THE HEALTH OF HORNSEY 1959 THE ANNUAL REPORT OF THE MEDICAL OFFICER OF HEALTH THE HEALTH OF HORNSEY 1959 THE ANNUAL REPORT OF THE MEDICAL OFFICER OF HEALTH MEMBERS OF THE COUNCIL *Councillor Miss O. R. ANDERSON, J. P. , Mayor *Councillor J. T. WILKINS, Deputy Mayor (Vice-Chairman of Health Committee) ALDERMEN G. S. AITKEN *S. G. GOULDING F. H. BAILEY, J. P. N. MULDOON, O. B. E. , J. P. D. F. W. BILLINGSLEY *G. F. N. NORMAN M. W. BURNS, D.L. , K.S.G. H. L. NORMAN E. C. CASTLE Miss J. RICHARDSON F. C. CAVE, C.B. E. , J. P. G. WATSON COUNCILLORS L. A. BAINS *Mrs. E. MCLEOD Miss M. M. BARRIE N. A. MULDOON *A. N. CAMMOCK C. MURRAY Mrs. J. M. CARTER F. NEUNER Mrs. K. M. ST. P. CRUMP *Mrs. M. PLEASANCE J. E. DA LUNG P. P. RIG BY *Mrs. M. E. M. DAVIES C. E. ROBINS R. S. DAVIES *H. A. L. ROSSI J. F. FORD *G. H. STANSALL *C. C. GALVIN M. H. WALEY-COHEN *V. P. GELLAY R. I. G. WATT *F. C. V. HAYWARD *Miss M. E. WEST P. M. KING *C. R. WILLIAMS E. M. LARARD (Chairman of Health Committee) *D. H. P. LEVY A. WILSON *Mrs. R. M. LEVY *F. J. WORSTER B. J. MCBRIDE H. J. WORMS A. R. WILSON *Members of Borough Health Committee at 31st December 1959 HEALTH DEPARTMENT, TOWN HALL, HORNSEY, N.8. To the Worshipful the Mayor, Aldermen and Councillors Mr. Mayor, Aldermen and Councillors, In accordance with my statutory duty I present the following report on public health conditions in the Borough for the year 1959. The population figure, as estimated by the Registrar General, again showed a slight decline from 96,670 in the previous year to 96,430. The birth rate of 18.0 was the highest for seven years and the percentage of hospital confinements rose from 80 per cent to 81.7 per cent. The adjusted death rate of 10. 9 compared favourably with that of 11. 6 for the country as a whole. While the general standard of health was well maintained there are certain matters to which I would draw particular attention. The infant mortality rate regrettably rose to 24. 0 compared with a figure of 22. 2 for England and Wales as a whole. A still birth rate of 13.1, however, was considerably lower than the figure of 21. 0 for the country or for Hornsey's rate, in the previous year, of 18.1. The neo-natal death rate was 20.8 and the peri-natal death rate 33. 6. Surprisingly the latter was appreciably lower in the case of illegitimate births. The occurrence of 22 cases of poliomyelitis was a matter for special concern and action by the Health Department during the year. Of this number 13 were cases in which some degree of paralysis occurred. Only one child fully vaccinated against the disease developed a paralysis and in this case the course of injections had not been completed until after incubation of the infection. If for no other reason the benefits of child nurture derived from day nursery provision were patently stressed by the increase in the number of children which were admitted during the year from broken homes or homes where there was only one parent. The follow-up of some 28 problem families in Hornsey, having between them 105 children, is described by the special services health visitor, together with constructive observations by her on procedures for dealing with these distressing cases. Significant information is given in the report of the extensive use made locally of the health visiting, home nursing and domestic help services. The most outstanding feature in the work of the school health service was that for handicapped pupils, and in particular an expansion of the comprehensive provision made for the ascertainment and treatment of loss of hearing by the establishment of an audiology clinic in relation to the special day 3 school for the deaf. Despite continued shortage of personnel in the dental service the work of the department maintained a very high standard of efficiency. Public health inspectors and clerical staffs had an exceptionally heavy year. Two Smoke Control Orders relating to some 4,231 dwellings and 538 commercial and other premises made considerable additional work in the department. In addition to routine action in relation to overcrowding and housing defects, the department prepared evidence for official representation of the final stage in the Campsbourne slum clearance area; and with the Borough Engineer's Department prepared a comprehensive report to the Council relating to future housing needs. The Council took legal proceedings under the Food Hygiene Regulations against a food handler who was smoking while at work. The case was dismissed on the defendant pleading he was smoking a herbal cigarette, not forbidden by the Regulations which specify use of tobacco (including snuff). As a result of this case representations were made by the Council to the Association of Municipal Corporations who in turn requested the Minister of Health to consider a revision of the law. This Regulation has been re-framed in The Food Hygiene (General) Regulations, 1960, to preclude such a defence in the future. In conclusion I wish to express my appreciation of the support and encouragement given to me by the Chairmen and Members of the various committees concerned; and to acknowledge the assistance and loyal support of my colleagues. I am, Your obedient servant, G. HAMILTON HOGBEN, Medical Officer of Health. September, 1960. 4 INFECTIOUS DISEASES POLIOMYELITIS Twenty-two Hornsey residents were notified during the year to be suffering from poliomyelitis; in thirteen cases paralysis was present. In addition one Hornsey resident died of paralytic poliomyelitis contracted while on holiday at a seaside resort. The death is included in the table shown later in this report. Three of the paralytic cases made complete recoveries and four others showed considerable improvement by the end of the year. One patient was still in hospital undergoing treatment at the end of the year; and six others had some degree of paralysis as follows:- 1. An infant boy aged 10 months on admission to hospital showed severe weakness of left shoulder muscles and some weakness of right leg. 2. A boy aged 3 years with weakness of muscles of left foot requiring leg iron support. 3. A boy aged 2| years, marked paralysis of right arm; now uses arm quite well, but cannot raise above head. 4. A boy of 7 years with weakness of the palate and having difficulty in swallowing made a good recovery. 5. A boy of 7 years with paralysis of both legs, may require minor orthopaedic surgery later. 6. A boy aged 3 years - brother of previous case; muscles of both legs mildly affected, but has made a good recovery. In the early summer a small outbreak occurred in a day nursery in the Borough. Two cases of paralytic poliomyelitis occurred in unvaccinated children and the infant brother and young sister of two children attending the nursery were both admitted to hospital suffering from paralytic and nonparalytic poliomyelitis respectively. Poliovirus (type 1) was isolated from the faeces of all four children. Shortly afterwards a three year old girl attending the nursery developed what was considered to be a simple upper respiratory tract infection; poliovirus (type 1) however, was isolated from the faeces. 5 A check of all the children in the nursery had earlier revealed that 16 had received three injections of poliomyelitis vaccine; 15 had had two injections and nine had had one injection. Among the 25 children who had not had an injection of poliomyelitis vaccine were the two paralytic cases and one of their siblings, the probable non-paralytic case as well as two children excluded as contacts. Of these 25, three were infants between the ages of six and eight months. It was decided not to vaccinate any more children for the time being because of inevitable delay in producing antibodies and the possible risk of provoking paralysis. The possible value of injecting the unprotected children with gamma globulin was therefore considered and it was decided to offer gamma globulin to all children who had not been vaccinated and to those who had received only one dose of vaccine at the time of the outbreak, providing they were known not to be excreting virus at that time. Gamma globulin was given to 22 eligible children whose parents had given consent. Only one injection was given to each child, which was accepted with little apparent concern, and there were no untoward physical reactions. No further cases of poliomyelitis occurred in the nursery. Efforts were made to collect faeces from each child on three occasions, in order to study the excretion of virus over a period of time in the different groups of children. Specimens of faeces were also collected from members of the staff. At one time or another 19 day nursery children were found to be excreting poliovirus. Eight symptomless excreters had received two or more doses of poliomyelitis vaccine. The two paralytic cases, the non-paralytic, and eight symptomless excreters were unvaccinated. A note on the increased demand for protection from young people is shown on page 74 of this report. MEASLES The number of notified cases of measles in 1959 was 707, only 25 being over the age of 10 years. Five children were admitted to hospital but all made uneventful recoveries. There were no deaths. 6 FOOD POISONING The number of food poisoning cases notified by medical practitioners during the year was nine - one proved fatal. Forty-eight other cases were found by investigation and of these all but four occurred in an outbreak at a boarding school. There were 10 single cases and the causal organism was identified in nine of them. Six were due to s. typhi-murium, one to s. Newport, one to s. anatum and another to toxin food poisoning. The fatal case was the result of the ingestion of heat-resistant CI. Welchii. Two adult sisters became violently ill with severe diarrhoea and vomiting within twelve hours after lunching together. They were removed to hospital but one died before admission. The dead woman's husband who also shared the meal suffered abdominal pain tenesmus and nausea. Heat-resistant C1. Welchii organisms were isolated from the body of the deceased and from the stools of the surviving sister who was discharged after 10 days. Part of the meal left over was examined at the Central Public Health Laboratory but no evidence of CI. Welchii could be found. However, from the history of the case it was evident that reheated meat must have been the food causing the illness. Reheated meat at the midday meal proved the suspected cause of the outbreak at the boarding school. Onset of illness - abdominal pains and diarrhoea - occurred in the early hours of Monday morning - some 14 hours after the meal. Samples of the meat and specimens of faeces of 29 of the persons (pupils and staff) who had eaten the meal were submitted for bacteriological examination. Heat-resistant C1. Welchii (non-haemolytic Type 4) were isolated from the meat and in 25 of the faecal specimens. Of 67 pupils 38 were taken ill but faecal specimens of 7 pupils who had had the meal, but showed no symptoms, were also positive. There was one other family outbreak involving a mother and her 6 year old daughter. The causal organism here was s. Newport but owing to the late date of notification it was not possible to obtain sufficient information about food consumed before the illness. 7 DYSENTERY Sixty-one cases of dysentery were notified during the year and in all but one case the causal organism was shigella sonne. Shigella flexner was isolated from the other patient, a man of 29 years who had recently been abroad. An outbreak occurred in a local Primary School and lasted for the whole of February. Twenty-one children in the Infants' Department and nine in the Junior Department were reported as suffering from diarrhoea and vomiting and of these twenty-one were found to be positive to shigella sonne. One member of the School staff serving the meals and pne of the infants' supervisors were also found to be carrying the organism and were excluded from work until shown to be free from infection. Previously, children were excluded until three consecutive negative specimens had been submitted, but owing to dislocation at home and at school, general practitioners were advised that children should be kept home for at least a week and allowed to return to school at the end of that period provided they had been symptom free for three days. The school lavatories were disinfected daily by the disinfection staff until the outbreak subsided. A recurrence of diarrhoea and sickness at the same school in September soon after the summer holidays when seventeen children and one teacher were affected was much milder in character and no causal organism was found. In November there was an outbreak of illness in the Lower School forms. of a Grammar School. The number of absentees rose from 41 to 61 in twentyfour hours. The homes of nine of the boys living in Hornsey were visited and faeces specimens bacteriologically examined. Six of them proved to be positive to shigella sonne. Nine boys living outside the Borough were affected and two of these were found to be excreting shigella sonne. Exclusion of children was carried out as before and the outbreak subsided without further incident. Early in April a family of father, mother and infant son of l| years was notified as suffering from dysentery. On bacteriological examination the father and the mother were shown to be negative but the baby proved positive to shigella sonne. As the father was a butcher, regular bacteriological examinations were carried out weekly until 1st June when the babyproved to be clear. Fortunately during this time the father was consistently negative. A child of 4 years, in attendance at a nursery class, contracted dysentery on 26th September and was excluded until 3 consecutive negative faeces specimens could be obtained. Despite treatment and regular bacteriological examination, he was not able to return to school until 14th January, 1960, although on two previous occasions two consecutive negative specimens had been obtained before he reverted to positive again. These two cases are cited to illustrate the considerable interference with school life which may be caused by sonne dysentery. Exclusion only while symptoms exist has greatly reduced absence from school and there is no evidence that the control of outbreaks has been in any way made more difficult. 8 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 for general practitioners during 1959:- Faeces 754 Sputum 22 Nose and throat swab 3 Throat swab 5 Per nasal swab 3 Rectal swab 1 Roast pork 1 Egg and ham loaf 1 Meat 1 Tap water 5 9 10 TUBERCULOSIS The total number of cases on the Tuberculosis Register at the end of 1959 was 1,011, viz., pulmonary 909, non-pulmonary 102. Pulmonary Non- Pulmonary Total Male Female Male Female Male Female (a) Number of Cases on Register at commencement of year 529 367 55 43 584 410 (b) Number of Cases notified for first time during year under Regulations 36 24 . 5 36 29 (c) Cases restored to Register 5 4 . 1 5 5 (d) Cases added to Register otherwise than by notification under Regulations (1) Transferred from other Districts. 53 39 1 . 54 39 (2) From Death Returns 4 1 . 2 4 3 (e) Number of Cases removed from Register 99 54 2 3 101 57 (f) Number of Cases remaining on Register at end of year 528 381 54 48 582 429 Cases removed from Register shown under (e) 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 PULMONARY 1 2 38 16 42 32 1 2 13 2 99 54 NON-PULMONARY • • 2 • • 1 . • • 2 2 3 11 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 . . . . . . 6 7 5 6 5 6 1 36 60 F • . • 1 2 1 6 5 4 4 • 1 • 24 Non-pulmonary F • • 1 • • 1 • • 1 2 • • • 5 5 OTHER THAN BY FORMA L NOTIFICA TION Death returns from Local Registrar Pulmonary M . . . . . . . . . . . 1 . 1 1 Inward transferable deaths Pulmonary M . . . . . . . . . 1 . 1 1 3 4 F . . • • • . • • . • • • 1 1 Non-pulmonary F . . . . . . . . 1 . . 1 . 2 2 Transfers from other Districts Pulmonary M . . . 1 2 1 9 18 5 6 8 3 . 53 92 F 1 • • 2 . 3 11 16 4 1 1 • . 39 Non-pulmonary M . • • • • • • 1 • • • . • 1 1 12 NOTIFICATION OF INFECTIOUS DISEASE BY AGE AND SEX AGE IN YEARS Scarlet fever Whooping cough Acute poliomyelitis Measles Dysentery Paralytic Non-paralytic M F M F M F M F M F M F Under 1 . . 5 1 1 1 . . 10 10 1 • 1 1 2 4 3 . . . . 37 33 2 1 2 1 2 . 6 1 . . . 35 34 2 1 3 2 3 4 3 2 2 . . 48 52 1 . 4 2 2 3 1 1 . 1 1 59 47 2 2 5-9 10 16 9 6 2 . 2 4 145 172 12 8 10-14 4 5 . 1 . . . . 8 8 4 3 15-24 3 . . . 1 . . . . 5 2 3 25 and over . . . . 2 . 1 . 2 2 8 9 TOTALS 23 30 25 21 10 3 4 5 344 363 34 27 53 46 13 9 707 61 AGE IN YEARS Acute pneumonia Erysipelas Food poisoning Puerperal pyrexia Ac.encephalitis Meningococcal infection Infective Postinfec. M F M F M F F M F M F M F Under 5 2 2 . . . 1 . . . . . . 1 5-14 1 2 . 1 1 1 . . . . . . . 15-44 4 8 . . . 2 12 . 1 1 . . . 45-64 14 6 . 2 . 4 . . . . . . . 65 and over 16 15 1 1 . . . . . . . . . TOTALS 37 33 1 4 1 8 12 . 1 1 . . 1 70 5 9 12 1 1 1 There were no cases of diphtheria. A baby girl suffering from ophthalmia neonatorum was nursed at home. There was no impairment of vision. 13 NOTIFICATION OF INFECTIOUS DISEASE BY WARDS Highgate Muswell Hill Crouch End Central Hornsey North Harringay South Harringay Stroud Green Finsbury Park Scarlet lever 5 2 2 14 4 2 17 7 Whooping cough 4 10 4 5 2 4 11 6 Acute poliomyelitis Paralytic 2 . 3 2 2 1 3 . Non-paralytic 1 . . 6 1 . 1 . Measles 110 216 70 75 56 66 89 25 Acute pneumonia 4 13 1 15 27 4 5 1 Dysentery 11 10 9 20 3 4 2 2 Erysipelas 1 . . 2 . 1 . 1 Food poisoning 3 1 . 2 1 1 . 1 Puerperal pyrexia . 8 . . 1 . 2 1 Ophthalmia neonatorum . • . 1 . . . . Meningococcal Infection . 1 . . . . . . Acute encephalitis Infective . 1 . . . . . . Post-infective . . . . . 1 . . TOTALS 141 262 89 142 97 84 130 44 SANITARY CIRCUMSTANCES 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 via Fortis Green. (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 and at Hornsey. 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 microbiological examinations. 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 supply is in all cases direct to dwelling houses; none is supplied by means of a stand-pipe. The water supplied to this area is not plumbo-solvent. Bacteriological Results of Water Passing into Supply after Chlorination Plate counts Coliform test (Average per ml.) Percentage samples Colonies counted on negative in 100 ml. agar 37°C. (20-24 hrs.) Coliform E. coli River Thames 772 16.3 99.88 100.0 New River 514 4.8 99.61 100.0 15 Average Results of the Chemical and Bacteriological Examination of the water supplied to Hornsey during the year 1959. Milligrammes per Litre (unless otherwise stated) River Thames New River (Ashford Common) (Stoke Newington & Hornsey) Ammonia Nitrogen 0.031 .018 Albuminoid Nitrogen . 077 .050 Oxidised Nitrogen: Nitrate 3.3 5.4 Chlorides as C1. 27 32 Oxygen abs. from permanganate 4 hrs. at 27°C. 1. 02 0. 50 Turbidity in terms of Silica 0. 4 0.1 Colour m.m. brown 2ft. Tube Burgess's Tintometer 9 5 Hardness (Total) 254 298 Hardness (non-carbonate) 54 70 pH. Value 7.9 7.8 Phosphate as PO4 0. 90 0. 55 Silicate as SiO2 9 12 Sulphate as SO4 54 59 Fluoride as F. 0.2 0.2 Magnesium as Mg. 4. 0 5. 0 B. O. D. 5 days at 20°C. Electrical Conductivity (gemmhos) 525 625 16 RIVERS POLLUTION The following figures relate to action taken to prevent pollution of surface water drains by sewerage. Premises inspected by drainage inspection assistant 5,854 Re-inspections 667 Premises inspected by district public health inspectors 555 Re-inspections 572 Number of premises in which defects were remedied after service of written or verbal notices 237 OPEN AIR SWIMMING POOL I am indebted to the Borough Engineer & Surveyor for the following information:- The Council's open air swimming pool in Park Road is the only public swimming bath in the Borough. It consists of two pools, one for adults 165 ft. x 75 ft., and another for children. The water is taken from the mains and is replenished every season. Filtration and breakdown chlorination is the method of purification used, the whole of the water in both pools being treated on an eight hour cycle. The water is sampled for bacteriological examination bi-monthly and results have proved very satisfactory. The procedure for bath side testing is for the Superintendent to take samples for determination of the pH value and the free residual cholorine. This is carried out three or four times each day according to the number of people using the bath. The total attendance during the 1959 season, i. e. from 2nd May to 26th September, was 147, 209 and the highest attendance on any one day was 4,235; on 6 days over 3, 000 people and on 13 days between 2,000 and 3,000 people used the pool. 17 INSPECTIONS BY PUBLIC HEALTH INSPECTORS 1st Inspection Re-inspections Food Food Premises (See table on page 38) Hawkers 5 . Street Traders . . Milk Sampling . . Ice Cream Sampling 6 . Infectious Diseases Notifiable Infectious Diseases 185 33 Food Poisoning 9 1 Infectious Disease Contacts 35 4 Smallpox Contacts . . Public Health Inspections Nuisances 1348 1922 Drainage 56 480 Drain tests 65 . Rodent Control 44 23 Overcrowding 4 5 Factories 98 85 Outworkers 81 . Renewal of Music and Dancing Licences 18 . Rivers Pollution 555 575 Smoke observations 59 25 Verminous conditions 16 2 Pests 42 4 Certificates of Disrepair 30 28 Revocation of Certificates of Disrepair 8 2 Hairdressers' Shops 6 . Housing Act Inspections House to House 807 183 Permitted numbers 48 3 Shops Inspections 269 11 Others Pet Animal Shops 6 1 Petroleum Stores 147 105 Fireguards 6 . Visits to old people 14 9 School Survey 10 18 SUMMARY OF SANITARY IMPROVEMENTS EFFECTED Drainage Number of houses and premises redrained 52 Repairs or amendments to existing drains 179 Drains or. gullies unstopped or cleansed 216 Manholes provided or repaired 73 Intercepting traps fixed 20 Soil and ventilation pipes repaired or renewed 41 Water-Closet and Sanitary Fittings Water-closets and sanitary fittings provided 7 Water-closet buildings provided or repaired 6 Water-closet pans provided or renewed 40 Water-closets unstopped, cleansed or repaired 14 Flushing cisterns provided or repaired 26 New sinks provided 41 New lavatory basins provided 26 Waste pipes trapped, repaired or unstopped 53 Baths provided or made usable 14 General Roofs repaired 108 Rain-water gutters, renewed or repaired 53 Rain-water pipes provided or repaired 47 Dampness remedied 75 Damp-proof courses provided 7 Yard paving provided or repaired 41 Rooms cleansed 16 Rooms disinfested of vermin 5 Floors repaired 69 Windows, doors, skylights, sashcords and fittings repaired 97 Window-sills repaired 49 Water-cisterns repaired, cleansed or covered 8 Water supply pipes repaired 15 Stoves, ranges, renewed or repaired 17 Flues and chimneys repaired 17 Accumulation of refuse removed 34 Dustbins provided 5 Miscellaneous items 118 19 FACTORIES ACT, 1937 Inspection of Factories Total No. of No. Inspections Factories Inspected Made Factories with Mechanical Power 202 94 179 Factories without Mechanical Power 35 4 4 Defects Found 12 notices were served during 1959 regarding want of cleanliness, unsuitable, defective and insufficient sanitary conveniences. 6 were complied with at the end of the year. 5 notices were served during 1958 concerning ventilation, unsuitable and defective sanitary conveniences, of these 2 were complied with at the end of 1959. Outworkers There are 199 Outworkers on the register engaged in the following occupations:- Making, altering, etc. of wearing apparel 134 Making of lace, lace curtains and nets 1 Manufacture of brass and brass articles 2 Making or repairing of umbrellas, sunshades, etc. 3 Making of artificial flowers 10 The making of boxes or other receptacles or parts thereof made wholly or partially of paper 9 Making of brushes 6 Feather sorting 1 Making of stuffed toys 1 Making or filling of Christmas crackers, Christmas stockings etc. 22 The weaving of textile fabric 3 Manufacture of lampshades other than lampshades made wholly of metal or glass or stone 7 81 visits were paid to outworkers' premises during the year. 20 LICENSING OF PET SHOPS During the year 13 inspections were carried out, 6 by the Veterinary Inspector and 7 by the Public Health Inspectors. Five existing licences were renewed at the beginning of the year. INSPECTION OF SHOPS 280 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 one written notice was served during the year as, generally speaking, the proprietors of shops remedied defects as the result of informal notices. A note on the inspection of food shops under the Food and Drugs Act and the Food Hygiene Regulations appears on page 39. ABATEMENT NOTICES The Notices served during the year were as follows:- Verbal Preliminary Statutory Public Health and Housing Acts 130 312 15 Shops Act . 1 . Food and Drugs Act 18 7 . Factories Act 4 12 . Prevention of Damage by Pests Act, 1949 1 Middlesex County Council Act, 1950 . 2 2 Heating Appliances (Fireguards) Act, 1952 2 . . Pet Animals Act, 1951 1 . . RODENT CONTROL The number of infestations by rats reported in the Borough during 1959 was 207. During the last four to six months of the year at least eighty per cent of these related to single rat infestations. It appears that normally rats live and feed in colonies but occasionally one or two rats of a colony seem to disassociate themselves from the rest. These rats, if in the sewers, appear to be reluctant to eat at any collective feeding points and have been observed under laboratory conditions to feed off the food dropped by other rats in the latter's passage from one feeding point to the next. Treatments with "Warfarin" are designed to encourage feeding and destruction over a period, and therefore scavenging by the stray rat is still possible but the use of sodium fluoroacetate is fatal in such minute doses that 21 any appreciable carrying of food can be discounted. It may be that the stray rat does come to the surface in such circumstances and is observed scavenging in gardens and open spaces, particularly in the region of "top end" and branch sewers. A three-monthly analysis for 1959 gives the number of surface infestations by one or more rats as follows January - March 59 April - June 74 July - September 50 October - December 24 207 In my Annual Report last year there is a reference to the first use in Hornsey of sodium fluoroacetate as a poison. This was carried out in November, 1958, using the services of a contractor. During 1959 the sewers were treated in January, May and August with sodium fluoroacetate, and in March and November with "Warfarin 5." The March treatment was on a very reduced scale in an endeavour to assess the reduction in the residual rat population of the sewers. It was found that whereas the "take" at the baiting points was between 60 and 70 per cent during 1957 and 1958 when zinc phosphide, arsenic and Warfarin had been used, after two treatments with sodium fluoroacetate in November, 1958 and January, 1959, the Warfarin check treatment on 600 soil and surface water sewer manholes showed only "takes" in 7 per cent of them. Two further treatments with sodium fluoroacetate in May and August, 1959, were carried out in co-operation with the staff of the Borough Engineer & Surveyor's Department, and followed in November 1959 by a treatment of 968 soil and surface water manholes with Warfarin - the "take" was between 3 and 5. 6 per cent only. The difference in these figures refers to 24 feeding points where the poison bait appeared to have been disturbed and where the reading was uncertain. It appears that a considerable reduction in the rat population has resulted from the use of sodium fluoroacetate and Warfarin in treatments of the sewers. This is indicated by the decreased "take" of the Warfarin bait from about 70 per cent in previous years and 3 to 5. 6 per cent in 1959. At the same time there has been a reduction in the number of surface infestations reported. During the last four months of the year the use of Warfarin 1 was discontinued in favour of Warfarin 5 which is considerably more potent, and the poison made more attractive to rats by supplementing the oatmeal base with sugar and oil. It is interesting to note that when taking poisons such as zinc phosphide and arsenic rats develop a "poison prejudice;" this is not so with Warfarin. With sodium fluoroacetate the action is more rapid than with Warfarin, even in the smallest quantities, and the complication of "poison prejudice" does not arise. Because such small quantities are effective it is necessary to use some other form of baiting and poisoning at least once a year in order to assess the effectiveness of the treatment and Warfarin appears to be the best answer to this at present, as the amount of bait taken by the rats is measurable. 22 HOUSING HOUSING SURVEY A complete survey of housing in relation to the replanning of the Borough was made and a joint report with the Borough Engineer and Surveyor, made to the Council early in 1960. The four principal matters which were recommended for early consideration were:- 1. Areas involving total demolition and clearance of unfit houses. 2. Accommodation for special classes of physically handicapped. 3. Special accommodation for aged handicapped persons. 4. Serious overcrowding. Under item 1 twelve areas were defined, five of them being considered as needing attention during the next five years. These involve 134 houses and 212 families. The paragraph on accommodation for special classes of physically handicapped deals with application for re-housing in which priority is desired on medical grounds. In considering these it has been found in the past that there are certain applicants who should be given priority over the ordinary housing waiting list, although they may attract insufficient points to be included on the "live" list; 48 such cases are referred to. Mention too is made of ten applicants re-housed "outside the points scheme" during the past ten years. There is no doubt that this action resulted in prolonging life in some cases, and preventing the worsening of illness in others. Special accommodation for aged handicapped persons is an urgent need in many cases to "set free" those "marooned" on upper floors as a result of chronic illness or disability. The 48 aged handicapped known to the department at the time the report was written were divided into five categories:- 1. Rheumatism and arthritis 16 2. Heart disease 8 3. Chronic respiratory illness (bronchitisetc.) 8 4. Crippling diseases of the nervous system 10 5. Absent, or useless lower limbs 4 Serious overcrowding causing undesirable mixing of the sexes in contravention of Section 77 (1) of the Housing Act, 1957, results in many cases from the letting of large houses in single and double room units. Of the 68 such families who have applied for re-housing, 18 only are on the "live" list. 23 CAMPSBOURNE CLEARANCE AREA In July the Council gave instructions for the inspection and representation of Stage VI to proceed. The properties included are as follows:- 1-35 (odd) factory premises and garage, Brook Road. 1-9 (odd) Boyton Road. 2-10 (even) Pembroke Road. factory premises (No. 12) All the premises were inspected during the year and the official representation to the Council was made on 2nd February, 1960. The houses represented as unfit were:- 1-11 (odd) Brook Road 1-3 and 7-9 (odd) Boyton Road 2-10 (even) Pembroke Road These and all the other properties in Stage VI were made the subject of a Compulsory Purchase Order by the Council. RE-HOUSING ON HEALTH GROUNDS The total number of housing cases reviewed on health grounds during the year was 82. In 51 cases action was as follows:- Nil points recommended 6 5 " " 8 10 " " 6 15 " " 30 Cases recommended for consideration outside the points scheme 1 The remaining 31 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 special categories as follows:- 1. Chronic medical or surgical conditions which have crippled the patient 2 11. Old persons needing ground floor accommodation because of infirmity, possibly with illness 6 111. Serious overcrowding causing undesirable mixing of the sexes with its accompanying moral danger 1 Four families with medical need were rehoused during the year. 24 HOUSE TO HOUSE INSPECTIONS During the year the public health inspectors carried out 807 house to house inspections under the Housing Act, 1957, in various parts of the Borough in order to ascertain the general condition of selected properties. Of this total, 566 premises became the subject of a special joint report of the Medical Officer of Health and the Borough Engineer & Surveyor. Detailed statistics are as follows:- No. of Category of Properties Houses No. of No. of Roaad houses Houses Houses NOT with owner- families repairable repairable under- occu- (approx.) at reason- at reason- ground piers able cost able cost rooms St. Ann's Road 9 9 . . . 9 St. Ann's Circus 10 10 . . . 10 Birkbeck Road 81 81 . . 5 100 Grove House Road 25 20 5 4 5 29 Haringey Road 55 45 10 . 20 70 Holland Road 14 11 3 . 4 16 St. Joseph's Road 48 48 . . . 48 Lightfoot Road 49 41 8 . . 21 73 St. Mary's Road 74 38 36 34 10 127 St. Mary's ViUas 4 4 . . 4 5 Rectory Road 39 38 1 . 8 50 Westfield Road 84 76 8 10 23 142 Haringey Grove 25 6 19 . 9 44 Clarendon Road 54 41 13 . . 17 81 Great North Road 1 1 . . 1 Upper Tollington Park 11 . . . 4 Enfield Road 32 . 32 . ) Enfield Gardens 11 . 11 . ) 5 58 Enfield Terrace 4 4 ) Gordon Road 2 . 2 . . 2 Ennis Road 28 27 1 . 12 75 Woodstock Road 83 81 2 . 32 256 Oxford Road 34 34 . . 17 82 Perth Road 40 40 . . 23 81 TOTALS 807 651 156 48 215 1363 The conclusions to be drawn from the survey reflect the influence of the Rent Act, 1957. In general, there is a trend towards an increase in the number of owner-occupiers, and properties previously rented, have been, and are being purchased by sitting tenants. This has resulted in considerable improvement in the condition of such properties and has been responsible for the improvement in the maintenance standard. In addition, it is evident that many owners have voluntarily improved the condition of their properties in order to qualify for permitted increases in rent. 25 CERTIFICATES OF DISREPAIR Applications for certificates of disrepair 23 Decisions not to issue certificates 1 Decisions to issue certificates (a) in respect of some defects 17 (b) in respect of all defects 7 Undertakings given by landlords 15 Undertakings refused . Certificates of disrepair issued 10 Applications for cancellation of certificates 16 Objections by tenants to cancellation of certificates 4 Decision by Council to cancel in spite of tenant's objection . Certificates cancelled 12 Applications for certificates as to remedying defects which landlord has undertaken to remedy: Certificates issued to landlords All defects remedied 7 Some defects remedied 6 Certificates issued to tenants Some defects unremedied 3 CLOSING ORDERS Property Part affected Order made Action taken 41 St. Mary's Road 3 underground rooms and scullery. 12th Jan. Rehousing not necessary, other rooms available. 2 Ennis Road Whole house. 12th Jan. Premises vacated. 59 Beresford Road 2 basement rooms (preparation of meals and storage of domestic articles permitted in back room.) 24th April Front room vacated. 27 Crouch Hall Road Whole house 4th June Premises vacated. 8 Enfield Gardens Whole house 4th June Premises vacated. 26 CLEAN AIR SMOKE CONTROL AREAS In January 1959 the Minister of Housing and Local Government urged local authorities to increase the tempo in declaring smoke control areas, also to prepare a five year programme and submit it to the Minister with an estimate of the number of years likely to be needed to complete plans for areas as a whole. A plan for Hornsey has been agreed which divides the Borough into twelve areas, each containing approximately 3, 000 dwellings and following the ward boundaries in most cases. A map showing the areas and the suggested order of dealing with the first five is given on page 31. It is hoped to make one new Order each year and complete the programme by 1970. To illustrate the improvement to be effected, a map is included on page 32 showing smoke control areas likely to be effective within the five year programme in the Boroughs adjacent to the Hornsey boundaries. Area No. 1 The Borough's first Smoke Control Order was made in January 1959. Objections were received and a public inquiry held in April. After considering the report of Her Majesty's Inspector who conducted the inquiry, the Minister confirmed the Order, but postponed the date of operation for one year to 1st September 1960. In confirming the Order the Minister stated that he had considered objections made regarding the choice of the area. Judged without reference to the Council's programme for the Borough as a whole, he agreed that they had some force, but that it was necessary to take into account the Council's proposal to make the whole Borough a smoke control area. A booklet setting out details of grants available and conditions to be observed was sent in July to all owners and occupiers of premises in which fireplaces needed alteration or replacement. Proposal forms were also sent but very few were returned by the end of the year. Area No. 2 The detailed survey of Area No. 2 was completed in October 1959 and the Order made by the Council in November. The estimated total cost of carrying out necessary adaptations and conversions was £28,136. No objections were received, and confirmation of the Order was received from the 27 Minister of Housing and Local Government in January 1960, the date of operation also being 1st September 1960. Necessitous Cases Although the statutory grant covers 70% of the cost of conversions the balance must be paid by the owner or occupier. It is realised that this may throw an impossible burden on some, particularly old age pensioners with only the statutory pension. To overcome this difficulty the Council is empowered to make additional grants, up to 100% of the cost if necessary, and a special Sub-Committee has been set up to deal with applications. One such case was dealt with in 1959, and an additional grant of £7.8s. 4d. was authorised. Fuel Supplies There is still much prejudice against coke for space heating in the home but with more experience of the new grates installed in these areas this should be dispelled. A British Standard for coke has been established (B. S. 3142:1959, Open fire coke) which will ensure the high quality of coke supplied to this Standard. The National Coal Board and the Gas Boards have been carrying on intensive and successful experiments in the production of new smokeless fuels and there are hopes of greater improvement in the near future. Administration The procedure for establishing Smoke Control Areas and bringing them into force is principally laid down in a Memorandum issued by the Ministry of Housing and Local Government. This Memorandum is full of sound guidance on general principles, and no great difficulty has been experienced in their application, but as soon as an Area has been confirmed difficulties on questions of detail abound. One such arises in applying the ten principles laid down in the Memorandum for determining the type and standard of work reasonably necessary in converting a fireplac e. A s the payment of Exchequer grant depends upon careful adherence to these principles by the Council, great care is needed. But it is not possible to be certain that a particular decision will coincide with the view of the Ministry. To illustrate this point, the fifth principle reads as follows - "When replacement of an appliance is necessary, reasonable freedom of choice should be given to the owner or occupier as between solid fuel, gas, electric and oil-burning appliances provided the total cost of the alternatives is broadly comparable. " This appears to be quite clear until it becomes necessary to consider the last two words in relation to particular cases. Then it is necessary to ask - what is "broadly comparable?" It should be remembered that the number of cases to be dealt with in each area may well exceed 2,000, 28 and treatment of all applications for grant must be impartial. This kind of problem cannot be satisfactorily resolved at local level, and it is desirable for more precise guidance on such points of detail to be widely circulated by the Central Government Department. Staff The work involved in implementing the Council's smoke control plan will be considerable. The Ministry requires detailed analysis of costs both at the estimate stage and also when final accounts are rendered. It may be hoped that the Ministry will be willing to dispense with some of the details in future areas when satisfied that the Council is working on the right lines. At present every dwelling in an area has to be visited during the preliminary survey. After confirmation of an Order, proposals from householders must be approved, and in some cases it is necessary to make another inspection to settle doubtful points. When the work has been completed it must be inspected, and finally the accounts must be carefully scrutinised before the grant is paid. Surveying a Smoke Control Area "High class residential roads with elegant houses standing in extensive gardens, tastefully furnished and decorated, with open log fireplaces or dog grates standing in beautifully designed marble surrounds. " Such is a description of properties encountered in part of the first Smoke Control Area to be surveyed by the public health inspectors. It was soon realised that adaptations of expensive and elaborate fireplaces would set many technical problems not invisaged in the Memorandum on Smoke Control Areas issued for the guidance of local authorities. Householders in the area were generally very interested and many problems, both of a technical and controversial nature were discussed when the inspectors interviewed them at their premises. The question of the best method of adapting or converting the fireplaces had to be decided together with an estimate of the cost. The majority of householders expressed their approval of the establishment of Smoke Control Areas and many people wished to be enlightened as to the relative efficiency of the smokeless fuels and the relative costs of usage. In some cases the inspector was even asked to give a brief description of the method of manufacture of the smokeless fuels and some idea of the carbon, gaseous, and ash content. During the course of the survey every endeavour was made to give advice and all possible assistance to anyone who made a genuine and interested enquiry, with the result that many persons who at first were not in favour of the proposed Order, were persuaded that the campaign for clean air was in fact consistent with the general advance in living conditions. The survey, therefore, was regarded by the public health inspectors not only as a detailed gathering of in- 29 formation on fireplaces, but also as a means of furthering the cause of health education in the clean air field. In view of the fact that every property was visited, including shops and factories, it would be true to say that in no other way could "clean air" be so thoroughly publicised. In an area such as this, a great deal of garden rubbish is burnt on bonfires, and in some cases logs from the estate are cut and stored for winter use. While it appears that logs will no longer be able to be used on household fires, the question of the burning of garden rubbish is a rather more controversial issue* Another matter which was found to cause much concern, particularly near busy roads, was the question of exhaust diesel fumes and smoke from heavy motor vehicles. Although it is known that experiments are in progress with the object of eliminating this nuisance (at least in part), the public are very conscious of this ever present menace and no really satisfactory answer could be made by the inspectors to these complaints. Following a public enquiry the Minister confirmed Smoke Control Area No. 1 to come in force on 1st September, 1960. The public health inspectors have had discussions with local builders regarding the practical problem involved in adapting various types of fireplaces, some of which in the Highgate Village area are of an unusual and antique design. Agreements are reached as to the most practical way to carry out the alterations at reasonable cost, care being taken by the inspector to ensure that the work is carried out efficiently and in accordance with the British Standards Specifications. With older fireplaces it is sometimes necessary to carry out ancillary work to gather-in large flue openings, as without such alterations even modern approved appliances cannot be operated. Reaction of the Public Generally the reaction of the public appears to be favourable. A common comment is "should have been done years ago. " The objection to coke has been mentioned but the British Standard discussed above should help, particularly if the suppliers make it widely known. 30 SMOKE CONTROL AREAS The Borough has been divided into twelve areas. Areas 1 and 2 come into operation on 1st September, 1960. Areas 3, 4 & 5 will follow in 1961, 1962 and 1963. FIVE YEAR PROGRAMME HORNSEY AN D ADJOINING BOROUGHS 33 ATMOSPHERIC POLLUTION - MEASUREMENT OF SMOKE, SULPHUR DIOXIDE AND SOLID DEPOSITS Smoke (milligrams per 100 cubic metres) Sulphur dioxide (parts per 100 million parts of air) Solid deposits (tons per sq. mile) Monthly average Highest daily reading Lowest daily reading Monthly average Highest daily reading Lowest daily reading (a) (b) (c) (a) (b) (c) (a) (b) (c) (a) (b) (c) (a) (b) (c) (a) (b) (c) (c) (d) (e) January 24 29 30 84 87 85 3 10 9 8.6 9.7 17. 5 37.4 30.0 58.0 1.1 1.4 3.6 16. 07 9.91 18.30 February 22 23 25 92 87 102 11 13 14 10.2 10.6 18.2 60.0 56. 0 86.7 2.6 3.2 5.6 7.63 7. 58 10.11 March 12 16 16 38 37 39 4 9 8 6.2 6.7 8.8 16.7 13.6 19.9 2.3 3.2 4.2 16.62 13.63 26.09 April 8 10 11 16 22 23 3 3 4 5.0 5.5 7.0 15.3 12.0 20. 0 1.7 1. 5 2.9 13.26 11.26 17.25 May 5 6 5 19 19 21 1 1 1 3.1 3.9 3.6 9.5 12.3 14. 0 1.2 1.4 0.2 4. 50 8.15 8.09 June 4 4 3 9 10 7 1 1 1 3.0 3.5 2.1 6.9 10.1 3.8 1.2 1. 5 0. 5 12.02 8.06 12.93 July 3 4 1 9 9 2 1 1 1 2. 5 2. 5 1.4 6.1 7.6 6.0 0.7 0. 5 0. 2 10. 46 7.75 12.00 August 4 3 1 9 7 1 1 1 1 2.5 2.2 1.0 4.8 3.8 2. 5 0.6 0.9 0.2 9.34 7.76 10. 51 September 5 4 1 13 12 1 1 1 1 3.6 2.7 1.7 13.8 10.7 5.4 0. 5 0.2 0.2 6.22 7.86 8.05 October 10 11 2 18 23 5 3 4 1 4.2 3.9 3.0 14. 5 8.7 6. 0 0. 5 1.3 1.0 13.02 10. 77 16.91 November 20 25 9 39 59 27 6 10 1 6.1 4.9 8.6 40.1 31.3 31.3 0.5 1.6 2,3 11. 53 25. 20 20. 07 December 14 18 5 38 43 9 6 9 1 3.5 2.7 5.2 13.1 4.8 14.7 1.7 1.4 2.3 15.84 9.47 16.86 Sites: (a) Fortis Green Depot. (b) Disinfecting Station. (c) Town Hall. (d) Highgate Depot, North Hill. (e) Electricity Sub-Station, Hampden Road. FOOD FOOD INSPECTION AND SUPERVISION The Hygienic Condition of Cooked Meat The bacteriological condition of meat products sold ready cooked for human consumption has been the subject of a careful examination by the Central Public Health Laboratory and by the Health Department. Suggested bacteriological standards which food of this type should satisfy so as to be regarded as reasonably safe and clean, have been published by the Central Public Health Laboratory. After consultation with the Laboratory it was arranged that six samples of cooked meat products per month, commencing in June, 1959, would be collected from shops in Hornsey and submitted for examination. From six series of monthly samples taken up to 31stDecember, 1959, there is evidence that greater care is necessary in the handling of cooked meats at all stages of production, storage and sale. In Hornsey there is no large scale processing of food products but some shop keepers do prepare their own hams and cooked meats. The department is endeavouring to ensure that separate instruments, kept thoroughly clean, are used in cutting and serving cooked meats, and that such food is kept atatemperature below 40 F to minimize the risk resulting from accidental contamination. Some shops are so congested that it is difficult to handle food satisfactorily and the processing or sale here of cooked meats should not be permitted. In all cases separate equipment should be used for raw food and for bacon. The public as well as the trader needs to be reminded that not only is precooked meat perishable, but, more important, it is an ideal medium in which food poisoning organisms grow. Such food should always be treated with respect, kept clean, cool and covered. It should be eaten as soon as possible so that any organisms introduced into the food during processing or handling in the food shop will be prevented from multiplying to such an extent as to cause food poisoning. Copies of the bacteriological report received by the Health Department are sent to the shop keeper, and the following comments on a few of the unsatisfactory samples illustrate the action which follows. 35 1. Brisket of beef. In this case, a shop specializing in the sale of cooked meats, the food is exhibited throughout the day in the shop window, and stored in a refrigerator at night. A suggestion by the shop keeper that continuous storage in the refrigerator would not be good for trade in that the public is inclined to purchase only food on display, was met by the counter suggestion for the installation of a refrigerated window, but up to the present this has not been done. 2. Cooked ham. Here the company agreed that several important improvements in the handling of foodstuff should be arranged at the shop and among these were provision of additional washing facilities for the staff, provision of a separate cutting machine for cooked meats, the introduction of routine washing down of the cooked meat machine at least four times a day, the proper screening of this type of food behind glass on the counter and later the installation of a cold air-spill cabinet on the counter. 3. Cooked ham. The company's representative was interviewed and it was pointed out that the cutting of cooked meat on the same machine as bacon was undesirable and likely to introduce contamination. The company undertook to provide a separate machine and to carry out certain other practices with a view to reducing the risk of contamination. A sample of chopped pork luncheon meat taken from the same shop some time later was found to be satisfactory. 4. Cooked ham. The shop premises were considered by the department to be overcrowded and the prepared foods were handled in an unsatisfactory manner. The actual cooking of the food was understood to be done on other premises belonging to the same firm in another part of London and the cooked hams delivered wrapped in greaseproof paper in a cardboard box. The sale of a ham at the Hornsey shop was said to take between four and five days although as long as fourteen days was mentioned as a possible period. Though claimed to be stored in a refrigerator, it must undergo very considerable handling before the last portion has been sold, and was cut on the same machine as the bacon, a most undesirable practice. A further sample taken from the shop showed that the hams were being delivered in the same manner as before. On this occasion the uncooked hams were being stored in a cold display cabinet, open at the top and placed immediately inside the door, where the customers stood. This particular shop presents a considerable problem to the department, although it is doubtful whether any specific requirement of the Food Hygiene Regulations is contravened. 5. Cooked ham. The company in this case approached the Health Department for suggestions to improve the handling of food. Additional screening of the food was recommended and separation of the machinery and utensils from those used for raw food. Samples of cooked food from the shop will be taken from time to time. 6. Roast pork. Information reached the Health Department that there had been a number of food poisoning cases associated with consumption of food from the shops owned by this company. In this particular case the food was known to be prepared at other premises belonging to the company. The source of contamination here might have been at the processing plant rather than at the shop in Hornsey, however, the matter was given careful attention and further samples taken from the shop in Hornsey. 36 7. Pork brawn. Where cooked meats were displayed in the shop window for business purposes, the shop keeper was advised to consider seriously the installation of a refrigerated window, which together with other necessary precautions would secure more satisfactory hygienic conditions. The meat here was prepared on very congested premises, but the shop keeper undertook on advice to discontinue this practice. 8. Cooked ham. Although a sample showed a surface plate count well within the suggested limits, at the same time coagulase positive staphylococci of the type usually associated with food poisoning, was isolated from the sample. This means that if ham, so infected, had been kept by the purchaser for a sufficient time at normal room temperature, the organisms would probably have multiplied sufficiently to be capable of causing food poisoning. 9. Cooked ham. The Laboratory here reported a sample as being inconclusive, and the presence of faecal coliform bacilli disturbing. A control sample was taken later and the manufacturers delivered the food to the shop while the Inspectors were present. The outside wrapping was sterilised, as was also were the knives used in cutting the sample. This sample was described as "very satisfactory" and faecal coliform were not found in 0.1 gram. The manufacturers were unable to ascertain whether the original sample was from home killed or imported ham. 10. Cooked ham. Here a sample was taken from a branch of a multiple food store. It had a satisfactory colony count but coagulase positive staphylococci of a strain usually associated with food poisoning was found. The company expressed great disappointment at the result and undertook to put their own bacteriological staff to work on the examination of storage and handling of these products at all stages in their firm. Summary of Results of 42 Cooked Meats Samples taken between June & December, 1959 Laboratory Comment June July Aug. Sept. Oct. Nov. Dec. Totals Very good 1 . . . 1 • • 2 Very satisfactory • . . 1 • 1 1 3 Satisfactory • 1 . 1 1 3 4 10 Within normal limits 2 1 . 3 . . 1 7 Doubtful . • . . 1 . • 1 Unsatisfactory 3 4 2 1 2 2 • 14 Very unsatisfactory . . 4 . . . . 4 Inconclusive • • • • 1 • • 1 37 FOOD PREMISES CLASSIFIED ACCORDING TO PRINCIPAL TRADES No. of Premises Registered under Section 16 of the Food and Drugs Act, 1955 (a) For Sale or Manufacture of Ice Cream (b) Prepared Foods Bakers and flour confectioners 22 3 . Butchers 48 . 30 Confectionery (sugar) 124 105 1 Fish (wet and dried) 10 2 3 Fish (fried) 8 . 1 Fruit and vegetables 73 11 . Grocery and provisions 129 34 . Milk 4 1 . Canteens 2 . . Preserved foods 2 . . Public houses and off licences 73 5 . Restaurants and cafes 63 2 . Ice cream 2 2 . Herbalist and health foods 1 . . Confectionery warehouse 1 . . Preserved food factory 3 . . Stalls: Fruit and vegetables 3 . . Jellied eels 1 . . Refreshments 1 • . REGISTRATION OF HAWKERS OF FOOD AND THEIR STORAGE PREMISES During the year two 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 34 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 24 MILK SUPPLY Six new registrations were effected under Part 111 of the Milk and Dairies Regulations, 1949. 38 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 4 . 32 9 Tuberculin Tested 2 . 25 9 Sterilised 5 . 46 10 ICE CREAM Six samples of ice cream were taken for bacteriological examination with the following results:- Grade 1: 5 Grade 2: 1 Grade 3: - Grade 4: - Samples classified within Grade 1 and 2 are satisfactory. INSPECTIONS OF FOOD PREMISES WERE MADE DURING THE YEAR AS FOLLOWS:- Bakehouses and Bakers' Shops 50 Grocers' Shops 232 Butchers' Shops 104 Milkshops 16 Canteens and Kitchens 19 Public Houses & Off Confectioners 67 Licences 24 Fish Shops 27 Prepared Food Shops 7 Greengrocers' Shops 79 Restaurants, Cafes, etc. 82 TOTAL INSPECTIONS 707 The following is a list of unsound food surrendered during 1959. Whereever possible this was salvaged for use as animal feeding or industrial purposes. Cwt. lb. Cwt. lb. Canned Vegetables . 20 Cheese . 1 Canned Fruit & Fruit Juices 1 111 Meat and Bacon 5 38 Canned Meat 8 52 Fish 1 32 Canned Fish . 18 Pickles . 79 Canned Soup . 1 Sugar . 8 Canned Jam & Marmalade . 1 Cereals . 55 Milk 75 pts. Vegetables 51 69 Powdered Milk . 12 Dried Fruit . 53 39 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 and Drugs Act, 1955 Samples procured in the Borough of Hornsey during the year 1959 Total samples Article procured Unsatisfactory Milk 79 Butter 10 Cakes 16 Cheese 6 Cooked Meat 14 Cream 13 1 Drugs 5 Fish and Fish Products 21 Fruit, fresh, canned etc. 12 Fruit Squash, Drinks etc. 6 Ice-Cream 10 Jelly 4 Liver 12 Margarine 5 Meat and Meat Products 43 4 Preserves 3 Sausages etc. 19 Spirits 4 Sweets 6 Vinegar 7 Miscellaneous 17 1 312 6 The following comments relate to samples noted as unsatisfactory:Cream A sample of sterilised cream sold by a multiple firm of grocers was found to be deficient in fat and rancid. Sterilised cream should consist of at least 23% butter fat, whereas this sample contained only 20%. No evidence was found to establish the cause, the tin being one of many thousands imported, and the firms concerned were officially cautioned. Meat and Meat Products A retail butcher was cautioned for selling minced beef which had been treated with sulphur dioxide preservative. The addition of preservative to fresh meat is prohibited under the Public Health (Preservatives etc. in Food) Regulations 1925 - 1958, and the butcher concerned, who was not English and inexperienced in our law, was advised accordingly. Minced beef obtained from 40 another butcher was found to be similarly suspect, but subsequent samples proved genuine. Miscellaneous Traces of preservative were found in a type of Japanese confectionery, but a subsequent sample when analysed gave a negative result, so that no further action was taken. Merchandise Marks Acts, 1887 - 1953 The majority of the inspection work carried out under the provisions of the above Acts is to ensure compliance with the requirements of the various Marking Orders made under the provisions of the Act of 1926. These Orders apply to the marking of the country of origin on imported foodstuffs, principally meat, apples, tomatoes, dried fruits, bacon, ham, poultry, butter and honey, upon sale and exposure for sale. Inspections were made at 196 premises of 956 displays of these foodstuffs. Proceedings were instigated against a butcher for selling and exposing for sale Argentine beef and offal not marked with an indication of the country of origin. Fines totalling £7. 0. Gd. were imposed with £5. 5. Od. costs. Another firm of butchers exposed for sale and sold Australian lamb with the false trade description "New Zealand" applied. Two joints were involved in a display of correctly marked meat and the matter was dealt with by sending an official caution. 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 in the case of a compounded food, with the names of the ingredients in descending order of proportion by weight. Furthermore, it controls the manner in which the presence of vitamins and minerals is disclosed and prescribes specific labelling of certain foods. A total of 942 articles of pre-packed food was examined at 127 different premises to verify compliance with these Regulations. False and Misleading Descriptions Food advertisements and labels have been scrutinised for false and misleading statements and descriptions. No serious infringements were disclosed. Corrective action taken within the whole area of the County has equal effect within each County district, and work under this heading is combined with inspections made under the terms of the Merchandise Marks Acts and the Labelling of Food Order. A number of firms have labelled tins of Instant Coffee as "100% Pure Coffee". This product consists of the instantly soluble solids of coffee obtained by a process of dehydration. The insoluble portion of the bean is omitted. 41 Representations have been made to have the description amended so that the product is not claimed to be whole coffee. Other examples where corrective action was sought are set out as follows The percentage fat content marking on Continental Cheeses when set out as a percentage "I. D. M. ", changed to a comprehensible statement of "Fat on the dry matter. " A Continental biscuit marked as "Cheese Filled", which contained a filling only 20 per cent cheese. Such descriptions of Continental soft cheeses as "Super-Creme", "Triple-Creme" and "Cream" etc. amended to indicate the true nature of the product, i.e. whole-milk cheese, cheese spread etc. Rice puddings marked as "Creamed Rice", fruit "syrups" labelled as fruit "juices", a "Seedless Fig Bar" which was found to contain crushed seeds, and cheese spreads described as "processed cheese". Slimming claims in respect of lemon juice drinks were challenged. There is no clinical proof that the consumption of lemon juice will reduce weight, and the firms concerned have been requested to indicate that the drink is merely one suitable for inclusion in a slimming diet. The claim that a particular breakfast cereal had twice as much honey as any other cereal was also challenged. Some extravagant claims in respect of medical remedies were challenged and the advertisements withdrawn. BAKEHOUSES There are 13 bakehouses in the Borough all of which are frequently inspected to ensure that hygienic conditions are maintained. In respect of three basement bakehouses for which certificates of suitability had been issued, the quinquennial examination was carried out in 1959. Section 54 of the Factories Act, 1937 requires that basement bakehouses be inspected every fifth year and, if found suitable as regards construction, height, light, ventilation and hygienic conditions, certificates of suitability shall be allowed to continue in operation. Two basement bakehouses were found to be satisfactory and notice was served that the certificate of suitability shall continue to operate. A third, was found to be below standard in many respects and the Council was recommended not to continue the certificate of suitability, and the firm was later notified that the certificate of suitability would cease to have effect after the expiration of six months. 42 LEGAL PROCEEDINGS Food and Drugs Act, 1955, Section 2 Date of Hearing Offence Result 1st July. Mould on pork sausages Fine £5. Costs £3.3s. Od. 8th July Mouldy French Sandwich Fine £1. Costs £2.2s. Cd. 28th October Mouldy meat pie Absolute discharge. Costs £3. 3s. Od. 4th November Mouldy cottage cheese Absolute discharge. Costs £3.3s. Od. 25th November Mouldy apricot pie Fine £3. Costs £2.2s. Od. 30th December Finger bandage in bun Fine £5. loaf Food Hygiene Regulations, 1955, Section 9(e) 6th April Smoking tobacco in food Case dismissed (defendant shop pleaded that he was smoking a herbal cigarette) 43 OLD PEOPLE'S WELFARE Only 20 new cases were reported to the Department during 1959 and in no case was it necessary to use compulsory powers of admission to a home or hospital. There is little doubt that the lower number of complaints for the second year in succession is largely due to the increased amount of home visiting carried out by the staff of the Old People's Welfare Council. The Secretary of the Old People's Welfare Council reports that over 7,600 visits were made during the year. These were needed by the increase in the number of old people becoming housebound during winter months. Parallel with this has been an increase of calls at the office which amounted to 3,462. Domiciliary visits, besides being a great help and comfort to the people concerned are also a means of advice on home safety, and special attention was paid during the winter to potential dangers from oil heaters and advice given to very many old people. The various kinds of assistance offered or organised by the Old People's Welfare Council include the distribution of gifts of coal paid for by the Hornsey parochial charities and by residents of the Borough. Seven hundred Christmas parcels bought from voluntary donations were distributed at Christmas time and four hundred old people received gifts of harvest fruit and groceries given by the school children of Hornsey. Hobbies are catered for by the provision of bulbs and plants to old folk who are interested, and in addition nine elderly people were provided with budgerigars and cages. Old people willing to carry on some form of part-time work in being helped were able to help others, as fifty elderly sick were given help in the home by other old people, who although unable to do heavy housework were able to carry out many household duties for a small payment. Sixty-three retired active gentlemen were found jobs of various kinds, such as light clerical work, gardening, hairdressing of housebound people, cleaning, minor home repairs and decorating. There is, in addition, a home employment scheme for the elderly. During 1959 there were twenty-five elderly people on the register who made articles for sale from materials which were in the main given by Hornsey tradesmen and residents. Half the selling price of the article is given to the maker and the other goes towards the various costs of administering the scheme. The money earned is very useful, but the most important part is the feeling of well-being caused by doing something of value. Knitting, sewing, embroidery and jewellery making were some of the crafts practised. Although this scheme is in its early days it promises well for the future and is something of which the Old People's Welfare Council is rightly proud. Holidays and outings were not forgotten and for the first time a party of old people were entertained at Clacton over the Christmas holiday. Two weeks holiday at Westcliff and Margate were enjoyed by 228 people at a nominal 45 cost. Those people, who were unable because of physical handicap or other reason, to join holiday parties, were taken on day outings to Westcliff, Brighton and Eastbourne. The chiropody services provided by the voluntary organisations were still a great boon, but quite inadequate to meet the real need. Housebound old people were treated in their homes as a result of donations from the Almeric Paget Trust. The Women's Voluntary Service continued their excellent work in providing 10,716 "Meals on Wheels" during the year. Fewer requests for residential care were received, but there is a demonstrated need for more accommodation for housebound elderly sick people who live alone and are unable to receive the necessary care from neighbours or friends. I am informed by the Hornsey and Wood Green Division of the British Red Cross Society that 137 patients were admitted to the Grove Lodge Convalescent Home for the Aged Sick. Of this number 106 were discharged fit to their homes, 12 went to welfare homes and 18 were re-admitted to hospital. In the Red Cross Welfare Home, Kenwyn Lodge, there are 29 residents between the ages of 64 years and 97 years. The three Evergreen Clubs run by the Society meet in school or church halls on Saturday afternoons. In addition a club for men meets every afternoon at Grove Lodge. Weekly sessions for chiropody treatment for old people are held at Grove Lodge and 563 patients were treated during the year. CLEANSING OF SOILED ARTICLES During the year 3814 bundles of articles were collected for cleansing under the terms of section 84 of the Public Health Act 1936. 41 people received assistance and 7 were still doing so at the end of the year. The highest number of cases being assisted at any one time was 18 and the service undoubtedly meets a very great need. 46 GENERAL MEDICAL EXAMINATION OF STAFF Twenty-nine persons were medically examined to determine their fitness for acceptance on the permanent staff; all 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. 98 persons were examined, 86 of whom were accepted for the scheme. 7 examinations were carried out for other purposes. MASSAGE AND SPECIAL TREATMENT Part Xll of the Middlesex County CouncilAct, 1944, which was brought into operation in Hornsey on 1st October 1952 provides that premises in the Borough used for the reception or treatment of persons requiring massage or special treatment must be licensed. 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. 20 premises were licensed during the year. The following summary shows the numbers licensed for each form of treatment. Massage 6 Chiropody 19 Electrical treatment 6 Other similar treatment 5 Three 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 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. Six inspections were made under the Pet Animals Act, 1951. 2 at Pet Shop - St. James's Lane. 2 at Pet Shop - 1 Clissold Cottages, Fortis Green. 2 at Pet Shop - 314c Park Road. There were no outbreaks of Fowl Pest. No action was necessary under the Tuberculosis Order of 1925. 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 two bodies, 1 man of 78 years and 1 woman of 85 years. PUBLIC MORTUARY The Hornsey mortuary and post-mortem room are situated at the Central Depot, Hornsey High Street. During the year 126 bodies were admitted and post-mortem examination carried out on all but one. Inquests were held on 11 bodies. PETROLEUM SPIRIT The number of establishments licensed for storage is 73 and the number of licences issued is as follows:- Petroleum 62 Cellulose 19 Naphthalene 1 Hydro-carbon 1 Petroleum mixtures 2 Total 85 (Nine establishments are licensed for more than one product) 48 VITAL STATISTICS Area (acres) 2,872 Area of Parks and Open Spaces (acres) 576 Population: Registrar General's estimate at 30 June, 1959 96,430 Number of separately assessed dwellings 1st April, 1959 24,686 Rateable value (General Rate) £1,543,882 Product of a penny rate 1959-60 £6,244 TOTAL LIVE AND STILL-BIRTHS 1,754 LIVE BIRTHS M. F. Total Legitimate 836 749 1,585 Illegitimate 70 76 146 Hlegitimate live births per cent of total of live births 8.4% Birth Rate (live births per 1,000 population) HORNSEY 18.0 Area Comparability Factor 0.93 Adjusted Rate for Hornsey 16.7 England and Wales (provisional) 16.5 Middlesex County (adjusted rate) 14. 4 STILL-BIRTHS M. F. Total Legitimate 12 10 22 Illegitimate 1 . 1 Still-birth Rate (per 1,000 total live and still-births) HORNSEY 13.1 England and Wales (provisional) 21.0 INFANT DEATHS (under 1 year of age) M. F. Total Legitimate 25 13 38 Illegitimate 3 2 5 49 Infant Mortality Rates (per 1,000 live births) HORNSEY: Legitimate 24.0 Illegitimate 34. 2 Total 24.8 England and Wales (provisional) 22.2 Middlesex County 19.4 NEO-NATAL DEATHS (under 4 weeks of age) M. F. Total Legitimate 23 11 34 Illegitimate 1 2 3 Neo-Natal Mortality Rates HORNSEY 21.4 England and Wales (provisional) 15.8 Early Neo-Natal Deaths (under 1 week of age) M. F. Total Legitimate 22 11 33 Illegitimate 1 2 3 Early Neo-Natal Mortality Rates Legitimate 20.8 Illegitimate 20.5 Total 20.8 PERI-NATAL DEATHS (early neo-natal deaths plus still-births) M. F. Total Legitimate 34 21 55 Illegitimate 2 2 4 Peri-Natal Mortality Rates (per 1,000 total live and still-births) Legitimate 34.2 Illegitimate 27.2 Total 33.6 50 MATERNAL MORTALITY RATES (per 1, 000 total live and still-births) HORNSEY Nil Middlesex County (13 deaths) 0.39 England and Wales (291 deaths) 0. 38 DEATHS FROM ALL CAUSES Males 521 1,187 Females 666 Death Rate (per 1,000 population) HORNSEY 12.3 Area Comparability Factor . 89 Adjusted Rate for Hornsey 10. 9 England and Wales 11.6 Middlesex County (adjusted rate) .11.4 51 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 . . . . . 3 2 1 6 9 F . . . . . 1 1 1 3 2 Tuberculosis, other M . . . . . . . . • 2 F . . . . . . 1 . 2 3 Syphilitic disease M . . . . . . 2 . 2 3 F . . . . . . 1 . 1 7 Acute poliomyelitis M . . . . . . • . 1 1 F . . . . . . • . • 9 Other infective and parasitic diseases M . . . . . 1 1 . 2 3 F . . . . . 1 • . 1 10 Malignant neoplasm, stomach M . . . . . 6 3 3 12 26 F . . . . . 4 3 7 14 11 Malignant neoplasm, lung, bronchus M . . . . . 23 14 9 47 59 F . . . . . 4 6 2 12 12 Malignant neoplasm, breast M . . . . . . . . . 26 F . . . . 2 9 8 7 26 13 Malignant neoplasm, uterus M . . . . . . . . . 9 F . . . . . 5 2 2 9 14 Other malignant and lymphatic neoplasms M . . . . 5 13 13 7 38 105 F . . . . 2 26 17 22 67 N. B. - No deaths occurred from the following causes:- 4 Diphtheria; 5 Whooping Cough; 6 Meningococcal infections; 8 Measles. 53 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 S 15 Leukaemia, aleukaemia M . . . . . . . 1 F . . . . . . . 1 1 16 Diabetes M . . . . . 1 . 1 4 F . . . . • 1 1 1 3 17 Vascular lesions of nervous system M . . . . 2 12 4 29 47 149 F . . . . 1 10 20 71 102 18 Coronary disease, angina M . . . . 3 35 38 47 123 227 F . . . . . 12 29 63 104 19 Hypertension with heart disease M . . . . . 1 3 7 12 34 F . . . . . 1 5 16 22 20 Other heart disease M . . . . . 4 7 20 35 113 F . . . . . 2 7 69 78 21 Other circulatory disease M . . . . . 3 4 10 18 62 F . . . . 1 4 5 34 44 22 Influenza M . . . . . 1 7 5 13 26 F . . . . . 1 3 8 13 23 Pneumonia M 2 . . . 2 5 8 19 36 71 F 1 . . . . 1 7 26 35 24 Bronchitis M 1 . . . . 5 12 16 34 70 F • . . . . 2 9 25 36 25 Other diseases of respiratory system M . . . . . 1 3 2 6 11 F • . . . . • 2 3 5 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 26 Ulcer of stomach and duodenum M . . . . . 3 2 . 5 10 F . . . . . 2 1 2 5 27 Gastritis, enteritis and diarrhoea M . . . . . . 1 1 2 5 F . . . . . . 1 2 3 28 Nephritis and nephrosis M . . . . . 3 . 1 4 5 F . . . . . • 1 • 1 29 Hyperplasia of prostate M . . . . . . 1 10 11 11 F . . . . . . • • • 31 Congenital malformations M 1 . . . . . . . 1 6 F 5 . . . . • • • 5 32 Other defined and ill-defined diseases M 24 . . . 1 7 7 12 52 104 F 7 . . . 1 9 6 29 52 33 Motor vehicle accidents M . . . . . 1 . 2 4 8 F . . . . 1 . 2 1 4 34 All other accidents M . . . . 1 . . . 3 15 F 2 . . . 1 . 2 7 12 35 Suicide M . . . 1 . 4 1 . 6 12 F . . . 1 1 3 . 1 6 TOTALS M 28 2 . 5 20 132 133 201 521 F 15 • 1 1 11 98 140 400 666 43 2 1 6 31 230 273 601 1187 N. B. - No deaths occurred from the following causes:- 30 Pregnancy, childbirth, abortion; 36 Homicide and operations of war. 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 Haemorrhaglc conditions M 2 . . . . 2 . . . 2 F . . . . . . . . . . Pneumonia M . . . . . . . . . 2 F • 1 . . . 1 . . . 1 Bronchitis M . . . . . • . . . 1 F . . . . . . . . . . Congenital Hydrocephalus M . . . . . . . . . . F 1 . . . . 1 . . . 1 Congenital malformations of heart M . . . . . . . . . . F 1 . . . . 1 . . . 1 Other congenital malformations M . . . . . . . . . l F 1 1 . . . 2 . . . 3 Injury at birth M 4 2 . . . 6 . . . 6 F . . . . . . . . . . Post-Natal Asphyxia and Atelectasis M 2 2 . . . 4 . . . 4 F 1 . . . . 1 . . . 1 Haemolytlc Disease of Newborn M 1 . . . . 2 . . . 2 F 1 . . . . 1 . . . 1 Immaturity M 6 2 . . . 8 . . . 8 F 4 1 . . . 5 . . . 5 Obstruction by Inhalation or Ingestion M . . . . . . . . . . F . 1 . . . 1 . . . 1 Accidental Mechanical Suffocation M . . . . . . . . . . F . . . . . . . . . 1 All other Causes M 1 l . . . 2 . . . 2 F • • . . . • . . . . TOTALS M 16 7 1 . . 24 2 1 1 28 F 9 4 • . . 13 . 2 . 15 25 11 1 . . 37 2 3 1 43 AREA PERSONAL AND SCHOOL HEALTH SERVICES HORNSEY AND TOTTENHAM (Joint Population 212,530) The tables are for the Area as a whole except where stated for Hornsey only 57 MEMBERS OF THE LOCAL AREA COMMITTEE AS AT 31st DECEMBER 1959 MEMBERS OF HORNSEY BOROUGH COUNCIL Councillor Miss O. R. ANDERSON, J. P. Mrs. J. CARTER Mr. D. H. P. LEVY " Mr. J. T. WILKINS (Chairman) Mr. C. R. WILLIAMS MEMBERS OF TOTTENHAM BOROUGH COUNCIL Alderman Mr. A. REED, A. C.I.I. , J. P. Mrs. A. F. REMINGTON Councillor Mrs. L. R. HARRINGTON (Vice-Chairman) Mr. H. LANGER " Mr. M. T. MORRIS Mrs. M. E. PROTHEROE MEMBERS OF MIDDLESEX COUNTY COUNCIL County Councillor Mr. F. H. BROOKS ,, ,,Mr. V. BUTLER ,, ,, Mrs. S. G. CHILD ,, ,, Mr. A. H. MILLER ,, ,, Mrs. M. E. SOALL ,, ,, Mrs. J. THEXTON MEMBERS NOMINATED BY APPROPRIATE HOSPITAL MANAGEMENT COMMITTEE Mrs. R. M. FRY Mr. L. HAYWARD PERSONS WHO MAY ATTEND IN AN ADVISORY CAPACITY Dr. L. HORNUNG (Middlesex Local Medical Committee) Mr. R. W. D. BROWNLIE ( " " Dental " ) Mr. L. HAYWARD ( " " Pharmaceutical " ) Miss V. EDEY (Royal College of Midwives) G. HAMILTON HOGBEN, M.R.C. S. , D. P. H. Medical Officer of Health and Area Medical Officer 58 HORNSEY DIVISIONAL EDUCATION COMMITTEE Alderman G. S. AITKEN F. H. BAILEY, J. P. D. F. W. BILLINGSLEY " M. W. BURNS, D.L. , K. S.G. .F. C. CAVE, (Vice-Chairman) N. MULDOON, J. P. G. WATSON Councillor Miss M. M. BARRIE A. N. CAMMOCK B. M. , B. Ch., D. L.O. Councillor Mrs. J. M. CARTER Mrs. K. M. ST. P. CRUMP (Chairman) Mrs. M. E. M. DAVIES R. S. DAVIES V. P. GELLAY, B. Sc. Mrs. E. McLEOD N. A. MULDOON " F. NEUNER " R. I. G. WATT, M. A. A. WILSON A. R. WILSON Eight Additional Members Rev. W. R. BUTLER, 35 Rokesly Avenue, N. 8. Miss H. M. CURTIS, B.A., Hornsey High School, Weston Park, 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. 10. Rev. W. S. KEMBLE, B. A., The Rectory, Hornsey, N. 8. Rev. C. C. MORGAN, M. A. , 11 Harefield Road, N. 8. Rev. A. STEWART, 1 Colney Hatch Lane, N. 10. 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. 10. County Councillor Mrs. J. THEXTON, 72 Oakfield Road, N. 4. 59 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 seven years and the percentage of hospital confinements was 81.1%, compared with 80% in 1958. 1959 1958 1957 Live Births (a) Domiciliary 649 708 566 (b) Hospital or Nursing Home 2881 2799 2679 Still Births (a) Domiciliary 4 6 3 (b) Hospital or Nursing Home 49 59 63 3583 3572 3311 Ante-natal Clinics The arrangements for four assistant medical officers with post graduate obstetrical qualifications to staff the ante-natal clinics and also to attend as honorary clinical assistants at local hospitals have worked well during the year. During the year discussions have taken place locally with the Medical Liaison Committees as to the implications of the Cranbrook Report on the Maternity Services. The Minister of Health has decided that many of the recommendations made require consultation with the authorities and organisations concerned before final decisions can be taken. The percentage of expectant mothers making at least one attendance at one of the local authority ante-natal clinics was 63. 6% during 1959 compared with 65. 7% the previous year. The following tables give details of attendances at ante-natal clinics, midwives clinics and mothercraft clinics during the year. 60 Ante-natal clinics No. of sessions held No. of new cases Total attendances Average attendance per session A.N. P. N. A.N. P.N. Burgoyne Road 76 207 115 1386 119 19.8 Church Road 74 128 71 1072 79 15.6 Fortis Green 101 241 104 1797 110 18.9 Hornsey Town Hall 154 382 168 2710 173 18.7 Mildura "Court 66 204 101 1381 108 22.6 Stroud Green 53 166 73 851 73 17.4 The Chestnuts 154 422 180 2831 183 19.6 Lordship Lane 154 284 144 1894 150 13.3 Park Lane 104 255 136 1321 136 14.0 Totals 936 2289 1092 15243 1131 17.5 Midwives No. of Total Average clinics sessions No. of attendance held attendances per session Burgoyne Road 24 154 6.4 Fortis Green 16 91 5.7 Hornsey Town Hall 13 123 9.5 Mildura Court 24 124 5.2 Stroud Green 25 232 9.3 Park Lane 89 326 3.7 Total 191 1050 5.5 Mothercraft No. of No. of new Total Average clinics sessions cases attendances attendance held per session Burgoyne Road 38 42 200 5.3 Church Road 46 66 232 5.0 Fortis Green 47 67 389 8.3 Hornsey Town Hall 50 153 625 12.5 Mildura Court 39 31 143 3.7 The Chestnuts 50 98 577 11.5 Lordship Lane 52 71 402 7.7 Park Lane 49 46 292 6.0 Total 371 574 2860 7.7 61 Infant Welfare Clinics These clinics have continued to run smoothly throughout the year. The mothers bring their babies regularly and derive great comfort from knowing that their offspring thrive. A careful check can be kept on those babies who do not progress satisfactorily mentally or physically; and mothers can be given guidance in management and feeding problems. The health visitors conduct separate sessions which help the doctors to see only those cases in which medical advice is necessary. The doctors' sessions are thus kept within reasonable numbers so that an unharrassed atmosphere can be created. This is becoming increasingly necessary; and allows time to penetrate into special difficulties and give suitable advice; the kind of advice which is most likely to be taken. The importance of recognising as early as possible any signs which might lead later to some permanent handicaps cannot be over stressed. Routine urine testing of young babies is now carried out in order to find those rare cases of mental retardation. Very early hearing tests are carried out with a view to detecting congenital deafness and reference to the Audiology clinic. There is a regrettable trend, as the baby grows older, for mothers to attend clinics less often. The toddler sessions thus seek to obtain more regular supervision of the 2-5 age group; as only in this way the developmental defects and behaviour problems can be found before they become serious. All the personnel working in these clinic shave been impressed with the upsurge of emotional problems of young mothers. There seems to be an increased urge by parents to do the 'best' for children and this calls for deep understanding, sympathy, tact and resourcefulness on the part of the health visitors and doctors and an increasing need for an intimate knowledge of all the social and special services. In turn this calls for even closer co-operation between the many services available and those who work in them, both by personal contacts and through the medium of liaison committees. Toddlers Clinics These sessions for the pre-school child continue to be conducted at all the centres; and present a challenge to all our staff. Ideally, after the second birthday the "toddler" should be seen by appointment at six monthly intervals or more frequently if necessary. In this way, defects, mental, physical or environmental, can be found and rectified before the child enters school. Those defects which are most likely to be a hindrance are those connected with sight, hearing, speech, motivation, mental acuity or social adjustment. The routine examination of children before they enter school is thus of the utmost importance; and makes it possible to reduce the number of untreated defects found in school entrants. 62 The following table shows details of attendances made at all centres during the year:- INFANT WELFARE Centre Sessions held First attendances under 1 year Under 1 year Over 1 but under 2 Over 2 but under 5 Total attendances Cases seen by M. O. Average attendance per session Burgoyne. Road 153 304 4888 753 193 5834 1416 38.1 Church Road 177 238 3298 554 116 3968 1556 22.4 Fortis Green 156 324 3878 782 166 4826 1840 30.9 Hornsey Town Hall 207 521 6093 1029 263 7385 2830 35.7 Mildura Court 104 252 3609 693 65 4367 1394 42.0 Stroud Green 101 264 3123 421 123 3667 1422 36.3 The Chestnuts 245 500 6607 922 204 7729 2539 31.5 Lordship Lane 258 412 5654 1122 169 6945 1772 26.9 Park Lane 204 358 5312 1093 305 6710 1697 32.9 Somerset Road 144 287 4167 903 204 5274 1609 36.6 Totals 1749 3460 46625 8272 1808 56705 18075 32.4 TODDLERS' CLINICS Centre Sessions held Total attendances Cases seen by M. O. Average attendance per session Burgoyne Road 28 508 508 18.1 Church Road 24 370 346 15.4 Fortis Green 28 405 405 14.5 Hornsey Town Hall 61 679 663 11.1 Mildura Court 50 680 629 13.6 Stroud Green 23 314 314 13.7 The Chestnuts 50 668 662 13.4 Lordship Lane 52 680 680 13.1 Park Lane 23 235 235 10.2 Somerset Road 39 504 504 12:9 Totals 378 5043 4946 13.3 63 Daily Guardian Scheme This scheme was re-introduced in 1947 for children of working mothers who are not eligible for day nursery accommodation for their pre-school age children. So far there has been no difficulty in finding a suitable number of women to undertake daily care of children who are taken to them and recovered from them by their parents each day. Proper safeguards are established for the welfare of such children and a written copy of the obligations of parents and daily guardians is given to each of the parties to the agreement to ensure that they are known. While the authority acts as an agent between parent and guardian, the actual placing is the responsibility of the parents. The scheme works easily. The children are seldom moved again after being accepted by a guardian unless the mother gives up work. The main reasons for using the scheme are financial ones. Health visitors are responsible for the approval of guardians for registration and for periodic visiting of children placed in their care. No person is registered if there is any doubt that the rules of the scheme will be followed and that a good standard of care can be maintained. It follows, therefore, that some applicants for registration are rejected and the authority is not involved if those rejected accept children for daily minding. Guardians are paid one shilling a day for each child minded (not exceeding two children) irrespective of what payment the parent may make to the guardian. During the year a larger number of children have been minded for a greater number of days. No. of Daily Guardians on Register 166 No. of Daily Guardians minding Children 90 No. of Children being minded 106 Total No. of Children minded during the year 231 Total No. of days minded 23,591 Total Payments made to Guardians £1179. l1s. 0d Day Nurseries All three day nurseries, Park Lane, Plevna and Stonecroft, are approved as training schools for student nursery nurses. The nursery matrons report that during the year there were more children admitted from broken homes or homes where there is only one parent than ever before. This is borne out by our records as regards children wholly supported by one parent and there is evidence to show that more than 50% of the children on the registers were in the 0-2 years age group. The periods for which children attended were in many cases shorter than in the past and 64 during the year approximately 30% stayed in the nurseries for up to one month; 50% for periods under one year, and 20% over one year. The constant change-over of children adds to the strains of day nursery work associated with the settling-in of so many children. Staff absences, due to sickness lowers the actual ratio of staff to children to what must be considered a dangerously low level so that in practice students or an inadequate number of staff may at times be left to supervise a considerable number of children. Students are away from the nurseries at the technical college on two days of each week for their theoretical training, and when they return, their practical training is reduced to a minimum. There is unlikely to be proper supervision of students or children in such circumstances and the amount of absenteeism may produce overstrain resulting from inadequate staffing in our day nurseries. The remedy may be either to consider students as supernumerary or that the nurseries be given a higher proportion of trained nursery nurses for the 0-2 age group. Student nursery nurse training and examination arrangements have been revised by the National Nursery Examination Board and in connection with this, nursery matrons were invited to attend a meeting at the Tottenham Technical College in January for a full discussion of the necessary modifications. The following table shows the attendances at Individual nurseries during the year:- 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 2 - 5 Under 2 2-5 Total Stonecroft 15 43 19 42 2673 10267 12940 50.8 Park Lane 20 30 21 26 3376 3466 6842 26.8 Plevna 20 30 19 35 3746 6435 10181 39.9 Totals 55 103 59 103 9795 20168 29963 117.5 Distribution of Welfare Foods The arrangements for issuing welfare foods were substantially the same as in the previous year. National Dried Orange Juice Cod Liver Oil Vit. A & D Tabs Milk (tins) (bottles) (bottles) (jackets) 1959 36350 98855 11676 11048 1958 39005 104980 12571 10420 1957 48243 156962 17347 10545 65 Priority Dental Service for Mothers and Young Children The following table gives details of attendances made and treatment given at all clinics during the past two years: - Expectant & Nursing Mothers Children under 5 Expectant & Nursing Mothers Children under 5 No. examined by dental officer 131 572 174 562 No. referred for treatment 127 467 171 523 New cases commenced " 127 421 155 479 Cases made dentally fit 55 178 64 172 Forms of dental treatment provided: Teeth extracted 159 369 274 432 Anaesthetics: (a) Local 68 26 100 56 (b) General 24 156 36 187 No. of fillings 220 474 372 469 No. of inlays - - 1 1 Scalings and gum treatment 90 - 108 - Silver nitrate treatment - 478 - 503 Dressings 114 162 126 150 Other operations 10 1 10 10 No. of radiographs (a) at County Council clinics 16 2 14 - (b) at hospital 1 - 1 - Denture dressings 163 - 178 - Dentures fitted:(a) full 16 4 14 (b) partial 32 - 29 - No. of attendances 588 872 758 981 No. of appointments not kept 138 199 145 186 No. of half days devoted to treatment 155 192 66 MIDWIFERY SERVICE (Section 23) Throughout the year difficulty has been encountered in maintaining a sufficient number of midwives to ensure a safe and workable service. Fortunately, it has been possible to find replacements for those midwives who left the service but it has been impossible to maintain a full establishment. Every effort is being made to attract midwives into the local service. Two were recruited from pupil midwives trained in the area and one other mainly because it was possible to offer housing accommodation. There is no doubt that facilities for transport and housing play an important part in the recruitment of midwives. The introduction of a shift system which would afford the midwife some undisturbed nights is proposed as soon as a sufficient number of staff can be obtained. Each midwife has undertaken more than the recommended number of deliveries. Any difficulty encountered is often due to the fact that people do not avail themselves of the services provided and there are still small numbers of pregnant women who do not receive adequate ante-natal care. One hundred per cent ante-natal care is the key to trouble-free confinements. An increasing number of general practitioners are undertaking antenatal care and engaging in the practice of obstetrics. Their co-operation with the midwives has been excellent. Early discharges from hospital continue to form a part of every midwife's work. Patients are commonly sent home on the third day following confinement and receive two visits on this day and a daily visit thereafter by their midwives until the fourteenth day. All midwives are at present up to date with refresher courses. These are found to be useful and stimulating and much appreciated by the midwives. One midwife is at present taking the course for the Midwife Teachers Diploma. Five or six pupil midwives are continuously in training on the district from the Alexandra Maternity Home at Muswell Hill. Seventeen pupils were trained in 1959, fifteen of whom were successful at the examination. The following table shows the work for the past year: - No. of deliveries attended 640 No. of visits made 13572 No. of hospital confinements discharged before 14th day 231 No. of visits made 2424 No. of cases in which medical aid was summoned 287 No. of cases in which gas and air analgesia was administered 470 No. of cases in which pethidine was administered 418 No. of cases in which trichloroethylene was administered 121 67 HEALTH VISITING SERVICE (Section 24) The main work of the health visitor is still basically the teaching of the principles of health and well being. Guiding towards health in clinics and homes is applied to the family as it is needed in consultation with parents or members of a family or individuals living alone. In those situations where the need is seen first by the health visitor she uses all her ingenuity and skill to move the family towards the attainment of health and the desire to achieve it. Listening, interpreting, counselling, instructing, encouraging, preventing, are some of the words used to describe the activities of the health visitor with each person who seeks her help or is sought out by her. In the wider field, the health visitor has been used by local health departments, hospitals, the Medical Research Council and other investigators connected with problems of peri-natal death rates, the health and development of children and other age groups. Student Health Visitors have been received for practical experience and observation visits for three terms during the year. Each is attached to one health visiting team and arrangements for continuity of visiting a few families are made. A balanced programme of special experience connected with all aspects of health visiting including contacts with schools and social agencies is also provided for them. A new feature of health visiting in the Area is the extension of the service to a Group Practice Centre. A health visitor attends the Centre for two sessions each week. One is a baby welfare session to offer advice and to make a selection of children to see the doctor for examination or opinion. This procedure conforms to much the same method as is used in local authority welfare centres. The second session the health visitor is present to listen to and to give counsel on various difficulties expressed to herself or the doctors by patients attending the Centre. Problems connected with the care of the aged and care of the family during the mother's absence in hospital for confinement or other reasons are talked over with patients and resolved where it is possible. The statutory and voluntary services available in the Area are made known, clarified and put into motion where they can help to overcome difficulties. The health visitor concerned also collects particulars of any patients for whom the general practitioners request a home visit. Some of these are dealt with by the health visitor herself, but those living outside her district are handed on to the health visitor on whose district the patient lives. This method of co-operation has not presented any complications. Mental Health Case Conference Health visitors presentation to the Case Conferences for health visitors has continued to be held at monthly intervals during the year. Eighteen cases were selected for discussion. Several individuals who were the topic of observation andwere inneed of psychiatric help were subsequently seen b y Dr. J. C. Sawle-Thomas, Regional Psychiatrist to the North East Metropolitan Regional Hospital Board and Consultant to the Price of Wales's Hospital. The 68 conferences are held under his guidance. Those family doctors who have been concerned with particular patients have been most co-operative throughout in assessing those indicated by the health visitor and by making ultimate referral to the consultant. Early signs of breakdown were the subject of report in some cases. There were others who were regarded as being unable to benefit from further psychiatric treatment or who have resisted the assistance that psychiatrists or psychiatric social workers can give them. It may be expedient for psychopaths to be returned to their homes when no further treatment or hospitalisation is of any value to the patient, but the burden of contending with them falls first of all on the family and relatives. It is also inevitable that the one constant visitor to the family, i. e. the health visitor, finds these cases come back to her or the special services health visitor who with the family doctor help to sustain them and their worried relatives. Special Services for Problem Families Miss H. J. Howse, special services health visitor for the Hornsey part of the Area reports:- "As so many agencies dealing with problem families or families with special difficulties feel that even after intensive work any improvement obtained does not last, endeavour has been made, where possible, to keep a check on the families dealt with. After 2¾ years the result of my observations of some 28 families, having between them 105 children, is as follows: - Children: - Four who were "in care" are now at home with their parents. Two children who were rejected by their mothers have had to be taken into care. Six children (three families) are in care because of severe mental illness of the mother. Two children (of one family) are in institutions because they are imbeciles. In all but one of the remainder of the cases the children have been kept together with their own parents; the exception is with its grandparents. It has been possible to keep 95 children at home with their parents and to bring home again to their parents four children who were "in care". Families Fourteen families have had association with the N. S. P. C. C. Twenty four parents have been under the supervision of probation officers, on probation or in prison. Twenty six parents suffer from mental illness or mental subnormality. In dealing with problem families my experience has shown that: - 1. From the beginning every opportunity must be taken to get families back 69 into and supported by the community. This means helping them to improve their relationships within their own families, with the schools their children attend and with all the activities offered by religious and other institutions. The first few weeks of intensive work when all the material matters are being dealt with must be used to develop such a good relationship that the attitudes of the family may gradually be changed and the services of the special worker be reduced. 2. When a family moves from furnished accommodation to unfurnished, secondhand furniture must be obtained and the family persuaded not to buy anything on hire purchase. 3. The less severe psychopath will work regularly if he can be helped to find work that he likes. For the severe psychopath there should be controlled workshops so that his time can be fully occupied away from his home for part of every day. 4. Those who are severely ill mentally can be helped but will always need support until a cure can be found for their illness. I have been very surprised at the amount of detailed work required in dealing with these families. A full day-to-day history must be kept so that at any moment information required is forthcoming. Reports have to be sent to different local authority departments, to general practitioners, hospitals, marriage guidance counsellors and other organisations, and the writing of them is very time-consuming. Although there is a great deal of publicity about all services available to the family, I get very many enquiries from various people needing help. Once they have been told of the statutory and voluntary services available, they are quite well able to deal with their own problems. I have felt for some time that a "Family Advice Bureau" would be of great value. " 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:- 1959 1958 Expectant Mothers First Visits 2285 1982 Total Visits 3511 3358 Children under 1 year of age First Visits 4234 4136 Total Visits 16056 16025 Children aged 1-2 Total Visits 8101 7771 Children aged 2-5 Total Visits 13202 12643 Other cases - Total Visits as Health Visitor 6246 6051 Total Visits as School Nurse 878 911 70 HOME NURSING SERVICE (Section 25) The treatment of cases during the year may be classified as follows:- Injections 1058 General nursing care 604 Blanket baths 313 Enemas 218 Dressings 263 Preparation for diagnostic investigation 264 Pessaries changed 48 Wash-outs, douches, etc. 45 Attendance at minor operation 1 Other treatments 77 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 17 15 5-15 40 32 16 - 39 62 173 40 - 64 274 472 65 and over 525 1191 920 1881 Cases attended during the year were referred from the following sources: - General Practitioners 2037 Hospitals 734 Chest Physicians 12 Health Department 4 Direct 14 It has been possible to keep a reasonably full staff of home nurses during 1959. Over the year, 28 nurses were employed in this service (including two male nurses). The number of part-time nurses has been reduced to four for the whole Area. This is a desirable change as it allows the work to be more evenly distributed over the whole of the nurses' working day. Very little change has been noted in the types of work, a preponderance of time is still spent with the aged and the aged sick. Many of the problems of these old people are the result of trying to maintain life when alone or feeble or helpless. 71 Nurses' Work and Education The nurses have been most co-operative and helpful with the observation visits of students from various training schools. Two nurses have themselves attended refresher courses during the year. Equipment An Oxford type hoist was received early in the year and has been in almost constant use since its arrival. It is of great use to both the nurse and the patient's relatives. Also it is easily transportable by private car. Other equipment and nursing aids have been obtained from the British Red Cross Society who have, as usual, been most helpful with all the many calls on their service. Transport The situation has improved considerably, particularly in Hornsey where cycling is so difficult, and ten of the fourteen nurses now use some form of motorised transport. The following table shows the work of the service during 1959: - Type of Case No. of new cases attended by home nurses during year No. of cases on register at end of year No. of visits paid by home nurses during year M F Total M F Total Medical 670 1270 1940 146 426 572 63875 Surgical 46 107 153 6 16 22 4712 Infectious Diseases 6 15 21 - - - 216 Tuberculosis 15 28 43 6 10 16 2977 Maternal Complications - 10 10 - 1 1 176 Others 2 3 5 — 31 Totals 739 1433 2172 158 453 611 71987 72 VACCINATION AND IMMUNISATION (Section 26) Vaccination against Smallpox The percentage of children under one year of age vaccinated against smallpox rose from 66.6% to 71.3% since my last Report. 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:- Under 1 year 1 year 2-4 years 5 - 14 years 15 years & over Total No. of Primary Vaccinations 1307 34 18 24 39 1422 No. of Revaccinations 1 1 4 26 180 212 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. It was decided to introduce a scheme for immunising children against diphtheria, whooping cough and tetanus, using a triple antigen. The scheme involves four injections during the first eighteen months of life as compared with five or six injections using separate antigens. The new scheme was brought into operation on 1st January 1960. The following table shows that the increase in the number of childrer immunised against diphtheria ir. 1958 continued during the year:- Age at date of Immunisation No. of Children Immunised No. of Children given Re-inforcing Injections Diphtheria Combined Diphtheria & Whooping Cough Whooping Cough only Diphtheria only Combined Diphtheria & Whooping Cough Under One 601 366 160 - • One 359 344 308 - - Two to Four 46 21 18 226 54 Five to Fourteen 84 8 3 421 18 *Fifteen & Over 2 - - - - Totals 1959 1092 739 489 647 72 Totals 1958 1204 614 405 567 31 * There were no children completing immunisation in this age group during 1958. 73 Poliomyelitis Vaccination The death of a well-known sporting personality from poliomyelitis in April 1959 stimulated interest in vaccination among young persons. As a consequence open sessions were held on Saturday mornings and during lunch hours. A total of 1,845 persons received first injections at these open sessions. Since the new year the scheme has been extended to include all persons up to the age of 40. The following table shows the number of persons completing courses of injections during 1959:- Number of Persons who during 1959 completed a course of Two Injections Three Injections Children born in the years 1943 to 1959 9097 1816 Young Persons born in the years 1933 to 1942 5421 3032 Expectant Mothers 632 672 General Practitioners and Families - 95 Ambulance Staff and Families - 18 Hospital Staff, Medical Students and their families 430 182 15,580 22,160 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 1959 197 applications were received compared with 177 the previous year. Of these, 176 were approved. 74 DOMESTIC HELP SERVICE (Section 29) The total number of cases provided with home help during the year was 1,755, the bulk of the cases comprising the chronic sick, including agedand infirm, who need more or less permanent help. The demands on the organisation can be readily appreciated when it is realised that over 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 tinued from 1958 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) 107 6 113 7 Tuberculosis 11 30 41 26 Chronic Sick (including aged and infirm) 517 945 1462 972 Others 126 13 139 19 Total 761 994 1755 1024 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 two cases were served for a total of 72 hours. HEALTH EDUCATION Programmes of special significance are planned from time to time in welfare centres and school clinics. This year a special effort on the Dangers of Home Accidents was arranged. Welfare centres were loaned display stands and informatory notices in co-operation with the Boroughs. To support these and to focus attention on to the theme, posters and leaflets on display dealt with the same subject. At the same time a more positive trend was taken up by health visitors in talks and mothercraft classes and schools. The stress here was that the home 75 should be a safe place for all members of the family, particularly those prone to accidents (e.g. the young and the elderly), attention being drawn to the common causes of dangerous and fatal accidents. Flannelgraphs were also used. The campaign stirred up considerable interest, discussions and questions. Some of these were kindled by press publicity on oil fires and promoted arbitrary questions such as "Which is the safe type of oil stove which can be bought for the home?" Health Visitors and School Nurses are engaged in some form of Health Education in every aspect of their work, but a special programme of talks to school children has been operating in this Area for a number of years. The talks are given to secondary modern school girls during their last year at school in Hornsey and Tottenham at the request of head teachers. This year 318 talks were given in schools alone. The substance of the instruction given is related to parentcraft, home-making and the local health services. The girls take a very active part in it and are usually taken to a local welfare centre some time during the series. Health Education programmes are also arranged for mothers attending welfare centres. They are held on a session free of other clinics. All mothers are welcome and mothers attending family doctors' surgeries and who do not attend the welfare centres for any other reason are also welcomed. Some family doctors send their expectant mothers to these sessions which are mainly concerned with the teaching of mothercraft. These sessions are popular and lively discussions are promoted amongst those attending. Members of the staff have given talks and taken classes during the year to a number of local organisations including Civil Defence, Young Wives' Clubs and young people's organisations. Some have also acted as examiners for the British Red Cross Society. SCHOOL HEALTH SERVICE Area School Populations The school population for the Area is 10,760 in Hornsey and 17,647 in Tottenham. This shows an overall decrease of 720 compared with the previous year. Hornsey Tottenham Primary Schools and Nursery Classes 6,017 8,632 Nursery Schools; - 204 Secondary Modern Schools 2,839 5,735 Grammar and Technical Schools 1,904 2,884 Special Schools - Physically Handicapped - 92 Blanche Nevilt School for Deaf - 100 10,760 17,647 76 Routine Medical Inspection The following table shows the number of Hornsey children inspected by years of birth and the classification of their physical condition. Year of Birth No. of Pupils Inspected Condition Satisfactory Number % 1955 & later 175 172 98.3 1954 522 510 97.7 1953 130 130 100.0 1952 17 16 94.1 1951 119 118 99.2 1950 625 623 99.7 1949 69 69 100.0 1948 150 150 100.0 1947 679 679 100.0 1946 330 330 100.0 1945 190 188 99.0 1944 & earlier 1010 1010 100.0 Total 4016 3995 99.48 As an experiment permitted under the School Health Service and Handicapped Pupils Regulations to dispense with routine medical inspections for specified age groups and to substitute periodic visits to schools to see selected cases, a pilot survey was carried out at one school among the eight to nine year olds, totalling 111 children. Of these, 40 were chosen by the teachers and head teachers for a special medical inspection. When the children were seen, however, it was found that almost all of them were either known to the School Health Service as being under treatment at for example the Chest Clinic or Children's Hospital, etc. Nevertheless it was obvious that the teachers wished to have advice concerning these children and this advice was given. During the following term the 71 "healthy" children were seen at periodic medical inspections to serve as controls. Of these, 50 were regarded as fit and not in need of advice or treatment. Of the remaining 21, it is considered that nine had defects, e.g. of vision and hearing, which would have been picked up by the school nurse or audiometrician. (In fact the two children with hearing defect had been so picked up and were under investigation). Of the remaining 12 children, six were referred for treatment and six for observation. As a result of this experiment the medical officer concerned is of the opinion that this is not a substitute for periodic medical inspections. 77 Infectious Diseases in School Children, 1959 Unlike the previous year, 1959 was an eventful year from the point of view of infection. There was, in the early months of the year, the usual biennial visitation of measles, over 700 cases being notified in school children. Poliomyelitis During the summer termthere was an outbreak of poliomyelitis in school and pre-school children. In all 13 cases of paralytic poliomyelitis and nine non-paralytic cases were notified. Details of the vaccinal state of these children are given below. It can be seen that only one fully vaccinated child developed paralytic poliomyelitis and in this case the third injection was almost certainly given while the child was incubating the infection. As some 60% of school and pre-school children in Tottenham and Hornsey are vaccinated, these figures are suggestive of a protective effect. Not One Two Three Total vaccinated dose doses doses Paralytic 9 3 - 1 13 poliomyelitis Non-paralytic 5 1 1 2 9 poliomyelitis Total 14 4 1 3 22 Of the paralytic cases four, including the fully vaccinated boy, made an almost complete recovery, two removed from the district, four were left with weakness in one limb, and three pre-school children were sufficiency handicapped as to make it likely that they will need to attend a special school. Dysentery Cases occurred sporadically over both boroughs during the year. In one school in Hornsey and another in Tottenham there was an explosive outbreak in the spring term which smouldered on for some time despite the usual measures taken to control it. Family doctors were notified of the outbreak and of the fact that the organism concerned was resistant to the sulphonamide drugs, the usual form of treatment. Tuberculosis There were nine cases of tuberculosis in school children over the whole Area, seven pulmonary, one of bone and one of eyes. The figure nine is misleading, however, as only five of these were new cases, the others being flareups of old infection or inward transfers. The five bona-fide new cases compare with six in 1958 and three in 1957. These cases were discussed with the appropriate Chest Physicians and in one case epidemiological investigation was considered necessary at the school, X-ray of all adult members of teaching and ancillary staff being recommended. All were X-rayed and found to be clear. 78 B.C.G. Vaccination Possibly because of the effort involved in promoting poliomyelitis vaccination, the B.C.G. vaccination figures were not quite as impressive in 1959 as in previous years. Figures relate to Hornsey only. 1959 Percentages 1958 Percentages Parents approached 806 100.0 1,218 100.0 Parents accepting 484 60.0 921 75.6 Mantoux positive 30 6.4 68 8.1 % Strong positive 50.0 50.0 % Weak positive 50.0 50.0 Mantoux negative 419 88.9 733 87.4 Total vaccinated 413 51.2 718 58.9 Those parents who did not respond to the invitation to have their child B.C.G. vaccinated in 1959 will be given a further opportunity in 1960. As a result of the Mantoux testing one girl aged 14 was found to be strongly positive. X-ray chest in the summer was normal but on re-X-ray later in the year the girl was found to have an early tuberculous lesion and was admitted to hopsital for treatment. SCHOOL DENTAL SERVICE During the past year the staff position has been:- Area Dental Officer 1 Full-time Dental Officers 5 Part-time Dental Officers 2 (equivalent to 9/llths full-time) Part-time Orthodontist (7/llths) 1 The work of the department was maintained during the year though handicapped by the unfortunate absence through illness of the Area Dental Officer during the last Quarter. The following tables show the work undertaken during the year in Hornsey:- 79 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 _ _ _ 5-16 and over 9025 4033 4033 Specials 830 791 789 Totals 9855 4824 4822 Number of pupils treatment commenced 2528 Number of pupils treatment completed 1734 Number of attendances made by pupils for treatment 5059 Number of appointments not kept 1255 Number of half days devoted to (a) Inspections 70 (b) Treatment 762 Fillings - Permanent Teeth 2789 Temporary Teeth 859 Number of teech filled - Permanent Teeth 2628 Temporary Teeth 839 Extractions - Permanent Teeth 259 Permanent Teeth for Orthodontia 29 Temporary Teeth 1465 Anaesthetics (a) General 544 (b) Local 545 (c) Regional 31 Other operations (a) Permanent Teeth 557 (b) Temporary Teeth 1476 SPECIAL DENTAL TREATMENT UNDERTAKEN BY DENTAL OFFICERS Number of Impressions, etc. 28 Number supplied with Dentures 10 Number of crowns and bridges 2 Number of Radiographs (a) At Dental Clinics 30 (b) At Hospitals 80 ORTHODONTIC EXAMINATIONS AND TREATMENT AGES 5 6 7 8 9 10 11 12 13 14+ Totals Pupils examined 3 1 5 7 9 6 5 8 2 3 49 Pupils selected for treatment 2 - 4 2 4 4 3 3 2 3 2 7 Commenced treatment (First Attendance) 95 Attendances made for treatment 892 Impressions, etc. 298 Fixed appliances fitted 4 Removable appliances fitted 50 Radiographs at Dental Clinics 28 Pupils treatment completed 19 Orthodontic sessions (half days) 82 Ear, Nose and Throat Clinics In Hornsey weekly sessions were continued on similar lines to previous years. Dr. F.P.M. Clarke, visiting consultant, reports that the conditions for which children were referred varied considerably from comparatively simple complaints to those of more serious import. Of those requiring investigation and treatment, apart from a small number of cases of chronic otorrhoea, most came within the category of "nasal conditions", e.g. sinus infection, rhinitis and excessive hypertrophy of adenoidal tissue. Prevention of some permanent disability in later life continues the main function of the clinic's work; and the special techniques evolved over many years have been shown to give excellent and lasting results. In Tottenham the ear, nose and throat clinic is now more closely related to the out-patient department of the Prince of Wales's General Hospital both departments being under the direction of Mr. W. McKenzie, F.R.C.S. One of the school medical officers (Dr. Nora Webster) assists in co-ordinating the work of this clinic with the audiology clinic and with the work undertaken in the Area for the ascertainment and educational treatment of the deaf. Audiology Clinic The appointment of Dr. L. Fisch as consultant otologist to the Area, as from July 1959, made it possible to establish an audiologyunit at the medical centre in Park Lane, without waiting, perhaps twelve months, for more suitable premises to be erected on a site adjacent to the Blanche Nevile School for the Deaf, Tottenham. Eventually it is expected that all children who need investigation of their ability to hear, training and supervision from a wide Area will attend the audiology unit. 81 Already excellent teamwork exists in the close collaboration seen between consultant otologist, head master of the special school and classes for the deaf, parents, school medical officers, general medical practitioners and health visiting staff. A total number of 56 new cases were seen and appropriate action taken in respect of their educational needs. The number of pre-school children referred for advice was comparatively large, namely, 17 out of 56. Four of these were found to be severely deaf; ten probably not deaf but in need of further observation to eliminate some possible hearing loss, and in three a final diagnosis of no loss of hearing showed that deafness was not the cause of retardation. Dr. Fisch further reports that the functioning of the audiology unit during 1959 provided valuable experience for planning the work for the future. The improved facilities should ensure that no child whose hearing is impaired suffers either because of late detection of the disability or lack of adequate training after a diagnosis has been made. Parents should get all essential help, guidance and encouragement when it happens that their child suffers from a hearing disability. AUDIOLOGY UNIT, 1959 Number of children seen 56 Pre-school children 17 Attending infant & junior schools 20 Attending senior schools 17 Over 5, but not at school 2 Reason for referrals among these 56 children were as follows: - For diagnosis 32 Immigrants to Area known to be deaf 4 Partially deaf children, advice as to placement 4 Children known to be deaf - 9 application for admission to nursery class, Blanche Nevile School or partially deaf unit Transfer from hospital out-patient 5 departments Advice as to placement where 2 deafness might be the cause of backwardness Source of Referrals:- Tottenham and Hornsey 38 Other boroughs in Middlesex 17 London - neighbouring boroughs 1 82 PRE-SCHOOL CHILDREN REFERRED TO AUDIOLOGY UNIT No. Age Sex Reasons for referral F.H. Remarks Source of Referral Decision and Disposal 1 2 F Known deaf. Not coping at day nursery. Yes - School Medical Officer, Tottenham. Admission to nursery at Blanche Nevile School. 2 lyr. 6mnths M Suspected deafness. Yes Has goitre School Medical Officer, Hornsey. Probably not deaf. 3 3 F Suspected deafness. No Coloured School Medical Officer, Hornsey. Probably not deaf. 4 2 M Suspected deafness. Yes School Medical Officer, Tottenham. Probably not deaf. To ordinary day nursery. 5 4 M Suspected deafness. Yes Poor speech School Medical Officer, Hornsey. Not deaf. 6 lyr. l0mnths M Suspected deafness. No Delayed speech. Indian. School Medical Officer, Hornsey. Deaf. To nursery unit at Blanche Nevile School. 7 1 M For adoption. Suspected deafness. No Illegitimate. Backward. School Medical Officer, Potters Bar. Not deaf. Backward. 8 2yrs. 4mnths M Suspected deafness. No Delayed speech School Medical Officer, Edmonton. Not deaf. 9 2½ M Suspected deafness. Yes Delayed speech. School Medical Officer, Tottenham. Not deaf. To normal day nursery. 10 4 M Suspected deafness. No Delayed speech. School Medical Officer, Hornsey. Probably not deaf. To nursery school. 11 3 M Suspected deafness. No Delayed speech. School Medical Officer, Tottenham. Not deaf. Possibly backward. 12 4 M Suspected deafness. No Articulation defect. School Medical Officer, Edmonton. Not deaf. 13 4 F Suspected deafness. No Delayed speech. School Medical Officer, Hornsey. Not deaf. 14 6mnths. M Suspected deafness. Yes - School Medical Officer, Southgate. Deaf. For auditory training. 15 3 M Known deaf. From Great Ormond St. for supervision. No Great Ormond Street Hospital. To nursery unit at Blanche Nevile School. 16 5mnths M Mother suspected deafness. No - School Medical Officer, Hendon. Probably not deaf. 17 5mnths M Slow. Matron at day nursery suspected deafness. No Illegitimate School Medical Officer, Southgate. Probably not deaf. Backward. 83 Vale Road School for Physically Handicapped Children Cerebral Palsy Unit During the year 29 children suffering from cerebral palsy were cared for at the Vale Road Day Special School for Physically Handicapped, Tottenham. Under the supervision of the visiting consultant (Dr. Dunham) and with the help of parent, teacher, nurse and therapists, it is possible to help the children to learn how to tackle normal tasks in a normal way both in and out of school, despite in most cases a grossly handicapped condition. Special arrangements are made for parents of children too young to attend the nursery class at the School, to be given advice and continued supervision. ANALYSIS OF CASES SEEN AT CEREBRAL PALSY UNIT IN 1959 Male Female Total Under 5 years 2 1 3 5-10 years 2 3 5 10-15 years 3 1 4 Over 15 years - 1 1 Total 7 6 13 Diagnosis Male Female Total Cerebral palsy 4 3 7 Amyotonia congenita 1 - 1 Mental retardation 2 - 2 Epilepsy and mental retardation 2 2 Emotional upset, minor motor defect 1 1 Total 7 6 13 Seven confirmed cases of Cerebral Palsy - Action Taken Admitted to Vale Road School in 1959 3 (Admitted to Vale Road School in January 1960) 1 Admitted in 1959 and awaiting place in educationally sub-normal school 1 Waiting for vacancy in Vale Road School 1 Under school age 1 84 NEW CASES SEEN AT CEREBRAL PALSY UNIT IN 1959 Case No. Date of Birth Sex Referred by Diagnosis Disposal 1 31.8.57 F Consultant Orthopaedic Surgeon, Tottenham. Cerebral palsyright hemiplegia. Under supervision of cerebral palsy unit. 2 6.11.53 F Area Medical Officer, Palmers Green. 1. Severe mental retardation. 2. Epilepsy. Ascertained as ineducable. For occupation centre. 3 21.4.47 M Area Medical Officer, Tottenham. Mental retardation. To remain at residential E. S. N. School. 4 23.9.53 M School Medical Officer, Hendon. Amyotonia congenita Vale Road P. H. School. 5 13.11.53 F School Medical Officer, Enfield. Cerebral palsy- 1. Left hemiplegia. 2. Mental retardation. Vale Road P. H. School. To be transferred to E. S. N. School. 6 12.9.54 M School Medical Officer, Enfield. Cerebral palsyspastic diplegia. Vale Road P. H. School. 7 29.3.52 M School Medical Officer, Tottenham. Cerebral palsyleft hemiplegia. To remain at ordinary school. Under supervision of cerebral palsy unit. 8 28.9.49 M School Medical Officer, Southgate. Cerebral palsy- 1. Mild generalised spasticity. 2. Emotional upset. Vale Road P. H. School. 9 13.11.46 M Paediatrician, Royal Northern Hospital. Cerebral palsygeneralised spasticity Waiting list for Vale Road School. 10 24. 4. 54 F Area Medical Officer, Enfield. Cerebral palsygeneralised spasticity Vale Road P. H. School. 11 4.8.48 F Consultant Psychiatrist 1. Emotional upset. 2. Minor motor defect Remain at ordinary school, and attend child guidance clinic. 12 17.8.58 M Consultant Otologist, Tottenham. 1. Mental retardation. 2. Minor motor defect Under supervision of cerebral palsy unit. 13 21.3.44 F Area Medical Officer, Hornsey. 1. Epilepsy. 2. Mental retardation. Lingfield Epileptic Colony. 85 Orthopaedic Clinics - Hornsey Specialist clinics have continued to be held for children found, in course of routine medical inspections or by reference from general practitioners, to have orthopaedic or postural defects. Remedial treatment is under taken by the physiotherapists associated with the particular clinic. The visiting consultant, Mr. E. T. Bailey, F. R.C.S., reports that of the new cases seen at the clinic, five were referred to the Highlands General Hospital for operative treatment. Following the outbreak of poliomyelitis in 1959, four children were treated at the clinic for residual paralysis with the probability that treatment will continue throughout the remainder of their school life. Two are of moderate severity unlikely adversely to affect their schooling. One is rather more severe but with the tenacity so often seen in such cases he has managed to attain the grade necessary for him to return to his original school. The fourth is under five years of age but her disability is of such severity that she will in all probability require to be educated at the Special Day School for Physically Handicapped. Special reference is made by Mr. Bailey to children who in the past have had to grow up with one leg shortened by reason of poliomyelitis, congenital defect or due to some other cause and to wear shoes raised to correct the defect. This may be unsightly and resented by the wearer. Such cases taken sufficiently early can, at the appropriate time, have an operation carried out upon the normal leg, which slows its growth so that at the time when growth ceases the legs are equal in length. One such case attending the clinic has been so treated, and further cases will have similar treatment in due course. Ophthalmic Clinics - Hornsey The visiting consultant, Dr. R.Welch, reports that in addition to a busy year correcting errors of refraction responsible for defective vision and symptoms of eye strain, special attention has been given at the clinic to the treatment of cases of squint and particularly those with amblyopia. It cannot be over-stressed that once the error of refraction has been corrected and occlusion of fixing eye adopted, cases of squint require the closest supervision until the defective vision is restored to normal or is greatly improved. If during this period the visual axes have not become parallel, then surgical procedure is essential to cure the squint. The orthoptist (Miss Cobb) at the clinic is able to give follow-up training to re-establish and maintain binocular single vision which is of such vital importance. Three unusual cases occurred during the year requiring reference to hospital. One was a congenital nystagmus with bilateral cataract and microphthalmos. Finally considered as unsuitable for operative treatment this boy 86 has been recommended admission to a special school for the partially sighted. Another, a case of nystagmus, occurred in an infant of eight months old and could therefore not be described as a congenital defect. A provisional diagnosis made in this case was atypical spasmus nutans although there was no sign of head nodding. Lastly a case of a girl of 14 years of age, recently arrived from Ghana, was found to have a complicated cataract in the right eye, and the left eye presented a picture of retinitis profliferans. Further investigations into the aetiology are being made by seriological tests, not yet available, but her condition-was considered to be the sequelae of Eale's disease. Child Guidance Clinic in Tottenham The visiting psychiatrist, Dr. W. H. Craike, commenced duties on the 5th Mry 1959 for two sessions per week. Dr. Craike reports that the problems were difficult behaviour at home and school, nocturnal enuresis and other psychosomatic symptoms, three cases of multiple tics, and three children with physical defects as well as emotional disturbances. They all came from working class backgrounds, some of the homes were materially good and some poor. There were eleven children of average intelligence, nine were of superior intelligence, and six were of below average intelligence. Four parents refused treatment at the outset, or broke off treatment after one session. There were four cases in which it was doubtful whether the parents would accept treatment, they are being kept under occasional observation, the parents being seen by the psychiatric social workers and the children by the Psychiatrist. Speech Therapy The senior speech therapist, Miss Came, reports that the "case load" of children suffering from speech defect continues to be heavy. The most economical use of the therapist's time lies in early assessment followed by early treatment. Stammering, Miss Came points out, most commonly manifests itself between the ages of two to five years - later it is rare. If treatment which is usually indirect can be given during the early years of plasticity, the prognosis is more hopeful; and every successfully treated case represents the prevention of perhaps years of later suffering. Children who have attained normal speech after treatment are reviewed periodically. Stammerers who have regained fluency of speech may be kept under observation for periods up to five years. 87 88 THE HANDICAPPED CHILD - Distribution in Hornsey as at 31st December, 1959 In Special Day Schools In Special Residential Schools In Maintained Primary and Secondary Schools In Independent Schools Not at School Total M F M F M F M F M F M F Blind . . 3 3 • . . . . . 3 3 Partially Sighted 1 2 . • . . • . . . 1 2 Deaf 1 1 . 1 . . ■ . . . 1 2 Partially Deaf 3 5 2 . • • . . . . 5 5 Educationally Sub-Normal 31 15 5 2 1 • . . . . 37 17 Epileptic • . 2 2 . • 1 . . 2 3 Maladjusted • • 9 2 3 1 6 1 . . 18 4 Physically Handicapped 5 3 5 . . . • . . . 15 5 Speech Defects 4 • 1 58 23 5 3 . . 67 27 Delicate . . 5 4 . . . . . . 5 4 Multiple Defects . • . • . . • . . . • • Totals 45 26 31 15 62 24 11 5 5 2 154 72 GRAND TOTALS 71 46 86 16 7 226 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. The number of new cases seen during the year was eight. Of these, six were female and two male. All of these were either rheumatic fever or chorea. 197 children remain on the register of the supervisory centre and of these 69 made 127 attendances, while in addition a number were seen in the ordinary paediatric out-patient sessions. These 197 cases are classified as follows Rheumatic fever 63 Rheumatic carditis 42 Rheumatic carditis with chorea 5 Chorea - uncomplicated 5 Rheumatic arthritis 5 Congenital heart lesions 54 Rheumatic pains 1 Streptococcal Allergy 1 Other cases 21 197 93 males 104 females Hospital School I am indebted to Mr. J. Power, M.A., Borough Education Officer Tottenham, for the following report:- "During the past year, in addition to the continued teaching of the children , at St. Ann's Hospital, in the Prince of Wales's Children's Unit, and the Poliomyelitis Ward, there has been an extension of individual teaching in several other wards. The age range of the children in both hospitals is from 4 to 15 years of age and teaching incorporates lessons to children, preparing for General Certificate of Education, commercial courses and individual tuition to a child with muscular dystrophy who is fitted in a special chair. Although a well equipped schoolroom is established in one of the wards, teaching is individual. Work follows the child's school curriculum as closely as possible and to this end, for long term pupils, close liaison is maintained with the day schools. Children who are not well enough to attend school receive bedside tuition. During the past year an 18 year old girl in the Poliomyelitis Ward passed her General Certificate of Education in Art despite the handicap of complete paralysis. 89 Always the children's hobbies are followed up, and often new interests developed. To this end we are endeavouring to arrange during the next holiday period a visit to the Royal Mint with a few children now in hospital who should have recovered by then. During the summer vacation two part-time teachers were employed to cater for the children in the long break from schoolwork. Handwork, embroidery, story reading, etc. kept the children happy and busy during this period. It is quite evident that the children enjoy school and welcome the teacher's arrival. Parents too are most appreciative and welcome the knowledge that the children's education continues while in hospital. 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 1955 and later 3 47 49 1954 8 125 126 1953 5 25 29 1952 . 3 3 1951 18 19 31 1950 82 118 185 1949 15 14 25 1948 40 30 64 1947 121 97 198 1946 54 51 87 1945 31 39 61 1944 and earlier 250 150 365 Total 627 718 1223 90 DEFECTS FOUND BY MEDICAL INSPECTION Defect or code number Defect or Disease Periodic Inspections Total Special Inspections Entrants Leavers Others (T) (O) (T) (O) (T) (O) (T) (O) (T) (O) 4 Skin 11 36 54 60 103 86 168 182 140 6 5 Eyes: a. Vision 17 9 205 9 405 44 627 62 59 22 b. Squint 28 5 13 3 36 3 77 11 4 2 c. Other 6 5 10 2 18 13 34 20 29 6 6 Ears: a. Hearing 2 18 5 9 16 27 23 54 50 18 b. Otitis media 16 38 1 15 7 50 24 103 11 1 C- Other 2 10 5 4 4 33 11 47 18 3 7 Nose and Throat 48 129 8 60 51 182 107 371 39 9 8 Speech 14 25 5 4 13 22 32 51 15 1 9 Lymphatic Glands 1 44 1 1 18 2 63 3 3 10 Heart 2 7 1 13 2 32 5 52 2 6 11 Lungs 34 25 13 22 23 47 70 94 5 8 12 Developmental: a. Hernia 1 1 1 4 2 5 b. Other 1 5 1 4 6 12 8 21 8 6 13 Orthopaedic: a. Posture 1 15 6 29 15 61 22 105 3 1 b. Feet 39 46 10 24 41 77 90 147 10 3 c. Other 11 46 14 37 29 108 54 191 45 10 14 Nervous System: a. Epilepsy 4 1 . 7 3 12 3 . b. Other • 3 1 4 4 15 5 22 i 15 Psychological: a. Development 1 11 1 4 5 10 7 25 3 b. Stability 3 43 4 21 15 90 22 154 12 11 16 Abdomen 4 16 • 7 11 22 15 45 9 1 17 Other 6 25 3 12 9 55 18 92 248 42 (T) Requiring Treatment (O) Requiring Observation 91 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 39 (b) Errors of refraction (including squint) 817 (c) Number of cases for whom spectacles were prescribed 410 GROUP 2 - DISEASES AND DEFECTS OF EAR, NOSE AND THROAT Received operative treatment for adenoids and chronic tonsillitis 191 Received other forms of treatment 149 Total number of pupils in schools who are known to have been provided with hearing aids: (a) During the current year 15 (b) In previous years 5 GROUP 3 - ORTHOPAEDIC AND POSTURAL DEFECTS Treated at clinics or out-patient departments 309 GROUP 4 - DISEASES OF THE SKIN (EXCLUDING UNCLEANUNESS) Impetigo 16 Other skin diseases 343 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 117 GROUP 7 - OTHER TREATMENT GIVEN (a) Minor Ailments 273 (b) Treatment other than (a) above and excluding con- valescent treatment 13 92 EDUCATION ACT 1944 - SECTIONS 57(3), 57(4) and 57(5) Cases dealt with under Section 57, Education Act 1944 Sub-Section 3: 4 Sub-Section 5: 3 MEDICAL EXAMINATIONS OF TEACHERS (a) Number of teachers examined as to fitness for appointment 11 (b) Number of students examined as to fitness for first appointment 28 (c) Number of students examined as to fitness for training course 69 93 STAFF BOROUGH HEALTH DEPARTMENT Medical Officer of Health Deputy Medical Officer of Health Veterinary Inspector Chief Public Health Inspector, Petroleum Inspector and Shops Inspector Chief Administrative Assistant Public Health and Shops Inspectors Senior Clerks Clerk Shorthand-typists Drainage Inspection Assistant Disinfectors and Mortuary attendants Rodent Operator G. HAMILTON HOGBEN, M. R. C. S., D.P.H. A. YARROW, M. B. , CH. B. , D. P. H. F. G. BUXTON, M. R.C.V.S. J. D. CHANCE, M.A.P.H.I., Public Health Inspector's Cert. Food Inspector's Cert. D. B. DA VIES, D.P.A. (Lond.) W. J. WILSON, D.P.A. (Lond.), M.A.P.H.I. 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 Diploma R. DOWNES, M.A.P.H.I., Public Health Inspector's Cert. S. SWINNERTON, M. A. P. H.L , Public Health Inspector's Cert. Food Inspector's Cert. A. K. D. SHUTTLEWORTH, M.A.P.H.I., Public Health Inspector's Cert. E. WILKINS, M.A.P.H.I., Public Health Inspector's Cert. Food Inspector's Cert. Smoke Inspector's Diploma E. S. GRAY, M.A.P.H.I., Public Health Inspector's Cert. Food Inspector's Cert. D. N. IRVINE, D.P.A. (Lond.) H. P. BRADFORD Mrs. M. M. BERRY Mrs. E. M. HICKS Miss A. A. GERRIE Miss A. GLENISTER H. S. FAGG P. F. HALL (Foreman) W. HOOPER S. J. TWINN E. J. MEAD 94 AREA HEALTH STAFF Deputy Area Medical Officer Senior Assistant Medical Officer Area Dental Officer Superintendent Health Visitor Non-medical Supervisor of Midwives & Home Nursing Superintendent Home Help Organiser Assistant Home Help Organisers Area Chief Clerk Deputy Area Chief Clerk Sectional Heads A. YARROW, M. B. , Ch. B., D.P.H. ALICE WHEILDON, M. B., B. S., M.R.C.O.G. V. SAINTY, L.D.S., R.C.S. Miss H. TOWNSEND, S. R.N., S.C.M. , H.V.; Miss F. E. CURTIS, S.R.N. , S. C. M. , H.V., M. T. D. Mrs. J. D. McILROY (Resigned 27. 9. 59) Miss D. WILLIAMS (Appointed 23.11. 59) Mrs. F. G. WILLS Miss D. BUCK (Resigned 24. 3. 59) Miss J. E. CAPLIN (Appointed 8. 6. 59) W. L. N. RELLEEN, T.D., D.P.A. J. B. BAMBROOK, D.M.A. A. BALLS N. P. CHILD H. J. DUNHAM, B.A. Classification of Staff Full-time Part-time Medical Officers 10 6 Dental Officers 6 3 Supervisory Nursing Staff 2 Administrative and Clerical Staff 36 8 Health Visitors/School Nurses 25 Student Health Visitors . 2 Clinic Nurses 8 Midwives 8 Home Nurses 24 4 Speech Therapists 3 Physiotherapists 2 Occupational Therapist 1 Chiropodists . 2 Gramophone Audiometrician 1 Orthoptists . 2 Dental Attendants 7 2 Day Nursery Staff 31 1 Home Help Service 5 164 Manual workers, domestic grades, etc. 10 22 179 216 95 INDEX Page Abatement Notices 21 Ante-natal Clinics 60 Atmospheric Pollution 33 Audiology Unit 81 Bakehouses 42 B. C. G. Vaccination 79 Births, Notification of 60 Burial of the Dead 48 Campsbourne Clearance Area 24 Cerebral Palsy Unit 84 Certificates of Disrepair 26 Child Guidance Clinic 87 Cleansing of Soiled Articles 46 Closing Orders 26 Daily Guardian Scheme 64 Day Nurseries 64 Deaths Classified 52 Dental Service, Priority 66 Dental Service, School 79 Diseases of Animals 48 Domestic Help Service 75 Dysentery 8 Ear, Nose and Throat Clinics 81 Factories, Inspection of 20 Food Poisoning 7 Food Premises classified according to Principal Trades — 38 Food Premises, Inspection of 39 Food Sampling 40 Handicapped Child, The 88 Hawkers of Food, Registration of 38 Health Education 75 Health Visiting Service 68 Home Nursing Service 71 Hospital Classes 89 House-to-House Inspections 25 Housing Survey 23 Ice Cream 39 Infant Deaths - Classified 55 96 Infant Welfare Clinics 62 Infectious Disease by Age and Sex 12 Infectious Disease by Wards 13 Infectious Diseases in School Children 78 Inspections by Public Health Inspectors 18 Laboratory Services 9 Legal Proceedings: Food Hygiene Regulations 43 Massage and Special Treatment 47 Measles 6 Meats, Hygienic condition of Cooked 35 Medical Examination of Staff 47 Midwifery Service 67 Milk Supply 38 Mortuary 48 Old People's Welfare 45 Ophthalmic Clinics 86 Orthopaedic Clinics 86 Pet Shops, Licensing of 21 Petroleum Spirit 48 Poliomyelitis 5 Recuperative Holidays 74 Re-housing on Health Grounds 24 Rheumatism Supervisory Centre 89 Rivers Pollution 17 Rodent Control 21 Sanitary Improvements Effected 19 School Health Service 76 School Health: Statistical Tables 90 Shops, Inspection of 21 Smoke Control Areas 27 Speech Therapy 87 Swimming Pool 17 Toddlers Clinics 62 Tuberculosis: New Cases 11 Tuberculosis: Cases on Register 10 Tuberculosis in Schools 78 Vaccination and Immunisation 73 Vital Statistics 49 Water Supply 15 Welfare Foods, Distribution of 65 97