H.439(1) HOR 052 THE ANNUAL REPORT OF THE MEDICAL OFFICER OF HEALTH THE HEALTH OF HORNSEY 1960 THE ANNUAL REPORT OF THE MEDICAL OFFICER OF HEALTH MEMBERS OF THE COUNCIL * Alderman Lt. Col. F. C. CAVE, C.B.E., T.D., J.P., Mayor * Councillor C. R. WILLIAMS, Deputy Mayor ALDERMEN G. S. AITKEN * S. G. GOULDING F. H. BAILEY, J. P. N. MULDOON, O.B.E., J. P. D. F. W. BILLINGS LEY * G. F. N. NORMAN M. W. BURNS, D.L., K.S.G. H. L. NORMAN E. C. CASTLE Miss J. RICHARDSON G. WATSON COUNCILLORS * Miss O. R. ANDERSON L. A. BAINS Miss M. M. BARRIE * A. N. CAMMOCK Mrs. J. M. CARTER Mrs. K. M. ST. P. CRUMP J. E. DALLING * Mrs. M. E. M. DAVIES * C. C. GALVIN * V. P. GELLAY * Mrs. B. M. GREENING * F. C. V. HAYWARD (Vice-Chairman of Health Committee) C. P. F. JENKIN P. M. KING E. M. LARARD * D. H. P. LEVY * Mrs. R. M. LEVY B. J. MCBRIDE N. A. MULDOON C. MURRAY F. NEUNER P. PHILLIPS * Mrs. M. PLEASANCE P. P. RIGBY * H. A. L. ROSSI D. P. SALINGER * G. H. STANSALL M. H. WALEY-COHEN R. I. G. WATT * Miss M. E. WEST * J. T. WILKINS (Chairman of Health Committee] T. W. WILKINS A. WILSON A. R. WILSON H. J. WORMS * Members of Borough Health Committee at 31st December 1960 HEALTH DEPARTMENT, TOWN HALL, HORNSEY, N.8. To the Worshipful the Mayor, Aldermen and Councillors Mr. Mayor, Ladies and Gentlemen, I submit herewith my Annual Report on the health services provided by local government in this Borough for the year ended 31st December, 1960. The mid-year population, as estimated by the Registrar General, was 96,570 representing an increase of 140 over the previous year. The Preliminary Report of the 1961 Census, now to hand, gives a figure of 97,885; or only 274 below that given at the census ten years ago. The birth rate of 19.6 was the highest recorded in the Borough since the year 1947. The number of illegitimate births of nearly 1 in 9 must be regarded as a social problem of grave public concern. The infantile death rate was 19.0 per thousand live births as compared with 24.8 in the previous year. The death rate of infants in the first week of life showed a marked decrease from 20.8 in 1959 to 13.2. With the number of still-births higher than in the previous year, the final peri-natal death rate fell from 33.6 to 29.1. The adjusted general death rate of 10.2 was again well below the national average of 11.5. Deaths from cancer generally were 242 as compared with 225 the previous year. Cancer of the lungs 54 showed a slight decrease. Two smoke control orders came into force during the year; and a third order was confirmed without necessity for a Public Local Enquiry since no objections were received. Patronised at the official opening by the Mayor (Councillor Miss O. R. Anderson, J.P.) and the Chairman of the Health Committee (Councillor C. R. Williams), a successful four day Clean Air Exhibition was held, in the month of May, at the Town Hall: demonstrating how the clean air of the countryside may be brought back to Hornsey by 3 co-operation of all concerned. In this short, but concentrated, effort assistance was readily given by many organisations whose staff, with those of the Council's were on duty throughout the hours of opening. Though difficult to assess the impact of such exhibitions on the public, it was apparent that much interest was aroused and expressions of appreciation were received particularly from residents in already; declared smoke control areas. In co-operation with the Department of Scientific and Industrial Research (reported in full in the body of this Report), a survey was made into the problem of smoke pollution from diesel motor vehicles passing along Archway Road, Highgate, with the result that measurements of pollution averaged, on a weekday, twelve times the background pollution of the neighbourhood at ten feet above ground level. Slum clearance, together with closing and/or demolition of unfit houses, made further progress during the year. Special attention too was given by public health inspectors to remedial action in tackling a growing problem of overcrowding in multi-occupied dwellings. The special housing needs of handicapped persons and accommodation requirements of the elderly were given further consideration by the Council. Retirement of the chief public health inspector (Mr. J. D. Chance), after a long and distinguished service of Hornsey, occurred in the month of May. Following public advertisement and interview of suitable candidates, Mr. Chance's deputy (Mr. W. J. Wilson) was unanimously appointed to succeed him. One month later my deputy in Hornsey and the Area Health Services (Dr. A. Yarrow) left to take up a joint appointment as Medical Officer of Health and Area Medical Officer in South East Essex to be succeeded in July by Dr. G. S. Udall whose previous wide experience quickly enabled him to take up his responsible duties here in Hornsey. By close attention to organisation and methods both Mr. Wilson and Mr. Davies have greatly assisted me in ensuring a happy and contented department with considerable increased responsibilities in administering the Clean Air Act, and in the many other functions of an active and go-ahead public health department. At the end of this Report I have continued, as in previous years, to place on record a brief account of the functions of the Area Health Committee (Hornsey and Tottenham), seemingly more important this year in the light of recommendations made by the: 4 Royal Commission on Local Government in Greater London. The new Retirement Clinic for men is designed to assist those about to reach the age of 65 in making necessary adjustments in their mode of life; and to meet mainly the needs of the able aged whose faculties are little if at all impaired. Advice is given by the medical officer in charge, after a thorough medical overhaul and reference to the family doctor, on such matters as suitable diet, prevention of accidents, occupation of leisure or in finding suitable remunerative employment (in co-operation with the Ministry of Labour) and development of interests essential to mental health and activity in advancing age. Such a service may not only prolong a contented and useful life, but save admission of more elderly people to welfare homes and hospitals. Close co-operation has continued in all branches of the health department with local hospitals, general medical practitioners, various local co-ordinating committees at officer level, the Borough Education Officer, head teachers and the many statutory and voluntary organisations with whom the establishment of cordial relations is so necessary in the interests of the public and for the efficiency of the service. A number of individual contributions to this Report have been made by colleagues in all sections of the health service and to whom I acknowledge my indebtedness for all their help and co-operation on this occasion and throughout the year. In conclusion I would like to express my gratitude to members of the Council, especially to the Chairmen of the Health Committee, Housing Committee, Education Committee, Area Health Committee and the Chairmen of the appropriate sub-committees for their understanding and encou rage me nt. I am, Your obedient servant, G. HAMILTON HOGBEN, Medical Officer of Health. 5 INFECTIOUS DISEASES Hornsey suffered no epidemic during 1960 and no deaths occurred from notifiable infectious diseases. Forty cases of scarlet fever occurred; all made uneventful recoveries. There was some increase in whooping cough, 114 cases were notified comparing with 46 in 1959. Other notifications included 29 cases of acute pneumonia, 10 of erysipelas, 7 of puerperal pyrexia and 2 of meningococcal infection. No special comment is called for on these cases. Poliomyelitis Two cases of poliomyelitis occurred, both paralytic. One was a schoolboy of 5 years, who was admitted to hospital after being unwell for 10 days at home; he developed weakness of the lower limbs. In hospital poliovirus type 3 was isolated from his stools. He was discharged after approximately 10 weeks and on examination less than 3 weeks afterwards it was found that he had a slight residual weakness in the muscle of the left thigh, absence of knee jerk and a slight foot drop in the same leg. He was able to walk briskly and to return to normal schooling. The other case was a married woman of 25 years, who had paralysis of her palate, pharynx and the right side of her face. Poliovirus (type 1) was isolated and the final diagnosis was polio-encephalitis. On discharge from hospital after less than 5 weeks the facial weakness had begun to improve and it was thought likely to clear completely. Neither patient had been vaccinated against poliomyelitis. Food Poisoning During the year general practitioners notified 16 cases of food poisoning; four other cases were found during investigation. One proved fatal. A small outbreak involved two families in one house, and a family outbreak affected two boys. In addition there were 15 single cases, the causal organisms being identified in eight of them as follows:- Salmonella typhi murium - 3; salmonella cholerae-suis - 1; salmonella Newport - 1; salmonella enteriditis - 3. 6 The difficulty of finding positive sources of infection, particularly when information is received late in the department, is illustrated by the small outbreak. The organism concerned was salmonella typhimurium. The mother contracted diarrhoea one Thursday and her husband and four month old baby on the following Sunday. Mother and baby were both positive but the organism was not isolated from the father's stools. The father of the second family in the same house also had symptoms and the same organism was isolated. He was a butcher and was excluded from work by the Medical Officer of Health of the area where he worked until proved negative. As he was a persistent carrier of salmonella infection he was admitted to hospital after six weeks and fortunately was able to be discharged fit to return to duty two weeks later. As information of this outbreak was not received in the department until two weeks after occurrence, it was quite impossible to obtain any sample of food or hope to trace the source of infection. The fatal case of food poisoning was caused by an organism not usually met with in this country, namely, salmonella choleraesuis, and the origin of infection could not be traced. The patient, a butcher, had severe pain, diarrhoea and vomiting early one morning and was admitted to hospital the following day. He had double vision, fever and extreme prostration. He died a month later and an inquest was held. The death was attributable to salmonella septicaemia. The shop where this patient had worked was thoroughly inspected and every effort made to trace any possible source of infection but without avail. The patient had all his meals sent from home and did not eat out at public restaurants. Two children in one family were infected by s. Heidelberg in June and as there had been other recent incidents of this infection in south east England, a doctor from the Central Public Health Laboratory at Colindale investigated these cases to ascertain any possible association. The family of husband, wife and two sons stayed for the week-end at their caravan in the country, taking all their food from home. The two boys bathed in sewerage polluted water. The day following their return the older son (13 years) developed fever, abdominal pain and diarrhoea; he was admitted to hospital 3 days later. The following day the younger brother (9 years) also became ill. S. Heidelberg was isolated from the stools of both children although neither parent was carrying the organisms. The source of the infection was not found and there was no apparent association with other recent incidents of s. Heidelberg infection in south east England. Dysentery Eighty-nine cases of dysentery were notified during the year and in all cases where found, the causal organism 7 was shigella sonne. Exclusion arrangements instituted last year were continued, children being kept away from school for at least 7 days and not allowed to return until they had been free from diarrhoea and sickness for 3 days. Absence from school has been considerably reduced, apparently with no loss of control over the spread of infection. Two outbreaks occurred in a day nursery. On the first occasion 7 babies being affected, two of whom were admitted to hospital. The second outbreak involved 18 babies, one being admitted to hospital, and one member of the staff. On each occasion infection cleared up without incident. Paratyphoid A resident of Hornsey, a man of 61 years, was admitted to hospital in July with a history of having had severe diarrhoea for five days and having had aneuria since the onset of diarrhoea. He was severely dehydrated and his blood pressure was too low to be recorded. His condition on admission was said to be colitis. He died less than 24 hours later. It was thought at first that he had died from food poisoning caused by an organism of the salmonella group, but later it was found to be an untypable paratyphoid B infection, an organism which was new to this country. The matter was reported to the Ministry of Health, who made enquiries regarding this and other salmonella cases which had been reported. No common source or vehicle of infection was found and no connection could be traced with other cases. This case was not notified. The only notification related to a boy of 3 years who probably contracted the disease on holiday; he made an uneventful recovery. Diphtheria No notifications of diphtheria were received during the year. During the last decade 3 cases occurred, one of which proved fatal. It is interesting to compare 10-year periods this century and from the table following these comments it would be seen that Hornsey has yet to have a decade completely free from diphtheria deaths. Perhaps this state of affairs will be achieved during the 1960's. One thing is certain, that to achieve this it will be necessary to keep up the proportion of children in the Borough being immunised against diphtheria. Fortunately, the acceptance rate for this last year or two shows some increase. It is not possible to relax after a job well done if the community is to be kept free from diphtheria. The very success of the immunisation campaign tends to give a false sense of security, but it should not be forgotten that diphtheria is a dangerous fatal disease. The immunisation process, which is simple and almost painless, is an effective protection. 8 For the first time in England and Wales, in 1959 there were no deaths from diphtheria; confirmed cases notified amounted to 102, which was an increase of 22 over 1958. In 1960 there were unfortunately, 5 deaths and 71 cases, but this compares happily with the normal pre-war situation when almost 3,000 child deaths were recorded annually from this disease. Diphtheria in Hornsey 1901 to 1960 Cases Deaths 1901 - 1910 1177 91 1911 - 1920 988 76 1921 - 1930 1904 52 1931 - 1940 780 27 1941 - 1950 184 1 1951 - 1960 3 1 Measles The number of notified cases was 82, only one being over the age of 10 years. Only one child was treated in hospital. All cases made uneventful recoveries and there were no deaths. 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 1960:- Sputum 45 Nose and throat swab 192 Throat swab 2 Per nasal swab 1 Faeces 826 Water 3 Urine 69 Miscellaneous foods 13 9 10 TUBERCULOSIS The total number of cases on the Tuberculosis Register at the end of 1960 was 1, 007, viz., pulmonary 904 non-pulmonary 103. Pulmonary Non-Pulmonary Total Male Female Male Female Male Female (a) Number of Cases on Register at commencement of year 528 381 54 48 582 429 (b) Number of Cases notified for first time during year under Regulations 25 21 2 3 27 24 (c) Cases restored to Register 3 2 - - 3 2 (d) Cases added to Register otherwise than by notification under Regulations (1) Transferred from other Districts 56 47 1 2 57 49 (2) From Death Returns 2 1 1 1 3 2 (e) Number of Cases removed from Register 107 55 5 4 112 59 (f) Number of Cases remaining on Register at end of year 507 397 53 50 560 447 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 1 45 25 48 25 5 - 8 4 107 55 NON-PULMONARY - - 3 2 1 1 - - 1 1 5 4 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 . . 2 . 1 1 3 4 2 2 6 4 . 25 46 F 1 1 1 • 1 2 4 5 4 • 1 1 • 21 Non-pulmonary M . . . . . . 1 1 . . . . . 2 5 F • • • • ■ • • 2 • • 1 • • 3 OTHER THAN BY FORMAL NOTIFICATION Death returns from Local Registrar Pulmonary Inward transferable deaths M • • • • • • • • • • • 1 • 1 1 Pulmonary M . . . . . . . . . . . 1 . 1 2 F • • • • . • . . . . 1 . 1 Non-pulmonary M . . . . . . . . . . . 1 . 1 2 F . . . . . . . . . 1 . . . 1 Transfers from other Districts Pulmonary M . . . . . 2 5 18 12 8 3 6 2 56 103 F • • 1 1 . 3 15 19 4 2 2 . • 47 Non-pulmonary M . . . . . . 1 . . . . . 1 3 F • • • • • • • 2 • • • • 2 12 NOTIFICATION OF INFECTIOUS DISEASE BY AGE AND SEX AGE IN YEARS Scarlet fever Whooping cough Acute Poliomyelitis Paralytic Meningococcal Infection Measles Dysentery M F M F M F M F M F M F Under 1 1 _ 3 12 _ _ 1 1 2 3 3 1 1 1 - 1 8 - - - - 8 8 6 5 2 3 - 9 5 - - - - 9 8 4 3 3 3 1 5 7 - - - - 4 11 3 2 4 2 2 6 5 . - - - 3 4 4 3 5-9 7 7 18 24 1 - - - 10 11 13 11 10-14 12 _ 1 3 - - - - - - 1 6 15-24 1 . 1 - - - - - 1 _ 3 4 25 and over - - 1 5 - 1 - - - - 3 14 TOTALS 30 10 45 69 1 1 1 1 37 45 40 49 AGE IN YEARS Acute pneumonia Erysipelas Food poisoning Puerperal pyrexia Paratyphoid fever M F M F M F F M F Under 5 5 2 «. 2 _ 1 _ 5-14 2 1 1 - 2 2 - - - 15-44 3 1 1 - 5 1 7 - - 45-64 6 4 2 4 3 1 - - - 65 and over 1 4 - 2 - - - - - TOTALS 17 12 4 6 12 4 7 1 - There were no cases of diphtheria or ophthalmia neonatorum. 13 NOTIFICATION OF INFECTIOUS DISEASE BY WARDS Highgate Muswell Hill Crouch End Central Hornsey North Harringay South Harringay Stroud Green Finsbury Park TOTALS Scarlet fever 5 4 1 16 3 1 8 2 40 Whooping cough 13 13 8 15 23 5 24 13 114 Acute poliomyelitis Paralytic - - - - 1 - - 1 2 Measles 10 2 5 7 9 23 20 6 82 Acute pneumonia 1 1 - 2 18 - 6 1 29 Dysentery 7 16 13 12 10 2 15 14 89 Erysipelas - - 1 1 - 3 4 1 10 Food poisoning 3 4 - 1 3 1 1 3 16 Puerperal pyrexia - 5 - 1 - 1 - - 7 Meningococcal Infection - - - 1 1 - - - 2 Paratyphoid fever 1 - - - - - - - 1 TOTALS 40 45 28 56 68 36 78 41 392 HOUSING AND SANITARY CIRCUMSTANCES Certain aspects of the work required to be carried out by public health inspectors in this Borough have changed considerably during the last few years. Before the war most of the inspectors' efforts were concentrated on securing the abatement of sanitary nuisances in tenanted houses and for this purpose the owners, from time to time, were required to carry out structural repairs to roofs and floors and wall and ceiling linings. Additionally the owner was normally considered to be responsible for the internal decorative condition of the house. Generally speaking houses were occupied as single dwellings by one family except in one or two small areas of older houses in the Borough. With the advent of the Rent Act the position with regard to repair and internal and external decoration of the tenanted dwelling house has been modified. In order to obtain the maximum permitted rent the owner was generally prepared to carry out necessary repairs to make the premises weatherproof and reasonably comfortable for occupation. The occupiers were themselves, in most cases, prepared to carry out the necessary internal decorative repair and the number of applications to the Council for action under the Public Health Act, has, since the Rent Act, progressively declined. Where an owner is not prepared to meet the reasonable requests for maintenance by the occupier, procedure is provided by the Rent Act which has been used in a number of cases and at the same time the information available to the Department suggests that the availability of this procedure to the occupier, has persuaded the owner to carry out work without recourse by the occupier, to the official procedure. The effect of these conditions has been an appreciable improvement in the general standard of repair and external and internal decoration of the majority of the tenanted houses in the Borough. Since the Rent Act came into force there appears to have been a noticeable increase in the number of owner-occupied dwellings in the Borough and this naturally has led to a further improvement in the condition of many of these houses. A long standing problem which the department is still called upon to solve, consists of the evacuation and demolition of houses which are old, dilapidated and beyond repair at anything approaching reasonable cost. Most of these houses are situated in groups but there are from time to time single houses, detached, semi-detached and terraced which reach a stage of dilapidation where they are no 14 longer fit for human habitation. The Council is proceeding with the clearance and re-development of the Campsbourne Area and a number of single houses in other parts of the Borough have been closed or demolished where this action appeared to be necessary, (see Table page 19). This type of work is really a continuation of slum clearance carried out by the department. Another aspect of housing calling for very much greater attention is the problem of overcrowding and houses in multiple occupation. These houses are brought to light in the course of routine inspections by the public health inspector or because of complaint from the occupiers or from people living nearby. Information from the Housing Department concerning applications for Council housing also reveals the multiple use of houses which were previously occupied by only one or two families. The practice is growing up of dividing three or four storey houses of up to ten or twelve rooms, into "single room flats" and this type of accommodation is even now being advertised on some of the private advertisement boards to be seen outside shops in some parts of the Borough. When these houses are inspected it is frequently found that the so called flats are overcrowded even according to the low standard which is laid down in the Housing Act. The owner has in most cases neglected his responsibility to make adequate enquiries as to the size of the family to whom he lets the accommodation nor does he inform them of the maximum number of persons permitted by the Housing Act to occupy that accommodation. Proof that the owner knew that the premises would become overcrowded is not readily forthcoming since the owner of such a house is not inclined to admit his default, whilst the tenant is disinclined to make a full statement of the circumstances. It has been suggested that the tenant does not wish to confirm that the owner knew that overcrowding would occur in order that he will not encourage the owner to evict him. The department finds this explanation difficult to accept because in these houses the accommodation is frequently furnished and therefore the tenant has no security of tenancy, or, if the accommodation is unfurnished the tenancy probably commenced after the introduction of the Rent Act and therefore the tenancy is not controlled. Furthermore the service of a notice regarding overcrowding on the owner, requires the owner to take all the necessary action to secure the abatement of the overcrowding and this normally means the early eviction of the tenant. Under the Housing Act the Council can declare the standards of amenities and sanitary facilities which should be available in houses in multiple occupation in the Borough. The Hornsey Borough 15 Council has adopted such standards with regard to the natural lighting, ventilation, water supply, drainage and sanitary conveniences, facilities for the storage, preparation and cooking of food and the disposal of waste water in houses in multiple occupation. Where appropriate, which means in a large number of cases, letters are sent to the owner requesting him to meet these standards. This work is proceeding at a normal rate but it is evident that there are a considerable number of houses requiring inspection under this heading. With regard to overcrowding the Council have considered a report listing over 20 recently verified cases of overcrowding. Thirteen of these were "new" and the families had been in occupation of the houses for periods of from a few weeks to 18 months and in each case the overcrowding occurred at the time of taking occupation of the accommodation. The Council gave instructions that this overcrowding was to be abated and legal proceedings were to be taken where appropriate. In a number of the other cases of overcrowding the law recognises that a family can become overcrowded by natural increase and the normal action regarding abatement is not available providing always, that the head of the overcrowded family has made application to the Council for housing accommodation. This type of case is dealt with very sympathetically by the Council and accommodation provided as soon as is practicable. There are certain further cases of overcrowding created by owner-occupiers who themselves, have entered upon premises which were inadequate for their needs. CAMPSBOURNE CLEARANCE AREA Stage VI In January the official representation to the Council of Stage VI was made in three parts as follows VI(a) 2-10 (even) Pembroke Road 1 & 3 Boyton Road VI(b) 7-9 (odd) Boyton Road VI(c) 1-11 (odd) Brook Road At the recommendation of the Housing Committee the following properties were added and the Council made a Compulsory Purchase Order. 5 Boyton Road Factory premises and garages in Brook Road Factory premises 12 Pembroke Road 13-35 (odd) Brook Road 16 Objections were received in respect of four properties, but were withdrawn concerning two of them. A Public Enquiry was held on 5th September and confirmation of the Order, with minor modifications, was made by the Minister in January, 1961. The Order became operative on 10th March, 1961. Stage VII On 20th December the official representation to the Council of Stage VII was made in two parts as follows:- VH(a) 16-38 (even) Campsbourne Road 9-21 (odd) Myddelton Road 12-26 (even) Myddelton Road VH(b) 32-36 (even) Myddelton Road At the recommendation of the Housing Committee the following properties were added. 2-14 (even) Campsbourne Road 2-10 (even) Myddelton Road 1- 5 (odd) & 23 Myddelton Road Derelict stables used as garage between 1 & 3 Myddelton Road Vacant land between 5 & 9 Myddelton Road and rear of 12-22 Campsbourne Road Objections were received in respect of 7 properties. A Public Enquiry was held in the Town Hall on 30th May, 1961. RE-HOUSING ON HEALTH GROUNDS The total number of housing cases reviewed on health grounds during the year was 84. In 69 cases action was as follows:- Nil points recommended 9 5 " " 9 10 " " 9 15 " " 40 Cases accepted by Committee for rehousing outside the points scheme 2 17 The remaining 15 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 having regard to other applicants on the waiting list. 24 cases were placed in special categories as follows:Group I Serious medical condition (a) Active pulmonary tuberculosis 2 (b) Other medical conditions 3 Group II Chronic medical or surgical conditions which have crippled the patient 11 Group HI Old persons needing ground floor accommodation because of infirmity possibly with illness 6 Group IV Serious overcrowding causing undesirable mixing of sexes with its accompanying moral danger 2 13 families with medical need were rehoused during the year. CERTIFICATES OF DISREPAIR Applications for certificates of disrepair 13 Decisions not to issue certificates 1 Decisions to issue certificates (a) in respect of some defects 8 (b) in respect of all defects 4 Undertakings given by landlords 6 Undertakings refused Certificates of disrepair issued 7 Applications for cancellation of certificates 6 Objections by tenants to cancellation of certificates 1 Decision by Council to cancel in spite of tenant's objection 2 Certificates cancelled 6 Applications for certificates as to remedying defects which landlord has undertaken to remedy: Certificates issued to landlords All defects remedied 4 18 CLOSING ORDERS Property Part affected Order operative Action taken 176 Stroud Green Road lower ground floor rooms 9th February Premises vacated. 50 Clarendon Road whole house 22nd March Occupants housed. re- 28 Campsbourne Road whole house 22nd March Occupants housed. re- 36 Campsbourne Road whole house 27th April Premises vacated. 480 Archway Road whole house 28th Dec. Occupants housed. re- CLOSING ORDER DETERMINED A Closing Order made on 14 Ennis Road on 10th October 1958 was determined on 12th July, 1960, the work required to render the premises fit for human habitation having been carried out. DEMOLITION ORDERS A Demolition Order was made on 12 Great North Road on 18th January, and the premises were demolished in June. INSPECTION OF SHOPS 131 inspections under the Shops Act were made and it was found that 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 19 LICENSING OF PET SHOPS During the year 23 inspections were carried out, 10 by the Veterinary Inspector and 13 by the Public Health Inspectors. Five existing licences were renewed at the beginning of the year and one more issued. HAIRDRESSERS Byelaws with respect to the business of hairdressers and barbers have applied in Hornsey since 1956 and there are 28 establishments for male hairdressing and 37 establishments for female hairdressing, which includes 7 establishments catering for both sexes. All the establishments were inspected during the year and with the exception of a few minor matters were found to be satisfactory according to the Byelaws which are designed to secure the cleanliness of the premises and of the staff and of the customers and equipment used. The Byelaws require the adequate sterilization of instruments, combs and hairbrushes and the use of clean protective covering for customers. 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 area is supplied from two main sources:- (a) River Thames derived water stored in the reservoirs at Littleton and Staines and treated at the Board's filtration works at Ashford Common, Kempton Park and Hanworth Road. 20 (b) Water from the New River derived from the River Lea at Ware and from wells along the course of the New River. This water is treated at the Board's filtration works at Stoke Newington and Hornsey. 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. No new sources of supply have been instituted and there have been no important extensions of trunk mains nor changes in the general scheme of supply to the Borough. New mains laid in the Borough during the year amount to 189 yards only. All new as well as 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. Details of the analytical results of the water passing into supply are shown below. Bacteriological Results of Water Passing into Supply after Chlorination No. of samples Plate counts Average colonies per ml. counted on agar at 37°C after 20-24 hrs. Coliform test Samples negative in 100 ml. Coliform E. coli River Thames 1,778 14.4 98.71% 100.0% New River 515 5.2 99.42% 100.0% Chemical Examination 104 samples of filtered water derived from the New River and 207 from River Thames derived water were taken for chemical examination. All were found to be satisfactory. The average fluoride content in the water supplied to Hornsey was 0.25 parts per million. 21 SEWERAGE The whole of the Borough is provided with sewerage facilities. That part of the Borough north of Fortis Green drains into the East Middlesex main sewerage system and the remainder of the Borough's sewerage system joins the northern out-falls of the London County Council's drainage system. RIVER POLLUTION Continuous inspections of surface water drains are carried out to prevent pollution. Now few new instances of sanitary fittings connected to the surface water drains are found. The usual defect is now the result of a fault developing. The following figures relate to action taken during 1960. Premises inspected by drainage inspection assistant 5,222 Re-inspections 728 Premises inspected by public health inspectors 286 Re-inspections 362 Number of premises in which defects were remedied 175 after service of written or verbal notices. 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 was opened in 1929. It consists of two pools, one for adults 165 ft. x 75 ft., and another for children. The water is taken from the mains of the Metropolitan Water Board and is replenished every season. The water is treated by pressure filtration and break-point chlorination, the whole of the water in both pools being treated on an eight hour cycle. The Superintendent takes samples for determination of the pH value and the free residual cholorine three or four times each day according to the number of people using the bath. Samples are taken for bacteriological examination at intervals and have proved satisfactory. 22 FACTORIES ACT, 1937 Inspection of Factories Total No. of Factories No. Inspected Inspections Made Factories with Mechanical Power 196 34 66 Factories without Mechanical Power 36 8 6 Defects Found 6 notices were served during 1960 regarding want of cleanliness, unsuitable, defective and insufficient sanitary conveniences. All were complied with at the end of the year. 3 notices served during 1959 were complied with during 1960. No prosecutions were instituted. Outworkers There are 213 Outworkers on the register engaged in the following occupations:- Making, altering, etc. of wearing apparel 162 Making of lace, lace curtains and nets 2 Making or repairing of umbrellas, sunshades, etc. 4 Making of artificial flowers 6 The making of boxes or other receptacles or parts thereof made wholly or partially of paper 8 Making of brushes 6 Feather sorting 1 Making of stuffed toys 1 Making or filling of Christmas crackers, Christmas stockings, etc. 7 The weaving of textile fabric 3 Manufacture of lampshades other than lampshades made wholly of metal or glass or stone 8 Covering of racquet or tennis balls 1 Making up of household linen 4 31 visits were paid to outworkers' premises during the year. No notices were served under Section 110 or Section 111 of the Act in connection with failure to send in list of outworkers or work in unwholesome premises. 23 RODENT CONTROL The opinion given in my Annual Report last year that the rat population had been considerably reduced by the use of sodium fluoroacetate and warfarin in the treatment of sewers is confirmed by the number of infestations by rats reported in the Borough during 1960 reaching the low figure of 110, by comparison with the figure of 207 for 1959. Of the 110 reported surface infestations no evidence of rats was found in 28 instances and the majority of the 82 referred to stray rats. There were no major infestations. Once again the final assessment of the year's work on the sewers is provided by the result of warfarin treatment commenced in October 1960. This treatment, which entails three visits to each of the selected baiting points - and 1196 were treated - is spread over some five weeks and was concluded towards the end of November 1960. It is interesting to note that during the time from 19th November 1960, when the treatment ended, until the end of the year (some 6 weeks) only 8 reports of rats were received. The percentage of "takes" in the sewers during the warfarin treatment was between 1.1% and 6.9% and once more the difference between these figures refers to some 83 feeding points where poison bait was disturbed and the reading was therefore uncertain. Comparative figures on surface infestations for 1959 and 1960 are as follows 1960 1959 January - March 21 59 April - June 25 74 July - September 37 50 October - December 27 24 110 207 24 INSPECTIONS BY PUBLIC HEALTH INSPECTORS 1st Inspection Re-inspections Food Food Premises (See table on page 38) 90 206 Hawkers 4 2 Street Traders 9 3 Infectious Diseases Notifiable Infectious Diseases 143 33 Food Poisoning 17 4 Infectious Disease Contacts 12 2 Public Health Inspections Nuisances 1107 1835 Drainage 93 258 Drain tests 42 2 Rodent Control 28 28 Overcrowding 21 8 Factories 37 65 Outworkers 27 4 Renewal of Music and Dancing Licences 19 11 Rivers Pollution 286 370 Smoke observations 24 17 Verminous conditions 29 8 Pests 34 2 Certificates of Disrepair 13 4 Revocation of Certificates of Disrepair 4 2 Hairdressers' Shops 68 11 Housing Act Inspections House to House 318 149 Permitted numbers 1 Houses in Multiple Occupation 66 22 Shops Inspections 131 Others Pet Animal Shops Petroleum Stores Fireguards Visits to old people 8 5 - - 1 - 18 20 25 SUMMARY OF SANITARY IMPROVEMENTS EFFECTED Drainage Number of houses and premises redrained 8 Repairs or amendments to existing drains 75 Drains or gullies unstopped or cleansed 118 Manholes provided or repaired 30 Intercepting traps fixed 14 Soil and ventilation pipes repaired or renewed 17 Water-Closet and Sanitary Fittings Water-closet buildings provided or repaired 17 Water-closet pans provided or renewed 23 Water-closets unstopped, cleansed or repaired 12 Flushing cisterns provided or repaired 20 New sinks provided 8 New lavatory basins provided 9 Waste pipes trapped, repaired or unstopped 41 Baths provided or made usable 5 General Roofs repaired 109 Rain-water gutters, renewed or repaired 47 Rain-water pipes provided or repaired 25 Dampness remedied 59 Damp-proof courses provided 5 Yard paving provided or repaired 15 Rooms cleansed 9 Rooms disinfested of vermin 8 Floors repaired 27 Windows, doors, skylights, sashcords and fittings repaired 62 Window-sills repaired 9 Water-cisterns repaired, cleansed or covered 6 Water supply pipes repaired 4 Stoves, ranges, renewed or repaired 8 Flues and chimneys repaired 4 Accumulation of refuse removed 30 Dustbins provided 9 Miscellaneous items 64 26 ABATEMENT NOTICES The Notices served during the year were as follows: - Verbal Preliminary Statutory Public Health and Housing Acts 87 330 19 Shops Act 2 1 Factories Act 2 4. 27 LEGAL PROCEEDINGS Date of Hearing Premises Offence Result Public Health Act, 1936 Sec. 92/93 17th August 80 Stapleton Hall Road General Defects Court Order work to be carried out within one month. Work completed January 1961. 24th August 133 Muswell Avenue General Defects Court Order work to be carried out within 28 days. Work completed January 1961. Shops Act, 1950 Sec. 53. 13th January Shop open on 3 Saturdays, after statutory declaration by trader that he conscientiously objected on religious grounds to opening on Saturdays. Fine £6. Costs £6. 6s. CLEAN AIR On 1st September 1960 the Hornsey Smoke Control Orders Nos. 1 and 2 came into force after over 12 months notice being given of the date of operation of the No. 1 Order, and 8 months in respect of No. 2. Every effort was made throughout the year to encourage householders who were eligible for the 70% grant towards the cost of necessary conversions and adaptations of grates and stoves, to make their arrangements early, but it is to be regretted that a very large proportion of the applications were not received until the latter part of August when there was inadequate time for the proposals to be fully examined and the necessary approvals granted so that the work could be carried out before the date of operation of the Order. This was new legislation and as such a number of doubtful points on interpretation required to be clarified, based on the experience which was being gained in bringing the Orders into operation so that the delay in receipt of applications only further complicated the position. The Council decided to grant a two months extension for the receipt of applications and in a restricted form necessary to meet the provisions of the Act, many additional approvals were given and grants paid. It is to be hoped that the householders in the Borough whose dwellings come within future smoke control areas, will commence their arrangements as soon as they are informed of the confirmation of the Order. It will undoubtedly be to their advantage and will lessen the rush of work during the few days before the Order comes into operation. The inspectorial and clerical staff of the department are available to discuss problems of owners and occupiers either at the Town Hall or by arrangement at the premises concerned. Smoke Control Order No. 3 was sent to the Ministry for confirmation before the end of 1960 and subject to such confirmation the Council proposes to bring the Order into operation on the 1st November, 1961. The fullest publicity will be given to the matter and the public's full co-operation is earnestly requested. The arrangement for the survey of individual premises, necessary as a preliminary to the declaration of a smoke control area, has been improved during 1960 by the appointment of a survey assistant specifically for this purpose. 28 His duty is to call at each dwelling in the proposed area and record details of the existing appliances, new appliances required and probable cost of installation as well as an estimate of present annual consumption of solid fuel. From this information an estimated is made on the number of appliances which will require replacement or adaptation and the cost of the proposed or necessary work and the variation in demand which will arise for smokeless fuel, gas and electricity in the proposed area. Between May and December approximately 2,500 premises were inspected. Measurement of Pollution For some years the department has maintained three deposit gauges which are changed each month and three instruments to measure daily the amount of smoke and sulphur dioxide in the atmosphere by the volumetric method. The figures gained from this apparatus contribute to the local and national information from which the degree of pollution can be assessed. The results are collated by the Warren Spring Laboratory of the Department of Scientific and Industrial Research and published in their monthly bulletin. During the year the Minister of Housing and Local Government addressing a Standing Conference, on which this Council is represented, recommended the adoption in principle, of the findings of a specialist working party on the measurement of atmospheric pollution. The Minister requested the co-operation of Local Authorities in implementing the recommendations of the Working Party Report and in particular the scheme to build up an improved national picture of the atmospheric pollution problem. These proposals included a request to a number of statistically selected Local Autnorities to establish daily smoke and sulphur dioxide filters, according to a new formula, the purpose of which is to create a national average for different types of districts i.e. residential district with high population, residential district with low population, industrial working district and smoke control areas, against which each Authority will be able to judge its own results. Hornsey has been selected as one of the areas to be included for the special calculations and the Council has agreed to co-operate by establishing measuring instruments on sites selected in co-operation with the staff of the Warren Spring Laboratory. Five smoke and sulphur dioxide filters and two deposit gauges were brought into use early in 1961. 29 30 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 15 18 9 38 54 43 5 8 1 4.6 5.3 6.7 13.5 29.0 20.0 1.2 1.4 1.6 13.31 8.64 13.95 February 15 19 20 34 37 40 6 11 10 4.7 5.9 9.0 14.3 15.0 21.8 1.5 1.4 2. 5 15. 40 11. 20 15.85 March 12 13 15 27 27 26 4 5 6 4.6 7.0 8. 0 9.2 36.7 15.8 1.8 2.5 3.2 18. 59 15. 68 17.01 April 7 8 9 20 17 20 3 4 3 3.7 3.6 5.4 8. 5 8. 2 13.6 2.0 1.9 2.1 20.63 10.13 14.73 May 6 7 8 13 15 17 1 3 2 4.0 3.2 5.4 8.9 7. 5 12.4 0. 6 1.0 1.6 12.16 11.99 11. 24 June 3 4 3 11 14 8 1 1 1 2.2 2.2 2.4 7.7 8.0 9.8 0.9 0.7 0.2 12.19 8.76 12.85 July 2 3 3 5 7 9 1 1 1 1.4 1.5 1.3 2.5 2.3 3.5 0.2 0.7 0.4 9.02 7. 24 12.08 August 3 4 4 6 8 10 1 1 1 1.6 1.5 1.9 3.4 3.0 4.6 0.2 0.5 0.5 8.21 6.99 12.37 September 5 7 7 8 12 14 1 2 1 1.3 1.5 2.6 3. 5 3.3 4.6 0.0 0.4 0. 5 9.72 8.62 12.76 October 9 14 15 20 27 31 4 8 9 2.6 4.3 6.7 5.0 8.2 15.8 1.0 1.4 1.5 9.80 8.24 10.65 November 12 17 18 32 35 40 3 6 7 3.3 4.7 7.3 9.0 15.8 10.2 0.9 1.9 3.2 12.19 10.76 19.32 December 14 21 22 31 49 57 3 4 7 4.5 8.1 9.8 8.6 29.6 20.3 1.0 0.9 4.0 12. 69 10.68 14. 69 Sites: (a) Fortis Green Depot. Disinfecting Station, (c) Tom Hall. (d) Highgate Depot, North Hill. (e) Electricity Sub-Station, Hampden Road. SMOKE POLLUTION FROM ROAD VEHICLES Between 26th August and 17th October 1960, in conjunction with the Warren Spring Laboratory of the Department of Scientific and industrial Research, a survey was made of the smoke pollution due to road traffic in Archway Road. Sampling Points Measurements of the hourly mean concentration of smoke at a height of 10 feet above the ground were made at a point in the building line beside Archway Road opposite the Highgate Underground Station; another set of measurements of concentration at the same height were made at a point 100 yards from the main road in the grounds of the Library in Shepherds Hill in order to provide information on the "background" concentration due to sources other than traffic. All measurements were made by passing a sample of air through a white filter and measuring the darkness of the stain produced. The figures given can therefore be taken as relative amounts of "black smoke". Background Concentration The background concentration of 30 micro- grammes per cubic metre is very similar to measurements made in neighbouring boroughs (allowing for some difference in ventilation) and may be regarded as a true measure of the pollution in the area. The mean pollution on weekdays (Mondays Friday) at the Archway Road site is, however, 360 microgrammes Per cubic metre - i. e. twelve times the background, and this additional Pollution can only be due to traffic. On weekdays, there are two maxima in the pollution due to traffic between 6 a. m. and 9 a. m. and between 7 p. m. and 10 p. m., the highest figures being observed between 7 a. m. and 8 a. m. when the mean concentration at Archway Road was 750 microgrammes per cubic metre, while at the library it was only 40 microgrammes per cubic metre. Traffic Flow and On a Tuesday and a Sunday during the survey, Smoke Concentration a census of road traffic was carried out at a point near the site of the measurements and these indicate that the variation during the day did not agree with the variation in the number of diesel vehicles passing (which does not vary much between 6 a.m. and 8 p.m.) The variation in concentration of pollution agreed in fact much better with the variation in total number of vehicles passing. This need not be taken to imply hat all vehicles contribute equally to the pollution since the amount smoke emitted by a diesel vehicle will be greater in periods of traffic congestion when it is subject to frequent halts. There will 31 also be some dependence on weather conditions - a separate study indicates that the pollution to be expected with a wind speed of 15 knots is only one-third of that at 5 knots. We may, however, eliminate both these variables to a large extent by comparing pollution on weekdays and on Sundays. From 10 a.m. to 8 p.m. there is approximately the same number of vehicles on both days, but far fewer diesel vehicles on the Sunday, and correspondingly lower pollution which shows conclusively that diesels are responsible. Layers of Pollution A few additional measurements were made at a height of six feet, at the edge of the carriageway at a series of points along the road; these indicate that there was not a very large change in concentration across the pavement, and that very similar concentrations are observed for some distance along the road. Another set of measurements made at different heights above the ground showed that there was little difference down to about 4 feet, but that concentrations at a height of 2 feet are about 50 per cent, higher. Some measurements were also made on the road behind "smoking" vehicles by means of a motorcycle and these indicated concentrations as high as 10,000 microgrammes per cubic metre, although 3,000 to 5,000 was more common. Inhalation Risks It is interesting to note that the amount of air drawn through the filter paper in one hour during the survey was approximately 2.5 cubic feet, the equivalent of 71 litres and that an average adult when walking at about 3 miles per hour inhales at the rate of 25 litres per minute. One of the hourly smoke stains, therefore, indicates approximately the amount of smoke which might be inhaled in three minutes by a person walking up Archway Road. Conclusion The average smoke pollution on weekdays in the Archway Road is approximately twelve times the background pollution of the district measured at ten feet above ground level. This pollution is shown to result from diesel vehicles in heavy traffic conditions. A greater concentration is found below 2 feet from the ground. 32 SMOKE CONCENTRATION: READINGS DURING HOURS OF HEAVY CONCENTRATION N.B. All readings are shown in microgrammes per cubic metre. Date Time Archway Road Shepherds Hill a. m. p.m. August Wed. 31st 7 - 8 1120 30 September Tue. 6th 6-7 1200 60 Wed. 7th 7-8 1480 10 „ „ 7 - 3 1330 50 Thur. 8th 6-7 1870 180 Tue. 13th 7-8 1080 20 Thur. 15th 7-8 650 40 Fri. 16th 11 - 12 810 70 Mon. 19th 9-10 1040 60 Wed. 21st 9-10 770 30 Fri. 23rd 8-9 760 30 Mon. 26th 6-7 610 less than 10 Tue. 27th 7-8 910 20 October Tue. 4th 7-8 1360 70 „ „ 8-9 1620 450 Wed. 5th 9-10 1060 80 Fri. 7th 9-10 1210 110 Mon. 17th 7-8 1440 280 „ „ 11 - 12 1600 680 Comparison of Recordings During past years 68 London sites showed overall averages for smoke concentrations as follows:- Summer (April to September) 100 Winter (October to March) 310 Yearly (April to March) 209 Sample results under special atmospheric conditions were as follows:- 5th - 8th December 1952 - The Great London Smog. The average concentration in the Thames Valley was 3750. At Woolwich figures of 5430 and 5220 were recorded. During November 1959, hourly readings were taken at Greenwich during light fog conditions and the maximum reading obtained over three days was 3600. 33 FOOD Another aspect of the re-orientation of the work of the public health inspector concerns food hygiene. The first Regulations to secure the improvement in the handling, preparation and storage of food came into force on the 1st January, 1956 and these Regulations were revised in 1960 coming into force on the 1st October of that year. The second edition varies generally only in detail from the first and a great deal of effort has been and continues to be made to ensure that premises on which food is handled are properly constructed, that the equipment is suitable for the job and that adequate attention is paid to all aspects of cleanliness both of the premises and of the persons who are engaged in the work. It must be evident that during the past few years there has been a striking improvement in the equipment, layout, lighting and general cleanliness of most food premises but continuous effort is required through the department to ensure that the better standards are maintained not only in the public portion of the premises but also in those parts of the establishment from which the public is excluded. The department is prepared at all times to discuss a problem with food traders and food handlers and the inspectors can draw upon their wide experience in offering advice and suggestions as to how the occupier of food premises, and his staff, can meet the requirements of the Regulations. It is necessary, however, to point out that the Council have the power to institute proceedings where the persons concerned do not meet their obligations and it should be emphasised that the Food Hygiene Regulations are designed as a code of continual practice and that any failure to meet the requirements of the Regulations is of itself an offence and can be made the subject of prosecution. However, the happy situation exists in the Borough whereby the large majority of food traders and food handlers are keen to-co-operate with the Council in ensuring that the public receive clean safe food, prepared and handled in clean safe conditions and it is to be hoped that this atmosphere will very soon apply to everybody in the Borough whose activities are governed by the Regulations. 34 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 23 4 - Butchers 46 - 27 Confectionery (sugar) 127 107 1 Fish (wet and dried) 11 2 3 Fish (fried) 8 - 1 Fruit and vegetables 76 11 - Grocery and provisions 124 33 17 Milk 4 1 - Canteens 2 - - Preserved foods 2 - - Public houses and off licences 69 8 - Restaurants and cafes 63 5 - Tobacconists and Newsagents 1 1 - Herbalist and health foods 1 - - Confectionery warehouse - - - 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 36 registered hawkers who are at present selling the following foods- Confectionery 1 Groceries 2 Eggs 1 Ice Cream 3 Fish 1 Winkles and shrimps 1 Fruit and vegetables 24 35 FOOD SAMPLING I am indebted to J. A. O'Keefe, Esq., 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 1960 - Article Total samples procured Unsatisfactory Milk (Various) 78 Butter and margarine 12 Cakes 12 Cheese 17 2 Cooked meat 21 Cream 10 Drugs 13 Fish and fish products 29 1 Fruit - fresh and canned, etc. 19 2 Ice-cream 6 Meat, meat products and liver 37 2 Sauce 6 Sausages, etc. 11 Sweets 3 Vinegar 35 Miscellaneous 21 Totals 330 7 The following comments relate to samples noted as unsatisfactory: Cheese Two samples of cream cheese were procured and upon analysis they proved to be processed cheese. The samples were taken from a large multiple store and it was felt that the cheese had been inadvertently misdescribed by an assistant in the shop and an official caution was issued. Fish An official caution was issued to a fishmonger within the Borough for describing and selling red fish as sea bream. 36 Fruit Two purchases of seedless oranges were procured and were found to contain quantities of seeds. Legal proceedings were instituted against the company concerned and fines on two counts of £5 and £2 respectively were imposed and an order made for the payment of costs amounting to two guineas. Meat Two samples of steakettes were procured and each was found to contain a prohibited preservative. An official caution was issued. Merchandise Marks Acts, 1 887 - 1 953 The majority of the inspection work carried out under the provisions of the above Act 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 fruit, bacon, ham, poultry, butter and honey upon sale and exposure for sale. Inspections were made at 151 premises of 768 displays of these foodstuffs. No infringements were detected. 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 932 articles of pre-packed food was examined at 132 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 Labelling of Food Order. Examples of where corrective action was sought are set out as follows: television and press advertisements which falsely described a processed cheese as a cream cheese, advertisements which falsely suggested a fruit content for sweets, jam-cream sponge and cream doughnuts which contained imitation cream, and chocolate liqueurs which were deficient in alcohol-content. 37 MILK SUPPLY Under the Milk (Special Designation) Regulations, 1960, the licences for the sale of special designated milk will from 1st January 1961 be granted by the food and drugs authority, which in this area is the County Council. The period for which a licence will be granted is extended from one year to five years and the system of granting supplementary licences for: dealers from outside the local authority's area is abolished. The? registration of distributors premises under the Milk and Dairies Regulations, 1949, will continue to be effected by this Council, thus from next year the unfortunate situation will exist wherein milk dealers must register with the Borough Council and obtain a licence to sell from the County Council. During 1960 eight new registrations were effected and licences for the sale of designated milk granted as follows:- Dealers' New Licences Supplementary Dealers' Renewals Supplementary Pasteurised 10 - 32 9 Tuberculin Tested 7 - 28 9 Sterilised 8 - 43 10 INSPECTIONS OF FOOD PREMISES WERE MADE DURING THE YEAR AS FOLLOWS:- Bakehouses and Bakers' Shops 15 Butchers' Shops 31 Canteens and Kitchens 8 Confectioners 13 Fish Shops 10 Greengrocers' Shops 57 Grocers' Shops 85 Public Houses & Off Licences 12 Prepared Food Shops 3 Restaurants, Cafes, etc. 62 TOTAL INSPECTIONS 296 The following is a list of unsound food surrendered during 1960. Wherever possible this was salvaged for use as animal feeding or industrial purposes. Cwt. lb. Cwt. lb. Canned Vegetables 10 Meat and Bacon 1 46 Canned Fruit & Fruit Juices 1 28 Fish 1 66 Canned Meat 7 48 Cereals 1 Canned Fish 8 Dried Fruit 45 Canned Soup 4 Poultry 46 Canned Jam & Marmalade 37 Potatoes 105 Milk 5 pints Frozen Eggs 42 38 LEGAL PROCEEDINGS Date of Hearing Offence Result Food and Drugs Act, 1955, Section 2 13th January Cardboard in bottle of milk. Fine £10. Costs £6. 6s. 18th May Finger of cotton glove in tinned salmon Fine £10. Costs £8. 8s. 12th October Cotton fibres in loaf Found guilty Costs £21. Food Hygiene Regulations, 1955 9th March Failure to keep walls and floors in good order so as to prevent risk of infestation by mice. (Reg. 23(l)(b)). Fine £3. Costs £2. 2s. Failure to keep metal bowl and tin container clean (Reg. 6(17)). Fine £3. Costs £2. 2s. 39 OLD PEOPLE'S WELFARE Apart from the many miscellaneous enquiries about old people known to the department, 26 new cases were reported during 1960, but it is pleasing to be able to report that compulsory action for removal to a home or hospital was not required. In two cases it might have been necessary to apply for a Magistrate's Order but both of the people concerned voluntarily entered hospital as their condition rapidly deteriorated. The remaining elderly people were enabled to obtain proper care in their own homes in co-operation with the services of the Area Health and Welfare Offices, and in some cases the Mental Health Department. Where hospital treatment is necessary the helpful consideration of the Geriatrician at the Whittington Hospital, Dr. A. N. Exton-Smith, and his staff, is always readily given and in some cases it has been possible to admit an old person for 3 or 4 weeks in order to enable other younger relatives to obtain a well earned rest. Home nurses and home helps play a very great part in keeping old people in their own homes and the staff of the Old People's Welfare Council in providing various amenities and services contribute very considerably to their happiness and wellbeing. The meals on wheels service regularly provided by the Women's Voluntary Services, is one, the value of which cannot be too strongly stressed. This organisation also co-operates with the Borough Librarian in providing a library book delivery service: thus enabling many housebound old people to receive the benefit and enjoyment of regular reading matter. CARE OF THE AGED It is estimated that there are in the Borough approximately 15,600 persons of pensionable age, most of whom live a normal happy life of retirement in their own homes. Some continue at full-time work; others in part-time occupation. Our attention is focussed on the lonely, infirm and the sick aged. These important groups have at their disposal the service of the following - general practitioners, personal health and environmental health services, the statutory and voluntary welfare services, the hospitals, the Ministry of Pensions and National Insurance, The National Assistance Board and various other services such as dental, ophthalmic and chiropody. 40 General Practitioners In the first instance the practitioner treats ailments of his aged patients. He may request the services of the district nurse, the home help, meals on wheels and home nursing appliances, e.g. commode, wheelchair etc. If the patient cannot be treated at home the doctor may arrange outpatient attendance at a hospital or admission for an acute or chronic case or the welfare officer to see cases with a view to admission to a welfare home. The Welfare Department The Welfare Officers visit very many old people in their own homes. The shortage °f welfare homes for aged persons is still a grave disadvantage and numerous beds in chronic sick hospitals have been occupied throughout the year by cases said to be suitable for welfare homes. The Local Area Health Authority is responsible for the services of district nurses, home helps and health visitors. Arrangements for the loan of sick room appliances are made through the agency of the British Red Cross Society. The Borough Public Health Authority for the following - advice from the Medical Officer of Health who in addition to the numerous services under his control acts as the centre of liaison in most matters, housing accommodation for aged, removal of aged in need of care and attention (Sec. 47 National Assistance Act), fumigation and disinfestation services where necessary, Soiled linen laundry for incontinent aged, use of slipper baths at reduced price. Cleansing of Soiled Articles During the year 412 bundles of articles were collected for cleansing under the terms of section 84 of the Public Health Act, 1936. The demand was lower than in previous years, 30 persons receiving help, although only four were doing so at the end of the year. The highest number of cases being assisted at any one time was 16 and there is no doubt that this service meets a very real need. 41 42 GENERA L MEDICAL EXAMINATION OF STAFF Sixty-nine persons were medically examined to determine their fitness for acceptance on the permanent staff; all but five 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. 87 persons were examined, 85 of whom were accepted for the scheme. 7 examinations were carried out for other purposes. MASSAGE AND SPECIAL TREATMENT Part XII of the Middlesex County Council Act, 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 has been found during inspections carried out in the year and generally speaking the standard maintained is good. Licences were issued in respect of 20 premises. The following summary shows the numbers licensed for each form of treatment. Massage 6 Chiropody 20 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. 43 DISEASES OF ANIMALS F. G. Buxton, Esq., M. R. C.V. S., the Council's Veterinary Inspector, has kindly supplied me with the following information:- Ten 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. Ten 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. 2 at Pet Shop - 69 Turnpike Lane. 1 at Pet Shop - 367 Archway Road. 1 at Pet Shop - 48 Stroud Green Road. There were no outbreaks of Fowl Pest. No action was necessary under the Tuberculosis Order of 1925. Twelve certificates were issued for animals and birds going abroad and blood tests taken in two cases as authorised by the Ministry of Agriculture Fisheries and Food. 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 six bodies, men of 29, 60, 64 and 68 years, a woman of 80 years and a stillborn female child found in Queen's Woods. PUBLIC MORTUARY The Hornsey mortuary and post-mortem room are situated at the Central Depot, Hornsey High Street. During the year 122 bodies were admitted and post-mortem examination carried out on all. Inquests were held on 13 bodies. 44 ACCIDENTAL DEATHS In Hornsey during the year 595 persons were injured on the roads, 7 of whom were killed. Of the injured 17 were under 5 years of age and 46 over 65 years. The older age group, however, included 4 killed and 16 seriously injured, which as may be expected is proportionately higher than in the other groups. Two persons under 30 years were killed in motor cycle accidents and one of 37 in a car crash. No other fatal accidents occurred to persons under the age of 70 years. Hornsey residents killed on the roads were five from motor vehicle accidents and all were over the age of 65 years. During the same period 9 fatal accidents occurred to Hornsey residents in or around the home. No information is available regarding non-fatal home accidents, many of which are not recorded as such, but it much not be forgotten that nationally these accidents cause more deaths than road or industrial accidents. The following tables show fatal road and home accidents in the Borough during 1960. ROAD ACCIDENTS Fatal Serious Slight Totals 0-5 - 4 13 17 5-15 - 13 57 70 15 - 65 3 71 383 457 65 - 4 16 26 46 Age not given 5 5 FATAL HOME ACCIDENTS 0 - 1 5 15-65 65 & over Coal gas poisoning - 1 - Other poisoning - 1 - Falls 1 1 3 Other accidents - 2 - PETROLEUM SPIRIT The number of establishments licensed for storage is 69 and the number of licences issued is as follows:- Petroleum 60 Cellulose 15 Hydro-carbon 2 Total 77 (Seven establishments are licensed for more than one product) 45 VITAL STATISTICS Area (acres) 2,871 Area of Parks and Open Spaces (acres) 576 Population: Registrar General's estimate at 30 June, 1960 96,570 Number of separately assessed dwellings 1st April, 1960 24,828 Rateable value (General Rate) at 1st April, 1960 - £1, 542, 566 Product of a penny rate 1960-61 (estimated) £6,340 TOTAL LIVE AND STILL-BIRTHS 1,926 LIVE BIRTHS M. F. Total Legitimate 896 815 1,711 Illegitimate 96 88 184 j Illegitimate live births per cent of total of live births 9.7% Birth Rate (live births per 1, 000 populat ion) HORNSEY 19.6 Area Comparability Factor 0. 94 Adjusted Rate for Hornsey 18.4 England and Wales (provisional) 17.1 Middlesex County (adjusted rate) 1E. 4 STILL-BIRTHS M. F. Total Legitimate 9 15 24 Illegitimate 4 3 7 Still-birth Rate (per 1,000 total live and still-births) HORNSEY 16.0 England and Wales (provisional) INFANT DEATHS (under 1 year of age) M. F. Total Legitimate 20 14 34 Illegitimate 2 - 2 46 Infant Mortality Rates (per 1,000 live births) HORNSEY: Legitimate 19.9 Illegitimate 10.9 Total 19.0 England and Wales (provisional) 21.7 Middlesex County 18.6 NEO-NATAL DEATHS (under 4 weeks of age) M. F. Total Legitimate 13 12 25 Illegitimate 2 - 2 Neo-Natal Mortality Rates HORNSEY 14.2 England and Wales (provisional) 15. 6 Early Neo-Natal Deaths (under 1 week of age) M. F. Total Legitimate 12 11 23 Illegitimate 2 - 2 Early Neo-Natal Mortality Rates Legitimate 13.4 Illegitimate 10.9 Total 13.2 PERI-NATAL DEATHS (early neo-natal deaths plus still-births) M. F. Total Legitimate 21 26 47 Illegitimate 6 3 9 Peri-Natal Mortality Rates (per 1,000 total live and still-births) Legitimate 23.5 Illegitimate 47.1 Total 29.1 47 MATERNAL MORTALITY RATES (per 1, 000 total live and still-births) HORNSEY Nil Middlesex County (7 deaths) 0.20 England and Wales (310 deaths) 0.39 DEATHS FROM ALL CAUSES Males 529 1,111 Females 582 Death Rate (per 1,000 population) HORNSEY 11.5 Area Comparability Factor 0.89 Adjusted Rate for Hornsey 10. 2 England and Wales 11.5 Middlesex County (adjusted rate) 11.1 48 49 DEATHS OF HO RNS E Y RESIDE NTS - Classified according to age groups and sexes Under 1 year 1 to 4 5 to 14 15 to 24 25 to 44 45 to 64 65 to 74 75 and over TOTALS 1 Tuberculosis, respiratory M . . . . 1 1 4 . 6 7 F . . . . . 1 . . 1 2 Tuberculosis, other M . . . . . . . . . . F . . . . . . . . • • 3 Syphilitic disease M . . . . . . . . . . F . . . . . . . . . . 9 Other infective and parasitic diseases M . . . . . 2 . . 2 3 F . . . . 1 • . . 1 10 Malignant neoplasm, stomach M . . . . 4 9 5 18 32 F . . . . . 4 5 5 14 11 Malignant neoplasm, lung, bronchus M . . . . 3 21 11 8 43 54 F . . . . 1 4 4 2 11 12 Malignant neoplasm, breast M . . . . . . . . . 21 F . . . . . 12 4 5 21 13 Malignant neoplasm, uterus M . . . . . . . . . 10 F . . . . 1 2 4 3 10 14 Other malignant and lymphatic neoplasms M . . . . 5 20 13 24 62 125 F . • 1 . 2 13 20 27 63 N.B. - No deaths occurred from the following causes:- 4 Diphtheria; 5 Whooping Cough; 6 Meningococcal infections; 7 Acute poliomyelitis; 8 Measles. 50 Deaths of Hornsey Residents - continued Under 1 year 1 to 4 5 to 14 15 to 24 25 to 44 45 to 64 65 to 74 75 and over TOTALS 15 Leukaemia, aleukaemia M . . . . . 3 . 3 4 F . . . . • • 1 1 16 Diabetes M . . . . . . 1 . 1 8 F . . . . 1 1 1 4 7 17 Vascular lesions of nervous system M . . . . . 10 10 25 45 131 F . . 1 1 . 10 14 60 86 18 Coronary disease, angina M . . . . 3 51 27 47 128 242 F . . . . . 10 26 78 114 19 Hypertension with heart disease M . . . . . 2 4 7 13 31 F . . . . . 1 1 16 18 20 Other heart disease M . . . . 2 7 27 36 109 F . . . 1 1 6 11 54 73 21 Other circulatory disease M . . . . . 3 6 9 18 44 F . . . . . . 5 21 26 23 Pneumonia M 4 . . . . 2 2 19 27 55 F 2 1 . . . 1 6 18 28 24 Bronchitis M 1 . . . . 10 12 14 37 52 F . . 1 . . . 2 11 15 25 Other diseases of respiratory system M . . . . 1 2 . 3 6 10 F . . . . • 1 . 3 4 N.B, No deaths occurred from the following cause:- 22 Influenza. 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 . . . . . . 1 1 3 5 11 F . . . . . . . • 6 6 27 Gastritis, enteritis and diarrhoea M 1 . . . . . 1 1 . 4 7 F . . . . . . 1 • 2 3 28 Nephritis and nephrosis M . . . . . . 3 1 . 4 10 F 1 . . . . 1 1 1 2 6 29 Hyperplasia of prostate M . . . . . . . 3 5 8 8 F . . . . . . • • • • 31 Congenital malformations M 2 . . . . . 3 . . 5 8 F 1 . . . . . . • • 3 32 Other defined and ill-defined diseases M 14 . . . . 1 7 7 7 36 92 F 10 . . . . 2 6 6 32 56 33 Motor vehicle accidents M . . . . . . . 3 . 3 5 F . . . . . . • • 2 2 34 All other accidents M . . . . 2 3 2 . . 8 16 F . . . . . 1 1 4 2 8 35 Suicide M . . . . 2 3 2 2 2 11 16 F . . . . 1 . 2 . 2 5 TOTALS M 22 . . 1 5 20 149 127 205 530 F 14 1 . 3 5 12 77 114 356 581 36 1 . 4 10 32 226 241 561 1111 N.B. - No deaths occurred from the following causes:- 30 Pregnancy, childbirth, abortion, 36 Homicide and operations of war. 51 INFANT DEATHS CLASSIFIED ACCORDING TO AGE AND SEX AGE AT DEATH Under 1 day 1- 6 Days l Week 2 Weeks 3 Weeks Total under 4 Weeks 1-2 Months 3-5 Months 6-11 Months Total under 1 Year Pneumonia M . . . . 1 1 1 1 1 4 F . 1 . 1 • 2 • . • 2 Bronchitis M . . . . . . . 1 . 1 F . . . . . . . . . • Gastro-Enteritis M. . . . . . . 1 . . 1 F . . . . . . . . . . Spina Bifida and meningocele M . . . . . . . . . . F . . . . . . 1 . . 1 Congenital malformations of heart M . . . . . . . 1 . l F . . . . . . . . . . Other congenital malformations M . . . . . 1 . . . l F . . . . . . . . . . Injury at birth M . 1 . . . 1 . . . l F 1 1 . . . 2 . . . 2 Post-Natal Asphyxia and Atelectasis M 5 2 . . . 7 . . . 7 F 2 . . . . 2 . . . 2 Immaturity M 4 1 . . . 5 . . . 5 F 2 3 . . . 5 . . . 5 All other Causes M . . . . . . . . . 1 F 1 . . . . 1 . 1 . 2 TOTALS M 10 4 . . 1 15 2 3 . 22 F 6 5 . 1 . 12 1 1 . 14 16 9 . 1 1 27 3 4 2 36 52 AREA PERSONAL AND SCHOOL HEALTH SERVICES HORNSEY AND TOTTENHAM (Joint Population 211,600) The tables are for the Area as a whole except where stated for Hornsey only 53 MEMBERS OF THE LOCAL AREA COMMITTEE AS AT 31st DECEMBER 1960 MEMBERS OF HORNSEY BOROUGH COUNCIL Councillor Miss O. R. ANDERSON, J.P. ,, Mrs. J. CARTER ,, Mr. L. HAYWARD ,, Mr. D. H. P. LEVY ,, Mr. J. T. WILKINS (Chairman) MEMBERS OF TOTTENHAM BOROUGH COUNCIL Alderman Mr. A. REED, A. C.I.I., J. P. ,, Mrs. A. F. REMINGTON, J. P. Councillor Mrs. L. P. HARRINGTON, J. P. (Vice-Caalrman) ,, Mr. H. LANGER, J. P. ,, Mrs. A. A. MILLER ,, 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. POSNER (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 54 HORNSEY DIVISIONAL EDUCATION COMMITTEE Alderman F. H. BAILEY, J.P. Councillor Mrs. K. M. ST.P. CRUMP " D. F. W. BILLINGS LEY (Chairman) M. W. BURNS, D.L., " V. P. GELLAY, B.Sc. K.S.G. (Vice-Chairman) " Mrs. B. M. GREENING " Lt. Col. F. C. CAVE, " C. P. F. JENKIN, M.A. C.B.E., T.D., J.P. " P. M. KING, M.A. N. MULDOON, J.P. " B. J. MCBRIDE " G. WATSON " N. A. MULDOON Councillor Miss M. M. BARRIE " F. NEUNER " A.N. CAMMOCK " D. P. SALINGER B.M., B.Ch.j D.L.O. " T. W. WILKINS Mrs. J. M. CARTER " A. 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. C. J. ETTINGER, 24b Shepherds Hill, N.6. Rev. W. S. KEMBLE, M.A., The Rectory, 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., 26 Park Farm Close, East End Road, N. 2. County Councillor Mrs. J. THEXTON, 72 Oakfield Road, N.4. 55 CARE OF MOTHERS AND YOUNG CHILDREN (Section 22) Notification of Births The following table shows the births notified during the year compared with previous years. The number notified last year was the highest for eight years and the percentage of hospital confinements was 79.6% compared with 81.7% in 1959. 1960 1959 1958 Live Births (a) Domiciliary 799 649 708 (b) Hospital or Nursing Home 3084 2881 2799 Still Births (a) Domiciliary 3 4 6 (b) Hospital or Nursing Home 55 49 59 3941 3583 3572 Maternity Services During 1960 the report of the Cranbrook Committee on the Maternity Services of the country continued to influence those administering maternity care. Many of its recommendations have not yet been implemented and there is cause for disappointment in the rate of improvement in the services. The report recommended that sufficient hospital maternity beds should be provided for a national average of 70% of all births to take place in hospital. In this Area we have 80% institutional confinements (hospital and nursing home) and still our greatest problem is lack of hospital beds. It is an unfortunate fact that hospitals appear so overwhelmed with numbers applying for booking that on occasions they are even forced to refuse admission to a mother whom they know to be a special medical risk during delivery. In the case of applications for admission on social grounds, e.g. where the house is considered unsuitable for a confinement, unless the request is made in the very early months of pregnancy it is common for the application to be refused. Our domicilary midwives frequently have to conduct deliveries in small singly-rented furnished rooms where bathrooms and kitchens are shared by several other tenants and where other children of the family have to be taken into a neighbour's room temporarily while the delivery takes place. Sometimes it is possible to arrange for admission to hospital through the Emergency Bed Service once labour has started but this is unsatisfactory for all, since the hospital has no prior knowledge of the mother and the mother is left in a state of indecision until the very last moment. 56 . To deal with this main problem and many others, special Maternity Liaison Committees have been formed where representatives of the three branches of the health service; hospitals, general practitioners and the health department can meet for discussions. Our department is represented on the North Central London and on the North Middlesex Liaison Committees. Both these have met twice in 1960 and it is hoped that their influence will make itself felt in the future. Ante-natal Clinics These clinics show no decline in numbers and continue to be busy sessions at almost all the centres. This is contrary to the experience in many parts of the country where local authority antenatal clinics have tended to fall away as general practitioners have taken a renewed interest in caring for their pregnant patients. The majority of patients attending doctors' sessions at the centres are booked for hospital confinement. They are saved frequent long journeys to the hospital by receiving attention locally in the intermediate months of pregnancy. All the centres now have midwives' sessions, apart from the doctors' sessions, where those expecting domiciliary confinements are examined by the midwife who is likely to be present at the birth. Wherever possible, patients expecting to be confined at home are encouraged to book a general practitioner to attend them for the pregnancy and birth but where they do not do this the mothers have two or three supervisory examinations by the clinic doctor. In Hornsey the majority of patients are booked for confinement at the Alexandra Maternity Home. The ante-natal care for these patients continues to be undertaken entirely by the local clinics. The matron of the Home knows all the Hornsey health visitors personally, which makes co-operation much easier. In the course of the year further improvements have been made in the system of exchanging information with the Home. The percentage of expectant mothers making at least one attendance at one of the local authority ante-natal clinics was 61.3% in 1960 compared with 63.6% the previous year. The following tables give details of attendances at ante-natal clinics, midwives clinics and mothercraft clinics during the year: Mothercraft and Relaxation Classes An additional class was commenced during the year at Mildura Court Centre, Hornsey. Both the health visitor and the midwife take part in the classes held at this Centre. 57 This totals eight weekly classes held in various welfare centres within the Area. 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 74 248 115 1553 115 22.5 Church Road 72 157 65 1015 65 15.0 Fortis Green 99 224 128 1927 132 20.8 Hornsey Town Hall 150 404 177 2862 182 20.3 Mildura Court 66 219 98 1543 100 24.9 Stroud Green 52 157 59 915 59 18.7 The Chestnuts 155 426 185 2832 186 19.5 Lordship Lane 151 301 135 1979 135 14.0 Park Lane 104 280 120 1525 120 15.8 Totals 923 2416 1082 16151 1094 18.7 Midwives clinics No. of sessions held Total No. of attendances Average attendance per session Burgoyne Road 23 193 8.4 Fortis Green 21 126 6.0 Hornsey Town Hall 21 311 14.8 Mildura Court 17 131 7.7 Stroud Green 24 225 9.4 Park Lane 83 349 4.2 Total 189 1335 7.1 Mothercraft clinics No. of sessions held No. of new cases Total attendances Average attendance per session Burgoyne Road 42 55 317 7.5 Church Road 46 50 213 4.6 Fortis Green 46 95 450 9.8 Hornsey Town Hall 49 141 664 13.6 Mildura Court 45 38 228 5.1 The Chestnuts 51 61 349 6.8 Lordship Lane 50 62 435 8.7 Park Lane 51 43 282 5. 5 Total 380 545 2938 7.7 58 Infant Welfare Clinics The clinics continue to be appreciated particularly by the young mothers of the Area and attendances have been much the same as in previous years. A considerable amount of the health visitor's time is spent with the mothers of very young babies who attend frequently in the early weeks until they have gained confidence in handling their own child. The need of a mother for re-assuring support and advice during the early weeks following the birth of her child is apparent to everyone working in the clinics. At this time the mother may be faced with a physiological mild depression following the birth as well as with the new baby. Visits are usually less frequent as the baby gets older but often the problems presented are more serious. In some cases the staff at the clinics find medical defects in the child, of which the mother was unaware, and they arrange for treatment to be carried out. Far more often, however, they find themselves reassuring mothers that certain suspected defects in the baby are within normal limits and that there is no need for them to seek treatment. This happens in cases of alleged tongue-tie, mild forms of umbilical hernia, certain types of naevi (birth marks) and mild forms of flat feet; all of which can occur for a short time in healthy children. Another trend towards a reversal in recent practice is seen in the advice given on certain behaviour disorders. The staff in recent years has worked hard to persuade mothers to take a more understanding and lenient attitude towards, for example, sleep problems, food refusal, and toilet training. Some mothers have conscientiously taken this a little too far and seem afraid to make even the mildest regulations for their babies, letting them do exactly as they please at all times. So now the clinic staff have to urge the introduction of some order and discipline in an increasing number of cases. All babies attending the clinics continue to have urine tests for phenylketonuria (a sign which shows that the child has an inborn error of metabolism which can lead to mental disorder) but in spite of the large number tested no case has, as yet, been confirmed. Toddlers Clinics The clinics are held mainly by appointment. Cards are sent to the mothers at about the time of the child's birthday and at sixmonthly intervals inviting them to bring their children between the age of two and five for routine medical inspection. Time is also available for any mother who wishes to come with her young child without appointment and for those where more frequent examinations are considered advisable. Almost all the children are seen by the doctor and the interviews are unhurried particularly where problems discussed relate to behavious disorders. At this age considerable 59 patience and adaptability is required to gain a child's confidence. Often every approach is resisted at first and then when the toddler's cooperation is finally won it is almost as difficult to persuade him to leave. Many children are found to become bored and difficult especially in their fourth year when their brothers and sisters are all at school and there is insufficient playing space at home. Many of them would benefit from admission to nursery schools or nursery classes but these are in such short supply that there are long waiting lists for entry. Usually the foresighted parents who get their children's names on to waiting lists early are not the ones in the most need and it happens that a child before reaching compulsory school age urgently requires to spend some part of the day in school and no place can be found for him. The teeth are always examined and it is not infrequent to find that dental caries appears in two to three year olds. Cases are referred for dental treatment and advice is given on teeth-cleaning and the dangers of too much sweet eating together with the importance of conserving the teeth in early life. Much time is also spent on children's feet. Where definite abnormality exists referral is made for orthopaedic advice but more often there is discussion on suitable shoes and shoe-fitting. Daily Guardian Scheme There has been an increase in the number of children minded by the day under this scheme as can be seen from the following table Number of Daily Guardians on register 197 Number of Daily Guardians minding Children 111 Number of Children being minded 141 Total number of Children minded during the year 297 Total number of days minded 29,128 The number of women who offer their services has always exceeded the demand. The scheme is in operation for those working mothers who ask for assistance in finding suitable daily minders for their children. It has proved to be a very useful service for those who do not qualify for day nursery admission. There are proper safeguards including the selection, registration and visiting of daily guardians by health visitors. The cost of payments made to daily guardians by the County Council is based on one shilling per day per child for each working day on which the child is minded. Parents make their own arrangements direct with the daily guardian for payment in excess of this. Amounts charged vary considerably throughout the Area as do the services provided. 60 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 154 371 5360 691 214 6265 1527 40.7 Church Road 208 269 3480 561 113 4154 1694 20.0 Fortis Green 149 399 4102 594 119 4815 1828 32.3 Hornsey Town Hall 204 544 6217 857 244 7318 3038 35.9 Mildura Court 104 269 3636 598 33 4267 1547 41.0 Stroud Green 106 260 2808 325 147 3280 1355 30.9 The Chestnuts 202 633 6456 814 154 7424 2459 36.8 Lordship Lane 247 408 5104 1081 309 6494 1532 26.3 Park Lane 207 364 4538 1134 276 5948 1613 28.6 Somerset Road 148 265 3529 834 270 4633 1210 31.3 Totals 1729 3782 45230 7489 1879 54598 17853 31.6 TODDLERS' CLINICS Centre Sessions held Total attendances Cases seen by M. O. Average attendance per session Burgoyne Road 26 480 480 18.5 Church Road 22 358 322 16.3 Fortis Green 28 432 432 15.4 Hornsey Town Hall 59 705 705 11.9 Mildura Court 49 694 621 14.2 Stroud Green 24 335 326 14.0 The Chestnuts 51 726 726 14.2 Lordship Lane 52 759 757 14.6 Park Lane 23 222 222 9.7 Somerset Road 39 475 474 12.2 Totals 373 5186 5065 13.9 61 Day Nurseries The number of daily attendances at the three day nurseries has increased this year and is accounted for by the rise in numbers at Park Lane Nursery. All three nurseries are recognised by the Ministry of Health as suitable for training nursery nurse students who take the two-year course for the National Nursery Examination Board's examination. This course provides practical work in day nurseries and theoretical teaching at the Tottenham Technical College. All qualified members of the day nursery staff assist in the practical training of student nursery nurses and in the care of normal children. The nursery day is a long one to enable working mothers to leave their children before they start work and to collect them at the end of their working day. Day nursery vacancies are allotted to children in certain priority groups. The largest of these is one where the mother is the sole wage earner. 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 ance Under 2 2 - 5 Under 2 2 - 5 Under 2 2 - 5 Total Stonecroft 15 43 18 43 3342 9050 12392 48.6 Park Lane 20 30 11 40 2880 6105 8985 35.2 Plevna 20 30 23 29 4668 6118 10786 42.3 Totals 55 103 52 112 10890 21273 32163 126.1 Handicapped Children A few handicapped children have been admitted to the nurseries during the year. In each case there has been medical recommendation for day nursery accommodation. Three of these have qualified in accordance with the categories of such children dealt with under Section 56 of the Education Act 1944 for the maintenance of which the Education Committee accepts responsibility. Five others have not been accepted under this provision since they fit in to types of handicap which do not qualify, and therefore admitted on health grounds under Section 22 of the National Health Service Act. This means that the parents in the latter case are assessed for payment or pay full cost. Three of the five children referred to above were found to be mentally retarded and two with a physical handicap resulting from poliomyelitis. 62 Nurseries and Child Minders Regulation Act 1948 The supervision of private day nurseries and child minders under these regulations continued throughout the year. Inspections were carried out at two to three monthly intervals, giving special attention to the provision of plentiful accommodation for activity both indoors and out, adequate numbers of staff, and suitable safety measures to avoid accidents. All new applications for registration were inspected in the company of a member of the County Architect's staff who advised on structural alterations and repairs. The following premises or persons were registered at the end of the year:- Private Day Nurseries Woodlands Nursery School 12 children 2-5 years mornings only Fortis Green Nursery 24 children 2-5 years all day Greygates Nursery 39 children 0-5 years all day Child Minders Mrs. Stringer, 101, Crouch Hill, N.8. 12 children 2-5 years mornings only Mrs. Kruger, 38, Crouch Hall Rd., N.8. 8 children 0-5 years all day Mrs. Barnard, Moravian Church Hall, Priory Road, N. 8. 16 children 2-5 years mornings only Mrs. Summers 53 Mount View Rd., N.4. 9 children 2-5 years mornings only Mrs. Watson, 7, Jackson's Lane, N. 6. 10 children 2-5 years mornings only Mrs. Best, 9 children 57, Collingwood Avenue, N. 10. 2-5 years mornings only Mrs. Wigley, 46, Onslow Gardens, N.10. Mrs. Keith, 2, Linzee Rd., N. 8. Not taking children at present Miss Hermitage, 28, Bedford Road, N.15. During the course of the year three new registrations were approved by the Committee and one was not approved. Four registrations have been withdrawn as the owners have discontinued their service. 63 Distribution of Welfare Foods The arrangements for issuing welfare foods were substantially the same as in the previous year. National Dried Milk (tins) Orange Juice (bottles) Cod Liver Oil Vit. (bottles) A & D Tabs. (packets) 1960 32910 99584 12790 12213 1959 36350 98855 11676 11048 1958 39005 104980 12571 10420 Priority Dental Service for Mothers and Young Children The dental officers have devoted 7% of their time to the inspection and treatment of the priority classes. There has been a slight increase in the number of expectant and nursing mothers inspected, compared with 1959, with a corresponding increase in the various forms of treatment. Although in respect of the children under five there has been a small reduction in inspection, the amount of conservative work carried out was larger. The average number of fillings and silver nitrate dressings per child treated was three, and extractions 0.95. A great need exists for dental health education, and a valuable opportunity is afforded when dealing with these mothers and young children. The following table gives details of attendances made and treatment given at all clinics during the past two years:- 64 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:- 1960 1959 Expectant & Nursing Mothers Children under 5 Expectant & Nursing Mothers Children under 5 No. examined by dental officer 162 539 131 572 No. referred for treatment 160 459 127 467 New cases commenced" 149 351 127 421 Cases made dentally fit 46 176 55 178 Forms of dental treatment provided: - Teeth extracted Anaesthetics:- 243 334 159 369 (a) Local - - 68 26 (b) General 81 179 24 156 No. of fillings 249 628 220 474 No. of inlays 2 - - - Scalings and gum treatment 133 - 90 - Silver nitrate treatment - 440 - 478 Dressings - - 114 162 Other operations 240 151 10 1 No. of radiographs (a) at County Council clinics 21 1 16 2 (b) at hospital - - 1 - Denture dressings - - 163 - Dentures fitted: - (a) full 24 - 16 4 (b) partial 28 5 32 - No. of attendances 736 1061 588 872 No. of appointments not kept 208 216 138 199 No. of half days devoted to treatment 194½ 155 65 MIDWIFERY SERVICE (Section 23) The problem of recruiting new midwives continues to be a main anxiety in the Service. We have been fortunate in appointing four new midwives during the year, one of whom is now accommodated in a municipal flat rented by the County Council, specifically for a midwife, from the Tottenham Borough Council. It was a disadvantage to recruitment that this flat was not available for a part of the year as the resigning midwife (with two young children) had several delays and setbacks in finding other accommodation. Every year there are some changed in the staff to which attention is drawn in the report, but a special tribute should be paid to the midwives who have been with us for many years and who continue to give loyal and devoted service. They form the backbone of the service and have a very high standard of skill and dependability. They seem to be at their best during periods of special pressure through which every midwifery service passes, working tirelessly and cheerfully until the stress is over. All the midwives now take part in ante-natal sessions at the centres whenever their duties allow. In future it is hoped to arrange for a midwife to be present at general practitioners' antenatal sessions, but it is envisaged that this will only be possible where there will be a sufficient number of patients to make this a justifiable use of the midwife's time. Co-operation between midwives and general practitioners continues to be excellent. Especially the long service midwives have come to know the doctors in their district very well and can work truly as a team. The minimum number of days after delivery on which the midwife must visit the patient has been reduced from fourteen days to ten days, by the Central Midwives Board. This is generally considered quite a safe alteration to the usual practice and has relieved the midwife from some unnecessary duties. However, there is still much pressure of work on the midwife. Each one of our staff has done more deliveries than the number recommended. The following table shows the work for the past year:- 1960 Number of deliveries attended 792 Number of visits made 15223 Number of hospital confinements discharged before 14th day 143 Number of visits made 1288 Number of cases in which medical aid was summoned 282 Number of cases in which gas and air analgesia was administered 508 Number of cases in which pethidine was administered 481 Number of cases in which gas and air and trichloroethylene were administered 32 66 HEALTH VISITING SERVICE (Section 24) The follow-up of the newly born after their discharge from hospital with their mothers on the tenth day of puerperium or earlier is still a very important part of the work of the health visitor. Additionally, also, the health visitor now follows up those mothers confined at home earlier than formerly (i. e. on the eleventh day instead of the fifteenth). It is commonly found that this visit is very much welcomed and appreciated and in many cases is the basis on which the relationship between health visitor and mother and baby is formed. The health of mother and baby is very much in the balance at this stage and often causes the health visitor to make a number of visits to give the mother the advice and support she needs to ensure the well-being of herself and the child during the first year. The value of this type of home visiting cannot be over-estimated and where it does not exist the work of the midwife may well be wasted. Much has been said about selective visiting of one kind and another according to the need of the family. It has been our experience, however, that so much hangs on the first and subsequent visits in the early life of the child that this type of visiting cannot be omitted and is regarded as being essential in nearly every case. Toddlers clinics to some extent have helped to reduce the number of visits paid to children in the two to five age group. The number of toddlers visited because they are placed for daily minding has increased. This is partly because there are more women offering themselves for daily minding to meet a known demand and also to see children placed with them for daily minding. Some women also have been reported as minding more than two children without being registered. Special visits have been made, therefore, to acquaint them of their legal responsibilities in this matter. Some of the latter have not wished to be known to the local authority as they were unlikely to be registered. Attendances at Toddlers clinics have also increased and these clinics prove to be popular with children and with parents. The idea of periodic overhaul for health appears to have appealed to most parents of children in this age group. Campaigns and Research Surveys Health visitors have been engaged in some special activities during the year to assist with surveys such as "The National Survey 67 on the Health and Development of Children" promoted by the Population Investigation Committee Institute of Child Health, University of London and the Colour Blindness in Girls Ovarian Agenesis Survey promoted by the Department of Health, Guy's Hospital. The vision of girls in the intermediate age group has been tested by the Ishihara Method by health visitors and school nurses as part of the preparation for routine medical inspection. Material obtained from this Survey has been passed to the County Council for forwarding. Phenylketonuria Survey of all live births - this has involved the testing of urine of each new baby unless the tests have been completed elsewhere. Two suspected cases were found but on further investigations proved to be negative. The procedure connected with the survey of newly born infants and phenylketonuria still continues as a routine test. Parents have proved to be interested and co-operative. Campaigns As part of their duty to inform the public on matters relating to or associated with health, health visitors/school nurses have taken part in publicising national and local campaigns on Accidents in the Home, Appeals for Blood Donors, Mass X-ray, Smoking and Lung Cancer, Mental Health, etc. Visual evidence of these which catch the eye of adults and children, such as flannelgraphs, posters and leaflets, have been displayed in the clinics to coincide with the timing of the campaigns. A very important part of the health visitor/school nurse's work is the teaching of parentcraft and home-making to individuals in their own homes and in schools. Married health visitors both fulltime and part-time are being recruited to the Area and this has made it possible to keep up the number of health visitors on our establishment and to maintain the standard of the Health Visiting Service. Health Visiting and Mental Health Health visitors' contribution to mental health has been mainly in supporting families in their day to day troubles and difficulties, in listening to a great many apparently small matters and in guiding parents towards their own solutions to problems and in encouraging them to act upon them. In the two Boroughs of Hornsey and Tottenham a great many people themselves seek out the health visitor by visiting her at the welfare centre or by telephoning her there to make an appointment for a home visit. This early effort to talk over some particular problem does much to attenuate it and to relieve anxieties before the difficulty expands to larger proportions. Some troubles relate to the care of the family during hospital confinement, 68 the feeding and care of young children, the minding of school children until parents return from work, school children getting "out of hand", housing difficulties, discharges from hospital, the care of the elderly, and matters causing trouble such as marital relationships and disharmony within the family. Social workers in other local authority or voluntary services have given full co-operation when requested. There is generally a very cordial relationship with all types of social welfare workers throughout the area. Special Services for Problem Families The most difficult cases taken over by the special services health visitors have been those where one or both parents were either of sub-normal intelligence or unstable. Family doctors and hospital psychiatrists have given considerable support and advice to health visitors in such cases. This triad of health visitor, family doctor and psychiatrist seems to be an intrinsic combination in dealing with early signs of breakdown or other psychiatric disturbance including those of long-standing. Mental Welfare Officers have taken over some in emergency and have referred back a few cases to the health visitor but these have proved to be very few numerically. It has been interesting to examine the sources of referrals of problem families to the special services health visitors. By far the largest number were brought forward by health visitors themselves. The remainder were reported by various local authority departments, by probation officers, almoners and family doctors. Before a particular case is accepted by the special services health visitor the health visitor for the district on which the family lives is consulted. Between them they decide whether the case is urgent and needs intensive work or can be carried by the health visitor. This act of selection is important in the interest of really urgent problems and to prevent the overloading of the special services health visitor's case load. The close contact between the specialist and other health visitors has been most rewarding in temporarily relieving health visitors of certain families until intensive work has been completed and in providing the specialist worker with background knowledge of the case and a constant field worker to whom the family can be returned. Mental Health Case Conferences Mental Health Case Conferences have been attended at the Prince of Wales's Hospital each month. Health visitors discussed a variety of cases with Dr. Sawle-Thomas, Consultant Psychiatrist. 69 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:- 1960 1959 Expectant Mothers First Visits 2084 2285 Total Visits 3436 3511 Children under 1 year of age First Visits 4837 4234 Total Visits 15295 16056 Children aged 1-2 Total Visits 7090 8101 Children aged 2-5 Total Visits 11526 13202 Other cases - Total Visits as Health Visitor 6219 6246 - Total Visits as School Nurse 776 878 HOME NURSING SERVICE (Section 25) The treatment of cases during the year may be classified as follows:- Injections 911 General Nursing care 476 Blanket baths 254 Enemas 143 Dressings 309 Preparation for diagnostic investigation 224 Pessaries changed 59 Wash-outs, douches, etc. 37 Attendance at minor operation 1 Other treatments 52 70 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 32 32 5-15 36 30 16 - 39 59 150 40 - 64 248 398 65 and over 459 1022 834 1632 Cases attended during the year were referred from the following sources:- General Practitioners 1759 Hospitals 672 Chest Physicians 17 Public Health Department 3 Direct 15 The work of the service has continued throughout the year without any significant change in the character or the amount of work undertaken and the staff has been maintained at near establishment level without undue difficulty in recruitment. Investigation into the use of Silicone During the months of January, February and March the nurses took part in as investigation into the prevention of bedsores by the use of Silicone. The silicone was used by the spray method and was supplied in two strengths which were used against controls of orthodox treatment. After the results had been submitted and reports considered the manufacturers found that the stronger solution gave better results although these were not as satisfactory as was hoped. A further test has, therefore, been initiated with the silicone suspended in a new medium. Home nurses are very actively concerned with the treatment and prevention of bedsores and they are awaiting with interest the final result of this work. 71 Introduction of disposable equipment A change is rapidly taking place in the various materials used by the nurse in her daily work. Much time used to be spent packing and sterilising dressings. Pre-packed sterile dressings are now available and in general use. Caps, gowns and masks all made of paper, sterilised and packed ready for use, are on the market and making their appearance in everyday use. Plastic syringes complete with needle, sterile, and requiring no preparation before use, are also readily obtainable. All these items can be destroyed after use and it will readily be understood that these disposable goods collectively result in a considerable saving of the nurses' time and also (because of the guaranteed sterility) in a wider margin of safety for the patient. Nurses' day to day work The great increase of the past few years in the amount of drugs given by injection seems to have passed its peak and many practitioners are using more of the new drugs which are given by mouth. The influenza epidemic brought many calls but the disease seemed to be of a mild type and did not unduly overburden the service. The main work of the home nurse is still amongst the aged in the two boroughs. Old people tend to be left alone during the day and those who live entirely alone present a multitude of problems. Four nurses attended refresher courses during the year and, as in previous years, students from teaching schools have accompanied home nurses for observation visits. Co-operation with other services The working of the service generally has been helped by good relations with general practitioners, chest physicians, hospitals and the other health and welfare services within the boroughs. The British Red Cross Society continued to meet the numerous requests to provide equipment and aids for the ill and the handicapped. 72 The following table shows the work of the service during the year:- 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 578 1043 1621 131 443 574 60983 Surgical 78 100 178 21 24 45 5113 Infectious Diseases 1 5 6 - . 53 Tuberculosis 17 14 31 10 4 14 2006 Maternal Complications - 15 15 - - - 154 Others 2 2 4 " 9 Totals 676 1179 1855 162 471 633 69318 VACCINATION AND IMMUNISATION (Section 26) Vaccination against Smallpox The percentage of children under one year of age vaccinated against smallpox fell from 71.3% to 48.7% 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 949 75 38 20 77 1159 No. of Revaccinations - - 4 17 186 207 73 Immunisation against Diphtheria, Tetanus and Whooping Cough The scheme for immunising children against diphtheria, whooping cough and tetanus using a triple antigen proved very successful during 1960 which was the first year of its operation. It has called for very careful programming to fit in with other prophylactic measures and the parents of all children in the area have been offered appointments as soon as their children have reached the age of two months. There is provision for following up defaulters to achieve maximum acceptance rates. Parents have the option of taking their children to their own family doctors for immunisation or attending at the clinics, and the following tables show the results in Hornsey. Age at date of immunisation. Diph. only Wpg. Cough only Tet. only Combined Diph. & Wpg. Cough Diph. & Tet. Diph., Tet. & Wpg. Cough Number of Children who completed a full course of Primary Immunisation Under 1 344 117 13 45 7 1297 1 - 2 261 354 5 17 1 134 2 - 4 75 40 3 6 - 45 5 - 14 89 1 2 3 2 14 15 & over 1-1 - Total 770 513 24 71 10 1490 Number of Children who received a Secondary (re-inforcing) Injection ) Under 1 - - - 1 - 2 - 2 - 4 296 19 2 7 - 15 5 - 14 320 1 - 7 1 18 15 & over - - - - 1 - Total 616 20 2 14 2 33 74 Poliomyelitis Vaccination The work of vaccinating persons up to the age of 40 continued to be undertaken both by general practitioners and at the clinics. The following table shows the number of persons completing courses of injections during 1960:- Number of Persons who completed a course of:- Two Injections Three Injections Children born in the years 1943-1960 2585 8062 Young Persons born in the Years 1933-1942 1190 6157 Persons born before 1933 who had not passed their 40th birthday 2365 1255 Others 9 52 Total 6149 15526 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 1960 176 applications were received compared with 197 the previous year. Of these, 134 were approved. DOMESTIC HELP SERVICE (Section 29) The total number of cases provided with home help during the year was 1,879, the bulk of the cases comprising the chronic sick, including aged and infirm, who need more or less permanent help. The following table shows details of the cases served during the year:- 75 Cases provided with help No. of new cases provided with help No. of old cases for which help was continued from 1959 Total No. of cases provided with help during year No. of cases still being provided with help at end of year Maternity (including expectant mothers) 107 7 113 3 Tuberculosis 10 26 36 24 Chronic Sick (including aged and infirm) 594 972 1566 1108 Others 120 19 139 18 Total 855 1024 1879 1153 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 56 hours. SCHOOL HEALTH SERVICE Area School Populations The school population for the Area is 10,720 in Hornsey and 17,458 in Tottenham. This shows an overall decrease of 229 compared with the previous year. (79-2) Hornsey (85) Tottenham Primary Schools and nursery classes 5798 8654 Nursery Schools - 205 Secondary Modern Schools 3015 5760 Grammar and Technical Schools 1907 2640 Special Schools - Physically Handicapped - 94 Blanche Nevile School for Deaf - 105 10720 17458 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 Number Satisfactory % 1956 & later 179 179 100.0 1955 587 583 99.3 1954 191 189 99.0 1953 126 125 99.2 1952 173 173 100.0 1951 718 715 99.6 1950 83 82 98.8 1949 242 242 100.0 1948 667 665 99.7 1947 362 362 100.0 1946 270 270 100.0 1945 & earlier 1247 1246 99.9 Total 4845 4831 99.7 One gratifying feature of this total is that although the total number of children examined during 1960 had increased by 829 compared with the previous year, yet 7 fewer pupils were deemed to be of unsatisfactory condition. In this connection, however, the term 'unsatisfactory' applies only to the child's general physique and the referral of minor defects to the ophthalmologists, ear, nose and throat specialists and orthopaedic surgeons continued to fill the special clinics to capacity. Infectious Diseases in School Children, 1960 From the point of view of infection, 1960 was, generally speaking, an uneventful year and, as had been anticipated, measles remained relatively quiescent. Poliomyelitis. Only one case of poliomyelitis occurred in a school child during the year. This was a boy, aged six years, who was admitted to hospital on the 30th November with evidence of paralysis. On discharge from hospital, be was seen by a school medical officer who found some residual weakness in his left leg, but this has not prevented him from returning to his normal school. 77 Dysentery. From time to time throughout the year cases occurred in both boroughs but there were no explosive outbreaks in the schools. A smouldering infection in a day nursery during August had its repercussions amongst older siblings of the inmates, but the general picture is indicated by the fall in recorded cases in Tottenham from 251 in 1959 to 66 in the year under review. Tuberculosis. In the year as a whole six new cases of tuberculosis were notified in children of school age, one more than the previous year; one child developed tubercular meningitis but the remaining cases were due to pulmonary infections. Two of these children attend schools outside this Area and the source case of one of them was traced to his school in Wales. In three of the four remaining cases an adult living in the same house was found to be infected and appropriate action was taken. In the sixth case, a girl of fourteen years, the pulmonary infection was discovered as a result of a strongly positive reaction to routine Mantoux testing. As no contact could be found in the household, in consultation with the chest physician, an epidemiological survey was instituted. Sixteen of her class mates were Mantoux tested and had chest X-rays, all with satisfactory results; whilst the remainder of her class had been dealt with previously as part of the normal B.C.G. programme A similar investigation of her teachers revealed no source of infection B.C.G. Vaccination. Throughout the year the B. C. G. programme was steadily pursued and more than twice the number of children were vaccinated compared with 1959. From the following table it will be seen that for the first time students from two technical colleges were brought into the scheme; an important inovation bearing in mind the susceptibility of the adolescent to this disease. School Children Students Totals % % % Parents approached 3455 306 3761 Parents accepting 2565 74.3 146 47.7 2711 72.1 Number tested 2487 131 2618 Mantoux positive 136 5.5 38 29.0 174 6.6 Mantoux negative 2242 90.1 91 69.5 2333 89.1 Failed-to attend for 109 4.4 2 1.5 111 4.3 reading Vaccinated (% of 2122 61.4 90 29.4 2212 58.8 those approached) 78 SCHOOL DENTAL SERVICE During the year the staff position has been as follows:- 5 Full-time Dental Officers 3 Part-time Dental Officers (equivalent to 16 /ll full-time), with several changes in the first quarter of the year 1 Part-time Orthodontist (6/11 - 7/11) The vacancy caused by the illness and subsequent retirement in February of Mr. V. Sainty, Area Dental Officer, was not filled until the end of September. One full-time and one part-time dental officers are re-employed after reaching pensionable age; and we are grateful for their services, but they can only be considered as a short term policy, with doubtful prospects, of replacement. 19,438 children were inspected, and of these 60% required treatment. There is evidence that many children are receiving regular treatment through the National Health Service. The work of the department proceeded steadily during the year, and the ratio of permanent teeth filled to permanent teeth extracted as a result of disease was 9.7 : 1. 161 evening sessions were carried out and proved very popular. The orthodontic clinic continues to have a long waiting list for treatment and there is urgent need for expansion of the service, especially in Hornsey. Dental officers themselves undertook cases in 108 sessions and thereby diverted time required for their basic dental surgery duties. A disturbing fact connected with all treatments is the large and increasing number of broken appointments. They have risen each year from 19.7% in 1957 to 22.1% in 1960. It is noticeable that these are fewer where there has been continuity of staff and where the patient can depend on being treated by the same dental officer. Equally important in this matter is the dental attendant of experience. The old type of surgery is gradually being re-equipped and brought into line with modern requirements. Good working conditions are necessary if dental officer staff are to be encouraged to enter our service. It is also planned to instal five high speed air turbines in 1961. 79 DENTAL INSPECTIONS AND TREATMENT - HORNSEY Number inspected 6549 Number found to require treatment 3955 Number referred for treatment at the County Council's Dental Clinics 3935 Number of pupils treatment commenced 1949 Number of pupils treatment completed ... 1133 Number of attendances made by pupils for treatment . 5184 Number of appointments not kept 1437 Number of half-days devoted to: (a) Inspection ... 45½ (b) Treatment 795 Fillings: Permanent Teeth 2768 Temporary Teeth . 1532 Number of teeth filled: Permanent Teeth 2539 Temporary Teeth 1435 Extractions: Permanent Teeth 243 Permanent Teeth for Orthodontia ... 48 Temporary Teeth ... ... ... 1082 General Anaesthetics 725 Other operations: (a) Permanent Teeth 870 (b) Temporary Teeth 1207 Number of pupils supplied with dentures ... 16 Number of crowns or inlays 6 Number of radiographs ... ... ... 88 ORTHODONTIC INSPECTIONS AND TREATMENT - HORNSEY Number of pupils inspected . 58 Number of pupils selected for treatment 48 Number of pupils commenced treatment (first attendance) 25 Number of cases carried forward from previous year . 6 Number of cases discontinued during the year 1 Number of attendances made for treatment 767 Number of appointments not kept . 125 Number of impressions, etc. 273 Number of pupils treated with appliances 24 Number of fixed appliances fitted 2 Number of removable appliances fitted 57 Number of radiographs 51 Number of pupils treatment completed 10 Number of orthodontic sessions (half-days) 62½ 80 Ear, Nose and Throat Clinics Weekly sessions were held by Dr. F. P. M. Clarke, the visiting consultant, for Hornsey children referred for a variety of conditions both in type and degree. Despite this antibiotic era, otorrhoea still constitutes a problem and the persistent and effective treatment of this complaint is a prerequisite in the prevention of conductive deafness. Sinus infection, recurrent tonsillitis and enlarged adenoidal pads were common causes of referral from the school clinics; yet familiarity must breed no contempt in these cases for they are sources of much general ill-health and frequent school absence. The close co-operation in Tottenham between the out-patient department of the Prince of Wales's General Hospital and the local authority clinic continued under the direction of Mr. William McKenzie, F. R. C. S., with the able assistance of one of the school medical officers (Dr. Nora Webster). During the year Mr. McKenzie addressed the school medical officers on some of the ear, nose and throat problems in connection with their work and a valuable and informative discussion followed his talk. Audiology Clinic As 1959 had seen the appointment of Dr. L. Fisch as consultant otologist to the Area, so 1960 was to herald the opening of the Audiology Unit in new premises on a site adjacent to the Blanche Nevile School for the Deaf at Tottenham. The investigation and ascertainment of deafness in children, and the subsequent training and educational placement of the child is essentially a matter of team-work. It is a pleasure, therefore, to record the good relations which exist between medical officers and educational personnel in the establishment of a full audiology service. In addition to the consultant otologist, a school medical officer and an audiometrician complete the medical component of the team, whilst their educational colleagues comprise the headmaster of the school (Mr. T. N. Brown), an educational psychologist and a peripatetic teacher of the deaf. Dr. Fisch reports that the accoustic conditions of the new premises are very satisfactory and when all the equipment, which has been ordered, has been assembled, the facilities for testing the hearing of children will be as good as at any audiology clinic in the country. It has been of great advantage to have the educational psychologist present at all sessions of the audiology unit, for she can observe the clinical examination of the child and will be no stranger to him should a full psychological assessment subsequently prove necessary. An important function of an audiology unit is to establish 81 the differential diagnosis between deafness and other possible causes of communication difficulty, notably, mental retardation. In this connection, it is now the approved practice in this Area before any child is ascertained as unsuitable for education in school under the Education Act 1944, for him first to be screened at the Audiology Unit to ensure that deafness plays no part in his mental retardation. The peripatetic teacher of the deaf visits pre-school children in their own homes to provide the necessary training to ensure they gain the maximum benefit from their hearing aids and, at the same time, to give the appropriate guidance to their parents. Children at ordinary schools, recommended for auditory training by the otologist, are visited by the peripatetic teacher after consultation with Mr. Brown and the head teachers of the schools concerned. As yet the peripatetic teacher has no room of her own at the unit where she can train children and interview parents but, ultimately, it is hoped that some such provision can be made. During the year a conference of the audiometricians in the employ of the Local Education Authority was held, under the chairmanship of Dr. Fisch. The aim of this conference, at which a number of school medical officers attended, was to consider methods of training and practice to ensure a uniform standard of audiometry. Perhaps the least satisfactory part of the Audiology service is in the making of good inserts for hearing aids and in the provision of these instruments without undue delay. At the present time children, having been recommended for a hearing aid at the Audiology Unit, then have to travel to a hospital in the Central London area for the inserts to be fitted, and there may be three to four months delay between the time the need for a hearing aid is confirmed and when it is in use by the child. As one looks to the future it becomes increasingly apparent that a fully-functioning audiology unit must have provisions for taking impressions of the inserts and for issuing hearing aids at the unit itself. 82 PRE-SCHOOL CHILDREN REFERRED TO AUDIO LOGY UNIT No. Age Sex Reasons for referral F.H. Remarks Source of Referral Decision and Disposal 1 5 months M ? Deafness No - S.M.O. Hendon. Not deaf. 2 4 years 7 months M ? Deafness No Delayed speech. S.M.O. Hornsey. Probably not deaf. To nursery school. 3 3 years 1 month M ? Deafness No Delayed speech. S.M.O. Tottenham. Deaf. To nursery unit at Blanche Nevile School. 4 3 years 10 months M ? Deafness No - S.M.O. Hornsey. Probably not deaf. 5 4 months F Mother suspected deafness No - S.M.O. Hendon. Probably not deaf. 6 4 years 1 month M ? Deafness No Delayed speech. S. M.O. Tottenham. Not deaf. Backward. 7 7 months M ? Deafness No Illegitimate. S.M.O. Southgate. Not deaf. 8 4 years M ? Deafness No Delayed Speech. S.M.O. Finchley. Probably not deaf. To nursery school. 9 3 years 5 months M ? Deafness Yes Articulation defect. S.M.O. Hornsey. Not deaf. 10 4 years 11 months M ? Deafness No - S.M.O. Southgate. Deaf. For auditory training. Possibly backward. 11 2 years 1 month M Mother suspected deafness No Delayed speech. S.M.O. Tottenham. Deaf. To nursery unit at Blanche Nevile School. 12 7 months F ? Deafness Yes Delayed speech. S.M.O. Hornsey. Not deaf. To ordinary day nursery. 13 1 year 11months M ? Deafness No Delayed speech. S.M.O. Hornsey. Probably not deaf. 14 9 months M ? Deafness Yes - S.M.O. Southgate. Deaf. For auditory training. 15 4 months M ? Deafness Yes - S.M.O. Hendon. Not deaf. 16 2 years 10 months M ? Deafness No Delayed speech. S.M.O. Hendon. Deaf. To nursery unit at Blanche Nevile School. 17 2 years 11 months M Partially deaf No - Gt. Ormond St. Hospital. Not deaf. To ordinary day nursery. 18 3 years 4 months M ? Deafness No Delayed speech. S.M.O. Edmonton. Not deaf. 19 3 months F ? Deafness Yes - S.M.O. Tottenham. Probably not deaf. 20 2 years 3 months F ? Deafness Yes Aural Consultant, Tottenham. Deaf. To nursery unit at Blanche Nevile School. 21 1 year F ? Deafness Yes - S.M.O. Hendon. Deaf. For auditory training. 83 No. Age Sex Reasons for referral F.H. Remarks Source of referral Decision and Disposal 22 4 years 9 months M To exclude deafness No Screening prior to ascertainment Borough Education Officer, Tottenham Not deaf. Probably backward. 23 4 years 7 months F Partially deaf Yes - S.M.O. Southgate. To Partially Deaf Unit, Tottenham. 24 3 years 5 months F Known deaf. From Gray's Inn Road. Yes " S.M.O. Southgate. To nursery unit at Blanche Nevile School. 25 3 years 6 months F ? Deafness No Delayed speech S.M.O. Enfield. To nursery unit at Blanche Nevile School. 26 4 years 1 month M ? Deafness No Delayed speech Transfer from Gray's Inn Road. Slightly deaf. Removal of tonsils and adenoids. For I.Q. assessment. 27 4 year 6 months M ? Deafness No Articulation deaf. S.M.O. Southgate. Deaf. For auditory training. 28 9 months F ? Deafness Yes - S.M.O. Hornsey. Not deaf. 29 5 years 3 months F ? Deafness No - Whittington Hospital. Not deaf. Backward. 30 4 years 1 month F Partially deaf No - C.M.O. Hertford. To Partially Deaf Unit, Tottenham. 31 9 months F ? Deafness Yes - S.M.O. Hornsey. Not deaf. 32 1 year 5 months M ? Unilateral deafness No - S.M.O. Potters Bar. Not deaf. Backward 33 3 years 3 months M ? Deafness Yes Delayed speech S.M.O. Tottenham. Not deaf. To ordinary day nursery. 34 4 years 6 months M ? Deafness No Haemolytic disease of the newborn. S.M.O. Edgware. Partially deaf. For auditory training. 35 4 years F ? Deafness. Retarded Language development. No Maternal rubella. C.M.O. Hertford. Transfer from Gray's Inn Road. To nursery class at Blanche Nevile School. 36 4 years 9 months M ? Deafness Yes Articulation defect. Aural Consultant, North Middlesex Hospital. Not deaf. For speech therapy. 37 2 years 9 months F Known deaf Yes " S. M.O. Tottenham. To nursery unit at Blanche Nevile School. 38 3 years 5 months F ? Deafness No Delayed speech. L.C.C. For admission to nursery unit at L.C.C. school for the deaf. 39 3 years 6 months M ? Deafness No " S.M.O. Hendon. To nursery unit at Blanche Nevile School. 40 5 years M ? Deafness No Articulation defect. S.M.O. Edmonton. Not deaf. For speech therapy. 41 42 4 years 3 months 4 years 7 months F F ? Unilateral deafness. Partially deaf No No Delayed speech. Retarded speech. S.M.O. Hornsey. Transfer from Gray's Inn Road. Awaiting I.Q. assessment. To Partially Deaf Unit, Tottenham. 84 AUDIOLOGY UNIT, 1960 Number of children seen 154 Pre-school children 42 Attending infant & junior schools 74 Attending senior schools 34 Over 5, but not at school 4 Reason for referrals among these 120 children were as follows: - For diagnosis 79 Immigrants to Area known to 4 be deaf Partially deaf children, advice as 6 to placement Children known to be deaf - 11 application for admission to nursery class, Blanche Nevile School or partially deaf unit Transfer from hospital out- 19 patient departments Advice as to placement where 1 deafness might be the cause of backwardness Source of Referrals:- Tottenham and Hornsey 83 Other boroughs in Middlesex 31 London - neighbouring boroughs 2 Hertfordshire 3 Essex 1 Vale Road School for Physically Handicapped Children Cerebral Palsy Unit During the year 25 children suffering from cerebral palsy were cared for at the Vale Road Day Special School for Physically Handicapped Children, Tottenham. The visiting consultant (Dr. William Dunham) exercises close supervision of these children, reviewing them individually at regular intervals. Teachers, therapist, school nurse and parents all strive to one end; namely, to enable these severely handicapped children to tackle the everyday activities of home and classroom, as far as possible in a normal way. 85 At the end of the year plans were well advanced for the opening of a small class for three or four children suffering from partial deafness as well as cerebral palsy. Not all children with dual handicaps are so happily placed, however, and it is difficult to find a suitable environment for palsied children with severe mental retardation. The educational auhtorities, not unnaturally, tend to regard these children of very low intellect as unsuitable for education in school. On the other hand, their physical frailty and unsteady gait render their placement in a junior training centre a hazardous procedure; nor is it reasonable to expect that adequate treatment of their physical handicap can be provided at such a centre. ANALYSIS OF CASES SEEN AT CEREBRAL PALSY UNIT IN 1960 Male Female Total Under 5 years 4 1 5 5-10 years 1 3 4 10-15 years 1 1 2 Over 15 years - - - Total 6 5 11 Diagnosis Male Female Total Cerebral Palsy 2 4 6 Mental Retardation 3 1 4 Spinal Paraplegia 1 - 1 Total 6 5 11 Six confirmed cases of Cerebral Palsy - Action Taken Admitted to Vale Road School in 1960 and awaiting placement 1 in residential P. H. school Awaiting vacancy at Vale Road School 1 Referred back to home area for admission to special 1 training school For admission to ordinary school on trial (1961) 1 Referred back to home area for admission to nursery 1 school Under school age 1 6 86 NEW CASES SEEN AT CEREBRAL PALSY UNIT IN 1960 Case Date of Birth Sex Referred by Diagnosis Disposal 1 19.11.48. F Area Medical Officer, Enfield. Cerebral palsy- 1. Left hemiplegia. 2. Intellectual and emotional retardation. For report as unsuitable for education. Special Training School. 2 6.12.47. M Area Medical Officer, Enfield. Cerebral palsySpastic diplegia. Vale Road P.H. School. 3 1. 3.55. F Area Medical Officer, Friern Barnet. Cerebellar Ataxia 7 Post-encephalitic. Nursery school. 4 5. 3.56. F Area Medical Officer, Hornsey. Cerebral palsy- 1. Mild hemiplegia. 2. Hyperkinetic. Ordinary school on trial. 5 6. 1.59. M Area Medical Officer, Potters Bar. Cerebral palsy, mild Minor epilepsy. Under supervision of Cerebral Palsy Unit. 6 25. 5.50. F Area Medical Officer, Finchley. Mental retardation. Kindergarten school. Under supervision of Cerebral Palsy Unit. 7 6.10. 56. M Area Medical Officer, Enfield. Mental retardation. Special Care Unit. 8 24.12. 55. M Area Medical Officer, Enfield. Mental retardation. School for delicate children. 9 16. 1.54. M Area Medical Officer, Hornsey. Spinal paraplegia. Vale Road P. H. School. 10 25. 8.58. M Area Medical Officer, Hornsey. Mental retardation. Special Training School. 11 11. 7.50. F Area Medical Officer, Friern Barnet. Cerebral PalsySpastic Triplegia. Vale Road P.H. School. 87 Children Unsuitable for Education in School The Mental Health Act 1959, by amending Section 57 of the Education Act 1944, introduced certain changes in the law relating to children suffering from a disability of mind which makes them unsuitable for education at school. These changes became operative on the 1st November 1960, and their effect broadly was to extend the rights of parents and to simplify administrative procedure. Under the new provisions, children are no longer reported as 'ineducable' but are recorded as 'unsuitable for education in school'. The object of this change was to implement a recommendation of the Royal Commission on the Law relating to Mental Illness and Mental Deficiency that children should not be declared 'ineducable', and that severely sub-normal children who cannot profit by education at an ordinary or special school should be recommended for training in training centres provided by local health authorities, or in hospital. The Minister has stressed that the small number of children who, although capable of profiting from education, are not satisfactorily placed in an ordinary or special school, may well be provided with education under powers conferred by Section 56 of the Education Act, either at home or in hospital. A main object of the legislation was to ensure that parents are kept fully informed of the significance of each stage of the procedure and of their own rights. To this end, the letter sent to parents by the local education authority informing them that they will be required to present their child for examination includes a statement of the duties and functions of the local education and health authorities relating to their child's care, couched in friendly and non-legal language. In this way unnecessary distress to parents may well be avoided. When a child has been recorded as unsuitable for education in school, the letter sent by the local education authority to the parents informing them of this now has to include a statement of the type of provision which is likely to be made for their child's care. In order that this may be done, the medical officer who has carried out the statutory examination consults the senior medical officer for Mental Health, and their recommendation for the child's placement is included in the borough school medical officer's report to the local education authority for submission to the appropriate committee. When the local education authority has decided to record a child as being unsuitable for education in school, the parents have a right of appeal to the Minister against the authority's decision. The revised provisions also give to parents a new right to request a review by the education authority of their child's case at any time after twelve months and this right may be exercised annually thereafter. Should the parents still reject the decision of the authority, the Minister acts as the final arbiter. 88 Orthopaedic Clinics Specialist clinics in both boroughs for children found to have orthopaedic or postural defects have been very well attended throughout 1960. Such cases are found at routine school medical inspection or referred by general practitioners. The physiotherapists have been at full stretch to provide the remedial therapy and breathing exercises prescribed by consultants to the clinics. In Hornsey, Mr. E. G. M. Palser has deputised for Mr. E. T. Bailey, F. R. C.S. on occasions and, as the waiting list of new cases shows no signs of waning despite long and heavy clinics, the introduction of additional sessions is envisaged in 1961. The postural defects of teenagers has been the special concern of Mr. E. Hambly, F.R. C.S., the visiting consultant at Tottenham, and he also continues to supervise the orthopaedic cases at the Vale Road School for Physically Handicapped Children. Of all such Cases, few call for more care than children with muscular dystrophy, yet patient and careful physiotherapy can do much to render school life more enjoyable for such children. To this end, every help and encouragement is given by the headmaster (Mr. Ives) and the teaching staff. Ophthalmic Clinics During the past year the Hornsey Eye Clinic has continued to be very busy, the majority of cases being referred for defects of vision due to errors of refraction. These were dealt with in the usual way and glasses prescribed. The visiting consultant, Dr. R. Welch, has, however, drawn attention to the large number of children who required a period of continuous treatment, especially those suffering from uni-ocular amblyopia Here, the vision in one eye is of a much lower standard than in the other, due either to a convergent squint or aniso-metropia. The requisite treatment, after the error of refraction has been corrected consists of occluding the non-amblyopic eye for periods varying from three to four months and during that period the children are seen at fortnightly intervals in the orthoptic clinic, where a careful record of the visual acuity is kept. As soon as the vision in the amblyopic eye has improved to near that of the Other eye a course of orthoptic treatment is given to establish and maintain binocular vision. To obtained the best results early detection of the condition is essential and enquiry should be made as to whether there is a family 89 history of poor vision in one eye - the so-called 'lazy eye', since this is suggestive. On following the above routine, the results on the whole have been satisfactory, but in those few cases where correction of an error of refraction and orthoptic treatment have failed to cure a squint surgical treatment becomes essential. An equally busy year was experienced at the Tottenham Ophthalmic Clinic where many children with refractive errors and squints were referred to the visiting consultant, Mr. T. Kletz. Of a wide variety of other conditions two of outstanding clinical interest were a case of buphthalmos (infantile glaucoma), and a case of trachoma. Both these children received further investigation in hospital; but, although the diagnosis of trachoma was confirmed bacteriologically, a search for contacts proved unavailing. Happily, the infection cleared up satisfactorily with treatment. Two pupils were registered as partially-sighted during 1960; a case of congenital nystagmus and another of congenital dislocation of the lenses. In December, Mr. Kletz demonstrated a number of clinical cases to the school medical officers in the Area, including cases of "squint" and the orthoptic methods used. Such an occasion, both enjoyable and instructive, encourages early detection of ophthalmic defects which both consultants so rightly stress. ORTHOPTIC CLINICS Number of new cases 88 Number of cases treated:- Complete success 62 Improving 47 Failed 7 Left district before completion of treatment 5 Total number of children occluded:- 121 Complete success 34 Partial success 4 Still on treatment 4 Failed to improve 5 47 Number of cases referred for surgery 5 90 Child Guidance Clinics During 1960 Dr. W. H. Craike, the consultant psychiatrist to the Lordship Lane Clinic, held two sessions per week to deal with the multiple conditions referred to him. Difficult behaviour at home and school, truancy and nocturnal enuresis formed the hard core of his problems; but children presenting a broad spectrum of psychosomatic symptoms were referred to him by both school medical officers and teachers. Dr. C. Phillips, who also undertook two sessions a week, left in March to take up an appointment in the United States of America and a replacement had not been appointed by the end of the year. Consequently, Dr. Craike's case load was heavily increased and there was a long waiting list of children for diagnostic interview at the end of the year. The year under review was one of transition in the Hornsey Child Guidance Clinic owing to the departure of Dr. Phillips who attended this clinic as well as the one in Tottenham and we were fortunate in obtaining the services, as locum tenens, of Dr. Rachel Shackleton. Nevertheless, the problems and the pressure of cases remained essentially the same as in Tottenham and much valuable work was done in maintaining this vital feature of the School Health Service. Speech Therapy During 1960 the speech therapists held frequent consultations with parents, teachers, health visitors, school medical officers and other specialists, in addition to maintaining their regular treatment programme. School visiting formed an integral part of the work and it is now accepted practice for school staffs to consult the speech therapist about any child with a communication problem. This close liaison helps the child with a stammer during the stress periods of his school life, with their new pressures and demands. These most commonly occur during the first year in the infant, junior and senior schools. Miss Joan Came, the senior speech therapist, emphasises that deviation in language development may be significant from the age of two years, and requires early investigation. Where the speech therapist finds a history suggestive of brain damage, hearing loss, severe emotional disturbance or other causative factors, further referral to the appropriate specialist is indicated. 91 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 . . 5 2 . . . 1 . 5 3 Partially Sighted 4 3 1 1 . . • • . 5 4 Deaf 4 4 2 2 • . . • • 6 6 Partially Deaf 10 8 1 1 2 . . . 2 15 9 Educationally Sub-Normal 64 45 14 2 4 • 1 • • 83 47 Epileptic . . 2 1 • . • 1 • 2 2 Maladjusted . . 13 2 4 3 14 5 3 1 34 11 Physically Handicapped 15 12 7 1 1 . . 1 4 1 27 15 Speech Defects 3 . 1 208 1ll 9 3 7 1 227 116 Delicate 2 9 9 7 1 . 1 . 1 . 14 16 Multiple Defects 3 3 1 2 1 . 1 . 1 . 7 5 Totals 105 84 55 22 221 114 26 11 18 3 425 234 GRAND TOTALS 189 77 335 37 21 659 92 Rheumatism Supervisory Centre Fortnightly sessions continued to be held in 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 nine. Of these, five were female and four male:- Rheumatic fever 5 Innocent Cardiac Murmur (other cases) 2 Streptococcal State (Allergy) 2 9 202 children remain on the register of the supervisory centre, and of these, 52 made 108 attendances, while in addition a number were seen in the ordinary paediatric out-patient sessions. These 202 cases were classified as follows:- Rheumatic fever 64 Rheumatic carditis 42 Rheumatic carditis with chorea 5 Chorea - uncomplicated 5 Rheumatic arthritis 5 Congenital heart lesions 54 Rheumatic pains 1 Streptococcal Allergy 3 Other cases 23 202 96 males 106 females Hospital School I am indebted to Mr. J. Power, M.A., Borough Education Officer, Tottenham, for the following report:- "The teaching of the children at St. Ann's Hospital and at the Prince of Wales's Hospital has progressed smoothly during the past year. Although the schoolroom is established in the Prince of Wales's Unit at St. Ann's Hospital, there has been considerable development of individual teaching in other wards, including tuition of pupils in cubicles in the tuberculosis wards. These patients, who are not in the infectious stage of the disease, are in their early teens. Tuition is specially important for them as often they are preparing for G.C.E. or other examinations. 93 From time to time assistance is given to older boys and girls who have left school and who have decided to take up further studies. Lessons in the schoolroom are necessarily varied as they must cater for a wide age range. Children with severe muscular disability attend school (often in special fitted chairs) and derive great benefit and pleasure from special sense training apparatus. Always the pupils' interests are at heart and to this end every effort is made to follow the child's own school curriculum including commercial subjects where necessary and to develop his particular hobbies. It has been possible on occasion to take the children for nature walks round the hospital grounds in wheelchairs and on foot. This has given much pleasure and been of real educational value. Part-time teachers were again employed during the long summer vacation to keep the children happy and busy with handwork, stories, games, etc. As in past years the Tottenham Library Service has been most helpful when special books have been required. Parents have shown their appreciation of lessons received by their children while in hospital, and it is quite evident that the children enjoy their school work. As always, the hospital staff has been most co-operative and helpful. Statistical Information Certain statistics relating to the work of the School Health Service in Hornsey and not included in the body of the report follow 94 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 1956 & later - 51 51 1955 4 161 163 1954 8 64 66 1953 12 30 36 1952 21 44 58 1951 101 159 225 1950 7 19 26 1949 51 42 83 1948 121 146 239 1947 67 84 129 1946 54 69 104 1945 & earlier 305 237 485 Total 751 1106 1665 OTHER INSPECTIONS Number of Special Inspections 1614 Number of Re-inspections 646 Total 2260 EDUCATION ACT 1944 - SECTIONS 57(3), 57(4) and 57(5) Cases dealt with under Section 57, Education Act 1944 Sub-Section 3: 3 Sub-Section 5: 2 Cases de-notified under Section 8, Education (Miscellaneous Provisions) Act 1948: 1 MEDICAL EXAMINATIONS OF TEACHERS (a) Number of teachers examined as to fitness for appointment 7 (b) Number of students examined as to fitness for first appointment 58 (c) Number of students examined as to fitness for training course 53 95 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 21 44 62 62 132 107 215 213 478 32 5 Eyes: a. Vision 13 32 242 14 496 96 751 142 106 5 b. Squint 33 4 20 74 6 127 10 10 c. Other 2 8 5 6 26 6 33 20 38 4 6 Ears: a. Hearing 18 6 9 8 23 12 50 26 86 33 b. Otitis media 13 22 3 16 16 71 32 109 8 3 c. Other 3 1 3 3 10 12 16 16 14 • 7 Nose and Throat 104 136 14 30 75 180 193 346 40 13 8 Speech 10 26 1 4 13 24 24 54 26 2 9 Lymphatic Glands 1 57 1 10 2 38 4 105 2 10 Heart 3 16 7 17 10 38 20 71 4 8 11 Lungs 35 27 29 12 62 40 126 79 17 8 12 Developmental: a. Hernia 3 3 2 2 4 7 7 . , b. Other 2 5 6 13 14 28 22 46 4 3 13 Orthopaedic: a. Posture 3 7 10 33 12 73 25 113 4 5 b. Feet 40 55 26 52 94 142 160 249 15 7 c. Other 14 19 19 25 42 94 75 138 44 3 14 Nervous System: a. Epilepsy . . 2 1 9 1 11 2 4 6 b. Other 1 4 4 13 12 17 17 34 7 2 15 Psychological: a. Development . 13 . 2 5 17 5 32 24 22 b. Stability 10 85 3 30 29 139 42 254 25 13 16 Abdomen 6 6 7 8 16 38 29 52 5 3 17 Other 7 15 8 34 17 117 32 166 153 37 (T) Requiring Treatment (O) Requiring Observation 96 TREATMENT OF PUPILS ATTENDING MAINTAINED PRIMARY AND SECONDARY SCHOOLS (including Nursery and Special Schools) Number of cases known to have been treated GROUP 1 - EYE DISEASES (e.g. blepharitis, conjunctivitis), DEFECTIVE VISION AND SQUINT. (a) External and other, excluding errors of refraction and squint 44 (b) Errors of refraction (including squint) 842 (c) Number of cases for whom spectacles were prescribed 418 GROUP 2 - DISEASES AND DEFECTS OF EAR, NOSE AND THROAT Received operative treatment for adenoids and chronic tonsillitis 263 Received other forms of treatment 165 Total number of pupils in schools who are known to have been provided with hearing aids: (a) During the current year 9 (b) In previous years 67 GROUP 3 - ORTHOPAEDIC AND POSTURAL DEFECTS Treated at clinics or out-patient departments 349 GROUP 4 - DISEASES OF THE SKIN (EXCLUDING UNCLEANLINESS) Impetigo & Scabies 14 Other skin diseases 619 GROUP 5 - CHILD GUIDANCE TREATMENT Treated at child guidance clinics (including cases sent to the Tavistock and other hospital clinics) 67 GROUP 6 - SPEECH THERAPY Treated by speech therapists 78 GROUP 7 - OTHER TREATMENT GIVEN (a) Minor Ailments 117 (b) Treatment other than (a) above and excluding convalescent treatment 37 97 STAFF BOROUGH HEALTH DEPARTMENT Medical Officer of Health G. HAMILTON HOGBEN, M. R. C. S., D. P. H. Deputy Medical Officer of Health A. YARROW, M. B., CH. B., D. P. H. (until 20th April) G. S. UDALL, M.A., M. B., B.Chir., D. P. H., D.C.H. (from 1st July) Veterinary Inspector F. G. BUXTON, M. R. C. V. S. Chief Public Health Inspector, J. D. CHANCE, M. A. P.H.L , (until 19th May) Petroleum Inspector and Public Health Inspector's Cert. Shops Inspector Food Inspector's Cert. W. J. WILSON, D.P.A. (Lond.), M.A. P.H.I., Public Health Inspector's Cert. (from 20th May) Food Inspector's Cert. Public Health and Shops Inspector E. WILKINS, M. A. P. H. I. Petroleum Inspector Public Health Inspector's Cert. Food Inspector's Cert. Smoke Inspector's Diploma Public Health Inspectors - E. HUNDY, M. A. P. H. I., (until 10th July) 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.I., Public Health Inspector's Cert. Food Inspector's Cert. A. K. D. SHUTTLEWORTH, M.A. P.H.I., Public Health Inspector's Cert. E. S. GRAY, M.A. P.H.I., Public Health Inspector's Cert. Food Inspector's Cert. Smoke Inspector's Diploma T. B. MEANEY, M. A. P. H. I., (from 5th September) Public Health Inspector's Cert. Food Inspector's Cert. Chief Administrative Assistant D. B. DA VIES, D. P. A. (Lond.) Senior Clerks D.N.IRVINE, D. P. A. (Lond.) H. P. BRADFORD Clerk Mrs. M. M. BERRY (until 3rd September) Shorthand-typists MRS. E. M. HICKS (until 31st July) MISS A. GERRIE MISS A. GLENISTER MISS J. FINNIGAN (from 2nd August) Survey Assistant (Smoke Control) W. R. WOOD (from 9th May) Drainage Inspector Assistant H. S. FAGG Disinfectors and Mortuary Attendants P. F. HALL (foreman) W. HOOPER S. J. TWINN Rodent Operator E. J. MEAD 98 AREA HEALTH STAFF Deputy Area Medical Officer A. YARROW, M. B., Ch.B., D. P.H. (Resigned 20.4.60.) G. S. UDALL, M. B., B.Chir., D. P. H., (Appointed 1.7.60.) D. C. H. Senior Assistuit Medical Officer ALICE WHEILDON, M.B., B.S., M.R.C.O.G. (Resigned 28.2.60.) RUTH GOLDER, M. B., Ch.B., D.R. C.O.G., (Appointed 2. 5.60.) D. P. H. Area Dental Officer V. SAINTY, L.D.S., R.C.S. (Retired 12.2.60.) MISS W. M. HUNT, L.D.S., R. F. P.S. (Appointed 26.9.60.) Superintendent Health Visitor MISS H. TOWNSEND, S. R. N., S. C. M., H. V. Non-medical Supervisor of MISS F. E. CURTIS, S.R. N., S. C. M., H. V., Midwives and Home M. T. D. Nursing Superintendent Home Help Organiser MISS D. WILLIAMS, S.R.N. Assistant Home Help Organisers MISS J. E. CAPLIN MRS. F. G. WILLS (Resigned 29.7.60) MRS. A. ORCHARD (Appointed 30.5.60) Area Chief Clerk W. L. N. RELLEEN, T.D., D. P. A. Deputy Area Chief Clerk J. B. BAMBROOK, D. M. A. Section Heads A. BALLS N. P. CHILD H. J. DUNHAM, B. A. Classification of staff Full-time Part-time Medical Officers 10 6 Dental Officers 6 4 Supervisory Nursing Staff 2 - Administrative and Clerical Staff 35 8 Health Visitors School Nurses 27 2 Student Health Visitors - 1 Clinic Nurses 7 - Midwives 11 - Home Nurses 24 4 Speech Therapists 2 2 Physiotherapist 1 - Occupational Therapist 1 - Chiropodists - 2 Gramophone Audiometrician 1 - Orthoptists - 2 Dental Attendants 3 2 Day Nursery Staff 35 2 Home Help Service 7 104 Manual workers, domestic grades, etc. 10 23 187 222 99 INDEX Page Abatement Notices 27 Accidental Deaths 45 Animals, Diseases of 44 Ante-natal Clinics 57 Audiology Clinic 81 B.C.G. Vaccination 78 Births, Notification of 56 Burial of the Dead 44 Campsbourne Clearance Area 16 Cerebral Palsy Unit 85 Certificates of Disrepair 18 Child Guidance Clinics 91 Children Unsuitable for Education in School 88 Chiropody, Licensing of Premises 43 Clean Air 28 Clean Air: Measurement of Pollution 29 Smoke from Diesel Vehicles 31 Cleansing of Soild Articles 41 Closing Orders 19 Daily Guardian Scheme 60 Day Nurseries 62 Deaths classified according to Age, Sex and Cause 49 Demolition Orders 19 Dental Service, Priority 64 Dental Service, School 79 Diphtheria, Immunisation against 74 Diseases of Animals 44 Domestic Help Service 75 Ear, Nose and Throat Clinics 81 Factories, Inspection of 23 Food 34 Food Premises classified according to Principal Trades 35 Food Premises, Inspection of 38 Food Sampling 36 Handicapped Children 62 Hawkers of Food 35 Hairdressers' Premises 20 Health Visiting Service 67 Home Nursing Service 70 Hospital School 93 Housing and Sanitary Circumstances: 14 Inspections by Public Health Inspectors 25 Infant Deaths classified according to Age, Sex and Cause 52 Infant Welfare Clinics 59 Infectious Diseases: Diphtheria 8 Dysentery 7 Food Poisoning 6 100 Infectious Diseases: Measles 9 Para-typhoid fever 8 Poliomyelitis 6 Tables: Infectious Diseases by Age and Sex 12 Infectious Diseases by Wards 13 Infectious Diseases in School Children 77 Laboratory Services 9 Legal Proceedings: Public Health Act 27 Food & Drugs Act and Food Hygiene Regulations 39 Massage and Special Treatment 43 Maternity Services 56 Midwifery Services 66 Midwives Ante-natal Clinics 58 Milk Supply 38 Mortuary 44 Mothercraft and Relaxation Classes 58 Nurseries and Child Minders Regulation Act 1948 63 Old People's Welfare 40 Ophthalmic Clinics 89 Orthopaedic Clinics 89 Outworkers Premises 23 Pet Shops, Licensing of 20 Petroleum, Licensing of Premises 45 Poliomyelitis, Vaccination against 75 Recuperative Holidays 75 Re-housing on Health Grounds 17 Rheumatism Supervisory Centre 93 Rivers Pollution 22 Rodent Control 24 Routine Medical Inspections 21 Sanitary Improvements Effected 26 School Health Service 76 Statistical Tables 95 Sewerage 22 Shops, Inspection of 19 Smallpox, Vaccination against 73 Smoke Control Areas 28 Speech Therapy 91 Staff, Medical Examination of 43 Swimming Pool 22 Tetanus, Immunisation against 74 Toddlers Clinics 59 Tuberculosis in Schools 78 Tuberculosis Tables: New Cases 11 Cases on Register 10 Vale Road School for Physically Handicapped Children 85 Vital Statistics 46 Water Supply 20 Welfare Foods, Distribution of 64 Whooping Cough, Immunisation against 74 101