TOT 23 TOTTENHAM'S HEALTH 1948 The Annual Report of the Medical Officer of Health, Borough of Tottenham. 1 MEMBERS OF THE TOWN COUNCIL Councillor A. E. Johnson, J. P. Mayor. Councillor R. W. H. Ford, Deputy Mayor. Alderman E. J. Field. Alderman The Rt. Hon. The „ A. E. Harvey. Lord Morrison, „ Mrs. M. C. Irving. P.C., J. P. „ Mrs. A. Kitchener. „ G. H. Ottaway, J. P. „ Mrs. J. D. Lynch. „ A. Reed, A.C.I.I.,J.P. „ J. H. Morrell, J. P. „ A. R. Turner. Councillor G. W. Blythe. „ R. H. Warren. „ F. G. Bohringer. Councillor F. A. F. Keay, J. P. „ S. Booley. „ E. P. Kent. „ Mrs. F. E. Boyton. „ L. A. Le Voi, M.I.M.I. „ K. H. Brill. „ Mrs. A. E. Lyons. „ J. W. H. Brown. „ Mrs. E. M. A. Morrell. „ A. Clark. „ The Lady Morrison. „ M. C. Coda. „ J. J. Pagin. ., C. H. Colyer. „ A. A. Pawson. „ A. J. Davies. „ Mrs. A. F. Remington. „ C. H. Gill. „ G. W. Rowley. „ K. A. E. Gregg. „ H. C. Scapens. „ Mrs. L. R. Harrington „ Mrs. M. E. Soall. „ W. S. Herbert. „ A. E. C. Taylor. „ J. W. Hollingsworth. „ H. W. Turner. „ Mrs. Q. V. Jacobs. „ C. Wise. Town Clerk: M. Lindsay Taylor, LL.B. 2 HEALTH AND HOUSING COMMITTEE. Alderman R. H. Warren. Chairman. His Worshipful The Mayor, Councillor A. E. Johnson, J. P. The Deputy Mayor, Councillor R. W. H. Ford. (Ex-officio members). Alderman Mrs. A. Kitchener. AldermanA. Reed, A.C.I.I., J.P. „ J. H. Morrell, J. P. „ A. R. Turner. Councillor G. W. Blythe. Councillor K. A. E. Gregg. „ F. G. Bohringer. „ Mrs. A. E. Lyons. „ J. W. H. Brown. „ The Lady Morrison. „ A. J. Davies. „ Mrs. A. F. Remington. Councillor G. W. Rowley. MATERNITY AND CHILD WELFARE COMMITTEE (Up to 5th July, 1948, when control passed to the County Council.) Councillor Mrs. L. R. Harrington. Chairman. Councillor Mrs. E. M. A. Morrell. Vice-Chairman. His Worshipful The Mayor, Councillor A. E. Johnson, J.P. The Deputy Mayor, Councillor R. W. H. Ford. (Ex-officio members). Alderman J. H. Morrell, J.P. Alderman A. Reed, A.C.I.I., J.P. Alderman A. R. Turner. Councillor S. Booley. Councillor Mrs. A. E. Lyons. „ C. H. Colyer. . „ Mrs. A. F. Remington. „ Mrs. Q. V. Jacobs. „ G. W. Rowley. „ F. A. F. Keay, J.P. „ Mrs. M. E. Soall. „ E. P. Kent. METROPOLITAN WATER BOARD. Council's Representative: Alderman E. J. Field. 3 STAFF OF THE PUBLIC HEALTH DEPARTMENT. Medical Officer of Health G. Hamilton Hogben, (Also Area Medical Officer, M. R. C. S., D. P. H. Middlesex County Council.) Deputy Medical Officer of Health J. CRamond, M.B., D.P. H. Chief Sanitary Inspector E. T. Jenkins, M.S.I. A. Chief Clerk A. W. Lawrence, M.S.I. A. Sanitary Inspectorial Staff. Senior District Sanitary Inspector—E. S. Glegg (a) (b) (d). C. J. Cattell (a) (b). L. J. Kerridge (a) (b). A. E. Clarke (a) (b) (e). B. J. H. Mercer (a) (b). G. A. Hagedorn (a). A. S. Muncey (a) (b). W. P. Kent (a) (b). W. Openshaw (a). F. J. Parsons (a) (b). Note.—(a) Certificate of the Royal Sanitary Institute and Sanitary Inspectors' Joint Examination Board. (b) Meat Inspectors' Certificate. (c) Smoke Inspectors' Certificate. (d) Institution of Sanitary Engineers' Certificate. (e) Sanitary Science Certificate. Shops Acts Inspectors. F. T. G. Lock. C. H. Goodwin (Assistant). Public Health Nurse. Mrs. W. Mathias, S.R.N. Clerical Staff. W. E. Lawson (Senior Clerk: D. J. McLintic (Senior Clerk: General). Housing). D. J. Legge. H. F. Smith. Miss C. Bird. T. A. Smale. Outside Staff. Foreman S. H. Reid. Disinfectors: Apparatus Disinfecting Attendants W. Butcher. Van Driver E. E. Mannell. A. E. Moon. Drain Testers A. E. Crow. Rodent Oper- F. T. Dowse. atives .. J. Lawrence. D. M. Hunter. G. W. Percival. W. A. Matthews. Disinfectors A. Dowse. F. J. Slater. A. Ferridge. R. C. Wilson. 4 Public Health Department, Town Hall, N.15. 1st October, 1949. His Worship the Mayor, Aldermen and Councillors of the Borough. Mr. Mayor, My Lord, My Lady, Ladies and Gentlemen, I have the honour to submit my Annual Report on the health of the Borough for the year ended 31st December, 1948. The population of Tottenham, as estimated by the RegistrarGeneral, is 130,000, an increase of 860 over 1947. In 1939 the figure was 144,000. The number of deaths amongst children under one year of age per 1,000 live births, was a record low figure of 23.7 compared with 27.3 for the previous year. As a result of the National Health Service Act, 1946, which came into operation on July 5th, 1948, the maternity and child welfare and ambulance services of the Borough were taken over during the year by the Middlesex County Council. Together with school health, these services have become merged, for the purpose of local day-to-day administration, with those hitherto administered by the Hornsey Borough Council, forming one of ten County Areas. The Borough health department has continued an all-out effort to make up for time lost in the war years in remedying sanitary defects and generally improving the standards of housing in the district. In the sphere of health education, special attention has been given during the year to a campaign for clean methods of food handling. I have the honour to be, Your obedient Servant, G. Hamilton Hogben, Medical Officer of Health. 5 GENERAL STATISTICS. Area of District in Acres 3,014 Population: Estimate of Registrar General of Civilian Population— Mid-year, 1948 130,000 31st December, 1948 129,800 Pre-War Population 144,400 Approximate Number of Dwellings in District 30,645 Rateable Value of District £1,018,880 Sum Represented by Penny Rate £4,166 Live Births— Legitimate 2,145 2,233 Illegitimate 88 Birth rate (per 1,000 population) 17.18 Still Births 55 Deaths 1,377 Death rate (per 1,000 population) 10.59 Infantile death rate (per 1,000 live births) 23.73 Maternal death rate (per 1,000 live and still-births) 0.87 (Note:—Detailed Vital Statistics appear on pages 79 to 85 in the Statistical Summary). 7 PART I INFECTIOUS DISEASES. Tuberculosis. The total number of new cases of tuberculosis notified during the year was 205, a rise of 16 on the previous year. 184 of these notifications were in respect of pulmonary tuberculosis. The number of deaths from tuberculosis was 66 (57 pulmonary tuberculosis) the lowest recorded figure for this disease. A detailed analysis of the notifications and deaths is shewn in the following summarv. Summary of Tuberculosis Cases. Age Periods. New Cases. Deaths. Pulmonary. NonPulmonary. Pulmonary. NonPulmonary. Males Females Males Females Males Females Males Females Under 1 year 2 — — — — — — — 1 to 5 years 4 3 1 2 — — — 1 5 to 15 „ 9 4 4 4 — 1 1 1 15 to 25 „ 26 36 — 2 6 1 — — 25 to 35 „ 22 19 4 — 8 5 2 — 35 to „ 13 9 1 1 7 5 — 1 45 to 55 „ 8 2 1 — 5 4 — — 55 to 65 „ 14 5 1 — 8 — 1 — 65 years and upwards 6 2 — — 7 — — 1 Age unknown — — — — — — — 1 Totals 104 80 12 9 41 16 4 5 Non-pulmonary cases affecting:— Male. Female Total. Ankle 1 — 1 Genito-urinary system 2 — 2 Glands 3 4 7 Hip — 1 1 Knee — 1 1 Meninges 3 1 4 Peritoneum — 1 1 Spine 2 1 3 Tarsus 1 — 1 12 9 21 8 TUBERCULOSIS. Notifications and Deaths occurring during the past twenty years. 9 A Mass X-Ray Unit visited Tottenham. The purpose of the visit was to offer free X-Rays of the chest to persons in the area. In order to facilitate procedure, separate days were allocated to senior scholars, industrial workers, local government employees, and the general public. The Borough Information Officer co-operated in preparing and distributing posters throughout the town. An article was printed in "Tottenham Calling." Photographic sequences showing person; being dealt with by a Mass X-Ray Unit were displayed upon hoardings, and by arrangement with a local trader, a large window was secured for an explanatory exhibition. So far as arrangements for children were concerned, all schools were circularised, and parents were informed of the facilities available in co-operation with the Borough Education Officer. Once the consent of parents had been given, pupils attended and departed to schedule in small groups, each in charge of a teacher who was offered X-Ray at the same visit. Local government employees wishing to attend the unit had appointments made for them by the head of the department. By spreading the appointments over a number of days, the minimum of disturbance in the routine of work was ensured. Following inspection of the miniature X-Ray photographs, the doctor in charge of the unit held a confidential consultation with those persons thought to require further investigation, referring them to their own doctor and to a chest physician. I am indebted to Dr. Hugh Ramsay, Mass Radiography Unit, of the North-East Metropolitan Regional Hospital Board, for the following report:— "It is not possible to give the actual record of different conditions discovered until much later, that is, after the various clinics have reported on cases referred to them, but I may say that I consider the investigation has been very worth while. From the following report, it will be seen that practically all groups of the population have been covered.'' 10 MASS RADIOGRAPHY. Tottenham Investigation. Total number X-Rayed 11,907 Number of large films called for 553 Group. Male. Female. Total. School Children 1,661 1,219 2,880 Large Films 31 32 63 St. Katherine's Training College — 128 128 Large Films — 4 4 School Teachers 24 44 68 Large Films 3 3 6 Tottenham Borough Council Employe's 326 136 462 Large Films 29 9 38 Public Sessions 659 950 1,609 Large Films 35 42 77 Factories and other Groups 4,323 2,437 6,760 Large Films 260 105 365 Diphtheria. The remarkable decline in the incidence of diphtheria continued during 1948. The final corrected figure for notifications during the year reached a new low record—3 only were notified, none of which proved fatal. This is the third year in succession that no death has resulted from diphtheria. The three children affected were aged 2 years, 7 years and 10 years. There is no record of any of these children completing a course of immunisation treatment, although the parents of the child aged 7 years stated that he was immunised during the war as an infant in another area. Four immunisation clinics were held each week, and continued following the transfer of this service to the County Council under the National Health Service Act. The Borough Council continues under its Public Health powers to support publicity campaigns for the promotion of immunisation. 11 DIPHTHERIA. Notifications for past 20 years. 12 Immunisation in relation to Child Population. The following table shows the number of children who had completed a full course of Immunisation at any time up to 31st December, 1948:— Age at 31.12.48 i.e., Born in Year. Under 1 1948 1 1947 2 1946 3 1945 4 1944 5 to 9 1939-43 10 to 14 1934-38 Total Under 15 Number Immunised 217 1,653 1,569 1,349 1,525 5,595 5,364 17,272 6,313 10,959 Estimated mid-year child Population 1948. 10,892 15,305 26,197 Percentage Immunised 57.96 71.60 65.93 Summary of Clinic Attendances. Centre. Total Attendances. No. of Schick Tests. Number of Individual cases completed. No. of Reinforcing Injections. Under five. 5—14 Total. Chestnuts 2,865 693 670 33 703 83 Town Hall 1,892 444 452 18 470 50 Lordship Lane 2,400 618 531 25 556 50 Park Lane 1,627 386 388 27 415 28 Private Doctors 92 — 45 1 46 — Totals 8,876 2,141 2,086 104 2,190 211 13 Scarlet Fever. There were 260 cases of Scarlet Fever notified during 1948, a slight reduction on last year's figure. 110 of the cases were satisfactorily nursed at home. The disease continues to be relatively mild, and no deaths were recorded. SCARLET FEVER. Notifications for past 20 years. 14 Measles. There were 825 notifications of this disease during 1948. The incidence of Measles appears to be increasing in recent years as is indicated by the following graph. It will be noted that the characteristic peaks and troughs shewing the biennial epidemics have steadily risen over the last six years. During the year 47 cases with some complication were removed to hospital, but no deaths were caused by this disease. MEASLES. Notifications received during the nine years that this disease has been notifiable. 15 Whooping Cough. During the year there were 334 cases of whooping cough notified within the Borough, and three deaths from this disease were recorded. In 39 cases the children affected were under 1 year of age. WHOOPING COUGH. Notifications received during the nine years that this disease has been notifiable. Investigations into the value of whooping cough vaccines, which are being carried on in Tottenham in collaboration with the Medical Research Council, have now been in progress for two years. 16 A preliminary analysis of the results has shown that the vaccines tested have significantly lessened the incidence and severity of the infection in the inoculated children. More work is required, however, to find out the best method of preparing a uniformly effective vaccine, and it is hoped that parents in Tottenham will co-operate in a further investigation in the same wholehearted manner as they have done in the past. Scabies. As a war-time measure, the Scabies Order was made in 1941 to combat the exceptional increase of scabies which threatened to be detrimental to the war effort. It was considered that the powers of entry into residential premises, and of compulsory examination and treatment, as contained in the Order, were not warranted in peace time and the Order was allowed to expire on the 31st December, 1947. Control has now reverted to reliance on the normal statutory powers as contained in the Public Health Acts. Scabies is, however, notifiable in this Borough, and the necessary treatment is arranged at the Public Cleansing Station. Notifications during 1948 numbered 63, and the following chart shows a steady diminution in the incidence of this disease. 17 Disinfection. In appropriate cases of infectious disease, disinfection in accord with modern practice is carried out after removal of the case to hospital or upon recovery of the patient when nursed at home. Summary of Disinfection work during 1948. Rooms disinfected after occurrence of infectious disease 463 Bedding disinfected after occurrence of infectious disease or death 387 Schools or Hospital Wards disinfected 15 Library Books disinfected 181 19 PART II FOOD CONTROL. Food Hygiene. A popular slogan of the day is ''Focus'' on this or that. It is certainly true to say that there has been a ' 'Focus on Food Hygiene.'' Tottenham, in common with many other boroughs, has not been behind in its efforts to awaken the public interest in this most important subject. More particularly it has tried to awaken the interest of the trade organisations which are most directly connected with the food industry. An inaugural meeting was held in the Central Library Hall on November 3rd, when the principal speaker was Professor Cruikshank, M.D., F. R.C. P., late of the Central Public Health Laboratory, Colindale. Alderman R. H. Warren, Chairman of the Health Committee, presided. In terms of attendance the meeting was a disappointment, but those present were well rewarded by an interesting and well delivered lecture, and stimulating discussion which followed. This has been followed by meetings with individual trade organisations, where the Chief Sanitary Inspector has been able to present the views of the department. It is to be hoped that the results of these meetings, together with the efforts of the department, will be reflected in a better standard of hygiene in the food premises throughout the borough. Food Premises. It is satisfying to be able to report a steady improvement in the condition of food premises. The raising of the building licence limits has created opportunities for securing improvements without recourse to statutory powers. More particularly we are pleased to record the improvements in two large dairies. By structural alterations and the addition of new plant, these two firms will produce even better results than in the past. 20 Example is better than precept, and the department hopes that it can use these as examples of the criterion which will be expected if certain dairies are to continue. Some of the smaller mixed shops and cafes still present a problem, but every effort is being made to secure the necessary improvements. Ice Cream. Routine sampling and systematic inspection continues to be undertaken in the supervision of ice cream production. The standard of hygiene is generally of a satisfactory character. Traders are usually willing to co-operate, and amenable to suggestions for improvement. The main difficulty in the production of ice cream is that it is essentially a seasonal product. Thus some traders regard it only as a profitable side line to their business during the summer months. Those manufacturers who make ice cream their main busi ness are as anxious to obtain consistently good results as the department itself. Samples are analysed by the National Laboratory Service, the grading being provisional. It must be emphasised that the tests made are only for bacteriological grading, the result being an indication of the standard of hygiene generally achieved in the factory. The number of premises registered during the year under Section 14 of the Food and Drugs Act, 1938, for the sale, etc., of ice cream, was as follows:— (1) For the sale of ice cream 30 (2) For the manufacture of ice cream 2 (3) For the manufacture and sale of ice cream 8 (4) For the storage of ice cream 2 Total number of certificates granted 42 Two applications for registration were refused as the premises concerned did not comply with the provisions of Section 13 of the Food and Drugs Act, 1938. Frequent washing of hands is essential where persons are preparing ice cream or other foods Modern equipment of a local Ice Cream Factory 21 SAMPLES OF ICE CREAM SUBMITTED FOR BACTERIOLOGICAL EXAMINATION. *Results. Grade 1 Grade 2 Grade 3 Grade 4 Total. Number of Samples taken where Ice Cream was produced in Tottenham. 17 11 10 31 69 Number of Samples taken where Ice Cream was produced in districts other than Tottenham 3 10 9 16 38 Total 20 21 19 47 107 *Provisional grading, based on the time taken to reduce methylene blue, is as follows:— Grade 1 4½ hours or more. Grade 2 2½ hours to 4 hours. Grade 3 ½ hour to 2 hours. Grade 4 0 hours. Milk (Special Designations) Regulations, 1936 to 1946. Licences were granted under the above-mentioned Regulations, as follows:— Pasteurised Milk: Pasteurisers' Licences 4 Dealers' Licences 16 Supplementary Licences 3 Tuberculin Tested Milk: Bottlers' licences 1 Dealers' Licences 12 Supplementary Licences 3 Accredited Milk: Nil. 22 Slaughterhouses and Knackers' Yards. Five premises are licensed as slaughterhouses under section 57 of the Food and Drugs Act, 1938. At only one of these premises is regular slaughtering carried on. This slaughterhouse deals mainly with horses. Another section of the premises is licensed as a knacker's yard. Regular visits are made by the District Sanitary Inspectors to ensure compliance with the regulations and to carry out post-mort m examinations of the animals slaughtered. During the year 15 licences to slaughter animals were issued in accordance with the provisions of the Slaughter of Animals Act, 1933. Middlesex County Council Act, 1944 : Section279 (Registration of Hawkers.) Certificates of Registration were issued for the sale and storage of fruit and vegetables, fish and shell-fish, as follows:— Sale. Storage. Fruit and Vegetables 9 9 Fish 2 2 Shell-fish 2 — Total 13 11 There was one application for registration which was not granted. The total number of hawkers registered in accordance with the provisions of the Middlesex County Council Act up to 31st December, 1948 was 89. 23 Food Condemned. The following tinned articles were condemned during the year, namely:— Anchovies 23 Gooseberries 2 Pilchards 106 Apple Jelly 2 Grapefruit 504 Pineapple 23 Apples 22 Grapefruit Juice 12,956 Plum Pudding 7 Apricots 38 Grapes 32 Plums 320 Bacon 23 Gravy Powder 28 Pork 33 Beans 170 Hake 5 Potatoes 15 Beef, Corned 292 Ham, Chopped 1 Prunes 8 Beef and Carrots, Boiled 39 Ham Loaf 2 Pudding 1 Herring Roes 2 Rabbit 2 Beef, Minced Loaf 56 Herring Spread, 48 Rhubarb 13 Beef, Roast 1 Smoked Roe Spread 1 Beetroot 180 Herrings 187 Salmon 115 Blackberries 1 Jam 102 Sandwich Spread 1 Brawn 2 Jellies 1 Sardines 161 Brisket of Beef 1 Kippered Herrings 2 Sausage Meat 1 Brislings 2 Lambs' Tongues 17 Sausages 33 Broth 9 Lemon Cheese 1 Silds 1 Cape Fish 3 Lemonade Powder 3 Snoek 1 Carrots 88 Lobster and Tomato Paste 23 Soup 225 Cheose 4 Spaghetti 19 Cherries 8 Luncheon Meat 171 Spinach 21 Chile Con Came 1 Macaroni 4 Sponge Pudding 1 Cocoa 1 Macedoine 45 Steak and Kidney 19 Cod Fish 4 Mackerel 2 Stew 9 Cod Livers 11 Marmalade 224 Stewed Steak 62 Cod Roes 20 Meat and Vegetable 184 Strawberries 1 Coffee 6 Meat, Potted 11 Syrup 2 Corn, Golden 5 Meat Roll 31 Tea, Sugar and Milk Compound 58 Crab 6 Milk 4,383 Crab Dressing 1 Mincemeat 1 Tomato Juice 60 Crab Spread 5 Mussels 206 Tomatoes 320 Crawfish 13 Mutton, Corned 16 Tongue 6 Crayfish 2 Orange Juice 62 Treacle 2 Damsons 11 Oranges 210 Treacle Pudding 1 Date Pudding 1 Ox Tongue 1 Turkey 3 Figs 2 Parsnips 1 Veal Loaf 32 Fish Cake 2 Pate de Foie 16 Veal, Jellied 1 Fish Paste 58 Peaches 188 Vegetables, Mixed 22 Fruit Salad 23 Pears 158 Whalemeat 7 Gherkins 13 Peas 584 Whiting 23 Golden Berries 8 Pemmican 320 Xmas Pudding 3 24 Other articles of food condemned were as follows:— Apricots, Dried 1068¾ lbs. Lamb 162 lbs. Bacon 64 lbs. 2 oz. Lard 56 lbs. 2 oz. Becona 14 lbs. Lemon Curd 1 jar Beef 536½ lbs. Marmalade 50 lbs. Biscuits 140¼ lbs. Macaroni 42 lbs. Blackcurrant Cordial 2 bottles Meat Paste 1 jar Black Pudding 12 lbs. Meat, Potted 2 jars Butter 20 lbs. 14 oz. Milk 21 pints Cake Mixture 33 lbs. Mints 11 lbs. Cat Fish 18 stone Mincemeat 1 jar Cereals 1 cwt. Mutton 255 lbs. Cheese 247/8 lbs. Oats 10 lbs. Chocolate 31 lbs. Olives 9 jars Chocolate Spread 48 packets Onions, Pickled 27 jars Cocoa 14 lbs. Oranges 28 lbs. Cod Fillets 6 stone Pears 230 lbs. Coffee 3 bottles Pickles 93 jars Cooking Fat 60 lbs. Plums 7 bottles Cordial 6 bottles Potatoes 12 lbs. Corned Beef Trimmings 34 lbs. Prunes 150 lbs. Cornflour 1 packet Rabbit 61 lbs. Cucumbers 14 jars Raisins 25 lbs. Currants 14 lbs. Rhubarb 12 bottles Custard Powder 15 lbs. Ryvita 1 packet Dabs 11 stone Salt 1 packet Dates 49 lbs. Sauce 2 bottles Dog Fish 38 stone Semolina 1 packet Egg, Dried 5 packets Skate Wings 40¼ stone Faggots 32 lbs. Sponge Mixture 3 packets Fish 32½ stone Suet 4 lbs. Fish Paste 7 jars Sugar 129 lbs. Fish Roes 307 lbs. Sweets, boiled 56 lbs. Flour 137 lbs. Swiss Rolls 14 Fruit Flavouring 22 bottles Tea 7¾ lbs. Gherkins 20 jars Toffee 4 lbs. Grapefruit Marmalade 50 lbs. Tomato Ketchup 1 bottle Grapefruit Squash 1 bottle Turkey 1 Gums, Clear 24 packets Vinegar 8 bottles Haddock 30 stone Weetabix 2 packets Herring Fillets, Smoked 17 jars Whelks 1 bag Honey 1 jar Wheat Flakes 1 packet Jam 8 jars Wheat, Puffed 6 oz. Jellies 1½ lbs. Wheat Snacks 2 packets Kippers 49 stone Whiting 7 stone 25 Food Sampling. The following information has been furnished by the Middlesex County Council Public Control Department relative to the Formal and Informal Samples taken in accordance with the Food and Drugs Act, 1938, namely:— SAMPLES OF FOOD AND DRUGS TAKEN IN THE BOROUGH OF TOTTENHAM DURING THE YEAR ENDED31st DECEMBER, \9iS. Article. Formal Samples. Informal Samples. Taken. Adulterated. Taken. Adulterated. Aspirin 1 — — — Borax and honey 1 — — — Butter 1 1 12 — Cod — — 3 — Coffee 1 — — — Coffee & chicory extract 1 — — — Cooked meat — — 2 — Cooking oil 2 2 — — Cream cake — — 16 — Flour, self-raising 2 — — — Gin — — 15 — Hake — — 2 1 Halibut — — 1 — Honey, glycerine & lemon linctus 1 — — — Horseradish sauce 1 — — — Imperial wine cocktail 1 — , — — Meat pie 1 — 11 — Meat savoury — — 3 — Milk 72 7 282 9 Milk, condensed 1 — — — Milk, South Devon 2 — — — New milk ice cream 1 1 — — Olive oil (edible) 1 — — — Pickled onions 1 1 1 1 Plaice — — 4 1 Preserves 2 — — — Pop-corn toffee — — 1 — Pure tomato juice — — 1 — Rissole, nut 1 — — — Rum — — 1 — Salad dressings 2 1 — — Sausages 3 1 7 — Sausage meat — — 1 — Sausage, cooked — — 7 1 Sherry — — 1 — Sole — — 2 — Sulphur tablets I — — — Sweet chocolate pudding 1 — — — Tomato ketchup 1 — — — Turpentine (med.) 1 . — — — Vinegar, malt 1 — — — Vinegar, non-brewed 2 — — — Whisky — — 19 1 White petroleum jelly 1 — — — Total 107 14 392 14 26 Food and Drugs Act, 1938: Prosecutions. The following prosecutions were made during 1948 under this Act, namely:— Section 13. Unsatisfactory conditions at premises used as a Cafe. Fined £5 0s. 0d. with £2 2s. 0d. costs. Section 9. Sale of bread unfit for human consumption. Rodent contamination. Fined £5 0s. 0d. with £3 3s. 0d. costs. Slab Cake containing a cigarette end. Dismissed under Probation of Offenders Act on payment of £2 2s. 0d. costs. Alleged rodent contamination of bread. Dismissed. 27 PART III SANITARY CIRCUMSTANCES OF THE AREA. Water Supply. The Borough water supply continues to come from the Metropolitan Water Board, and gives no cause for anxiety. Sampling of the well supplies to factories has been carried out. Drainage and Sewerage. The area is drained on two separate systems, soil and surface water being kept apart. Soil sewage is pumped into the L.C.C. system and surface water allowed to flow into the River Lee. The necessary action has been taken where soil drains are found to be connected to the surface water system. Closet Accommodation. The water carriage system is in operation over the whole of the Borough. The cases where more than one family have to share W.C. accommodation are still too many. It is to be hoped that a higher standard will be applied to existing houses and thus enable the local authority to ensure that each family has its own lavatory. Atmospheric Pollution. It is a sad reflection to think that whilst the population expect, as a right, pure and wholesome water supply, clean and diseasefree food, reasonable sanitary conditions in the house and in the factory, they are content to breathe in an atmosphere which is heavily polluted by the products of industrial and domestic coal combustion. When complaints are received, it is the practice of the technical staff to visit the offending factory, and, by advice and co-operation with the management, bring about improvements. As an example of this advice, three factories are at present fitting or have fitted grit-arresting apparatus. The greatest offender is, without doubt, the domestic fireplace, but the possibility of every householder using a smokeless fuel is still very remote. 28 Sanitary Administration. The Annual Report should be able to show steady progress maintained by the environmental health services. Until the war years, this has been true—during the war, however, progress was halted. Since the end of the war, recovery has proved slow by reason of other demands on output in the national recovery drive. Restrictions are being lifted, however, in some directions, and co-operation from outside is proving greater than has been the case hitherto. One factor which must not be overlooked is the question of making available to the public, information dealing with the services provided by the Department. This is being increasingly met through the medium of "Tottenham Calling" and also by lectures and talks to various bodies and organisations. Progress is a relative term—but it is only by public co-operation that it can be ensured. Housing. Housing in its various aspects, has continued to be the main preoccupation of this department during the year under review. The easing of building licence restrictions has, however, gone some little way towards encouraging the more enlightened type of property owner to do things for himself. Here and there some of the larger estates are being brightened by a much-needed application of outside paint. In many cases this only serves to emphasise the deterioration which has taken place in adjoining houses. In this connection, under the powers of Section 260, Middlesex County Council Act, 1944, a dwelling house which has not been kept "sufficiently repaired and painted—so as to prevent the dilapidation thereof," is deemed a house "not in all respects fit for human habitation." Here, one would imagine, is all the power necessary to have outside painting done. It must be remembered, however, that a "right of appeal" exists to the County Court. In another district of Middlesex such an appeal recently succeeded, and it is essential to be satisfied that the work is necessary to prevent dilapidation, before requirement of this work. The department, however, does specify this item in Section 9 Housing Act notices when the occasion demands. 29 Sections 9 and 10, Housing Act, 1936. The department continues to make use of these important sections of the Housing Act in their efforts to secure improved housing conditions. In spite of the relaxation in the restriction on building licensing, there is no great reduction in the extent of the work carried out in owners' default. Discretion must, however, be applied in deciding the areas of the Borough in which to apply the provisions of the Housing Act. The question of what is ' 'reasonable cost'' becomes more difficult to resolve—building costs have increased tremendously whilst rents remain static. One cannot help but express sympathy with certain property owners, particularly those owners of the type who have one or two houses. One aspect of action under the provisions of these sections of the Act which deserves consideration is the financial one. As the local authority often allow the payments for work carried out in the owners' default to be spread over a period, the result is that the Council have a considerable sum of money tied up in the properties. Housing Act, 1936: Section 9—Legal Proceedings. There was one appeal to the County Court against the cost of work executed by the Council in default under section 9 of the Housing Act, 1936. The Court reduced the charge from £58 14s. 8d. to £46 16s. 9d. During 1948 the Council decided to institute proceedings to obtain Receivership Orders in respect of two premises where work had been executed by the Council in the owners' default and it had not been possible to obtain payment for such work. Housing Act, 1936: Section 11—Demolition Orders. I must again reiterate my warning of previous years, that, whilst the department is reluctant to exercise the powers under this Section, rapidly changing conditions make it unavoidable. In many cases we are faced with the problem that no minimum specification is possible in order that action can be taken under the Public Health Act, 1936. Any major specification, on the other 30 hand, renders it impossible to carry out the work at a reasonable cost—an essential requirement for action under Section 9, Housing Act, 1936. During 1948 Demolition Orders were made with respect to the following 30 premises, namely:— White Cottage, Brunswick Road; 29, Cranleigh Road; *33, The Hale; *35, ,, ,, *37, „ ,, *39, ,, ,, *41, ,, „ 55, ,, „ 57, ,, ,, 8a, Lawrence Road; 48, Pretoria Road; 49, ,, „ 50, ,, „ 1, Tewkesbury Road; 3, Tewkesbury Road; 5, ,, „ 7, ,, „ 11, ,, „ 11! 13, ,, ,, 15, ,, „ 21, ,, ,, 23, ,, ,, 25, ,, „ 27, ,, ,, 29, ,, „ 5, Union Row; 6, ,, „ 7,,, „ 8, ,, „ Note.—*An Appeal was made against these Orders, which was allowed on the owners' undertaking that the premises would not be used for human habitation and that they would take steps to remove the existing tenants. A Demolition Order made in 1946 in respect of 86, High Cross Road was quashed by the Court. The judgment was somewhat complicated and the Judge reached his decision because, although he was satisfied that the premises were not capable of being rendered fit at reasonable expense as a single dwelling unit, he found that it was open for him to consider whether the premises could be said to be ' 'capable of being rendered fit at reasonable expense'' by being converted into flats. He found that the refusal of the Ministry of Health in connection with the licence was irrelevant to the case before him because the question is not "can the house be rendered fit ?", but "is it capable of being rendered fit ?" The owner wished to be allowed to give an undertaking to carry out the conversions in question but the Judge held that for technical reasons he had no power to accept an undertaking at the hearing of the Appeal. The premises have now been reconditioned and converted into three flats. 31 Housing Act, 1936: Section 12—Closing Orders. During the year 1948, Closing Orders were made with respect to the attic rooms at Nos. 8 and 10 Etherley Road, Tottenham. Action was also taken with respect to rooms at Nos. 9a and 9c, Albany Road, when an undertaking from the owner that the rooms in question would not be used for human habitation, was accepted. A Closing Order affecting No. 52 Grand Parade was determined, the Council being satisfied that the room had now been rendered fit for human habitation. Byelaws made under the Housing Act, 1936 Prosecution. Principal tenant failed to provide adequate water supply, washing facilities and sanitary accommodation for sub-tenant and would not allow free access to those facilities already existing in house. Fined £1. Public Health Act. The increase in the use of the nuisance sections of the Public Health Act, 1936 is inevitable. This is due to the ever increasing deterioration in the poorer types of houses, houses which—it is hoped—will be dealt with under the slum clearance provisions of the Housing Acts. Houses also, which are in areas where action under the Town and Country Planning Act is contemplated, are dealt with under the Public Health Act. It is not always possible to prepare a specification by which only a minimum is required. There are many houses, the Tewkesbury Estate particularly, where the only solution is the reintroduction of clearance area procedure. Owners are justified in fighting any attempt to make them spend money on properties which are not economically worth it. Neither is it reasonable to expect that the staff can keep this type of house in a reasonably habitable condition for an indefinite period. They would be failing in their duty if—as has been done in many cases—they did not represent these houses for demolition. Unless, however, clearance area procedure is recommenced, large-scale representation will not be possible. Public Health Act, 1936: Section 83—Prosecution. A summons was issued against one person under this section with respect to the dirty condition of the rooms in which she was living. The Court imposed a fine of £2. Failure to cleanse the 32 mises subsequent to the hearing resulted in a further summons when the Court ordered a daily penalty of 5s. Od. for every day that the offence continued thereafter. Public Health Act, 1936: Section 94—Prosecutions. The following is the result of prosecutions for failure to comply with Abatement Notices during 1948, namely:— 1. Order to comply with notice forthwith and fined £2 Os. Od. with £2 2s. Od. costs. 2. Summons withdrawn on receipt of written undertaking to reimburse Council with cost of work to be carried out by local authority. 3. Order to comply with notice within 28 days and pay £2 2s. Od. costs. 4. Order to comply with notice within 28 days and fined £2 Os. Od. with £4 4s. Od. costs. 5. Order to comply with notice within 28 days and fined £2 Os. Od. with £2 2s. Od. costs. 6. Order to comply with notice forthwith and fined £2 Os. Od. with £3 3s. Od. costs. 7. Order to comply with notice within 14 days and pay £2 2s. Od. costs. A subsequent Appeal to Quarter Sessions was dismissed with the exception that the costs were remitted. Public Health Act, 1936: Section 154— Prosecution. A summons was issued against a person for an offence under this section of the Public Health Act, 1936. A street merchant was found to be exchanging toy balloons, etc., for old rags. The Court imposed a penalty of 5s. Od. for the offence. Housing Lettings. The department continues to maintain an active interest in the letting of corporation houses. Cases are brought to our notice where medical or public health considerations make it necessary for the Medical Officer of Health to exercise his prerogative to make representations to the Housing Department. It is unnecessary to stress the importance of proper and adequate advice being given to the Lettings Committee when questions of medical consideration arise. 33 Representations are not made to the appropriate officer until full enquiry has been made and a visit paid to the applicant. Due consideration is given to the factors involved, and whilst we appreciate the lengthiness of the waiting list, such cases are not put forward until we are satisfied that urgent action is desirable. Notices Served. Statutory:— Housing Act, 1936: Section 9 1,211 Public Health Act, 1936: Section 24 12 Section 39 51 Section 45 19 Section 48 1 Section 79 3 Section 83 2 Section 93 141 Food and Drugs Act, 1938: Section 13 1 Shops Act, 1934: Section 10 1 Total 1,442 Informal 3,798 Inspections carried out by the Sanitary Inspectors and defects remedied. Drains reconstructed 50 Drains repaired 338 Drains cleared 270 W.C. Cisterns repaired or renewed 405 W.C. Pans renewed 390 W.C. Pans cleansed 65 Waste Pipes repaired or renewed 331 Rain water pipes repaired or renewed 999 Roofs repaired or renewed 1,816 Eaves Gutters repaired or renewed 1,140 Drinking Water Cisterns renewed 30 Drinking Water Cisterns covered 24 34 Water Service Pipes repaired 192 Water Supply reinstated 33 Yards repaired or reconstructed 183 Sinks renewed or provided 171 Floors repaired or renewed 1,035 Floors ventilated 466 Dampness remedied— by insertion of damp-proof courses 375 by pointing of brickwork 296 by internal rendering 575 by miscellaneous rem dies 380 Window Frames and Sashes repaired or renewed, or painted 1,262 Coppers repaired or renewed, or provided 85 Fireplaces, Stoves and Ovens repaired or renewed 574 Flues and Chimney Stacks repaired 281 Brickwork of Walls repaired and walls rebuilt 254 Ventilated Food Stores provided 24 Rooms cleansed 2,341 Wall plaster repaired and redecorated 1,039 Ceiling plaster repaired and redecorated 1,045 Staircases, Passages and Landings cleansed 518 Staircases, Balconies and Steps repaired or renewed 174 Noxious Accumulations removed 67 Nuisances arising from animals abated 22 Miscellaneous Defects remedied 1,259 Repair of Houses by the Council. Work carried out in default or by agreement with owners during 1948:— Housing Act, 1936: £ s. d. Section 9. 181 premises: 13,160 8 4 Public Health Act, 1936: Section 24. 12 premises: 31 8 9 Section 39. 11 premises: 235 18 4 Section 45. 7 premises: 51 13 0 Section 79. 1 premises: 19 6 Section 93 4 premises: 519 11 6 £13,999 19 5 35 Shops Acts, 1912-1938. The supervision of shops and the administration of the acts is carried out by systematic visitation of shops throughout the Borough by the Shops Acts Inspectors, and an up-to-date register of shop premises is maintained. In the general administration of the Shops Acts, 4,812 inspections were made during the year, and the majority of contraventions reported have been minor infringements of the Shops Acts, such as non-exhibition of statutory notices, in respect of which 351 verbal warnings and notices were issued. Shops in the Tottenham (Remainder) Area are closed for the weekly half-holiday at 1 p.m. on Thursday, and in the Harringay area at 1 p.m. on Wednesday, with the exception of butchers who close on Monday at 1 p.m. throughout the Borough, subject to the alternative day (Saturday) in all cases. Regular visits and investigations are made on the days of the weekly half-holiday, and in the evening, to ensure that the provisions of the Acts and the various closing orders made thereunder are complied with. 239 visits were made for this purpose. Shops (Hours of Closing) Act, 1928, as amended by Defence (General) Regulation 60 AB. For the period of the winter months, 7th November, 1948, to 5th March, 1949, an Order was made for the later closing of hairdressers' and barbers' shops in the Borough at 6.30 p.m. Shops (Sunday Trading Restriction) Act, 1936. The provisions of this Act are effectively enforced by means of systematic investigations and observations. The conditions relating to the employment of assistants on Sunday, and the compensatory holidays in lieu thereof, are being complied with. 139 visits were made for this purpose. 36 Shops Act, 1934, and Young Persons Employment Act, 1938. Routine visits have been made to ensure that the provisions of these Acts relating to the employment of shop workers were effectively applied. The conditions of employment of young persons and shop workers generally have improved, both with respect to working hours and health and comfort arrangements. 398 special visits were made in connection with these Acts. Legal proceedings were taken in the following instance:— The occupier of a shop was summoned for employing a young person under 16 for 8¾ hours, knowing he had already been employed in a factory for 43¼ hours during the same week. The Defendant was fined £5 0s. 0d. and costs £7 9s. 0d. It is gratifying to note that the provisions of the Shops Acts generally have been well observed. Good Rule and Government Byelaws: Prosecution. One prosecution was made by the Council under these Byelaws during 1948, when an offender was fined 10s. Od. for allowing his dog to foul the public footpath. Factories. Systematic and regular inspections are carried out in all factories, and close co-operation is maintained with H.M. Inspector of Factories. Departmental co-operation is maintained with the Borough Engineer's Department—particularly with respect to matters affecting town planning requirements. It is, however, to be regretted that no more positive action can be taken to prevent this "mushroom growth" than the laborious procedure by way of the Town and Country Planning Acts. 37 Factories Act, 1937. 1. Inspections for purposes of provisions as to health (including inspections made by Sanitary Inspectors). Premises. Number on Register. Number of Inspections. Written notices. Occupiers prosecuted (1) (2) (3) (4) (5) (i) Factories in which Sections 1, 2, 3, 4 and 6 are to be enforced by Local Authorities 64 17 7 — (ii) Factories not included in (i) to which Section 7 applies: (a) Subject to the Local Authorities (Transfer of Enforcement) Order, 1938 597 262 90 1 (6) Others — — — — (iii) Other Premises under the Act (excluding out-workers' premises) — — — — Total 661 279 97 1 2.—Cases in which defects were found. Particulars. Number of cases in which defects were found. Number of cases in which prosecutions were instituted. Found. Remedied Referred To H.M. Inspector. By H.M. Inspector. (1) (2) (3) (4) (5) (6) Want of cleanliness (S. 1) 5 4 — 6 — Overcrowding (S. 2) — — — — — Unreasonable temperature (S.3) — — — — — Inadequate ventilation (S.4) — — — — — Ineffective drainage of floors (S.6) — — — — — Sanitary Conveniences (S.7): (a) Insufficient 8 6 — 2 1 (b) Unsuitable or defective 77 71 — 21 — (c) Not separate for sexes 5 5 — — — Other offences (not including offences relating to Homework) 2 1 5 — — Total 97 87 5 29 1 N.B.—10 cases in which defects were found were outstanding at the end of the year. 38 Factories Act, 1937: Section 7—Prosecution. A prosecution was adjourned sine die by the Court when the defendants submitted proposals for the provision of sanitary accommodation so as to comply with the Sanitary Accommodation Regulations, 1938. Outwork (Sections 110 and 111). Nature of Work Section 110 Section 111 No. of out-workers in August list required by Section 110(l)(c) No. of cases of default in sending lists to the Council. No. of prosecutions for failure to supply lists. No. of instances of work in unwholesome premises. Notices served. Prosecutions. (1) (2) (3) (4) (5) (6) (7) Wearing Apparel 463 — — 3 — — Household Linen 50 — — — — — Making of tents 4 — — — — — Brass and Brass articles 73 — — — — — Artificial Flowers 27 — — — — — Paper Bags 3 — — — — — The making of Boxes or other receptacles or parts thereof made wholly or partially of paper 171 — — — — — Carding, etc. of buttons, etc. 3 — — — — — Toys 123 — — — — — Total 917 — — 3 — — Notices were served under the provisions of the Housing Act, 1936, on tho owners of 10 premises where home work is carried on. NATIONAL ASSISTANCE ACT, 1948. Section 47. Persons in need of Care and Attention. In view of certain difficulties which have been encountered in the application of this Act, it has been considered advisable to present a selection of illustrative cases. Certain paragraphs of Section 47 are worthy of particular attention, in relation to the material which follows:— 39 "(1) The following provisions of this section shall have ' 'effect for the purpose of securing the necessary care and attention ' 'for persons who— "(a) are suffering from grave chronic disease or, being aged, "infirm or physically incapacitated, are living in insanitary "conditions, and (b) are unable to devote to themselves, and are not receiving "from other persons, proper care and attention. "(2) If the medical officer of health certifies in writing to ' 'the appropriate authority that he is satisfied after thorough "inquiry and consideration that in the interests of any such ' 'person as aforesaid residing in the area of the authority, or for "preventing injury to health of, or serious nuisance to, other "persons, it is necessary to remove any such person as aforesaid "from the premises in which he is residing, the appropriate "authority may apply to a court of summary jurisdiction having "jurisdiction in the place where the premises are situated for an "order under the next following subsection. '' (3) On any such application the court may, if satisfied on "oral evidence of the allegations in the certificate, and that it "is expedient so to do, order the removal of the person to whom "the application relates, by such officer of the appropriate "authority as may be specified in the order, to a suitable hospital "or other place in, or within convenient distance of, the area of ' 'the appropriate authority, and his detention and maintenance "therein: " Provided that the Court shall not order the removal of a "person to any premises, unless either the person managing ' 'the premises has been heard in the proceedings or seven clear ' 'days' notice has been given to him of the intended application ' 'and of the time and place at which it is proposed to be made. "(4) An order under the last foregoing subsection may be "made so as to authorise a person's detention for any period not "exceeding three months, and the court may from time to time "by order extend that period for such further period, not exceeding three months, as the court may determine. "(5) An order under subsection (3) of this section may be "varied by an order of the court so as to substitute for the place "referred to in that subsection such other suitable place in, or "within convenient distance of, the area of the appropriate 40 "authority as the court may determine, so however, that the "proviso to the said subsection (3) shall with the necessary "modification apply to any proceedings under this subsection. "(7) No application under this section shall be entertained ' 'by the court unless seven clear days before the making of the "application, notice has been given of the intended application ' 'and of the time and place at which it is proposed to be made— "(a) where the application is for an order under subsection (3) or "(4) of this section, to the person in respect of whom the "application is made or to some person in charge of him; "(b) where the application is for the revocation of such an ' 'order, to the medical officer of health.'' Case No. 1. Attention was attracted by a letter from the tenants of an old lady. According to them, she was owner of the house, occupier of a portion of it, and a nuisance to everyone in it because of her senile habits. Upon inspection, it was found that conditions were as described, but that the old lady was logical, independent in thought and means, and happy in her lot. She would not agree to going into & home. After careful discussion, it was decided that action under the Assistance Act should be postponed until the possibilities of supplying home help had been investigated. Home help having been refused, the old lady was visited again. Her conditions were unchanged, and she was still unwilling to go to a home. Upon a third visit, she was found to be logical in mind, but greatly enfeebled. She then agreed to go to hospital, and this was arranged that day. We heard later that her decline had continued, and that she had died in hospital. Case No. 2. An old gentleman with some private means was being supplied with a furnished room, attention and meals. His private doctor had expressed to the landlady an opinion that the old gentleman should be "taken away." The landlady lost no time in bringing this to the attention of the Health Department. When visited, the old man was in bed, but it was evident that he was not bed-fast. He had relatives who would not visit him. He was living a contented life in moderately insanitary conditions, and he was receiving from his landlady a certain amount of care and 41 attention. He refused to go anywhere, refused to discuss his condition, or to be examined, but said that he would be guided by his own doctor. When his own doctor was approached, he dissociated himself from this aspect of the case, and would not give more than a vague opinion inclining more towards Institutional than Hospital disposal. From our own observations, we would have thought that hospital was indicated, but in the absence of definite information from the patient's own doctor, the Area Welfare Officer was asked to visit. He gave his opinion that the old gentleman was not suited to institutional care. A second visit was made. The gentleman refused to go anywhere, and refused to be examined, but repeated that he would be guided by his own doctor. Once again the doctor was asked for his cooperation, so that he might arrange for the old gentleman to go willingly to hospital, but he refused, saying that the Health Department had to accept responsibility for this aspect of the case, and that he would only attend his private patient for matters concerned with illness. In an attempt to clarify the position, the Health Department requested the Town Clerk's legal advice as to whether, in order to guide the court in specifying removal to institutional or hospital accommodation, there were powers of compulsory examination under the National Assistance Act, or any other Act. Legal advice was received that no power of compulsory examination existed for such a purpose. A third visit was made. Conditions were as before, except that the landlady wished to know what we had come for. She had obtained another 5s. Od. per week from the old gentleman. The landlady was happy, the old gentleman continued to be content with his lot. The private doctor had not appeared. Although we were not happy about the case, there was little further that could be done at the time. Case No. 3. An old lady's son sent us a well-turned letter. He was working, he was also doing the housework and the shopping. There was nobody else to help in the home. Upon calling, we were assailed at the door by a young and voluble relative who lived but a few doors away. She stated that it was impossible for her to do anything to help the old lady, but her reasons were not impressive. Having sustained a barrage of words, eventually we were admitted to the old lady. 42 She was active, the house was clean. She did not wish to go away, and the matter had never previously been put to her. According to the relative, the old lady was not well, but although her doctor visited, he had never examined her. Upon writing to the doctor for a clinical opinion, no reply was received. When telephoned, he confirmed that he was in attendance upon the old lady, but said that he could express no opinion upon her condition, insofar as it might relate to admission to hospital or institution. In view of the circumstances, it was decided that no action was indicated in this case. Case No. 4. This was initiated by a letter from a person who let rooms to an old lady. Upon visiting, it was discovered that life had been made very difficult for the old lady. Although it had been alleged that her circumstances were insanitary, they were not so. Unknown to the informants however, was the fact that she was suffering from a grave chronic disease. The old lady was unable properly to look after herself and she was receiving no adequate attention from other persons. Her doctor confirmed that she was suffering from a grave chronic disease, that she had been an in-patient in a hospital, that she was continuing to attend there as an out-patient, and that he had failed in his efforts to have her re-admitted. When the matter was put to the lady, she refused to go to hospital or to have home help, and it was decided to invoke the National Assistance Act, 1948. Being advised that there was no power delegated under the National Assistance Act which would have enabled the Chairman and Medical Officer of Health to initiate action, the case had to await the approval of the next meeting of the Health Committee. In the meantime, a letter was addressed to the N.E. Metropolitan Regional Hospital Board, advising them of our intention to take action under the National Assistance Act, and requesting them to make preliminary arrangements for her admission to hospital. They replied, saying that the matter had been referred to the Emergency Bed Service. Accordingly, another letter was forwarded to the Regional Board, drawing their attention to Section 47 paragraph 3, and asking for their observations upon the matter of naming the person "managing the premises." The Board then replied that application should be made to the Hospital Group Management Committee controlling the hospital at which the old lady had been an in-patient and an out-patient. Application was so made. In 43 view of a later opinion of the Regional Hospital Board, it is of interest to note that in this case the Hospital Group Management Committee was not that of our own area. By the time this correspondence had reached its conclusion, the Health Committee had met, and the case was in the hands of the Legal Department. Eventually a day was secured for hearing at court, but upon visiting the old lady to serve her notice of this, it was discovered that she had died. Case No. 5. An old lady had fallen sick. She was being looked after by her tenants. They brought the case to the notice of the Health Department when the old lady's demands became so exacting that they were unable to secure an unbroken night's sleep. In consultation with the family doctor, it was learned that the old lady's condition did not lend itself to diagnosis without hospital facilities, but that she had refused to enter hospital for investigation and possible treatment. When visited, her circumstances were entirely sanitary, and it was evident that she was receiving adequate attention from her tenants, although at some inconvenience to them. The tenants refused to say whether they were or were not willing to continue their attention, and the old lady refused to have home help or to go to hospital. Within a day or two, we were informed by the tenants that they had found it necessary to leave the address. Visiting with the family doctor, we found conditions still to be as before, except that the old lady was unattended. A relative was to visit the old lady from time to time in order to look after her. We expressed dissatisfaction, and did our best to persuade the old lady to accept home help or transfer to hospital. She refused. That same day we essayed to discover how the National Assistance Act or any other Act might be operated in order to force the old lady into hospital. In the end it was evident that there was no power to proceed with a celerity suited to the case, but in the realisation that the requisite seven day's notice constituted an immovable barrier, we decided to operate the National Assistance Act with all possible speed, and a message was conveyed to the relatives, impressing upon them the changed nature of the case now that the old lady was unattended by her tenants. Upon the following morning, information was received that the old lady had died during the night. 44 Case No. 6. An old gentleman was living in a single room. Owing to his insanitary habits, he had become a nuisance to those living in the remainder of the house, and they made representation to the Town Hall. He was found to be dirty, infirm, unable to look after himself, and living in conditions of absolute squalor. He was unwilling to enter an institution. The National Assistance Act was invoked. So filthy was his room that home helps would not do anything temporarily while the case was being prepared. An attempt was made to elucidate whom we should address as "the person managing the premises" in the case of hospital or institutional disposal, and further, we sought some definite assurance that priority admission would be accorded to persons who had been dealt with under the Assistance Act. In the case of institutional provision, Middlesex County Council stated that if they were given notice they would, if possible, give the name of an establishment to which the notice could be addressed, and that they would endeavour to reserve the first vacancy occurring at that establishment at about the anticipated date of the Order. When the North-East Metropolitan Regional Hospital Board was approached, it opined that notice should be given to the Secretary of the Hospital Management Committee for the area concerned. A further approach was made to the Regional Hospital Board, pointing out that the hospital accommodation under the control of the local Hospital Management Committee did not seem suited in type or extent to the expeditious reception of the chronic class of case that would most usually lead to action undeR the National Assistance Act, and it was suggested that as the Regional Hospital Board had control of sufficient hospital accommodation, admissions to hospital could be made with much greater expedition were the Board to accept responsibility and nominate someone to be addressed as "the person managing the premises." The North-East Regional Board replied, suggesting as before, that notice should be given to the Secretary of the Local Hospital Management Committee. From this correspondence it will be evident that there was no delay in determining the procedure for having the old gentleman admitted to an institution, the choice of disposal originally indicated by his condition. The preparation of the case having concluded, a date was received for the hearing at court, and the old gentleman 45 was visited in order to serve upon him a notice in this connection. He and his room had not changed much, except that both were more soiled. He announced his intention of fighting the case. Upon the day before the hearing in court, being on other visits, we called upon the old gentleman in passing. He was lying, helpless, in bed. It appeared that he was suffering from the effects of a stroke. Upon questioning others in the house, it was learned that his doctor had called some five days previously. The doctor had viewed his helpless condition, and had said that the old gentleman was a hospital case, but that nothing could be done in this matter. He had not called subsequently. After some conversation the old gentleman agreed that he should go to hospital, and this was arranged by the Health Department with a hospital not under the control of the Local Hospital Management Committee, so that he was admitted within an hour. The Court was then informed of the circumstances, and it was agreed that the case should be deferred. A consideration of these cases, in relation to selected paragraphs of the National Assistance Act, 1948, will give rise to some thought. It would appear to be indicated in connection with Section 47 of the Act that:— (1) Power of examination should exist, so that a Medical Officer of Health may ascertain, in doubtful cases, whether removal to a hospital or institution is appropriate. (2) A Medical Officer of Health should have authority to call for a fully explanatory certificate from any general medical practitioner who has been in attendance upon the case. This certificate to include details of all steps already taken by the medical practitioner. (3) Some clear indication is required of what cases may be presented for institutional acceptance. (4) There should be a means of delegating power so that the Medical Officer of Health may proceed as expeditiously as possible, and further power should be given by amending legislation so that real urgency can be attained in an emergency. (5) Regulation should determine that persons having wide enough authority are those to be named in an application for institutional or hospital admission. 46 (6) Regulation should assure priority in admission for those cases dealt with under the National Assistance Act, 1948. Section 50: Burials. This section makes it the duty of the Council to arrange the burial of any person who has died in the district where it appears that there are no suitable arrangements for the disposal of the body. During 1948 two burials were arranged in accordance with this section. 47 PART IV DISINFESTATION. Bed-bugs. D. D. T. continues to give good results in combating the bed-bug. During the year 268 houses were treated for bugs, when 591 rooms were sprayed. In addition to spraying the rooms, the bedding was removed to the Corporation's Cleansing and Disinfecting Station, where it was treated in the steam disinfector. As a precaution against the infestation of houses let by the Council, complete disinfestation of the new tenants' belongings is carried out before they move in. To accomplish this, the Council arrange all removals. By co-operation with the Metropolitan Borough of Hackney the removal van, with contents, is treated in a cyanide chamber at the Hackney Cleansing Station, the tenant being warned not to pack any foodstuffs in the van. The bedding and soft furnishings are treated in the steam disinfector at our Markfield Road Station. In this way the tenants are assured of a clean start in their new homes. So that mild infestations should not be overlooked and to avoid any feeling of stigma which might be attached were only verminous cases to be treated, a rule is made that the belongings of all new tenants must be subjected to this disinfestation treatment. Fleas. Complaints are occasionally received of flea infestations. It has been found that a thorough clean-up by the tenant, followed by treatment with D.D.T. effectively eradicates this pest. Flies. Publicity has been given to the disease carrying capacity of the house-fly and every opportunity is taken by the department to emphasise the great need for the regular removal and proper covering of all refuse and other likely breeding grounds for flies. 48 Advice is given on the best methods of controlling fly nuisances and particular attention is paid in this respect to the various premises in the district where food is prepared, stored or sold. It has been found that this advice is welcomed by the proprietors and that they are usually anxious to co-operate in combating this pest, which they are becoming to recognise as, not only a danger to health, but also as an agent causing deterioration and putrefaction of foodstuSs. Cockroaches and Beetles. The Public Health Department continued to assist householders in dealing with infestations from these insects. Usually they are found to nest in inaccessible parts around the fireplace. To eradicate them it is usually necessary to have the floorboards lifted and, using a dusting gun, to liberally scatter D.D.T. powder around the hearth and into cavities thereunder. A charge of 2/6d. is made for the Council's services. Summary of Disinfestation Work during 1948. Insect. Private Houses. Council Houses Total. Houses. Rooms Houses. Rooms Houses. Rooms Bugs 255 563 13 28 268 591 Fleas 2 8 — — 2 8 Beetles 29 52 — — 29 52 Woodworm 8 20 — — 8 20 Silverfish 0 3 — — 2 3 Flies 6 9 — — 6 9 Ants 12 12 — — 12 12 Slugs 1 1 — — 1 1 Wasps 1 1 — — 1 1 Total 316 669 13 28 329 697 Disinfestation upon removal to Council dwellings was carried out in 135 instances. Rodent Control. Effective and prompt action is taken by the departmental operators in all cases where complaints are received regarding the presence of rats. Rodent Control - Regular baiting of sewers to reduce rat population 49 National campaigns are now in the hands of the Ministry of Agriculture and Fisheries, the responsibilities having been transferred from the Food Ministry. New legislation is before Parliament, but it seems unlikely that anything will appear on the statute book before 1950. Maintenance treatment of the sewers has again been carried out, one during December—January, and one in May—June. Block control methods are used in the treatment of private dwelling-houses. Summary of Dwelling-houses and Business Premises treated during 1948. (1) Dwelling-houses 662 (2) Business and Factory Premises 109 (3) Total charges for (2) above £73 18s. 9d. The seventh and eighth treatments of sewers were carried out during the year, with the following results:— Type of take. 7th Treatment. 8th Treatment. Small poison take 180 173 Good poison take 128 80 Complete poison take 248 301 No poison take 555 557 Total number of manholes baited 1,111 1,111 Estimated number of rats killed 5,835 6,064 In both treatments the bait base and poison used were sausage rusk and 2½ per cent. Zinc Phosphide. 51 PART V MATERNITY AND CHILD WELFARE. The following report indicates the work carried out by the Maternity and Child Welfare Department from January 1st to July 4th, 1948, when the services were transferred under the National Health Service Act of 1946 to the Middlesex County Council. Municipal Midwifery Service. During the period under review 14 midwives were employed in the Municipal Midwifery Service, 4 less than in the previous year. The work of the midwives continued to consist chiefly of visits to expectant mothers in their homes, attendances at antenatal clinics, and the delivery of the mothers who had arranged for home confinement. Each mother was visited for 14 days following the birth of her baby. Two visits were paid on the first three days and two or more on any day should the mother's or baby's condition so require. The total births notified during this period of the year was 1,229. Of these 38 were still-births, leaving a total of 1,191 live births. The midwives attended 554 cases, 15 of which were as maternity nurses. Gas and air analgesia was used wherever requested and no midwives employed, with the exception of two who were about to retire, failed to complete the course of training in analgesia. Premature infants received extra care from the midwife and much time has been spent establishing breast feeding and ministering to the special needs of these babies. Attendances at Ante-Natal Sessions. Centre. Sessions Attendances. Cases from 1947 1948 New Cases January 1 to July 4 PostNatal The Chestnuts 127 2,213 343 364 148 Lordship Lane 103 2,015 279 309 124 Park Lane 75 1,658 185 250 73 Total 305 5,886 807 923 345 52 Maternal Mortality (to July 4th). Puerperal sepsis 0 Other puerperal causes 2 Total 2 Puerperal Pyrexia. Two cases of puerperal pyrexia were notified as Tottenham cases from the Mothers' Hospital, Clapton. Both cases recovered. Ophthalmia Neonatorum. Three cases of Ophthalmia Neonatorum were notified from outside hospitals for information only, the cases being counted in the district in which they occurred. All three cases recovered. Record of Municipal Midwifery Cases. Number of deliveries 539 Number attended as maternity nurse 15 554 Primipara cases 124 Multipara cases 430 Ante-natal visits 911 Nursing visits 8,392 Midwives in private practice. Deliveries 21 Total 575 Home Help Service. The acute shortage of suitable women willing to act as Home Helps rendered this assistance difficult, help being restricted to maternity cases. Financial aid was allowed in 23 necessitous cases of which 18 were in need of free assistance. 53 Maternity Hospital Provision. Arrangements for maternity hospital beds have been made as heretofore with the North Middlesex Hospital and the Mothers' Hospital, Clapton. Other cases have been admitted to maternity hospitals within the London region by private arrangements made by the patients. Under Ministry of Health circular 85/1948, dated 3rd June, the evacuation scheme for confinements was closed down. The following table shows the distribution of hospital confinements:— The Mothers' Hospital, Clapton 185 The North Middlesex Hospital 255 Other London Hospitals 200 Under the "Evacuation" scheme 14 Total hospital confinements 654 Municipal Midwifery Service and Hospital Saturday Fund Vouchers. In March, 1948, the offer was accepted of the Hospital Saturday Fund Association to pay £1 12s. 6d. per case for Municipal Domiciliary Midwifery cases, in respect of members of the Hospital Saturday Fund resident within the Borough; no further fee to be collected from the patients. This was in line with the arrangement already in operation for the Hospital Savings Association. Midwives Acts, 1902-1926: Medical Practitioners Fees Regulations, 1948, S.I. No. 695. Under the Ministry of Health circular 51/48 the revision of fees to medical practitioners called in by midwives became effective as from April 18th. The Midwives Salaries Committee : Consolidated Recommendations : Midwives S.C. Notes No. 5. These recommendations were adopted by the Maternity and Child Welfare Committee in February. 54 Registration of Nursing Homes. Section 187/195 Nursing Home; Public Health Act, 1936, in respect of the registration of Nursing Homes by the Borough Council was revoked, the power passing to the Middlesex County Council on July 5th. Certificates of exemption from registration as Nursing Homes were extended by the Maternity and Child Welfare Committee in respect of the Prince of Wales's General Hospital and the Home and Hostel for Jewish Incurables from May to July, 1948. Care of Premature Infants. Premature births Total Still births Live births Subsequent report Removed Alive after first month Alive at July 4th Deaths Domiciliary births 34 5 29 3 25 24 2 Institutional births (born outside the borough) 42 7 35 3 28 28 4 Totals *76 12 64 6 53 52 6 Total. *Twin births—live births (domiciliary) 6; institutional 2 8 still „ (domiciliary) 2; institutional- 2 10 Total deaths 6: Causes— Total. (1) Under one month—domiciliary—congenital malformation of heart 1 Institutional—prematurity 3 erythroblastosis foetalis 1 4 (2) Over one month—domiciliary—bronchial pneumonia 1 6 Home Nursing. This work has continued to be carried out with efficiency by the Queen's Institute of District Nursing, from their headquarters and nurses home in Bruce Grove. The number of individual cases attended was 620, with a total of 10,805 home visits. Health Visiting Service. A number of changes of staff occurred in the period under review and Miss Ruth Driscall, Public Health Nurse, Syracuse, continued to work in the department, while Miss Lennon, Deputy 55 Superintendent Health Visitor was undertaking Miss Driscall's duties in America. This exchange system of health visitors has proved eminently successful and arrangements are now being negotiated for a similar exchange with New Zealand. Staff meetings were held each month at which special matters of general interest were discussed. Student health visitors from the National Health Society received their practical training within the department. Each student attended for two days weekly for three months and also attended the School Medical Department for a similar period and in each case arrangements were made through the courtesy of the Clerk of the Court for a visit to the Juvenile and County Courts. The health visitors have maintained a close contact with the day nurseries and have rendered valuable service in the follow-up of absentees from the nurseries. Members of the staff have given talks and demonstrations to school children and voluntary organisations within the Borough. Distinguished visitors and postgraduate health visitors have visited the department. Work of Health Visitors. The health visitors have been fully occupied in their duties of safeguarding the health of mothers and children under five years and in acting as infant life protection officers. Their duties included the home visitation of expectant and nursing mothers; children from birth to five years of age for many special as well as routine purposes; foster-mothers and daily minders; follow-up visits for general defects found at toddler and infant welfare clinics to ensure that medical recommendations were carried out; follow-up visits following the notification of infectious diseases; initial and subsequent visits to homes of applicants for adoption orders. In addition to home visitation, health visitors were in regular attendance at the infant welfare clinic at the Town Hall and at the three health centres, where they assisted at the ante-natal, postnatal. gynaecological, and infant and toddler clinics, mothercraft demonstrations, ultra-violet light treatment, dental anaesthetic sessions for expectant mothers, and mothers' clubs. The department has arranged for the selection and admission of children to day and residential nurseries; made arrangements for hospital confinements for mothers in special need on medical or social grounds and has reported cases of neglect of children to the 56 N.S.P.C.C. Officer. It has also had close co-operation with the British Red Cross Society, the Invalid Children's Aid Association, the Clapton Mothers' Hospital and Almoners of various hospitals. Details of Home Visiting by Health Visitors. Expectant Mothers Children under 1 year Over 1 year Totals. First Visits. Re-visits. First visits. Re-visits. Re-visits. 870 979 1,177 2,949 5,061 11,036 Other visits :—Infantile Deaths 15 Still Births 42 Ophthalmia Neonatorum 3 Pneumonia 26 Infectious Diseases 546 Public Health Act, 1936; Child Life Protection.. 59 Adoption of Children (Regulation) Act, 1939 39 Special visits—Mothers 277 Children 104 Total 12,147 Dockets for sheets—598 were given to expectant mothers. Breast Feeding. The following table shows the types of infant feeding and their incidence in the total infant population for the period January 1st to July 4th, based on the notified births, i.e., 1,229. Breast fed 545 Part Breast fed + milk, dried milk or condensed milk 378 Bottle feeding—Cow's milk 15 Dried milk 155 Other artificial feeding 5 Feeding unknown, i.e. removals, deaths, etc. 131 Total 1,229 Attendances at the Infant Welfare Sessions. Centre. Sessions Weighings: infant attendances. New cases. Weighings: over 1 year attendances. New Cases Examined by doctor.- Lordship Lane 130 3,930 273 1,191 21 834 The Chestnuts, St. Ann's Road 131 4,505 359 814 28 1,122 Park Lane 83 2,675 207 554 7 854 Town Hall 26 953 102 96 — — Total 370 12,063 941 2,655 56 2,810 DETAILS OF CLINICS Clinic. Address. Monday. Tuesday. Wednesday. Thursday. Friday. Saturday. Ante-Natal Chestnuts (St. Ann's Road). 9.0 a. m. 2.0 p. m. — 9.0 a. m. 2.0 p. m. 9.0 a.m. — — Park Lane 2.0 p. m. — 2.0 p. m. — 9.0 a. m. — Lordship Lane — 9.0 a. m. — — 9.0 a. m. — 2.0 p. m. 2.0 p. m. Infant Welfare Chestnuts — 2.0 p.m. 2.0 p. m. d 2.0 p. m. 9.0 a. m. d — Park Lane — 9.0 a. m. — 2.0 p. m. 2.0 p. m. D 2.0 p.m. D — Lordship Lane 2.0 p. m. d 2.0 p. m. d 9.0 a. m. d 2.0 p. m. 9.0 a. m. 2.0 p.m. — — Town Hall — 2.0 p. m. — — — Toddlers (2—5 yrs.) Chestnuts (St. Ann's Road). — — 9.0 a. m. d — — — Park Lane — 9.0 a. m. d — — — — Lordship Lane — — — 2.0 p. m. d Immunisation Chestnuts (St. Ann's Road). 2.0 p. m. — — — — — Park Lane — — — 2.0 p. m. — — Lordship Lane — — 2.0 p. m. — — — Town Hall — 2.0 p. m. — — — — Minor Ailments Park Lano — 9.0 a. m. — 9.0 a. m. — 9.0 a. m. Lordship Lane 1.30 p. m. — 1.30 p. m. — 1.30 p. m. — Cornwall Road 1.30 p. m. — 1.30 p.m. — 1.30 p. m. — Dental (by appointment) Chestnuts (St. Ann's Road). 9.0 a. m. 9.0 a. m. 9.0 a. m. 9.0 a.m. 9.0 a. m. — Park Lane 2.0 p. m. 2.0 p.m. 2.0 p.m. 2.0 p. m. 2.0 p. m. — Lordship Lane Town Hall Ophthalmic (by appointment) Lordship Lane — — 9.0 a. m. 1.30 p.m. 9.0 a. m. — Aural (by appointment) Park Lane Treatment, 2.0 p. m. — 2.0 p.m. Treatment, 2.0 p.m. 9.0 a. m. — Orthopaedic (by appointment) Lordship Lane — 2nd and 4th in the month 9.30 a. m. — — — — Remedial Exercises (by appointment) Lordship Lane 2.0 p. m. 9 a. m. and 2 p. m. 9 a. m. and 2.0 p. m. 2.0 p.m. 9 a. m. and 2.0 p. m. 9.0 a. m. Vale Road School for Physically Handicapped 9.0 a. m. — — 9.0 a. m. — — Speech Therapy (by appointment) Park Lane 2.0 p.m. — — — 2.0 p.m. — Lordship Lane 9.30 a. m. 9.30 a. m. — 9.30 a. m. 2.0 p.m. — — Cornwall Road — 2.0 p.m. 9.30 a. m. — 9.30 a. m. — Rheumatism (by appointment) Lordship Lane — 2.0 p.m. monthly. — — — — Ultra-Violet Light Lordship Lane 2.0 p. m. — — 2.0 p. m. — — Chiropody (by appointment) Lordship Lane — 9.30 a. m. — 9.30 a.m. — — 57 Attendances at Toddler Clinics. Health Centre Sessions held. Appointments made. Actual attendances. New. Re-examinations. Total The Chestnuts 26 566 152 244 396 Lordship Lane 25 558 113 300 413 Park Lane 21 364 58 187 245 Total 72 1,488 323 731 1,054 Attendances at Specialist Clinics. The arrangement with the school health service for children under five to attend the special clinics has continued during the year. Consultations and treatments were as follows:— Clinics. Number of Consultations. Number of Treatments. Minor Ailments 4 4 Dental 120 197 Orthopædic 72 138 Ear, Nose and Throat 32 38 Ophthalmic 134 38 Child Life Protection. The health visitors paid 59 visits as Infant Life Protection Visitors in respect of 19 foster-children. The number on the register at July 4th was 16. Adoption of Children (Regulation) Act, 1939 (Sec. 7). 39 visits were paid by health visitors up to July 4th, and adoptions were completed in respect of 11 children. The number under supervision on July 4th was 9. Care of Illegitimate Children (Circular 2866). The co-operation between the Maternity and Child Welfare Department and the moral welfare worker has continued, and the number of mothers referred to her was 20. 58 babies who remained with the mother 14 Babies who were adopted 5 Babies who were fostered 1 Babies who died — Babies who were still-born — Result unknown as mother left district — Total 20 GENERAL HOSPITAL TREATMENT. Hospital treatment included two infants for special dietetic treatment, three orthopædic cases, and ten children referred for dental X-ray. Tonsil and adenoid and allied cases were treated, as in former years, at the Prince of Wales's General Hospital. The Maternity and Child Welfare Committee agreed to pay for cases referred to hospital from the infant welfare clinics, at the same rate as for school children. (Ministry of Education circular 102, 31/5/1916). Cases treated from October, 1946 to July 4th, 1948. Total number 64. Cost £614 19s. 2d. Included in cost £73 15s. 9d. specialist treatment. Included in above cases were: mastoidectomy 4; medical case 1; otitis media 6; myrigotomy 1; septic pharyngitis 1. In-patient treatment: 44 for 2 days; 20 over 20 days. Convalescent Home Treatment. The Invalid Children's Aid Association has co-operated with the department in placing 17 children. Number of children who stayed for 1 to 10 weeks 9 Number of children who stayed for 11 to 20 weeks 7 Number of children who stayed over 20 weeks 1 Total 17 59 Of this number five were free cases, the other twelve paying varying amounts weekly towards the cost. In addition to the above, six children were already away on the 1st January, 1948, and stayed during the year from 3 to 18 weeks. Nature of Defects for which Convalescent Treatment was advised. Defect. No. of children Defect. No. of children. Bronchitis 4 Poliomyelitis 1 Pneumonia — Otitis Media 3 Malnutrition and Debility 5 Discharging Ear 1 Post-Measles 1 Glands 1 Post-whooping cough 1 Erythema Nodosum. 1 Mastoid 2 Still's Disease 1 Catarrh 1 Abscess 1 The following mothers were sent away through the Church Army Fresh Air Fund:— 5 mothers with children. Dental Care for Mothers and Young Children. The number of expectant mothers found to require dental treatment was 395. A further 60 nursing mothers received treatment. The number of children under the age of five years treated from infant welfare centres and nurseries was 197. The main classes of treatment undertaken were as follows:— Extractions (expectant and nursing mothers) 681 Extractions (children under five) 136 Fillings (expectant and nursing mothers) 492 Fillings (children under five) 56 Scalings 182 Artificial dentures supplied to mothers 58 Health Education. Special emphasis has been given to all methods of teaching to promote health by the spoken word, visual aids, films, use of blackboards, show cases and demonstrations and also the written word by the distribution of leaflets. 60 Talks were given by health visitors during ante-natal clinics, infant welfare clinics, individually and in groups. A large number of senior school girls have visited health centres and nurseries for observation visits and demonstrations of infant care and baby bathing, and by their evident pleasure and questions they have shown their interest in nurseries and local health services. Distribution of Vitamins and Accessory Foods. The centres have continued to act as an agency for the distribution of the national dried milk, cod-liver oil and fruit juices. The local food office have supplied the following figures of distributions:— Bottles of cod-liver oil 16,386 Bottles of orange juice 60,583 Tins of national dried milk 41,180 Packets of cod-liver oil capsules 4,198 Of this quantity 75 per cent. was issued by the local food office and the remaining 25 per cent. through the four welfare centres. In addition to the above issues, supplies were issued to the medical officer of health for distribution as follows:— To Institutions and Schools. Bottles of cod-liver oil 1,335 Bottles of orange juice 4,360 Tins of national dried milk 594 To Nurseries. Bottles of cod-liver oil 348 Bottles of orange juice 1,092 DAY NURSERIES. The present nurseries provide accommodation for 140 children daily. All nurseries are approved training schools for student nursery nurses. The health visitors have arranged for the selection and admission of children to day and residential nurseries. Toy equipment has been improved and greater facilities have been made for free play in the toddler age group. 61 Waiting Lists. In June the Maternity and Child Welfare Committee considered a report of the day nursery service and the hardship existing amongst families whose children were on the priority waiting lists. It was decided that certain children should not be re-admitted to the nurseries and that vacancies arising from these exclusions be allotted to children who are deprived of the care of one or both parents or cases of hardship or emergency. Parents of children who cannot be admitted immediately to a day nursery are advised to take advantage of the Daily Guardian Scheme. General Health. All nurseries were visited weekly by a medical officer and all children were medically examined at three-monthly periods, or more frequently where necessary. Those not previously immunised against diphtheria were, with the consent of their parents, immunised on admission to the nurseries. The health of the children and the staff has been remarkably good and all children have benefited from their stay in the nurseries. BENGEO HOUSE RESIDENTIAL NURSERY. Pursuant to the powers under the Children Act, Middlesex County Council accepted responsibility for the maintenance of the nursery on July 4th. During the first six months of 1948 the Tottenham Maternity and Child Welfare Committee improved the living conditions of the staff by providing and equipping a sitting-room for student nursery nurses and replacing worn out beds and bedding for all members of the staff, as well as other improvements. Many Tottenham children have benefited from a short stay at the nursery where a very high standard of child care is maintained and Tottenham parents have been assisted at a period when it has been difficult for them to give adequate care and attention to their children. The nursery has been provisionally approved by the Ministry of Health as a training nursery for student nursery nurses. 62 NURSERIES—SUMMARY OF ATTENDANCES. Day Nurseries. January to March. April to June. Attendances 1948 (half-year) (whole days) Total Total. Days open. Average daily attendances. Under 2 Over 2 Park Lane: Under 2 years of age 591 564 1,155 4,788 129 37.12 Over 2 years of age 1,888 1,745 3,633 Lordship Lane: Under 2 years of age 659 692 1,351 4,665 129 36.17 Over 2 years of age 1,595 1,719 3,314 Plevna C'resent: Under 2 years of age 1,049 1,011 2,060 5,643 129 43.74 Over 2 years of age 1,805 1,778 3,583 Residential Nursery, Bengeo House, Hertford. In residence 1.1.1948—19; Admissions—33; Discharges—22; In residence 4.7.1948—30, 63 DAILY GUARDIAN SCHEME. This scheme was inaugurated in Tottenham in February, 1948, mainly on account of the large day nursery waiting lists, and has been of great service to working mothers who have no other means of arranging for the daily care of their children. The Tottenham Borough Council has paid an approved guardian 1s. 0d. per child for each day that the child is in her care. Working mothers make their own arrangements for payment in excess of this grant. The scheme has proved to be a success in the short period that it has been in operation and up to July 4th 39 guardians undertook the care of 43 children. Total expenditure of the scheme was £71 19s. Od. The scheme is not intended to be operated as a substitute for the day nursery but as an adjunct to it during the period that the demand for nursery places exceeds the vacancies. Health visitors are responsible for the visiting and recommendation of each suitable guardian and for the periodic visiting of the child while in the guardian's care. The number of daily guardians on the register at date of transfer was 27 in respect of 29 children. VOLUNTARY FUND FOR THE ASSISTANCE OF TOTTENHAM MOTHERS. The May meeting of the Maternity and Child Welfare Committee authorised the sum of £173 14s. 4d. created by voluntary contributions to be transferred to the Mayor of Tottenham's Distress Fund; this money to be used where no other official provision is made, for temporary assistance or holidays for mothers or residents within the Borough of Tottenham. 65 PART VI AMBULANCE SERVICE. Under the National Health Service Act, 1946, control of this service passed to the County Council on the 5th July, 1948, and, therefore, this report covers the first half-year only. A 24-hour service was maintained for the conveyance of noninfectious sickness or accident cases to hospitals or clinics for treatment. Maternity cases were also dealt with upon request, no prior notification being required. No charge was made to Tottenham residents for the use of the ambulance within the district. The service was also provided free of charge for the conveyance of cases to hospitals within the Metropolitan Police Area, but a fee of 5s. Od. was payable for return journeys. A reduced charge of 2s. 6d was made with respect to the North Middlesex Hospital, which is situated in the adjoining Borough of Edmonton. A fleet of six ambulances was used to operate the service, but the age of some of the vehicles, and the difficulty of obtaining spare parts, made it difficult to keep all the vehicles in commission. Nevertheless, by the careful arrangement of timetables for the routine treatment cases, it was possible to provide an efficient service at all times, and for an immediate response to be made to all urgent calls. The first of three new Austin " Welfarer " Ambulances ordered in May, 1947, was delivered and put into service on the 3rd February, replacing vehicle AMD 836, which had been in continuous service since 1933. Mileage Record Chart for the period 1st January, 1948, to 4th July, 1948. Month WW 1277 AMD 836 HMV 500 LMG 600 FMF 741 HX 5179 Total. January 1,227 474 SML — 598 1,258 172 3,729 483 February 442 986 — 976 681 317 3,402 March 570 1.560 94 1,403 717 — 4,344 April 436 1,265 383 660 1,145 — 3,889 May 335 1,245 710 985 751 — 4,026 June 356 1,292 627 1,232 739 — 4,246 July (4 days) 141 210 21 154 38 — 564 Total 3,507 7,032 1,835 6,008 5,329 489 24,200 66 No. of Accident and Hospital cases conveyed 4,690 No. of Maternity cases conveyed 357 The oxygen resuscitator was used on 9 occasions for the following cases:— Gas poisoning 3 Pneumonia 2 Heart attack 1 Collapse 1 Asthma 1 Arthritis 1 Total 9 Children's Transport Service. This service was linked with the ambulances, and operated by ambulance personnel. Three buses were used to convey children to the Day Special Schools, and the cost recovered from the County Education Authority. The County Council took over the work on the 5th July, 1948. Mileage Record Chart for the period 1st January, 1948, to 4th July, 1948. Months. FMF 742 CMV 13 SML 144 Total. January 924 845 841 2.610 February 620 490 1,014 2,124 March 524 407 945 1,876 April 636 532 1,118 2,286 May 573 456 1,048 2,077 June 637 657 1,313 2,607 July (4 days) 70 65 120 255 Total 3,984 3,452 6,399 13,835 67 PART VII GENERAL. Hospitals. The hospitals in the district passed under the control of the Tottenham Management Committee of the North-East Metropolitan Regional Hospital Board in July, 1948. The general hospital requirements of residents are largely met by the Prince of Wales's Hospital, which is situated centrally in the Borough, and by the North Middlesex Hospital in the adjoining district of Edmonton. For the special needs of the inhabitants, the teaching and specialist hospitals of London are available and are within easy travelling distance. The North-Eastern Hospital, St. Ann's Road, Tottenham, is available for the treatment of infectious disease cases. Diabetes. The National Health Service Act, 1946, made it possible for diabetic patients to obtain insulin free, on prescriptions by the general medical practitioners attending them under the Service. Prior to the Act coming into force on 5th July, 1948, a free supply was authorised by the Ministry of Health according to their circular 2734 of 1943, and the Borough Council provided insulin to 39 necessitous persons at a cost of £132 15s. 9d. LABORATORY FACILITIES. The Public Health Laboratory Service at Colindale, Middlesex, is available free of charge for the bacteriological examination of specimens. On the 15th November, 1948, a branch laboratory was opened in Edmonton. This now deals with most of the specimens from Tottenham. Outfits and containers may be obtained locally from the Public Health Department, and specimens left there for onward transmission to the Laboratory. Except in special urgency, specimens should reach the department before 3.15 p.m. on week-days and 11.30 a.m. on Saturdays. The following examinations were carried out by the Laboratories during 1948, namely:— 68 RECORD OF EXAMINATIONS. ThRoat/Nose Swabs : Total Specimens 1,147 Diphtheria Bacilli 1 Hemolytic Streptococci 323 Vincent's Angina 8 Negative 815 Faeces : Total Specimens 325 Shigella 27 Salmonella 5 Protozoa 4 Negative 289 Sputum: Total Specimens 31 T.B. Culture 1 T.B. Smear 5 Other Organisms 1 Negative 24 Pertussis: Total Specimens 190 Cough Plate 3 Post-nasal Swab 29 Negative 158 Milk : Total Specimens 9 Pasteurised 2 Other 7 Ice Cream : Total Specimens 107 Water: Total Specimens 9 Domestic Supplies, etc. 2 Swimming Pools 7 Miscellaneous Specimens 62 Total number of Specimens 1,880 69 THE BATHS AND WASH HOUSES SERVICE. This Municipal Service is of great personal value to all citizens, providing swimming baths for healthy indoor and openair recreation, private slipper baths for personal cleanliness and public laundries for carrying out the family wash in a speedy and labour-saving manner for the housewife's benefit. The service consists of the following:— Central Baths adjoining the Town Hall. Two indoor swimming pools, eighteen slipper baths for males and twelve s'.ipper baths for females. Also there are medicated Baths, such as Foam and Pine, for the treatment of persons suffering from Rheumatism, Sciatica, Lumbago and allied complaints. Bromley Road and Tiverton Road Baths and Public Laundries. The public laundries each comprise nine rotating washingmachines with hand washing stalls, power operated hydroextractors, mangles, hot air drying chambers and electric irons. There are sixteen slipper baths at Bromley Road and twentytwo at Tiverton Road. The Conway Road establishment consists of eighteen slipper baths. The Lido, Lordship Lane is a large open-air bathing pool, complete with diving stages, spring-boards, chutes, sun-bathing terraces and dressing accommodation for 1,200 bathers at one time. Additional amenities consist of Restaurant and Cafe, terraced seating for spectators and a free car park. The whole of the water supplied to the swimming pool is filtered and sterilised by modern filtration system, ensuring the safety of the bathers' health at all times. Special facilities are afforded to old age pensioners enabling them to have free hot baths during the greater part of the week. Also during certain hours, children up to 14 years of age can obtain hot baths for 1d. provided own towel and soap is used. 70 How much the services are appreciated can well be realised from the following details of patronage during the year ended March 31st, 1949. Swimming Baths:— Indoor 158,593 Open-Air 71,427 Spectators 12,422 Slipper Baths 221,443 Wash-houses 44,874 Total 508,759 DEVELOPMENT IN THE TECHNIQUE OF SWIMMING BATH WATER TREATMENT. I am indebted to Mr. G. Swarbrick, M.N.A.B.S., A.I.E.C., Baths Superintendent, for the following information on this important subject, namely:— "Although the number of bathers at the Council Swimming Baths averages 250,000 annually few of that number have any idea of the work entailed in supplying and maintaining a high standard of sterile water to safeguard their health. Contaminated water can be the source of many types of diseases. To obtain and maintain a degree of safety is the chief aim of every Baths Superintendent in charge of public swimming pools used by every class of the community and of all ages. The fear of contamination of the bath water is greatly reduced by the instruction of personal hygiene to the users. Matters such as pre-cleansing of the body, the nostrils and hair, and not spitting in the bath water are most important. It is remarkable the number of people who still look upon the swimming bath as a means of cleansing the body, an idea which is entirely erroneous. Gone is the era of the 'fill and empty' system, when the bath was filled with clean water and allowed to be used for three days and then it was emptied and refilled again. The charge to bathe was gradually decreased each day as the water became dirtier, and as may be expected ' clean water day ' was the most popular. The 71 purpose of this article is to convey to the bathing public a knowledge of the latest processes involved in providing a constant supply of sterile water at all times. To minimise the risk of infection from participating in a bathe in public swimming baths, most local authorities have installed filtration systems. The system not only reduces risk of infection to a minimum, but also proves economical in water supply and heating costs; it also gives an inviting appearance to the water in the pool at all times, which is so essential to reputation and an inducement to bathe. The purification of swimming bath water consists of three phases:—filtration, aeration and sterilisation. Filtration is, briefly stated, the removal of suspended matter, colour and approximately 90 per cent, of bacteria. Aeration is applied before filtration for the purpose of removal of offensive and impure gases, and regulating the soluble mineral contents such as iron, present in solution, being brought into suspension by oxidisation and thereby easily removed by the filter beds. Aeration is also applied after filtration to re-saturate the water with oxygen before re-entering the bath, giving a bright and sparkling appearance and assisting to maintain its purity and tonic effects upon the bathers. Sterilisation is a most important part of the purification process, for although the water may possess a lovely clear and sparkling appearance to the eye after filtration, it cannot be said to be sterile unless it has been through the process of chlorination. 'Bacteria ' is a word that conjures up terrible ideas to the minds of many people; although it may be safely said that there are many kinds of organisms which are in no way harmful to the human being, yet at the same time precautions must be taken to eliminate as far as possible those organisms which are of a harmful nature. It has been definitely proved for several years that if swimming bath water is to be maintained in a bacteriologically safe condition, it must be subjected to a process of continuous disinfection by a re-agent such as chlorine gas. Chlorination as the process is termed, should always be a continuous process, not merely at night when bathing has ceased, as such intermittent practice can only partly achieve its objective 72 and is therefore unsatisfactory. Chlorination after filtration in this country has so far been done by three methods : (1) The addition of bleaching powder in solution; (2) The addition of liquids known as hypochlorite solution containing usually from 10 to 14 per cent, of free chlorine; (3) By the administration of chlorine gas in solution. With the great variation in ' bathing loads ' and the consequent large variations in pollution, the ' chlorine demand ' of the water renders the problem of efficient chlorination without giving rise to complaints, by no means a simple one. Proper chlorination therefore, involves accurate dosage which must be capable of easy and rapid variation to meet the large variations in the incoming pollution, and so maintaining the correct amount of free chlorine in the water, after its ' chlorine demand ' has been satisfied. This in turn involves the provision of an appliance that is sufficiently precise to give an estimation of the free chlorine, accurate between the limits required, yet simple enough to be operated by a member of the Baths staff, who is not necessarily an expert chemist. The Ministry of Health recommended that the free chlorine actually present in the water of the pool (not merely in the filtrate) should amount to not less than 0.2 and not more than 0.5 parts per million of water. The maximum of 0.5 parts per million of free chlorine being a reasonable and sufficient margin of safety to obviate complaints of smell of chlorine or smarting eyes. A further development in sterilisation of swimming bath water was the use of ammonia in conjunction with chlorine, forming a compound known as chloramine. The use of chloramine in connection with swimming bath sterilisation compared more favourably than the use of chlorine alone, owing to the prolonged effective action which is characteristic of such compounds. The reason is that none of the chloramine is used up in the oxidation of the organic matter, whilst a considerable proportion of added chlorine is invariably destroyed in this manner. The addition of ammonia seems to increase not only the efficacy of the chlorine, but the length of time during which it is able to produce its disinfecting action; also the method is less liable to produce complaint than the simple administration of chlorine. As in the case of chlorine, the ammonia is administered in gaseous form by a special apparatus 73 known as the Ammoniator, which enables accurate dosage to be made and is quite simple to operate. The dosage is usually in the ratio of 1/8 to 1/2 of that of chlorine, and is always added to the water after filtration, and before the chlorine. As in all forms of scientific research, discoveries are bound to occur, and such is the case with regard to the sterilisation of swimming bath waters. Research and development work followed by extensive field experiments, have demonstrated that through the adoption of a new technique the bactericidal efficiency of the chlorination treatment can be greatly increased. In addition, chlorine may be made to perform many other useful functions in the purification process. Chlorine is now being used as an aid to coagulation for improvement of colour, for elimination of objectionable taste and odour, and for the prevention of various growths in storage reservoirs, purification works and distribution systems. In order to understand and assess the value of the recent discoveries, it is perhaps desirable to review briefly the history and advancement of the three different chlorination methods previously used, i.e. : (i) Simple chlorination; (ii) Chlorine/ammonia treatment (the chloramine process); (iii) Chlorination and dechlorination. Simple chlorination as first introduced for the sterilisation of public drinking water was found quite effective in eliminating pathogenic bacteria, but certain disadvantages soon became apparent. Unpleasant tastes were often produced unless the water was practically free from organic and inorganic impurities, and it was also found that the chlorine residual disappeared quickly. The development of the chloramine process consisting of combining ammonia with chlorine to form chloramine compounds, was a distinct step forward which materially helped in overcoming the disadvantages of simple chlorination, but introduced other problems due to the fact that the oxidising potential of the chloramine compounds is much lower than that of chlorine alone. Chlorination and dechlorination have been used in a somewhat haphazard way in order to take advantage of the rapid sterilising effect of simple chlorination without having a residual in the distributing system. Generally speaking, the process was applied 74 without a true understanding of the possibilities, and the methods adopted should not go under the name of ' superchlorination and dechlorination ' although this designation is often used. There is a distinct difference between the procedure of chlorination followed by dechlorination and that of superchlorination, and it is the full understanding of this difference which has led to the development of a new chlorination technique. It is only within the last few years that the importance of pioneer work carried out during the first world war by Sir Alexander Houston, Director of Water Examination of the Metropolitan Water Board, has been fully realised. He demonstrated that high doses of chlorine destroyed taste and odour, and he advocated that when difficulty arose from taste created or intensified by chlorine, the solution was ' chlorine boldness 'not' chlorine timidity,' and suggested that in the chlorination of water half measures were worse than none. Attention was focussed on superchlorination again in 1939, and later by a great many investigators in this form of water treatment; this eventually led to the development of a new superchlorination technique which, because of the characteristic' hump ' and ' dip ' in the dosage-residual curve, obtained on most waters during early investigations, has become widely known under the name of ' breakpoint ' chlorination. Previously established practice was to chlorinate to a chlorine residual. It was modified by being called a chloramine residual when ammonia was applied together with chlorine. Now the modern practice is to chlorinate to one of two definite specific determinable chlorine residuals, either combined available chlorine residual or free available chlorine residual. Modern chlorination practice, of which break-point process forms a part, is based on an understanding of these two residuals, how to determine them and how to obtain and maintain them. When carrying out break-point chlorination, it is essential that careful and accurate pH control of the water should be maintained. pH values are in the nature of a scale of measurement of the intensity of acidity or alkalinity of the water. The scale being divided into 14 parts, and from the theoretical reasoning the absolute neutrality point is 7. Above 7 indicating the alkaline condition and below 7 the acid condition, increasing in intensity as the figures differ more and more from 7. 75 Combined available chlorine residual is defined as a chlorine residual in which the chlorine present has combined with ammonia to form pure chloramines or other chloro-derivatives. A free available chlorine residual is defined as a chlorine residual which is present either as hypochlorous acid or hypochlorite ion, or both depending upon the pH of the water in which the residual is present. In water treatment the free available chlorine residual is composed of hypochlorous acid only below a pH of 6.5 and hypochlorite ion, almost exclusively above a pH of 9.5. Free available chlorine residual will therefore normally be composed of a mixture of hypochlorous acid and hypochlorite ion. At a pH of 7.5 there is an approximately equal mixture. Combined available chlorine is a weak oxidising agent, and is slow in killing bacteria. For residuals of the same magnitude and normal pH water, a combined available chlorine residual requires for certain bacteria a contact time one hundred times longer than a free available chlorine residual. To kill certain bacteria in water of normal pH in the same period of time, the magnitude of combined available chlorine residual must be twenty-five times as great as that of free available chlorine residual. Free available chlorine is a strong oxidising agent, and its action on bacteria is rapid. Certain types commonly present in drinking water are killed after only a few seconds exposure. The killing time is, however, materially increased when the pH of the water reaches 9.5 to 10.0. A free available chlorine residual is a persistent and stable chlorine residual provided the chlorine demand of the water, the plant and the pipelines have been satisfied. This may appear to be an overstatement, but it is an established fact that the residual is persistent. Several plants in the country are maintaining a free available chlorine residual throughout the distributing system. Colour removal is a particularly interesting field, where a number of investigators have reported excellent results with free available chlorination. The effect, however, is somewhat unpredictable, and the pH value of the water is of importance. Often where indifferent results have been obtained a slight alteration in 76 the pH has given the desired effect, but it remains necessary that each problem be treated individually on its merits. In swimming baths the maintenance of free available chlorine residual will provide a safeguard of an entirely different order when compared with older methods of sterilisation. The rapid bactericidal action of free available chlorine will materially reduce the danger of contamination being carried from one bather to another in the pool. The break-point process will effect the destruction of ammonia, and considerable benefits are obtained from saving in coagulants, increased filter runs and a great improvement in the appearance of the water. It has been found that free available residuals up to 3 parts per million can be maintained in the pool without any complaints from the bathers. A number of swimming baths in England are now equipped for breakpoint chlorination, and the results have been so encouraging that if the experiences to date are substantiated in further work, it seems likely that break-point chlorination will become the recognised system for the treatment of swimming bath water. Break-point chlorination with careful and accurate pH control may be readily introduced into any swimming bath, the only essential being provision of correct and adequate equipment. Samples of the bath water are tested each day by the Baths staff and in addition, the Medical Officer of Health arranges for samples to be sent to the laboratory for analysis. Summing up, the chief essentials of a modern water treatment plant, such as is installed in the Council's public bathing places, are to provide a constant supply of water, clear and sparkling in appearance and sterilised against any possible infection of disease. Finally, it should be said that although everything possible is done by the baths authorities to maintain a 'safe' standard of bath water, the bathers themselves can be of great assistance in this direction by the observance of personal hygiene." 77 Daily Collection of House Refuse—Pilot Survey. I am indebted to my colleague, Mr. H. Gurney, M.I.P.C., for the following report on a matter of special public health interest. "In May, 1947, the Cleansing Committee put into operation a scheme for the daily collection of household refuse from dwellings. The area selected comprised 241 houses with a population of 900, the unit being increased in September, 1947, to 392 houses with an estimated population of 1,462 and detailed statistics have been compiled with a view to determining the economics of the scheme. From a Public Health standpoint, the advantages of a daily collection of refuse are obvious, whilst the practical operation of the pilot scheme has been sufficiently encouraging to justify its extension in the near future to a further area comprising a population of approximately 12,000, after which, sufficient data will be obtainable to decide on its practicability for adoption throughout the whole Borough. Briefly, the modus operandi is as follows:— 1. Each householder is provided with two small bins or buckets, each with a capacity of 0.5 cubic feet, the receptacles being fitted with non-detachable lids, one for the deposit of kitchen waste, the other for all other refuse except paper, the latter being kept separate and stored in a small sack also provided by the Council. Each morning, except Sundays, the housewife places each receptacle she requires to be emptied in the forecourt of the dwelling. 2. The operator, known as a district cleaner, is provided with a small battery propelled tractor, to which is attached three large containers for the storage of waste paper, kitchen waste and other refuse. 3. Commencing at 7.30 a.m. each morning, the district cleaner removes the contents of the householders' receptacles, finishing work at approximately 12 noon each day, except Mondays, when the larger quantity of refuse accumulating over the week-end necessitates working on refuse collection until approximately 2.30 p.m. 79 PART VIII STATISTICAL SUMMARY. Area of the District in acres 3,014 Pre-war Population 144,400 Registrar-General's estimate of the Civilian Population:— Mid-year, 1948 130,000 31st December, 1948 129,800 Rateable Value £1,018,880 Sum represented by penny rate £4,166 Births and Deaths. Registered live-births: Total. Males. Females. Legitimate 2,145 1,142 1,003 Illegitimate 88 50 38 2,233 1,192 1,041 Birth Rate (per 1,000 estimated population) 17.18 Stillbirths: Total. Males. Females Legitmate 50 26 24 Illegitimate 5 1 4 55 27 28 Stillbirth Rate per 1,000 total (live and still) births 24.03 Deaths— Males 745 Females 632 Total 1,377 Death rate (per 1,000 estimated population) 10.59 Deaths from Cancer—Males, 140; Females, 132 272 Deaths from Diphtheria — Deaths from Measles - Deaths from Whooping Cough 3 Deaths from Diarrhoea (under 2 years) 5 78 On completion of his '"round" the operator returns to the depot with his load and after lunch, he proceeds back to his district and cleans the street adjacent to the collecting area. The following statistics cover a period of 2 years ending August 31st, 1949:— Approximate Population, 1,462. Number of Dwellings, 392. Year Ended Year Ended 31st Aug., 1948 31st Aug. 1949 T. C. Q. Lbs. T. C. Q. Lbs. Waste Paper 19 8 0 16 23 9 2 11 Kitchen Waste 65 12 3 7 62 8 3 8 Other Refuse 196 19 0 15 217 2 1 9 Total Tonnage 282 0 0 10 303 0 3 0 Percentage Waste Paper 7.0% 7.7% Percentage Kitchen Waste 23.0% 20.5% Total man-hours collecting 1,330 1,322 It will be observed that waste paper and kitchen waste represent 30 per cent. (1948) and 28 per cent. (1949) of the total refuse collected. These two constituents are responsible for the great bulk of the nuisance contained in household refuse when deposited in the normal type of dustbin pending its weekly collection, kitchen waste because of its high putrescible content and wastepaper because of its bulk. The daily collection eliminates these objections and the value realised from the sale of the kitchen waste and paper entirely offsets the additional cost of the more frequent collection, thus providing an improved service without extra cost. Whilst it should be noted that the figures apply to the pilot scheme only they indicate consistent results of an encouraging nature over a long period." 80 Maternal Deaths:— Puerperal Sepsis 0 Other Puerperal Causes 2 Total 2 Maternal Death Rate (per 1,000 total live and still births) 0.874 Deaths of Infants under 1 year of age: Total. Males, Females Legitimate 49 25 24 Illegitimate 4 3 1 53 28 25 Infantile Death Rate (all infants per 1,000 live births) 23.73 Legitimate Infants per 1,000 legitimate live births.. 22.84 Illegitimate Infants per 1,000 illegitimate live births 45.45 The population shows an increase of 860 over the figure of 129,140 for 1947; in 1938 it was 144,400, The birth-rate 17.18 compared with 21.57 in 1947 and 13.1 in 1938. Registered live births totalled 2,233, compared with 2,785 in 1947, the proportion of males to females being 1,192 boys and 1,041 girls. The infantile death-rate 23.73 was lower than the rate for 1947 27.29. Deaths in the first 4 weeks of life caused a neo-natal mortality of 14.77 per 1,000 live births, as compared with 16.16 in 1947. The maternal death-rate was 0.874 compared with 1.052 in 1947. The general death-rate of the whole population showed a reduction over the previous year—10.59 compared with 11.31. 81 82 Table I STATISTICS OF TOTTENHAM FOR THE LAST TWENTY YEARS. Year Population Deaths Death Rate Births Birth Rate Infantile Deaths Infant Death Rate Number of Cases. Puerperal Fever and Puerperal Pyrexia Scarlet Fever Diphtheria Typhoid Fever SmallPox 1929 168,000 1,839 10.9 2,561 15.2 162 63.2 19 536 562 5 6 1930 170,000 1,569 9.2 2,510 14.8 137 54.6 22 574 541 6 131 1931 159,300 1,621 10.2 2,345 14.7 124 52.9 19 571 220 6 7 1932 156,800 1,591 10.1 2,214 14.2 114 51.4 37 452 149 4 5 1933 154,700 1,618 10.5 2,138 13.8 118 55.2 35 551 194 5 4 1934 152,694 1,572 10.3 2,091 13.7 108 51.6 34 628 300 1 - 1935 150,310 1,456 9.7 1,969 13.1 108 54.8 41 577 286 3 - 1936 148,600 1,600 10.8 1,931 13.0 100 51.8 37 430 227 5 - 1937 146,200 1,617 11.1 1,973 13.5 126 63.9 36 306 236 7 - 1938 144,400 1,512 10.5 1,893 13.1 89 47.0 23 186 221 - - 1939 142,400 1,406 10.3 1 1,776* 12.5 66 37.95 15 335 60 — - 136,000 1,739 1940 119,400 1,703 14.26 1,666* 13.95 64 41.05 20 103 28 5 - 1941 105,620 1,418 13.43 1,559 1,560* 14.77 61 46.35 13 103 73 4 - 1,316 1942 110,100 1,349 2.25 1,819 16.52 79 43.43 12 295 75 1 - 1943 110,350 1,513 13.71 1,970 17.85 86 43.65 9 340 107 - - 1944 108,180 1,356 12.53 2,066 19.09 87 42.11 13 206 44 - - 1945 110,600 1,371 12.40 1,988 17.97 78 39.24 14 214 47 - - 1946 124,830 1,491 11.94 2,580 20.67 88 34.11 13 323 83 - - 1947 129,140 1,461 11.31 2,785 21.57 76 27.29 24 272 22 1 - 1948 130.000 1,377 10.59 2,233 17.18 53 23.73 5 260 3 - - *For the years 1939—1941 alternative birth figures were given by the Registrar-General:— (а) for calculation of birth rates; and (b) for calculation of death rates or the incidence of notifiable diseases. Likewise for the year 1939 only, two population figures were given:— (a) for calculation of birth rates; and (b) for calculation of death rates, etc. 83 Deaths during the year 1948, of Residents of the Borough of Tottenham classified according to Diseases. Cause of Death. Males. Females. Total. Typhoid and Paratyphoid Fevers — — — Measles — — — Scarlet Fever — — — Whooping Cough — 3 3 Diphtheria — — — Influenza 2 3 5 Encephalitis Lethargica 2 — 2 Cerebro-Spinal Fever — — — Tuberculosis of the Respiratory System 41 16 57 Other Tuberculous Diseases 4 5 9 Syphilis 4 5 9 General Paralysis of the Insane (Tabes Dorsalis) ) - — — Cancer, Malignant Disease 140 132 272 Diabetes 1 3 4 Cerebral Haemorrhage, etc. 53 67 120 Heart Diseases 180 181 361 Other Circulatory Diseases 31 32 63 Bronchitis 84 47 131 Pneumonia (all forms) 32 25 57 Other Respiratory Diseases 10 6 16 Peptic Ulcer 13 4 17 Diarrhoea (under 2 years) 4 1 5 Appendicitis 2 5 7 Other Digestive Diseases 11 12 23 Acute and Chronic Nephritis 8 9 17 Puerperal Sepsis — — — Other Puerperal Causes — 2 2 Congenital Debility, Premature Birth, Malformations 21 16 37 Road Traffic Accidents 12 4 16 Other Violent Causes 17 11 28 Suicide 14 7 21 Acute Poliomyelitis and Polio-encephalitis 1 — 1 All other causes 58 36 94 745 632 1,377 84 Table 11 Infantile Deaths in Ages and Sexes during the year 1948. Cause of Death. Under 1 week. 1—2 weeks. 2—3 weeks. 3—4 weeks. Total under 4 weeks. 1—3 months. 3—6 months. 6—0 months. 9—12 months. Total deaths under 1 year. Males. Females. Bronchitis — — — — — 2 1 — — 3 — 3 Diarrhoea and Enteritis — — — — — 1 — 2 1 4 3 1 Measles — — — — — — — — — — — — Pneumonia — — 1 — 1 2 1 1 — 5 o 3 Premature Births,Congenital Malformations, etc. 28 1 3 32 1 1 2 1 37 21 16 Miliary Tuberculosis — — — — — — — — — — — — T.B. Meningitis — — — — — — — — — — — — Whooping Cough — — — — — — 1 — 1 2 — 2 Other Causes — — — — — — 1 — 1 2 2 — Totals 28 1 1 3 33 6 5 5 4 53 28 25 85 Table 111 Table of Cases of Infectious Disease coming to the knowledge of the Medical Officer of Health during the year 1948 in the Borough of Tottenham, classified according to Diseases and Ages. Notifiable Disease. Males. Females Under one. 1—2 2—3 3—4 4—5 5—10 10—15 15—20 20—35 35—45 45—65 65 & over. Total Cases Removed to Hospital. Scarlet Fever 123 137 12 10 15 35 118 51 11 5 2 1 — 149 Measles 432 393 25 106 120 118 118 317 10 7 4 — — — 47 Whooping Cough 169 165 39 54 47 44 54 87 3 1 3 2 — — 27 Pneumonia 43 32 6 4 2 2 1 4 3 2 5 2 23 21 2 Erysipelas 15 17 — — — — — 1 I — 3 8 13 6 18 Scabies 30 33 1 3 3 2 1 12 8 5 19 5 4 — — Food Poisoning 1 3 — — — 1 — — — — 1 1 1 — 1 Puerperal Pyrexia — 5 4 1 — — 1 Paratyphoid 1 — — — — — — — 1 — — — — — — Cerebro Spinal Fever 1 2 — — — — — 2 — — 1 — — — 3 Polioencephalitis 1 — — — — — — — — — — 1 — — 1 Poliomyelitis 4 2 — 1 — — — 2 1 1 1 — — — 6 Diphtheria 2 1 — — 1 — — 1 1 — — — — — 3 Enteritis 4 1 5 — — — — — 4 Pulmonary Tuberculosis 104 80 2 2 — 3 2 7 6 23 80 22 29 8 — Other forms of Tuberculosis 12 9 — — — 1 2 4 4 — 6 2 2 — — Totals 942 880 78 182 183 186 213 555 89 50 132 46 73 35 262 87 INDEX—continued. PAge Knackers' Yards 22 Laboratory Facilities 67, 68 Legal Proceedings— Housing Act Byelaws 31 Public Health Act, 1936—8. 83 31, 32 s. 94 32 s. 154 32 Good Rule and Government Byelaws 36 Factories Act, 1937 38 Food and Drugs Act, 1938 26 Mass X-Ray Unit 10 Maternity and Child Welfare Committee 2 Maternity and Child Welfare 51-63 Maternity Hospital Provision 53, 54 Maternal Mortality 52, 80 Measles 14 Middlesex County Council Act, 1944—s. 279. Hawkers 22 Midwifery Service 51 Milk (Special Designations) Regulations 1936 to 1946 21 National Assistance Act, 1948—s. 47 38, 46 s. 50 46 Notices served by Sanitary Inspectors 33 Nuisances, Public Health Act, 1936 31, 32 Nursing Homes, Registration 54 Nurseries, Day 60—62 ,, Residential 61 Ophthalmia Neonatorum 52 Outworkers 38 Preface 4 Premature Infants, Care of 54 Puerperal Pyrexia 52 Public Health Act, 1936—s. 83 31, 32 s. 94 31, 32 s. 154 32 Public Health Department Staff 3 Rag Merchants; Prosecution 32 Refuse Collection: Pilot Survey 77, 78 Repairs in Default 34 Rodent Control 48, 49 Sanitary Administration 28 Sanitary Inspectors— Summary of Inspections 33, 34 ,, ,, Notices Served 33 Scabies 16 Scarlet Fever 13 Sewerage and Drainage 27 Shops Acts, 1912—1938 35, 36 Slaughterhouses 22 Smoke Abatement 27 Specialist Clinics 57 Statistical Summary 79-85 Swimming Bath Water Treatment 70-76 Toddler Clinics 57 Tuberculosis 7-10 Vitamins and Accessory Foods 60 Washhouses 69, 70 Water Supply 27 Whooping Cough 15, 16 Young Persons Employment Act, 1938 36