods. The unmarried mothers, who are not cohabiting and do not have a regular relationship find it difficult to persevere with contraception. They feel that without a regular partner it is not worth bothering about contraception. They form a vulnerable group because as a result of their loneliness they may enter into a brief liaison and find themselves pregnant again. The majority of women referred to the service do accept and persevere with contraception and many will attend clinics on their own after the initial home visit. This is especially true of these going to the IUD clinic at the Prince of Wales's but it is still difficult to get women who are using oral contraceptives to go to clinics, perhaps because of the anxieties still surrounding the pill they need the reassurance of frequent home visits. A minority of women who may have multiple problems find it difficult to persevere with contraception. It is just these women who may be receiving help from the social services and it is unfortunate that because of the recent upheavals of reorganisation within the social services departments this aspect of preventive work appearsto have suffered. Health Visitors, with their essentially practical approach, have seen family planning as another aspect of preventive medicine which when it is successful can contribute to the increased well being of the whole family. The Social Worker with his different training that places less emphasis on "direction" of his clients may be so involved with all the varied and multiple problems of families he sees that "preventive" work such as discussion about contraception may tend to get neglected. Family planning is not and cannot be 53 the cure of all social ills but where it is successful it can allow time for other problems to be dealt with. So often pregnancy may be an escape from a problem — boredom in the young teenager who has nothing to look forward to and plan for; apathy and a feeling of hopelessness in a mother of a large family living in poverty in overcrowded conditions. Contraception has to be "sold" as something that has a positive contribution to make to a family's well being and happiness. Those living in more favourable circumstances have always seen the advantages of contraception. I believe it is our job in the health and social services departments to make this information available with sympathy and tact to those families that we work with and that the domiciliary service should be seen as an additional agency that can provide this kind of advice and help. Dental Care for the Priority Classes Mr. G.C.H. Kramer, Chief Dental Officer, reports as follows:— The trend of recent years has been for a reduction in demand for treatment by the expectant and nursing mothers, and to a lesser extent for the pre-school children, who together comprise the designated Priority Classes. This trend is common in many parts of the country where dental practitioners are increasingly able and willing to accept such patients for treatment in the National Health Service. It is most desirable that the mothers should be under the continuing care of a dental practitioner instead of attending one of our clinics for only the short period of eligibility and thereafter attending nowhere and, if such regular attendance is established, there is much to be said in favour of children in the family also attending the same practitioner. In the year under review, the number of sessions devoted to the Priority Classes was fewer by 21 than in the previous year. This reflected the slightly lesser demand and was in no way due to our affording any less priority to these important classes. The small reduction in the number of sessions brought about a corresponding small reduction in the treatments provided, but there was no indication of any change in the general pattern. The statistics are as follows:— Expectant and nursing mothers Pre-school children Number examined 138 801 Requiring treatment 130 587 Attendances for treatment 379 1,655 Treatment completed 66 387 Number of fillings 215 1,388 Teeth filled 194 1,258 Number of extractions 50 331 General anaesthetics 2 118 Number of prophylaxes 91 107 Teeth otherwise conserved - 91 Other operations 137 422 Number of radiographs 24 5 Crowns and inlays 2 - Total number of dentures 12 Number of treatment sessions 280 Fluoridation of Water Supplies The Council considered the fluoridation of water supplies after they had received a request for their views from some of the consumer authorities of the Lea Valley Water Company's water supply. The Council had been given some information by the Medical Officer of Health and a considerable amount of information by the antifluoridationists. Fluoridation of water supplies as a means of improving dental health has met with most success in those countries where the cost of dental treatment falls heaviest on the patient. The Council decided by 32 votes to 27 against fluoridation although they were advised by the Health Committee that fluoridation was the most effective and cheapest way of reducing dental decay, and that the present cost of dental treatment in the Middlesex Executive Council area is £2.92 per head per annum in contrast to the cheapness of the fluoridation of water supply which in the Birmingham area is 0.91 pence per head. 54 Geriatric Services Retirement Advice Clinics continued to function at a low level of activity with only a small number of clients attending. But it now appears to have been worthwhile maintaining the level of expertise in this field gained over several years, as it was announced in 1972 that the Council had agreed to the provision of three geriatric visitor posts in the year 1972/73. With these it is hoped not only to improve the services for the elderly sick in the Borough, but to enlarge, in connection with the clinics, the means of prevention of disease, enabling as many older people as possible to live their lives to the full. The Geriatric Co-ordinating Committee further established itself as a valuable instrument for concentrating the maximum expertise of the Health Department, Social Services and Hospitals on older people who are in or near crisis. The Committee was originally formed to avoid where practicable the necessity for compulsory removal to a hospital or old people's home. It seeks to achieve this by affording the maximum choice of action to the old person concerned, ensuring that all the services enabling his or her remaining at home are provided, but at the same time pointing out any pleasanter alternatives that are within reach. Often it would seem that it is not so much that the Committee and the elderly person are of differing opinions on the right course of action, but that one is a little ahead of the other. Most problems are ultimately resolved in a manner satisfactory to both parties. Only in one case was it necessary to use the force of the law. An elderly man, in a deteriorating state of health, refused an offer of a place in an old people's home, despite persuasion from his doctor, his family and Council staff. At length, on the Thursday before Easter week-end, he was found lying helpless in bed, still refusing assistance. An emergency order under Section 47 of the National Assistance Act, 1948, was obtained from a Magistrate, and he was admitted to hospital, where he died a few days later. Fifty three new cases were referred to the Committee during the year. Twenty four old cases were kept under review. Eight went into Old People's Homes, 6 died and 45 were removed from the list with the proviso that they could be returned at any time. Two left the area. Chiropody Demands on the limited staff and resources of the Chiropody Service are so great that it became necessary, in order to treat as many as possible, to space treatments at a minimum of eight weeks, except in specially authorised cases. Applicants for domiciliary ohiropody have, when visited in the last year or so, usually turned out to be in genuine need of treatment at home, but it has been possible in a significant proportion of cases to identify other disabilities and contact agencies which would be able to help them. Chiropody No. of applications received 1970 1971 Clinic or Surgery New Cases 990 852 Domiciliary New Cases 474 383 Waiting for assessment 12 25 Number of Assessments made for Domiciliary treatment during 1970 1971 Domiciliary treatment all the year New Cases 291 291 Transferred from clinics 12 6 Domiciliary treatment winter months New Cases 16 15 Transferred from clinics 7 - Referred to Home Nursing Department for nail cutting New Cases 45 37 Transferred from clinics 2 — Clinic treatment only New Cases 55 20 Old Cases - - Cases that could be dealt with by relatives or friends New Cases - 2 Cases no action taken 21 18 449 389 1,604 clinic sessions were held during the year, including sessions for school children. 55 Patients receiving treatment at at end of year at 1970 1971[/$$$] Clinics 1,782 1,886 Private Surgeries 1,278 1,424 Domiciliary treatment 1,231 1,290 Waiting for clinic appointments 52 76 New patients on waiting list-Clinic 69 150 Patients referred to Home Nursing for nail cutting 114 1970 1971 Number of patients treated including school children 4,461 4,760 Number of treatments given at Clinics 10,651 10,251 At private surgeries 6,747 6,668 Domiciliary 5,568 5,570 School Children 1,651 1,135 Total Treatments 24,617 23,624 1970 1971 New patients treated at clinics 648 336 at private surgeries 272 366 at domiciliary 247 369 school children 269 171 Totals 1,436 1,242 Vaccination against Diphtheria, Whooping Cough, Tetanus, Poliomyelitis, Measles and Rubella The following tables record the number of persons under the age of 16 known to have received a primary course or a 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/WC Dip/Tet Dip. w.c. Tet. Polio (Sabin) Meas. Rubella Total 0-1 year 53 - - - - - 48 1 - 102 1-2 years 1,706 - 202 - - 2 1,910 1,092 - 4,912 2 - 4 years 777 2 209 - - 2 997 1,279 - 3,266 4-6 years 30 1 364 10 • 24 427 293 2 1,151 6-16 years 41 • 127 3 - 392 342 115 66 1,086 TOTALS 2,607 3 902 13 - 420 3,724 2,780 68 10,517 B. The number who received a reinforcing dose Age at date of Immunisation Triple Dip/WC Dip/Tet Dip W.C. Tet. Polio (Sabin) Total. 0 - 1 year - 1 • 2 years 55 - 7 - - 1 64 126 2 - 4 years 153 1 113 1 1 • 252 521 4 - 6 years 71 10 1,940 34 7 58 2,082 4,202 6-16 years 28 8 649 11 - 572 1,252 2,520 TOTALS 307 19 2,709 46 8 630 3,650 7,369 56 Vaccination against Smallpox The following table records the number of persons under the age of 16, known to have been vaccinated or re-vaccinated during the year by general practitioners and clinic medical officers. NOTE: Following the receipt of Circular CMO 12/71 from the Department of Health & Social Security, dated 12 July 1971, smallpox vaccination in clinics ceased. Under 1 year 1 year 2 - 4 years 5 - 15 years Total Number of primary vaccinations 15 295 1,286 134 1,730 Number of re-vaccinations — 2 108 1,166 1,276 Infectious Diseases W.T. Orton, Deputy Medical Officer of Health A significant and increasing proportion of intestinal infection orginates abroad, tourists being particularly vulnerable. We must, therefore, hope that some Southern European countries will, in the future, undertake adequate practical means of prevention of salmonellosis, especially typhoid and paratyphoid fevers. Measles Measles vaccination has so distorted the normal biennial pattern of measles that it is no longer possible to be certain of a definite seasonal variation. However, there was evidence of a rise during the winter, reaching a weekly maximum of 75 at the end of February which fell away to below 10 in May, where it remained for the rest of the year. There was a total of 882 notifications, an unnecessarily high figure resulting from the failure of many parents to have their children vaccinated against measles. Meningococcal Meningitis A young child attending a private day nursery developed a fulminating infection which rapidly proved fatal. In view of the urgency of the situation, a local general practitioner prescribed one of the sulpha drugs for all those who had been in close contact, in case any of them were incubating the disease. All the family doctors involved were informed of this action and concurred with it. No other cases developed subsequently. Enteric Fever Infections of this kind, usually taking place abroad, have been more common this year. The one case of paratyphoid was evidently infected on holiday in Spain. On contacting the travel agency concerned it was found that a member of their staff had had gastro-enteritis which could have had the same origin and have infected the patient. The Department of Health was informed but it is not known whether any action was taken by the Spanish authorities. Two cases of typhoid occurred after visits to India. Another took place in a child who had been to Turkey. His illness presented as a fever of unknown origin, and all investigations proved negative. Only after he was discharged from hospital cured was a report received which gave clear serological proof that he had had typhoid. There were considerable language difficulties in investigating an infection in a young man who became seriously ill after returning from Italy. It eventually became evident that either the disease had had an unusually long incubation period or he had been infected after return. Enquiries were made in various local cafes he had visited and specimens obtained, but all were negative. It would appear that the former explanation is probably the correct one, especially since the organism was of a type usually found in Italy. An exceptionally difficult problem, which has not been completely solved at the time of writing, began when a family containing a known typhoid carrier moved in to Haringey from a neighbouring borough. Normally typhoid carriers are not difficult to deal with from a public health point of view as long as they are not food handlers or work very closely with young children, and most accept our advice on personal hygiene and are not a danger to the public. We were, however, anxious about this lady, who herself had been infected abroad, and had subsequently passed on the disease to two relatives and a neighbour's child. She was visited at frequent intervals, warned about the risk of the spread of infection, advised on hygiene and, as she was known to have an unhealthy gall bladder, she was advised about an operation which could probably improve her health and might also render her free from infection. Later on, one of her own children took ill with the disease and she has now decided to have the operation. 57 Food Poisoning Salmonella typhimurium was the organism encountered most frequently during the year, followed by Salmonella enteritidis. One patient suffering from the former infection unfortunately developed a carrier state which did not clear up until seven months after the date of the original infection. This had necessitated his giving up the part of his work which involved food handling. An unusual infection, Salmonella aba, developed in a home run by the Council in another local authority area. The Health Department co-operated closely with the Social Services Directorate and the other Health Department in bringing the outbreak under control. Detailed enquiries failed to reveal the sources. The organism proved to be persistent and, on recent appraisal, was still found to be present in one of the original patients. Rubella Subsequent to the decision of the Council in July, 1971, to reverse its previous policy not to undertake rubella vaccination of girls aged 11 to 13 years, it had been hoped to begin this in the autumn of 1971. This had to be postponed, however, due to the heavy demands on medical staff but the programme was set in motion using mainly senior medical officers early in 1972 and completed before midsummer. Psittacosis The considerable trade in exotic foreign birds is a cause of growing concern. The effect on the birds themselves is usually disastrous, most do not survive the experience; but there is also evidence that the owners too may have cause for regret. In co-operation with its veterinary adviser the Health Department investigated a small outbreak of psittacosis, a disease of birds of the parrot family which is highly infectious to human beings. An Amazon parrot was found to be ill when purchased and died after about a month. By this time the owner had developed an influenzal type of illness strongly suggestive of psittacosis. His wife developed a cough. Both recovered. A specimen of his blood was highly positive for the disease, the wife's indicated a mild infection. A post-mortem carried out on the parrot resulted in findings highly suspicious of psittacosis. There was also some anxiety in the Department because one of the staff visiting the shop concerned developed a cough during the inquiry; but fortunately he was found not to have been ill from this cause. There is a general opinion in the medical and veterinary professions that there should be tighter legal controls over the importation of exotic birds. Lead Poisoning A London Children's hospital requested the assistance of the Health Department in the case of a five year old boy who had been admitted suffering from lead poisoning, caused by chewing paint. The home was visited and samples taken for analysis and the paint responsible for the poisoning was identified. The parents, however, refused to remove the paint on the grounds that they intended to leave that house. It was decided to keep the child in hospital and, as soon as they stated the address of their future home, this too was visited and paint samples taken for lead estimation. This revealed that some of the paint there would cause lead poisoning if chewed. It was then found that removal of all this paint and replacement by modern low lead paints would cost more than £200. Eventually this was arranged with financial assistance from the Director of Social Services. Subsequently the child was discharged from hospital and has been in good health since, with no recurrence of his abnormal dietary habits or his lead poisoning. Sexually Transmitted Diseases Any hopes that might have been raised by the 1970 figures for attendance at the Special Clinic at the Prince of Wales's Hospital which were about the same, if not slightly lower than those of the preceding year, have been dispelled by the 1971 returns which have resumed the dizzying climb of previous years. Indeed, at 1,671 the total of venereal conditions is almost twice that of 1966, the first complete year of Haringey's existence (896). But even these give only a partial view of the real problem as it affects Haringey residents. The Prince of Wales Special Clinic is only one of many in Greater London. Some boroughs have as many as three, a few have none. It has been obvious to us for some time that we would never know the real situation until we learnt the attendances of residents of Haringey at clinics in other parts of London. Unfortunately, although all these clinics are supposed to provide these figures, many did not do so and our information was therefore incomplete. Eventually, it was decided to write individually to all the clinics which did not send us returns, asking them to let us have them in future. These have almost all been received, with the exception of a very few from distant clinics where the numbers would be nil or extremely small. 58 The total of new Haringey cases suffering from sexually transmitted diseases in 1971 was 7,149. Twenty three point four per cent, i.e. less than a quarter, attended the clinic in Haringey. If the clinics in boroughs bordering on Haringey are included, 76.6 per cent were seen in Haringey or its environs. Perhaps because of good communications to the south and west, 1,509 (21.1 per cent) attended clinics in Westminster, the City of London, and Tower Hamlets. The River Thames is evidently a significant boundary as only 65 crossed to clinics on the other side. A most encouraging development with great promise for the future was the appointment during the year of a V.D. Contact Tracer, who has already undertaken much useful work in limiting the spread of these diseases by following up contacts and arranging for them to be examined and treated. New Haringey Cases attending Prince of Wales's Hospital Clinic Year Totals of Venereal Conditions Syphilis Gonorrhea Other Venereal Conditions Primary and Secondary Other 1966 896 3 9 96 788 1967 1,101 5 15 216 865 1968 1,090 4 10 259 817 1969 1,316 4 8 255 1,049 1970 1,260 4 5 258 1,001 1971 1,671 6 13 310 1,342 Renal Dialysis Arrangements for adaptation of homes for the installation of artificial kidney machines were approved by the Minister of Health in January, 1968. Since that time thirteen homes in Haringey have been adapted, three during the year 1971. There is no doubt that the availability of renal dialysis to patients in their own homes has contributed considerably to the happiness and well being of the patients and their families and has enabled the Kidney Units in hospitals to offer treatment to an increased number of patients. So far as the community is concerned the cost of maintaining a patient at home is considerably less than if the treatment has to take place completely within the hospital. Hospital authorities provide and maintain the haemodialysis equipment and provide the relevant medical services and instruct the patient in the day to day care and maintenance of the equipment. They also pay for the extra cost of electricity as well as for the installation and rental of a telephone where necessary. Installation of the equipment normally requires a room not less than about 10 ft. x 12 ft. which is suitable for a single bed and the dialysis equipment. Space for a sink with a good supply of hot and cold water, a water softener, electricity supply and storage space for sterile dressings and concentrated fluids must also be allowed for. The walls and ceiling are made washable and free of cracks and the flooring is covered with a sealed waterproof covering which is extended up the walls and the raised threshold, installed at the door. These adaptations which include special connections to the sewerage system are currently costing approximately £400 each. During the year one room, the first to be adapted in the Borough (in 1968) had considerable work carried out to bring the room up to present day standards. HEALTH EDUCATION In Schools Health Education programmes continue in the schools and arouse interest in both teachers and pupils. This is seen by the many requests for the section to participate in the school curriculum and the increased use of the section's audio-visual aids. A revised audio-visual aid catalogue was produced to assist schools. Once health education has been introduced in the syllabus it is encouraging to see that it remains on the timetable, although encouraging this throws increased demand on the health education officer's time and it is not always possible to provide other departmental personnel to participate in school programmes. To assist teachers to carry out health education in schools the section arranged a series of eight talks, at the Teachers' Centre in the Spring Term. The aims of the talks were to give teachers information on the medical/social problems of today, to discuss their presentation within the school curriculum and emphasize the Services and audio-visual aids available in the Borough. Speakers were drawn from the Health Department, Marriage Guidance Council and the Family Planning Association. 59 To assess the amount and nature of sex education being carried out in schools the Education Service, in co-operation with the Health Department, sent out a questionnaire to all primary and secondary schools. Two separate meetings of secondary and primary head teachers were held to discuss the results, and it was proposed that a working party be formed to investigate the possibility of in-service training for teachers in health education. A new series of first aid lectures for a small group of fifth form pupils taking C.S.E. human biology, resulted in a high standard being attained by these pupils in comparison with more able pupils. The health education officer repeated the first aid course in the Autumn Term for those pupils due to take the C.S.E. exam in 1972. Pupils taking part in these first aid courses, also take the St. John's Junior First Aid Exam. Health Education in schools and Parent Teachers Associations covered a variety of topics concerning dental health and nutrition, drugs, smoking and health problems, first aid, food hygiene, sex education including child development, ante-natal and post-natal care, contraception, venereal diseases. Local Authority and National Health Services. A total of 118 talks was given in 6 primary schools and 7 secondary comprehensive schools, to a total of 1,730 school children. Cervical Cytology Publicity The health education section co-operates closely with the Haringey Women's Cancer Control Committee in publicising the cervical cytology services in the Borough. At the beginning of the year the Committee distributed literature and the Borough's cervical cytology application forms to every household (in the area encompassed by St. Ann's Road, Seven Sisters Road and Harringay Stadium). As this is a small committee with limited resources and time, it was decided later in 1971 that more women in the "at risk" group could be better approached through letters from their general practitioners. A doctor attached to the group practice at Stuart Crescent Health Centre provided the first list of these women. The Committee members met monthly at the Health Centre to carry out the clerical work involved. It would appear from these first results that women respond more readily to this personal contact, than to the time consuming door-to-door leafleting previously carried out by the Committee members. It is planned to offer this service to other general practitioners. Publicity material was also circulated to the staff welfare officers of factories and other large commercial concerns, this resulted in requests for cervical cytology sessions in some of these establishments. "Welcome to Citizenship" Exhibition 1971 The section was responsible for providing the Department's display depicting some aspects of the personal and environmental health services of the Borough. The display was geared to the new voters and the school parties who also attended the exhibition. Health Education to other Establishments and Outside Organisations The health education officer gave lectures on the School Health Service to students on the Medical Secretaries Course at Tottenham Technical College. Talks continue to be given on request to youth organisations, women's and old people's clubs. Audio-visual aids and other equipment are frequently loaned to these groups. The section continues to support health visitors with films etc. for their mothercraft and relaxation classes, also providing audio-visual aid material and talks for the in-service training of pupil midwives and student public health inspectors. Film shows are arranged for the professional members of the staff relating to the various aspects of their work. Publications A third audiology booklet, "Notes on Unilateral Deafness" was produced in conjunction with Dr. Fisch, Consultant Otologist. This booklet, together with the two previous booklets, "Notes on High Frequency Deafness" and "How to Talk to the Elderly Deaf" has had national and world-wide distribution. Re-housing — Assessment on Medical Grounds The number of cases referred to the Health Department for assessment of their priority for rehousing on medical grounds rose from 715 in 1970 to 921 in 1971. 60 As can be seen from Table 2, 78 cases during the year were considered urgent enough to be referred direct to the Housing Tenancy Selection Panel on medical grounds. The Health Department has a growing list of such urgent cases waiting to be heard by the Panel, and there are still many who have been approved by the Panel but are waiting for suitable accommodation to become available. The great need for ground floor and warden assisted flats for elderly and disabled people continues to delay the rehousing of these very needy medical cases. During 1971 a new scheme for the assessment of medical cases has been adopted. Previously, any housing applicant who felt he had medical grounds for priority was asked by the Housing Department to obtain a supporting letter from his general practitioner. This resulted in general practitioners being inundated with requests for letters and put them in the difficult position of not really being able to refuse a request, even though they might feel the applicant's medical claims were not very strong. Under the new scheme, which has been adopted by several London boroughs, housing applicants who think they have medical grounds for priority are given a form to fill in stating their medical reasons, and the names of their general practitioners and/or hospital specialists. These forms are passed to the Health Department for assessment by a Senior Medical Officer and, in many cases, a judgment of the medical priority can be made without further delay. If and when the Medical Officer requires additional information he will write to the general practitioner or hospital specialist concerned, who can write an unbiased and more medically detailed reply, knowing that it will be sent confidentially direct to the Medical Officer of Health. The scheme was implemented in August, 1971 and so far seems to be working well. From the Medical Officers' point of view it reduces the number of time-consuming home visits, because more accurate information can be obtained from the general practitioner. A growing number of Council tenants who request transfers of housing on medical grounds, are referred each year to the Health Department by the Housing Department. A considerable number of these are from people who find life in a tower block of flats intolerable, and develop such symptoms as depression, nervous instability, claustrophobia, fear of heights and fear of lifts. While these cases are considered sympathetically they are not usually given very high priority on medical grounds because there are other cases with well-defined physical ailments who need to be helped first. As can be seen from Table 2 159 cases were recommended for a transfer on medical grounds in 1971. The fact that there are so many requests for transfer from people with "nervous" disorders, very often supported by their general practitioners, indicates that high-rise blocks of flats are not the ideal way of solving the housing problem. TABLE 1 Housing Assessment on Medical Grounds Month No. of cases Housing Dept. Source of Request Hospital, G.P. or Clinic Tenant, HV, PHI etc. January 48 38 8 2 February 91 67 22 2 March 57 32 13 12 April 101 87 7 7 May 110 98 7 5 June 59 36 13 10 July 49 33 8 8 August 50 23 12 15 September 80 54 17 9 October 125 94 12 19 November 93 68 6 19 December 58 51 2 5 Total * 921 681 127 113 * These figures include second investigations carried out during the year 61 TABLE 2 Medical Priorities recommended during 1971 No. of cases Special — refer to Panel 78 1 st degree 215 2nd degree 137 3rd degree 132 Recommended for transfer 159 Recommended for hostel accommodation 2 accommodation to be shared 9 priority when Clearance Area is being rehoused 4 Recommended to be referred to other sections 5 79 cases were investigated where no medical recommendation was made. These figures include second assessments made during the year Staff — Medical Assessment or Examination Assessments without examination Medical Examination For admission to service or superannuation 1,415 24 For extension of service 11 2 After long-term sickness 31 28 Not completed — returned to work or retired 43 — Teaching Staff Teacher Trainees 250 Teachers on first appointment 115 Hornsey College of Art — end of term teachers 72 On behalf of other local authorities 4 Total dealt with 1,500 495 Assessments shown by Services Service Medical Assessments Extension of Service Superannuation Fund Without examination Examined Architect's 15 - - Baths 3 1 — — Catering 1 - — - Chief Executive's 40 - - - Cleansing & Transport 7 1 - 3 Comptroller & Treasurer 27 — - - Education 919 20 13 4 Engineer & Surveyor's 59 4 - 9 Health 68 - - — Housing 37 - - - Libraries 21 — - - Parks 1 — — — Planning 18 - - - Public Control 1 — — — Social Services 185 — — — Valuation 7 — — — Tottenham Technical College Students 30 - - 1,439 26 13 16 62 PART III SCHOOL HEALTH SERVICE REPORT OF THE PRINCIPAL SCHOOL MEDICAL OFFICER FOR THE YEAR 1971 EDUCATION COMMITTEE 1971/72 Councillor Mrs. S.A. Berkery Smith JP (Chairman) Councillor D.F.W. Billingsley (Vice-Chairman) Alderman C.C.H. Chalker BA Alderman V. Gellay BSc MlnstP ARIC Alderman Mrs. N. Harrison Councillor Mrs. L.A. Angell Councillor Mrs. G. Atkinson Councillor D. Clark Councillor Miss R. Harris TD Councillor A.G. Hudson Councillor Miss S.A. Jones Councillor Mrs. E. Murphy Councillor G. Murphy Councillor G.W.C. Peacock Councillor P.P. Rigby JP Co-opted Members Mr. J.G. Elkington BA Mr. R.E. Grout Mrs. H. Peston Fr. A. Pollet Schools Sub-Committee Councillor Mrs. L.A. Angell (Chairman) Alderman Mrs. N. Harrison (Vice-Chairman) Alderman V. Gellay BSc MlnstP ARIC Councillor Mrs. S.A. Berkery Smith JP Councillor D.F.W. Billingsley Councillor Miss R. Harris TD Councillor A.G. Hudson Councillor V.N. Jary Co-opted Members Mrs. C.P. Payne Mr. S. Edwards PRINCIPAL SCHOOL HEALTH STAFF J.L. Patton, MB ChB MFCM(RCP) DPH Medical Officer of Health and Principal School Medical Officer W.T. Orton, MB BCh BAO MFCM(RCP) DPH Deputy Medical Officer of Health and Deputy Principal School Medical Officer Mary C. Douglas, MB ChB MFCM(RCP) DPH Principal Medical Officer (School Health) G.C.H. Kramer LDS RCS Chief Dental Officer and Principal School Dental Officer 64 To The Worshipful the Mayor, Aldermen and Councillors of Haringey I have the honour to present for your consideration the report on the work of the School Health Service for the year 1971. The year has seen one important change in that the William Harvey School, which was formerly a Training Centre and the responsibility of the Health Department, is now a school and therefore an Educational responsibility. I am pleased to say that this change has not affected the teamwork between teachers and medical staff which is so necessary in a school of this sort. The school was built to meet a need based on estimates made in 1967, but having met this estimated need we find a new problem in that some arrangements must be made so that all the school leavers have somewhere to go. We find also that the school is having to deal with more than the estimated number of children requiring special care. The opening of the Moselle School in 1971 has provided a useful service for some children who need more care than can be given in ordinary schools. The Council were anxious about the effects of the withdrawal of free school milk from children aged 7 to 12 and in the Report I described the arrangements which have been made so that an increased number of children are now receiving free milk on the grounds of health. During the year the Inter-services Committee on Youth has set up a working party on youth consultation centres and we have been recommended to set up a pilot scheme consultation service to offer facilities for the diagnosis treatment and counselling of adolescent psychiatric problems on a day attendance basis. In the reorganisation of the Health Service now pending the future of the School Health Service is uncertain. Will it remain with the Education Authority or will it pass with the Personal Health Services to the new Area Health authority? Once again I am pleased to record thanks to all those who have contributed to the work of the School Health Service, the Chairman and Members of the Education Committee and the Chief Education Officer and staff who during a difficult year have given us their usual efficient co-operation at all levels and above all may I pay tribute to the teachers on whose enthusiasm and support we are increasingly dependent. J.L. PATTON MB ChB DPH Principal School Medical Officer 65 SCHOOL HEALTH SERVICE Dr. Mary Douglas, Principal Medical Officer School Population The School population of the Borough on 20 January 1972 was as shown in the following table:— Primary Schools and Nursery Classes 24,828 Nursery Schools 370 Secondary Comprehensive Schools 13,101 Other Secondary Schools 1,072 Special Schools — The Vale School (for Physically Handicapped) 87 Blanche Nevile School (for the Deaf) 155 (including classes for partially-hearing) The Moselle School (for Educationally Sub-normal) 73 William C. Harvey School (for severely Educationally Sub-normal) 101 Suntrap Residential Open-Air School 100 TOTAL 39,887 Medical Examinations in School The medical examination of the school child is designed to prevent any handicap impeding the child's ability to learn. Particular attention is therefore directed to the supervision of the special senses. Routine medical inspection of the school children is undertaken on entry to school and in the final year of school life. At other times examination is by selection. Such children may have been found to have a defect at a routine medical inspection or they may be selected for examination at the request of the parent or Head Teacher. The school doctors try to visit their schools at regular intervals so that they may be available for consultation with the Head Teacher or staff. The schools for handicapped children receive visits from a medical officer at least once a week. Periodic Medical Inspection The following table shows the number of children inspected by years of birth and the classification of their physical condition:— Year of Birth Number of Pupils inspected Physical Condition of Pupils inspected Satisfactory Unsatisfactory Number % Number % 1967 & later 266 266 100 - - 1966 1,631 1,628 99.8 3 0.2 1965 2,491 2,486 99.8 5 0.2 1964 863 861 99.8 2 0.2 1963 424 420 99.1 4 0.9 1962 336 335 99.7 1 0.3 * 1961 * 762 * 759 99.6 *3 0.4 * 1960 * 937 * 936 99.9 *1 0.1 * 1959 * 562 * 559 99.5 *3 0.5 1958 247 244 98.8 3 1.2 1957 696 694 99.7 2 0.3 1956 & earlier 776 774 99.7 2 0.3 TOTALS 9,991 9,962 99.7 29 0.3 *Signifies Selective Medical Examinations In the Appendix to this report will be found an analysis of the defects found at periodic medical inspections to require treatment or observation. 66 "U" Children 1971 Twenty nine children were seen at routine medical examinations and were classified by the examining doctor as "unsatisfactory" and these included many cases of malnutrition of different types. The total included eleven obese children, and five children who were under-sized or flabby and therefore were alleged to be suffering from some degree of malnutrition. In many instances the failure to put on weight was due to failure in secondary absorption, either because the child was educationally sub-normal or suffered from constitutional disease, and not from any failure on the part of the parent or school to provide the child with adequate food. The remaining children in this category suffer from a variety of conditions including asthma, educational subnormality and congenital defects. Other Medical Inspections The following are the numbers of special inspections and re-inspections carried out during 1971. A special inspection is one which is carried out at the special request of a parent, doctor, nurse or a teacher, usually at a school clinic. Number of special inspections 3,070 Number of re-inspections 2,241 TOTAL 5,311 An analysis of the defects found at special inspections to require treatment or observation will be found in the Appendix. Medical Treatment Details are given in the Appendix 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. 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. Although it is the duty of the local Authority to ascertain these children from the age of 2 years, it is desirable, especially in the case of blind, deaf and 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. Therapeutic education cannot start too early in the life of a child and his parents, whatever the handicap. The School Health Service and Handicapped Pupils Regulations 1953 defined the various categories of handicapped pupils as follows:— (a) Blind—pupils who have no sight or whose sight is likely to become so defective that they require education by methods not involving the use of sight. (b) Partially sighted—pupils who by reason of defective vision cannot follow the normal regime of ordinary schools without detriment to their sight or to their educational development, but can be educated by special methods involving the use of sight. (c) Deaf — pupils who have no hearing or whose hearing is so defective that they require education by methods used by deaf pupils without naturally acquired speech or language. (d) Partially hearing — pupils who have some naturally acquired speech and language but whose hearing is so defective that they require for their education special arrangements or facilities though not necessarily all the educational methods used for deaf pupils. (e) Educationally subnormal — pupils who by reason of limited ability or other conditions resulting in educational retardation require some specialised form of education wholly or partly in substitution for the education normally given in ordinary schools. (f) Epileptic — pupils who by reason of epilepsy cannot be educated under the normal regime of ordinary schools without detriment to themselves or other pupils. (g) Maladjusted — pupils who show evidence of emotional instability or psychological disturbance and require special educational treatment in order to effect their personal, social or educational readjustment. (h) Physically handicapped — pupils not suffering solely from a defect of sight or hearing who by reason of disease or crippling defect cannot, without detriment to their health or educational development, be satisfactorily educated under the normal regime of ordinary schools. (i) Pupils suffering from speech defect — who on account of defect or lack of speech, not due to deafness, require special educational treatment. 67 (j) Delicate — pupils not falling under any other category who by reason of impaired physical condition need a change of environment or cannot without risk to their health or educational development be educated under the normal regime of ordinary schools. The ideal situation is to keep as many children as possible within the ordinary school system, even the severely handicapped. The authority must be prepared to experiment, such projects require close co-operation between the Education and Health Departments. Pupils handicapped by severe blindness or deafness are normally educated in special schools. Children with handicaps in other categories may attend ordinary schools with special consideration where necessary. The vast majority of children with speech defects are educated in ordinary schools and most children suffering from epilepsy or diabetes are able to be educated in ordinary schools. Where appropriate arrangements cannot be made for handicapped children in ordinary schools, or where the child fails to maintain reasonable progress, or is unhappy because of his disability, arrangements are made for education in day or residential special schools. As the number of children with more than one disability who do not fall clearly in one category is increasing, there is special need for facilities to assess each child's total handicap and to provide the appropriate special educational treatment. Home tuition may be arranged on a temporary or permanent basis for children who are unfit for education at school. Children who are in hospital for prolonged periods are given help from the hospital school. In the Appendix will be found a table, for which I am indebted to the Chief Education Officer, showing the number of pupils newly ascertained as handicapped, and newly placed in special schools during the year; and the distribution of ascertained handicapped children and the number awaiting placement on 20 January 1972. Special School Provision (a) Day Special Schools The following are the day special schools in Haringey:— Name of School Category of handicapped pupil Number on roll on 31 December 1971 Total Haringey children Out-Borough children The Vale School Physically handicapped 54 29 83 Blanche Nevile School (includes units at Risley Avenue Infant and Junior and Drayton Comprehensive Schools for partially-hearing children) Deaf and partially hearing 50 105 155 The Moselle School Educationally subnormal 74 1 75 William C. Harvey School Educationally subnormal 103 - 103 The children attending the partially-hearing units require special teaching because of their hearing difficulty, but are otherwise fully integrated with ordinary school life. Because the Moselle School is housed in temporary accommodation and cannot accommodate all children who require its facilities, 145 children are now attending special schools out of the Borough. It is hoped that this situation will be resolved when the new school building is opened in the near future. Partially-sighted pupils who require day special schooling are placed mainly in the Joseph Clarke School, Walthamstow or New River School, Islington and delicate pupils mainly at Hazelbury Open-Air School, Enfield. During the year two children of nursery school age attended a special class for children with difficulties of communication, held at the Wolfson Centre, Mecklenburgh Square, W.C.1. 68 (b) Residential Special Schools The Borough's residential open-air school, Suntrap School, Hayling Island, Hampshire, accepts delicate and physically handicapped children — boys of primary school age (5-11) and girls of all ages. The resident staff includes a night nurse, and a medical practitioner attends twice a week and a dental officer once a week. The number of children placed at Suntrap at the end of 1971 was 100 of whom 16 were Haringey children and 84 children from other Boroughs. Blind children are educated in residential special schools. Children with other handicaps who require residential education are placed in schools administered by other local authorities or independent bodies, apart from children suffering from severe epilepsy who are placed in hospital special schools. Hospital Classes I am indebted to the Chief Education Officer for the following report:— "Tuition for children who have been in-patients at the St. Ann's and Prince of Wales's General Hospitals continued during 1971. Because of a fall in the number of school-age children admitted to the hospitals, one of the two full-time teachers, who retired in December 1970, was replaced by a part-time teacher. Because of the wide age-range of the children (5-15 years) most of the teaching is individual but occasionally it is possible to teach in small groups. By close liaison the pupils follow as far as possible their own school curriculum subject to consideration of the child's medical progress. The teachers are helped in their work by the full co-operation of the hospital staff and the Haringey Library Service." THE SCHOOL CLINIC Medical Officer Sessions Sessions staffed by school medical officers are held to deal with minor day-to-day medical problems, the followup of defects found at periodic and other medical inspections and particular problems brought by parents. School Clinic sessions also afford opportunity for special work to be carried out by school medical officers, including weight watching and warts clinics. A medical examination is offered to all school children who are new entrants to the country, including any child who has been out of the country for a year or more and has returned. This provides an opportunity to have the childrens' immunisation and vaccination programmes brought into line with other children in the Borough and also enables parents to meet the school doctor and discuss their child's health with him. Under these arrangements 328 children were examined during the year. Home Tuition During the year 6 children received home tuition for varying periods under Section 56 of the Education Act 1944 because they were not well enough to attend school for a considerable period. Day Nurseries — Admission of Handicapped Children As in previous years, children in the following categories were admitted on a medical recommendation to the day nurseries administered by the Social Services Department without charge to the parents, the cost being borne by the Education Committee under Section 56 of the Education Act 1944, if the child was over two years old. (i) Deaf, partially-hearing, partially-sighted, physically handicapped, maladjusted. (ii) Mentally handicapped children under five years of age. (iii) Children over one year old of deaf or deaf/mute mothers. During 1971, 10 Haringey children were in attendance at day nurseries under these arrangements, and at the end of the year 6 of these children were still in attendance. Recuperative Holidays During 1971 4 boys and 5 girls were recommended for recuperative holidays in order to assist their recovery after illness, and 1 boy and 1 girl were placed in suitable homes for a period of two weeks in each case. Plantar Warts Weekly sessions continued to be held at Weston Park and Lordship Lane Clinics, to deal with Plantar warts, and Dr. K. Shah reports as follows on the work at these clinics: — "The wart clinics at Lordship Lane and Weston Park progressed satisfactorily during the past year. The figures below show the number of sessions at both these clinics and the number of cases treated during 1970 and 1971". 69 Clinic Number of Sessions Total A ttendances New Cases Number treated with electrocautery 1970 1971 1970 1971 1970 1971 1970 1971 Lordship Lane Weston Park 48 50 49 51 770 541 611 569 265 206 239 190 94 81 93 87 TOTAL 98 100 1311 1180 471 429 175 180 Weight Watching Clinics The weight watching clinic at Fortis Green Medical Centre continued during the year, and the following report has been submitted by the medical officer in charge:— "29 children attended during the year - 17 girls (7 of whom were grossly obese) and 12 boys (9 grossly obese). Of the 13 moderately obese children, 7 failed to lose weight; 6 averaged a weight loss of 3 lbs. and the best weight loss was 10 lbs. Of the 16 grossly obese children, 7 failed to lose weight; 9 averaged a weight loss of 6 lbs., and the best weight loss was 18 lbs". The weight watching clinic at Burgoyne Road continued to develop throughout the year. The medical officer in charge has submitted the following report:— "This report is based on a group of 28 girls and 16 boys who attended regularly. The girls averaged 4.7 visits to the clinic per child, the boys 3.6 visits. The ages of the girls at the first visit ranged from 6 to 17, and of the boys from 5 to 13. The mean overweight of the girls at their first visit was 32 lbs., and of the boys 29 lbs. The losses in weight of the girls during their period of attendance ranged from 39 lbs. to 8 ozs., the mean loss being 6 lbs., and of the boys from 20 lbs. to 9 ozs., the mean loss being 5 lbs. It is hoped that it will be possible to give more comprehensive figures for 1972, when the clinic will have been in full operation for a longer continuous period". Consultant Sessions Orthopaedic Clinics An Orthopaedic Consultant Session is held fortnightly at the Lordship Lane Clinic for children from the Tottenham and Wood Green parts of the Borough. For children from the Hornsey district of Haringey there is a weekly consultant session held at the Whittington Hospital. These sessions deal mainly with minor Orthopaedic defects. Details of attendances at the Lordship Lane Clinic during the year were as follows: — Consultant sessions Under 5 years Over 5 years Totals New Cases 55 109 164 Attendances 62 132 194 Physiotherapy sessions Under 5 years Over 5 years Totals New Cases 17 46 63 Attendances 66 148 214 The following are details of attendances at the Whittington Hospital Orthopaedic Clinic during the yean:- Under 5 years Over 5 years Totals New Cases 68 125 193 Attendances 73 135 208 There were no physiotherapy sessions held at Weston Park Clinic, Hornsey, because of the illness of the physiotherapist. 70 Ophthalmic Clinics Seven weekly ophthalmic sessions are held — three at Lordship Lane Clinic, Tottenham; two at Weston Park Clinic, Hornsey; and two at Stuart Crescent Health Centre, Wood Green. Dr. T.G. Kletz, Consultant Ophthalmologist to the Lordship Lane Clinic, reports as follows on the year's work:— "The work at Lordship Lane Ophthalmic Clinic is the investigation and correction of refractive errors and eye muscle defects. There are three ophthalmic sessions weekly. There is also a full time orthoptist. The ethnic survey into myopia is continuing and it is interesting to note that whilst the majority of children attending the clinic are of immigrant families, the incidence of myopia continues to be approximately double that of the native population, with by far the highest proportion in the West Indians. Total attendances — Native 40% — Immigrant 60% New cases seen — Native 37.2% Immigrant 62.8% Immigrant cases were — West Indian 57% Cypriot 10% Irish 16% Indian 14% The remainder consisting of Europeans, Africans and Far Eastern origin. Myopia — Native 16.8% of new cases seen Immigrant 32.7% of new cases seen For West Indians, 41% of the new cases were myopic. 60% of the high myopes were West Indians." 71 Dr. Peswani, Consultant Ophthalmologist to the Weston Park Clinic, reports as follows: — "The Weston Park Ophthalmic Clinic was continued with two sessions weekly. During the past two years the attendances were as under:— Under 5 years Over 5 years Totals 1970 1971 1970 1971 1970 1971 A ttendances 129 172 1,159 1,354 1,288 1,526 New Cases 61 87 380 393 441 480 As the figures show there has been considerable increase in the number of pre-school age children referred to the clinic, which / feel is a step in the right direction. / hope this trend will continue." Medical Services at the Vale School for physically handicapped children This school offers day education to physically handicapped children in the borough and also from the London Boroughs of Enfield and part of Barnet. I must again express my gratitude to Mr. A.J. Ives, headmaster of the school, and his staff for their valued co-operation with the medical staff. The medical team at the school consists of a visiting consultant, school medical officer, physiotherapist, occupational therapist and speech therapist. 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, 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. Dr. Dunham reports as follows on the work of the unit during 1971:— "The proportion of children attending the Vale School for Physically Handicapped Children who have cerebral palsy — who are "spastics" — remains at about one in three, a proportion which has been almost constant for several years. These children have in common difficulty in co-ordinating their movements, but these difficulties vary both in kind and in severity from one child to another; affected children may have other problems such as deafness as well. Recognizing these facts, the school has, as well as a visiting school medical officer, a visiting consultant whose job it is to try to sort out the difficulties of the individual child, and a whole-time therapist who, in collaboration with the parents and teachers, tries to organize the child's life so that he overcomes his movement difficulties as rapidly and as completely as possible. Where the child is attending hospital, school and home management of the child are organized in collaboration with the hospital consultant. The earlier in his life a child comes under supervision the better he is likely to respond and parents are encouraged to bring children with cerebral palsy to the school for assessment and advice on management, even before they reach school age." Of the five new cases seen at the unit during 1971, three were Haringey children and two from outside the Borough. One of these children was under five years of age and four over five. Recommendations made for the new cases were as follows:— Recommended for admission to the Vale Special School 4 Recommended for later re-assessment 1 Medical Services at the William C. Harvey School Medical supervision for the children who attend this school for the more severely educationally subnormal children is provided by a team consisting of two visiting medical officers, a full time school nurse, a part time physiotherapist, and a speech therapist who at present attends on one session a week. It is hoped in the near future to increase this provision to full time physiotherapy and an increased number of speech therapy sessions, as soon as additional staff can be obtained. The presence of a high proportion of children in the school with severe dual handicaps stresses the urgent need for increased speech and physio/occupational therapy facilities. Audiology Unit The Audiology Unit is within the curtilage of Blanche Nevile School and there is excellent co-operation between the medical and teaching staff. Three sessions are held each week. The medical team consists of a Consultant Otologist, Medical Officers, and three audiometricians. There is regular supervision of pre-school children with hearing defects and school children with hearingloss who attend ordinary schools. Pre school children with hearing loss are admitted where possible to day nurseries, play groups and where necessary to the nursery class at the Blanche Nevile School. Many of these children wear hearing aids and those not attending Blanche Nevile School are supervised by two full time peripatetic teachers who work in close co-operation with Dr. L. Fisch. the Consultant Otologist. 72 Dr. Fisch reports as follows on the year's work at the unit:— "One of the important factors in the work of this clinic is the good teamwork which is essential for all the aspects of the care for children with hearing impairment — diagnosis, assessment, continuous re-assessment, parent guidance, training and education. I am glad to report that this teamwork continued very well through the past year. Close co-operation with the Headmaster of the Blanche Nevile School for the Deaf is an important link between the clinic and the many educational aspects. When children who attend the school for the deaf or the units for partially-hearing children were re-examined and re-assessed at the clinic, the class teacher was able to attend with the child — the greatest possible help and leading to better assessment. The waiting list was kept to reasonable limits but strenuous effort is necessary to keep it so. / am glad to say that no child who needs urgent examination has to wait long. We were still one peripatetic teacher short (at present two teachers must work very hard in order to cover the most essential and urgent part of the work). / hope this situation will be remedied. / am very glad to hear that the peripatetic teachers have been upgraded. With the consequent improvement in their salaries, / hope it will be easier to acquire suitably qualified teachers for this work. Our hearing aid service greatly improved. Our audiometricians are now skilled in taking impressions from ears and the electronic engineer attached to the school keeps close watch on the hearing aids in use, repairs and maintains the instruments in good condition. There has been a significant improvement in the provision of a greater variety of National Health hearing aids and / am able to prescribe aids suited to various types and degrees of hearing loss. The peripatetic teachers train children in the proper use of the aids and supervise their use at home and in normal schools. Co-operation with the Technical Design section of the Hornsey College of Art continued. A prototype of a new free field audiometer was elaborated. This should make a significant advance in testing, especially screen testing, young children. One of the members of the staff of the college designed a new series of test cards (for testing hearing of speech) and these are now in process of validation. / hope these cards will then be produced commercially. A new booklet has been prepared in our series of booklets giving practical advice to parents and teachers concerning hearing impairment in children. The new booklet is entitled "Notes on Unilateral Deafness". These booklets are now sold nationwide in large numbers and the cost of production is more than covered by their sale. Further booklets are in preparation. The production of these booklets is made possible by the enthusiastic co-operation of the staff of the Health Education department. Visits by speech therapists, medical officers, student health visitors and other personnel were frequent throughout the year. There is an increasing demand for attendances at the clinic for instruction and teaching. Unfortunately our facilities are limited in this respect because of the lack of a one way viewing window with an observation room. The planned construction of this has not materialised as yet. The work of the clinic proceeded well during 1971 and because of the co-operation of all concerned, including the medical and educational authorities, this borough has evolved a very advanced and comprehensive audiology service." The following is an analysis of the cases seen during 1971:— Age -1 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 Total New cases in year 105 24 36 35 37 17 21 18 10 9 7 8 7 4 3 4 2 347 Cases brought forward from previous year 4 9 2 21 28 32 20 37 42 33 27 26 18 24 26 14 25 388 Re-exams of old and new cases 3 9 9 13 12 16 3 13 11 8 3 0 2 3 3 1 1 110 Total Attendances 845 Pre-School Children = 347 Attending Infant and Junior Schools = 345 Attending Senior Schools = 153 TOTAL = 845 73 Reason for referral of new cases:— For diagnosis 190 Known to be deaf, examination before admission to Blanche Nevile School 2 Immigrants to borough, known to be deaf 5 Partially hearing, advice as to placement 1 Auditory training 2 "At risk" 125 Transfer from hospital outpatients depts. 19 Advice as to placement where deafness might be the cause of backwardness 3 Total 347 35 of these referrals were from other boroughs Audiometric and Vision Screening Routine audiometric and vision screening is carried out by three full time audiometrician/vision testers. Vision testing in school by the Keystone apparatus is combined with audiometric screening in junior and secondary schools and an additional screening test is given in the last year at school. Audiometric screening is carried out twice in infants schools — in the first and last year; once in junior schools; and once in secondary schools — in the first year. 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. Audiometry is carried out for any child referred by his family doctor and the result is sent to the doctor so that he may carry out any further investigations which he considers necessary unless he specifically asks for these investigations to be carried out at the audiology unit. Vision screening by the Keystone apparatus continues to be carried out in junior and secondary schools. In infants' schools vision testing is carried out by the school nurse at periodic inspections and the orthoptists carry out screening procedures for the discovery of latent squints. KEYSTONE VISION SCREENING APPARATUS 74 The following report has been supplied jointly by an orthoptist and a senior technician:— "This method of vision testing is both accurate and quick. It takes an average of 2 minutes each child for detailed testing, including depth, perception, distant and near vision, distant and near muscle balance, also colour vision. The test can be conducted in quite restricted space with the children looking directly into the Keystone for all parts of the test. The first Keystone test is carried out on all children in the Borough aged 9 and 10 years, prior to medical examination by selection, and then at age 11/12, and at 15/16 years, so that eye defects can be detected before the concentrated learning period of the older pupil. However, it is proposed by the Principal School Medical Officer that as from September 1972, one senior school from each area in Haringey be selected and the 1st, 3rd and 5th year children be tested. It will then be possible to ascertain if any children who pass the test in the 3rd year, fail in the 5th year. It will take three years to show any results. The ideal would be that each child should have a test at least every two years but this would require another Keystone and more staff. An appropriate assessment of failure is 1 in 6 — about 17%. The Keystone has been found to be impractical for vision screening below the age of 10 years". During 1971, the follow-up by orthoptists of Keystone screening "Failures" gave the following results:— Junior Schools Senior Schools Number % (of Keystone "Failures") Number % (of Keystone "Failures") Keystone "Failures" referred to Orthoptist 331 - 430 — Confirmed as failures by Orthoptist — 238 72 369 86 Already receiving treatment 67 20 181 42 Minor defects not requiring treatment 78 24 101 23 Referred to ophthalmic clinic for investigation 93 28 87 20 Speech Therapy Mrs. E.R.P. McKeown, senior speech therapist, reports as follows: — "For most of the year one full time and six part time therapists have together practically filled the approved establishment of four full time therapists. Sessions have continued at eight school clinics, the Vale School and the William C. Harvey Special School and during the year a new clinic was established at the Moselle E.S.N. School. Student therapists have attended four clinics for practical training under the supervision of resident therapists. Numbers attending in 1971 Under five years 921 Over five years 3,888 Total 4,809 Therapists have visited schools regularly with the intention of seeing all reception classes, the newly established nursery groups and any other children referred by teachers. The Borough has a high incidence of immigrants and it has become noticeable during the year that more children from this group, particularly the very young, are being referred with delayed language development. But now that more secondary schools are being visited, it is not uncommon to find that older immigrant children are being referred for help in improving sub-standard English. This poses an interesting question whether the requirement is for therapy or special education. In the past two years regular visiting of schools and counselling of parents have become well established and the requirement for therapy services can now be better assessed. It is apparent that certain areas of the service need strengthening and this can only be effectively achieved by an increase in the establishment." Child Guidance Service The Borough has two child guidance centres under the administration of the Chief Education Officer (at Lordship Lane, Tottenham and at Tetherdown, Hornsey). Two Consultant Psychiatrists, who are seconded by the regional hospital boards, act as medical directors — Dr. Nina Meyer carrying out five weekly sessions at the Tottenham Clinic and Dr. K. Graf holding two sessions at the Hornsey Clinic. Dr. Meyer reports as follows on the year's work at Lordship Lane:— 75 "This year, although a fruitful one, has been sad, in that we have lost the help of two valued workers, namely the Play Therapist and an Educational Psychologist, both of whom have resigned in order to have their own families. It is always sad when valued workers are lost, since this work depends so much on people who are fitted for it by training and endowment. There are, however, encouraging aspects on the Haringey scene, in that there are indications of greater cohesion in the Social Services and greater communications between people working in the different fields. There is an encouraging growth of awareness of the problems facing us, the new departments seem prepared to consider new methods and approaches to increase the potential of the limited human resources at our disposal to deal with the ever-growing pressure of social and psychiatric problems. Regrettably, however, residential and educational amenities, although increasing, do not keep up with the evergrowing need. The absence of a Day Maladjusted School in this area is very crippling indeed for the work of the Child Guidance Clinic. The Tutorial Groups are valiantly trying to fill this gap, but without a doubt, we should have a Day Maladjusted School in this area, where so many children are so very disturbed for so many reasons. In this Clinic we continue to give a service as adequate as we can. One of the hopeful aspects has been increasing responsibility that the Psychologists who have been with us some time, are able to take with their cases. As a result the pressure on clinic referrals has fallen, and we are able to give more time and service to the very disturbed ones who are eventually referred to us. We have had 181 referrals: of these 6 were re-referrals; this we feel is not a bad percentage. Of the new referrals, twenty-two cases were not proceeded with, either because there was improvement, or because the child was no longer accessible to our care. There is, of course, a great deal of movement in this Borough, with families moving out and some of our cases end in this way. In such circumstances we generally refer them to the new local authority. During the year we have colosed 175 cases, of which 106 improved as a result of help from the clinic; this makes improvement reach sixty per cent. Of a further twelve cases of the 175, the mother reported improvement prior to the children being seen, and another ten had moved away; the remainder were either those who were not co-operative, did not respond to offered appointments, or had transferred to other agents, clinics, hospitals, etc. Since the children we have had to deal with are the most disturbed ones (the less disturbed being taken over by the School Psychological Service) we are increasingly using the services of hospital and in-patient units. The Psychotherapist has treated thirty-four children intensively during this year, and the Psychiatric Social Workers maintain contact with the families." Dr. Graf reports as follows on the year's work at Tetherdown:— "The scope of work in the Clinic has progressively expanded over the years and the establishment of all specialists involved has increased except for the two psychiatric sessions, which have remained unaltered now for 21 years. It is regrettable that as a result of the now definitely insufficient psychiatric establishment the Medical Director has to delegate some of the work which falls within his competence to his non-medical colleagues in the clinic, and that because of the lack of a medical assistant he has to spend much valuable time in routine work which would not require consultant expertise and experience. In accordance with developing trends in community medicine, more psychiatric time should be spent in extra-clinical activities by the consultant in Children's Homes, schools, families, etc., but this has so far been impossible to arrange because of the extent of his intra-clinical duties. In spite of the employment of two non-medical and two medically qualified sessional psychotherapists who currently have 26 children in treatment, there is still a waiting list for psychotherapy of 24 children, which although it is not excessive in comparison with other similar clinics, still re-emphasises the need for an increase in the psychiatric and psychotherapy establishment. There are at present 58 children placed in boarding schools by us. The number of children referred for Child Guidance investigation in 1971 was 234. The majority (110) were referred from schools through teachers, or by the parents themselves (30). The Chief Education Officer and Educational Psychologists sent us 26 children, while 48 came through medical sources (family doctors, school medical officers and hospital consultants). The remaining referrals reached us through the Social Services Department (9), Probation Officers, Play Group Leaders and Citizens' Advice Bureaux. It is very difficult to describe specific problems brought to the Clinic for advice, diagnosis and treatment, because most children presented themselves with a multiplicity of symptoms and complaints for which there were usually a whole constellation of causes responsible. It is very rare indeed in child psychiatry to find a case presenting with a single symptom, such as bed-wetting, and equally there is nearly always more than one reason or cause for a child's disturbed behaviour. In the majority of cases (86) it was impossible to describe any specific behaviour which led to the referral, but the causes usually lay in circumstances within the family or the immediate environment. Educational Problems (81) including learning difficulties and irregular school attendance, aggressive 76 behaviour in school and at home (20), unhappiness, immaturity or social withdrawal (31), or more specifically enuresis, soiling, stealing and telling lies (2) were among the reasons for which parents sought advice. As usual, boys (157) predominated over girls (78), the peak age for referrals was 7 years (33), the next most frequent age group was 14 years (26), which means a shift from the usual average age of 11-13, up and down the range. The majority of cases were dealt with by more or less extended advice and help given to parents (99), a large number of children (75) were helped by educational modifications including special school or residential arrangements, while only 19 cases were found in need of individual psychotherapy. The parents of 21 children referred failed to respond to our invitations to come to the Clinic, and 5 moved out of the Borough before they could be seen. Not every child required assessment by all members of the team and the psychiatrist, who has only two weekly half-days, had 130 appointments during the year, usually of one hour duration. These were spent in establishing a diagnosis (78), reviewing the progress of old clinic cases (27) or boarding school attenders (17) while one child had eight therapeutic sessions with him. The future of child guidance within the National Health Service is uncertain. Although child guidance clinics have practised community and family therapy and casework long before its importance was recognised by other medical and social agencies, and child psychiatrists created well over 50 years ago the concept of team-work which is now the basis of the new Social Services, little attention to the future of this service and the status of its staff has been given in the Seebohm Committee's recommendations or the Green Paper and Consultative Document on the Reorganisation of the National Health Service. It may well be that health, education and social services will compete for this valuable prize, but history clearly connects child guidance and psychiatric services for children with the health and education departments, and it has been my privilege as a representative at the Annual Meeting of the B.M.A. in Leicester this year to put a motion which emphasised the essentially medical nature of our service, which was unanimously accepted by the meeting. It has also been suggested that diagnostic and therapeutic clinics should be separated and organised by the education and health services respectively, but this would in my view be a mistake since diagnosis and treatment form integral parts of the same process of helping disturbed children, and / have always believed that in spite of the closest co-operation the separate areas of competence and organisation of child guidance and school psychological services will have to be maintained." Since Dr. Graf's report was written the Education Committee proposes to set up an additional child guidance centre for children in the Wood Green district of the Borough in the near future, and the North West Metropolitan Regional Hospital Board has agreed to appoint a psychiatrist to carry out two weekly sessions at the new centre. 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 1971. The following table gives details of B.C.G. vaccinations carried out by the Council during the year: — School Children Number % Parents approached 3,550 — Parents accepted 2,904 81.8 Number skin tested 2,144 — Number found positive 127 5.9 Number found negative 1,921 89.6 Number failed to attend for Mantoux reading 144 6.7 Number vaccinated (% of those approached) 1,888 53.2 Cases of Tuberculosis occuring in Teachers or Pupils Investigations were carried out on the advice of the Chest Physician at two primary junior schools where cases of pulmonary tuberculosis had occurred amongst the pupils. School (a) Classmates of the patient were investigated with the following results:— School (b) No. of pupils skin tested 19 No. referred to Chest Clinic for further investigation 3 No. of pupils skin tested 215 No. referred to Chest Clinic for further investigation 14 No additional case was discovered at either of the schools concerned. 77 Co-operation with the Prince of Wales's Hospital The Department's close link with the Prince of Wales's Hospital continues. Senior medical officers attend weekly sessions at the Rheumatism Supervisory Clinic held at the hospital under the direction of Dr. Ian M. Anderson, consultant paediatrician, and at a general paediatric clinic. I am grateful to Dr. Anderson for the following report on the year's work at the Rheumatism Clinic:— "During 1971 only one case of rheumatic fever was admitted to the Paediatric Unit at St. Ann's General Hospital. There were 66 new cases of congenital cardiac lesions seen during 1971 in Paediatric Clinics at The Prince of Wales's General Hospital. Total number of new cases in 1971 67 (Male 35 Female 32) In Haringey Borough 64 From other Boroughs 3 75% were referred from Child Health Clinics Cases classified as follows:— Total In Haringey From Other Areas Male Female Rheumatic Fever 1 - 1 - 1 Congenital cardiac lesions — 66 64 2 35 31 Innocent Murmur 44 42 2 24 20 A trial septal defects 5 5 - 3 2 Ventricular septal defects 9 9 - 4 5 Venous hum 1 1 - 1 - Pulmonary stenosis 3 3 - 1 2 Idiopathic cardiomegaly 1 1 - 1 - Mitral incompetence 1 1 - - 1 Extra systoles 1 1 - - 1 Cardiomegaly with ventricular septal defect 1 1 - 1 1 Three of the new cases have been transferred to the Westminster Hospital to attend Dr. I.M. Anderson's Cardiac Clinic there for further investigation and follow-up." A medical officer from the department, acting as registrar, attends a weekly session at the hospital held by Mr. William McKenzie, Consultant Ear, Nose and Throat Surgeon. Hygiene Inspections School Nurses continued to carry out regular hygiene inspections in the schools, to guard against the spread of infection and contagion. The following are details of the hygiene inspections carried out during 1971:— Number of individual examinations of pupils in schools 74,586 Number of individual pupils found to have nits in the hair 380 Ringworm of the Scalp Cases of ringworm of the scalp continue to occur sporadically. During the year 8 cases occurred in 3 schools throughout the Borough. I am grateful to St. John's Hospital for Diseases of the Skin for the screening procedure which they continue to carry out in these cases. No evidence of spread of infection was discovered. All doubtful cases were referred to the Consultant Dermatologist at the Prince of Wales's Hospital for further investigation. 78 Milk in Schools The Education (Milk) Act 1971 The change in the legislation meant that from the commencement of the Autumn Term, 1971 free milk would only be supplied to:— a) children in infant and nursery schools up to the end of the Summer Term next following the 7th birthday. b) children in primary schools where a school medical officer certifies that he should be provided with milk at school. c) all children in special schools. The parents of the children involved were informed and asked, if they considered that their child should receive free milk for health reasons, to apply in writing to the Principal School Medical Officer. Only a small number of parents, less than 2%, expressed this wish and following this low acceptance rate the Council decided to arrange for a medical examination of all those children aged between 7 and 11 who no longer received school milk and in order to do this a number of doctors were employed sessionally in the school health service. The parents were again advised and those parents who did not wish their children to be considered for free milk on health grounds were asked to reply in writing and only a small percentage did so. The Department of Education and Science ruled that the certification of pupils for the supply of free school milk on the grounds of health is a question for the professional judgement of the school medical officer and emphasised that there is nothing in the Act which requires the medical officer to wait until there is overt sign of malnutrition before giving a certificate. During the Autumn Term 6,308 children were examined and of these 3,900, about 62%, were given a certificate leading to the issue of a free ⅓ rd of a pint of milk a day. Deaths of School Children It is with regret that 1 include the following details of local school children who died during 1971:— Sex Age Cause of Death Years Months M 14 7 Genetic disorder M 14 3 Road accident M 5 2 Bronchopneumonia in severely handicapped child M 7 6 Congenital heart disease M 8 7 Bronchopneumonia in severely handicapped child M 8 11 Malignant disease M 9 10 Home accident M 10 2 Bronchopneumonia in severely handicapped child F 5 10 Tumour M 5 2 Road accident M 6 9 Post-operative collapse F 12 10 Sickle cell crisis following operation Road Accidents to School Children I am indebted to the Accident Prevention Officer for the following details of road accidents involving school children during 1971:— Fatal Serious t Pedestrians Infant School 1 14 63 Junior School — 19 70 Secondary Schools - 9 47 Passenger Accidents Private Vehicles — — 25 Goods Vehicles — 1 1 Public Service Vehicles - 2 17 Cyclists Junior Schools — 3 10 Secondary Schools 1 2 21 TOTAL 2 50 254 79 LIST OF SCHOOL HEALTH CLINICS AS AT 31 DECEMBER 1971 a — School Advice e — Orthopaedic j — Audiology Unit b — Dental f — Physiotherapy k — Child Guidance c — Ophthalmic g — Cerebral Palsy Unit I — Chiropody d — Orthoptic h — Speech a All Saints' Church Hall, 11 Church Road N6 j Blanche Nevile School for the Deaf, Philip Lane N15 abh Burgoyne Road Clinic, 58 Burgoyne Road N4 b Chestnuts Clinic, 268 St. Ann's Road N15 k Child Guidance Centre, Tetherdown N10 abh School Clinic, 128 Cornwall Road N15 abh Medical Centre, 150 Fortis Green N10 ah Gordon Road Clinic, 1a Gordon Road N11 b Dental Clinic, 334 High Road N15 abcdefhkl Medical Centre, 239 Lordship Lane N17 abh Medical Centre, 131 Park Lane N17 a Somerset Road Clinic, 370 High Road N17 abcdh Health Centre, 8 Stuart Crescent N22 abcdfhl Medical Centre, rear of Hornsey Town Hall, 23a Weston Park N8 dfgh The Vale School for Physically Handicapped Children N4 h The Moselle School for Educationally Subnormal Children, The Green N15 fh The William C. Harvey School for Educationally Subnormal Children, Adams Road N17 SCHOOL DENTAL SERVICE Mr. G.C.H. Kramer, Principal School Dental Officer, reports as follows:— "Change and decay in all around / see" (Hymn "Abide with Me") Inspection and Treatment "The continuing increase in the number of children in our schools is imposing problems which can not be resolved while the number of dental officers in our service remains no higher than in the past. The total of pupils on the school rolls at 39,887 is greater by 1,823 than at the corresponding time a year ago, and as compared with the report for the year 1965 the total has risen by 6,731, which is an increase of no less than 20.3% Even in the early years of the life of the Borough the need and demand for dental treatment was far in excess of our resources, and the relentless increase during the intervening years has made the situation ever more difficult. Recruitment of dental officers is commented upon more fully in the appropriate section later. The number of sessions devoted to inspections in the schools was 142, a decrease of 43 from the previous year, during which 12,787 children were inspected for the first time in the year, while a further 4,396 were first inspected in the clinics. The total of 17,183 individual children inspected was only 43.1% of the school population and was by far the lowest proportion we have ever been able to see, yet because of the very great amount of treatment found to be necessary by reason of the low standard of dental health, this resulted in a demand for treatment fully sufficient to occupy all the available time of our dental officers. It would be totally unrealistic to achieve a higher and more satisfactory percentage of inspections by creating a demand which we were quite unable to meet. A further 2,536 children were re-inspected during the year and, of the total of first and re-inspections numbering altogether 19,719, treatment was required for 12,067 or 61.2%. Treatment sessions totalled 4,024, which was 123 more than in the previous year, and of these 748 were for our orthodontic service. Despite the increased number of sessions there was some reduction in conservative treatment carried out, reflecting the very time-consuming nature of this work when every reasonable effort is made to avoid removing teeth: but still there was an increase in the numbers of both temporary and permanent teeth extracted. This most unwelcome trend was largely attributable to the many patients for whom multiple extractions were unavoidable after gross decay had rendered many teeth beyond possibility of saving by any method. Staffing The staffing position, recorded as always on the last day of the calendar year under review, remained almost unchanged numerically compared with the previous year: the full-time equivalent of 1.7 Orthodontists was the same, while the full-time equivalent of dental officers at 7.7 was an increase of 0.3, but figures similar to those for 80 a previous year conceal changes of individual members of staff: some having left and been replaced, usually after an interval during which we were below even the previous insufficient number, by newcomers who need to learn the methods and routine of a public health service. While the nationally negotiated salary scales for dental officers with Local Authorities continue to provide a strong disincentive to recruitment, we have to depend heavily on sessionally employed dental officers who are at a financial advantage by such arrangement and, while we value their contribution to the service, this does nothing to build a stable staffing situation. Overall, recruitment to local authority dental services throughout the United Kingdom suffers such difficulty that virtually none are able fully to meet the demands on their services. The World Health Organisation recommends an ideal dentist to head-of-total-population ratio of 1 to 2,000, but as a total population will include many whose dental needs are minimal, for example full-denture wearers, the ideal for comprehensive dental care of the very vulnerable children up to school leaving age would seem to be as presently in the Scandinavian countries at 1 to between 900 and 1,200. Excluding the orthodontists whose duties do not include general dental treatment, the ratio of dental officers to children on the school rolls in Haringey is now 1 to 5,180 which, despite the contribution from those general dental practitioners who do treat children, is grossly excessive. Additionally, about 7% of the effective strength of our dental officers is devoted to treatment of the priority classes, pre-school children and expectant and nursing mothers and, for the purposes of the calculation above, should really be deducted from the total figure to give a ratio of one dental officer to 5,540 school children. In an area where the average standard of child dental health is poor, our problems are formidable. Blood Testing of Certain Ethnic Groups Our successful routine of blood testing as a safety measure before administration of general anaesthetics has continued, with a further 425 patients tested during the year. Although there were no startling results from these, there were 2 found to be unfit for an anaesthetic at all and 24 for whom special care was needed. There were additional findings referred to our medical service which did not have implications in the provision of dental treatment. From March 1969 when we started what has now become a well established routine to the end of the year under review, we have carried out this test for 1,388 patients. Apart from the positive findings which have made possible the avoidance of risks to patients, it is very reassuring for the anaesthetist to know that these otherwise concealed hazards have been excluded for the remainder of the patients." Dental Inspection and Treatment Pupils first inspected at school 12,787 Pupils first inspected at clinics 4,396 Pupils re-inspected 2,536 Number found to require treatment 12,067 Number of fillings: Permanent teeth 10,767 Temporary teeth 9,299 Number of teeth filled: Permanent teeth 9,212 Temporary teeth 8,518 Extractions: Permanent teeth unsavable 428 Permanent teeth for orthodontia 370 Temporary teeth 3,668 General anaesthetics administered: Total 1,065 By dental officers 667 Number of dentures supplied 16 Number of crowns and inlays 18 Number of teeth root filled 16 Number of prophylaxes 1,491 Number of teeth otherwise conserved 597 Other operations 4,001 81 Orthodontic Treatment: Cases remaining from previous year 181 New cases commenced during year 203 Number of appliances fitted: Removable 326 Fixed 42 Number of impressions, adjustments etc. 3,833 Number of radiographs 3,188 82 APPENDIX SCHOOL HEALTH SERVICE STATISTICS FOR 1971 SCHOOL HEALTH SERVICE STATISTICS 1971 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 1967 & later 6 24 28 1966 64 306 321 1965 152 577 662 1964 76 212 252 1963 40 108 118 1962 35 78 96 1961* 54 100* 124* 1960* 115* 254* 317* 1959* 62* 177* 217* 1958 46 83 105 1957 58 70 109 1956 & earlier 113 114 182 TOTALS 821 2,103 2,531 *Signifies "Selective" medical examinations Defect Code No. Defect or Disease 1 Periodic Inspections Special Inspections Entrants Leavers Total including all other age groups inspected T O T O T O T O 4 Skin 92 340 29 135 216 717 243 74 5 Eyes (a) Vision 273 325 122 175 821 792 200 109 (b) Squint 107 181 8 18 189 270 10 5 (c) Other 39 61 1 25 63 146 47 25 6 Ears (a) Hearing 43 110 7 26 121 248 34 32 (b) Otitis Media 30 134 1 9 46 222 16 9 (c) Other 52 107 3 26 117 194 65 45 7 Nose and Throat 113 672 - 50 190 1045 51 111 8 Speech 55 171 1 10 84 274 39 29 9 Lymphatic Glands 15 188 - 14 20 277 4 9 10 Heart 25 161 7 25 57 300 29 65 11 Lungs 52 180 10 44 126 420 34 71 12 Developmental: (a) Hernia 17 73 2 13 24 112 3 8 (b) Other 38 189 6 46 167 453 115 200 13 Orthopaedic: (a) Posture 33 101 5 26 99 222 12 52 (b) Feet 146 339 11 98 283 685 57 95 (c) Other 43 156 10 41 154 319 50 69 14 Nervous System: (a) Epilepsy 10 28 1 4 33 78 16 12 (b) Other 10 44 3 5 38 86 16 12 15 Psychological: (a) Development 17 115 1 16 32 259 86 44 (b) Stability 140 483 2 39 257 852 91 180 16 Abdomen 11 63 3 19 29 122 23 16 17 Other 19 52 3 8 65 106 122 98 T — Requiring Treatment 0 — Requiring Observation 84 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 336 (b) Errors of refraction, including squint 3,156 TOTAL 3,492 (c) Number of pupils for whom spectacles were prescribed 1,128 GROUP 2 Diseases and Defects of Ear, Nose and Throat Received operative treatment for:— (a) Diseases of the ear 3 (b) Adenoids and Chronic Tonsilitis 47 (c) Other nose and throat conditions — Received other forms of treatment 356 TOTAL 406 Total number of pupils still on the register of schools at 31 December 1971 provided with hearing aids: (a) During the current year 19 (b) In previous years (excluding any pupils shown at (a) above who were provided with an aid in a previous year) 49 GROUP 3 Orthopaedic and Postural Defects Number of pupils known to have been treated at clinics or at out-patients departments 542 GROUP 4 Diseases of the skin (excluding uncleanliness) Ringworm (i) Scalp 8 (ii) Body 6 Scabies 11 Impetigo 33 Other skin diseases 1,089 TOTAL 1,147 GROUP 5 Child Guidance Treatment Number of pupils treated at child guidance clinics (including cases sent to the Tavistock and other hospital clinics) 635 GROUP 6 Speech Therapy Number of pupils treated by speech therapists 445 GROUP 7 Other Treatment given (a) Number of miscellaneous minor ailments treated by the Council 329 (b) Pupils who received convalescent treatment under School Health Service arrangements 2 (c) Pupils who received BCG vaccination 1,888 (d) Treatment other than (a) (b) and (c) above 528 85 98 RETURN OF ASCERTAINED HANDICAPPED PUPILS REQUIRING SPECIAL EDUCATION FACILITIES CATEGORY IN THE CALENDAR YEAR DISTRIBUTION ON 20 JANUARY 1972 Number newly ascertained as requiring education in a Special School (other than hospital Special Schools) Number newly placed in Special Schools (other than hospital Special Schools) Number on register of — Number 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 Act 1944 Totals Maintained Special Schools Non-Maintained Special Schools Independent Schools Day Boarding Day Boarding Day Boarding Boys Girls Boys Girls B G B G B G B G B G B G B G B G B G B G B G Blind Pupils - - - - - - 3 1 - - 1 1 - - - - - - - - - - - - 4 2 Partially Sighted Pupils 3 2 1 2 9 7 — — — — — 1 — - — — - 1 - - — - - - 9 9 Deaf Pupils - 3 1 5 12 14 1 1 - - - 3 - - - - - 1 - 1 - - - - 13 20 Part ially Hearing Pupils 5 1 — 4 9 16 1 - - - - - - - - - 2 - - - - - - - 12 16 Physically Handicapped Pupils 10 7 4 3 29 28 1 - - - 3 2 - 1 - - 3 2 - - - - - - 36 33 Delicate Pupils 25 15 15 12 25 23 13 15 - - - - - - - - 7 3 3 - - - - - 48 41 Maladjusted Pupils 23 10 20 8 3 3 11 — — — 27 11 8 2 4 — 3 1 16 6 - - - - 72 23 Educationally Subnormal Pupils 49 33 58 44 205 149 13 2 3 5 2 6 7 4 1 - 38 22 1 - 269 189 Epileptic Pupils - - - - - - - - - - 1 - - - - - - - 1 - - - - - 2 - Pupils with Speech Defects 2 2 1 - - - - - - - - - 3 1 - - 2 1 - - - - - - 5 2 TOTALS 117 73 100 78 292 240 43 19 3 5 34 24 18 8 5 - 55 31 20 8 - - - - 470 335 GRAND TOTALS 190 178 532 62 8 58 26 5 86 28 _ _ 805 INDEX Page No. Advice Clinics for the Elderly 55 Ante-natal Clinics 42 Atmospheric Pollution 14 Audiology Unit 72 Audiometry 74 Births, Notification of 42 Care of Mothers and Young Children 42 Cervical Cytology 42 Publicity 60 Child Guidance Service75 Child Health Clinics 44 Chimney Heights 14 Chiropody Services 55 Cleansing and Disinfection 17 Clearance Areas 21 Comparability Factors 7 Congenital malformations 45 Deaths of Haringey Residents 8 Deaths of School Children 79 Defects remedied 18 Dental Care: Priority Classes 54 School 80 Diseases of Animals Act 1950 20 Drainage and Sewerage 12 Drainage Stoppages 20 Education Committee 64 Enteric Fever 57 Environmental Health 12 Factories 37 Family Doctor, co-operation with 40 Family Planning 48 Fluoridation of Water Supplies 54 Food Complaints 33 Food Hawkers 36 Food Hygiene 30 Food Imported 31 Food Poisoning 58 Food Premises 30 Food Sampling 31 Furnace Installations 14 General Practitioner Service 40 Geriatric Services 55 Hairdressers 37 Handicapped Pupils 67 Requiring special educational facilities 86 Handicapped Register, Children on 46 Health Centres 42 Health Committee 1 Health Education 59 Health Visiting 46 Home Nursing Service 47 Home Tuition 69 Hospital Services, co-operation with 40, 78 Page No. House Drying 20 Houses in Multiple Occupation 28 Housing applications, assessment on medical grounds 60 Imported Food 31 Improvement Areas 23 Grants 24 of dwellings 27 Infectious Diseases 57 Infectious Diseases, Notification of 11 Insect Pests 17 Inspections carried out by Public Health Inspectors 17 Laundry services for the incontinent 17 Lead poisoning 58 Measles 57 Meat Inspection 35 Medical examination of staff 62 Medical examinations in schools 66 Meningococcal Meningitis 57 Midwifery Service 47 Milk Distributors 31 Milk in Schools 79 Mortuary 17 Mothercraft and Relaxation Classes 44 Multiple occupation, Houses in 28 Noise 20 Nursing Services 46 Observation Register, Children on 46 Off ices, Shops and Railway Premises Act 1963 36 Ophthalmic Clinics 71 Orthopaedic Clinics 70 Outworkers 37 Pet Shops and Animal Boarding Establishments 21 Phenylketonuria 47 Plantar Warts 89 Psittacosis 58 Publications 60 Qualification Certificates 27 Radioactive Substances Act 1960 39 Rag Flock etc 19 Recuperative Holidays 69 Refuse, Accumulations of 20 Renal Dialysis 59 Ringworm 78 Road accidents to School Children 79 Rodent Control 16 Rubella 58 School Clinic, The 69 School Dental Service 80 School Health Clinics, list of 80 School Health Service 66 School Health Service Statistics 84 School Population 66 Sexually Transmitted Disease 58 Shops Act 1950-1966 37 Special Schools Provision 68 Page No. Speech Therapy 75 Staff 2, 64 Staff Medical Assessments 55 Statistics, School Dental 81 Statistics, School Health 84 Statistics, Vital 6, 10 Statutory Notices Served 19 Statutory Nuisances, Abatement of 20 Street Trading 37 Surface Water Pollution 12 Swimming Baths and Paddling Pools 14 Toddlers' Clinics 45 Tuberculosis in Schools 77 Tuberculosis 64 Tuberculosis, Prevention by B.C.G. vaccination 77 'U' Children 67 Unfit houses 21 Vaccination against Diphtheria, Whooping Cough, Tetanus, Poliomyelitis Measles and Rubella 56 Vaccination against Smallpox 57 Venereal Disease 58 Vision Screening 74 Vital Statistics 6 since 1965 10 Water Supplies 12 Weight Watching Clinics 70 Welfare Foods, Distribution of 43