THE ANNUAL REPORT OF THE MEDICAL OFFICER OF HEALTH AC. 439(1) Hornsey Hor oso THE HEALTH OF HORNSEY 1958 THE HEALTH OF HORNSEY 1958 THE ANNUAL REPORT OF THE MEDICAL OFFICER OF HEALTH 29.10.59 BOROUGH HEALTH COMMITTEE Chairman: Councillor C. R. WILLIAMS Vice-Chairman: Councillor J. T. WILKINS ” Ex-officio" The Mayor, Alderman G. WATSON, J.P. Alderman S. G. GOULDING Alderman G. F. N. NORMAN ” Miss J. RICHARDSON Councillor Miss O. R. ANDERSON Councillor H. A. L. ROSSI, LL.M. ” A. N. CAMMOCK, „ P. G. STAPLEY B.M., B.Ch., D.L.O. ” C. V. TIPPING ” C. C. GALVIN ” Miss M. E. WEST ” V. P. GELLAY, B.Sc. „ H. J. WORMS ” D. P. H. LEVY ” F. J. WORSTER ” P. PHILLIPS LOCAL AREA HEALTH COMMITTEE Chairman: Councillor Mrs. M. E. PROTHEROE Vice-Chairman: Councillor Miss M. E.WEST Representing Hornsey Borough Council Councillor Miss O. R. ANDERSON Councillor Mr. J. T. WILKINS ” Mrs. J. CARTER „ Mr. C. R. WILLIAMS ” Miss M. E. WEST Representing Tottenham Borough Council Alderman Mr. A. REED, A.C.I.I., J.P. Councillor Mr. H. LANGER Mrs. A, F. REMINGTON ” Mr. M. T. MORRIS Councillor Mrs. F. E. HAYNES „ Mrs. M. E. PROTHEROE Representing Middlesex County Council County Coun. Mr. V. BUTLER County Coun. Mrs. M. E. SOALL ” ” Mrs. S. G. CHILD „ „ Mrs. J. THEXTON ” ” Mrs. R.A. FREEDMAN „ „ Mr. A. H. MILLER Representing Hospital Management Committee Mrs. R. M. FRY Mr. M. W. BURNS, D.L., K.S.G. Co-opted in advisory capacity Dr. L. HORNUNG (Middlesex Local Medical Committee) Mr. R. W. D. BROWNLIE (Middlesex Local Dental Committee) Mr. L. HAYWARD (Middlesex Local Pharmaceutical Committee) Miss E. HAZELL (Royal College of Nursing) Miss V. EDEY (Royal College of Midwives) 2 HORNSEY DIVISIONAL EDUCATION COMMITTEE The MAYOR Councillor Mrs. J. M. CARTER Alderman G.S.AITKEN „ Mrs. K. M. ST. P. CRUMP ” F. H. BAILEY, J.P. (Vice-Chairman) ” D. F. W. BILLINGSLEY „ P. F. H. EMERY ” M. W. BURNS, „ V. P. GELLAY, B.Sc. D.L..K.S.G. (Chairman) „ F. NEUNER ” F. C. CAVE, ” C. V. TIPPING C.B.E., T.D., J.P. „ M. H. WALEY-COHEN ” N. MULDOON, J.P. „ R. I. G. WATT, M.A. Councillor Miss M. M. BARRIE „ J. T. WILKINS ” A. N. CAMMOCK, „ A. WILSON B.M., B.Ch., D.L.O. „ H. J. WORMS EIGHT ADDITIONAL MEMBERS Rev. W. R. BUTLER, 35 Rokesly Avenue, N.8. Mrs. M. DARLINGTON, Ph.D., B.SC., 27 Cholmeley Crescent, N.6. Dr. F. W. M. DRAPER, F.S.A., 26 The Avenue, N.1O. Rev. O. R. FULLJAMES, M.A., The Rectory, Hornsey, N.8. S. C. NUNN, M.A., 14 Bosworth Road, New Barnet, Herts. Rev. A. STEWART, I Colney Hatch Lane, N.IO. Mrs. J. TILLING, 11 Pages Hill, N.IO. D. A. T. WILLIAMS, St Michael's School, North Road, N 6. TWO APPOINTED MEMBERS County Councillor Mrs. H. C. NORMAN, J.P., 13 Wood Vale, N.IO. County Councillor Mrs. J. THEXTON, 72 Oakfield Road, N.4. 3 STAFF BOROUGH HEALTH DEPARTMENT Medical Officer of Health G. HAMILTON HOGBEN, M.R.C.S., D.P.H. Deputy Medical Officer of Health A. YARROW. M.B., CH.B., D.P.H. Veterinary Inspector F. G. BUXTON, M.R.C.V.S. Chief Public Health Inspec- J. D. CHANCE, M.A.P.H.I., tor, Petroleum Inspector Public Health Inspector's Cert. and Shops Inspector Food Inspector's Cert. Chief Administrative Assistant D. B. DAVIES, D.P.A. (Lond.) Public Health and Shops W. J. WILSON, D.P.A. (Lond.), M.A.P.H.I., Inspectors Public Health Inspector's Cert. Food Inspector's Cert. E. HUNDY, M.A.P.H.I., Public Health Inspector's Cert. Food Inspector's Cert. Cert, in Sanitary Science. Smoke Inspector's Cert. R. DOWNES, M.A.P.H.I., Public Health Inspector's Cert. S. SWINNERTON, M.A.P.H.I., Public Health Inspector's Cert. Food Inspector's Cert. A. K. D. SHUTTLEWORTH, M.A.P.H.I., Public Health Inspector's Cert. E. J. WILKINS, M.A.P.H.I., Public Health Inspector's Cert. Food Inspector's Cert. (One vacancy) Senior Clerks D. N. IRVINE, D.P.A. (Lond.) H. P. BRADFORD Clerk Mrs. M. M. BERRY Shorthand-typists Mrs. E. M. HICKS Miss A. A. GERRIE Miss A. GLENISTER Drainage Inspection Assistant H. S. FAGG Disinfectors and Mortuary P. F. HALL (Foreman) Attendants W. HOOPER S. J. TWINN Rodent Operator E. J. MEAD 4 AREA HEALTH STAFF Deputy Area Medical Officer A. YARROW, M.B., Ch.B., D.P.H. Senior Assistant Medical Mrs. J. H.. GARROW, M.B., Ch.B., D.P.H. Officer (Retired 15.1.59) Area Dental Officer V. SAINTY, L.D.S., R.C.S. Superintendent Health Miss H. TOWNSEND, S.R.N., S.C.M., H.V. Visitor Non-medical Supervisor of Midwives and Home Miss F. E. CURTIS, S.R.N., S.C.M., H.V., Nursing Superintendent M.T.D. Home Help Organiser Mrs. J. D. MclLROY Assistant Home Help Mrs. F. G WILLS Organisers Miss D. BUCK Area Chief Clerk W. L. N. RELLEEN, T.D., D.P.A. Deputy Area Chief Clerk J. B. BAMBROOK, D.M.A. Sectional Heads A. BALLS N. P. CHILD H. J. DUNHAM, B.A. Classification of Staff Full-time Part-time Medical Officers 9 7 Dental Officers 6 2 Supervisory Nursing Staff 2 Administrative and Clerical Staff 37 8 Health Visitors/School Nurses 29 Clinic Nurses 8 Midwives 8 Home Nurses 20 6 Speech Therapists 3 Physiotherapists 1 3 Occupational Therapists 1 Chiropodists . 2 Gramophone Audiometrician 1 Orthoptists . 2 Dental Attendants 7 1 Day Nursery Staff 36 1 Home Help Service 9 164 Manual workers, domestic grades, etc. 9 24 186 220 5 HEALTH DEPARTMENT, TOWN HALL, HORNSEY, N.8. To the Worshipful the Mayor, Alderman and Councillors Mr. Mayor, Alderman and Councillors, I have the honour to submit the Annual Report on the health of the Borough for the year ended 31st December, 1958. In general the standard of health was well maintained and no serious outbreak of infectious disease occurred during the year. The population figure, as estimated by the Registrar General, showed a slight decline from 96,890 to 96,670. Deaths from all causes numbered 1,137, giving an adjusted death rate of 10.6 per thousand of the population. The total number of live births was 1,745, showing a rise in the birth rate to 18.1 as compared with 16.2 in the previous year. Thirty-three infants died in the first year of life giving an infantile mortality rate of 18.9—slightly higher than in the previous year. A survey of all peri-natal deaths, commenced almost three years ago in Hornsey, is already producing interesting and helpful information and is referred to in this Report. Further progress was made in the field of "slum" clearance, and in improving housing conditions generally. The Council gave further consideration during the year to the special housing needs of the aged and physically handicapped, a number of whom are virtually marooned in upstairs rooms. For many, ground floor accommodation or accommodation with suitable lifts, is the only solution to a happier and fuller life. Under the Clean Air Act all preliminary work of surveying properties and estimating costs necessary for establishing the first "smoke control area" in the district was carried out during the year. The two most rewarding aspects of the year's work in the day-to-day administration of the school and personal health services, have been the special attention given to the needs of handicapped children and the Government sponsored scheme for protection of a susceptible population against poliomyelitis. Excellent co-operation locally has existed between hospital consultants, general medical practitioners and local authority staff. Further opportunity too, was afforded during the year for taking part in medical research by local authority staff and in particular the health visitors. In conclusion I wish to acknowledge my sincere appreciation of the support given me by the Chairmen and members of the various Committees 7 concerned with the health of the Borough. To my deputy, Dr. A. Yarrow, and heads of the various departments in the Borough and Area health services, I am indeed grateful for their assistance and loyal support throughout the year. I have the honour to be. Your obedient servant, G. HAMILTON HOGBEN, Medical Officer of Health. 30th September, 1959, INFECTIOUS DISEASES POLIOMYELITIS Two Hornsey children of school age suffered from poliomyelitis during the year, the disease proving fatal in one case. The scheme for vaccination against this disease was extended during the year, and the progress made is referred to on page 74 of this report. MEASLES Following the high incidence in 1957, the number of notified cases of measles in 1958 was higher than expected, namely 652 cases. Only 14 patients were over the age of 10 years. 17 children were admitted to hospital but all made uneventful recoveries; there were no deaths. DYSENTERY Fifty-one cases of dysentery occurred during the year, the causal organism being in all cases shigella sonne. A minor outbreak occurred at food premises in the Borough in which six employees suffered from diarrhoea. On bacteriological examination shigella sonne were isolated from specimens submitted by three of them, but the other three proved negative. The premises were visited and arrangements made for specimens to be submitted from all members of the staff. The firm's medical officer met representatives of the Health Department and every possible precaution was taken. Later, as a result of inspection made at the time of the outbreak extensive work was undertaken which resulted in considerable improvement in amenities for the staff and a higher standard of hygiene generally. The only other matter of note was the need to exclude a baker from duty for a short time as he was found to be positive to shigell sonne. Compensation was paid by the Borough Council under the Public Health Act for a period of nearly three weeks, £6 18s. Od in all being paid. FOOD POISONING In January Circular 5/58 was received from the Minister of Health with revised Memorandum 188/Med on investigation of food poisoning. Provision is made for inclusion in the return of cases which have not been notified under the Food & Drugs Act but have been ascertained by the Medical Officer of Health through other channels and also for a separate return of Salmonella infections which are not considered to be foodborne. Medical practitioners were reminded of the value of prompt 9 notification of cases of food poisoning. The memorandum emphasises, however, that investigation of outbreaks has revealed some important factors in their causation and give the following list. (i) The foodstuff or one of its ingredients may be primarily infected and the infection may survive the cooking or other preparation of the food. (ii) A primarily infected article may contaminate equipment and lead to secondary infection of other food products. (iii) The amount of noxious material which survives cooking may be so small that no harm would result from immediate consumption. With delay in consumption, however, inappropriate storage, including misuse of refrigeration, and bad handling can lead to such growth of organisms, sometimes with the formation of enterotoxin, as will cause frank disease. (iv) An infection introduced by food handlers can survive and multiply in such products as cream, imitation cream, custard and table sweets, cold meat, meat products, soups and gravies. These foods can easily become dangerous under certain conditions of domestic storage, though they would remain sound and comparatively free of risk if stored under ideal conditions in well-equipped premises. Sixteen cases of food poisoning were notified by medical practitioners and six others found during the investigation of sources of infection. One outbreak occurred which involved six people and the story of this outbreak is typical of many cases of food poisoning as shown in (iii) above. Some beef was cooked on a Friday and then placed in a meat safe in a cupboard below the stairs until Sunday when the family ate some of it cold. No ill effect resulted from this meal. The next day the family ate more of the cold beef for the evening meal and about 2-3 a.m. on Tuesday all six had violent abdominal pains and diarrhoea. Heat resistant Clostridium welchii, type 3, were isolated from the meat and also from faecal specimens submitted by four of the patients, another proved negative, and one refused to co-operate in the investigation. The condition required before food poisoning organisms can cause illness are food, moisture, warmth and time to increase in numbers. The beef was infected by heat resistant cl. welchii which survived the cooking process but in insufficient numbers to cause illness. No illness was caused at lunch time of Sunday but by Monday evening the numbers of organisms were sufficient to make the family ill. No other outbreaks occurred but there were sixteen single cases, eight due to s. typhi-murium, one to s. Derby and another to CI. Welchii. Compensation amounting to £9 18s. 4d. was paid to a woman excluded from work as a suspected case of food poisoning. The case proved to be positive to s. typhi-murium but quickly responded to treatment. 10 LABORATORY SERVICES The Public Health Laboratory Service provides a comprehensive service for the bacteriological examination of specimens submitted by general medical practitioners and local authorities. The Health Department is the collection centre for specimens submitted by medical practitioners in Hornsey and containers are obtainable from the department during office hours. Specimens are collected daily at approximately 3.30 p.m., and 10.30 a.m. on Saturdays, but they may be sent direct to the laboratory at Coppetts Wood Hospital up to 5 p.m. on Mondays to Fridays and 12 noon on Saturdays. A 24-hour emergency service is maintained by the Central Public Health Laboratory, Colindale. The following is a summary of reports made on Hornsey patients during 1958:— Faeces 447 Throat-Swab 4 Urine 1 Nasal Swab 1 Blood 1 Sputum 7 Rectal Swab 27 Section of cervical cord 1 11 TUBERCULOSIS The total number of cases on the Tuberculosis Register at the end of 1957 was 993, viz., pulmonary 894, non-pulmonary 99. Pulmonary Non-Pulmonary Total Male Female Male Female Male Female (a) Number of Cases on Register at commencement of year 539 355 54 45 593 400 (b) Number of Cases notified for first time during year under Regulations 29 27 2 1 31 28 (c) Cases restored to Register 3 2 . • 3 2 (d) Cases added to Register otherwise than by notification under Regulations (1) Transferred from other Districts 31 27 . 1 31 28 (2) From Death Returns 5 2 . . 5 2 (e) Number of Cases removed from Register 78 46 1 4 79 50 (f) Number of Cases remaining on Register at end of year 529 367 55 43 584 410 Cases removed from Register shown under (s) are accounted for as follows:— Found not to be T.B. Recovered Removed to another area Died at home Died at Sanatorium or other Institution TOTAL M F M F M F M F M F M F . 3 19 11 49 PULMONARY 2 8 1 78 46 29 2 . . 1 3 . NON-PULMONARY 1 . . . 1 4 According to the return of deaths by the Registrar General a female between 45 and 64 years of age died of non-pulmonary tuberculosis, but no record of this death can be traced locally. CASES OF TUBERCULOSIS COMING TO THE KNOWLEDGE OF THE MEDICAL OFFICER OF HEALTH DURING THE YEAR Under 1 year 1 year 2 to 4 5 to 9 10 to 14 15 to 19 20 to 24 25 to 34 35 to 44 45 to 54 55 to 64 65 to 74 75 and over TOTALS BY FORMAL NOTIFICATION Pulmonary M . . 1 . . 2 6 7 2 3 6 2 . 29 56 F • . . 1 . . 5 10 4 2 3 1 1 27 Non-pulmonary M . . . . . . . 1 . 1 . . . 2 3 F . • . . . 1 . . . . . • . 1 OTHER THAN BY FORMAL NOTIFICATION Death returns from Local Registrar Pulmonary M . . . . . . . . . . 1 . 1 2 3 F . . . . . . . 1 . . . . . 1 Inward transferable deaths Pulmonary M . . . . . . . . . . 1 1 1 3 4 F . . . . . . . . 1 . . . . 1 Transfers from other Districts Pulmonary M . . . . 1 1 3 12 5 3 4 2 31 58 F . . . . 1 1 10 12 3 . . • . 27 Non-pulmonary F . . • • . . . . . . 1 • . 1 1 13 NOTIFICATION OF INFECTIOUS DISEASE BY AGE AND SEX AGE IN YEARS Scarlet fever Whooping cough Acute Poliomyelitis Meningococcal infection Measles Dysentery M F M F M F M F M F M F Under 1 1 2 . . . 1 14 10 1 1 1 1 1 5 . . . . 31 32 1 1 2 2 2 5 . • 49 49 . 4 3 . 3 3 . . . . . 25 35 . 1 4 7 3 . 1 . . . . 55 46 1 1 5-9 22 30 4 4 1 . . . 166 126 8 6 10-14 5 3 . . 1 . . . 1 5 1 5 15-24 . 2 . . . . . . 3 2 4 4 25 and over . . 1 . . . . . . 3 5 8 TOTALS 38 45 14 12 2 . . 1 344 308 21 30 83 26 2 . 652 51 AGE IN YEARS Acute pneumonia Typhoid fever Erysipelas Food poisoning Puerperal pyrexia M F M F M F M F F Under 5 3 . . . . . . . 1 . 5-14 2 2 . . . . . 1 2 . 15-44 4 2 . 1 . 2 2 6 2 II 45-64 9 . . . . 3 5 3 1 . 65 and over 11 9 . . . . 4 . . . TOTALS 29 13 1 . 5 11 10 6 11 42 1 16 16 1 11 There were no cases of diphtheria or ophthalmia neonatorum. 14 NOTIFICATION OF INFECTIOUS DISEASE BY WARDS Highgate Muswell Hill Crouch End Central Hornsey North Harringay South Harringay Stroud Green Finsbury Park TOTALS Scarlet fever 4 16 7 21 8 3 17 7 83 Whooping cough 6 1 . 6 5 2 4 2 26 Acute poliomyelitis Paralytic . . . . . . 2 . 2 Measles 26 23 32 140 102 55 129 145 652 Acute pneumonia . 2 2 8 13 2 12 3 42 Dysentery 6 1 15 4 4 2 17 2 51 Erysipelas 1 2 3 3 1 1 3 2 16 Food poisoning 1 1 6 1 • 3 3 1 16 Puerperal pyrexia 2 6 • 1 • . 1 1 11 Typhoid fever • • 1 . • . • . 1 Meningococcal Infection • • . 1 • . . . 1 TOTALS 46 52 66 185 133 68 188 163 901 15 HOUSING AND SANITARY CIRCUMSTANCES RE-HOUSING ON HEALTH GROUNDS The total number of housing cases reviewed on health grounds during the year was 77. In 44 cases action was as follows:— Nil points recommended 7 5 “ “ 6 10 “ “ 8 15 “ “ 22 Cases recommended for consideration outside the points scheme 1 The remaining 33 cases, in which no further action was taken, were referred to this department direct from doctors, almoners and health visitors. It was considered that action already taken was sufficient to meet the case. 19 cases were placed in categories as follows:— I. Serious medical conditions (a) Active pulmonary tuberculosis 3 (b) Other medical conditions 2 II. Chronic medical or surgical conditions which have crippled the patient 8 III. Old persons needing ground floor accommodation because of infirmity, possibly with illness 5 IV. Serious overcrowding causing undesirable mixing of the sexes with its accompanying moral danger - Eleven families with medical grounds were rehoused during the year, one being a special case recommended for consideration outside the points scheme. The 30-year old wife of another applicant contracted poliomyelitis and was left with severe paralysis of both legs. The Council decided to replan one flat in a block to be built so as to meet the needs of such a case as far as possible. As the woman was confined to a wheel chair, provision was made for sliding doors throughout the flat, re-siting of electric switches, and other modifications. Part of the cost of these alterations was met by the County Council Welfare Committee. 17 Housing of Old People In 1957 the Council decided that its housing policy would have due regard to the needs of old and physically handicapped persons, particularly in connection with redevelopment proposals and the improvement of pre-war Council property. A memorandum from the Ministry of Housing and Local Government (No. 18/57) contained suggestions to increase the accommodation available for old people. The principal suggestions were:—increased provision of one-bedroom dwellings; greater flexibility in the number of bathrooms and lavatories provided, and the conversion of old houses. In addition it made recommendations on some details of design. Twenty-two handicapped old people requiring rehousing were known to the department in 1957 when it was suggested that 80 dwellings might meet the need in the borough. By the end of 1958 the number of known cases had increased to forty-two, and these were classified into five groups as follows:— 1. Rheumatism and arthritis 14 2. Heart disease 8 3. Chronic respiratory illness (bronchitis, etc.) 8 4. Crippling diseases of nervous system 8 5. Lower limb or limbs useless through amputation or other reason 4 CLOSING AND DEMOLITION ORDERS Closing Orders Property Part affected Order made Action taken 21 Myddelton Rd. Whole house 14th Jan. Two families rehoused. One tenant found other accommodation 16 Grove House Rd. Whole house 14th Jan. One family still in occupation at end of year. 18 Grove House Rd. Whole house 14th Jan. One family found other accommodation. One family still in occupation at end of year. 12 Wembury Rd. Basement flat 14th Jan. One family rehoused. 9 Myddelton Rd. Whole house 16th July Two families still in occupation at end of year. 14 Grove House Rd. Whole house 10th Oct. One family still in occupation at end of year. 14 Ennis Road Whole house 10th Oct. Four families still in occupation at end of year. 18 Property Part affected Order mode Action taken II Myddelton Rd. Whole house 10th Nov. Three families still in occupation at end of year. 13 Myddelton Rd. Whole house 12th Dec. Three families still in occupation at end of year. Demolition Orders A Demolition Order was made in respect of Grove Cottage, The Grove, Alexandra Palace, on 16th July, 1958. The tenant was still in occupation at the end of the year. On 12th September 1958 a Demolition Order was substituted for a Closing Order made on 7, Myddelton Road on 12th November 1954. The premises were demolished by the Council in view of their dangerous condition, the cost being borne by the Council in consideration of the surrender of the lease. CERTIFICATES OF DISREPAIR The Rent Act 1957 came into force in July 1957 and a brief note on procedure was given in my report for 1957. The number of applications for certificates of disrepair was 120 for the last half of 1957 but in 1958 the numbers fell steadily, and in the whole year only 91 applications were received. The figures for 1958 were as follows:— Applications for certificates of disrepair 91 Decisions not to issue certificates 2 Decisions to issue certificates (a) in respect of some defects 76 (b) in respect of all defects 19 Undertakings given by landlords 62 Undertakings refused — Certificates of disrepair issued 44 Applications for cancellation of certificates 49 Objections by tenants to cancellation of certificates 10 Decision by Council to cancel in spite of tenant's objection 4 Certificates cancelled 45 Applications for certificates as to remedying defects which landlord has undertaken to remedy: Certificates issued to landlords All defects remedied 14 Some defects remedied 5 Certificates issued to tenants All defects unremedied 6 Some defects unremedied 11 All defects remedied 2 19 RIVERS POLLUTION The following figures relate to action taken to prevent pollution of surface water drains by sewerage. Premises inspected by drainage inspection assistant 5,363 Re-inspections 1,296 Premises inspected by district public health inspectors 442 Re-inspections 651 Number of premises in which defects were remedied after service of written or verbal notices 273 In 62 cases the soil drainage was found to be connected to the surface drainage, and action was taken to remedy this. In 245 cases there was a defect in the intercepting chamber, usually due to a cap being displaced or missing, and these defects were also remedied. ATMOSPHERIC POLLUTION Deposited Matter The extent of pollution by deposited matter is determined by examination of the solid and liquid matter collected by the deposit gauges each month. With the exception of the Wightman Road site (d) it will be seen that the total solids deposited each month in Hornsey is appreciably less than the average figure for the whole country as shown in table II. It was felt that the high figures obtained at site (d), were not representative of the area and on the 1st April this gauge was moved to a more unobstructed position at the Electricity Sub-Station, Hampden Road. This may prove to be a more representative site, and has so far averaged about 15 tons per square mile, but insufficient time has elapsed to arrive at definite conclusions. Suspended Matter (Smoke) Smoke is measured by passing a known volume of outside air through a white filter paper, the darkness of the stain depending on the amount of smoke in the air. The filter paper is changed every 24 hours, and the density of the stain measured. From this information a simple calculation gives the concentration of smoke which is usually stated in milligrammes per 100 cubic metres of air. Smoke concentration in the air in this Borough is shown to be appreciably less than the national average concentration, the national figures for 1956-7 being 21 milligrammes per 100 cubic metres, compared with 11 at Fortis Green and 15 at the Central Depot. No annual figure is yet available for the Town Hall site but the winter reading of 20 milligrammes may be compared with the national average of 27 milligrammes. A great deal of the considerably greater smoke concentration in winter is due to domestic sources. 20 Sulphur Dioxide Sulphur dioxide in the air is measured by passing a measured volume of air through a solution of hydrogen peroxide, and determining by titration with alkali, the amount of acid collected. The sulphur dioxide concentration is expressed in parts per 100 million, and the average figure for the whole country in 1956-7 was 7. The instruments at Fortis Green and the Central Depot gave readings of 4 and 6 respectively but the Town Hall winter figure of 9 equalled the national figure for the same period. Smoke and sulphur dioxide concentrations tend to vary in the same proportions, and are much higher during the winter months but locally there may be variations in the proportions. Motor Vehicle Exhausts The Report of the Committee on Air Pollution (Beaver Report 1954) expressed the opinion that if diesel engined vehicles were properly maintained, serviced and driven, they need not emit smoke. Contribution of exhaust gases to the total volume of air pollution was stated to be still relatively small, but could reach considerable proportions locally in areas of heavy traffic congestion when the movement of air is restricted. Where trunk or main roads pass through the Borough, carrying heavy traffic, this smoke nuisance from diesel engine exhausts has tended to become more serious with the ever increasing growth of motor transport. The Beaver Report considered that the present law on the subject (enforceable by the police) was both explicit and adequate. The Motor Vehicles (Construction and Use) Regulations, made under the Road Traffic Act, require that every motor vehicle shall be constructed, maintained and driven so as to prevent the emission of smoke, etc. Following a recommendation by the Beaver Committee, investigations are being carried out by the Department of Scientific and Industrial Research to examine methods by which the emission of harmful substances from motor vehicle exhausts can be reduced. 21 Table 1: ATMOSPHERIC POLLUTION—MEASUREMENT OF SMOKE, SULPHUR DIOXIDE AND SOLID DEPOSITS 1958 SMOKE (milligrams per 100 cubic metres) SULPHUR DIOXIDE (parts per 100 million parts of air) SOLID DEPOSITS (tons per square mile) Monthly average Highest daily reading Lowest daily reading Monthly average Highest daily reading Lowest daily reading (c) (d) (e) (f) (a) (b) (c) (a) (b) (c) (a) (b) (c) (a) (b) (c) (a) (b) (c) (a) (b) (c) January 17 22 22 42 43 48 6 10 10 4.2 6.8 10.8 12.6 31.1 22.1 I.I 2.3 4.5 23.01 21.74 10.03 . February 13 17 18 32 30 36 5 8 10 4.0 4.9 9.0 11.5 11.4 15.8 1.4 1.2 4.5 14.51 42.23 10.68 . March 15 17 17 28 35 31 7 12 11 5.2 7.0 8.6 11.6 13.2 16.5 1.6 3.1 5.1 15.18 27.14 10.84 . April 9 11 11 18 16 19 4 6 6 3.7 4.7 6.0 8.3 8.9 10.6 1.5 1.8 2.3 11.63 . 8.97 12.21 May 6 7 7 12 14 13 2 2 3 3.0 3.9 3.8 7.2 10.3 10.5 0.5 1.4 1.8 20.59 . 11.92 15.45 June 5 6 5 9 12 10 1 2 2 3.2 3.8 3.4 7.1 8.6 8.2 1.4 1.3 1.2 11.76 . 10.27 15.74 July 4 5 5 13 13 11 1 2 2 3.0 3.7 2.9 10.6 8.2 6.8 0.6 1.3 0.8 11.72 . 8.76 13.55 August 5 6 5 12 13 11 1 1 2 2.7 3.5 3.1 8.4 7.5 6.2 1.3 1.5 1.4 13.00 . 6.98 15.85 September 6 8 7 16 13 19 2 2 2 3.4 4.4 4.3 8.6 9.4 10.4 1.0 1.5 1.4 11.18 . 9.31 15.26 October 13 16 16 52 54 67 4 7 6 4.0 5.4 7.7 19.2 20.0 28.6 1.1 1.2 3.0 13.08 . 7.16 17.15 November 23 27 28 58 75 67 6 8 14 5.0 6.3 12.1 16.0 16.4 24.2 0.8 0.5 5.0 9.32 . 9.82 14.97 December 25 28 28 54 63 59 9 11 11 5.8 7.8 13.3 14.5 24.6 29.0 1.4 1.5 2.0 12.04 . 10.58 15.74 Sites: (a) Fortis Green Depot. (b) Disinfecting Station, (c) Town Hall, (d) Church of Christ, Wightman Road, (e) Highgate Depot, North Hill. (f) Electricity Sub-Station, Hampden Road. 22 Table II: DEPOSITED MATTER, COMPARATIVE FIGURES Deposited Matter National Average Site (c) Site (d) Site (g) Finsbury Park West Hill Highgate 1949-54 S. W. Year S. W. Year S. W. Year S. W. Year S. W. Year S. W. Year Soluble 10.5 11.3 10.8 10.8 11.2 11.0 20.9 30.9 25.9 8.0 9.9 8.9 10.3 10.4 10.4 . . 5.9 Insoluble 6.4 8.1 7.3 4.8 7.1 6.0 6.4 9.9 8.2 4.3 8.0 6.2 4.4 5.8 5.0 . . 8.3 Total 16.9 19.4 18.1 15.6 18.3 17.0 27.3 40.8 34.1 12.3 17.9 15.1 14.7 16.2 15.4 . . 14.2 1954-5 Soluble 10.5 10.8 10.7 12.3 9.0 10.6 22.0 22.0 22.0 6.9 8.9 7.9 6.8 9.0 7.9 5.0 6.6 5.8 Insoluble 7.5 9.0 8.2 4.2 6.8 5.5 6.5 8.8 7.7 4.5 8.0 6.3 3.4 7.0 5.2 7.7 9.8 8.7 Total 18.0 19.8 18.9 16.5 15.8 16.1 28.5 30.8 29.7 11.4 16.9 14.2 10.2 16.0 13.1 12.7 16.4 14.5 1955-6 Soluble 10.8 10.5 10.7 9.4 9.3 9.4 20.0 19.8 19.9 7.7 7.7 7.7 10.9 8.0 9.5 7.6 5.0 6.3 Insoluble 16.9 8.3 7.5 4.2 5.4 4.9 5.5 6.9 6.2 4.2 6.4 5.3 4.4 5.0 4.7 6.6 7.4 7.0 Total 27.7 18.8 18.2 13.6 14.7 14.3 25.5 26.7 26.1 11.9 14.1 13.0 15.3 13.0 14.2 14.2 12.4 13.3 1956-7 Soluble 10.4 9.7 10.1 5.7 5.6 5.7 17.8 13.2 15.4 5.7 Site (e) 5.2 5.4 8.4 8.6 8.5 7.0 7.6 7.3 Insoluble 7.4 7.8 7.6 6.0 5.7 5.8 8.4 8.3 8.4 5.6 5.5 5.5 4.3 4.0 4.2 7.9 6.7 7.3 Total 17.8 17.5 17.7 11.7 11.3 11.5 26.2 21.5 23.8 11.3 10.7 10.9 12.7 12.6 12.7 14.9 14.3 M.t (c), (d), (e) These sites are as stated at the foot of Table 1. (g) Mather's Factory, Frobisher Road, N.8. The Finsbury Park gauge is maintained by the London County Counci and the West Hill gauge by the Borough of St. Pancras. "S" refers to the period 1st April-30th September and "W" to the period 1st October-3lst March. 23 SMOKE CONTROL AREAS The serious "smog" of December 1952 led the Government to set up the Committee on Air Pollution (The 'Beaver' Committee) whose recommendations led to the Clean Air Act, 1956. The Act has three main objects. First, to prohibit the emission of dark smoke from all chimneys, second, to control the emission of smoke, dust and grit from industrial furnaces; and third, to establish Smoke Control areas. The problem of industrial smoke in Hornsey is relatively small, as the Borough is mainly residential in character; the principal task is therefore, to establish Smoke Control Areas in which the emission of any smoke due to burning an unauthorised fuel from the chimney of any building is an offence. 'Authorised fuels' are prescribed by Regulation and these include coke, anthracite, low volatile steam coal, low temperature carbonisation fuels such as Coalite, Rexco and Cleanglow, briquetted fuels carbonised in the process of manufacture, gas and electricity. To assist in the replacement or adaptations of domestic fireplaces which cannot burn smokeless fuels, a grant of 70% of the cost in respect of private dwellings is given by the Council. Where it thinks fit the Council may re-imburse the whole cost. The Minister of Housing and Local Government will repay to the Council 40% of the cost provided the conditions laid down by him have been observed. These conditions are mainly concerned with the proper fixing of the appliances, ensuring that they are selected only from the approved lists, and that the work for which grant is paid is reasonably necessary. It is also an essential condition that the work shall have been done during the period between the confirmation of the Order by the Minister and the date on which the Order comes into force. The Act prescribes that this period must be at least six months. Financial assistance may also be given to religious bodies or voluntary bodies whose primary objects are charitable, educational or for the advancement of social welfare, but the cost of such grants will be borne entirely by the Council. Late in 1957 the Council approved in principle the first area consisting of 344 acres in Highgate, at the extreme south-western corner of the Borough. The area contains 1150 dwellings and 73 other premises. Provisional approval for this area was received from the Minister in October 1958 and a detailed survey was then carried out to ascertain, among other things, the estimated cost of carrying out the necessary adaptations and replacements. This survey was completed by the end of the year, the estimated total cost being £9,274. The necessary Order was made by the Council in January 1959. Six objections were received, and a Public Local Enquiry was held before Mr.W. J. Brown, O.B.E., F.R.I.B.A., F.R.I.C.S., on the 14th April 1959. The order was confirmed by the Minister and will come into force on 1st September, I960. 24 FACTORIES ACT, 1937 I. Inspection of Factories Total No. of No. Inspections Factories Inspected Made Factories with Mechanical Power 189 83 161 Factories without Mechanical Power 35 12 16 2. Defects Found In 15 instances notices were served regarding unsuitable or defective sanitary conveniences. Twelve were complied with before the end of the year. One notice served in 1957 concerning inadequate ventilation was complied with and another was cancelled owing to change of ownership of the factory. Outworkers There are 267 Outworkers on the register engaged in the following occupations:— Making, altering, etc. of wearing apparel 171 Making of household linen 3 Making of lace, lace curtains and nets 2 Manufacture of brass and brass articles 11 Making or repairing of umbrellas, sunshades, etc. 9 Making of artificial flowers 11 The making of boxes or other receptacles or parts thereof made wholly or partially of paper 18 Making of brushes 8 Feather sorting 3 Carding, boxing, or packeting of buttons, hooks, etc. 1 Making or filling of Christmas crackers, Christmas stockings, etc 14 The weaving of textile fabric 4 Manufacture of lampshades other than lampshades made wholly of metal or glass or stone 12 71 visits were paid to outworkers' premises during the year. 25 RODENT CONTROL Normal routine investigation of complaints from the public continued and a summary of the work done is given in the following table. Properties inspected as a result of notification 333 Other properties investigated 242 Properties found to be infested:— Rats (a) Major infestations. (b) Minor infestations 198 Mice (a) Major infestations. (b) Minor infestations 93 Infested properties treated by Rodent Operator 186 Treatments 193 Written notices served 1 SEWER TREATMENT There are 1810 manholes in the soil and surface water sewers in the Borough and during 1958 two major treatments for the destruction of rats were carried out. On each occasion about two thirds of the manholes were dealt with. The first treatment was carried out in April and May, three visits being made to each manhole during a period of 8 days. On the first visit soaked bread was used as a bait and on the second and third visits the "take" of the bait by the rats was checked and it was replaced by soaked bread containing arsenic. In about 40 per cent. of the manholes there was evidence that rats had eaten some of the bait and poison. In June a sample testing and poisoning of 120 manholes, previously giving evidence of infestation, was carried out. This time the bait and poison was oatmeal, castor sugar, oil and Warfarin, and it was found that in 78 of these there was still evidence of rats. A further sample of these taken later in June revealed no further take and thus indicated a great reduction in the residual rat population of these sewers. It was felt that six-monthly treatments of the sewers was not sufficiently frequent, as rats not killed had sufficient time to breed and increase considerably in numbers before the next treatment. It was decided, therefore, to adopt a new form of treatment using 0.25% of sodium fluoroacetate. This poison does not require prebaiting. The first treatment over a period of two weeks covered 1,176 manholes. Direct evidence of the elimination of rats is not obtainable at the baiting points, as this poison is effective in very small quantities. For this reason it has been decided to carry out four treatments per year, 26 three using sodium fluoroacetate and the fourth using Warfarin. The last treatment should then enable a much more accurate assessment of the effectiveness of the treatment to be made. From other available evidence such as the escape of rats from the soil sewers through broken drains, it appears that the sodium fluoroacetate treatment has been extremely effective. Details of the first sewer maintenance treatment are given in the following table:— Soil Surface Water Sewer Sewer Manholes baited 1213 40 Manholes showing complete prebait take 517 13 Manholes showing partial prebait take 141 1 Bait and poison used Soaked bread and arsenic LEGAL PROCEEDINGS UNDER SECTION 94 OF THE PUBLIC HEALTH ACT, 1936 On 2nd April a Court Order was obtained requiring the Council to remedy a defective back addition roof at 24 Ennis Road, the name and address of the owner not being known. Subsequently a firm of house agents acknowledged their liability for the property and the work was completed by them on 4th June. WATER SUPPLY I am indebted to Dr. E. Windle Taylor, Director of Water Examination of the Metropolitan Water Board, for the following information. The supply for Hornsey area has been satisfactory both in quantity and quality during the year. The supply came from two main sources:— (a) River Thames derived water stored in Queen Mary reservoir and treated at the Board's filtration works at Ashford Common. (b) Water from the New River derived from the River Lea and from wells and treated at the Board's filtration works at Stoke Newington. Samples are collected on five days of every week, or more often if required, at each stage of the purification process as well as samples from the distribution system, and tests include physical, chemical and micro-biological examinations. 27 All new and repaired mains are chlorinated before being restored to use and samples of water from them are tested to ensure that its quality is up to that normally supplied. The water supplied to this area is not plumbo-solvent. The water supply is in all cases direct to dwelling houses; none is supplied by means of a stand-pipe. Average Results of the Chemical and Bacteriological Examination of the water supplied to Hornsey during the year 1958. Milligrammes per Litre (unless otherwise stated) River Thames via Ashford Common New River (Stoke Newington) Ammonia Nitrogen 0.043 0.038 Albuminoid Nitrogen 0.080 0.054 Oxidised Nitrogen: Nitrate 4.0 5.9 Chlorides as CI 27 32 Oxygen abs. from permanganate 4 hrs. at 27°C. 1.32 0.64 Turbidity in terms of Silica 0.3 0.1 Colour m.m. brown 2ft. Tube Burgess's Tintometer 12 6 Hardness (Total) 276 302 Hardness (non-carbonate) 68 78 pH. Value 7.8 7.8 Phosphate as P04 0.85 0.55 Silicate as SiO2 8 12 Sulphate as SO4 . 62 Fluoride as F. . 0.15 Magnesium as Mg. . 5 B.O.D. 5 days at 20oC. . . Electrical Conductivity (gem mhos) 550 625 Bacteriological Results of Water Passing into Supply after Chlorination No. of Samples in each case: 259 Plate counts (Average per ml.) Colonies counted on agar 37°C. Coliform test Percentage samples i negative in 100 ml. . ... (20-24 hrs.) Coliform E.coli River Thames via Ashford Common 23.0 99.61 100.0 New River (Stoke Newington 8.0 100.0 100.0 28 LICENSING OF PET SHOPS During the year 15 inspections were carried out, 5 by the Veterinary Inspector and 10 by the Public Health Inspectors. Five existing licences were renewed at the beginning of the year. INSPECTION OF SHOPS 248 visits were paid to shops and, apart from a number of minor infringements, which were dealt with, the provisions of the Shops Act have been well observed. Only five written notices were served during the year as, generally speaking, the proprietors of shops remedied defects as the result of informal notices. The following work was carried out:— Clothing accommodation provided 1 Sanitary accommodation provided 2 Sanitary accommodation labelled 1 Rooms cleansed and repaired 2 Washing facilities provided 1 Rear steps over water closet renewed 1 Water closet pan cleansed 1 ABATEMENT NOTICES The Notices served during the year were as follows:— Verbal Preliminary Statutory Public Health and Housing Acts 123 398 33 Shops Act 5 5 . Food and Drugs Act 33 14 . Factories Act 15 11 Prevention of Damage by Pests Act, 1949 2 • Middlesex County Council Act, 1950 . 2 2 Heating Appliances (Fireguards) Act, 1952 2 1 . Hairdressers Byelaws 1 1 . Water Act, 1945 . 1 . 29 INSPECTIONS BY PUBLIC HEALTH INSPECTORS Food 1st Inspection Re-Inspections Food Premises (See table on page 36) 539 187 Hawkers 15 . Street Traders 2 . Milk Sampling 36 . Ice Cream Sampling 34 • Infectious Diseases Notifiable Infectious Diseases 213 37 Food Poisoning 16 5 Infectious Disease Contacts 9 5 Smallpox Contacts • 2 Public Health Inspections Nuisances 1,391 2.285 Drainage 95 370 Drain tests 88 • Rodent Control 130 99 Overcrowding 11 7 Factories 95 82 Outworkers 71 . Renewal of Music and Dancing Licences 27 3 Rivers Pollution 442 651 Smoke observations 109 1 Verminous conditions 8 3 Pests 50 9 Certificates of Disrepair 135 101 Revocation of Certificates of repair 26 11 Hairdressers' Shops 13 2 Housing Act Inspections House to House 139 2 Permitted numbers 11 • Shops Inspections 229 19 Others Pet Animal Shops 10 . Petroleum Stores 206 66 Fireguards 6 5 Visits to old people 17 12 30 SUMMARY OF SANITARY IMPROVEMENTS EFFECTED Drainage Number of houses and premises redrained 84 Repairs or amendments to existing drains 188 Drains or gullies unstopped or cleansed 184 Manholes provided or repaired 40 Intercepting traps fixed 30 Soil and ventilation pipes repaired or renewed28 Water-Closet and Sanitary Fittings Water-closets and sanitary fittings provided 2 Water-closet buildings provided or repaired 8 Water-closet pans provided or renewed 54 Water-closets unstopped, cleansed or repaired 12 Flushing cisterns provided or repaired 19 New sinks provided 16 New lavatory basins provided 13 Waste pipes trapped, repaired or unstopped 71 Baths provided or made usable 8 General Roofs repaired 169 Rain-water gutters, renewed or repaired 69 Rain-water pipes provided or repaired 57 Dampness remedied 72 Damp-proof courses provided 5 Yard paving provided or repaired 34 Rooms cleansed 45 Floors repaired 45 Windows, doors, skylights, sashcords and fittings repaired 84 Window-sills repaired 15 Water-cisterns repaired, cleansed or covered 2 Water supply pipes repaired 7 Stoves, ranges, renewed or repaired 15 Flues and chimneys repaired 15 Accumulation of refuse removed 12 Dustbins provided 14 Miscellaneous items 91 31 FOOD FOOD HYGIENE In recent years there has been growing public interest in clean food. Previously the only complaint about food normally received in the Health Department was that of the presence of a "foreign body", such as a cigarette end, finger stall, piece of wire. Now increasing attention is paid to the standard of cleanliness in the shops, not only in the structure and method of display but also in the personal habits of assistants; this must be welcomed. Only by the active co-operation of the public can a high standard of cleanliness be achieved and maintained. Complaints from customers re-inforce the persuasion and cajoling of the public health inspectors. Still one meets managers of shops who think that food hygiene is over-emphasised and fail to appreciate the increase in food poisoning and the ever-growing knowledge of the causes. More enlightened shopkeepers are aware that clean food is good business and the general standard is steadily improving. The Food Hygiene Regulations define 'open food' as food not contained in a container of such materials, and so closed, as to exclude all risk of contamination. Food premises should not be congested, they should be planned so that thorough cleaning can easily be carried out, well lit and properly ventilated. It will be apparent to the customer that such premises are kept clean. The next essential is that all who serve or otherwise handle food shall be careful that the hygienic condition of the food is not affected by careless or thoughtless personal habits. Further, food premises should be used only for foods and the ever growing practice of selling odorous commodities such as soap, detergents and disinfectants is to be deplored particularly where 'open food' is sold. The law does not prohibit this, nor indeed does it prohibit the storage and sale of paraffin from food premises and the local authority could take action only in specific cases if it could prove to the Court that there had been contamination of food by one of these substances. Such proof is often difficult to obtain. 33 FOOD PREMISES CLASSIFIED ACCORDING TO PRINCIPAL TRADES No. of Premises Registered under Section 16 of the Food and Drugs Act, I955 (a) For Sale or Manufacture of Ice Cream (b) Prepared Foods Bakers and flour confectioners 22 4 1 Butchers 50 1 30 Confectionery (sugar) 125 105 1 Fish (wet and dried) 11 3 3 Fish (fried) 8 . 1 Fruit and vegetables 70 9 . Grocery and provisions 136 40 16 Milk 4 1 . Canteens 3 . . Preserved foods 2 1 . Public houses and off licences 72 5 . Restaurants and cafes 65 2 . Ice cream 2 2 . Herbalist and health foods 1 . . Confectionery warehouse 1 . . Preserved food factory 2 • . Stalls: . . Fruit and vegetables 3 . . Jellied eels 1 . . Refreshments 1 • . REGISTRATION OF HAWKERS OF FOOD AND THEIR STORAGE PREMISES During the year three new registrations were effected under Section 11 of the Middlesex County Council Act, 1950, and at the end of the year there was in the Borough one registered storage premises used by a hawker from another Borough and 32 registered hawkers who are at present selling the following foods:— Confectionery 1 Groceries 1 Eggs 1 Ice Cream 5 Fish 1 Winkles and shrimps 1 Fruit and vegetables 22 MILK SUPPLY Three new registrations were effected under Part III of the Milk and Dairies Regulations, 1949. 34 Licences for the sale of special designated milk under the Milk (Special Designation) (Pasteurised and Sterilised Milk) Regulations, 1949, were granted as follows. New Licences Renewals Dealers' Supplementary Dealers' Supplementary Pasteurised 6 . 30 10 Tuberculin Tested 3 25 10 Sterilised 5 . 47 11 Thirty-six samples of milk were taken in course of delivery or from shops and submitted for bacteriological examination. All proved to be satisfactory. BAKEHOUSES There are 14 bakehouses in the Borough, three of them being underground and in respect of which certificates of suitability are in force. Those underground are subject to special inspection every five years under Section 54 of the Factories Act, 1937 and the next special inspection is due in 1959. All bakehouses are frequently inspected to ensure that hygienic conditions are maintained. SLAUGHTERHOUSES No slaughterhouse licences have been issued since 1939. There are 42 meat traders and with eight exceptions they obtain all meat supplies from Smithfield Market. ICE CREAM Thirty-four samples of ice cream were taken for bacteriological examination with the following results:— Grade 1: 24 Grade 2: 7 Grade 3: 2 Grade 4: 1 Samples classified within Grades 3 and 4 are unsatisfactory. Investigations were carried out to ascertain at what stage in the production the contamination occurred. More effective sterilisation was introduced in the plant from which the Grade 4 sample was obtained, and subsequent samples proved satisfactory. One of the Grade 3 results was of a sample taken from ice cream manufactured in bulk in a neighbouring borough and the information was transferred to that authority for further investigation. The second Grade 3 sample was below standard because of lack of care in preparation of the mix from which it was taken. Later samples proved satisfactory. 35 LEGAL PROCEEDINGS UNDER SECTION 2 OF THE FOOD AND DRUGS ACT, 1955 Date of Hearing Offence Result 15th January Mould on steak & kidney Fine £10. Costs £2 2s. Od. pie 23rd April Piece of leather in bottle of Fine £10. Costs £6 6s. Od. milk 6th November Foil in bottle of milk Fine £20. Costs £36 15s. Od. INSPECTIONS OF FOOD PREMISES WERE MADE DURING THE YEAR AS FOLLOWS:— Bakehouses and Bakers' Shops 42 Grocers' Shops 228 Butchers' Shops 78 Milkshops 46 Canteens and Kitchens 27 Public Houses and Off Licences 28 Confectioners 74 Prepared Food Shops 5 Fish Shops 30 Restaurants, Cafes, etc. 90 Greengrocers' Shops 78 TOTAL INSPECTIONS 726 The following is a list of unsound food surrendered during 1958. Wherever possible this was salvaged for use as animal feeding or industrial purposes. Cwt lb. Cwt. lb. Canned Vegetables 1 70 Cheese . 22 Canned Fruit and Fruit Juices 1 75 Meat and Bacon 3 44 Canned Meat 7 67 Fish 2 . Canned Fish . 2 Pickles . 52 Canned Soup . 3 Margarine . 12 Canned Jam and Marmalade . 59 Cereals . 75 Canned Milk 31/4 pts. Potatoes 21 103 Eggs 150 Dates . 80 Dried Peas . 50 FOOD SAMPLING I am indebted to Mr. J. A. O'Keefe, O.B.E., Chief Officer of Public Control of the Middlesex County Council for the following information. Food arid Drugs Act, 1955 List of Samples procured in the Borough of Hornsey during the year 1958. Article Total Samples Procured Unsatisfactory Milk (Various) 77 . Butter 8 . Cakes 21 . Cheese 17 3 Cream 22 1 36 Article Total Samples Procured Unsatisfactory Drugs 14 . Fish and Fish Products 19 . Fruit—Fresh and Canned 4 . Ice-Cream 4 . Liver 9 . Margarine 7 . Meat and Meat Products 48 . Preserves 5 . Sausages, Etc. 21 . Spirits 4 . Sweets 10 . Vinegar 11 1 Miscellaneous 29 2 Totals 330 7 The following comments relate to samples noted as unsatisfactory. Cheese A sample sold by retail as "cream cheese" was found to contain less than 50% of milk fat which is necessary before the description "cream" can be applied to a cheese. The retailer had purchased this food under the description "creamery cheese" a designation which he had misunderstood. This trader was cautioned. Two further samples, of processed cheese, were found to bear false descriptions. These samples consisted of packets of assorted cheese spreads which were described as "processed cheese" and one of the assortment was described as "Gorgonzola cheese spread", whereas it was made from Gorgonzola and Cheddar cheeses. The manufacturers were cautioned and they took immediate steps to rectify these errors Cream A sample of tinned sterilised cream was found to be slightly deficient in milk fat. The investigations into this sample were not concluded by the end of 1958. Vinegar A sample sold as "vinegar" was found to be non-brewed condiment. A letter of caution was sent to the retailer concerned. Miscellaneous A sample of oyster sauce imported from the Far East, was found to contain a prohibited preservative, namely benzoic acid, to the extent of 851 parts per million. The label bore a statement indicating the presence of this preservative and this should have been seen and its significance realised by the retailer. For this reason he received an official caution as did also the importer of this food. 37 A sample of canned mixed vegetables was found to bear a label which was misleading as to the nature of the contents of the can. This misleading arose both from a pictorial representation and from the statement of the ingredients. A letter of caution was sent to the packers concerned. Merchandise Marks Acts, 1887-1953 The majority of the inspection work carried out under the provisions of the above Acts relates to ensuring that the requirements of the various Marking Orders made under the provisions of the Act of 1926, and which relate to the marking with an indication of origin of certain imported foodstuffs when exposed for sale or sold, are complied with. Inspections were made at 128 separate premises of 262 displays of meat, apples, tomatoes, dried fruit and butter. A letter of caution was sent to one firm who were found to be exposing for sale Australian Lamb bearing the false trade description "New Zealand" Labelling of Food Order, 1953 This Order requires pre-packed food to be marked with the name and address, or with the registered trade mark, of the packer or labeller. It also requires such food to be labelled with its common or usual name (if any) and with the names of the ingredients of a compounded food. It also controls the manner in which the presence of vitamins and minerals is disclosed and prescribes specific labelling of certain foods. A total of 651 articles of pre-packed food was examined at 165 premises to ascertain whether the above requirements were complied with; no serious infringements of this Order were detected. False or Misleading Descriptions As in previous years food advertisements and labels have been scrutinised for false or misleading statements and descriptions. Much of this scrutiny of food labels can be combined with inspection work under the Labelling of Food Order. No serious infringements were disclosed. Corrective action was secured in relation to descriptions applied to "milk block", "Double Tea", an imitation cream powder, cakes filled with a mixture of butter and sugar, canned mixed vegetables, raspberry syrup, powdered soup mixes, medium red salmon, gorgonzola cheese spread and cheese spread. 38 GENERAL MEDICAL EXAMINATION OF STAFF Twenty-five persons were medically examined to determine their fitness for acceptance on the permanent staff; all except one were found to be fit. One of the conditions of the scheme for sickness pay for employees who come within the scope of the National and Provincial Councils for Non-Trading Services (Manual Workers) is that all new employees be required to submit to a medical examination before the completion of six months' service with the Council in order to determine their fitness for admission to the scheme. 86 persons were examined, 51 of whom were accepted for the scheme. One examination was carried out for other purposes. PERINATAL MORTALITY SURVEY Since the turn of the century there has been a steady fall in the infant mortality and stillbirth rates. Although there has been considerable progress in the care of babies during the first week of life, the fall in infant mortality has been mainly confined to babies over one week old. Hornsey has been in the forefront of progress in this field, and, like most boroughs in the south of England, these vital statistics have always shown low rates. Perinatal mortality relates to stillbirths and deaths of babies under one week old; in the main the causes of deaths are the same. Of recent years, however, no further advance has been made, and indeed from 1956 onwards the rates have shown a rise. An enquiry was immediately set in hand; a meeting was held in the Health Department with the consultant obstetricians at nearby hospitals and it was decided to carry out a thorough investigation of all perinatal deaths occurring either as home confinements or at these hospitals (North Middlesex and Whittington, including Alexandra Maternity Home). Some two-thirds of all births were thus included in the survey. In addition certain enquiries were made about all deaths occurring in hospitals other than the above. I am particularly indebted to Mr. J. M. Scott, O.B.E., and Mr. R. G. Law of the Whittington Hospital and Mr. A. W. Purdie of the North Middlesex Hospital, who have personally taken part in the survey. This survey was undertaken in 1957 and during 1958 its results were discussed with the obstetricians at a further meeting. They were enthusiastically of the opinion that the survey should be continued for a further two years, i.e. for 1958 and 1959 so as to confirm the results obtained. All those concerned in ante-natal care, doctors, midwives and health visitors, are being kept in touch with progress of the survey. While, statistically speaking, accurate statements are not yet possible, it can be seen that the deaths fall into four broad categories. 1. Congenital defects. 2. Toxaemia of pregnancy. 39 3. Accidents of labour. 4. Placental insufficiency and prematurity without obvious cause. Social factors are of particular importance, in this survey, in relation to categories 2 and 4. Social changes in the borough have been very considerable in the past few years and it is considered that these alone could be responsible for much of the rise in perinatal deaths. As a result of the findings in the first year of the survey certain decisions have already been taken which it is hoped may cut the incidence of deaths due to toxaemia of pregnancy. It is hoped to have complete results available early in I960. WELFARE OF OLD PEOPLE In spite of all the services, voluntary and official, provided to help old people there are still cases which are referred to the Borough Health Department as being in need of care and attention. Each case is investigated and reviewed at intervals and an attempt is made to ensure that every assistance available is, in fact, being given. During 1958 the number of new cases referred to the department was lower than has been usual in recent years, 27 being investigated. Old people are happiest in their own homes and it must be agreed they should be enabled to continue there as long as possible. In a surprisingly large number of cases householders or other tenants in the same house give a very great deal of help to aged people, and without their help many more would need accommodation in Old People's Homes. One sometimes hears that the younger generation today do not take the same care of the old people as they used to in the past; there appears to be no foundation for this comment. The community certainly takes more care of the aged people than has ever been the case in the history of the country, but critics sometimes do not realise that two out of three old people in hospital are widowed, divorced or unmarried. It is mainly the "single" old people who present the problems. The long term solution then is through the preventive health services, although there will always be great scope for voluntary services to fill the gaps in official action; and as has so frequently been the pattern in the past, showing the way to the solution of many of the difficulties not previously tackled. Persuading old people to make themselves known is always difficult. When investigations are made, after reports from neighbours, old people will often assert that they were not aware of the services available. This is true in many instances, but it is equally true that old people in genuine need often isolate themselves deliberately and will not come forward to seek the aid of services even when they know of their existence. Hornsey is fortunate in having a very active Old People's Welfare Council with an energetic and keen team of workers under the leadership of Mrs. Adams. The "Meals on Wheels" service organised by the Women's Voluntary Service is also of great value in helping to maintain the health of old people in their homes. The average number of meals provided weekly during 1958 was 191. 40 Among the preventive services for which a need has been clearly demonstrated is that of chiropody, and it is encouraging to know that the Government has now given authority for local health authorities to establish chiropody services in their areas. In Hornsey provision has been made through the Old People'sWelfare Council for this for many years, but the need cannot be met wholly from voluntary sources. To ensure that old people are enabled to stay in their own homes for as long as possible, bungalows or flats suitable for old people, who may be infirm, should be available. The local housing authorities may help considerably in this respect and in some areas blocks specially designed for handicapped people have been built. The Hornsey Housing Trust has for many years met a great need by the provision of small flatlets. Other interesting experiments which have proved very successful are going on in other parts of the country, and the boarding out schemes whereby old people are boarded out with younger families are in some cases proving greatly to the benefit of the old people concerned. Further experimentation is needed in housing old people. One which recently came to my notice consisted of a small self-contained flatlet as an annexe to a family house. The annexe housed the old parents ideally, that is, where they could maintain an independent existence while being near their children and grandchildren. In spite of every effort occasionally one meets a case where the only solution is statutory action to compel an aged person to enter an Old People's Home. Early in the year my attention was drawn by a general practitioner to an old lady of 77 years who was living alone and had reached the state where it was felt she could no longer continue on her own. Other occupants of the house were seriously concerned lest she should set the place on fire as she was so confused mentally, and on one occasion was seen by a member of my department to be attempting to light the gas with a rusty pair of old curling tongs; fortunately there was no money in the gas meter and no harm resulted. This old lady had several times been found by the police wandering and was taken home by them. For a considerable time the landlady had been supplying meals and doing a certain amount of cleaning for her, but she was now at the end of her tether and felt she could not continue. On examination the room was found to be untidy, and unwashed crockery from previous meals was still on the table. There was no vermin and the conditions were reasonably clean but there was little sign of food. Arrangements were made for a home help to visit and the area welfare officer was notified. At the same time the Old People's Welfare Council were asked to see what help they could offer. A few days later it was reported that her gas had been cut off and other services might also be discontinued as she paid no bills. In spite of the help given she deteriorated rapidly and in the patient's own interest, it became necessary for me to obtain authority from the Council to apply to the Court for an Order for her to be detained in a suitable Home for a period of not more than three months. Notice was at once given to the County Council that application would be made to the Court, but no suitable vacancy could be found for this lady for over 41 three weeks from that time—12 days after obtaining a Court Order. When she was visited before the expiry of the Order it was found that she was much better physically but retained memory only for her youth, although she was able to understand enough of day-to-day matters. It was felt that she had insufficient volition to return home from the Institution and therefore remained voluntarily under care. I am informed by Dr. A. N. Exton Smith, Physician to the Geriatric Department of Whittington Hospital, that the total number of Hornsey patients admitted to their Unit during 1958 was 247. The average length of stay in hospital was about 10 weeks and those who were transferred to "Whittington" in Broadlands Road for convalescence stayed, on average, a further 5 weeks. Almost a quarter of the patients were transferred for convalescence, the majority of these being women but as there were now 4 beds for men at the Halfway House in Broadlands Road more men would benefit in the future. Hill Homes Mrs. Margaret Hill, C.B.E., Chairman of Hill Homes Ltd., has provided me with the following information. "There are six Homes:— "Trees", 2, Broadlands Road, N.6. "Delia Grotten", 21, View Road, N.6. 14, Bishopswood Road, N.6. "Northolme", 22, Broadlands Road, N.6. 22, Stanhope Road, N.6. "Nuffield Lodge", 22, Shepherd's Hill, N.6. In addition, there is a half-way house, "Whittington" at 20, Broadlands Road, N.6., which we run for the King Edward's Hospital Fund for London and the Hospital, and which takes 30 patients for convalescence. Including the half-way house, we have 225 beds and practically all our residents are extremely old or suffering from infirmity. We take no able-bodied younger people at all. The majority of our residents stay until the end of their lives unless they require definite hospital treatment. We have between 1,000 and 1,500 applications a year which shows the need for care of this type. We have nearly 100 staff including gardeners. The charges vary between £3 17s. and £5 15s. 6d. per week. 55 pay for their own maintenance, the others all come under Part III accommodation and are maintained by the appropriate County Councils." Activities of the Old People's Welfare Council I am indebted to Councillor Miss O. Anderson, Chairman of the Old People's Welfare Council for the following report. "There are approximately 4,000 names on our Register, and during the year more than 4,000 visits were paid by the visitors attached to the 42 staff. In some cases several visits had to be made to one person to help them with their special needs. The visitors work about 4 hours daily, and the whole of the Borough is covered. Their calls give much relief and pleasure to the aged, and problems such as supply of clothing can be dealt with through the clothing store operated by the Women's Voluntary Service in Crouch End. The W.V.S. "Meals-on-Wheels" Service also assists many aged people living alone, or with relatives out all day, to receive a good meal several times weekly. Thirty-three aged people were found places in small private Homes at a reasonable charge. These are mainly old people who are not considered suitable for a large Welfare Home, and who were not in need of hospital care. Many elderly people suffer from foot troubles, and a chiropody service is of great value. The house-bound cases are aided by the Almeric Paget Trust, and 310 aged persons were able to pay personal visits to receive attention to their feet. The Welfare Council were able to supply five wheel-chairs, given by friends, to assist housebound aged persons to get around to some extent. Commodes, medical requisites, back rests, mackintosh sheets and beds and bedding for incontinent old people were also supplied during the year. Some furniture and wireless sets (all gifts from the residents of the Borough) were also given to persons in need. The Welfare Council is able to help with shopping for old people who cannot go out in severe weather, and also acts as escort to and from hospital. Two hundred elderly pensioners were given two weeks holiday at the seaside for a very small charge. The Hornsey Borough Council generously donate the major cost of this very real benefit to the elderly. Each day some 25 persons call at the office—their problems are varied and many. Close contact is maintained between the local doctors, hospital almoners and the health department of the Borough. It is usual for hospital almoners to contact the office when an old person is about to be discharged from hospital. This is very necessary if the patient is living alone. The staff undertake to see that a fire is made up, the bed aired, neighbours contacted, and some shopping laid in before the old person returns. They also deal with any special requirements for special meals if a diet is necessary. Many of the old folk are able to cope with life fairly well, but difficult and sad cases do arise, and the Old People's Welfare Council deal with these with sympathy and efficiency. Two typical cases of this kind from last year's records are:— (I) A lady aged 80, who was brought to notice by neighbours, who stated she was very ill, but would be a difficult person to talk to. It was found that the old lady was living in a damp, dark basement room, lying on a filthy bed, covered by old coats. The room was bitterly cold, no food was to be seen, and mice were running about the floor. The old 43 lady was very deaf, and it was difficult to make her understand that the visitors were friends. Her breathing was laboured, and she appeared to be very ill indeed. The visitor lit a fire, bought food, and telephoned for a doctor, who came the same evening, and the following day the old lady was admitted to hospital suffering from pneumonia. It was found on investigation that her real age was 70, that she was a widow without any family, and that she had been spending her pension on gin. She spent some weeks in hospital, and returned home to a beautifully clean room with a good stock of food in the larder, but alas, good living was too much for her, and one morning she was found to have passed away in her sleep. She was totally deaf, and a deaf aid was unsuitable for her. (2) Miss G, an old lady of 83, was a very independent type, small in stature, and her weight at the time of the visit was only 4 stone. She retired to bed during the winter months, refused a home help, was abusive to visitors, and would not accept meals delivered by the W.V.S. She was a source of great worry to her landlady, and refused to allow her doctor to examine her. After many visits, she was persuaded to allow her doctor to see her while the visitor was present, and he found that she was suffering from malnutrition, and was no longer able to care for herself. The old lady steadily refused to enter a Home, although the county welfare officer also visited her. On one occasion, our visitor had to wash her from head to foot, as she was in such a state of filth and neglect. A district nurse was called in, and was able to examine her. The old lady had developed serious incontinent habits, and her bed was soaked with urine, and her body severely burned by this condition. Clean nightdresses, bedding and a mattress was supplied by the Welfare Council. After many visits, the old lady was eventually persuaded to enter a Home." CLEANSING OF SOILED ARTICLES During the year 1,160 bundles of articles were collected for cleansing under the terms of section 84 of the Public Health Act 1936. 60 people received assistance and 13 were still doing so at the end of the year. The highest number of cases being assisted at any one time was 20 and the service undoubtedly meets a very great need. PETROLEUM SPIRIT The number of establishments licensed for storage is 75 and the number of licenses issued is as follows:— Petroleum 64 Cellulose 18 Naphthalene 1 Hydro-carbon 1 Petroleum mixtures 1 Total 85 (Nine establishments are licensed for more than one product). 44 The construction of new installations in the Borough has been strictly supervised and tested and no conflagration occurred at licensed premises during the year. The attention of the owners of the Petroleum Service Stations was directed to the model conditions for electrical equipment used in connection with petrol service pumps. This code has now been incorporated in the conditions attached to the issue of petroleum licences of the Council and alterations repairs or renewals have been carried out to electrically operated pumps throughout the year in order to comply as far as practicable. The revised code will be given full effect in I960. DISEASES OF ANIMALS Mr. F. G. Buxton, M.R.C.V.S., the Council's Veterinary Inspector has kindly supplied me with the following information:— Two inspections were made on store pigs at the piggeries, 5 Clissold Cottages, Fortis Green, under the Contagious Diseases of Animals Acts. No licences were issued under the Acts. Five inspections were made under the Pet Animals Act, 1951. 2 at Pet Shop—St. James's Lane. 2 at Pet Shop—I Clissold Cottages, Fortis Green. I at Pet Shop—314c Park Road. There were no outbreaks of Fowl Pest. No action was necessary under the Tuberculosis Order of 1925. The Diseases of Animals (Waste Foods) Order 1957 On 1st June 1957 Diseases of Animals Authorities became responsible for issuing licences in respect of waste food boiling plants and the inspection of such plants. The aim of the Order is to reduce the risk of spread of foot and mouth disease and other diseases. Local authorities do not need to have licences for boiling plants nor do persons having not more than 4 weaned pigs and 50 head of poultry who boil waste food for feeding on their premises to their own stock. The effect of the Order is to prohibit the use of the specified waste foods for feeding to animals or poultry unless the foods have been boiled for at least an hour. Also persons collecting or receiving waste foods from the premises of other persons shall not feed the food to animals or move it from their premises until it has been boiled in a licensed plant. Except that in cases where no animals or poultry are kept on the collector's premises the unboiled waste may be removed by any licensed holder or any person who operates a plant that does not need to be licensed. Unboiled waste foods must not be allowed to come into contact with boiled waste food. 45 The waste foods specified are: (a) any meat, bones, offal or other part of the carcase of any animal or of any poultry. (b) any broken or waste foodstuffs (including table or kitchen refuse, scraps or waste) which contain or have been in contact with any meat, bones or offal or with any other part of the carcase of any animal or poultry. In Hornsey there is only one plant which comes under the Regulation, this is situated at the rear of 5, Clissold Cottages where normally between 12 and 15 pigs are kept. The waste food collected is boiled in a steam injection plant for about 10 hours. The Fowl Pest (Infected Areas Restrictions) Amendment Order, 1958 The Order which came into force on 8th September 1958 amended the Order of 1956. The principal amendments permit the Ministry inspectors to licence the movement of poultry into an Infected Area for immediate slaughter subject to safeguards designed to prevent the spread of infection and the holding of sales of poultry on farm premises at the termination of a tenancy. Movements of birds from the sale to premises within the infected area may take place under licence issued by the local authority if the birds are to be slaughtered or by the Ministry if they are for further rearing. BURIAL OF THE DEAD Under Section 50 of the National Assistance Act, 1948, it is the responsibility of the Borough Council to arrange the burial or cremation of all persons who die in the Borough for whom no suitable arrangements would otherwise be made. Arrangements were made for the burial of eight bodies, I man, 3 women and 4 baby boys. PUBLIC MORTUARY The Hornsey mortuary and post-mortem room are situated at the Central Depot, Hornsey High Street. During the year 143 bodies were admitted for post-mortem examination. Inquests were held on 24 bodies. MASSAGE AND SPECIAL TREATMENT Part XII of the Middlesex County Council Act, 1944, was brought into operation in Hornsey on 1st October 1952. This provides that any premises in the Borough used or represented as being used or intended to be used for the reception or treatment of persons requiring massage or special treatment must be licensed. The treatments are defined as (a) massage, manicure or chiropody; or (b) electric treatment or radiant heat light electric vapour or other baths for therapeutic treatment; or 46 (c) other similar treatment. The Act gives the Council power to inspect licensed premises, and these inspections are carried out by the Deputy Medical Officer of Health. No reason for complaint had been found during inspections carried out in the year and generally speaking the standard maintained is good. 18 premises were licensed during the year. The following summary shows the numbers licensed for each form of treatment. Massage 6 Chiropody 17 Electrical treatment 5 Other similar treatment 4 Four exemption certificates were received from registered members of the Chartered Society of Physiotherapy. Such certificates in an approved form signed by two registered medical practitioners exempt members from the need to obtain a licence but their premises are nevertheless subject to inspection. 47 VITAL STATISTICS Area (acres) 2,872 Area of Parks and Open Spaces (acres) 576 Population: Registrar General's estimate at 30 June, 1958 96,670 Number of separately assessed dwellings 1st April, 1958 24,528 Rateable value (General Rate) £1,483,452 Product of a penny rate 1958-59 £6,038 TOTAL LIVE AND STILL-BIRTHS 1,777 LIVE BIRTHS M. F. Total Legitimate 839 761 1,600 Illegitimate 79 66 145 Illegitimate live births per cent of total live births 9.1% Birth Rate (live births per 1,000 population) HORNSEY 18.1 Area Comparability Factor 0.93 Adjusted Rate for Hornsey 16.8 England and Wales (provisional) 16.4 Middlesex County (adjusted rate) 14.2 STILL-BIRTHS M. F. Total Legitimate 20 10 30 Illegitimate 2 • 2 Still-birth Rate (per 1,000 total live and still-births) HORNSEY 18.1 England and Wales (provisional) 21.6 INFANT DEATHS (under 1 year of age) M. F. Total Legitimate 19 11 30 Illegitimate 3 • 3 Infant Mortality Rates (per 1,000 live births) HORNSEY: Legitimate 18.8 Illegitimate 20.7 Total 18.9 England and Wales (provisional) 22.6 Middlesex County 18.9 48 NEO-NATAL DEATHS (under 4 weeks of age) M. F. Total Legitimate 18 9 27 Illegitimate 2 • 2 Neo-Natal Mortality Rates HORNSEY 16.6 England and Wales (provisional) 16.2 MATERNAL MORTALITY RATES (per 1,000 total live and still-births) HORNSEY Nil Middlesex County (13 deaths) 0.39 England and Wales (326 deaths) 0.43 DEATHS FROM ALL CAUSES Males 500 1,137 Females 637 Death Rate (per 1,000 population) HORNSEY 11.8 Area Comparability Factor .90 Adjusted Rate for Hornsey 10.6 England and Wales 11.7 Middlesex County (adjusted rate) 11.1 49 DEATHS OF HORNSEY RESIDENTS—Classified according to age groups and sexes Under 1 year 1 to 4 5 to 14 15 to 24 25 to 44 45 to 64 65 to 74 75 and over TOTALS 1 Tuberculosis, respiratory M . . . . . 1 . 2 3 6 F . . . . 2 1 . • 3 2 Tuberculosis, other M . . . . . . . . . 1 F . . . . . I . . 1 3 Syphilitic disease M . . . . . 1 2 1 4 4 F . . . . . . . . 7 Acute poliomyelitis M . . . . . . . . 1 1 F . . . . . . . . . 9 Other infective and parasitic diseases M . . . . . . . . . 1 F . . . . . . . . 1 10 Malignant neoplasm, stomach M . . . . . 7 5 9 21 31 F . . . . . • 2 8 10 II Malignant neoplasm, lung, bronchus M . . . . 2 21 10 9 42 55 F . . . . 1 7 2 3 13 12 Malignant neoplasm, breast M . . . . . . . . . 25 F . . . . 4 8 7 6 25 13 Malignant neoplasm, uterus M . . . . . . . . . 8 F . . . . . 5 1 1 8 14 Other malignant and lymphatic neoplasms M . . . . 2 12 15 11 40 95 F . . 1 . 3 19 5 27 55 N.B.—No deaths occurred from the following causes:— 4 Diphtheria; 5 Whooping Cough; 6 Meningococcal infections; 8 Measles. 50 51 Deaths of Hornsey Residents—continued Under 1 year 1 to 4 5 to 14 15 to 24 25 to 44 45 to 64 65 to 74 75 and over TOTALS 15 Leukaemia, aleukaemia M • • 1 • • • • • 1 3 F . . 1 • • 1 • • 2 16 Diabetes M • • • • • • • 1 1 4 F • • • • • • 1 2 3 17 Vascular lesions of nervous system M • • • • • 9 8 19 36 135 F • • • 1 • 14 22 62 99 18 Coronary disease, angina M • • • • 5 39 33 34 111 193 F • • • • • 6 26 50 82 19 Hypertension with heart disease M • • • • • 3 2 6 II 32 F • • • • • 1 7 13 21 20 Other heart disease M • • • • 1 3 12 18 34 124 F • • • • • 9 13 68 90 21 Other circulatory disease M • • • • 1 5 6 14 26 82 F • • • • 1 5 10 40 56 22 Influenza M • • • • • 1 1 • 2 2 F • • • • • • • • • 23 Pneumonia M 5 1 • • • 2 4 12 24 59 F 2 • 1 • • 2 6 24 35 24 Bronchitis M • • • • • 9 19 22 50 85 F • • • • • 5 7 23 35 25 Other diseases of respiratory system M • • • • 1 1 4 • 6 9 F • • • • 1 2 • • 3 26 Ulcer of stomach and duodenum M • • • • • 2 1 3 6 14 F • • • • • 3 1 4 8 52 Deaths of Hornsey Residents—continued Under 1 year 1 to 4 5 to 14 15 to 24 25 to 44 45 to 64 65 to 74 75 and over TOTALS 27 Gastritis, enteritis and diarrhoea M • • • • . . 1 . 1 6 F . . . . • 1 2 2 5 28 Nephritis and nephrosis M . . . . . 3 1 . 4 6 F . . . . . 1 . 1 2 29 Hyperplasia of prostate M . . . . . . 3 4 7 7 F . . . . . . . . . 31 Congenital malformations M 3 . . . . 1 . . 4 8 F 3 . . . • 1 . . 4 32 Other defined and ill-defined diseases M 13 . . . 2 7 2 9 35 82 F 5 . . . . 6 II 25 47 33 Motor vehicle accidents M . . . 1 2 3 1 1 9 12 F . . . 1 . • • 2 3 34 All other accidents M 1 . . 3 2 1 1 1 9 26 F 1 . . . 2 2 2 10 17 35 Suicide M . . . 1 2 4 2 3 12 21 F . . . 1 2 4 . 2 9 TOTALS M 22 3 3 5 20 135 133 179 500 F II • 3 3 17 104 125 374 637 33 3 6 8 37 239 258 553 1,137 N.B.—No deaths occurred from the following causes:— 30 Pregnancy, childbirth, abortion; 36 Homicide and operations of war. 53 INFANT DEATHS CLASSIFIED ACCORDING TO AGE AND SEX AGE AT DEATH Under 1 Day 1-6 Days 1 Week 2 Weeks 3 Weeks Total under 4 Weeks 1-2 Months 3-5 Months 6-11 Months Total under 1 Year Haemorrhagic conditions M . 1 • • • 1 • • • 1 1 F • • • • • • • • • • Pneumonia M • 2 • 2 • 4 1 • • 5 7 F • • • 1 • 1 • • • 2 Congenital malformations of heart M • 1 • • • 1 • • • 1 3 F • 1 • • • 2 • • • 2 Other congenital malformations M 1 1 • • • 2 • • • 2 3 F • • • 1 • 1 • • • • Injury at birth M 1 • • • • I • • • 1 2 F • 1 • • • 1 • • • 1 Post-Natal Asphyxia and Atelectasis M 3 3 • • • 6 • • • 6 7 F 1 • • • • | • • • 1 Haemolytic Disease of Newborn M • • • • • • • • • • 2 F 2 • • • • 2 • • • 2 Immaturity M 1 3 • • • 4 • • • 4 4 F • • • • • • • • • • Accident by Fire or Hot Substance M • • • • • • 1 • • • 1 F • • • • • • • • • • Accidental Mechanical Suffocation M • • • • • • • • • • 1 F • • • • • • 1 • • 1 All other Causes M 1 • • • • 1 • • • 1 2 F • 1 • • • 1 • • • 1 TOTALS M 7 11 • 2 • 20 2 • • 22 33 F 3 3 • 3 • 9 1 1 • II 10 14 • 5 • 29 3 1 • 33 Area Personal and School Health Services Hornsey and Tottenham (Joint Population 214,370) The tables are for the Area as a whole except where stated for Hornsey only 55 CARE OF MOTHERS AND YOUNG CHILDREN (Section 22) Notification of Births The following table shows the births notified during the year compared with previous years. The number notified last year was the highest for six years and the percentage of hospital confinements was 80%, compared with 82.8% in 1957. 1958 1957 1956 Live Births (a) Domiciliary 708 566 534 (b) Hospital or Nursing Home 2,799 2,679 2,589 Still Births (a) Domiciliary 6 3 4 (b) Hospital or Nursing Home 59 63 56 3,572 3,311 3,183 Ante-natal Clinics Following the retirement of Dr. Esther Rickards, consultant obstetrician in Tottenham, negotiations took place with the North East Metropolitan Regional Hospital Board and the Tottenham and Edmonton Group Hospital Management Committees, as a result of which links were established with the North Middlesex Hospital and Bearsted Memorial Hospital in respect of consultant cover. The staffing of the ante-natal clinics in Tottenham will in future be taken over from the North East Metropolitan Regional Hospital Board by four assistant medical officers with obstetrical qualifications appointed as honorary clinical assistants at either the North Middlesex or Bearsted Hospital for alternate weekly sessions. The percentage of expectant mothers making at least one attendance at one of the local authority ante-natal clinics was 65.7% during 1958 compared with 68.5% the previous year. During the last quarter of the year, the number of sessions at The Chestnuts and Lordship Lane clinics were reduced by one a week in each case The following table gives details of attendances at all clinics in the Area:— 56  No. of sessions held No. of new cases Total attendances Average attendance per session A.N. P.N. A.N. P.N. Burgoyne Road 73 193 116 1,376 119 20.5 Church Road 72 171 82 1,291 83 19.1 Fortis Green 102 216 122 1,657 129 17.5 Hornsey Town Hall 155 363 170 2,574 176 17.7 Mildura Court 64 214 101 1,563 105 26.0 Stroud Green 52 138 71 604 71 13.0 The Chestnuts 193 445 206 2,885 208 16.0 Lordship Lane 185 299 167 2,033 170 11.9 Park Lane 105 308 122 1,602 124 16.4 Totals 1958 1,001 2,347 1,157 15,536 1,234 16.7 Totals 1957 1,029 2,267 1,120 15,131 1,238 15.9 Totals 1956 997 2,192 1,132 14,808 1,193 16.0 Midwives Ante-natal Clinics The following table shows the attendances made during the year:— Midwives Clinic No. of sessions held Total No. of attendances Average attendance per session Burgoyne Road 20 115 5.8 Fortis Green 14 61 4.4 Hornsey Town Hall 15 105 7.0 Mildura Court 12 76 6.3 Stroud Green 24 171 7.1 Park Lane 130 653 5.0 Total 205 1,143 5.5 Mothercraft Clinics The following table shows attendances at Mothercraft clinics during the year:— Clinic No. of sessions held No. of new cases Total No. of attendances Average attendance per session Burgoyne Road 43 40 282 6.6 Church Road 45 40 287 6.4 Fortis Green 47 77 427 9.1 Hornsey Town Hall 51 100 452 8.9 Mildura Court 42 37 195 4.6 The Chestnuts 51 107 597 11.7 Lordship Lane 51 84 527 10.3 Park Lane 50 53 263 5.3 Total 380 538 3,030 8.0 57 Child Welfare Centres There are ten Centres in the Area where child welfare clinics are held. The percentage of children under one year of age who attended for the first time during the year continued the improvement noted in 1956 and is now at the maximum level. Here mothers seek the advice and counsel of doctor and health visitor. The majority of children are weighed at each attendance and the combination of weight check and discussion on the child's behaviour, feeding, progress and general care continues to be the basis on which mothers' anxieties and fears are dispelled. There are so many booklets and journals which publish information and articles on infant feeding and child care as to be confusing to many who read them. Mothers find that the child welfare centre is a good place in which to sort out and obtain information which will be useful for the individual child. Arrangements for vaccination and immunisation are also made at these centres. The continuance of this preventive work has eliminated many conditions which were common among children in the past and could well be present today without this service. There is no doubt that the standard of child well-being amongst those who attend the centres is very good indeed. In general the children who attend are healthy, but if treatment is necessary the matter is referred to the family doctor. Co-ordination between clinic, health visitor and family doctor grows steadily in cordiality to the advantage of all concerned. The following table shows details of attendances made at all centres during the year:— Name of Centre No. of sessions held No. of first attendances under 1 year No. of attendances Total attendances No. of cases seen by M.O. Average attendance per session Under 1 year Over 1 but under 2 years Over 2 but under 5 years Burgoyne Road 152 300 4,700 830 189 5,719 1,413 37.6 Church Road 153 252 3,282 516 63 3,861 1,391 25.2 Fortis Green 152 320 4,082 527 155 4,764 1,889 31.3 Hornsey Town Hall 206 508 6,084 938 260 7,282 2,726 35.3 Mildura Court 105 271 3,958 733 44 4,735 1,609 45.1 Stroud Green 100 240 3,162 392 110 3,664 1,300 36.6 The Chestnuts 256 603 7,129 1,088 224 8,441 2,351 32.9 Lordship Lane 253 438 5,942 1,176 222 7,340 1,766 29.0 Park Lane 205 314 4,813 910 199 5,922 1,693 28.9 Somerset Road 151 304 4,292 797 139 5,228 1,701 34.6 Totals 1958 1,733 3,550 47,444 7,907 1,605 56,956 17,839 32.9 Totals 1957 1,691 3,154 44,667 7,091 1,980 53,738 17,017 31.8 Totals 1956 1,660 2,945 41,816 6,716 2,208 50,740 15,758 30.6 58 Toddlers Clinics These clinics continued to be held at all maternity and child welfare centres. During the year, owing to a reduction in the average attandances, the Church Road clinic was changed from a weekly to a fortnightly one. It is usual for children between the ages of two and five years to attend these clinics. Many of them emanate from infant welfare clinics. For others it is more suitable and convenient to attend by appointment at intervals of approximately six months than to attend a busy infant welfare session. Every child attends by appointment and is seen by the doctor. Parents are most co-operative about these attendances and appear to be fully conscious of their value. It is now common for the child's parent to telephone the health visitor for another appointment if for any reason the child is unable to attend. Such action cuts down the number of follow-up visits which might be made by the health visitor and is evidence of the easy bond that exists between them. The aim of these periodic medical examinations is to maintain the health and well-being of the child until he reaches school age and is subject to medical examination provided by the school health service. Small defects are sometimes found and arrangements made for correction before further deterioration occurs. This visit also gives parents an opportunity of a quiet discussion with the clinic doctor on any matter of concern to them and the child. Numbers are limited in order to preserve the quiet unhurried character of these occasions. Most children enjoy these visits and are sometimes reluctant to leave. Suitable toys are always available and give obvious pleasure to these youngsters. The following table gives details of attendances at the individual clinics:— Name of Centre No. of sessions held Total attendances No. of cases seen by M.O. Average attendance per session Burgoyne Road 29 477 477 16.4 Church Road 31 402 362 13.0 Fortis Green 24 340 340 14.1 Hornsey Town Hall 61 631 630 10.3 Mildura Court 49 680 632 13.9 Stroud Green 24 307 307 12.8 The Chestnuts 50 597 584 11.9 Lordship Lane 51 644 629 12.6 Park Lane 50 437 436 8.7 Somerset Road 39 495 495 12.7 Totals 1958 408 5,010 4,892 12.3 Totals 1957 433 5,407 5,256 12.5 Totals 1956 449 5,296 5,207 11.8 59 Health Education A very important part of the health visitor/school nurse's work is the teaching of parentcraft and home making in schools, welfare centres, to individuals in their own homes, and to local organisations. Class teaching in schools (particularly secondary modern girls schools) in the Area has developed since 1950, until this year a total of 389 talks have been given in schools alone. This is a heavy but worth-while programme. The aim is that as many girls as possible shall take part in discussions and demonstrations on health and home-making and acquire a knowledge of the services available to the family before leaving school. We have now reached the position where young mothers attending maternity and child welfare centres renew their acquaintance with health visitors from whom they have had guidance as adolescents. All maternity and child welfare centres in the Area hold mothercraft classes at weekly intervals at which health visitors lead the discussions among young mothers or expectant mothers. Advance programmes of the subjects to be discussed are arranged at each centre. Film strips and other visual demonstrations are used to illustrate the subject under discussion. Home safety exhibitions were arranged at each maternity and child welfare centre to coincide with the national campaign on "Accidents in the Home". Tottenham Road and Home Safety Officer was very cooperative in supplying and transporting models to the three main maternity and child welfare centres. A number of health visitor/school nurses have also given talks to various women's clubs and have acted as lecturers and examiners for the British Red Cross Society's Cadets and young people's, mothercraft, first aid and home nursing groups. Daily Guardian Scheme This well tried scheme for the daily minding of children who are not eligible for admission to day nurseries has been in operation for eleven years. The number of guardians registered has always exceeded the demand, but this is useful providing they are well spread over the Area. It is essential from the working mother's point of view that the daily guardian's home should be within easy reach of the mother's home or work place. There are proper safeguards to ensure that both parents and guardians understand their responsibilities under the scheme and that a reasonably good standard of care is maintained. Health visitors are responsible for 60 the selection and approval of guardians for registration and for periodic visits to the guardian's home after the child has been placed. The majority of children minded by this means are placed for comparatively short periods. Daily Guardian Scheme Return for Year ended 31st December, 1958 No. of Daily Guardians on Register 160 No. of Daily Guardians minding Children 73 No. of Children being minded 85 Total No. of Children minded during the year 175 Total No. of days minded 16,628 Total Payments made to Guardians £831 8s. 0d. Day Nurseries Day nursery accommodation for children of working mothers and others is still much sought after and is easily the most popular method of daily minding. This year 39 applications for admission concerning 46 children had to be refused as not complying with the necessary conditions for admission. In all these cases either daily guardian or other arrangements were made. No application was refused where health or social conditions were such as to come within the scheme. There are, however, a substantial number of enquiries made by parents who wish to improve their position either by saving money for house purchase or similar purpose. During the year the number of coloured children admitted has increased and they attract attention in each nursery. Nursery matrons state that there are certain features connected with these children which call for different handling. Coloured children appear to take longer to settle in and are more demanding of staff time. They appear to be more affectionate, more vigorous and physically more mature. For this reason attempts have been made to up-grade them to the next age group, without success. Experience shows that they are more dependent, that their mental growth does not conform with their physical advancement and therefore they do not easily fit into the higher age group. These children are quite popular with the staff and the other children. Handicapped Children. There has been a slight rise in the number of handicapped children admitted to the nurseries solely on medical grounds. They include hearing children of deaf parents who have the opportunity in the nurseries of developing a reasonably correct speech pattern instead of remaining retarded. Others include children who were disabled by poliomyelitis, cerebral palsy and mental retardment. All these children have made very considerable progress. On the whole they are accepted and helped by the other children and the devoted attention of members of the day nursery staff. The acceptance of such children in a nursery involves certain adjustments such as arranging for individual responsibility 61 for the care of the child and care in placing in the age group best fitted for their disabilities and giving them short periods with children in their own chronological age group. Most of the parents of these children are very co-operative but there are a few who would withhold the child from this treatment because of financial assessment to pay the nursery charges. The following table shows the attendances at individual nurseries during the year:— Name of Day Nursery No. of approved places at end of year No. of children on register at end of year Total No. of attendances Average daily attendance Under 2 2-5 Under 2 Under 2 2-5 Total Stonecroft 15 53 17 54 3,521 10,176 13,697 53.7 Park Lane 20 30 19 19 2,498 5,852 8,350 32.7 Plevna 20 30 20 26 3,613 6,913 10,526 41.3 Totals 1958 55 113 56 99 9,632 22,941 32,573 127.7 Totals 1957 55 113 51 113 10,084 20,838 30,922 121.7 Totals 1956 55 113 37 106 6,940 21,367 28,307 111.4 Distribution of Welfare Foods There was a decrease in the issue of nutrients during the year as compared with 1957 which was expected owing to the increase in the price of National Dried Milk and the restrictions on the supply of orange juice operating during a full year. The arrangements for issuing welfare foods were substantially the same as in the previous year. National Dried Milk (tins) Orange Juice (bottles) Cod Liver Oil (bottles) Vit. A & D Tablets (packets) Totals 1958 39,005 104,980 12,571 10,420 Totals 1957 48,243 156,962 17,347 10,545 62 Priority Dental Service for Mothers and Young Children The Dental service as a whole is discussed later in this report under the school health service. The following table gives details of attendances made and treatment given at all clinics during the past three years:— 1958 1957 1956 Expectant and Nursing Mothers Children under 5 Expectant and Nursing Mothers Children under 5 Expectant and Nursing Mothers Children under 5 No. examined by dental officer 174 562 190 568 234 670 No. referred for treatment 171 523 188 548 226 618 New cases commenced treatment 155 479 172 531 218 551 Cases made dentally fit 64 172 84 323 76 321 Forms of dental treatment provided:— Teeth extracted 274 432 205 432 235 506 Anaesthetics:— (a) Local 100 56 85 69 84 72 (b) General 36 187 36 175 39 213 No. of fillings 372 469 358 847 380 1,169 No. of root fillings 1 . . . . . No. of inlays 1 1 2 . 1 . Scalings and gum treatment 108 . 76 . 128 . Silver nitrate treatment . 503 . 550 . 565 Dressings 126 150 86 338 163 674 Other operations 10 10 30 64 48 138 No. of Radiographs: (a) at County Council clinics 14 . 13 1 28 . (b) at hospital 1 . . . 2 1 Denture dressings 178 . 112 . 179 . Dentures fitted:— (a) full 14 . 8 . 18 . (b) partial 29 . 32 . 39 . No. of attendances 758 981 634 1,154 873 1,583 No. of appointments not kept 145 186 187 227 193 247 No. of half days devoted to treatment 192 221 296 63 MIDWIFERY SERVICE (Section 23) At the end of the year nine midwives were employed in the Area, two of whom live and work in Hornsey. Seven of the midwives are approved teachers and during the year 21 pupil midwives were received for the district part of their training. As was foreseen there has been a considerable increase in the number of home confinements and the midwives each had a heavy case load. They have worked well together and have done much more than the usual quota of work laid down per midwife. The number of women delivered in their own homes totalled 698, while 98 women were nursed at home following confinement in hospital. The tendency is to send mothers home much earlier than previously and most were sent home on the second day following delivery. A small number were sent home a few hours after delivery. In addition to duties in the clinic, ante-natal and other visits, the midwives undertook work in connection with the National Birthday Trust's investigations into the causes of perinatal mortality. The survey lasted over a period of three months, March, April and May. During the first week in March a detailed and comprehensive questionnaire was completed for every delivery and for the rest of the period, in the case of every death or stillbirth. It is significant of the midwives' good relationship with their patients that no woman refused to complete the form although much of the required information was of a personal and intimate nature. This is an important investigation as the neo-natal death rate is causing concern throughout the country. The large number of removals into the Area, particularly in Stroud Green, has caused an increase in the number of late bookings and in the calls to the midwife of patients in labour who have made no arrangements at all. These latter cases are causing much concern amongst the midwives as they have no prior information about the patient's obstetric history and there is often difficulty in getting a doctor to attend such cases. A great deal of time is spent on these patients who usually contact every possible source of help when labour is well advanced and such a case recently involved the following services—police who visited the patient's house and the midwife's house, ambulance service who sent an ambulance to "stand by", an L.C.C. midwife who lived nearby, a midwife from Tottenham who was sent to the house. Two hospitals were also contacted. In addition telephone calls were received at a clinic, at three midwives' houses, at the Area Health Office and at the Supervisor of Midwives' house. The cost in time and petrol on such a case is considerable in addition to disrupting the normal work of the services involved. Transport. With the present extreme shortage of midwives, it is vital that every midwife who is able to drive should have the use of a car, primarily because she is able to do more work in less time and also while working at such pressure to conserve her energy. 64 An analysis of the work of the service during the past three years is shown in the table below:— 1958 1957 1956 No. of deliveries attended 698 555 509 No. of visits made 14,730 12,163 8,846 No. of hospital confinements discharged before 14th day 98 76 38 No. of visits made 910 708 354 No. of cases in which medical aid was summoned 297 176 143 No. of cases in which gas and air analgesia was administered 588 431 400 No. of cases in which pethidine was administered 483 322 265 No. of cases in which trichloroethylene was administered 65 46 33 HEALTH VISITING SERVICE (Section 24) The main work of the health visitor in the welfare centre and the home is well known and is concerned with the maintenance of health and wellbeing of each member of the family from the youngest to the oldest. Health visitors receive a great many telephone calls from parents, almoners, family doctors and others during the year. This direct and harmonious interchange between those concerned shows how much team work has advanced in recent years. The majority of these calls are requests for home visits, for advice or reports of one kind or another. Requests also come in for early visits to those being admitted or discharged from hospitals. Visits of this kind are increasing and give the health visitor an opportunity to prevent or relieve distress and provide a firm intermediate link between patients, their homes and hospitals. Local hospitals have provided medical reports this year on the condition of aged persons discharged from hospital and these have been of considerable help to health visitors in making the follow-up home visits. In the field of mental health a worth while experiment resulted from a talk given in March 1958 by Dr. J. C. Sawle-Thomas, Regional Psychiatrist to the North East Metropolitan Regional Hospital Board and Consultant 65 Psychiatrist to the Prince of Wales's General Hospital, to members of the medical and health visiting staff on "The implications of the Royal Commission Report on Mental Health". He made a plea for closer co-operation between hospital and local authority services. Later arrangements were made for a monthly case discussion session for health visitors in the psychiatric department at the Prince of Wales's General Hospital at which health visitors presented cases known to them of early signs of mental breakdown. It was not intended that the Consultant should see any patient who might be the subject of the case conference, except by referral from the family doctor, and no person concerned was asked to attend while the case was under discussion. The purpose of such case conferences is to assist health visitors to obtain a fuller understanding of mental health and methods by which health visitors can more adequately assist individuals and families; and are particularly helpful where families find it difficult to cope with a mentally sick adult or one nearing breakdown living at home. The first case conference was held in the late afternoon of 2nd June and at monthly intervals for the rest of the year. These occasions have proved to be a very real help to health visitors who have presented cases and others who have attended as observers. It is perhaps too early to assess the effect this may have beyond emphasising that the conferences are fulfilling the purpose for which they were started and to state how fortunate we are to have the guidance and counsel of Dr. Sawle-Thomas at a time when a great many people are pondering on the effect that new legislation may have in this country. This is also the first year in which the health visitor has been able to refer young children directly to a psychiatrist specialising in child guidance. The health visitor makes appointments for parents to attend with the child and she is herself present throughout the interview. The psychiatrist (Dr. C. Phillips) attends one session a week to see children of under two years of age who are revealing early patterns of behaviour which cause disquiet or uneasiness for their parents. Children suffering from sleeplessness, feeding difficulties, retardment of speech, over-activity and other disorders have been seen. While it is common for mothers to be the sole parent present at the initial interview it is not at all unusual for both parents to attend subsequently or for fathers to offer to be present. Children, parents and health visitors have profited from these interviews although the reaction to the technique used varies considerably. Time cannot be allowed to be a pressing factor if the underlying motives for behaviour are to come to the surface. It is for this reason that a small number of interviews is arranged for each session. 66 Student Health Visitors Eight students from Battersea Polytechnic, the Royal College of Nursing and County Council sponsored students were accepted for practical training during the year. Considerable care is taken in the preparation of their programme to ensure that they have as wide experience as possible of all the services which may have a bearing on their future work. Health visitors, education authorities, local voluntary bodies and the chief officers of various statutory services have been most co-operative in making this possible. Student Nurses Programmes of observation visits for student nurses from the Prince of Wales's General Hospital and from the Middlesex Hospital, W.I. have been arranged in the Area during the year. The visits follow lectures on "Social Aspects of Disease" and are intended to give practical and visual illustration of work done in the public health field of the National Health Service. The intention is to give each student an opportunity to observe a different aspect of the public health services so that as much as possible can be reported upon in the general discussions which are held when the student nurses return to hospital. Lectures During the year the Superintendent Health Visitor (Miss Townsend) gave eight lectures on the Social Aspects of Disease to student nurses in training at the Prince of Wales's General Hospital. A number of other talks to local bodies and one to a Ministry of Education Course for Western European Union delegates have also been given. Visitors Visitors to the Area include ward sisters from the Staff College of King Edward's Fund for London, student nursery nurses from residential nurseries, health visitor students from the Royal College of Nursing, student teachers, Barnado's Home Office Course students, student sister tutors and others studying Occupational Health Nursing. Two Birmingham University social science students also attended and other small local groups of young people. The majority of these are interested in the health visitors functions and many of the programmes arranged for these visitors include actual experience with the health visitor. Voluntary Organisations Clinic premises have been made available to voluntary bodies, the National Blood Transfusion Service, the Family Planning Association and the Old People's Welfare Committee. The family Planning Association has had the use of the School Clinic, Weston Park, Hornsey on Monday 67 and Tuesday evenings each week and on Wednesday evenings at Lordship Lane School Clinic, Tottenham. Voluntary Workers. The secretaries and members of clinic voluntary workers have given considerable reliable and efficient service in Hornsey Maternity and Child Welfare Centres and are commended on their loyal support throughout the year. Specialised Visiting of Problem Families Two special services health visitors have undertaken this work for families in particular need. There can be no doubt that only health visitors of considerable vocation and experience are likely to continue in this sphere of distressing but rewarding work of rehabilitating problem families or those bordering on a "break-up" of family life. It is not enough to call to give advice since these families are generally incapable of acting upon advice without considerable support and assistance. Our experience has shown that it is necessary for the specialised worker to be in the home a good deal to show the family what they can do for themselves and to wait upon the unfolding of concealed unsolved personal prostrations which are so often part of the source of the family's downfall. The state of the home is in general indicative of the level to which the family has descended and from which it must be encouraged to rise. It is no solution to arrange for the services of a home help or other person to do the work. Of those referred to the special services health visitors a substantial number of the parents are either suffering from mental defect, mental illness, physical deterioration, have been "in trouble" or "inside" or have a combination of two or more of these failings. Both special services health visitors received the greatest assistance and support from family doctors; local clergy, statutory and voluntary agencies and individuals. All appear to have recognised the significance of this work and are very willing to be called upon for help. Every home visited showed evidence of the intensive work done with the family. The combined efforts of members of the family in redecorating their rooms does much to pull them together in making the best of their homes and giving them pride in their efforts. In general it is not easy to get them moving into doing this but once started they work well and have great pleasure in the results. Considerable debts have been accumulated by most problem families, but by constant encouragement these can be, in a comparatively short time, very substantially reduced. Saving in public funds Apart from uniting and rehabilitating the family into the community as a whole, the work of these visitors shows considerable saving in the expenditure of public monies on each family, as will be seen illustrated in the following two examples:— 68 Weekly expenditure from public funds before being taken over by the Specialist Health Visitor Family A Father on N.A.B. £3 17s. 6d. plus 15s. 0d. rent (Family allowances paid to the Children's Department) £4 12 6 6 children in care:— 3 in residential nurseries—approximate cost £30 0 0 2 in residential homes —approximate cost £24 0 0 £58 12 6 Free meals to returned school children 15 0 3 children at day nurseries free (charged at full cost) £9 15 0 Expenditure entailed by keeping the family together for school meals and day nursery accommodation £10 10 0 This shows a weekly saving of public expenditure of £48 2 6 Family B Mother ill and unable to cope. Five children in care:— 3 of these at approximate weekly cost £24 0 0 2 of these at approximate weekly cost £20 0 0 £44 0 0 After the children returned home the following help was given:— 3 free dinners for school children 15 0 2 children in day nursery free (charged at full cost) £6 10 0 Home help 10 hours weekly (charged at full cost) £2 0 0 £9 5 0 Saving to public expenditure a weekly sum of £34 15 0 69 It will be seen from these two illustrations that support by public funds in the case of divided families is tremendously costly. By keeping the family together with some, but considerably less, financial expenditure, the family gains confidence, self respect and is happier than it is when separated. It would be sanguine to think that every case can be entirely left to its own devices once the main difficulties have been settled. It is for this reason that the visitor slowly relinquishes her support and in some cases finds others to take her place in this respect. It is our opinion, however, that this work is very essential to the family in grave difficulties and to the community in which it lives. Statistics The following table shows the number of visits paid by health visitors during the past two years:— No. of visits paid by Health Visitors working in the Area 1958 1957 Expectant Mothers First Visits 1,982 1,781 Total Visits 3,358 2,850 Children under 1 year of age First Visits 4,136 3,759 Total Visits 160,25 14,568 Children aged 1-2 Total Visits 7,771 7,191 Children aged 2-5 Total Visits 12,643 11,952 Other cases Total Visits as Health Visitor 6,051 5,489 Total Visits as School Nurse 911 983 70 HOME NURSING SERVICE (Section 25) The number of nurses employed in the Area at the end of the year was 19 full-time and 7 part-time, and again care of the aged sick made the greatest demand on the service. The total number of visits paid by home nurses during the year was 79,286. The treatment of cases during the year may be classified as follows:— Injections 1,431 General nursing care 576 Blanket baths 354 Enemas 332 Dressings 324 Preparation for diagnostic investigation 186 Pessaries changed 58 Wash-outs, douches, etc. 42 Attendance at minor operation I Other treatments 152 The sex and age of patients at the time of the nurse's first visit may be classified as follows:— Age Males Females 0-4 21 15 5-15 39 36 16-39 88 179 40-64 372 631 65 and over 589 1,203 1,109 2,064 Cases attended during the year were referred from the following sources:— General Practitioners 2,363 Hospitals 789 Chest Physicians 18 Public Health Department 3 The shortage of car transport must again be emphasised in that only 25% of the nursing staff have any form of individual motorised transport, the remainder being dependent on bicycles and public transport. 71 Co-operation with voluntary and other outside services has been well maintained and in particular with the British Red Cross Society who deal with the distribution of nursing equipment on loan, the W.V.S., and the Old People's Welfare Organisations who have assisted in the supply of clothing and bed linen in approved cases. Further details of the work of the home nursing service is shown in the following table:— Type of Case No. of new cases attended by home nurses during year No. of cases remaining on register at end of year No. of visits paid by home nurses during year M F Total M F Total Medical 788 1,306 2,094 157 439 596 70,499 Surgical 79 107 186 II 10 21 4,874 Infectious Diseases 3 1 4 . . . 51 Tuberculosis 19 21 40 6 6 12 3,850 Maternal complications . 2 2 • . • 12 Totals 1958 889 1,437 2,326 174 455 629 79,286 Totals 1957 903 1,707 2,610 1 220 627 847 87,851 72 VACCINATION AND IMMUNISATION (Section 26) Vaccination against Smallpox The percentage of children in the Area under one year of age vaccinated against smallpox rose to 66.6%. The following table records the number of persons known to have been vaccinated or re-vaccinated during the year by general practitioners and clinic medical officers:— This table relates to Hornsey only. Under 1 year 1 year 2-4 year 5-14 years 15 years and over Total No. of Primary Vaccinations 1,276 44 27 32 65 1,444 No. of Revaccinations 3 1 6 21 173 204 Immunisation against Diphtheria and Whooping Cough The policy of using separate vaccines in clinics for immunisation against diphtheria and whooping cough continued during the year. The following table shows a considerable increase in the number of children being immunised against diphtheria, and efforts are being made, in spite of administrative difficulties, to achieve equally satisfactory results in regard to whooping cough immunisation. This table relates to Hornsey only. Age at date of immunisation No. of children immunised No. of children given re-inforcing injections Diphtheria only Combined Diphtheria and Whooping Cough Whooping Cough only Diphtheria only Combined Diphtheria and Whooping Cough Under One 740 298 116 . . One 264 293 276 . . Two to Four 86 19 10 173 12 Five to Fourteen 114 4 3 394 19 Totals 1958 1,204 614 405 567 31 Totals 1957 428 875 153 379 33 73 Poliomyelitis Vaccination (A) Extension of Scheme As a result of Ministry of Health Circular 20/58, the poliomyelitis vaccination scheme was extended to persons born in the years 1933-42, so that in fact all persons up to and including 25 years of age, as well as special categories of any age, became eligible for this protection. Publicity was given to the extended scheme during the week commencing 27th October 1958 by means of advertisements in the local press, B.B.C. radio and television broadcasts, posters, car stickers and leaflets. General practitioners have been kept fully informed and have given valuable assistance in vaccinating patients who preferred to attend their own doctors' surgeries. In this Area an approach was made to all factories with more than 50 employees and as a result, leaflets explaining the scheme were distributed through pay packets. Many of the firms also asked for posters and car stickers which were immediately supplied. An experiment was tried with "open" sessions on Saturday mornings at which eligible persons could attend without appointment and which were publicised in the local press. Four such sessions have been held but only 55 persons availed themselves of this opportunity. The scheme also provides for evening sessions to suit the convenience of persons who may be working and unable to attend during the normal day-time sessions. Only 17 persons, however, have asked for an evening appointment and as they are scattered over the Area and it would not be possible to arrange a session convenient for them all, they have been offered the alternative of approaching their family doctors or attending a normal day-time session. Three of the factories in the Area have asked for sessions to be arranged during working hours in their factories and some 300 persons will receive protection in this way. (B) Third Injections The Ministry of Health also decided that third injections should be offered to all persons who had had two injections provided that the third injection was given not less than seven months after the second injection. Third injections were commenced at the beginning of October 1958 and by the end of the year 6,939 persons had received this extra protection. 74 (C) Progress of Scheme Total number of persons receiving two injections during the period 1st January to 31st October, 1958, either from general practitioners or at clinics 18,165 Vaccinations carried out during the period 1st November to 31st December, 1958:— No. of persons who completed a course of two injections during the period No. of applicants not yet vaccinated with one or two injections No. of persons who have received one injection only at any time up to 31.12.58 Children born in years 1943-1958 1,591 1,540 601 Young persons born in years 1933-1942 494 102 119 Expectant mothers 136 15 38 General practitioners and families 10 . . Ambulance staff and families 1 . . Hospital staff, medical students and their families vaccinated by general practitioners 25 . . Totals 2,257 1,657 758 In addition, 1,450 doses of vaccine were issued to general practitioners for first injections, but it will not be known into which of the above categories these fall until completed record cards have been received. 75 PREVENTION OF ILLNESS, CARE, AND AFTER CARE (Section 28) Recuperative Holidays The Area health staff continued to be responsible for dealing with applications for recuperative holidays and during 1958 177 applications were received compared with 253 the previous year. Of these, 142 were approved. DOMESTIC HELP SERVICE (Section 29) The total number of cases provided with home help during the year was 1715, the bulk of the cases comprising the chronic sick, including aged and infirm, who need more or less permanent help. The demands on the organisation can be readily appreciated when it is realised that nearly 1,000 patients require help week by week. The following table shows details of the cases served during the year:— Cases provided with help No. of new cases provided with help No. of old cases for which help was continued from 1957 Total No. of cases provided with help during year Total No. of cases still being provided with help at end of year Maternity (including expectant mothers) 106 10 116 6 Tuberculosis 13 34 47 30 Chronic Sick (including aged and infirm) 481 941 1,422 945 Others 118 12 130 13 Total 718 997 1,715 994 76 Night Service This service continued during the year to provide help for patients who are very ill or dying and who need night attention, and so enable relatives or others who normally provide this assistance to get a certain amount of relief. During the year five cases were served for a total of 96 hours. Training Scheme The scheme to give some instruction to home helps was continued during the year, three courses being arranged. SCHOOL HEALTH SERVICE General The year was an extremely busy one for the school health service. Owing to the priority given to poliomyelitis vaccination the number of sessions devoted to periodic medical examinations had to be curtailed, the cut being made in the intermediate examinations as it was felt that the entrants and leavers examinations must be held. Despite difficulties the B.C.G. vaccination and diphtheria booster dose programmes in schools were proceeded with. Much credit is due to the clerical staff responsible for organising these overlapping programmes. That all the work is worth while is shown by the vital and infectious disease statistics for the Area. The work of the cerebral palsy unit at Vale Road Day Special School for the Physically Handicapped continues to increase, 51 children being under supervision as against 44 in 1957. Further reference to the work of the unit will be found in the report of the Consultant on page 87. It appears likely that further provision for educable cerebral palsied children is likely to prove necessary at this School. The number of partially deaf children in attendance at the Senior and Junior partially deaf units continues to increase and discussions have taken place with a view to increasing the number of classes for these children. The work of the audiology unit has been rather hampered by lack of suitable facilities and by a delay in decisions as to the appointment of a permanent audiologist. Writing now in May 1959 it does appear that these problems will shortly be overcome. Routine Medical Inspection The following table shows the number of Hornsey children inspected by years of birth and the classification of their physical condition. 77 Year of Birth Number of Pupils Inspected Condition Satisfactory Number % 1954 and Later 209 209 100.0 1953 619 619 100.0 1952 108 108 100.0 1951 27 27 100.0 1950 176 176 100.0 1949 744 744 100.0 1948 107 107 100.0 1947 229 229 100.0 1946 720 719 99.9 1945 279 279 100.0 1944 228 228 100.0 1943 and Earlier 924 924 100.0 Total 4,370 4,369 99.98 Infectious Diseases in School Children With the exception of tuberculosis which showed a slight increase, the year 1958 was uneventful from the point of view of infection. Three cases of poliomyelitis occurred in unvaccinated children; two of the three were brothers and unfortunately one died and the other is still in hospital with residual paralysis, the third case made an excellent recovery. There were no cases of diphtheria and no outbreaks of food poisoning or dysentery during the year. B.C.G. Vaccination Despite the special effort involved in carrying out poliomyelitis vac cination in 1958 it was felt that B.C.G. vaccination should be maintained as heretofore. Considerable difficulties were met in ensuring that the two schemes did not overlap. 1958 1957 Parents approached 1,218 % 1,128 % Parents accepting 921 75.6 947 83.9 Mantoux positive 68 8.1 91 11.8 % Strong positive 50.0 61.6 % Weak positive 50.0 38.4 Mantoux negative 733 87.4 702 85.6 Total vaccinated 718 58.9 of children in group approached 691 61.3 of children in group approached 78 It is interesting to note that as a result of investigation of strongly Mantoux positive children and their families at the Chest Clinic, two cases of tuberculosis were discovered; 1. a girl of 13 was Mantoux tested at school and found by X-ray to have early tuberculosis and was admitted to Highwood Hospital. In January 1959 she was reported as fit to return to school on chemotherapy. 2. a boy of 13 was found to be strongly tuberculin positive. His X-ray was clear but that of his father showed bilateral active pulmonary tuberculosis and he was admitted to hospital for treatment. Tuberculosis in Schools During 1958 a total of six cases of tuberculosis were notified in school children, five pulmonary and one of bone. This compares with three in the previous year and seven and fourteen in 1956 and 1955 respectively. These cases were discussed with the appropriate chest physicians and in two instances epidemiological investigations were considered necessary at the school. 1. A case of pulmonary tuberculosis was discovered in a senior pupil at a special school in Tottenham. This boy's parents had not accepted the offer of B.C.G. vaccination for him. Following on consultation with the chest physician, it was decided to undertake epidemiological investigations at this school. As a result of skin testing, four children were found to be tuberculin positive. These plus seven children who had had B.C.G. and two who had tuberculous meningitis, in all of whom the tuberculin test was of no value, were referred for X-ray. In addition, all of the teaching and domestic staff were X-rayed. In all cases X-rays were negative, but in view of the highly infective nature of the primary case, the chest physician has asked for a repeat X-ray of the children early in the new year. 2. Following the notification of a case of tuberculosis in a girl attending a primary school in Hornsey, epidemiological investigations were undertaken at the school. As a result of skin testing of her classmates, all the children were found to be Mantoux negative and no further action was, therefore, necessary. All the teaching and domestic staff were X-rayed and found to be fit. School Nursing Service The field covered by the school nurse has included preparation for and attendance at routine medical inspections of school children, attendance at various specialist and minor ailment clinics, certain home visits to parents of school children including those required for the follow-up of defaulters from clinics, home reports for hospitals or for the giving of advice to parents. Every school was visited at the beginning of each term in order to carry out hygiene inspections and further visits were made as often as 79 papeared necessary. School visits of this kind are an important part of the measures taken by the school nurse for the maintenance of the cleanliness and health of the school child. The discovering of minor defects and verminous conditions before these develop into matters of serious concern are the primary duties of the school nurse and are intended to fill in the gaps between routine medical inspections which occur on at least three occasions in the life of each school child. Close contact between the head teachers, class teachers and the school nurse is maintained at all times. It may be the occasion when the nurse makes recommendations to the head teacher that the child should see his family doctor, attend a clinic or temporarily be excluded from school. The problem of reducing the number of vermin infested children in schools has been the grave concern of school nurses for many years and has taxed their resolution, patience, ingenuity and tact. It is not uncommon today for parents to seek the help and advice of the school nurse before the condition has had a chance to affect others and to submit each member of the family for scrutiny in order to clear up the matter. This new commonsense attitude of parents appears to be replacing the old anragonisms and feelings of parental guilt associated with infestation. Family doctors and industrial firms have also been amongst those who have sought the assistance and advice of the school nurse. Modern insecticides, smaller families, health teaching and improved standards of hygiene in schools and home may be some of the factors which together have reduced the infestation figures, as shown in the following table:— HORNSEY 1947 1958 Number of examinations 21,595 19,571 Number of pupils found to be infested 105 23 The decline in the school nurse's work connected with verminous conditions and minor ailments has, to some extent, been replaced by work linked with B.C.G. and poliomyelitis vaccination campaigns. In general the trend of the school nursing service is more preventive in character than it has ever been. There is more opportunity for the school child to meet the school nurse as a friend with whom all sorts of things can be discussed unhurriedly. This is a healthier position from which the school child can view the machinery of the health services and may have farreaching results. In the School for the Physically Handicapped a fulltime nurse is employed, and her duties regarded as an integral part of the life of the school. She sees the children into and out of school transport, deals with minor disorders, attends medical inspections, carries out treatment prescribed by the school medical officer and by visiting consultants. She also visits the homes of pupils where necessary; is present at school meals and takes part in out-of-school activities by accompanying school parties to various Saturday functions. It may be said that her continued presence in the school relieves pupils and teachers from anxieties which are common to special schools of this type. 80 Health Education in Schools Our programme of health education in schools has continued. This was started in co-operation with head teachers mainly because of concern about problem families and early marriages for which it seemed the adolescent had very little preparation. Also that general instruction on health was not fully covered by the normal school curriculum. Encouragement to develop and increase these programmes was given by the keenness of the children, demands from other schools and in at least one unexpected occurrence. Here a girl of a problem family who had been present at a series of health talks in the school arrived one day at a welfare centre. She told the health visitor that she had brought her baby sister to see her because she was worried about the child, and while her mother allowed her to take the baby to the health visitor she could not be bothered to do so herself. During the year 389 talks were given in secondary modern schools. Health visitors and one school nurse with training and a special flair for teaching undertook this work. School Dental Service The Area Dental Officer (Mr. Sainty) reports:— During the past year the staff position, in addition to the Area Dental Officer, has been:— Full time Dental Officers to 31st July 6 Full time Dental Officers thereafter 5 Part time Dental Officers (equivalent to 9/11ths of one full time appointment) 2 Part time Orthodontist 1 There was a slight falling off in the number of school children attending for treatment and, consequently, in some categories of treatment. One reason for this may be that treatment is now more readily obtainable under the National Health Service than previously. Evidence of increased treatment outside the school dental service is seen at routine dental inspections and it is only natural that some parents may prefer to have their children treated by their family dentist. The fact that evening treatment is welcomed by many is shown by the continuing success of this at the dental clinic in the Park Lane Centre where it has been in operation for several years. This Area, in company with others, took part in the quinquennial survey of the Ministry of Education into the incidence of dental caries in school children. Two age-groups are involved—5 year olds and 12 year olds. Previous surveys took place in 1948 and 1953. In this Area 446 5-year olds and 740 12-year olds were inspected for this purpose. The long waiting list for treatment at the Orthodontic Clinic continues and there seems little prospect of improvement. The treatment of maternity and child welfare cases has continued as in recent years and there is nothing fresh to report. The following tables show the work carried out during the year in Hornsey:— 81 DENTAL INSPECTIONS AND TREATMENT Age Groups No. Inspected No. found to require treatment No. referred for treatment at the County Council's Dental Clinics Under 5 35 16 16 5-16 and over 9,798 4,616 4,610 Specials 1,026 951 926 Totals 10,859 5,583 5,552 Number of pupils treatment commenced 2,533 Number of pupils treatment completed 1,820 Number of attendances made by pupils for treatment 5,811 Number of appointments not kept 1,283 Number of half days devoted to (a) Inspections 74 (b) Treatment 890 Fillings—Permanent Teeth 3,652 Temporary Teeth 1,109 Number of Teeth filled—Permanent Teeth 3,273 Temporary Teeth 1,066 Extractions—Permanent Teeth 330 Permanent Teeth for Orthodontia 32 Temporary Teeth 1,611 Anaesthetics (a) General 562 (b) Local 497 (c) Regional 22 Other operations (a) Permanent Teeth 587 (b) Temporary Teeth 1,461 SPECIAL DENTAL TREATMENT UNDERTAKEN BY DENTAL OFFICERS Number of Impressions, etc 59 Number supplied with Dentures 12 Number of crowns and bridges 3 Number of Radiographs (a) At Dental Clinics 36 (b) At Hospitals — ORTHODONTIC EXAMINATION AND TREATMENT AGES 5 6 7 8 9 10 II 12 13 14 Totals Pupils examined 2 2 6 9 21 12 9 12 5 4 82 Pupils selected for treatment 2 I 5 6 14 10 7 5 4 — 54 Commenced treatment (first attendance) 123 Attendances made for treatment 782 Impressions, etc 416 Fixed appliances fitted — Removable appliances fitted 61 Radiographs at Dental Clinics 30 Pupils treatment completed 16 Orthodontic sessions (half days) 69 82 83 THE HANDICAPPED CHILD—Distribution in Hornsey as at 31st December, 1958 CATEGORY In Special Day Schools 1 In Special Residential Schools In Maintained Primary and Secondary Schools In Independent Schools Not at School TOTAL B G B G B G B G B G B G Blind . . 3 3 . . . . . . 3 3 Partially Sighted 3 2 . . . . . . . . 3 2 Deaf 3 1 . . . . . . . . 3 1 Partially Deaf 2 5 2 . . . . . . . 4 5 Educationally Sub-Normal 28 15 5 4 . . . . . . 33 19 Epileptic . . 1 1 . . . 1 . . 1 2 Maladjusted • . 7 1 . 1 10 3 . . 17 5 Physically Handicapped 7 2 2 . . . . . 1 1 10 3 Speech Defects . . . . 92 28 1 2 2 2 95 32 Delicate . 1 6 4 . . . . . . 6 5 Totals 43 26 26 13 92 29 II 6 3 3 175 77 GRAND TOTALS 69 39 121 17 6 252 THE HANDICAPPED CHILD The Deaf Child During 1958 the International Congress on the Modern Educationa Treatment of Deafness took place in Manchester at which many hundreds of delegates from all over the world attended. An opportunity was thus afforded of taking stock of our progress and of new trends in the educational treatment of the deaf child. Ascertainment The first essential in any such programme is early ascertainment. The results of recent research have shown us the vulnerable groups in which to look for deaf children. Audiometry in school children by means of the gramophone and pure tone sweep test audiometer has become routine now in most of Great Britain. At the same time it should not be looked upon as an instrument of case-finding of severely deaf children. Case finding of such children should take place long before the age of compulsory school attendance. Professor and Mrs. Ewing have suggested a method of routine screening tests of hearing of all babies by health visitors. This method while crude does get results though there is evidence to show that the same results could be obtained by a more selective method of screening those at known risk. The audiology clinic plays a most important part in early ascertainment. By now the example set by such clinics as that at the Royal National, Throat, Nose and Ear Hospital, London, is well known and it is generally agreed that an extension of these clinics to all parts of the country is required. Their aim is the detection of deafness in children at the earliest possible age and to give subsequent aid to the child and his family in overcoming the handicap. Auditory Training The necessity for auditory training is well recognised and accepted by all. Beyond this, however, is the great schism—at least in this country and apparently in the United States as well. There are those who "hold these truths to be self-evident" —that all deaf children recognised early enough, fitted with a hearing aid and spoken to according to the recognised methods of auditory training, will learn to understand and reproduce spoken language without the necessity of education in a special school. There are some who will accept virtually no qualification of this assertion. Others reply that it is wholly false. An objective assessment of the results of this treatment is an urgent necessity. It is possible that the happiness and well being of some children is being sacrificed to what may be theory rather than fact. Prosthetics Advances in electronics have been astonishingly rapid in recent years with the risk of rendering expensive apparatus rapidly out of date. The cumbersome battery aids are being replaced by transistor aids. The 84 induction loop system enables children to move freely about in class while still remaining in contact with the teacher's voice. Integration The undoubted achievements made possible by earlier and more accurate diagnosis, auditory training and hearing aids have made the integration of deaf and partially deaf children into the hearing community and in particular in ordinary day schools, a very live issue. Many papers were read at last year's conference on this subject. At the same time it is widely felt in the educational field that the claims for results of such integration are exaggerated. There are undoubtedly cases where children theoretically able to manage in a hearing environment become maladjusted there and improve on removal to a special unit where they are able to mix with other children handicapped like themselves. It is also true that deaf adults left to themselves do tend to mix with other deaf persons although they are quite able to manage in a hearing community. The Non-oral Child To the outsider there would appear no doubt that some children leave schools for the deaf unable to communicate orally with their hearing fellows. Various reasons have been given for these failures—late diagnosis, residential schooling as opposed to day schools, insufficient use of hearing aids, separation from the hearing community. Some teachers say they have no such failures. It may be, however, that for some reason, either of disordered physiology, or psychology, that some deaf children can never become oral and it is important to try and ascertain if this is so, to discover such children and to teach them appropriately by the best form of sign language. Such views are by some regarded as heresy but this should not deter the research worker. Conclusions There is need for further fundamental research into many problems of deafness. A good deal of work is being done but it is either un-co-ordinated or ill-co-ordinated. It is felt that a central body should be set up to be responsible for overall planning of research, to draw up a list of priorities and to allocate reaserch fields to the various centres engaged in research —both University and clinical centres. If a lead were given by the Ministry of Education—the most appropriate body—other interested organisations such as the Medical Research Council, the National Institute of Teachers of the Deaf, the voluntary societies, the University centres and the school medical group of the Society of Medical Officers of Health would no doubt respond. 85 AUDIOLOGY UNIT No. Age Sex Reasons for referral P.H. Remarks Source of Referral Decision and Disposal 1 3 M ? Deaf ? Mentally defective N.K. Illegitimate School Medical Officer, Finchley Not deaf Ineducable 2 9 M Suitability for Partially Deaf Unit. Maladjusted in ordinary school None High intelligence Audiology Unit, Gray's Inn Road Junior Partially Deaf Unit 3 10 M Suitability for Partially Deaf Unit N.K. Partially sighted Diabetic School Medical Officer, Ealing Blanche Nevile School 4 II M Suitability for Partially Deaf Unit Erythroblastosis. Epileptic School Medical Officer, Willesden Trial at Partially Deaf Unit unsatisfactory 5 1 1/12 M ? Deaf N.K. Cleft palate Illegitimate School Medical Officer, Southgate Deaf—for training 6 8 3,12 F Suitability for Partially Deaf Unit Nil Chronic suppurative otitis media School Medical Officer, Ealing Junior Partially Deaf Unit 7 12 M Suitability for Partially Deaf Unit Nil Educationally sub-normal Maladjusted School Medical Officer, Willesden Unsuitable for Partially Deaf Unit 8 II M Suitability for Partially Deaf Unit Nil Backward London County Council Under consideration 9 13 F Transfer from Wales N.K. Backward School Medical Officer, Hornsey Senior Partially Deaf Unit 10 4 M ? Deaf ? Backward Nil — Paediatrician Backward Not deaf II II M Suitability for Partially Deaf Unit. Lack of progress in ordinary school Nil Chronic suppurative otitis media School Medical Officer, Potters Bar Senior Partially Deaf Unit 12 3 M ? Deaf ? Mentally defective Nil Blind. In care of County Council School Medical Officer, Tottenham Not deaf. Mentally defective 13 3 9/12 M Suitable for Nursery at Blanche Nevile School Nil — School Medical Officer, Hendon For Nursery Unit 14 II M Sutability for Partially Deaf Unit Nil Meningitis School Medical Officer, Hounslow Senior Partially Deaf Unit I5 8 M Suitability for Partially Deaf Unit N.K. In Catholic Children's Home School Medical Officer, Enfield Junior Partially Deaf Unit 86 Number of children seen 15 Pre-school children 5 Attending infant and junior schools 7 Attending senior schools 3 Reason for referrals among these 15 children were as follows:— For diagnosis 4 Immigrants to Area, known to be deaf I Partially deaf children, advice as to placement 7 Children known to be deaf—application for admission to nursery class, Blanche Nevile School or partially deaf unit 3 Source of Referrals:— Tottenham and Hornsey 3 Other Boroughs in Middlesex 11 London—neighbouring Boroughs I Vale Road School for Physically Handicapped Children Cerebral Palsy Unit The number of children at the Vale Road School for Physically Handicapped Children at the end of the year was 94, of whom children with cerebral palsy, poliomyelitis or heart disease accounted for rather more than 75%. The aim of the school is, of course, to provide for each child so far as possible a normal education under the special conditions made necessary by his handicap. For such children, the requirements are normal schooling, medical treatment and modified activity, and in many cases each of these can be treated as a separate problem. The Consultant (Dr. Dunham) in charge of the children with cerebral palsy comments that the normal schooling and modified activity—together with out-of-school work and play—can all be "medical treatment", training in doing things of everyday life in a normal way. In the school, therefore, the aim of those whose special concern is with the 29 children with cerebral palsy is to help the children to learn how to tackle normal tasks in a normal way, and advise others how they also may do this. The team operates, therefore, in the classroom, the playground and the swimming bath, rather than in a "treatment room". Girls from South Grove School, who share domestic science, needlework and swimming with children from the school, collaborate in the work. Parents attend for advice. And, in order that normal habits of movement should be established from the first, special provision is made for parents of children too young to attend even the nursery classes to be given advice. The "medical treatment" provided is thus a co-operative effort by parents, teachers, nurse, therapist and doctor to carry out what may be called "training by the direct method". The Consultant wishes to pay tribute to the keen cooperative spirit of all engaged in the work. During the year advice has been given from the school on the management of 22 pre-school children, of two children attending occupation centres and of two children attending the Blanche Nevile School for the Deaf. Of the 22 pre-school children, three are in attendance at County Council Day Nurseries. 87 CHILDREN SEEN FOR THE FIRST TIME AT THE CEREBRAL PALSY UNIT IN 1958 Case No. Age Sex Referred by Diagnosis Disposal 1 4 F School Medical Officer, Tottenham Congenital deafness. Cerebral palsy— generalised spasticity Blanche Nevile School, supervised by Dr. Dunham 2 4 4/12 F School Medical Officer, Hendon Mental retardation Referred back to School Medical Officer, Hendon 3 3 F Paediatrician Mental retardation, probably ineducable. Minor motor defect Home care. ? Institution later 4 2 4/12 F Area Medical Officer, Tottenham Mental retardation. Minor motor defect Supervised at cerebral palsy unit 5 6 8/12 F School Medical Officer, Friern Barnet Cerebral palsy— variable rigidity. Mental retardation, probably ineducable Home care. Occupation centre later 6 4 9/12 M School Medical Officer, Tottenham Psychological; post T.B.M. Child Guidance Clinic. Normal schooling 7 4 11/12 F School Medical Officer, Edmonton Cerebral palsy— generalised spasticity Vale Road P.H. School 8 1½ M Area Medical Officer, Hornsey Minor motor defect Supervised at Cerebral Palsy Unit 9 5 F Paediatrician Cerebral palsy— generalised spasticity. Probably mentally retarded Vale Road P.H. School 10 5 10/12 F School Medical Officer, Wood Green Cerebral palsy— generalised spasticity Vale Road P.H. School II 2 11/12 M Area Medical Officer, Hendon Mental retardation, probably ineducable Referred back to Area Medical Officer 12 7 M School Medical Officer, Wood Green Cerebral palsy— variable rigidity. Probably mentally retarded Vale Road P.H. School 13 9 7/12 F School Medical Officer, Tottenham Left hemiplegia. Emotional problem Vale Road P.H. School 14 4 2/12 F Paediatrician Left hemiplegia (post influenzal meningitis) Epilepsy. Mental defective Occupation Centre 15 2 8/12 F Area Medical Officer, Tottenham Cerebral palsy— variable rigidity Waiting List for Vale Road School 16 4 M School Medical Officer, Tottenham Cerebral palsy— generalised spasticity. Mental retardation Waiting List for Vale Road School 17 5 6/12 M School Medical Officer, Hornsey Mental retardation Infants School. For mental assessment 88 Age and Sex Distribution of Cases M F Total Under 5 years 4 6 10 5-10 years 2 5 7 Totals 6 II 17 M F Total Cerebral palsy—educable or probably educable 2 4 6 Cerebral palsy with deafness probably educable I 1 Cerebral palsy—ineducable or probably ineducable 3 3 Total 10 Mental defect with minor motor lesion 2 3 5 Post T.B. meningitis—psychological 1 . 1 Minor motor defect—probably normal 1 . I Total 7 Rheumatism Supervisory Centre Fortnightly sessions continue to be held at the paediatric department of the Prince of Wales's General Hospital under the direction of Dr. Ian M. Anderson, M.D., F.R.C.P., consultant paediatrician. There was a sharp fall in the number of new cases seen during the year, from 29 in 1956-57 to 9 in 1957-58. Of the nine new cases seen, six were female and three male and of the total, four were cases of congenital heart disease. 196 children remain on the register of the supervisory centre and of these 91 made 174 attendances, while in addition a number were seen in the ordinary paediatric out-patient sessions. These 196 cases are classified as follows:— Rheumatic fever 61 Rheumatic carditis 40 Rheumatic fever with chorea I Rheumatic carditis with chorea 5 Chorea—uncomplicated 5 Rheumatic arthritis 5 Congenital heart lesions 57 Rheumatic pains I Other cases 21 Total 196 96 males 100 females 89 Ear, Nose and Throat Clinics The visiting Aural Surgeon (Dr. F. P. M. Clarke) reports that the usual weekly sessions of the ear, nose and throat clinics have been held at Park Lane Medical Centre, Tottenham and at the Town Hall Centre, Hornsey. The procedure at these clinics as regards administration, treatment and recommendations, has followed along the customary lines adopted in the past and discussed in previous Annual Reports. On average, there has been a very good attendance of children, school and pre-school, at all the clinics throughout the year, and in those instances requiring special treatment over a long period attendance was equally good, almost all completing the courses prescribed for them. The results were, on the whole, very satisfactory and appreciated by the parents. The primary object of these special clinics since their establishment in the early twenties has been chiefly in the field of prevention. In no other group can the ideals of preventive medicine be better illustrated, or the excellent effects of its correct practice be more clearly demonstrated than among school and pre-school children. It is well known that many of the chronic ailments and debilitating conditions met with among the adult public had their origin during school age, and are the results of undetected, or incorrectly treated, or neglected symptomatic predisposing factors in childhood. During childhood there are many signs, symptoms or "complaints" which may be considered only trivial by parents but which to the trained and competent observer indicate, if not treated, a portent of serious consequences to follow—perhaps a permanent disability in later life. It is to these "complaints" among school and pre-school children that this preventive work can be most suitably adopted, by detecting, investigating and treating the very earliest stages of many diseases and abnormal conditions and thus prevent their development into a chronic form requiring perhaps later, radical surgical procedures. The frequency with which the early signs of certain serious defects occur in the ear, and nose particularly—less often in the throat—among children of school and even pre-school age would appear not to be sufficiently realised. They are often very slight but significant symptoms and may sometimes pass unnoticed or incorrectly appreciated. This tendency may be due to a too cursory general examination, or to the situation of the symptoms being remote from the ear or nose their relationship with their real site of origin is not suspected. As well, the symptoms may be slight and cause no great discomfort at this stage and so their presence is not regarded as of much consequence. In the case of the ear, perhaps the most common defect is deafness in school and adult life, which can be traced in very many instances to an otitis media, neglected or improperly treated during early school or pre-school years. We have found from experience that the correct treatment can be carried out satisfactorily only at the clinics. Home treatment 90 is usually unreliable. Chronic deafness, too, can be due to abnormal conditions left untreated in the nose, such as "nasal obstruction", sinusitis, rhinitis, whose early symptoms are quite common in young children. They act by interference with the necessary aeration of the middle ear, or by the extension of infection into the middle ear and set up a suppurative otitis media which may progress to the chronic form and permanent deafness. The normal functions of the healthy nose owing to their controlling influence over the fine working of the chest organs, lungs, heart and circulation, certain abdominal organs, and the brain are of special importance in the maintenance of the health of body and mind. Many of the early signs of defects which interfere with and upset these normal functions in later life are clearly discernible on close examination of the nose and naso-pharynx during school age. "Nasal obstruction" on account of its far-reaching and serious effects is perhaps one of the most frequent and important nasal defects to look out for during a school child's medical examination. It is very common and is, unfortunately, only too frequently overlooked. It is surprising how little understood are and how little attention is given to the widespread detrimental effects of defective nasal breathing; and it is all the more so when it is realised that a large number of the symptoms of nasal obstruction and impaired hearing originate during childhood and if at this stage were detected and correctly treated the whole train of widespread ill-effects and disease set up by their progressive development could be eliminated. It is well to emphasise here the importance and urgency of 'following-up' the very earliest symptoms of ear trouble, otitis media and impaired hearing. Orthopaedic Service, Hornsey I am indebted to Mr. E. Palser, M.R.C.S., for the following report:— "During the year attendances at the Orthopaedic Clinic have been 698 for examination and 1,281 for treatment by the physiotherapist. The number of new cases was 283, and the number of discharges was a comparable figure. This represents an increase in the total work of the clinic, but a reduction in the number of new cases seen during the year. The running of the clinic in its present form with the help of the Hornsey Central Hospital in taking X-rays and carrying out some pathological investigations has been smooth and without complications which could not be dealt with under the present set-up. The variety and degree of severity of the cases which the school medical officers have referred to this clinic shows an acute appreciation of the type 91 of case we wish to see. A small number do not require immediate active treatment but are still welcome, as they may require observation. The majority require treatment and receive it at the clinic. Some again require operative treatment. This year there were eight, and of these, seven have been admitted to the Orthopaedic Unit at Highlands General Hospital. The parents of the remaining one are unfortunately unable to make up their minds. This is unusual, as the parents and children are usually most co-operative in carrying out the treatment suggested". Ophthalmic Clinic, Hornsey I am indebted to Dr. R. Welch, M.D., for the following report:— "During 1958 I have been in charge of the eye clinics at Hornsey Treatment Centre and during this period they have been exceptionally busy. The cases seen are for the most part referred after routine school medical examinations, generally because of defective vision in one or both eyes. Others have symptoms suggestive of eye-strain such as headaches and blurred vision especially after close work. A smaller group of cases are those who have developed an obvious or suspected squint and as these are serious they are given priority in arranging appointments. Another class of cases examined at the clinic are those sent by doctors in charge of welfare clinics. The importance of the latter I shall show later. Where indications are present for doing a refraction, Atropine is used as a cycloplegic for very young children. For older children Gutt. Hyoscine or Gutt. Homatropine and Cocaine are used as a mydriatic so as not to interfere with their school work and progress. In many cases refractions are done without a mydriatic. Where necessary, glasses are prescribed and the child is kept under supervision and examined at appropriate intervals of about one year. This re-examination at intervals is necessary as during years of growth refractions often change, especially in cases of myopia. Supervision is also necessary to ensure that glasses are worn as prescribed and are in good repair and also to determine when glasses are no longer necessary. Incidentally I deprecate the practice of prescribing glasses for all and sundry errors of refraction as a routine practice. Only when specific indications for their need are present should glasses be prescribed. Attention is specially directed to those cases who are found to have a unilateral amblyopia—often unsuspected—whether it is associated with a manifest or latent squint or anisometropia. After correcting the error of refraction with the appropriate glasses, occlusion is immediately begun and the visual acuity, especially in the amblyopic eye, is reviewed weekly. Very close supervision of these cases is kept by the orthoptist to ensure that the occlusion is efficient and not tampered with. Full explanations are given to parents as to the necessity and importance of this treatment and to secure their co-operation which is usually forthcoming. In this way, results obtained have been most satisfactory and visual acuity in the 92 amblyopic eye has very often improved from 6/60 or 6/36 to 6/6 or near 6/6. This is followed by a course of orthoptic exercises to re-establish and maintain binocular vision. A most valuable part of the work at the clinics is the opportunity afforded of seeing very young children—sometimes infants—in the preschool age. Squints can then be treated at their inception which in many cases alone can guarantee a successful result. Such cases—where squint appears in the first or second year of life and where there is a family history of a "lazy eye"—may develop an intractable and irretrievable amblyopia by the time school age is reached. It is gratifying to be able to see and treat these cases usually referred by the doctors at the child welfare clinics. Another type of case which is closely supervised at the clinic is the patient with progressively increasing myopia. Advice is given as to their management with a view to arresting it and where the clinical signs of progressive myopia are pronounced and associated with poor vision, a partially sighted school is recommended. I am indebted to the orthoptist for her invaluable help in treating the above-mentioned cases of squint and also those who present symptoms due to anomalies of oculo-motor balance and who have not acquired full binocular vision". Child Guidance Service Dr. C. Phillips, M.R.C.S., D.P.M., visiting psychiatrist, reports:— "The year under review has seen the work of the Child Guidance Centres at Hornsey and Tottenham continuing in much the same way as has been described in previous reports. We have been fortunate in filling the somewhat long-standing vacancy for a part-time psychotherapist for the Tottenham Child Guidance Clinic, and this has greatly increased our facilities for treatment since the time of her appointment in April 1958. Work with the treatment and investigation of behaviour disorders in children under five is going on, and health visitors have been encouraged to bring cases for consultation and treatment. A scheme is in progress whereby each health visitor in turn is present at the diagnostic interview and the subsequent treatment interview(s). By this means it is hoped to give them an insight into simple methods that can be used to deal with emotional disturbances in young children at the beginning before they have become difficult and complicated. It is hoped, too, that this will make a significant contribution to the prevention of illness in school children and consequently diminish the amount of instability in adults whose mothers have had the benefit of sound advice and help during the formative years " 93 Speech Therapy Miss Came, Senior Speech Therapist, reports as follows:— "Once again, many schools were visited in 1958. Their support and co-operation have been invaluable. Teachers show increasing awareness of the crippling effects of a speech handicap on emotional growth and/or educational progress. Infant school head teachers commonly consult the speech therapist about children with such difficulties. The head master and staff of Tottenham Grammar School have shown equal concern that every stammerer should receive treatment. In Hornsey, the speech therapist reports a less satisfactory position, possibly arising through staff changes in the past. She mentions that some children have not reached her until long past the optimum age for treatment. The dangerously unscientific statement "he'll grow out of it" may also account for some delayed referrals. A future survey of Hornsey children needing speech therapy is suggested." Hospital Classes I am indebted to Mr. J. Power, M.A., Borough Education Officer, Tottenham, for the following report:— "The tuition of children at St. Ann's and the Prince of Wales's General Hospitals has continued during the past year under the two full-time teachers provided by the Tottenham Education Committee. An average of 29 long-term patients regularly receive tuition and in addition every effort is made to cater for children who are patients for shorter periods. At St. Ann's Hospital, a schoolroom is established in one of the wards in which those children who are well enough to be moved take their lessons. The schoolroom is very well equipped with school furniture, a library, a wireless set, an electric gramophone, etc. and the hospital authorities have provided a television set which can be used for school programmes. The Tottenham Library Service also assists in the provision of books. As the age of the children ranges from 5 to 15 years, teaching is mainly individual. Other children are taught at their bedside in a number of wards, including the poliomyelitis ward. In the latter ward there is a 17 year old girl who, despite complete paralysis, has obtained a scholarship from the Swiss Foot and Mouth Painting Association. The Education Committee have arranged for an art teacher to give instruction in art twice weekly in this case and, as a result, arrangements are in hand for her to take the G.C.E. examination in art this year. Four teaching sessions per week are given at the Prince of Wales's General Hospital. 94 As far as possible, each child continues his school studies and to this end close liaison is maintained with the day schools. Encouragement is also given in the pursuit of hobbies which stimulate interest and avoid boredom. Interest in the Hospital Classes has been aroused by the publication of photographs in the national press. On the whole, the children are eager to have lessons while in hospital and, after returning to normal day school, many write expressing appreciation of the help given. The parents, too, welcome the knowledge that their children's education continues while they are in-patients. The classes enjoy the ready co-operation of the hospital staff which is so essential to the success of the scheme". Statistical Information The following tables give further statistical information relating to the school health service in Hornsey. PUPILS FOUND TO REQUIRE TREATMENT AT MEDICAL INSPECTION Number of individual pupils found at periodic medical inspections to require treatment (excluding dental diseases and infestation with vermin) Year of Birth For defective vision (excluding squint) For any of the other conditions recorded Total Individual Pupils 1954 and later 4 46 48 1953 21 112 129 1952 3 18 20 1951 3 3 5 1950 18 34 47 1949 99 137 210 1948 16 15 28 1947 60 34 87 1946 130 141 243 1945 45 46 79 1944 37 36 69 1943 and earlier 208 133 309 TOTAL 644 755 1,274 95 DEFECTS FOUND BY MEDICAL INSPECTION Defect or Code Number Defect or Disease Periodic Inspections Special Inspections Entrants Leavers Others Total (T) (O) (T) (O) (T) (O) (T) (O) (T) (O) 4 Skin 18 30 53 58 118 108 189 196 244 8 5 Eyes: (a) Vision 28 11 168 7 448 53 644 71 108 12 (b) Squint 21 1 6 1 50 4 77 6 5 . (c) Other 3 3 6 2 19 17 28 22 46 5 6 Ears: (a) Hearing 1 13 3 8 19 19 23 40 75 19 (b) Otitis media II 36 1 14 9 28 21 78 5 . (c) Other 1 10 3 4 3 11 7 25 13 1 7 Nose and Throat 39 119 13 30 55 173 107 322 38 6 8 Speech 10 12 1 . 20 20 31 32 25 2 9 Lymphatic Glands 5 28 . 2 1 21 6 51 . 3 10 Heart 4 8 2 14 8 29 14 51 1 6 II Lungs 16 30 9 18 34 53 59 101 II 23 12 Developmental: (a) Hernia 3 3 1 . 2 4 6 7 1 . (b) Other . 2 1 5 7 20 8 27 24 . 13 Orthopaedic: (a) Posture 4 9 5 20 17 55 26 84 6 3 (b) Feet 14 25 13 30 35 52 62 107 8 3 (c) Other 13 50 10 21 43 104 66 175 77 13 14 Nervous System: (a) Epilepsy 1 . 3 1 8 5 12 6 2 2 (b) Other 1 3 4 2 5 9 10 14 5 . 15 Psychological: (a) Development 1 4 2 4 7 9 10 17 21 9 (b) Stability 2 24 2 12 11 63 15 99 12 19 16 Abdomen 7 12 . 5 15 20 22 37 8 11 17 Other 7 11 3 12 22 36 32 59 146 40 (T) Requiring Treatment. (O) Requiring Observation. 96 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 84 (b) Errors of refraction (including squint) 977 TOTAL 1,061 (c) Number of cases for whom spectacles were prescribed 430 GROUP 2—DISEASES AND DEFECTS OF EAR, NOSE AND THROAT Received operative treatment for adenoids and chronic tonsillitis 172 Received other forms of treatment 168 TOTAL 340 Total number of pupils in schools who are known to have been provided with hearing aids: (a) During the current year 1 (b) In previous years *9 GROUP 3—ORTHOPAEDIC AND POSTURAL DEFECTS Treated at clinics or out-patient departments 293 GROUP 4—DISEASES OF THE SKIN (EXCLUDING UNCLEANLINESS) Impetigo 5 Other skin diseases 445 TOTAL 450 GROUP 5—CHILD GUIDANCE TREATMENT Treated at child guidance clinics (including cases sent to the Tavistock and other hospital clinics) 59 GROUP 6—SPEECH THERAPY Treated by speech therapists 147 GROUP 7—OTHER TREATMENT GIVEN (a) Minor Ailments 226 (b) Treatment other than (a) above and excluding convalescent treatment 55 *Includes 4 children found during I958 to have been previously provided with Hearing Aids. 9 EMPLOYMENT OF CHILDREN AND YOUNG PERSONS 1. Number of children medically examined in order to ascertain whether they were physically fit to undertake employment of a light nature outside school hours 70 2. Number of children examined as to fitness to take part in entertainments 14 All were found to be fit. EDUCATION ACT 1944—SECTION 57(3) AND 57(5) Cases dealt with under Section 57, Education Act 1944:— Sub-Section 3: 2 Sub-Section 5: 2 MEDICAL EXAMINATIONS OF TEACHERS (a) Number of teachers examined as to fitness for appointment 4 (b) Number of Students examined as to fitness for first appointment 14 (c) Number of Students examined as to fitness for training course 15 98 INDEX Page Abatement Notices 29 Ante-natal Clinics 56 Atmospheric Pollution 20 Audiology Unit 86 Bakehouses 35 B.C.G. Vaccination 78 Births, Notification of 56 Burial of the Dead 46 Cerebral Palsy Unit 87 Certificates of Disrepair 19 Child Guidance Service 93 Child Welfare Centres 58 Cleansing of Soiled Articles 44 Closing and Demolition Orders 18 Daily Guardian Scheme 60 Day Nurseries 61 Deaf Child, The 84 Deaths Classified 50 Dental Service, Priority 63 Dental Service, School 82 Diphtheria, Immunisation against 73 Diseases of Animals: Fowl Pest (Infected Areas Restrictions) Amendment Order, 1958 46 Inspections 45 (Waste Foods) Order, 1957 45 Domestic Help Service 76 Dysentery 9 Ear, Nose and Throat Clinics 90 Factories, Inspection of 25 Food 33 Food and Drugs Act, Legal Proceedings 36 Food Hygiene 33 Food Poisoning 9 Food Premises classified according to their Principal Trade 34 Food Premises, Inspection of 36 Food Sampling 36 Handicapped Child, The 83 Hawkers of Food, Registration of 34 Health Education 60 Health Education in Schools 81 Health Visiting Service 65 Home Nursing Service 71 Hospital Classes 94 Housing and Sanitary Circumstances 17 99 Page Ice Cream 35 Infant Deaths—Classified 53 Infectious Diseases in School Children 78 Infectious Diseases Tables 14 Inspections by Public Health Inspectors 30 Laboratory Services 11 Massage and Special Treatment 46 Measles 9 Medical Examination of Staff 39 Midwifery Service 64 Midwives Ante-natal Clinics 57 Milk Supply 34 Mortuary 46 Mothercraft Clinics 57 Ophthalmic Clinic 92 Orthopaedic Service 91 Outworkers 25 Perinatal Mortality 39 Petroleum Spirit 44 Pet Shops, Licensing of 29 Poliomyelitis 9 Poliomyelitis, Vaccination against 74 Public Health Act, Legal Proceedings 27 Recuperative Holidays 76 Re-housing on Health Grounds 17 Rheumatism Supervisory Centre 89 Rivers Pollution 20 Rodent Control 26 Routine Medical Inspections 77 Sanitary Improvements Effected 31 School Health Service 77 School Nursing Service 79 Shops Inspection 29 Slaughterhouses 35 Smallpox, Vaccination against 73 Speech Therapy 94 Toddlers Clinics 59 Tuberculosis in Schools 79 Tuberculosis Tables 12 Unsound Food Surrendered 36 Vale Road School for Physically Handicapped Children 87 Vital Statistics 48 Water Supply 27 Welfare Foods, Distribution of 62 Welfare of Old People 40 Whooping Cough, Immunisation against 73 100