TOT 24 TOTTENHAM'S HEALTH 1949 The Annual Report of the Medical Officer of Health, Borough of Tottenham. 1 MEMBERS OF THE COUNCIL Councillor R. W. H. Ford, J. P. Mayor. Alderman Mrs. A. Kitchener, Deputy Mayor. Alderman E. J. Field. Alderman G. H. Ottaway. ,, Mrs. M. C. Irving. ,, J. J. Pagin. Mrs. J. D. Lynch. ,, A. Reed, A.C.I.I., J.P. ,, ,T. H. Morrell, J.P. ,, A. R. Turner. ,, The Rt. Hon. The Lord ,, R. H. Warren. Morrison, P.C.,D.L.,J.P. Councillor H. E. Ashby. Councillor H. Langer. ,, Mrs. M. Berry, J.P. ,, L. A. LeVoi, M.I.M.I. ,, G. W. Blythe. ,, Mrs. A. E. Lyons. ,, F. G. Bohringer. ,, Mrs. E. M. A. Morrell. ,, Mrs. F. E. Boyton. ,, The Lady Morrison. ,, C. H. Colyer. ,, A. A. Pawson. ,, A. J. Davies. ,, P. Readings. ,, K. A. E. Gregg. ,, Mrs. A. F. Remington. ,, Mrs. L. R. Harrington. ,, W. T. Richards. ,, W. S. Herbert. ,, G. W. Rowley. ,, Mrs. M. W. Holland. ., H. C. Scapens. ,, J. W. Hollingsworth. ,, A. E. Soall. ,, Mrs. F. C. Ilsley. ,, A. E. C. Taylor. ,, Mrs. Q. Y. Jacobs. ,, H. W. Turner. ,, A. E. Johnson, J.P. ,, MissL. E. A.Whitworth ,, F. A. F. Keay, J.P. ,, C. Wise. Town Clerk: M. Lindsay Taylor, LL.B. 2 HEALTH AND HOUSING COMMITTEE. Alderman R. H. Warren. Chairman. His Worshipful The Mayor. Councillor R. W. H. Ford. J. P. The Deputy Mayor, Alderman Mrs. A. Kitchener. (Kr-officio members). Alderman J. H. Morrell, .T.I'. Alderman A. Reed. A.0.1.1.. J. P. Alderman A. R. Turner. Councillor Mrs. M. Berry, J. P. Councillor Mrs. A. E. Lyons. F. G. Bohringer. ,, The Lady Morrison. ,, A. ,T. Davies. ,, Mrs. A. F. Remington. ,, K. A. E. Gregg. ,, G. W. Rowley. Mrs. M. W. Holland. ., A. E. Soall. 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. M.C.C., and Medical Officer of Health, Hornsey.) 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) (6) (c). C. J. Cattell (a) (b). L. J. Kerridge (a) (b). A. E. Clarke (a) (b) (c) (d). B. J. H. Mercer (a) (b). G. A. Hagedorn (a) (b). 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) Institution of Sanitary Engineers' Certificate. (d) 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. Mrs. E. K. Parker. C. J. Lemon. Miss C. Bird. T. A. Smale. Outside Staff. Foreman .. S. H. Reid. Disinfectors: Apparatus Disinfecting Attendants W. Butcher. Van Driver E. E. Mannell. A. Dowse. Drain Testers A. E. Crow. A. E. Moon. F. T. Dowse. Rodent OperW. A. Matthews. atives .. J. Lawrence. P. C. Moore. G. W. Percival. F. J. Slater. Labourer .. A. Ferridge. R. C. Wilson. 4 Public Health Department, Town Hall, Tottenham, N.15. His Worship the Mayor, Aldermen and Councillors of the Borough of Tottenham. Mr. Mayor, My Lord, My Lady, Ladies and Gentlemen, I have the honour to submit my Annual Report on certain aspects of the health of the Borough for the year ended 31st December, 1949. The birth rate fell to near the pre-war level at 15.45 as compared with 17.18 in 1948 and 21.57 for the peak year 1947. The number of deaths of infants under one year maintained a low level of '24.89. The general death rate showed a slight increase over the previous year, namely, 11.07 compared with 10.59 in 1948. For the fourth year in succession no death occurred from diphtheria. Deaths from Road Traffic Accidents were reduced from 16 to 9, and other violent causes from 26 to 11. Suicide accounted for 20 as compared with 21 in the previous year. Notified cases of 'pulmonary tuberculosis numbered 210, which with the figure of 60 deaths from this disease, shows a slight increase over the previous year. Ten cases of poliomyelitis and five of polioencephalitis were recorded; and in each case total or partial recovery resulted. No epidemic of infectious disease occurred during the year. The various sections of this Report dealing with environmental hygiene reveal the large volume of conscientious and painstaking work accomplished by the sanitary inspectors and the clerical staff, particularly in connection with housing and the inspection and supervision of food. As in 1948 special attention was given to the operation of section 47 of the National Assistance Act in the welfare of aged persons. This, the first completed year of deprivation to the Borough Council of control over the administration of the personal health services means that for the first time in the history of school medicine 5 and maternity and child welfare work in this country, the Annual Report of your Medical Officer of Health must make no mention of the operation of these vital local health services. The high reputation of Tottenham over so many years prior to the National Health Service Act, would seem to have warranted a more substantial delegation of powers and recognition of the status of this Authority as a competent "+++all purpose" unit of local government. The year 1950 marks the centenary of public health in this Borough, since it was in 1850 that Tottenham was among the first to set up a Local Sanitary Board under powers given by the Public Health Act, 1848. At every stage thereafter in the evolution of the public health service, Tottenham adopted all legislation for the advancement of preventive and social medicine within its own boundaries. At a time when it is forced to lose to the County so much of its former autonomy, it should not be overlooked that, as a part of its progressive outlook, Tottenham preceded the County Council and any of the county districts in Middlesex in the appointment of a whole-time medical officer of health. To the Chairman and Members of the Health and Housing Committee I am extremely indebted for their support and kind encouragement in what has proved the most difficult period in my twenty years' experience as a Medical Officer of Health. Also I wish to acknowledge the loyalty and assistance of the Chief Sanitary Inspector—Mr. Jenkins, the Chief Clerk—Mr. Lawrence, and the whole staff of the Public Health Department. I am, Your obedient Servant, 6. Hamilton Hogben, Medical Officer of Health. 30th September, 1950. 6 GENERAL STATISTICS. Area of District in Acres 3,014 Population: Estimate of Registrar General of Population— Mid-year, 1949 (Civilian) 130,040 ,, (Total) 130,140 31st December, 1949 (Civilian) 129,630 Pre-War Population 144,400 Approximate Number of Dwellings in District 30,327 Rateable Value of District £1,009,477 Sum Represented by Penny Rate £4,016 Live Births— Legitimate 1,914] Illegitimate 95 2,009 Birth rate (per 1,000 population) 15.45 Still Births 36 Deaths 1,440 Death rate (per 1,000 population) 11.07 Infantile death rate (per 1,000 live births) 24.89 Maternal death rate (per 1,000 live and still-births) 0.00 Comparability Factor 1.07 (Note :—Detailed Vital Statistics appear on pages 61 to 67 in the Statistical Summary). 7 PART I INFECTIOUS DISEASE. Table 3 in the statistical summary (page 67) gives details of cases of infectious diseases coming to the knowledge of the Medical Officer of Health during 1949, and shows their distribution according to sex and age. It will be noted that there have been no unusual outbreaks during the year. The one case of malaria was induced for therapeutic purposes. Tuberculosis. There were 232 new cases of tuberculosis notified, a rise of 27 on the previous year. 210 of these notifications were in respect of cases of pulmonary tuberculosis. Deaths from pulmonary tuberculosis numbered 60 (41 males and 19 females), and non-pulmonary tuberculosis caused 7 deaths (5 males and 2 females). The death rate from all forms of tuberculosis was 0.515 per 1,000 population. The number of cases on the Department's register at 31st December, 1949, was 1,273 (1,072 pulmonary and 201 non-pulmonary tuberculosis). This was an increase of 154 on the previous year. For some years there has been a steady increase in the number of cases on the register, although the number of fresh notifications has shown little change. It would therefore appear that the increase is due to two factors, namely:— 1. Improvements in the treatment of tuberculosis have resulted in a considerable increase in the expectation of life of the tuberculosis sufferer. This is demonstrated by the diagrams analysing the pulmonary tuberculosis deaths for 1929 compared with 1949. (See diagram on page 8.) 2. The movement into the district of cases of tuberculosis. 8 1929—128 Deaths. 1949—60 Deaths. Deaths from pulmonary tuberculosis shewing age-group distribution. 9 Summary of Tuberculosis Cases. Age Periods. New Cases. Deaths. Pulmonary. NonPulmonary. Pulmonary. NonPulmonary. Male Female Male Female Male Female Male Female Under 1 year — — 1 — — — — — ] to 4 years 4 2 1 2 — — 2 1 5 to 14 ,, 9 8 2 2 — — 1 — 15 to 24 ,, 30 31 1 3 1 3 — — 25 to 34 ,, 30 22 1 4 6 3 — — 35 to 44 ,, 16 13 —. 3 8 1 1 — 45 to 54 ,. 13 3 — — 6 5 1 — 55 to 64 ,, 12 2 — — 9 4 — — 65 years and up 11 4 1 1 11 3 — 1 Totals .. 125 85 7 15 41 19 5 2 Non-pulmonary cases affecting:— Male. Female. Total Abdomen 1 — 1 Ankle — 1 1 Eye — 1 1 Genito-urinary system — 4 4 Glands 1 5 6 Meninges 3 2 5 Miliary — 1 1 Skin — 1 1 Spine 1 — 1 Surgical 1 — 1 7 15 22 Mass Radiography. I am indebted to the North East Metropolitan Regional Hospital Board for the following details of the results of the Mass Radiography investigation which was completed in Tottenham early in 1949. The preliminary report upon the investigation was contained in my report for 1948. Total number X-Rayed 11,907 Number of films regarded as normal 11,202 Number of large films called for 553 10 Number of Cases of Pulmonary Tuberculosis. Female. Male. Total. Inactive Primary 74 101 175 Inactive Post Primary 51 123 174 Active Primary 1 1 2 Active Post Primary 22 21 43 Disposal of Cases of Active Pulmonary Tuberculosis Referred to Clinics. Female. Male. Total. Recommended for admission to hospital or sanatorium 14 14 28 Retained at Clinic for observation 9 8 17 The Active Cases Discovered were in the following groups. Female. Male. Total. Local Factories 9 12 21 Public Sessions 8 7 15 State Schools 4 2 6 Others 2 1 3 Total 23 22 45 Cases Unable to Classify. Failed to attend for repeat miniature film 1 Failed to attend for large film 16 Failed to attend for clinical investigation 1 Failed to attend Clinic 4 Awaiting final diagnosis (not Pulmonary Tuberculosis) 2 11 Some Abnormalities Discovered (other than Tuberculosis). Old Fracture of clavicle with, separation of fragments 1 Bronchiectasis 16 Pneumokoniosis 2 Pleural effusion (non-tuberculous) 1 Carcinoma 2 Cardio-vascular lesions—acquired 33 Pneumatocoele 2 Sarcoidosis 1 Diphtheria. There were 28 notifications of Diphtheria during the year, but in 24 cases the diagnosis was corrected by the hospital authorities, so that the final corrected figure for Diphtheria was 4 cases. The other cases were amended to:— Tonsillitis 20 Peritonsillar Inflammation 1 Vincent's Angina 1 Glandular Fever 1 Scarlet Fever 1 For the fourth year in succession no death has resulted from Diphtheria. The four children were aged 1¾, 3½, 4½ and 9½. There was no record of any of the children having completed a course of immunisation treatment. There is little doubt that the diphtheria immunisation campaign of recent years has been largely responsible for the spectacular results in the prevention of this disease. The Area Health Service, under the County Council, continues the immunisation services established by the Borough Council, and details of the clinics can be found in the table facing page 59 of this report. 12 Infectious Diseases—Co-ordination of Services. 13 The following tables have been compiled in the Area Health Service, showing the progress of immunisation during the year:— 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, 1949:— Age at 31.12.49 i.e., Born in Year. Under 1 1948 1 1948 2 1947 3 1946 4 1945 5 to 9 1940-44 10 to 14 1935-39 Total Under 15 Number Immunised 323 1,274 1,710 1,593 1,404 5,868 5,786 17,958 6,304 11,654 Estimated mid-year child Population 1949. 10,950 15, 490 26,440 Percentage Immunised 57.6 75.2 67.9 Scarlet Fever. There were '251 cases of Scarlet Fever notified during 1949,a reduction of 9 on the previous year's figure. 125 of these cases were treated in hospital, the remainder being nursed at home. The disease continued to be of a mild character, and no deaths from this disease were recorded. The following are amended diagnoses of certain cases originally notified as- Scarlet Fever:— Tonsillitis 7 Toxic Erythema 3 Measles 2 Gingivitis and Ulcerative Glossitis 1 Otitis Media 1 Rubella 1 Erythema Nodosum 1 14 Poliomyelitis and Polioencephalitis. There was no epidemic of these diseases in Tottenham. During the year 10 cases of poliomyelitis and 5 cases of polioencephalitis were notified. The poliomyelitis cases, which were all notified between 20th August and 29th November, were scattered throughout the borough, and not localised in any particular area. Measles. There were 967 notifications of this disease during 1949, an increase of 142 on the previous year. The prevalence of this disease is considered to have a biennial cycle, so that the 1949 figure should be compared with 1947 rather than 1948. This comparison shows a reduction of 260. During the year 61 cases, with some complication, were removed to hospital, but no deaths were caused by this disease. Whooping Cough. During the year there were 199 notifications of this disease, but in no case did death result. 10 cases with complications were admitted to hospital. The following is an extract from the preliminary statement of the Medical Eesearch Council upon the Whooping Cough Trials which are being carried out in Tottenham and certain other districts:— "As part of the investigation, the Whooping Cough Immunization Committee organized a series of controlled field trials in which the experience of children inoculated with pertussis vaccine could be compared with that of control children. Large-scale trials have now been carried out in collaboration with the Medical Officers of Health of Oxford, Manchester, Tottenham, Wembley, Edmonton, Leeds and West Ham, using a number of different vaccines of both British and American origin. Each trial was planned in a similar manner. Children mostly between the ages of 6 and 18 months, whose parents agreed that they should take part, were divided by the method of random sampling into two groups. The children in one 15 group—the test group—were inoculated with the pertussis vaccine under trial, while those in the other group—the control group—were inoculated with an ' 'anti-catarrhal'' vaccine containing no H. pertussis. After inoculation the children in both groups were kept under close observation for a period of at least two years, by monthly home visits made by specially appointed nurse-visitors. Those children who came into known contact with whooping cough or who developed symptoms which might be those of early whooping cough, received special visits in order that a bacteriological diagnosis might be made. As it was essential that observers should not be influenced in their clinical assessment of the disease, efforts were made to ensure that neither the doctor, the nurse-visitor nor the parents should know whether the child under observation was in the test or the control group. Seven of the early trials comprising a total of 4,691 test and control children have now been in progress for over two years, and from a preliminary analysis of the results the following general conclusions may be drawn:— (a) In each trial the random allocation to test and control produced two equivalent groups of children, comparable in age, sex, duration of breast-feeding, size of family and incidence of infections other than whooping cough. (b) In six of the trials the incidence and severity of whooping cough in the test groups were appreciably less than in the control groups. In the seventh trial the results were only slightly more favourable in the test group. (c) There was considerable variation in the prophylactic potency of vaccines from different sources, and there was probably also some variation in the potency of different batches of vaccine from the same source. (d) One particular type of vaccine, not at present readily available, was found to give decidedly better protection against the disease than any of the others tested. The reason for variations in the prophylactic potency of these vaccines is not clear, nor is there yet available a conclusive laboratory method of assay by which this property of a vaccine can be accurately assessed, but an investigation is in progress in which the prophylactic value in children of a number of 16 different vaccines is being compared with their immunizing properties as shown by laboratory tests. With this aim in view trials have already been begun in Manchester, Oxford, Cardiff. Poole, Walthamstow and Leyton. No investigation has so far been made of the value of combined pertussis-diphtheria prophylactic, as it was considered desirable to avoid the inclusion of any factor that might complicate the issue, and to do nothing that might possibly harm the diphtheria immunization campaign at a stage when the true value of whooping cough immunization was unknown. This preliminary statement has been prepared on account of the interest shown by health authorities in the outcome of these investigations. A detailed analysis is now being made, and should be ready for publication early in 1950. Members of the Committee and the Medical Officers of Health concerned wish to record their gratitude to the many thousands of parents who have collaborated and are still collaborating in the investigation, and who, when control groups have been essential, have volunteered to take part in the full knowledge that their children would not necessarily receive pertussis vaccine." Scabies. There was another marked drop in the incidence of this disease, the number of notifications for 1949 being 18. Treatment continues to be given, when requested, at the Council's Cleansing Station at Markfield Road. Summary of Disinfection work during 1949. Booms disinfected after occurrence of infectious disease 498 Bedding disinfected after occurrence of infectious disease or death 405 Schools or Hospital Wards disinfected 5 Library Books disinfected 89 Articles disinfected for the Ambulance Service: Blankets 247 White Coats 158 Pillow Slips78 483 17 PART II FOOD CONTROL. Food Hygiene. Decided improvements continued to be made in the standards of food premises, and many new concerns, particularly catering establishments, have been opened during the year. Interest in the important subject of Food Hygiene has been maintained by regular visits to food premises and by means of local propaganda to augment national publicity. Articles of interest to the public have appeared in the Council's monthly publication, "Tottenham Calling." Towards the end of the year the Council decided to adopt the Ministry of Food's model bye-laws relating to the wrapping, handling and delivery of food, and preparations are being made to renew the food hygiene campaign when the bye-laws come into operation. Tottenham is at a disadvantage in that there are not many live trade organisations in the borough, as it is through such organisations that one hopes to reach the individual trader. It is hoped to arrange meetings in order to group traders who are not organised with those who are. Milk and Dairies. During 1949 there was a fairly comprehensive revision of the milk and dairies legislation. On the 1st October the Food and Drugs (Milk and Dairies) Act, 1944, became operative, and in addition the following new legislation came into force, namely:— 1. Milk (Special Designations) Act, 1949. 2. Milk (Special Designation) (Raw Milk) Regulations, 1949. 3. Milk (Special Designation) (Pasteurised and Sterilised Milk) Regulations, 1949. 4. Milk and Dairies Regulations, 1949. This legislation brought about an important alteration in the function of the local authority. The council are no longer responsible for the licensing of pasteurising establishments, and it is to be regretted that this function, as in so many other cases in recent years, passes to the county council, as this alteration in the law now leads to dual control. The county council are responsible for the pasteurising process, and the borough council for the cleanliness of 18 the utensils and equipment used, thus two sets of officials visit where only one did previously. Although no longer under the control of the council, it is interesting to note that one firm who previously pasteurised a large quantity of their own milk now buy it pasteurised and bottled ready for delivery to the customer. For the first time premises selling sterilised milk require to be licensed. The following is a summary of the applications dealt with for licences to use special designations, namely:— Milk (Special Designation) (Pasteurised and Sterilised Milk) Regulations, 1949. Dealers' Licences, authorising the use of the designation ' 'Pasteurised'' 54 Dealers' Licences, authorising the use of the designation "Sterilised" 113 Dealers' Supplementary Licences, authorising the use of the designation "Pasteurised" 13 Dealers' Supplementary Licences, authorising the use of the designation "Sterilised" 14 Milk (Special Designation) (Raw Milk) Regulations, 1949. Dealers' Licences, authorising the use of the designation "Tuberculin Tested" 23 Dealers' Licences, authorising the use of the designation "Accredited" 2 Dealers' Supplementary Licences, authorising the use of the designation ' 'Tuberculin Tested'' . . . . 13 Dealers' Supplementary Licences, authorising the use of the designation "Accredited" 1 During the year 79 applications for registration as milk distributors were dealt with, and 6 applications were received in respect of dairies. The number of premises and distributors registered at the 31st December, 1949, was as follows:— Number of Distributors registered 120 Number of Dairies registered 12 Ice Cream. Ice cream production in the borough is generally satisfactory, and regular visits and sampling continues. It is a cause for satisfaction that consistently good results are being obtained by the Council's own production plant. 19 The total number of certificates issued in accordance with Section 14 of the Food and Drugs Act, 1938 (up to 31st December, 1949), was as follows:— Sale of Ice Cream 211 Manufacture and Sale of Ice Cream 41 Manufacture of Ice Cream 2 Storage of Ice Cream 2 Total 256 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:— For the sale of Ice Cream 32 For the manufacture of Ice Cream 1 Total number of certificates granted 33 One application for registration was withdrawn, but no applications for registration were refused. 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. 23 6 4 — 33 Number of Samples taken where Ice Cream was produced in districts other than Tottenham .. 4 - - - 4 Total 27 6 4 — 37 *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. 20 Slaughter-houses and Knackers' Yards. Five premises are licensed under Section 57 of the Food and Drugs Act, 1938, as slaughter-houses, but only one of these premises is in regular use, and deals mainly with the slaughter of horses. Another part of the premises is licensed as a knackers' yard. Regular visits are maintained by the district sanitary inspectors. During the year 15 licences to slaughter animals were issued, in accordance with the provisions of the Slaughter of Animals Act, 1933. Basement Bakehouses. At the outbreak of the war there were two basement bakehouses remaining in the Borough, and action was pending in one case for its closure in accordance with section 54 of the Factories Act, 1937, as the premises were not considered suitable. As a result of the quinquennial review in 1948 it was decided that the certificates of suitability should be withdrawn in both cases. An appeal was lodged in one case and, by mutual consent, an Order was made by the Court extending the certificate of suitability until the 31st January, 1950, in order to permit the firm to make arrangements to vacate the premises. The premises were vacated on the 28th January, 1950. The proprietors of the other basement bakehouse are taking steps to construct a new bakehouse so that the basement premises can be closed. 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 20 21 Fish 1 1 Shell-fish 1 — Total 22 22 21 There were three applications which were not granted. The total number of hawkers registered in accordance with the provisions of the Middlesex County Council Act up to 31st December, 1949, was 112. Preserved Food. Number of premises registered during the year in accordance with the provisions of Section 14 of the Food and Drugs Act, 1938 : 3. One registration was not granted, due to certain works not being completed. The total number of registrations up to 31st December, 1949, was 96. Legal Proceedings. The following prosecutions were made during 1949, namely:— Food and Drugs Act, 1938. Section 13.—Unsatisfactory conditions at premises. Fined £2 Os. Od. with £2 9s. 6d. costs, with a further £3 3s. Od. costs when summons was re-issued, for failure to carry out work after the first hearing of the case. Unsatisfactory condition of premises. Fined £5 with £2 2s. Od. costs. Section 9.—Nail in bun. Fined £10 with £2 2s. Od. costs. Glass in milk bottle. Case dismissed under Criminal Justices Act, 1948, on payment of £5 5s. Od. costs. Nail in bread roll. Fined £5 0s. Od. with £3 3s. Od. costs. Glass in swiss roll. Fined £10 0s. Od. with £3 3s. Od. costs. Fly in cake. Fined £1 0s. Od. with £1 Is. Od. costs. Milk and Dairies Regulations, 1926-43. Dirty milk bottle. Fined £10 with £3 costs. 22 Food Condemned. The following tinned articles were condemned during the year, namely:— Anchovies 3 Apple Dumpling 1 Apple Puree 49 Apples 6 Apple Sauce 8 Apricots 25 Baby Cereal 1 Bacon 3 Barracuta 3 Beans 248 Beetroot 30 Brawn 82 Brisket of Beef 4 Brislings 29 Broth 2 Carrots 93 Cherries 16 Chile Con Carne 5 Christmas Pudding 6 Cod 4 Cod Liver and Roe Spread 20 Cod Liver Spread 12 Cod Roes 13 Corned Beef 132 Corned Mutton 39 Cornish Pasty Mix 1 Crabmeat 1 Crab Paste 29 Crawfish 64 Crayfish 36 Custard Powder 1 Dried Egg 2 Fish 2 Fish Cakes 12 Fish Paste 7 Fish Roes 164 Frankfurters 2 Fruit Pudding 1 Fruit Salad 1 Gherkins 1 Gooseberries 4 Grapefruit 50 Grapefruit Juice 32,061 Grapes 91 Hake 12 Ham Loaf 4 Herring Roes 3 Herrings 29 Jam 54 Jellied Beef 1 Lobster Paste 3 Luncheon Meat 658 Macaroni 2 Macedoine 72 Mandarin Oranges 1 Marmalade 87 Meat and Cereals 1 Meat in Gravy 16 Meat Lunch 10 Meat and Vegetable 55 Meat Paste 1 Meat Pudding 6 Milk 3,106 Minced Beef Loaf 67 Mixed Vegetables 8 Mussels 32 Orange Juice 40 Orange and Grapefruit Juice (Blended) 432 Pate de Foie 1 Peaches 117 Peanut Butter 1 Pears 14 Peas .631 Pilchards 74 Pineapple 140 Pineapple Juice 165 Plum Pudding 14 Plums 135 Pork 89 Porkam 4 Pork and Beef Loaf 4 Potatoes 5 Potted Meat 10 Prunes 27 Pudding 3 Rabbit 11 Rhubarb 16 Runner Beans 7 Salmon 55 Sardines 49 Sausages 12 Silds 6 Snoek 1 Soup 478 Spaghetti 61 Steak and Kidney Pudding 2 Stewed Steak 8 Strawberries 1 Syrup 5 Tomato Juice 28 Tomato Puree 1 Tomatoes 121 Tongue 22 Treacle Pudding 15 Veal 9 Veal Loaf 91 Veal and Ham Loaf 9 Whalemeat 9 Whiting 33 23 Other articles of food condemned were as follows:— Apple Pulp 1 barrel Bacon 32½ lbs. Baking Powder 2 lbs. Beef 340 lbs. 7 oz. Biscuits 1 lb. Bovril 1 bottle Butter 8½ lbs. Cake 144 lbs. Cake Flour 1 packet Cheese 670 lbs. Chocolates 3½ lbs. Chocolate Coconut Ice 750 lbs. Cocoa ½ lb. Cod 53½ stone Cod Roes 2 stone Coffee 12½ lbs. Coffee Essence 7 bottles Condensed Milk 10½ cwt. Conger Eels 2½ stone Cooking Fat ½ lb. Cornflour 4 packets Creaming Mixture 75 lbs. Crispbread 1 packet Currants 3 lbs. Curry Powder 1 packet Custard Powder 3½ lbs. Dates 11 packets Desiccated Coconut 1,660 lbs. Dog Fish 13 stone Dried Egg 2 packets Eggs 161 Fish 5 stone Fish Paste 10 jars Flour 36 lbs. Fowls 12 French Capers 24 jars Fruit Cake 22 lbs. Ginger Cordial 1 bottle Ginger Powder 2 lbs. Haddock 4 stone Halibut 31 lbs. Ham 6 lbs. Honey 1 jar Horseradish Cream 1 jar Jam 14 jars Jelly Crystals 1 packet Lamb 210½ lbs. Lard 9½ lbs. Lemon Squash 1 bottle Lettuces 40 boxes Macaroni 14½ lbs. Mackerel 3½ stone Malted Food 50 packets Margarine 9 lbs. Marmalade 6 jars Marmite 1 bottle Matzos 2 packets Mayonnaise 1 bottle Milts 70 lbs. Minced Beef Loaf 16 lbs. Mincemeat 2 jars Mutton 125 lbs. Oatmeal 7 cwt. 48 lbs. Oats 50 packets Onions 1 jar Ox Brains 80 lbs. Ox Kidney 6½ lbs. Pastry Mixture 86 cwt. 53 lbs. 14 oz. Pears 28 lbs. Peas 173 lbs. Pepper 1 drum Pickles 8 jars Plaice 22 stone Plums 2 jars Potatoes 1 cwt. Potted Meat 118 jars Prunes 1 box Pudding Mixture 4 packets Rabbits 120 lbs. Rhubarb 22 bottles Rice 2 lbs. Rock Eel 2½ stone Sago 7 lbs. Salad Cream 293 jars Sauce 6 bottles Semolina 14 lbs. Skate 42½ stone Smoked Herrings 19 jars Soup Powder 13 packets Spice 1 lb. Sponge Flour 2 packets Suet 38½ lbs. Sugar 21 lbs. Sultanas 21½ lbs. Sweetened Fat 24 packets Tapioca 6 cwt. Tea 55 lbs. Toffee 5 lbs. Tomatoes 13 cwt. 32 lbs. Veal 86 lbs. Vermicelli 16 packets Vinegar 2 bottles Wheat Flakes 16 packets Whiting 17½ stone 24 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, 1949. Article. Formal Samples. Informal Samples. Taken. Incorrect. Taken. Incorrect. Milk 56 1 39 - Milk, New 47 18 205 1 Milk, South Devon 1 12 - Butter (with roll) — — 1 - Cheese Spread 1 — — - Drugs 5 — 1 - Fish (various) — — 4 - Flour, Self-raising 1 — — - Ice Cream 1 — — - Jelly, Table 1 — — - Marmalade 1 — — - Meat and offal products 4 — 48 - Mincemeat 1 — — - Potato Crisps I — — - Salad Cream 1 — 1 - Sandwich Mixture 1 — — - Sherbet 1 1 — - Spirits 1 — 42 1 Sweets and Confectionery 9 3 14 - Swephat 1 — — - Tomato Sandwich Spread 1 — — - Tomato Ketchup 1 — 1 - Vinegars 3 — — - Total 139 23 368 2 25 PART III SANITARY CIRCUMSTANCES OF THE AREA. Water Supply. Water is supplied to the borough by the Metropolitan Water Board. No cause for anxiety arises on the question of purity, but there is room for improvement in times of drought regarding the supply. Factories which have their own wells receive routine visits, and samples of the supply are taken for analysis. Drainage and Sewerage. The system whereby soil and surface water is kept separate continues in operation. During the year under review the department has been active in carrying out investigations of pollution in the Lesser Moselle and Stonebridge brooks. The investigations are still proceeding. Closet Accommodation. The water carriage system is in operation in the whole area of the borough. In addition to dealing with sanitary accommodation in factories and dwelling houses attention has been given to shops. In certain cases exemption certificates have been granted where satisfactory alternatives are provided. Atmospheric Pollution. The problem of atmospheric pollution in a large industrial borough such as Tottenham is a difficult and complex one. The pollution caused by industrial undertakings using normal fuel, i.e. coal or oil, is usually solved in a satisfactory manner. Industrialists themselves realise that efficient operation of their boiler plant means an economy in every direction. 26 The problems which give rise to the greater difficulties are those where the fuel used is not coal or oil. Wood waste is the chief offender in this respect, but with the assistance of the Ministry of Fuel and Power Engineers the problem is being dealt with in an energetic manner. Sanitary Administration. The environmental health services have made steady progress. Recovery from the restrictions of the war, and the immediate po itwar years, although not complete, is moving in the right direction. The department is expanding its activities, not only to overcome an accumulation of arrears of work, but to widen spheres of environmental hygiene. New legislation will provide us with an opportunity to raise the standard of hygiene, and every effort will be made to take advantage of the change. Housing. No review of housing matters would be complete without some comment on new legislation. The most noteworthy contribution during the year is the introduction of the Housing Act, 1949. This is an Act which contains many provisions to assist local authorities and owners in their housing difficulties—not the least important section of which is Section 1. The effect of this section is to remove from the existing Housing Acts the expression "working classes." This is an improvement long overdue, and local authorities will now be able to deal with all houses in the area on the same basis. Two further provisions of interest contained jn the Act are those which provide power for the quashing of demolition orders (Section 2), and a provision whereby it is possible to make a closing order on a house which is unfit for human habitation, where the house is scheduled as one of historic or architectural interest (Section 3). 27 This latter provision is, however, one which might well give rise to great problems. Closing order procedure itself will not be difficult, but preservation of the building will present not only an economic problem, but the possibility of a nuisance arising must not be overlooked. Two further sections worthy of mention are Sections 4 and 20. The former empowers the local authority to make advances for the purpose of increasing housing accommodation, and the latter to make grants for improvement of existing houses. Regulations have been made for these purposes and incorporate a condition which should prove of great value to all local authorities. This condition can be referred to as the "16 point standard," to which all houses must conform where applications for grants are made. It should raise the standard of judgment in assessing the fitness of houses, and should enable the local authority to deal effectively, by way of slum clearance, with "border line" houses. Standard for a satisfactory house in the Report of the Standards of Fitness for Habitation Sub-Committee of the Central Housing Advisory Committee. The dwelling must— (i) be in all respects dry; (ii) be in a good state of repair; (iii) have each room properly lighted and ventilated; (iv) have an adequate supply of wholesome water laid on for all purposes inside the dwelling; (v) be provided with efficient and adequate means of supplying hot water for domestic purposes; (vi) have an internal or otherwise readily accessible water closet; (vii) have a fixed bath, preferably in a separate room ; (viii) be provided with a sink or sinks, and with suitable arrangements for the disposal of waste water; (ix) be provided with facilities for domestic washing, including a copper, preferably in a separate room; (x) have a proper drainage system; (xi) be provided with adequate points for artificial lighting in each room; (xii) be provided with adequate facilities for heating each habitable room; 28 (xiii) have satisfactory facilities for preparing and cooking food; (xiv) have a well-ventilated larder or food store; (xv) have proper provision for the storage of fuel; (xvi) have a satisfactorily surfaced path to outbuildings and convenient access from a street to the back door. Housing Act, 1936, Section 9. A great deal of work continues to be done to secure the repair of insanitary houses by the use of Section 9 of the Housing Act, 1936. Many of the difficulties, however, and much of the delay would be overcome if owners or agents would act on receipt of a preliminary or intimation notice. Negotiations with the War Damage Commission are often left until the last minute, and applications for extension of time are not infrequent for this purpose. Although few, if any, appeals have been lodged with the County Court, many instances occur where owners and agents are not prepared to carry out the terms of the statutory notice. It is the view of the department that once served the terms of a statutory notice can only be varied by the County Court Judge. If, therefore, owners who have suggestions to make as alternatives to the notice would make them when only a preliminary notice has been served, many of the difficulties would not arise. Cases occur where it has been necessary to go over work which has already been carried out by the owner, on the grounds that it has not been done efficiently. One cannot be sure, however, what the reaction of the judge would be in the case of an appeal. In one case—mentioned in my last year's report—the learned judge expressed the view that appearance did not matter so long as, in this case, the wall was clean. Supplies of materials are again becoming difficult, particularly slates, timber and bricks. During the year 1,016 statutory notices were served under section 9 of the Housing Act, 1936, and in 106 cases it was necessary to carry out the repairs in the owners' default. The cost of the 29 latter, which is recoverable from the owners concerned, totalled £6,593 6s. 5d. Legal proceedings were instituted in 4 cases for the recovery of the costs of the works; in three cases judgment was obtained for the amounts involved, plus the costs of the action, and in the fourth case a Receivership Order was made. In addition, the Council made orders in 3 cases under section 10 (5) for the payment by instalments of outstanding accounts. In one case it was necessary to take action against an owner under section 159 for obstruction of the Council's workmen, who were carrying out repairs in the owner's default in accordance with section 10. The court made the necessary order that the owner should permit the works to be executed. Housing Act, 1936, Section 11. The experience of this local authority gives emphasis to the warnings contained in my reports of the past years. There are many houses in the borough which cannot, and should not, be the subject of sanitary notices for repairs. These houses have outlived their usefulness and are a source of trouble to the department, and in some cases a source of danger to the occupants. During the year the following 14 houses, which were the subject of Demolition Orders made prior to 1949, were demolished, namely:— Premises. Date of Order. Date Demolished. Brunswick Square, White Cottage 2.4.48 31.3.49 *Cranleigh Road, No. 29 13.10.48 4.5.49 High Cross Road, No. 136 7.8.47 24.8.49 Tewkesbury Road, No. 1 20.5.48 17.6.49 ,, ,, No. 3 20.5.48 17.6.49 ,, ,, No. 5 20.5.48 5.9.49 ,, ,, No. 7 20.5.48 17.6.49 No. 11 20.5.48 17.6.49 ,, ,, No. 13 20.5.48 17.6.49 ,, ,, No. 21 20.5.48 17.6.49 No. 23 20.5.48 17.6.49 No. 25 20.5.48 17.6.49 ,, ,, No. 27 20.5.48 17.6.49 ,, ,, No. 29 20.5.48 17.6.49 (Note: * = House demolished by local authority in accordance with Section 13 of the Housing Act, 1936.) 30 In addition, the following premises, which were the subject of undertakings under section 11 of the Housing Act, 1936, that they would not be used for human habitation after the existing tenants had been rehoused, were vacated in May, 1949, namely:— Nos. 33, 37 and 41, The Hale. Action under section 11 was initiated in 1949 in respect of the undermentioned premises with the following results, namely:— 10, Wimborne Road Undertaking accepted that house would be rendered fit for human habitation. 31, Tewkesbury Road Demolition order made on 8th August, 1949. At the 31st December, 1949, the following premises which were the subject of Orders under section 11, had not yet been demolished, namely:— Premises. Date of Order. Lawrence Road, No. 8a 13.10.48 Railway Terrace, No. 5 25. 8.41 ,, ,, No. 6 4. 6.42 ,, No. 7 4. 6.42 ,, ,, No. 8 7. 8.47 No. 9 25. 8.41 No. 10 1. 6.43 No. 12 7. 8.47 ,, ,, No. 14 7. 8.47 Stanley Grove, No. 4 1. 6.43 Tewkesbury Road, No. 15 .. 20. 5.48 No. 31 8. 8.49 Union Row, No. 5 . 11. 8.48 No. 6 11. 8.48 No. 7 11. 8.48 No. 8 11. 8.48 Housing Act, 1936, Section 12. During the year under review consideration has been given to the question of basement rooms in the Seven Sisters area. Over 60 properties were inspected and represented, and closing orders made in respect of all those not at present being used for human habitation. Of those used for human habitation, three have closing orders on them and the remainder will be dealt with as they become vacant. 31 Other areas of the borough, mainly in the White Hart Lane ward, which are likely to give rise to the same problem, are being kept under observation. Premises the subject of Closing Orders during 1949. Address. Rooms affected. Date of Order. 341-363 (odd), Seven Sisters Road Front basement 31.5.49 367-377 (odd) „ „ „ „ „ 389-407 (odd) „ „ „ „ „ 411-415 (odd) „ „ „ „ „ 425 „ „ „ „ „ 429-447 (odd) „ „ „ „ „ 449-477 (odd) „ „ Front and rear basement. „ 417 „ „ Front basement 23.12.49 427 „ „ „ „ „ Housing Act, 1936—Part V. After representations and discussions with Ministry officials the local authority has been successful in obtaining permission to proceed with the compulsory acquisition of part of the Tewkesbury Declaratory Area. The first stage will be the acquisition of approximately 9 acres of land on which there are 170 houses. It has been decided to proceed by way of Part V of the Housing Act, 1936: this department will not, therefore, be called upon to deal with any of the houses, even though they are so insanitary as to warrant demolition. The department, however, will no doubt be required to give evidence, particularly in the event of any objections being lodged. It is to be hoped that the process of acquisition and development will proceed at a reasonable pace in order to avoid the task of trying to keep the houses wind and weather proof. This is a task which is difficult and uneconomic, even at the present time—but occupiers might well expect more from the Council—as owners. The project generally is one which is long overdue, accentuated by delays of war-time conditions, and will receive general approbation. 32 The Tewkesbury estate has for a very long time presented a problem of special character. Many of the houses have outlived their useful life and keeping them habitable has not, and is not, easy. Occupiers have shown great restraint, and are to be commended on the spirit in which they have accepted the difficulties of the Council. Public Health Act, 1936. In the paragraph of my report dealing with Section 11, Housing Act, 1936, I stress the warnings given in previous annual reports. In many cases where action is contemplated under the nuisance sections of the Public Health Act, very careful consideration must be given to all the factors concerned. I have indicated in earlier reports the difficulty in preparing even minimum specifications under this Act, a recent case taken to Court by the Council gives point to this statement. Nuisance notices were served in respect of two houses and the owner had to be taken to court. The defence pleaded and quoted the Rolls v. Salisbury Corporation case, that the houses were not worth spending any money on them. The magistrates adjourned the case for six months and suggested that the two parties try to reach agreement. The outcome of this case is that action will now be taken under Section 11 of the Housing Act, 1936, so that demolition orders may be made. Procedure for dealing with houses under the Public Health Act is slower and no action can be taken by the local authority to carry out work in default until a magistrate's court has made an order. Public Health Act, 1936, Part III: Prosecutions. Legal proceedings were taken in seven cases where owners or occupiers failed to comply with abatement notices, with the following results, namely:— 33 Case No. Period allowed in Abatement Order. Fine. Costs. Remarks. £ s. d. 1 28 days — — 2 28 days — 2 9 6 — 3 21 days — 2 9 6 — 4 21 days — 2 2 0 — o 7 days £2 3 3 0 Later remanded in custody for non-payment of penalty and costs. After medical examination an Order was made under the Lunacy Acts. 6 21 days Steps to be taken to prevent recurrence of nuisance. 7 7 days £2 2 2 0 Committed to prison for 14 days for non-payment of fine and costs. Housing Lettings. The department continues to get many enquiries from applicants regarding Corporation houses and regarding applications made to other authorities, particularly the London County Council. Overcrowding, within the meaning of Part IV of the Housing Act, 1936, is certified by the department, and such certifications are accepted by other authorities. General housing conditions are investigated, and where it is justifiable representations are made on behalf of the applicant. Housing needs on medical and psychological grounds must be taken into account equally with physical overcrowding; and the Medical Officer of Health is in the best position to advise the committee. During the year under review the Health Department conducted a special investigation of housing cases in which applicants claimed that rehousing should be effected on medical grounds. This investigation resulted from the increasing number of such claims being made to the Health Department by letter, 'phone and personal callers. District sanitary inspectors and health visitors had also reported an increasing number of cases in which despite all 34 customary action, applicants still claimed that only rehousing would meet their health needs. In the case of every representation, from whatsoever source received, the claim was carefully scrutinised, together with all other available information bearing upon the case. If, after this scrutiny, it was thought that the claim did not contain medical grounds for re-housing, but was concerned more with building defects, hygiene, housing management or other such matters, then, with this information, the case was referred for attention through the customary channels of the Health or Housing Departments. When deemed to be worthy of further investigation the Health Department inspected the existing accommodation, and weighed it against the detail of the expanded claim for rehousing on medical grounds. If indicated, the factual basis of the general claim was subsequently verified by enquiries made of family doctors, hospitals, or other related medical authorities. A word picture and plan was then prepared. This, without entering into personal detail, gave in ordinary language a description of the applicant's accommodation, the medical grounds presented by them in relation to its unsuitability and the findings and recommendations concerning this. If the recommendation was that the situation could be remedied by repair work, rearrangement within the house, amicable agreement between tenants, or, in short, by any means other than re-housing, then, as with cases considered at preliminary scrutiny not to be within the special scope of this investigation, full information was passed to appropriate persons or organisations so that either action might be taken by them or that they might advise the applicant what he or she should do in the matter. These persons or organisations included sanitary inspectors, health visitors, area welfare departments, national assistance officers, family doctors, the British Red Cross and W.V.S., and the legal advice bureau. Where all possible action had already been taken, and rehousing had still been claimed on medical grounds, then, if after visiting and investigation, it was considered that the claim was not 35 justified, a report to this effect was forwarded to the Housing Department and the applicant was informed that a report had been sent there. When it was decided that re-housing was required on medical grounds or would be so required even after all other action had been taken, then the picture and plan were forwarded to whatever authority was concerned with the applicant's re-housing, and as before, the applicant was informed that a report has been sent there. In positive cases sent to the Tottenham Housing Department, it remained for that department to consider our findings and recommendations, together with all other factors known to them, and where, within the points scheme, such action was possible, the Housing Manager presented every facet of the case to the Housing Lettings, etc., Sub-Committee for their decision. SUMMARY OF HOUSING ENQUIRIES DEALT WITH DURING 1949. *No. of cases referred to Tottenham Housing Department with report 93 No. of cases referred to Tottenham Housing Department without recommendation 13 No. of cases referred to L.C.C. Housing Department with report 6 No. of cases referred to L.C.C. Housing Department without recommendation 2 No. of cases referred to other local authorities with report 3 Other reports 4 *Note : 39 of these cases were considered by the Housing Lettings, etc., Sub-Committee and dealt with as follows:— Allocated suitable accommodation 23 Action deferred 6 Referred to other local authorities 4 No action 6 36 Inspections carried out by the Sanitary Inspectors. Infectious Disease 361 Complaints investigated 5,194 Re-inspections 10,046 Factories 539 Workplaces 58 Dairies, etc. 255 Slaughter-houses 29 Bakehouses 131 Public House Urinals 66 Stables and Mews 19 Fruiterers, etc. 155 Fish Shops 147 Butchers' Shops 229 Other Food Premises 616 Drains Tested 639 Drains Defective 348 Small Dwellings Acquisition Acts 7 Appointments and Interviews 920 Other visits 1,939 Outworkers 333 Requisitioned Houses 60 Notices Served. Statutory:— Housing Act, 1936: Section 9 1,016 Section 11 2 Section 12 98 Section 66 4 Public Health Act, 1936: Section 24 27 Section 39 62 Section 45 17 Section 48 8 Section 66 1 Section 79 1 Section 83 2 Section 84 1 Section 94 204 37 Tottenham Urban District Council Act, 1900: Section 48 1 Food and Drugs Act, 1938: Section 13 1 Total 1,445 Informal 3,285 Defects remedied. Drains reconstructed 68 Drains repaired 361 Drains cleared 211 W.C. Cisterns repaired or renewed 229 W.C. Pans renewed 264 W.C. Pans cleansed 80 Waste Pipes repaired or renewed 225 Rain water pipes repaired or renewed 673 Roofs repaired or renewed 1,211 Eaves Gutters repaired or renewed 612 Drinking Water Cisterns renewed 17 Drinking Water Cisterns covered 17 Water Service Pipes repaired 99 Water Supply reinstated 32 Yards repaired or reconstructed 186 Sinks renewed or provided 111 Floors repaired or renewed 765 Floors ventilated 383 Dampness remedied— by insertion of damp-proof courses 274 by pointing of brickwork 270 by internal rendering 420 by miscellaneous remedies 111 Window Frames and Sashes repaired or renewed, or painted 987 Coppers repaired or renewed, or provided 85 Fireplaces, Stoves and Ovens repaired or renewed 597 Flues and Chimney Stacks repaired 260 Brickwork of Walls repaired and Walls rebuilt 243 Ventilated Food Stores provided 25 Rooms cleansed 2,243 38 Staircases, Passages and Landings cleansed 483 Staircases, Balconies and Steps repaired or renewed 174 Noxious Accumulations removed 29 Nuisances arising from Animals abated 17 Miscellaneous Defects remedied 840 Repair of Houses by the Council. Work carried out in default or by agreement With owners during 1949:— Housing Act, 1936 £ s. d. Section 9 106 premises 6,593 6 5 Section 11 1 premises 30 0 0 Public Health Act, 1936: Section 24 18 premises 342 5 7 Section 39 18 premises 261 2 1 Section 45 3 premises 27 16 5 Section 93 3 premises 252 4 6 £7,506 15 0 39 PART IV DISINFESTATION. The department continues to give every assistance in the extermination of pests. In some cases the service is provided free of charge, whilst in others a small charge is made to cover the cost of the materials and labour used. The following is the scale of charges which have been approved by the Council, namely:— Disinfection and Disinfestation Charges. Charge. Rodent Control. Private Houses Free. Business Premises According to time and material + 10 per cent. Bugs and Fleas. Private Houses Free. Business Premises According to time and material (minimum charge 5s.). Other Insect Pests. Private Houses 2s. 6d. Business Premises According to time and terial (minimum charge 5s.). Steam Disinfection. After Infectious Disease Free. After Death Free. For other reasons 2s. 6d. per article or bundle. Ambulance Coats and Blankets 3d. per article. ,, Pillow Slips l½d. ,, 10 SUMMARY OF DISINFESTATION WORK DURING 1949. Cause. Private Houses. Council Houses. Other Premises. Total. Houses. Rooms. Houses. Rooms. Houses. Rooms. Other Premises. Bugs 266 543 13 38 279 581 Fleas 8 27 — — 8 27 Beetles 47 83 — — 8 Schools 47 83 8 Wood Worm 5 8 — — 5 8 Moths 3 2 — — 3 2 Ants 12 1 — — 12 1 Weevils 1 1 — — 1 1 Flies 4 10 — — 1 Canteen 4 10 1 Slugs 1 1 — — 1 1 Wasps 1 — — — 1 Total 348 676 13 38 9 361 714 9 Disinfestation upon removal to Council dwellings was carried out in 70 instances. 41 Rodent Control. Rodent control continues to be carried out in accordance with the Ministry of Agriculture and Fisheries' approved methods. Block control is operated on all possible occasions and, in conjunction with the treatment, drains and sewers are tested. Maintenance treatments have again been carried out in the Corporation sewers—these during the months of May-June and November-December. Sewer maintenance—Results of baiting in Manholes. Type of take. 9th Treatment. 10th Treatment. Small poison take 233 189 Good poison take 195 156 Complete poison take 117 284 No poison take 566 481 Total number of manholes baited 1,111 1,110 Estimated number of rats killed 3,822 6,723 Summary of Dwelling-houses and Business Premises treated during 1949. (1) Dwelling-houses 689 (2) Business and Factory Premises 101 (3) Total charged for (2) above £60 7s. 4d. 43 PART V FACTORIES. Routine visits are made to all factories in the borough, and an exchange of information is carried on with the H.M. Inspector of Factories. The number of complaints regarding noise from factories has increased, and where possible these have been dealt with in a satisfactory manner. Co-operation with the Town Planning department is encouraged, but we do find there is a tendency to regard the "planning angle" as being of more importance than that of the public health. Too often we find that complaints have been investigated on "planning grounds," only to find that nothing can be done. Delay would be avoided if such complaints were investigated jointly and the departments were together. Factories Act, 1937. 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 (i) Factories in which Sections 1, 2, 3, 4 and 6 are to be enforced by Local Authorities 74 11 (ii) Factories not included in (i) to which Section 7 applies: (a) Subject to the Local Authorities (Transfer of Enforcement) Order, 1938 673 528 44 (6) Others — — — — (iii) Other Premises under the Act (excluding out-workers' premises) Total 747 539 44 — 44 Cases in which defects were found. Particulars. Number of cases in which defects Number of cases in which prosecutions were instituted. were found. Referred Fo und. Remedied To H.M. Inspector. By H.M. Inspector. Want of cleanliness (S. 1) 1 1 1 — Overcrowding (S. 2) — — — — — Unreasonable temperature (S. 3) - - - - - Inadequate ventilation (S.4) - - ___ Ineffective drainage of floors (S.6) - - - - - Sanitary Conveniences (s.7): - - - - - (a) Insufficient 1 1 - 1 — (6) Unsuitable or defective 52 50 - 6 (c) Not separate for sexes 3 3 - 1 - Other offences (not including offences relating to Homework) 12 7 1 — — Totai.s 69 62 2 8 — Note. -7 cases in which defects were found were outstanding at the end of the year. Outworkers (Sections 110 and 111). Nature of Work Section 110 Section 111 No. of outworkers isn August lists required by Section 110(i)(c) No. of cases of default in sending lists to Council No. of prosecutions for failure to send lists No. of instances of work in unwholesonvo premises Notices served Prosecutions Wearing Apparel 408 — — 1 — — Household Linen 14 Brass and Brass articles 154 - - - - - Artificial Flowers 10 — — — — — Making of boxes or other receptacles or parts thereof made wholly or partially of paper 147 - - - - - Carding, etc. of buttons 4 - - - - - Toys 77 - - - - - Lampshades 2 — — — — — Brush manufacture 9 Feather sorting 5 — — — — — Making, etc. of Xmas Crackers 8 1 - - - - Making, etc. of Umbrellas 1 - - - - - Totals 839 - - 1 - - A Chiropody Service for Old People is provided by the Tottenham Branch of the British Red Cross Society. A " Meals-on-Wheels " Service for Old People is provided by the Tottenham Branch of the Women's Voluntary Service. 45 PART VI PERSONS IN NEED OF CARE AND ATTENTION. During the year the Health Department received many enquiries for assistance in obtaining care and attention. These requests were made mainly by callers who, in the majority of cases, were relatives; but in some instances neighbours of public spirit. To provide an effective service experience has illustrated the importance of the closest possible liaison between the Health Department in the Town Hall and such outside local agencies as the general medical practitioner, hospital, local health authority, welfare department and voluntary organisations. For aged persons unable to secure care and attention for themselves the family doctor is the person to whom they must turn. He can best determine whether care may be given in the home, hospital or a residential home. Deciding that the aged person should remain at home the family doctor, by making application to the local area health office, may secure the services of health visitor, domestic help and/or home nurse. Should hospital treatment be required it is the family doctor who arranges admission by applying to a suitable convenient hospital, or, in the event of failure, by requesting the assistance of the Emergency Bed Service. When a stay in a residential home is indicated the family doctor may forward the necessary particulars to the area welfare office. If a second opinion is required arrangements may be made by the family doctor to call in a consultant under the National Health Service. The health visitor has been known to residents in Tottenham for many years by her work for mothers and children at home, school and clinic. She advised and helped the family through each succeeding new birth, until the grown child left school, maintaining a friendly link between the family and all local authority social and health services. The National Health Service Act extended her duties so as to make it possible for her to give advice on health matters throughout the entire span of family life. By 1949 she was fully recognised as a participant in assisting with the care and attention of the aged. Changing social conditions, health and education policy has, however, greatly increased the pressure of basic health visiting duties, and an insufficient number of health 46 visitors is at present available to spread that pressure in order that new work may be fully met. The home nursing, like the health visiting service, is still much below establishment. The intention of the Act is to make such a service available to all who require it, so that the only qualifications should be need and the family doctor's request. The Tottenham District Nursing Association which has rendered such valuable service to the residents of Tottenham in past years, continues to provide, under the administration of the Area Health Committee, a service of infinite scope with promise of expansion. As had been foreseen, the removal of financial barriers to medical attention resulted in an increased number of people being able to consult their doctors, and to an increase in the number of known cases of sickness requiring home nursing. The domestic help service grew from beginnings in which a local authority might arrange for families to have help with the housework when the mother was having a baby. This is now extended to provide such help when, for any medical reason, it is required. The number of expert public-spirited women in this service has considerably grown, some working full-time and others part-time. The position of aged persons requiring hospital treatment was eased by the setting up of a twenty-bed geriatric ward at the St. Ann's General Hospital. Failure to arrange admission locally has brought intense pressure to bear on the Emergency Bed Service—a voluntary agency provided by King Edward's Hospital Fund, whereby country-wide branches of the Bed Service are kept informed of the vacant bed position of all hospitals in their area. On receipt of a "failed admission" notification it is possible to assess from exact knowledge the position of hospital beds in the region, and select one having a vacant bed or place the case on the waiting list. This information is then transmitted to the family doctor who has requested assistance. It cannot' be held against the Bed Service that immediate success has been limited by the very few beds available. Although a high percentage of cases during the year have had to be placed on waiting lists, there is at least the satisfaction of knowing that each particular list had been prepared with the need of the cases in mind, and with the intention of securing the earliest possible admission. Although the requirements of many aged persons can be met by arranging for care to be provided within their own homes, or in 47 hospital, there are those who require more than daytime care at home, and yet less than the full medical care of the hospital. For such the Area Welfare Officer endeavours to arrange accommodation in residential homes set up under the National Assistance Act, 1948. Prior to this Act much was said and written of "institutions" and of how they were to become "homes" in fact as well as in name. The name change has been made and management humanised, but owing to few new homes being erected it has been necessary to continue to use the old institutional buildings, which can never provide the qualities intended by the new legislation; nor are there as yet anything like sufficient homes for aged persons desirous of being admitted. Despite the frustration of having too little accommodation at their disposal the Area Welfare Officer and his staff have done everything possible in visiting, assisting and co-operating with others for the benefit of the needy old people in the district. Another such example was afforded by the Assistance Officer and his staff at the local offices of the National Assistance Board. Through them willing help has been given, both in money and in kind. For example, blankets, bedding, clothing were sometimes provided, and in certain cases of incapacity payments were made to enable laundry to be sent out. When necessary there were always available supplements to old age pensions and monetary assistance at any age. covering a variety of handicapped conditions. These have been arranged without the stigma of charity, and fully in accord with the principles of national insurance. Many persons referred to the Health Department as being in need of care and attention proved, on investigation, to be so only in relation to the condition of their housing accommodation. Here the district sanitary inspectors were often able to assist the occupants in making the home suitable for continued occupation. When possible and appropriate, by co-operation with the Housing Manager, aged couples were offered suitable accommodation in speciallydesigned old people's flats on the Corporation estates. Those who sought care and attention through voluntary agencies turned, in the main, to the British Red Cross Society, Women's Voluntary Service and the Old Age Pensioners' Associations. These organisations offered friendship, advice and the attraction of shared activities. The British Red Cross Society provided its members with domestic help, nursing in their home and a chiropody service at the local headquarters and, in addition, the facilities of "Evergreen" clubs. The Women's Voluntary Service either provided a 48 reasonably priced mid-day meal in halls throughout the Borough, or delivered by a "meals on wheels" service to the home. These, together with the services of the Old Age Pensioners' Associations, must receive the highest commendation from all those interested in the welfare of the aged. So far little attention has been paid to the needs of the aged who are able and willing to undertake suitable employment. There would seem to be a case for the early establishment of an Employment Bureau for the Able Aged, where special attention could be given to the placing of persons anxious to continue in whole or parttime employment. National Assistance Act, 1948: Section 47. In my Annual Report for 1948 I cited a number of cases illustrating difficulties in applying this section of the Act. Of the cases in which court action was considered during 1949 I have selected the following four to show different aspects of the work. (1) A doctor 'phoned one morning, saying that he had a patient requiring admission to hospital, that he had arranged a bed, but that the patient had refused to go to hospital. The doctor detailed the condition and surroundings of the patient, and when we agreed that if these facts were correct, we should be justified in applying for a court order to remove the patient to hospital, the doctor asked how long it would take us to admit the patient in this way. On being informed that the Assistance Act required one week's notice to be given to those concerned, the doctor said that the hospital bed. arranged by him, could be held open only for that morning; he charged the department with full responsibility for the case and said that he would create a public outcry concerning our inability to move quickly. We could only reply that we would investigate the case and inform him of our opinion, but that at least one week's delay was inevitable, according to the terms of the Act. Visiting the patient within half-an-hour we found an aged man abed in his one room. He was unable to look after himself and the lady from whom he rented the room stated that she was unwell herself, and that her doctor had advised her to cease what little attention she had been giving the patient. The old gentleman was obviously in need of care and attention, but he confirmed that he had refused to go to hospital. We talked with him of this and that, of his life, his trade, and his 49 interests. After twenty minutes we talked again of hospital, and he agreed to go there. Telephoning the doctor, we informed him that all was well, his patient was now willing to enter hospital, and as the doctor had said he had a bed being held vacant for that morning, he could now proceed with the admission in the usual way. 2. A district sanitary inspector reported that in following up a complaint, he had found a disabled old man confined to one insanitary room. On further investigation this case was proved to be so crippled with arthritis that his days were spent between his bed and a nearby chair, using certain cooking and other facilities within arm's reach. A male relative shared the room with him, but that relative was usually out of the house all day. The room itself was laden with old papers, boxes, dust-covered articles, and dirt. The bed was filthy. We offered to assist him in making application for a place in a residential home, and asked him to discuss this and the cleaning of the room with his relative. A few days later this relative reported that the old man would not allow the room to be cleansed and that he refused to consider entering a residential home. On visiting again, it was confirmed that these were his views. The Court agreed with our representation that he was aged, infirm, living in insanitary conditions, and was unable to devote to himself, and was not receiving from other persons proper care and attention. He was admitted for three months to a residential home. His relative went temporarily to live elsewhere while tke district sanitary inspector had the room and its contents cleansed and redecoration done. We visited the old man several times at his residential home. He was happy, grateful for the care which was being given him, and he had decided, of his own free will, to continue staying there. (3) The son of an old lady wrote from his distant home, expressing regret at his inability to help, but asking us to assist his mother's family doctor in having her admitted to hospital. When visited, her two rooms were found to be bright and clean and in no way insanitary. She was lying helpless, in bed, and she had been so for some time. Her doctor had arranged home help, but had been unable either to secure home nursing or to have her admitted to hospital. A private nurse had been attending during night-time but she was now leaving. 50 Relatives of the old lady had been taking it in turn to come daily from their own busy homes and minister to her many needs. They were worn out by the strain. In consultation with the lady's own doctor certain medical facts were disclosed in relation to her need for hospital treatment, and, in view of these facts and the other circumstances of the case, the Health Department served notice on a hospital that it was intended to apply to Court for an order of admission. The day before the case was to be heard in court the old lady was admitted to hospital. (4) For some time an old lady had been receiving home help. The home help organiser reported that more care was required than was possible within the home. On visiting, the old lady was found to be living alone, almost entirely confined to her one upstairs room, and often confined to bed. She had inconvenient and even dangerous access to cooking facilities, sanitation and water supply, while her fuel store was entirely beyond the reach of her physical powers. On inspection the room was found to be developing an infestation of vermin in certain inaccessible places. This old lady was being cared for early morning, day and evening, by a home help, a kindly neighbour, and a devoted male relative who lived and worked some distance away. The neighbour, a busy woman, was finding the protracted giving of care beyond her own resources of time and energy. On making enquiries of the old lady's doctor, he opined that she should be in a residential home. The old lady's relative informed us that she had been on the waiting list with this in view for a period of one year. The old lady herself seemed unable quite to make up her mind whether she would indeed go to a residential home, even were the Area Welfare Officer able to provide an immediate vacancy. As it was evident that there was no time to be lost, with her relative's approval, an application was made at court. Within five days of the application being granted she was admitted to a residential home. From past experience it has become clear to the Health Department that the official powers, functions, and information accorded 51 them in this field are altogether too small to undertake the help expected of us by the people of Tottenham. Of the many agencies already described, having recognised positions in the provision of care and attention, it will be evident that several had difficulty in meeting that part of the problem which was theirs. Greater still was the difficulty inherent in the lack of any one agency to coordinate the work of the various separate agencies. Realising, this the Health Department acted voluntarily as a co-ordinating body in all cases brought to its notice. Advice was given to all persons and organisations requesting it. The various needs of cases were brought to the attention of those properly concerned with meeting those needs, and, by maintaining touch with cases, these needs were pressed until, so far as possible, they were met. All cases requ'ring special attention were visited. By these means, by adviee, allocation, co-ordination and action, Tottenham people requiring care at home were provided, as requisite, with medical care, nursing, visiting and home help. In other special cases, with the family doctor's or the Area Welfare Officer's help, we were able to arrange, according to urgency, admission t6 a hospital or residential home, and for many others to be more favourably placed in respect of admission than they would have been without our assistance. Much of this voluntary co-ordination was done by telephone or by personal contact, and only when necessary was writing resorted to. Because of this, it is impossible to say how many Tottenham cases were so assisted, but they did constitute quite a portion of the daily work of the Health Department. When one reflects that because of our voluntary, non-official, position in this matter, only a percentage of Tottenham cases found their way to us, it will be realised how great was the volume of work really requiring to be done, and how great was the need for the creation of some known local agency with power and position fully to co-ordinate all organisations concerned in the giving of care and attention. 53 PART VII GENERAL. Medical Examination of Candidates for Employment in Established Posts of the Tottenham Borough Council. During the twelve months ended 5th April, 1950, a total of 61 candidates for established posts were examined in the Tottenham Health Department. This examination included the taking of a personal and family history of illness, a clinical examination of all systems, a blood pressure reading, a urine test, and a chest X-ray. Chest X-rays were carried out by previous appointment at the Chest Clinic, Tottenham, so that they followed shortly after the clinical examination at the Town Hall. The very few candidates presenting written evidence of a satisfactory mass radiography result within the previous twelve months were not X-rayed. Of the 61 candidates examined, 45 were men and 16 women. The age distribution of the 61 candidates was as follows:— 15-19 20-24 25-29 30-34 35-43 44-52 53-61 62 + Total Men 8 4 14 7 8 3 1 _ 45 Women 6 4 2 2 1 1 - - 16 Total .. 14 8 16 9 9 4 1 - 61 Men. Certain results of examination of 45 male candidates for established posts. No. of Men. Eyes Defective natural Corrected with glasses 9 vision 18 Requiring the supply of glasses 5 Requiring alteration of present glasses 4 54 No. of Men. Ears. Defective hearing 2 Teeth. Defective natural den- Wearing dentures 5 tition 7 Requiring denjtal treatment 2 Feet. Minor foot defects (Flat foot, bunion, hammer toe.) 5 Chest No significant pulX-ray. monary abnormality 40 Evidence of past healed tuberculosis 2 Requiring further investigation 3 Other Defects 3 One man failed to pass the examination because of an ear condition, two because of chest conditions, and two because of other defects. Women. Certain results of examination of 16 female candidates for established posts. No. of Women. Eyes. Defective natural Corrected with glasses 3 vision 6 Requiring the supply of glasses 1 Requiring alteration of present glasses 2 Ears. Defective hearing 2 Teeth. Defective natural den- Wearing dentures 2 tition 3 Requiring dental treatment 1 Feet. Minor foot defects 1 Chest No significant pulmonX-ray. ary abnormality 15 Evidence of past healed tuberculosis 1 55 No woman failed to pass the examination. If any defect required treatment or investigation, candidates were informed that they should seek the advice of their own doctors or dentists, and when indicated, a confidential clinical report was forwarded to the doctor concerned. No statistical comparisons or conclusions can be drawn from the results of medical examination of a small selected population sample comprising 45 men and 16 women. If, however, the sample does not allow one to deduce probabilities concerning either those examined or a much larger and more widely representative population, at least one may hazard possibilities, finding, among other things, cause for the heavy national demand on optical services, and reason for the national provision for all persons of regular routine health overhauls of such a type as is provided by the Borough Council on initial consideration for established employment. Laboratory Service. The Public Health Laboratory Service provides a comprehensive service for the bacteriological examination of specimens submitted by general practitioners and local authorities. To relieve pressure of work at their Edmonton Branch, it recently became necessary to send all Tottenham specimens to a branch laboratory at Coppett's Wood Hospital, Hornsey. The existing system for the supply of containers and the delivery of specimens by the Public Health Department remains unchanged. Specimens may be sent to the Public Health Department, and providing they reach there not later than 3.0 p.m. on Monday to Friday, and 11.0 a.m. on Saturday, they will be sent on the same day by special messenger to the Hornsey laboratory. As it is not possible to send a second messenger on any one day, it is essential that specimens be delivered to the Town Hall before the times stated. Alternatively, specimens may be sent direct to the Hornsey laboratory, which remains open until 5.0 p.m. on Monday to Friday, and 12 noon on Saturday. A 24-hour emergency service is maintained by the Central Laboratory at Colindale. 56 The following is a summary of the work carried out during 1949, namely:— RECORD OF EXAMINATIONS. Throat Nose Swabs : Total Specimens 496 Diphtheria Bacilli 7 Haemolytic Streptococci 138 Vincent's Angina 22 Negative 329 Faeces: Total Specimens 211 Shigella 5 Salmonella 21 Protozoa 19 Negative 166 Sputum: Total Specimens 14 T.B. Smear 2 Other Organisms Negative 12 Pertussis : Total Specimens 49 Post-nasal Swabs 7 Negative 42 Milk : Total Specimens 21 Pasteurised 18 Other 3 Ice Cream : Total Specimens 43 Water: Total Specimens 4 Domestic Supplies, etc. 2 Swimming Pools 2 Miscellaneous Specimens 260 Total number of Specimens 1,098 57 HOSPITALS—NORTH-EAST METROPOLITAN HOSPITAL REGIONAL BOARD. The hospitals in the Borough are locally administered by the Tottenham Group Hospital Management Committee, whose offices are at the Prince of Wales's General Hospital. Tottenham. The Group comprises the following hospitals, namely:— Bearsted Memorial Hospital (and Annexe at Hampton Court) 60 maternity beds. St. Ann's General Hospital 756 beds (including infectious disease). Prince of Wales's General Hospital, Tottenham, and Annexe at Nazeing (Princess Louise Convalescent Home) 260 beds. Tottenham Chest Clinic - The following table gives details of the out-patient clinics provided by the Prince of Wales's General Hospital:— 58 PRINCE OF WALES'S HOSPITAL. Timetable of Out-Patient Clinics. Monday Tues. Wed. Thurs. Friday Sat. Medical P.M. P.M. P.M. A.M. & Surgical P.M. P.M. A.M. P.M. P.M. Diseases of Women and Obstetrics P.M. P.M. Children (Medical) A.M. A.M. Eye A.M. Throat, Nose and Ear P.M. P.M. Skin P.M. A.M. Teeth A.M. Neurological P.M. Genito-Urinary .. A.M. Psychiatric P.M. Physical Medicine 9—5 9—5 9-12 9—5 9-5 9-12 X-ray 9—5 9—5 9—5 9—5 9—5 9-12 Orthopaedic A.M. Fractures A.M. & P.M. P.M. A.M. & P.M. A.M. & P. M. A.M. Allergy P. M. Venereal Diseases, Medical Officer 5—7 5—7 4.30—6 10—12 5—7 V.D. Intermediate Treatment 8—7 8—7 8—6 8—5 8—7 8—12 Doctors' letters required. All patients seen by appointment. The Casualty Department is open day and night, including Sundays, for medical and surgical emergencies. AREA HEALTH SERVICE No. 3 (Tottenham) DETAILS OF CLINICS Clinic. Address. Monday. Tuesday. Wednesday. Thursday. Friday. Saturday. Ante-Natal Chestnuts (St. Ann's 9.0 a.m. 9.0 a. m. 9.0 a.m. Road). Park Lane 2.0 p. m. 2.0 p.m. - 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 - 2.0 p. 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 — 9.0 a.m. d 9.0 a.m. — - 2.0 p.m. 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. — — - Minor Ailments Park Lane 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. 2.0 p.m. 9.0 a.m. 2.0 p.m. 9.0 a.m. 2.0 p. m. 9.0 a. m. 2.0 p.m. 9.0 a.m. 2.0 p.m. — Park Lane 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 Vale Road School for Physically Handicapped 2.0 p. m. 9.0 a.m. 9 a. m. and 2 p.m. 9 a. m. and 2.0 p.m. 2.0 p.m. 9.0 a.m. 9 a. m. and 2.0 p.m. 9.0 a. m. Speech Therapy (by appointment) Park Lane Lordship Lane 2.0 p.m. 9.30 a.m. 9.30 a.m. — 9.30 a. m. 2.0 p. m. — Cornwall Road Vale Road School for Physically Handicapped — All Day 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. Children 9.30 a.m. Mothers — 9.30 a.m. Children 9.30 a.m. Mothers — D = Doctor in attendance. 59 AREA HEALTH SERVICE. The personal health services now provided by the Middlesex County Council are administered from the Area Health Office, Somerset Road, Tottenham, N.17. The table facing gives details of the clinics provided in Tottenham. AREA WELFARE SERVICE. The Welfare Service of the Middlesex County Council is administered in Tottenham by the Area Welfare Officer, 5, Lansdowne Road, Tottenham, N.17, telephone number TOTtenham 1212, and it is to this officer that enquiries should be directed regarding the admission of persons to residential homes provided by the Middlesex County Council. LUNACY AND MENTAL TREATMENT ACTS. The Authorised Officers for the purpose of these Acts have their offices at 5, Lansdowne Road, Tottenham, N.17, telephone number TOTtenham 1211. AMBULANCE SERVICE. Ambulances are stationed at the Central Fire Station, and are on call for urgent cases throughout the day and night. Telephone number TOTtenham 2222, or STAmford Hill 2222. 61 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, 1949 130,040 31st December, 1949 129,630 Total Population 130,140 Rateable Value £1,009,477 Sum represented by penny rate £4,016 Births and Deaths. Registered live-births Total. Males. Females. Legitimate 1,914 987 927 Illegitimate 95 60 35 2,009 1,047 962 Birth Rate (per 1,000 estimated population) 15. 5 Stillbirths: Total. Males. Females Legitimate 36 16 20 Illegitimate — — 36 16 20 Stillbirth Rate per 1,000 total (live and still) births 17.6 Deaths— Males 756 Females 684 Total 1,440 Death rate (per 1,000 estimated population) 11.07 Deaths from Cancer—Males, 122; Females, 142 264 Deaths from Diphtheria - Deaths from Measles - Deaths from Whooping Cough — Deaths from Diarrhoea (under 2 years) 1 62 Maternal Deaths:— Puerperal Sepsis 0 Otter Puerperal Causes 0 Total 0 Maternal Death Rate (per 1,000 total live and still births) 0.00 Deaths of Infants under 1 year of age: Total. Males. Females Legitimate 46 32 14 Illegitimate 4 4 0 50 36 14 Infantile Death Rate (all infants per 1,000 live births) 24.89 Legitimate Infants per 1,000 legitimate live births 24.03 Illegitimate Infants per 1,000 illegitimate live births 42.1 The civilian population shows an increase of 40 over the figure of 130,000 for 1948; in 1938 it was 144,400. The birth-rate 15.45 compared with 17.48 in 1948 and 13.1 in 1938. Registered live births totalled 2,009, compared with 2,233 in 1948, the proportion of males to females being 1,047 boys and 9 32 girls. The infantile death-rate 24.89 was higher than the rate for 1948 23.73. Deaths in the first 4 weeks of life caused a neo-natal mortality of 17.42 per 1,000 live births, as compared with 14.77 in 1948. The maternal death-rate was 0.00 compared with 0.87 in 1948. The general death-rate of the whole population showed an increase over the previous year—11.07 compared with 10.59. Oi & Table I STATISTICS OF TOTTENHAM FOR THE LAST TWENTY YEARS. Number of Cases. Year Population Deaths Death Rate Births Birth Rate Infantile Deaths Infant Death Rate Puerperal Fever and Puerperal Pyrexia Scarlet Fever Diphtheria Typhoid Fever SmallPox 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 11,776* 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 — 1,559 1941 105,620 1,418 13.43 1,560* | 14.77 61 46.35 13 103 73 4 — 1 1,316 1942 110,100 1,349 12.25 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 — 1949 130,040 1,440 11.07 2,009 15.45 50 24.89 15 251 4 ♦For the years 1939—1941 alternative birth figures were given by the Registrar-General:— (a) 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 populatjon figures were given:— (a) for calculation of birth rates; and (b) for calculation of death rates, etc. 64 Deaths during the year 1949, of Residents of the Borough of Tottenham classified according to Diseases. Cause of Death. Males. Females. Total. Typhoid and Paratyphoid Fevers — — — Cerebro-Spinal Fever — — — Scarlet Fever — — — Whooping Cough — — — Diphtheria — — — Tuberculosis of Respiratory System 41 19 60 Other forms of Tuberculous 5 2 7 Syphilitic Diseases 7 1 8 Influenza 5 7 12 Measles — — — Acute Poliomyelitis and Polio-encephalitis — — — Acute Infectious Encephalitis — — — Cancer, Malignant Disease 122 142 264 Diabetes 2 2 4 Cerebral Haemorrhage, etc. 67 83 150 Heart Diseases 215 207 422 Other Circulatory Diseases 38 23 61 Bronchitis 72 56 128 Pneumonia 36 31 67 Other Respiratory Diseases 12 9 21 Peptic Ulcer 15 5 20 Diarrhoea (under 2 years of age) 1 — 1 Appendicitis — 2 2 Other Digestive Diseases 11 11 22 Acute and Chronic Nephritis 12 10 22 Puerperal Sepsis — — — Other Puerperal Causes — — — Premature Births 9 3 12 Congenital Malformations, Birth Injuries, etc 23 10 33 Suicide 9 11 20 Road Traffic Accidents 7 2 9 Other Violent Causes 5 6 11 All other causes 42 42 84 756 684 1,440 65 66 Table 11 Infantile Deaths in Ages and Sexes during the year 1949. 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—9 months. 9—12 months. Total deaths under 1 year. Males. Females. Bronchitis — — — — — 1 — — 1 1 Congenital Malformations, Birth Injuries, etc. 19 3 1 1 24 7 1 - 1 33 23 10 Diarrhoea and Enteritis _ — — 1 — — — 1 1 — Pneumonia ~ — — — — 1 1 — — 2 2 — Prematurity 12 — — — 12 — — — — 12 9 3 Other Causes — — — — — 1 — — 1 __ 1 Totals 31 3 1 1 36 10 3 — 1 50 36 14 77 Table III Table of Cases of Infectious Disease coming to the knowledge of the Medical Officer of Health during the year 1949, in the Borough of Tottenham, classified according to Diseases and Ages. Notifiable Disease. Under 1 1— 2— 3— 4— 5—9 10—14 15—19 20—34 35—44 45—64 65 & up Total. Total Cases removed to Hospital. M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. Scarlet Fever — 1 2 5 5 4 13 18 17 11 69 56 17 18 4 4 3 3 1 — — — — — 251 125 Measles 18 25 61 61 85 71 64 73 76 61 173 176 3 5 1 5 1 6 1 — — — — 1 967 61 Whooping Cough 12 5 12 9 11 18 13 18 16 13 28 37 — 3 — 1 — 2 — 1 — — — — 199 10 Pneumonia 1 — 1 — 1 — — — — — 2 4 2 1 2 1 5 6 4 4 12 5 11 11 73 5 Erysipelas - - - - - - - - - - - - - 1 - 1 1 3 — 1 2 10 1 3 23 10 Scabies — — 1 — — 1 1 1 1 1 2 1 — — — 2 5 — — — 1 — — 1 18 — Food Poisoning — — — — — - — — — — — — — — — 1 — 2 1 — 2 — — 1 7 2 Puerperal Pyrexia - - - - - - - - - - - - - - - - - 14 - 1 - - - - 15 6 Cerebro Spinal Fever - - - - 1 - - - - - - 1 - - - - 1 - - - - - - - 3 3 Polioencephalitis - - 1 - - - - - - - — 1 1 2 - - - - - - - - - - 5 5 Poliomyelitis 1 - — — — — — 1 1 1 2 1 1 1 — — 1 — — — — — — — 10 10 Diphtheria - - - 1 - - 1 - 1 - - 1 - - - - - - - - - - - - 4 4 Dysentery.. - - - - - - - - - - - - - - - - 1 - - - - - - 1 2 2 Malaria - - - - - - - - - - - - - - - - - - 1 - - - - - 1 — Ophthalmia Neonatorum 1 — - - - - - - - - - - - - - - - - - - - - - - 1 — Pulmonary Tuberculosis — — 1 1 1 1 1 — 1 — 5 4 4 4 17 14 43 39 16 13 25 5 11 4 210 — Other forms of Tuberculosis 1 — — 2 L — — — — — 1 2 1 — — 1 2 6 — 3 — — 1 1 22 — 34 31 79 79 105 95 93 111 113 87 282 284 29 35 24 30 63 81 24 23 42 20 24 23 1811 243 69 INDEX PAGE Ambulance Service 59 Area Health Service 59 Area Welfare Service 59 Atmospheric Pollution 25 Bakehouses, Basement 20 Closet Accommodation 25 Council, Members of 1 Deaths 64 Diphtheria 10 Disinfection 16 Disinfection Charges 39 Disinfestation 39 Disinfestation Charges 39 Drainage and Sewerage 25 Factories 43 Food—Condemned 22 Hygiene 17 Preservation 21 Sampling 24 Hawkers 20 Health and Housing Committee 2 Hospitals 57 Housing 26 Housing Act, 1936, s. 9 28 s. 11 29 s. 12 30 Part V 31 Lettings 33 Ice Cream 18 Immunisation, Diphtheria 13 Infantile Deaths 66 Infectious Disease 7 Knackers' Yards 20 Laboratory Service 55 Legal Proceedings 21, 29, 32 Lunacy and Mental Treatment Acts 59 Mass Radiography 9 Maternal Deaths 62 Measles 14 Medical Examination prior to staff appointments 53 Metropolitan Water Board 2 Milk and Dairies 17 National Assistance Act, 1948, s. 47 48 Notices Served 36 Outworkers 44 70 IN DEX—continued. PAGE Persons in need of Care and Attention 45 Polioencephalitis 14 Poliomyelitis 14 Prince of Wales's General Hospital 57, 58 Public Health Act, Part III 32 Public Health Department, Staff 3 Repairs in Default 38 Rodent Control 41 Sanitary Administration 26 Sanitary Inspectors, Summary of Inspections . 36 Scabies 16 Scarlet Fever 13 Sewerage and Drainage 25 Slaughterhouses 20 Statistical Summary 61 Tewkesbury Declaratory Area 31 Tuberculosis 7 Water Supply 25 Whooping Cough 14 Work in Default 38 Service & Quality CRUSHA & SON LTD. TOTTSNMAM ENFISLO & WOOD GREEN