TOTTENHAM'S HEALTH 1951 The Annual Report of the Medical Officer of Health. Borough of Tottenham. TOTTENHAM'S HEALTH 1951 The Annual Report of the Medical Officer of Health, Borough of Tottenham. Health Department, Town Hall, Tottenham, N. 15. To His Worshipful 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 this my Annual Report on the health of the Borough for the year ended the 31st December, 1951. The 1951 census figure showed a further reduction in population to 126,921 as compared with the last census figure (1931) of 157,772. Notwithstanding this reduction, overcrowding and a high density rate continue to be the major public health and housing problems of the Borough. Utmost co-operation locally between the various administrative bodies concerned with the National Health Service has been the constant aim of the department, and by the good will of all concerned a measure of achievement has been obtained. The close relations which existed in Tottenham before the Act between the Prince of Wales's General Hospital and the work of the local authorities has been maintained and further extended. This is particularly seen in the care and after care of children and the aged sick. At the St. Ann's General Hospital co-operation has been most marked in the establishment there of a supervisory centre for cases of acute rheumatism in children; and in the setting-up of a Geriatric Unit of 80 beds for the aged sick. Sanitary inspectors and area medical auxiliary staffs assist the work of the hospital in providing reports upon the environmental conditions, and by a 'follow-up' in the homes of all cases considered for admission to hospital beds. In the case of the aged the sanitary inspectors' visits ensure that housing accommodation temporarily vacated on admission to hospital is available for re-occupation if and when discharge from hospital is necessary All interested in the smooth running of the nation's health services must realise, however, the many and real difficulties that still exist in a proper sharing of information for the common good as between the various administrative bodies concerned. It must be realised too that no parity of importance appears evident in the public mind as between the preventive and curative services. Yet the intention of the National Health Service Act was to produce a comprehensive health service for prevention, diagnosis and treatment of illness and expressed in that order. The preventive services, built up to a high degree of efficiency by local authorities between the two world wars, have now become almost totally submerged by the growth of the curative services. The trend to transfer to Regional Hospital Boards all specialist clinics hitherto administered by local authorities, is not found in practice to further the work of health education which was such an important feature in the past. Delay in implementing the Act's directive as to the establishment of experimental health centres must restrict the scope of the general practitioner service in making prevention of illness and promotion of health priority functions in the daily routine.- Details of the work of the public health department in this Borough are set out in appropriate sections of the report.; As in previous years particular attention has been paid to housing repairs, demolition or closing of individual unfit houses; and a significant resumption of the procedure for clearance of an "unhealthy area" in the district. In addition to progress made in housing matters, the sanitary inspectors have made a special endeavour to improve the conditions of food preparation and handling, with a gratifying response of co-operation from the local food trade. In the final preparation of this report as in carrying out the routine work of the department during the year, I owe much to the loyalty and efficiency of the Chief Sanitary Inspector, Mr. E.T.,; Jenkins, my Chief Clerk, Mr, A,. W.Lawrence and the whole staff of the health department. For assistance and encouragement in carrying out my duties as your Medical Officer of Health I am deeply indebted to the Chairman (Alderman R. H. Warren) and to Members of the Health and Housing Committee. At the time of going to press it has not been found possible to include in this years report the second phase in the centenary of public health in Tottenham, the first phase of which was included in an appendix to the Report in 1950. I have the honour to be, Your obedient servant, C. Hamilton Hogben 1st September,19520 Medical Officer of Health. 1 MEMBERS OF THE COUNCIL Councillor J.W. Hollingsworth, J. P. MAYOR Councillor K.A.E. Gregg, DEPUTY MAYOR Alderman Councillor „ E.J. Field „ W. S. Herbert. „ Mrs. M. C. Irving. „ Mrs. A. Kitchener. „ Mrs. J.D. Lynch. „ J.H. Morrell, J.P. (Died 1. 11. 51) „ The Rt. Hon. The „ Lord Morrison, „ P.C. ,D.L. ,J.P. „ H.E. Ashby „ Mrs. M. Berry, J.P. „ J.W.H. Brown. „ E.J.J. Carter. „ A. W. Catley. „ A. Clark. „ P.F. Collins, „ C.H. Colyer. „ A.J. Davies. „ R.W.H. Ford. „ Mrs. F.E. Haynes. „ Mrs. M.W. Holland. „ Mrs. F.C. Ilsley. Alderman J.J. Pagin. „ A. Reed, A.C.I.I., J.P. „ A. R. Turner. „ H.W. Turner. „ R. H. Warren. Councillor Mrs. Q. V. Jacobs „ A.E. Johnson. F.A.F. Keay, J. P. „ S. E. Kemp. „ H. Langer. „ Mrs. A. A. Miller. „ Mrs. L.E. A. Morris. „ The Lady Morrison. „ A. A. Pawson. „ P. Readings. „ Mrs. A.F. Remington. „ W. T. Richards. „ P. Roberts. „ G.W. Rowley. „ A.E. Soall. „ G. E.R. Stanley. „ C. Wise. Town Clerk: M. Lindsay Taylor, LL. B. 2 HEALTH AND HOUSING COMMITTEE Alderman R. H. Warren Chairman His Worshipful The Mayor, Councillor J. W. Hollingsworth, J.P. The Deputy Mayor, Councillor K.A.E. Gregg. (Ex-officio members) Alderman J.H. Morrell, J.P. Alderman A, Reed, A,C.I.I.,J.P. Alderman A.R. Turner. Councillor Mrs. M. Berry, J.P, Councillor The Lady Morrison, „ J. W.H. Brown. „ Mrs. A.F. Remington. „ P.P. Collins. „ P.H. Roberts. „ R.W.H. Ford. „ G.W. Rowley,, „ Mrs. M.W. Holland. „ A.E. Soall. METROPOLITAN WATER BOARD Council's Representative: Alderman E.J. Field STAFF OF THE PUBLIC HEALTH DEPARTMENT Medical Officer of Health Deputy Medical Officer of Health Chief Sanitary Inspector Chief Clerk G. Hamilton Hogben, M.R.C.S., D.P.H. Vacant E.T. Jenkins,M. S. I. A. A.W.Lawrence,M. S.I. A. 3 Sanitary Inspectorial Staff Senior District Sanitary Inspector - E.S. Glegg (a) (b) (c) C.J. Cattell (a) (b) A.E. Clarke (a) (b) (c) (d) D. R. Howe (a) (Commenced 19.2.51) C.J. Johnson (a) (b) (Commenced 19. 2. 51) ¥. P. Kent (a) (b) L.J. Kerridge (a) (b) E. Kipping (a) (b) (Commenced 9.4.51) G.W. Maidlow (a) (b) (Commenced 19.2.51) 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 Inspector F.T.G. Lock Public Health Nurse Mrs. W. Mathias, S.R.N. Clerical Staff W. E. Lawson (Senior Clerk: General). C. J. Lemon C.S. Clark Mrs. E. D. Whittle (Commenced 12.2.51) D.J. McLintic (Senior Clerk: Housing). Mrs. E.K. Parker Miss C. E. Bird R. Hull. Outside Staff Foreman Disinfecting Van Driver Drain Testers S.H. Reid Disinfectors: Attendants E.E. Mannell A. E. Crow F. T. Dowse W.A. Matthews (Left 10.2.51) R.E. Hobbs B. Joscelyn (Commenced 8.3.51) F.J. Slater R. C. Wilson Rodent Operatives Labourer Apparatus W. Butcher A. Dowse A. E. Moon J. Lawrence G.W. Percival A. Ferridge 4 GENERAL STATISTICS Area of District in Acres 3,013 Population: Census 8th April, 1951 126,921 Estimate of Registrar General of Population - Mid-year, 1951 126,800 Pre-War Population 144,400 Approximate Number of Dwellings in DiStrict 30,541 Rateable Value of District at 1st April, 1951 £1,017,402 Sum Represented by Penny Rate at 1st April, 1951 £4,076 Live Births - Legitimate 1,595 , 1,673 Illegitimate 78 (Birth rate) (per 1,000 population) 13.19 Still Births 44 Deaths 1,520 Death rate (per 1,000 population) 11.99 Infantile death rate (per 1,000 live births) 25.7 Maternal death rate (per 1,000 live and still-births) 1.747 Comparability Factors - Deaths 1. 0 6 Births 0.93 (note: Detailed vital statistics appear on pages 49 to 58 in the Statistical Summary). 5 CONTENTS page Part i Control of Disease 6 „ ii Food Control 17 „ III Sanitary Circumstances of the Area 26 „ IV Factories and Shops 38 „ V General 43 „ VI Statistical Summary 49 Appendix Statistical Return of the Work of the Local Area Health Committee No. 3 of The Middlesex County Council 59 6 PART I CONTROL OP DISEASE During the year there were no serious outbreaks of infectious disease. In addition to the compulsorily notifiable diseases medical practitioners have been requested to notify on a voluntary basis all cases of acute rheumatism in children under 16 years. Tuberculosis In 1951 there were 201 new cases of tuberculosis notified, an increase of 27 on the previous year. 192 of these notifications were in respect of cases of pulmonary tuberculosis. Deaths from pulmonary tuberculosis numbered 33 (21 males and 12 females), and non-pulmonary tuberculosis caused 2 deaths (2 females). The death rate from all forms of tuberculosis was 0.276 per 1,000 population, the lowest ever recorded for the borough. The number of cases on the Department's register at 31st December, 1951 was 1,595 (1,414 pulmonary and 181 non-pulmonary tuberculosis). This was an increase of 130 on the previous year. An analysis of the notifications of new cases of pulmonary tuberculosis discloses that nearly 60% more males than females were affected. The frequency distribution tables for males and females shows a marked difference between the two sexes. Whilst the disease appears to attack males of all age groups, the females affected are mainly in the teens or twenties. 7 Distribution of New Tuberculosis Cases notified during 1951 Age Periods New Cases Deaths Pulmonary Non-pulmonary Pulmonary Non-pulmonary Male Female Male Female Male Female Male Female. Under 1 Year - - - - - - - - 1 to 4 Years 10 6 1 2 1 1 - - 5 to 9 „ 11 8 - 1 - 1 - - 10 to 14 „ 1 2 - - - - - - 15 to 19 „ 9 11 - - - - - - 20 to 24 „ 8 18 1 1 - 1 - - 25 to 29 „ 10 12 - 1 - 2 - - 30 to 34 „ 13 7 1 - - 1 - - 35 to 39 „ 9 5 - 1 3 2 - - 40 to 44 „ 6 - - - 2 - - - 45 to 49 „ 7 2 - - 3 3 - - 50 to 54 „ 6 1 - - 3 1 - - 55 to 59 „ 8 - - - 1 - - 1 60 to 64 „ 9 1 - - 1 - - - 65 to 69 „ 9 - - - 1 - - - 70 to 74 „ - - - - 5 - - - 75 years and over 2 1 - - l - - 1 118 74 3 6 21 12 - 2 The following is an analysis of new cases of non-pulmonary tuberculosis notified during 1951:- Male Female Total Genito-urinary system 2 2 4 Pelvis - l l Meninges 1 2 3 Spine - 1 l 3 6 9 8 9 Ward Distribution. Cases of Tuberculosis on the Register at 31st December, 1951 Ward Estimated Population Male Female Total Rate per 1 000 population Pulmonary NonPulmonary Pulmonary NonPulmonary White Hart Lane 12,328 122 6 112 15 255 20.7 Park 11,953 75 18 67 17 177 14.8 Coleraine 12,078 52 9 48 2 111 9.2 West Green 11,716 56 7 53 12 128 10.9 Bruce Grove & Central 11,432 68 4 43 1 116 10.2 High Cross & Stoneleigh 11,308 71 12 52 10 145 12.8 Green Lanes 11,224 71 5 57 4 137 12.2 Chestnuts 11,562 59 4 45 9 117 10.1 Seven Sisters 10,824 80 9 47 7 143 13.2 Town Hall 11,289 72 7 50 11 140 12.4 Stamford Hill 11,086 75 5 39 7 126 11.4 Total 126,800 801 86 613 95 1,595 12.6 Note: To obtain the estimated population for each ward, the Registrar-General estimate for the borough has been divided in the same proportions as number of persons on the Register of Electors for each ward. The White Hart Lane Ward is comprised mainly of London County Council and Tottenham Borough Council housing estates, and the priority that has been given to rehousing necessitous tuberculous cases is reflected in the high tuberculosis rate in that Ward.; Park Ward which has the second highest rate also takes in part of the L.C,C, estate. B. C. G. Inoculation The Medical Research Council are conducting an investigation into the efficacy of B.C.G, inoculation in the prevention of tuberculosis. Part of the investigation is among the children of the school-leaving age group, and the parents of all Tottenham school children who are about to leave school are invited to cooperate in the trials. A more detailed report on the trials is contained on page 84 of the Appendix to this report. Scarlet Fever 245 cases of scarlet fever were notified during 1951, a decrease of 111 from the previous year's figure, which was 10 mally high, and 10 below the 1949 figure. 115 of these cases were treated in hospital, the remainder being nursed at home.; The disease continued to be of a mild character and again no death from the disease was recorded. The following are the amended diagnoses of certain cases originally notified as scarlet fever:- Abrasions of Face, 1; Bronchitis and Dermatitis, 1; Coryza, 1; Dentition Rash, 1; Dyspepsia, 1; Measles, 2; Meningococcosis, 1; No obvious Disease, 3; Pyrexia of Unknown Origin, 1; Rubella, 3; Tonsillitis, 8; Urticaria, 1.; Details of the cases treated in hospital are as follows:- Hospital Diagnosis Correct and Cases Treated to a Conclusion. Diagnosis Incorrect Number of Cases Average stay in Hospital (days) Number of Cases Average stay in Hospital (days) St. Ann's General 97 16.3 23 11.7 Other Hospitals 18 29.1 1 16.0 Diphtheria During 1951, for the first year since records have been kept, there was not a single confirmed case of Diphtheria, and it is over six years since the last death occurred from this disease. 15 diphtheria notifications were received during the year, but in each case the diagnosis was corrected by the hospital authorities. The amended diagnoses were as follows:- Glandular Fever, 2; Leukaemia, 1. Measles, 1; Pharyngitis, 1; Rhinitis, 1; Tonsillitis, 9. This very gratifying position is the result of the sustained campaign during the past fifteen years for the immunisation of children, and the whole-hearted response of the parents in ensuring that such a high proportion of children has been treated. Parents, however, should not allow the success in recent years to cause any slackening in their vigilance against diphtheria, for it is only by maintaining a high percentage of immunised children that the disease can be held in check. Prom figures supplied by the Area Health Office the following 11 table has been compiled showing the number of children at 31st December, 1951, who had completed a course of immunisation at any time before that date (i.e. at any time since 1st January, 1937). Immunisation in Relation to Child Population Age at 31.12.51. i. e. Born in year Under 1 1951 1 1950 2 1949 3 1948 4 1947 5 to 9 1942-1946 10 to 14 1937-1941 Total under 15 Number Immunised 133 924 1192 1487 1814 / 7 578 6096 y 19224 5,550 13,674 Estimated midyear Child Population 1950 Children under five 10,340 Children 5 to 14 15,705 26045 Percentage Immunised 53.7% 87.1% 73.8 Whooping Cough During the year there were 427 notifications of this disease, and death resulted in 2 cases. 40 cases with complications were admitted to hospital.; Whooping cough vaccination trials carried out under the auspices of the Medical Research Council continue to be followed with the greatest interest The effectiveness of vaccination in preventing or modifying this disease is not now questioned, but the trials continue locally in order to find the best type of vaccine to adopt for general use. Details of the whooping cough vaccination trials appear in my report as Area Medical Officer, which is printed as an appendix to this report. Measles There were 1,331 notifications of Measles during 1951, 44 cases with complications being admitted to hospital. The notification rate remains high, but this is doubtless due to the increased susceptible child population resulting from the high birthrate at the end of the war years. The following graph showing Measles notification rates with a graph of the birthrate for 5 years earlier demonstrates this point. To level out the biennial peaks and troughs which characterise the incidence of Measles,average figures for 2 y3ar periods are shown. MEASLES Incidence Rate and Birthrate 5 years earlier BIRTHS MEASLES Year No. No. with previous year Populat ion (1, 000's) Populat ion with previous year (1.000 s) Average Annual Rate per 1,000 for 2 years Year NO. No. with previous year Population (1,000's) Population with previous year (1.000's) Average Annual Rate per 1. 000 for 2 years 1935 1969 - 150.3 - - 1940 236 - 119. 4 _ 1936 1931 3900 148.6 298.9 13.05 1941 1044 1280 105.6 225.0 5.69 1937 1973 3904 146.2 294.8 13.28 1942 712 1756 110.1 215.7 8.14 1938 1893 3866 144.4 290.6 13. 31 1943 1037 1749 110.3 220.4 7 93 1939 1776 3669 142.4 286.8 12.79 1944 297 1334 108.2 218.5 6.10 1940 1666 3442 119.4 261.8 13.15 1945 1088 1385 110.6 218.8 6.33 1941 1560 3226 105.6 225.0 14.34 1946 592 1680 124.8 235.4 7.13 1942 1819 3379 110.1 215.7 15.66 1947 1227 1819 129.1 253 .9 7.16 1943 1970 3789 110.3 220.4 17.19 1948 825 2052 130.0 259.1 7.92 1944 2066 4036 108.2 218.5 18.47 1949 967 1792 130.0 260.0 6.89 1945 1988 4054 110.6 218.8 18.52 1950 1622 2589 129.4 259.4 9.98 1946 2580 4568 124.8 235.4 19.4 1951 1331 2953 126.8 256.2 11.52 1947 2785 5365 129.1 253.9 21.13 1948 2233 5018 130.0 259.1 19.36 1949 2009 4242 130.0 260.0 16.31 1950 1727 3736 129.4 259.4 14.40 1951 1673 3400 126.8 256.2 13.27 12 MEASLES Notification Rate and Birthrate shown five years earlier 13 14 Poliomyelitis During the year there were four confirmed cases of paralytic poliomyelitis. Details of these cases were as follows:- Date of Notification Sex Age (Years) Site of Paralysis Recent History of Inoculations,etc. 8.1.51. Male 5 Legs Nil 18.6.51 Male 9 Palate Nil 5.11.51 Male 40 Generalised Nil 6.12.51 Female 35 Legs and Left Shoulder Nil Puerperal Pyrexia The Puerperal Pyrexia Regulations 1951, replacing the 1939 regulations came into operation on the 1st August 1951. It had been found that the then existing definition of the condition was ambiguous and, in addition, the use of various drugs now freely available may have the effect of reducing temperature promptly and so of preventing an infection from becoming notifiable because the raised temperature was not maintained or did not recur. There may thus have been a greater risk of spread of infection from such cases in maternity hospitals if the case did not become notifiable and so subject to the ordinary measures of control. With these considerations in mind a new and more precise definition was introduced. The new definition of puerperal pyrexia is any febrile condition occurring in a woman in whom a temperature of 100.40 Fahrenheit (380 Centigrade) or more has occurred within fourteen days after childbirth or miscarriage. Dysentery During the year there were 112 notifications of Sonne Dysentery. Many of these cases were of a mild character and in earlier years would have been passed over as non-specific diarrhoea. With the present laboratory facilities for faeces examination, it usually is possible to establish the cause which is most often the Sonne bacillus. In December there was an explosive outbreak of dysentery in a school in the adjoining borough of Hornsey. Tottenham children attending the school were visited and faeces specimens obtained 15 for bacteriological examination. In 17 of the 32 Tottenham children attending the school at the time of the outbreak the faeces contained sonne bacilli. Food Poisoning During 1951 there were no outbreaks of food poisoning and there were only four confirmed cases notified; one in February and the remaining three in May. In only one case was the causal agent identified; this was Salmonella Typhi Murium. Winter Epidemics Although influenza is not a notifiable disease, it is desirable that early information should be available of any possible winter epidemics. The notification rate for pneumonia and the death returns give some indication of the severity of winter epidemics, and an early indication is also obtained from the weekly returns of new cases of sickness in the area registered with the Ministry of National Insurance. At the end of 1950 and the beginning of 1951 influenza gave rise to an increase in the amount of sickness reported, but this fell rapidly during January, and by mid-February had reached a normal level for the time of the year There were no epidemics in the mild winter of 1951/2. Acute Rheumatism A rheumatism supervisory centre at the St. Ann's General Hospital was established as from the 1st August, 1951. The centre is under the supervision of the Consultant Paediatrician, Dr. I.M. Anderson, and is concerned with the full range of care (including in-patient and out-patient treatment and a cardiological clinic) for the rheumatic child up to 16 years of age. To assist in the investigation of the incidence of the disease, the sanitary inspectors furnish environmental reports on all cases dealt with at the centre. General practitioners have been requested to notify me of all cases of acute rheumatism in children under 16 years so as to ensure that they come to the notice of the Centre, It is hoped at a later date to ask the Minister of Health to make acute rheumatism a compulsory notifiable disease within the borough. 16 Cancer Deaths from the various forms of cancer are analysed in the Statistical Summary (page 58). 273 or 18% of the total deaths were caused by this disease. The very high proportion of males who died from cancer of the respiratory system would appear to lend credence to the belief that smoking has some predisposing influence. There were 29 deaths from cancer of the breast, which was the most common site of this disease in females. Summary of Disinfection work during 1951 Rooms disinfected after occurrence of infectious disease 469 Bedding disinfected after occurrence of infectious disease or death 332 Library books disinfected 57 Articles disinfected for the Ambulance Service:- Blankets 672 White Coats 220 Pillow Slips 188 1,080 17 PART II FOOD CONTROL Food Premises The task of promoting sound standards of hygiene in food premises generally has been steadily pursued. In this type of work, however, there is little to show, generally good conditions do not call attention to themselves; it is the bad ones that are more spectacular. The general standard of food premises shows improvement. This is in part due to better maintained premises in contrast to that prevailing immediately after the war; and to better standards of food handling. Food handling methods at the end of the war were very bad, and the public was generally indifferent in its demand for better standards. There has been a steady pressure brought to bear on traders and food handlers, and although there is still much educational work to be done in this direction, improvement is distinctly noticeable. Catering Establishments During the summer a report was prepared on the conditions prevailing in catering establishments within the Borough, These were reviewed in the light of the Report of the Catering Trades Working Party entitled "Hygiene in Catering Establishments". Although the Report has not the force of law it forms a most valuable yardstick with which to measure the amount by which catering establishments pass or fall short of recommended standards, and greatly assists officers of local authorities in their efforts to reach some common standard in those establishments which it is their duty to inspect. 18 The survey on which our own report was based was made over a period by the sanitary inspectors during their ordinary routine visits. It is satisfactory to note that the most important aspect of this review showed that the local catering establishments, in general, maintained a reasonably high standard of hygiene. It was apparent however, that in a number of cases, particularly in the smaller cafes, the planning of kitchens was not good, and their equipment a minimum. Shortcomings in the facilities and equipment provided, comprised in the main; lack of adequate sinks, (few had more than one), inadequate hot water supplies and insufficient cold storage facilities. Action to remedy these defects has been taken since the survey. In some instances, building restrictions have held up major replanning, and progressive managements find themselves forced to continue operations in premissis which they themselves consider out of date or inadequate and which they are anxious to improve. Suggestions from the Health Department are on the whole very well received, and local caterers are keen to play their part in promoting a good standard of food hygiene. Milk and Dairies On the 1st October, 1951, a Ministry of Food Order came into force specifying that all milk sold by retail within the Greater London area (which includes Tottenham) must be specially designated milk, that is, "sterilised", "pasteurised","tuberculin tested" or "accredited" milk. Every milk dealer known to the Department holds a licence under the Milk (Special Designation Regulations, and the following is a summary of the licences issued for 1951, namely:- Milk (Special Designation) (Pasteurised and Sterilised Milk) Regulations, 1949 Dealers' Licences - "Pasteurised" 64 Dealers' Licences - "Sterilised" 138 Dealers' Supplementary Licences - "Pasteurised" 12 Dealers' Supplementary Licences - "Sterilised" 13 19 Milk (Special Designation) (Raw Milk) Regulations, 1949 Dealers' Licences - "Tuberculin Tested" 31 Dealers' Licences - "Accredited" 3 Dealers' Supplementary Licences - "Tuberculin Tested" 12 Dealers' Supplementary Licences - "Accredited" 1 During the year 29 applications for registration as milk distributors were dealt with. No applications were received in respect of dairies. Of the 29 new registrations. 14 were in respect of new premises and the other 15 were in respect of the change of proprietorship of previously registered premises. The sale of milk from 6 premises was discontinued during the year. The number of premises and distributors registered at 31st December, 1951, was as follows:- Number of Distributors registered 138 Number of Dairies registered 11 The Middlesex County Council is the licensing authority for premises at which milk is processed and the County Public Control Department have furnished the following report on this matter, namely:- "During 1951, 3 dealer's (pasteurisers) licences and 1 dealer's (sterilisers) licence were in force. At each of these 4 premises the processing plant was subjected to regular inspection by my Council's officers. 143 samples of "pasteurised" milk were procured of which 3 (two from one processor and one from another) failed to pass the phosphatase test. Apart from advice and warning no further action was deemed necessary in these cases. 49 samples of "sterilised" milk from the one licensee were procured and all passed the turbidity test". Ice Cream Routine sampling and systematic inspection continues to be undertaken in the supervision of the production of ice cream. Regular visits are also made to premises where loose ice cream is sold, but increasing numbers of dealers are switching over to the sale of pre-packed ice cream, where the risk of contamination is greatly reduced. The Department's insistence on proper hygienic methods in the manufacture and handling of this commodity has resulted in a 20 siderable improvement in the bacteriological grading of samples submitted for examination by the Public Health Laboratory Service. The following ice cream premises were registered during 1951 namely:- For the sale of Ice Cream 35 For the manufacture and sale of Ice Cream 0 Total 35 10 premises which ceased to be used for the sale of ice cream were removed from the register. The total number of premises on the register in accordance with Section 14 of the Food and Drugs Act, 1938, at 31st December, 1951, was as follows:- Sale of Ice Cream 235 Manufacture and Sale of Ice Cream 36 Storage of Ice Cream 2 Total 273 Samples of Ice Cream Submitted for Bacteriological Examination Results Total Grade I- Grade 2 Grade 3 Grade 4 Number of Samples taken where ice cream was produced in Tottenham 11 3 - - 14 Number of Samples taken where Ice Cream was produced in districts other than Tottenham 13 2 - - 15 Total 24 5 - - 29 Preserved Foods 103 premises used in connection with the manufacture and/or preparation of preserved foods are registered under Section 14 the Food & Drugs Act, 1938. During the year 11 new registrations were made. 4. were found to be discontinued. 21 Manufacture of Sausages 6 Manufacture of Sausages and Preparation of Preserved Foods 5 Middlesex County Council Act, 1950: Section 11 - Registration of Hawkers. Section 11 of the Middlesex County Council Act 1950 was adopted by Tottenham and came into operation in the Borough on the 1st April, 1951 This section which replaces section 279 of the Middlesex County Council Act, 1944, extends the requirements for the registration of food hawkers so that it is now necessary for hawkers of any foodstuff to be registered by the Council 16 new applications were investigated by the sanitary inspectors in 1951 and found to be satisfactory. The following is a summary of the registration of hawkers and their storage premises as at the 31st December, 1951:- Articles Number of Persons Registered for sale Number of Storage Premises Fruit and Vegetables 111 107 Shell Fish 14 9 Fish 8 8 Ice Cream 5 1 Peanuts 1 1 Light Refreshments (Mobile Canteen) 1 1 140 127 4 hawkers were found to have discontinued using their storage premises Slaughterhouses and Knackers' Yards Five premises are licensed as slaughterhouses under Section 57 of the Food and Drugs Act, 1938 Regular slaughtering is carried on at only one of these and this establishment deals solely with the slaughter of horses for human consumption. The number of horses slaughtered in the slaughterhouse during the past four years is as follows:- 1948 1949 1950 1951 3,189 2,889 2,750 2,856 22 Another section of the premises is licensed as a knacker's yard and during 1951, 1,810 animals were dealt with there. Regular visits are made by the District Sanitary Inspectors to ensure compliance with the regulations. During the year 14 licences to slaughter were issued under the provisions of the Slaughter of Animals Act, 1933. Food Condemned The following tinned articles were condemned during the year, namely:- Anchovies 1 Crawfish 5 Meat and Vegetable 9 Apple Jelly 3 Crayfish 1 Meat Paste 1 Apple Pulp 79 Cucumbers 3 Meat Pudding 3 Apple Puree 48 Damsons 65 Milk 1,992 Apples 91 Pig Pudding 1 Milk Whipping Compound 19 Apricot Pulp 186 Pigs 4 Minced Beef Leaf 117 Apricots 61 Fruit Salad 109 Mincemeat 3 Baby Food 233 Gherkins 6 Mutton Hash 1 Bacon 2 Gooseberries 38 Orange Juice 12 Beans 474 Grapefruit Juice 19 Oranges 248 Beef and Pork Loaf 2 Grapefruit 37 Pate de Foie 2 Beetroot 120 Grapes 59 Peaches 67 Bilberries 1 Greengages 164 Peach Pulp 41 Blackberries 20 Guavas 9 Peanut Butter 2 Blackcurrant Jelly 1 Guava Jelly 1 Pears 55 Blackcurrants 25 Ham 689 peas 872 Brawn 5 Ham Loaf 30 Pease Pudding 2 Brislings 14 Ham and Beef Loaf 1 Pilchards 64 Broth 46 Herring Roes 7 Pineapple 252 Carrots 53 Herrings 16 Pineapple Jelly 2 Celery 1 Irish Stew 2 Pineapple Juice 17 Cherries 238 Jam 134 Pineapple Pulp 7 Chicken 16 Kidneys 2 Plums 724 Christmas Pudding 4 Lobster 1 Pork 11 Coconut 5 Loganberries 4 Potato and Whale meat Rissoles 1 Cod f is h 1 Luncheon Meat 964 Prawns 3 Coffee 1 Macaroni 21 Prunes 304 Corned Beef 76 Macedoine 14 Rabbit 6 Corned Mutton 6 Mackerel 2 Raspberries 69 Crab 14 Marmalade 21 Raspberries and Redcurrants 16 Crab Paste 1 Meat and Gravy 5 Redcurrants 1 23 Rhubarb 53 Steamed Pudding 1 Tomato Pulp 1 Salmon 105 Stewed Steak 109 Tomato Puree 33 Sardines 181 Strawberries 85 Tongue 15 Sauerkraut 4 Sweet Corn 3 Veal 30 Sausages 18 Syrup 3 Veal Loaf 29 Soup 1,006 Tomatoes 466 Veal and Ham Loaf 4 Spaghetti 123 Tomato Juice 93 Veal, Pork & Beef Loaf 1 Spinach Puree 1 Tomato Paste 26 Mixed Vegetables 17 Young berries 9 Other articles of food condemned were as follows Bacon 121bs. 10oz. Luncheon Meat 5 lbs. 13oz. Barley Kernels 57 packets Macaroni 33 1bs. Beef 1, 37314 lbs. Marmalade 1 jar Blackberries 7 bottles Marshmallows 254 lbs. Boiled Sweets 6 lbs. Melt 3 stone Butter 6 lbs. Oats 38½ lbs. Cake 49 lbs. 11oz. Pears 30 1bs. Calves' Heads 83 lbs Pickles 1 jar Cheese 123¾ lbs. Plums 1 jar Chocolates 29 lbs. Pork 34 lbs. 11oz Chocolate Caramels 11 lbs. Potatoes 66 lbs. Creaming Mixture 194 packets Pudding Mixture 2 packets "crest" 78 bars Rabbits 88 lbs. Dogfish 15 stone Red Cabbage 2 jars Eggs 489 Rock Ee1 3 stone Pigs 38 lbs. Sausage Rusk 100 lbs. Pish Paste 9 jars Sheep s Heads 234 lbs. Fondant 28 lbs Skate 22½ stone Fruit Cordial 1 bottle Spaghetti 8 lbs. Haddock 5 stone Sugar 2 lbs. Ham 59½ lbs. Sugared Sweets 5 lbs. Herrings 3½ stone Tea 1½ lbs. Kippers 1 stone Tomato Ketchup 3 bottles Lamb 5 lbs. l0oz. Tomatoes l00 lbs. Lemon Curd 2 jars Veal 5½ lbs. "vita Gravy" 21 packets. 24 Food Sampling The Public Control Department of the Middlesex County Council has supplied the following information of food and drugs sampling in the borough during 1951:- FOOD AND DRUGS ACT, 1938 List of samples procured in the Borough of Tottenham during the year 1951 Article Total samples procured Unsatisfactory Milk, various 270 9 Beef and Carrots, tinned 1 - Cakes, various 47 - Chocolate Liqueurs l 1 Cake Mixture l - Coffee & Chicory Essence l - Condensed Milk 1 - Cooked Meat 7 - Cooking Oil 8 - Cream 2 - Curry Powder 2 - Dripping 3 Drugs 10 - Egg Vermicelli 1 - Fish, various 22 3 Fish Cake and Paste 4 - Flour 1 - Fruit Squash 3 - Horserelish 1 - Ice Cream 2 - Jam 1 - Jelly 1 - Lemon Curd 4 - Meat Pie 3 - Milk Chocolate l - Mustard l - Peas, tinned l - Pepper Compound 2 - Raisin Wine 1 l Salad Cream 1 - Sausages 32 - carried forward 436 14 25 Article Total samples procured Total Unsatisfactory brought forward 436 14 Sausage Meat 5 - Tomato Ketchup 2 - Whalemeat a - Whiskey 24 - 468 14 Food and Drugs Act. Legal Proceedings Case 1. Unsound Chocolate Confectionery. 145 cwts seized and subsequently condemned by Magistrate. Proceedings instituted against company alleging that this unsound food was deposited on their premises for the purpose of manufacturing another type of confectionery for sale for human consumption. Case dismissed. Case 2. Section 13, Food and Drugs Act, 1938. Summons in relations to the cleanliness of the premises was adjourned for two months so that the defendants could be informed of the steps they must take to comply with this section of the Act. Case 3. Sale of unsound bread:- The defendant pleaded guilty and was fined £5. Case 4. Mice excreta in bread:- The defendant pleaded guilty to the offence and was fined £20 plus £2.2s. costs. 26 PART 3 SANITARY CIRCUMSTANCES OF THE AREA Water Supply The Metropolitan Water Board continues to supply water to the Borough and I am indebted to the Director of Water Examination for the following information "The supply to the Tottenham area has been satisfactory both in quantity and quality during the year 1951, The area is supplied from two sources: (a) Water from the New River and treated at the Board's filtration works at Hornsey and Stoke Newington (b) River Thames water stored in Walton reservoir and treated at the Board's filtration works at Walton Samples are collected on five days in every week, or more often if required, at each stage of the purification process and tests include physical, chemical and microbiological examination The water supplied to this area is not plumbo solvent All new and repaired mains are chlorinated before being restored to use and samples of water from them are tested bac teriologically to ensure that its quality is up to that normally supplied" "Details of the analytical results of the water passing into supply are given in the following tables":- <r Average Results of the Chemical and Bacteriological Examinations of the Water Supplied to the Borough of Tottenham for the Year 195a Parts per Million (Unless otherwise stated) Description of the Sample No, of Samples Ammoniacal Nitrogen Albuminoid Nitrogen Oxidised Nitrogen Chlorides as CI. Oxygen, abs. from Permanganate 3hrs at 80°F Turbidity in Terms of Silica Colour. m.m. brown 2ft. Tube Burgess's Tintometer Hardness (Total) Hardness (Non- carbonate) PH. Value Phosphate as P.O. 111 4 Silica as si0 2 Conductivity Nitrite Nitrate New River water filtered at Hornsey works 250 0.033 0.074 7. 4 40. 8 0.80 0.1 9 308 80 7. 7 0. 51 15 550 New River water filtered at Stoke New- Winston works 250 0.041 0.075 6. 8 40.8 0.78 0.1 9 305 80 7.8 0.48 13 550 River Thames water filtered at Walton works 249 0.021 0.088 4. 5 23.0 1.35 0.2 16 258 63 7.8 0.33 13 450 Bacteriological Results Description of Sample No. of Samples No. of microbes per ml. Colonies counted on agar after 20 24 hrs. at 37°C. Bact. coli Test percentage of samples negative to Bact. coli in 100 ml. Bact. coli per 100 ml. New River water filtered at Hornsey works 256 36.0 100.0 Nil New River water filtered at Stoke Newington works 256 35.6 99.6 0.012 River Thames water filtered at Walton works 255 22.7 99.6 0.004 28 Drainage and Sewerage Surface and soil water continues to be drained separately. Investigations into pollution of watercourses has been undertaken with reasonable success. This particularly so in the industrial area in Brantwood Road, where we have been able to get factory owners to carry out remedial works. Closet Accommodation The water carriage system operates throughout the Borough. Close liaison has been observed with Her Majesty's Factory Inspector in dealing with the closet accommodation in factories. Atmospheric Pollution The improvement noted in previous Annual Reports continues to be maintained. Firms who use normal solid fuel are alive to the fact that faulty combustion, and in consequence, atmospheric pollution, is an economic matter as well as a public health one, Incomplete combustion represents a waste of fuel and this economic consideration does much to influence industrialists in combating this practice. No such consideration applies to those firms where fuel is mainly the waste products of the factories, i.e„ offcuts and woodwaste. In the main, the pollution caused is due to woodwaste being burned on plants which were never designed for the purpose. It is in this direction that "prior approval" could do much to prevent the nuisance from arising. Housing In a densely built up area such as Tottenham the main preoccupation of the Health Department is that of housing, The economics of housing is a national problem and owners, everywhere stress the impossibility of keeping their houses in a reasonable state of repair. This factor is having much influence on the present and future problems. The Borough has many houses which have outlived their useful lives and it is recognised that clearance is the final solution. There are however other houses which have many years of 29 ful life before them if they are properly maintained. It is this lack of maintenance - for the economic reasons mentioned - which is creating the problem of future areas for clearance. It has been said that the persons owning a few houses must sell one of them to pay for repairs to the remainder. This can easily be true. The only solution appears to be some form of rent revision, with proper safeguards that any permitted increases are spent on repairs. Housing Act, Sections 9 and 10 The application of the provisions of these sections has continued throughout the year. A question which required some consideration when inspecting houses as a result of complaints is, whether to deal only with the complaint or to inspect the whole house. Owners often make the point that the tenant has not complained about certain items which may appear in a notice. But the inclusion or the exclusion of anything on a notice must be left to the judgment of the sanitary inspector In this way the criticism, that the tenant is setting the standard can be avoided. Only too often inspectors are asked to include items of a decorative character on the notice simply because it has not been done for many years. It must not be forgotten that in any case of appeal the inspector will be required to justify - to the Court the inclusion of any item on the notice, The following is a summary of work carried out under Sections 9 and 10 in the owner's default, during the past 15 years, namely:- 30 Year Number of Houses Cost £ s. d. 1937 12 420 5 5 1938 5 66 13 11 1939 31 605 3 5 1940 3 25 4 4 1941 19 319 7 0 1942 21 543 4 10 1943 114 2,559 7 3 1944 45 1,026 6 9 1945 17 658 3 11 1946 152 7, 329 16 8 1947 241 14,272 16 9 1948 181 13,160 8 4 1949 106 6,593 6 5 1950 77 4,035 8 5 1951 72 3, 186 3 4 Housing Act - Legal Proceedings In one case an Appeal was lodged in the County Court against a demand for the cost of works carried out in default under section 10 of the Housing Act, 1936 The Judge decided that the figure of £104. 17s, demanded was excessive and reduced this amount to £70. Other grounds of the Appeal were dismissed. Housing Act, 1936, Section 11 Action under the provisions of Section 11 is, as far as possible, avoided From time to time however the department is faced with a situation where no other course is possible. Members of the Council will be aware that the Corporation itself has sought - by means of acquisition to avoid the necessity of demolishing houses which are occupied,, Many of the demolition orders are unopposed by the owners and few, if any. cases occur where undertakings to carry out work of repairs are submitted. This seems to point to the uneconomic position in which some house owners find themselves. There have been cases however where the demolition order having been made and the tenants rehoused, owners have sought permission to repair. This is no doubt done with a view to sale of the house with vacant possession It is hardly necessary to add that such cases do not succeed. 31 PREMISES THE SUBJECTS OF DEMOLITION ORDERS - NOT DEMOLISHED AS AT 31ST DECEMBER, 1951 PREMISES DATE OF ORDER 22, Hale Gardens 5.4.50 10, The Hale 5.4.50 16, The Hale 2.3.51 55, The Hale 2. 4.48 57, The Hale 2.4.48 * 8A, Lawrence Road 13.10.48 1, Railway Terrace 3.2.50 2, Railway Terrace 3.2.50 * 3, Railway Terrace 3.2.50 4, Railway Terrace 3.2.50 4, Stanley Grove 1.6.43 * 180, Tewkesbury Road 31.7.51 5, Union Row 11.8.48 6, Union Row 11.8.48 7, Union Row 11.8. 48 8. Union Row 11.8.48 * 22, Whitehall Street 31.7.51 * These premises are still occupied PREMISES DEMOLISHED DURING. 1951 PREMISES DATE OF ORDER DATE DEMOLISHED 31, Tewkesbury Road 8.8.49 18.10.51 378, West Green Road 5.4.50 1.6.51 380, West Green Road 13.4.51 23.8.51 PREMISES THE SUBJECT OF CLOSING ORDERS MADE DURING 1951 PREMISES PART OF PREMISES CONCERNED DATE OF ORDER 409, Seven Sisters Road Front Basement 8.8.51 419, Seven Sisters Road Front Basement 8.8.51 421, Seven Sisters Road Front Basement 8.8.51 423, Seven Sisters Road Front Basement 8.8.51 32 Housing Act, 1936. Part 3 It has long been my view and that of the Chief Sanitary Inspector that clearance area procedure should be revived . Instructions were given by the Council to deal with Arthur Road and Bloomfield Road. The area itself, although not large, has been a cause of concern for many years. These old and worn out three storied houses have long been beyond proper repair. A public enquiry was held in November, the owners opposing the Council's application to have the area confirmed by the Ministry. Although this report officially covers the year ended 31st December, 1951. confirmation of the Order has since been receiv.ed. There are however other areas in the Borough where clearance procedure is equally urgent; and it is only because of the difficulty of alternative accommodation that these areas have not been submitted, The provision of alternative accommodation for displaced persons is an indispensable condition and it is a matter of policy as to how these considerations can be balanced against the general housing needs of the Borough. Public Health Act, 1936 Many facets of public health administration are dealt with under the provisions of the Public Health Act. An ever increasing number of complaints concerned with housing conditions are dealt with under the nuisances sections,, It is however considered good policy to use specific sections for specific matters rather than to combine them on a general nuisance notice Examples of specific matters are drains, Section 39; Water Closets Section 45; verminous room, verminous articles and verminous persons - Section 83 and 84. Rights of appeal exist in certain cases, but this does not apply to the nuisances sections. In these cases a magistrates order is required and to this extent the procedure may be more prolonged and a greater time taken to alleviate conditions. The average complainant expresses the opinion that because his or her complaint is concerned with what he or she considers a 33 health matter, the Council have the power to act. Unfortunately this is not always possible, there are numerous miscellaneous matters which can only be settled by the complainant taking action under the common law if legal action is indeed necessary. These complaints are usually in the nature of domestic disagreements between tenant and sub-tenant. Such matters how ever are not disregarded. It is usual for the sanitary inspector to visit and use his endeavours to find a satisfactory solution acceptable to both parties. Abatement Notices - Legal Proceedings Case l. Two Orders were made requiring work to be completed within fourteen days. Costs of 9/6d. were allowed on each Order. Case 2. An Order was made for work to be carried out in fourteen days and a fine of £2 imposed. Case 3. Three Orders were made providing for the work to be carried out within seven days and costs allowed (7/6d. on each Order). Case 4. An order was made requiring the owner to carry out works required within twenty-eight days, £2, 2s, costs were awarded. The Order was not complied with* a fine of £2 plus £3. 3s. costs was imposed and the defendant was informed that he is liable to a fine of £1 per day until the work is completed., Later a further fine of £1. 14s. with £5. 5s. costs was imposed for non-compliance with the Order. Case 5. The Summons was withdrawn as the work required had been completed. The Defendant paid £2. 2s.costs. Case 6. In view of the fact that the work required had been completed, the summons was withdrawn on payment of 4s. costs. Case 7. The defendant was ordered to carry out the work required within 28 days and ordered to pay £2. 2s. costs. Later a fine of £3 was imposed and the defendant ordered to pay £3. 3s. costs for non-compliance with the Order. Case 8. A Summons was adjourned sine die on payment of £1. 1s. costs, the owner having undertaken to carry out the work. Case 9. Summons withdrawn as the work had been commenced on payment of £1. 1s. costs. 34 Rodent Control Work on rodent control has been carried out in accordance with the Ministry of Agriculture and Fisheries approved methods. Systematic treatments have been given to certain of the Corporation's premises. No contracts are entered into with owners of business premises, but this does not prevent us from cooperating with owners and carrying out treatments - the cost of which is charged. Sewer maintenance treatments have been carried out during the year, details of which are set out below. Sewer Maintenance - Results of Baiting in Manholes MAY/JUNE, 1951 OCTOBER, 1951 Treatment No. 13 Treatment No.14 Complete poison takes - Complete poison takes - Good poison takes 144 Good poison takes 242 Small poison takes 412 Small poison takes 361 No poison takes 544 No poison takes 499 Total manholes treated 1110 Total manholes treated 1102 Estimated killed 4760 Estimated killed 7235 Summary of Dwelling-houses and Business premises treatec during 1951:- (1) Dwelling-houses „ „ „ 580 (2) Business and Factory Premises 130 (3) Total charged for (2) above £89.7s.5d. Inspections Carried out by the Sanitary Inspectors Infectious disease 484 Complaints investigated 4,645 Re-inspections 11,362 Factories 733 Workplaces 66 Dairies, etc. 237 Fruiterers, etc. 137 Fish shops 139 Butchers' shops 257 35 Bakehouses 141 Other food premises 1,032 Slaughter-houses 48 Public House urinals 69 Appointments and interviews 912 Drains tested 496 Drains defective 327 Small Dwellings Acquisition Acts 84 Requisitioned houses 227 Stables and mews 38 Outworkers 788 Other visits 2,370 Notices Served. Statutory Housing Act, 1936: Section 9 673 Section 11 10 Section 12 8 Public Health Act, 1936: Section 24 17 Section 39 59 Section 45 15 Section 48 41 Section 83 1 Section 94 266 Tottenham Urban District Council Act, 1900 Section 48 1 1,091 Informal 2,830 Defects Remedied Drains reconstructed ... ... ... ... 63 Drains repaired 345 Drains cleared 236 W. C. Cistern repaired or renewed 183 W. C. Pans renewed 173 W. C. Pans cleansed 70 Waste Pipes repaired or renewed 164 Rain water pipes repaired or renewed 458 Roofs repaired or renewed 1151 36 Eaves Gutters repaired or renewed 691 Drinking Water Cisterns renewed 17 Drinking Water Cisterns covered 12 Water Service Pipes repaired 119 Water Supply reinstated 51 Yards repaired or reconstructed 161 Sinks renewed or provided 81 Floors repaired or renewed 484 Floors ventilated 194 Dampness remedied by insertion of damp-proof courses 129 by pointing of brickwork 208 by internal rendering 405 by miscellaneous remedies 284 Window Frames and Sashes repaired or renewed, or painted 795 Coppers repaired or renewed, or provided 29 Fireplaces, Stoves and Ovens repaired or renewed 457 Flues and Chimney Stacks repaired 143 Brickwork of Walls repaired and Walls rebuilt 141 Ventilated Food Stores provided 5 Rooms cleansed 1165 Staircases, Passages and Landings cleansed 341 Staircases, Balconies and Steps repaired or renewed 128 Noxious Accumulations removed 42 Nuisances arising from Animals abated 8 Miscellaneous Defects remedied 1235 Repair of Houses by the Council Work carried out in default or by agreement with owners during 1951:- Housing Act, 1936; £ s. d. Section 9 72 premises 3.186 3 4 Public Health Act, 1936; Section 24 13 premises 330 0 6 Section 39 25 premises 761 13 4 Section 45 1 premises 10 13 4 Section 79 1 premises 3 7 4 Section 94 2 premises 415 12 6 4,707 10 4 37 SUMMARY OF DISINFESTATION WORK DURING 1951 Cause Private Houses Council Houses Other Premises Total Houses Rooms Houses Rooms Houses Rooms Other Premises Ants 5 3 Canteens 3 Nurseries 1 Clinic 1 School 5 8 Beetles 26 36 2 Schools 26 36 2 Bugs 203 445 12 34 215 479 Fleas 3 7 3 7 Flies 3 5 3 5 Weevils 1 Warehouse 1 Wood Beetle 4 8 4 8 TOTAL 244 501 12 34 11 256 535 11 Disinfestation upon removal to Council dwellings was carried out in 174 instances. 38 PART IV FACTORIES AND SHOPS Tottenham has a large number of diverse industries in its • area. Altogether there are 729 factories on the Factories Register varying from small businesses with one or two employees to large concerns employing two or three thousand people. Close co-operation is maintained with H M. Inspector of Factories and systematic and regular inspections are carried out by the sanitary inspectors to ensure compliance with those parts of the Factories Act which are enforceable by the local authority. Factories Act, 1937 Inspections for purposes of provisions as to health (including inspections made by Sanitary Inspectors) Premises Number on Register Number of inspect ions Written notices Occupier pr osecuted (i) Factories in which Section 1,2,3,4 and 6 are to be enforced by Local Authorities 61 13 2 (ii) Factories not included in (i) in which Section 7 is enforced by the Local Authority 668 576 55 (iii) Other Premises in which Section 7 is enforced by the Local Authority (excluding out-workers' premises) 4 2 Total 733 591 57 39 8 Non-Mechanical Factories were discontinued and 71 Mechanical Factories were also found to have been discontinued. There were 82 new factories started in 1951, (mechanical) and 3 new non-mechanical Factories. Cases in which defects were found Particulars Number of cases in which defects were found No. of cases in which prosecutions were instituted Pound Remedied Referred To H. m. Inspector by h.m. Inspector Want of cleanliness (S.1). 11 10 Overcrowding (S. 2). Unreasonable Temperature (S. 3). Inadequate Ventilation (S. 4). Ineffective drainage of floors (S. 6). 1 1 Sanitary conveniences (S.7). (a) insufficient 4 2 2 (b) Unsuitable or defective 80 73 8 (c) Not separate for sexes Other offences (not including offences relating to Outwork) Total 96 86 10 NOTE 10 cases in which defects were found were outstanding at the end of the year. Outworkers (Section 110 and in) Regular visits are made by the Sanitary Inspectors to the homes of persons notified to the Department as outworkers. It It has been found that the home conditions are generally satisfactory and that the cleanliness in such homes is usually above average, 40 Nature of Work Section 110 Section 111 No of outworkers in August list required by Section 110 (1) (c) No of cases of default in sending lists to the Council No. of prosecutions for failure to send list No. of instances of work in unwholesome premises Not ices served Prose- cut ions Wearing apparel 337 Brass & Brass articles 190 Locks, latches and keys 3 1 Umbrellas 1 Artificial flowers 12 The making of boxes or other receptacles or parts thereof made wholly or partially of paper 155 1 1 Brush making 3 Feather sorting 9 Carding etc. of buttons etc. 9 Stuffed toys 26 Cosaques, Christmas crackers, Christmas stockings etc. 17 Lampshades 3 Total 763 1 1 During 1951, 788 visits were made to outworkers premises by the Sanitary Inspectors,, Shops Act In the administration of the Shops Acts, 2737 inspections were made by the Shops Inspector. Most contraventions recorded have been minor defaults, the non exhibition of statutory notices, and the failure to keep proper records of young persons hours of employment in respect of which 318 verbal warnings and notices have been issued. Systematic visitation of shops throughout the Borough has secured effective administration, and information obtained for the 41 purpose of keeping an up-to- date register of shops in the Borough. Regular visits and investigations are made on the days of the weekly half holiday, and in the evening to ensure that the provisions of the Act, and the various early closing orders made thereunder are duly complied with. Shops in the Tottenham (Remainder) Area are closed for the weekly half holiday on Thursday, and in the Harringay Area on Wednesday, subject to the various exemptions. Butchers shops close on Monday subject to the alternative day (Saturday) in all cases, In connection with half-holiday closing 156 visits were made. Half Holiday for Shops Assistants Every shop assistant in every class of shop must be allowed a half-holiday once a week commencing not later than 1.30 p.m. The rule applies whether the shops are required to be closed for a weekly half-holiday or not. Meal Times The requirements in respect of assistants meal times are as follows:- Dinner: If the hours of employment include the hours from 11.30 am to 2.30 p,m, each assistant must be allowed an interval of at least three quarters of an hour within that time if the meal is taken on the premises or an interval of a full hour within that time if the meal is taken off the premises. Tea If the hours of employment include the hours from 4,0 p.m. to 7 p.m., each assistant must be allowed an interval of half an hour within that time. No assistant shall be employed for more than 6 hours (5 hours if under 18) without an interval of at least 20 minutes being allowed during the course there of. General Closing Hours - Winter Months For the period of the Winter months, 4th November,1951 to March, 1952, an Order was made for the later closing of hairdressers and barbers shops in the Borough at 6.30 p.m. There was no suspension of the General Closing hours during the period immediately prior to Christmas 1951. 42 Sunday Trading The provisions of the Act restricting Sunday Trading are effectively enforced by means of systematic investigations and observations. Considering the opportunities for Sunday trading due to exceptions, exemptions and High Court decisions it is gratifying to note that, very few shops, open on Sunday in Tottenham. Shops Act and Young Persons Employment Act, 1938 Routine visits and inspections were made to ensure that the provisions of these Acts relating to the employment of shop workers were effectively applied The conditions of employment of young persons, and shop workers generally have improved, both with res pect to working hours and health and comfort arrangements Owing to the mild winter the amount of absenteeism was con siderably less than 1950, in spite of the restrictions on the heating of shops 173 special visits were made in connection with these Acts, Shopkeepers are desirous of taking reasonable measures to comply with all the requirements of the Acts, and are ready to obtain and act upon the advice, and instructions given by the Shops Inspector 43 PART V GENERAL Medical Examinations of Candidates for Employment in Established Posts of the Council During the year 134 candidates were medically examined prior to admission to the Superannuation scheme, 6 failed to pass the examination, Public Health Laboratory Service The Public Health Laboratory Service provides a comprehensive service for the bacteriological examination of specimens submitted by general practitioners and local authorities 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 branch 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 Saturdayu The address is:- Public Health Laboratory, Coppett's Wood Hospital, Coppett's Road. N.10. A 24-hour emergency service is maintained by the Central Laboratory at Colindale. 44 The following is a summary of the work carried out during 1951, namely:- Record of Examinations Throat/Nose Swabs: Total Specimens 269 Diphtheria Bacilli - Haemolytic Streptococci 59 Negative 210 Faeces: Total Specimens 973 Shigella 281 Salmonella 5 Negative 687 Sputum: Total Specimens 16 T.B. Smear 3 Other Organisms 2 Negative 11 Pertussis: Total Specimens 58 Postnasal Swabs 9 Negative 49 Ice Cream: Total Specimens 22 Water from Swimming Pools: Total Specimens 1 Miscellaneous Specimens 362 Total Number of Specimens 1,701 Persons in need of Care and Attention Cases investigated by the department of persons in need of care and attention are in the main those of aged persons. They can be divided into two classes, (1) Those needing hospital treatment (2) Those needing removal to an old persons home. The investigations carried out under the first heading are done in conjuction with or at the request of the hospital. During the year 130 cases were visited, and of these the majority were admitted to the hospital. Information regarding cases of the second group is obtained from various sources. Direct complaints and frequent cases are notified by the old peoples welfare organisers and others are 45 discovered by sanitary inspectors in the course of their visits. Previous annual reports have set out in detail the methods by which these cases are assisted and dealt with. National Assistance Act. Section 47 It is not our practice to take action under the provisions of the National Assistance Act as soon as a case is brought to our notice. Every effort is made to seek other means of securing some alteration in the general conditions. Cases are kept under surveillance before the final request is made to the Council for authority to proceed in the Magistrates Court. One case only was taken to the Magistrates Court during the year details of which are as follows:- Information was received from the National Assistance Board that an old man, aged 82, was living alone. He occupied two rooms on the second floor. A visit revealed that the rooms in question were extremely dirty and verminous, the old man himself had not bathed probably for a year. He was very deaf and somewhat rambling in his statements, He kept a cat which used the room as a lavatory, The gas cooker in one of the rooms had obviously not been used for a very long time and the old man subsisted mainly on bread, jam and butter or margarine. All efforts over a period of months failed to persuade him to enter a home voluntarily and the magistrates court finally heard the case and made an order for 3 months. National Assistance Act 1948, Section 50: Burials During the year it was necessary to arrange six burials where deaths occurred and no suitable arrangements for burial would otherwise have been made. Establishments for Massage and Special Treatment Part XII of the Middlesex County Council Act, 1944, provides for the annual licensing of establishments of this description. These are defined by the Act as "premises used for the reception or treatment of persons requiring;- (a) Massage manicure or chiopody, or (b) electric treatment or radiant heat light electric vapour or other baths for therapeutic treatment (c) other similar treatment". 46 Seven premises were licensed in the Borough. During 1951 byelaws for the regulation of these establishments were confirmed by the Home Secretary and come into operation on the 1st August, 1951. Rag Flock and Other Filling Materials Act, 1951 The aim of this Act which came into force on the 1st November 1951, is to secure the use of clean filling materials in upholstered articles which are stuffed or lined For this purpose it requires with certain exceptions that premises where upholstery is carried on shall be registered by the Local Authority. It is an offence to sell or have on such premises any unclean filling materials, or to sell any article • containing unclean filling materials. The Act contains special provisions regarding rag flock, and premises where it is manufactured or stored are required to be licensed by the Local Authority. It is an offence to have unclean rag flock on such premises It is a duty of the Local Authority to enforce the provisions of the Act and in particular to secure the necessary inspection of registered and licensed premises The Medical Officer of Health and Sanitary Inspectors have been appointed as authorised officers for the purpose of the Act The fee for registration is £1 as is the fee for a Licence which must be renewed annually. At the 31st December, 1951, 1 establishment was licensed for the manufacture of rag flock and 19 premises were registered for the use of filling materials. Pet Animals Act, 1951 This Act which comes into force on the 1st April. 1952, regulates the sale of pet animals and provides that no person shall keep a pet shop except under the authority of a licence by the local authority. The Medical Officer of Health and the Sanitary Inspectors were authorised by the Council to enforce the provisions of the Act. The Council have decided that the licence fee shall be five shillings and that the licences shall be subject to the following conditions, namely:- 47 1. No animal (including birds and fishes, i.e. all vertebrates) shall be exposed to strong light or heat or be deprived of adequate warmth and animals (other than fish or reptiles) shall not be kept in cellars unless there is ventilation and light adequate for their health. 2. Animals shall at all times be kept in accommodation suitable as respects size, temperature, lighting, ventilation and cleanliness. 3. No animal shall be displayed in a cage, hutch, box or other receptacle on a pavement or in such other position so as to expose it to interference or annoyance by persons or animals outside the shop premises and no animal shall be displayed for sale outside the premises during inclement weather. 4. All animals shall be suitably fed and watered at least once every 12 hours (except where an adequate supply of food and fresh water is constantly available) and all animals shall be visited at least once every 12 hours, including the week-end. 5. Stock shall not be crowded into the shop to such an extent that ingress and egress is difficult. 6. Stock (such as dog biscuits, seeds, etc.) kept outside the premises or elsewhere during business hours, must not be stored at night, in gangways of the premises, so as to cause obstruction in the event of fire or other emergency, 7.' Licensees shall ensure that a responsible person shall at all times be in or within a reasonable distance from the premises for the purpose of giving warning and taking other necessary steps in the event of fire or other emergency. In the case of premises which are lock-up, outside business hours the licensee shall appoint a responsible person residing within a reasonable distance to the premises to have custody of the key The name and address of such person shall be displayed in legible characters on the front door, or windows, of the premises, and be notified to the nearest Fire Station. A supply of water and sand and/or an efficient fire extinguisher must always be available on the premises. 8. No animal which is suffering from or could reasonably be suspected of having come into contact with any other animals suffering from any infectious disease shall be brought or kept on the premises unless it is properly isolated from the other animals therein. 48 9. Day-old chicks shall on no account be handed to customers in paper bags or other unsuitable containers, 10. No mammal shall be sold unweaned, or if weaned, at an age at which it should not have been weaned. 11. Where animals are kept in cages, hutches, boxes or other receptacles placed on top of other cages, hutches, boxes or other receptacles, effective means shall be provided for preventing water, food or other droppings falling on to or contaminating the animals or other surroundings which are underneath. 49 PART VI STATISTICAL SUMMARY The classification of deaths is in accordance with the International List of Diseases,Injuries and Causes of Death, as revised in 1948 under the auspices of the World Health Organisation. 1931 1950 1951 Area of District in acres 3,013 3,013 3,013 Population: Census, April, 1951. 157,748 - 126,921 Mid-Year: Registrar General' estimate s 159,300 129,400 126,800 Rateable Value £882,264 £1,009,477 £1,017,402 Sum represented by penny rate £3,583 £4,060 £4,076 Births: Registered live-births (a) Legitimate: Males 1,133 836 844 Females 1,136 808 751 Total: 2,269 1,644 1,595 (b) Illegitimate: Males 33 39 37 Females 43 44 41 Total: 76 83 78 Where available comparable figures for the previous census year 1931 are given in the following statistical summary in addition to the figures for 1950. 50  1931 1950 1951 (c) Total live-births: Males 1,166 875 881 Females 1,179 852 792 Total: 2,345 1,727 1,673 Birth Rate per 1,000 estimated population 14.7 13.35 13.19 Stillbirths (a) Legitimate: Males 15 21 Females 13 21 Total: 28 42 (b) Illegitimate: Males 5 1 Females 0 1 Total: 5 2 (c) Total stillbirths, Males 20 22 Females 13 22 Total: 88 33 44 Stillbirth rate per 1,000 total (live and still) births 36.17 18.75 25.63 Deaths Males 704 795 Females 678 725 Total: 1,621 1,382 1,520 Death Rate per 1,000 estimated population 10.2 10.68 11.99 Maternal Deaths Puerperal Sepsis 3 0 0 Other puerperal causes 7 0 3 Total: 10 0 3 Maternal Death Rate per 1,000 total (live and still) births 4.12 Nil 1.747 51  1931 1950 1951 Deaths of Infants under 1 year of age (a) Legitimate: Males 19 24 Females 17 17 Total: 36 41 Rate per 1,000 legitimate live births 21.90 25.70 (b) Illegitimate: Males 1 2 Females 4 0 Total: 5 2 Rate per 1,000 illegitimate live births 60.24 25.64 (c) Total Infantile Deaths: Males 67 20 26 Female s 57 21 17 Total: 124 41 43 Infantile Death Rate per 1,000 live births 52.9 23.74 25.70 Neo-Natal Deaths Deaths of Infants under 4 weeks 57 31 30 Neo-Natal Death Rate per 1,000 live births 2 4.31 17.95 17.93 Comparability Factors Births .94 .93 Deaths l.07 l.06 52 DEATHS DURING THE YEAR 1951 OF RESIDENTS OF THE BOROUGH OF TOTTENHAM CLASSIFIED ACCORDING TO DISEASES Cause of Death Males Females Total Tuberculosis of respiratory system 21 12 33 Tuberculosis other forms - 2 2 Syphilitic disease 2 3 5 Diphtheria - - - Whooping Cough 2 - 2 Meningococcal Infections - - - Acute poliomyelitis - - - Measles - - - Other infective & parasitic diseases 2 - 2 Cancer, malignant disease 139 126 265 Leukemia, Aleukemia 4 4 8 Diabetes 2 8 10 Vascular lesions of nervous system 49 97 146 Heart Diseases 247 220 467 Other circulatory diseases 25 30 55 Influenza 13 4 17 Pneumonia 45 44 89 Bronchitis 108 54 162 Other diseases of respiratory system 5 4 9 Ulcer of stomach and duodenum 17 6 23 Gastritis, enteritis & diarrhœa - 2 2 Nephritis and nephrosis 8 6 14 Hyperplasia of prostate 13 - 13 Pregnancy, childbirth and abortion - 3 3 Congenital Malformations 5 6 11 Other defined and ill defined disease ?s 59 76 135 Motor vehicle accidents 10 3 13 All other accidents 14 9 23 Suicide 5 5 10 Homicide and operations of war - l 1 795 725 1520 53 INFANTILE DEATHS IN AGES AND SEXES DURING THE YEAR 1951 CAUSE OF DEATH DAYS MONTHS 0 1 2 3 4 5 6 7- 14- 21 Total Under 4 Weeks 1 2 3 4 5 6 7 8 9 11- Total Deaths Under 1 Year Male Female Whooping Cough 1 1 1 Pneumonia and Bronchitis 1 1 1 1 4 1 1 2 8 4 4 Gastroenteritis and Diarrhoea 1 1 1 Congenital Malformation; Birth injuries Atelectasis 6 3 1 1 2 13 1 1 15 9 6 Prematurity 4 3 1 8 8 5 3 Other Causes 2 1 1 1 5 3 1 1 10 7 3 Total 13 8 2 2 -• - - 1 2 2 30 2 5 3 - - 1 - - - 2 43 26 17 54 Deaths during 1951, classified according to sex and age Age Group Male Female Total Under 1 year 26 17 43 1 year 2 1 3 2-4years 3 5 8 5-14 " - 4 4 15 - 24 " 3 4 7 25 - 34 " 12 18 30 35 - 44 " 28 26 54 45 - 54 " 70 45 115 55 - 64 " 154 89 243 65 - 74 " 234 205 440 75 - 84 " 212 223 434 85 years and up 51 88 139 Total 795 725 1,520 55 Birth-rates, Death-rates, Analysis of Mortality, Maternal Mortality and Case - rates for Certain Infectious Diseases in the year 1951 for Tottenham compared with the Registrar General's provisional figures based on Quarterly Returns England and Wales 126 County Boroughs and Great Towns (including London) 148 Smaller Towns (Resident Population 25,000- 50,000 at 1931 Census) London Administrative County Tottenham -Rates per 1,000 Home Population BIRTHS Live births 15. 5 17. 3 16.7 17.8 13.19 Still births 0.36 0.45 0.38 0.37 0.35 DEATHS All causes 12.5 13.4 12.5 13.1 11.99 Typhoid and paratyphoid 0.00 0.00 0.00 - - Whooping Cough 0.01 0.01 0.01 0.01 0.02 Diphtheria 0.00 0. 00 0.00 0.00 - Tuberculosis 0.31 0.37 0.31 0.38 0.28 Influenza 0.38 0.36 0.38 0.23 0.13 Smallpox 0.00 0.00 0.00 - - Acute polio myelitis (including polioencephalitis) 0.00 0.01 0.01 0.00 - Pneumonia 0.61 0.65 0.63 0.61 0.70 NOTIFICATIONS (CORRECTED) Typhoid fever 0.00 0.00 0.00 0.01 - Paratyphoid fever 0.02 0.03 0.02 0.01 - Meningococcal infection 0.03 0.04 0.03 0.03 0.03 Scarlet fever Whooping 1.11 1.20 1.20 1.10 1.93 Cough 3.87 3.62 4.00 3.11 3.37 Diphtheria 0.02 0.02 0.03 0.01 - Erysipelas 0.14 0.15 0.12 0.15 0.09 Smallpox 0.00 0.00 0.00 - - Measles 14. 07 13.93 14.82 14.64 10.50 Pneumonia 0.99 1.04 0.96 0.72 0.98 ACUTE POLIO MYELITIS (INCLUDING POLIOENCEPHALITIS) Paralytic Non 0.03 0.03 0.03 0.02 0.03 Paralytic 0.02 0.02 0.03 0.02 - Food poisoning 0.13 0.15 0.08 0.23 0.03 -Rates per 1,000 Live Births- DEATHS All causes under l year of age 29.6 33.9 27.6 26.4 25.70 N0TIFICATIONS (CORRECTED) -Rates per 1,000 Total (Live and Still) Births Puerperal fever and Pyrexia 10.66 13.77 8.08 14.90 2.91 Statistics of Tottenham for the last Twenty Years Year Population Deaths Death Rate Births Birth Rate Infantile Deaths Infant Death Rate Number of Cases Puerperal Fever and Puerperal Pyrexia Scarlet Fever Diphtheria Typhoid Fever Small Pox 1932 156,800 1,591 10.1 2,214 14.2 114 51.4 37 452 149 4 5 1933 154,700 1,618 10.5 2,138 13.8 118 55. 2 35 551 194 5 4 1934 152,694 1,572 10.3 2.091 13.7 108 51.6 34 628 300 1 - 1935 150,310 1,456 9.7 1,969 13.1 108 54.8 41 577 286 3 - 1936 148,600 1,600 10.8 1,931 13.0 100 51.8 37 430 227 5 - 1937 146,200 1,617 11.1 1,973 13.5 126 63.9 36 306 236 7 - 1938 144,400 1,512 10.5 1,893 13.1 89 47.0 23 186 221 - - 1939 (142,400*) 1,406 10.3 (1,776* 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 - (l,559 ) 1941 105,620 1,418 13.43 (1,560*) 14.77 61 46.35 13 103 73 4 - (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 l,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 - - 1950 129,400 1,382 10.68 1,727 13.35 41 23.74 9 356 3 - - 1951 126,800 1,520 11.99 1,673 13.19 43 25.70 5 245 - - - 57 Table of Cases of Infectious Disease coming to the knowledge of the Medical Officer of Health during the year 1951, in the Borough of Tottenham, classified according to Diseases and Ages Diseases 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 3 2 7 8 18 5 27 25 67 65 7 5 2 - 1 - _ = 1 1 - - 245 115 Measles ... 30 33 79 63 88 87 117 109 146 125 211 211 8 12 - 3 2 6 - - 1 - - - 1331 64 Whooping Cough ... 18 16 27 25 27 18 33 30 40 42 57 84 4 3 - - - 2 - - - 1 - - 427 40 Pneumonia 1 2 3 1 - 1 1 2 1 1 2 5 2 - - 2 6 4 11 3 18 14 27 18 125 33 Erysipelas ... - - - - - - - - - - - - - - - - - 1 - 1 3 2 1 4 12 3 Scabies ... - - - - - - 1 - - - 1 2 1 2 - - - 3 - 1 - 1 - - 12 - Pood Poisoning - - - - - - - - 1 1 - - - - - - 1 - - _ _ 1 - 4 - Puerperal Pyrexia - - - - - - - - - - - - - - - 1 - 4 - _ _ _ - 5 3 Meningococcal Infection - - 1 - 1 - 1 - - - - - - - - - - - - - - 1 - - 4 4 Acute Encephalitis Infective ... - - - - - - - - - - - - - - - - - - - - - - - - - - Post Infectious - - - - - - - - - - - - - - - - - - - - - - - - - Acute Poliomyelitis Paralytic ... - - - - - - - - - - 1 1 - - - - - - 1 1 - - - - 4 4 Non paralytic ... - - - - - - - - - - - - - - _ - - - - - - - - - - - Diphtheria ... - - - - - - - - - - - - - - - - - - - - - - - - - - Dysentery 2 4 3 7 5 5 7 11 6 2 12 17 5 3 - - 4 7 4 1 1 5 1 - 112 20 Ophthalmia Neonatorum ... - 1 - - - - - - - - - - - - - - - - - - - - - - 1 - Tuberculosis Pulmonary - - 4 - 5 1 3 1 2 11 8 1 2 9 11 31 37 15 5 30 4 11 1 192 - Tuberculosis, Other forms ... - - - - 1 2 - - -• - - 1 - » - 2 2 _ 1 - - - - 9 - Total 51 57 120 98 134 122 178 160 222 198 36 2 394 28 27 11 17 47 66 31 13 54 30 40 23 2483 286 58 CANCER DEATHS 1951 Classification of Deaths showing Age and Sex distribution and System Affected Total 0-4 5- 9 10 14 15-19 20-24 25-34 35-44 45-54 55-64 65-74 75-84 85 & up M F M F M F M F M F M F M F M F M F M F M F M F M F Buccal cavity and pharynx 5 1 2 3 1 Digestive Organs and Peritoneum 52 56 1 1 1 4 5 7 16 12 18 13 11 16 1 2 Respiratory system 49 5 2 1 5 20 4 18 4 Breast and Genitourinary system 21 49 1 6 4 8 12 6 17 6 8 1 1 Other and unspecified sites 9 11 1 3 1 1 4 2 4 2 1 1 Lymphatic & Haematopoietic Tissues 7 8 1 1 3 1 1 1 3 2 2 Total 143 130 1 1 1 1 5 3 12 14 13 48 34 48 34 26 25 2 5 APPENDIX MIDDLESEX COUNTY COUNCIL LOCAL AREA HEALTH COMMITTEE No. 3 (HORNSEY AND TOTTENHAM) STATISTICAL RETURN FOR THE YEAR ENDING 31ST DECEMBER 1951 JOINT POPULATION OF AREA - 225,690 59 LOCAL AREA HEALTH COMMITTEE FOR TOTTENHAM AND HORNSEY as at 31st December, 1951 Members of Tottenham Borough Council Alderman Mr. A. Reed, A.C.I.I., J.P. Alderman Mr. R H. Warren. Councillor Mr. R. W. H. Ford. Councillor The Lady Morrison. Councillor Mrs. A. F. Remington. (Vice-Chairman) Councillor Mr. G. W. Rowley. Members of Hornsey Borough Council Councillor Miss 0. R. Anderson, (Chairman) Councillor Mr. R. A, Butler, J.P. Councillor Mr. W. J. M. Crosland. Councillor Mrs. W L. Le Messurier, Councillor Miss M. Toyne. Members of Middlesex County Council County Councillor Mr. J. W. Barter, F.C.I.S., A.M.I.I.A., A.I.A.C. County Councillor Mr. M. W. Burns. County Councillor Mr. R. A. Clarke. County Councillor Mrs. K„ M. St. P. Crump. County Councillor Mrs. W. A. Kent. Nominated Members Members Nominatbd by Appropriate Hospital Management Committees Mrs. R. M. Fry. Mr. W. V. Wall, J.P. Member with Knowledge and Experience of Home Nursing Mr. A. E. Stevens. 60 Member Nominated by Royal College of Midwives Miss C. Knott, M.B.E. Member Nominated by Middlesex Local Medical Committee Dr. E. C. Girling. Member Nominated by Middlesex Local Dental Committee Mr. R. W. D. Brownlie Member Nominated by Middlesex Local Pharmaceutical Committee Mr, L. Hayward. 61 A- NATIONAL HEALTH SERVICE ACT, 19 4 6 (PART III SERVICES) CARE OF MOTHERS AND YOUNG CHILDREN (SECTION 22) Tottenham and Hornsey provide a comprehensive health service for expectant and nursing mothers and their children from birth until they enter school. Care of the Expectant Mother. The aim of this service is to promote the mental and physical well being of the mother from early pregnancy until the confinement The team of doctor, health visitor and midwife works together in all the ante-natal clinics to this end and co-operates with the general practitioner, the obstetric consultants of the Regional Hospital Boards and the hospital almoners. Through the local health service, arrangements for domiciliary confinement or the reservation of a hospital bed on medical or social grounds are made for each expectant mother, whilst antenatal examinations are carried out in one of the local clinics. This saves unnecessary travelling, frees the mother from anxiety and conserves her energy. The system of card reports on ante-nataL care and confinement which has operated successfully with the North Middlesex Hospital was at our request extended to the Clapton Mothers' Hospital during 1951. The services of a home help, if required, are available for all domiciliary confinements and, where necessary, day nursery accommodation can be provided as a temporary measure for pre school children during the mother's confinement and puerperium. In the ante-natal clinic each expectant mother has a specimen of blood taken for examination by the National Laboratory Service and appointments can be made for X-ray examination and special treatments including dental care. Ambulance conveyance from home to the clinic is arranged when it is required. 62 The health visitor sees the mother at the clinic and in her home to advise on the availability of the various services and to discuss the solution of her problems. Relaxation Classes for Expectant Mothers. These are now operating in five clinics. Instruction in three clinics is given by a health visitor and in two others by a physiotherapist. The purpose of these classes is to show the mother how to practise muscular relaxation which can be so beneficial to her in labour and conducive to natural childbirth. The classes are popular and mothers of ten return after the puerperium to receive advice on post-natal exercises. Mothercraft Classes. These are held in five clinics and are mainly for mothers who are expecting their first baby. Education in mothercraft is given by health visitors' talks and demonstrations. Discussion and guestions follow and add to the value of the classes. Tea is also provided Post-natal Care. Each mother is encouraged to visit the clinic to receive a post-natal examination by the doctor who was responsible for the ante natal care. The examination is made approximately six weeks after confinement and this is an important feature of the health service which is intended to ensure that disabilities which may result from childbirth should be remedied at once in order to prevent the impairment of the health of the mother in future years. Child Welfare Centres. The following centres are under the control of the Area Health Committee 1. Medical Centre, Lordship Lane, N.17. 2. Medical Centre, Park Lane, N.17. 3. The Chestnuts, St. Anns Road, N.15. 4. School Clinic, Cornwall Road, N.15. 5. Medical Centre, rear of Hornsey Town Hall, N„8. 6. Welfare Centre, Burgoyne Road, N.4. 7. Welfare Centre, Church Road, N.6 8. Welfare Centre, 162 Stroud Green Road, N.4. 63 9- Welfare Centre, Mildura Court, N.8. 10. Welfare Centre, Electricity Showrooms, Fortis Green, N.10. Of the above centres, Nos. l, 2, 5, 8 and 9 were especially designed for the purpose, No. 4 is a prefrabricated building, while the remaining centres have been adapted from buildings which were originally designed for quite different functions. In addition, the following school clinics are under the control of the Hornsey Divisional Executive 1. School Clinic, 41 Coldfall Avenue, N.10. 2. School Clinic, Campsbourne School, N.8. The scope of the work carried on at the above centres is shown by the following table:- Type of Clinics No. of sessions per week Dental 522 Minor Ailments 36 Infant Welfare 32 Ante-natal 205¾ Speech Therapy 18½ Physiotherapy 13 Toddlers 8 Ophthalmic 5 Aural 5 Midwives 5 Chiropody 5 Immunisation 42 Orthoptic 4 Mothercraft 5 Ante-natal Exercises 2 Orthopaedic 1 217¼ Infant Welfare Clinics. These are held in nine centres and are well attended- This reflects favourably on the work of the health visitor especially regarding the attendance of new babies. Here in addition to home visiting, the supervision of the health of babies and young children and advice to their mothers is given by health visitors and doctors specially qualified in child health. 64 The regular weighing and physical examination does much to reassure the mother regarding the normal development and progress and has probably contributed to the satisfactory condition of most young children in the Area. When the child reaches five years of age, the medical and health visiting records become available for the school medical officer when the child is medically examined as a school entrant. The progress of infant welfare has steadily advanced in the course of the years aid it is stimulating to observe the awareness of the general public and paediatric departments of hospitals. Interchange of clinic and hospital doctors and attendance of a health visitor at certain sessions has been of mutual benefit to both sections of the health service. Toddlers Clinics. Toddlers clinics were inaugurated in Tottenham in 1938 and are now operating in 8 welfare centres in the Area. Their object is to ensure the periodic physical examination of children from two to five years of age who are not regular attenders at clinics, day nurseries, nursery schools or nursery classes. All the children are seen by appointment except in a minority of cases where special advice is urgently required, Routine medical examination of children in this group is appreciated by parents who invariably write to ask for another appointment if for any reason they are unable to keep the one assigned to them. Attendance ensures early detection and correction, before the child enters school, of defects or disorders which might otherwise become more serious, Statistics. The following tables of notification of births, maternal deaths, and care of mothers and young children include figures relating to Preceding years for comparative purposes. 65 Table 1 - Notification of Births 1947 1949 19 50 1951 Live Births (a) Domiciliary 4819 3598 862 666 (b) Hospital or Nursing Home 2342 2422 Still Births (a) Domiciliary 116 74 5 9 (b) Hospital or Nursing Home 62 65 4935 3672 3261 3162 1947 1949 19 50 1951 No. of Maternal Deaths 5 - 2 5 Table 2 - Care of Mothers Ante-natal Clinics No. of Sessions Held No. of New Cases Total No. of Attendances Average Attendances Per Session A.N. P.N. A. N. P.N. Burgoyne Road 48 139 12 5 1113 125 25.8 Church Road 72 151 65 1315 65 19.2 Fortis Green 51 198 135 138 3 136 29.8 Hornsey Town Hall 205 334 156 2943 158 15.1 Mildura Court 33 79 28 677 26 21.3 Campsbourne 23 65 38 561 38 26.0 Stroud Green Road 52 134 67 941 67 19.4 The Chestnuts 2 49 539 280 3484 280 15.1 Lordship Lane 203 454 228 2901 229 15.4 Park Lane 102 346 208 1681 208 18.5 TOTALS 1951 1038 2439 1330 16999 1332 17.7 1950 1082 2594 1303 19006 1331 18.7 1949 1074 2714 1438 20617 1491 20.6 1947 1075 3822 1243 22004 1384 21.8 Separate post-natal clinics are not held. 66 Table 2 (contd) Other Women's Clinics No. of Sessions Held No. of New Cases Total No. of Attendances Average Attendance Per Session Midwives Burgoyne Road 43 9 200 4.6 Fortis Green 47 6 543 11.6 Park Lane 150 1 1267 8.4 Stroud Green Rd. 51 15 263 5.1 TOTALS 1951 291 31 2273 7.8 1950 257 26 2306 8.9 1949 182 5 1495 8.2 Table 3 - Care of Young Children Infant Welfare Centres No. of Sessions Held First Attendance Total Attendances Seen by Dr. Average Attendances Under 1 Over 1 Under 1 Over 1 Bnrgoyne Road 125 223 37 3375 1169 1315 36.0 Church Road 150 192 15 2982 1196 1332 29.2 Fortis Green 160 260 16 3651 1328 1440 31.1 Hornsey Town Hall 202 364 26 4968 2595 2988 37.4 Mildura Court 56 96 6 1946 482 696 43.4 Campsbourne 46 100 6 1252 448 542 37.0 Stroud Green Road 103 167 10 2678 1128 684 37.0 The Chestnuts 250 584 29 5899 1656 2319 30.2 Lordship Lane 2 54 454 38 6180 2016 1442 32.3 Park Lane 205 314 15 4828 1244 1377 29.6 Toddlers Sessions Burgoyne Road 23 - 36 - 373 373 16.2 Church Road 42 - 22 - 482 470 11.5 Fortis Green 22 - 28 - 286 286 13.0 Hornsey Town Hall 36 - 29 - 4 53 4 30 12.6 Mildura Court 22 - 19 - 400 345 18.2 Campsbourne 17 - 7 - 302 276 17.7 The Chestnuts 51 - 38 - 749 749 14.6 Lordship Lane 52 - 48 - 854 854 16.4 Park Lane 102 - 29 - 1092 1090 10.7 TOTALS 1951 1918 2754 453 37759 18253 19008 29.2 1950 1781 2735 290 41171 18625 18427 34.1 1949 1810 3212 1575 47009 20351 20197 37.2 1947 1478 4538 568 62906 15448 18739 46.2 67 Day Nurseries. At the beginning of 1951 there were seven nurseries in this Area, four in Hornsey and three in Tottenham, with a total accommodation for 345 children. The smallest of these nurseries (Vincent House) was in an inadequate building which was in need of much repair and was very uneconomical to run. It was decided, that, subject to the approval of the Minister of Health, the nursery should be closed and that the children attending should gradually be absorbed into the remaining nurseries. This was accomplished and the nursery was closed on 31st March 1951 The admission of children to the remaining six nurseries has been strictly controlled by a Panel of the Area Health Committee, ensuring that all children admitted into the nurseries or names placed on the waiting list come within the Middlesex County Council's rules for admission. The family circumstances of all the children accommodated in the nurseries are reviewed approximately every three months and in certain cases parents are given notice to remove their children in order that others on the waiting list might benefit from the Day Nursery Service. This has made the running of the nurseries more difficult, yet has, at the same time, given the staff the satisfaction of knowing that they have been helping families in greatest need. All six nurseries have been approved by the Ministry as train ing nurseries and this is an encouragement in maintaining a good standard of work and gives additional interest to the daily routine. The ten students who sat for their examination in 1951 were all successful and the staff of the Technical College and those in the nurseries are to be congratulated on this result. 68 Table 4 - Day Nurseries Day Nurseries Number of approved Places at end of Year No. of Children on Register at end of Year At tendances No. of days Open 0-2 Years 2-5 Years 0-2 Years 2-5 Years 0-2 Years 2-5 Years Total Ladywell 24 50 25 53 4654 10020 14674 254 Stonecroft 15 45 17 47 2923 9415 12338 254 Red Gables 23 23 22 31 3641 6235 9876 254 Vincent House (closed 31 3,51) - - - - 255 556 811 63 Park lane 20 30 21 37 3722 6475 10197 254 Lordship Lane 10 30 10 26 1942 6053 7995 254 Plevna Crescent 20 30 19 38 4730 6725 11455 254 Totals 1951 112 208 114 232 21867 45479 67346 1587 1950 122 223 90 224 20678 48170 68848 2103 1949 146 249 118 246 29036 63246 92282 2436 1947 152 252 - - 27574 62677 90251 2026 Priority Dental Service. The following table shows the work carried out by the dental officers. Table 5 - Priority Dental Service 1947 1949 1950 1951 Expectant & Nursing Mothers Children Under 5 Expect ant & Nursing Mothers Children Under 5 Expect ant & Nursing Mothers Children Under 5 Expect ant & Nursing Mothers Children Under 5 No. exam, by Dental Of 243 245 1113 698 492 842 43 879 No. ref, for Treatment 890 221 971 639 423 781 42 795 NEW Cases comm. Treatmt. 230 174 756 679 422 711 37 715 Cases made dentally fit Forms of dental Treatmt provided:- 155 211 255 559 21 462 Teeth extracted 1946 430 940 777 377 637 53 893 Anaesthetics:- (a) Local 14 - 316 141 138 122 10 196 (b) General 7 114 152 212 100 288 9 275 No. of fillings 1563 634 985 676 557 1023 35 1005 No. of root fillings - - 1 - (No„ of crowns & bridges - - - - No. of inlays 1 - - - Scaling & gum treatmt. 367 - 223 125 16 - Silver nitrate Treatmt - 843 7 828 - 944 Dressings 78 94 646 6 687 Other operations 729 475 60 4 29 198 1 94 No. of Radiographs 'a/ at C. C. Clinics 20 1 38 - - 2 lb) at Hospital - - - - - - Denture dressings 460 - 312 - 55 - Dentures fitted:- (a) Full 278 176 - 48 - 6 - (b) Partial 69 - 8 - No. of attendances 1238 768 1953 1527 1099 1702 104 1663 No. of appts not kept 748 149 326 176 16 230 No. of days devoted to service 297 212 212 69 Daily Guardian Scheme. This scheme provides for the payment to daily guardians of 1/per day for each child minded while the mother is at work. Health visitors are responsible for the visiting and recommendation of suitable women as daily guardians and for periodic visiting of children while in their care. In addition, guardians are required to take the children to the nearest welfare centre each month. At the end of 1951 there were 100 daily guardians on the register, of whom 58 were minding 64 children. The number of individual children minded during the year was 129 and they were in the care of guardians for 15,710 days, MIDWIFERY SERVICE (SECTION 23) During 1951 the number of domiciliary midwives employed in the Area was 15, and the number of cases attended averaged 44 per midwife. Midwives attend at the confinement and visit for 14 days thereafter. During the first 3 days after birth the midwife attends twice a day and for the remainder of the time she attends once daily. In addition several home visits are made to the expectant mother during pregnancy prior to attendance at the ante natal and midwives1 clinics. Two of the midwives reach retiring age during 1952 and it is not proposed to replace them as, with the present number of home confinements, the remaining 13 midwives should be sufficient for the work. Eight of the midwives are approved by the Central Midwives Board as teachers for Part II district training of pupil midwives. Pupils are attached to the midwifery teachers for 3 months and 6 pupils are in training at any one time. During this period each pupil has to take 10 cases. Under the rules of the Central Midwives Board midwives may now administer pethidine to patients if they consider it necessary. This has been welcomed by the midwives and found to be beneficial to the patients. All the midwives are qualified in the administration of gas and air analgesia which is available to mothers on request. 70 Premature babies born at home have received extra care, including provision of special clothing and hot water bottles The following table is of interest in demonstrating the decline in the domiciliary midwifery service since the inception of the National Health Service. Table 6 - Midwifery Service. Maternity cases attended by County Council Domiciliary Midwives:- 19 47 1949 1950 1951 As Midwife 2171 771 708 589 As Maternity Nurse 174 154 71 TOTALS 2171 945 862 660 Administration of Gas and Air Analgesia by County Council Domiciliary Midwives:- 1947 1949 19 50 1951 As Midwife 213 391 352 368 As Maternity Nurse 89 30 TOTALS 213 391 441 398 Medical Aid 1949 1950 1951 (a) No. of domiciliary cases in which medical aid was summoned:- (i) Where the medical practitioner had arranged to provide the patient with maternity medical service under the National Health Service 251 24 12 (ii) Others 162 166 (b) For cases in institutions - 5 13 TOTALS 251 191 191 HEALTH VISITING (SECTION 24) The work of the health visitor has enlarged its scope since the National Health Service Act came into force. This is mainly because the field work has widened to include the care of the 71 family as a whole, including the aged, instead of as previously only the care of the mother and child- Also because the health visitor's special knowledge of social conditions affecting the welfare of the family has been in greater demand by hospitals and other agencies working in the National Health Service or co operating with it. The consequent increase in the writing of reports has encroached on the health visit's time more than ever before. Each health visitor spends a proportion of her time in home visiting, health education in schools and clinics, duties in Maternity and Child Welfare Centres, School clinics and routine hygiene and medical examinations in schools. Some of these latter duties are undertaken by school and clinic nurses. Requests for talks to school girl leavers has increased and now these are given regularly each term in a number of schools in the Area, During the year members of the health visiting staff have assisted with special investigations on B. C. G„ inoculations for school leavers; the social needs of people living in large blocks of flats and the nutritional survey of anaemia in housewives. A health visitor also attends the Prince of Wales's Hospital Paediatric and Rheumatism Clinics on one half-day session per week and carries out special visits connected with applications for convalescence, admission to hospital and hospital discharges Each health visitor' is appointed to combined work of health visiting and school nursing but a proportion of routine clinic and school medical work is delegated to school and clinic nurses, so that the health visitor is enabled to devote more time to the socio-medical duties which have developed to meet present day needs. Practical health visiting experience has been provided in the Area for student fiealth visitors from Middlesex, Essex, The Royal College of Nursing and the London County Council The following table records the number of visits paid by health visitors working in this Area and shows a progressive rise over the past 3 years. 72 Table 7 - Health Visiting Service. Number of visits paid by all Health Visitors working in the Area to:- 1947 1949 1950 1951 First Visits Total Visits First Visits Total Visits First Visits Total Visits First Visits Total Visits Expectant Mothers 2648 4852 20 54 4829 1782 4562 1721 4544 Children under 1 year 4516 15331 3472 11928 2940 11386 3158 13825 Children 1-5 years 286 17225 38 15990 75 16658 27 18146 Children of school age Not Available 804 2008 4 1886 5 2367 Child Life Protection cases 72 482 37 295 3 25 - - Adoption cases - 32 47 152 3 20 - - Other persons - 2165 6 52 76 5 922 1589 1969 3253 TOTALS 40087 35967 36126 42135 No, of health visitors employed at end of 1951:- (a) Whole time on health visiting - (b) Part time on health visiting 28 (c) Equivalent whole time health visiting services provided under (b) - including attendances at clinics 17 HOME NURSING (SECTION 25) In Tottenham, the District Nursing Association continued to operate Bruce Grove Nurses Home on behalf of the County Council. Here there is accommodation for 8 resident nurses but in spite of continuous efforts throughout the year it was not possible to staff the home fully and at the end of the year the Superintendent and 5 nurses were in residence. Non-resident nurses working in Tottenham report to the Home daily for instructions. The demand for home nurses is increasing A greater number of patients receive drugs by injection, often daily, over long periods, and sometimes four-hourly for short periods, The acutely ill and the chronic sick are also attended, and as the number of old and feeble people living alone increases, so will the demand on the home nursing service expand. There are many well-qualified women living in the Area who are willing to give part-time service so that there is no real difficulty in maintaining the establishment. There is, however, 73 a serious deficiency of full-time nurses willing to work as nonresident nurses from their own homes or as resident nurses from the Bruce Grove Nurses Home, so that the burden of evening and week-end visits does fall upon the few full-time nurses employed. Table 8 - Home Nursing Service. Total Males over 14 Females over 14 M & F 14 and under Cases on register on 1.1.51 341 10 5 233 3 New cases during year 2403 774 1468 161 Cases completed during year 2295 743 1397 155 Cases remaining on register on 31.12.51 449 136 304 9 Total number of visits during 1951 62,124 " " " " " 1950 50,265 " " " " " 1949 40,076 No. of home nurses employed at end of 1951- (a) Whole time on home nursing 14 (b) Part time on home nursing 16 (c) Equivalent whole time of staff shown under (b) 10 VACCINATION AND IMMUNISATION (SECTION 26) Since compulsory vaccination ceased, and parents no longer get a letter reminding them to make an appointment with the doc to for him to call and vaccinate the baby, the percentage of vaccinated children under 1 year of age fell from 41% in 1947 to 18% in 1949. In 1951 there were signs that the percentage is improving To convince a mother of the need for vaccination is at times an absorbing task, and it has to be done with consideration and a clear explanation of the fundamental principles- Propaganda for protection against smallpox , as for diphtheria, forms a routine function of the medical and nursing staff of the area health service. 74 The following table records the number of persons known to have been vaccinated or re-vaccinated during 1951. Table 9 - Vaccinations- 1951. Under 1 year 1 to 4 years 5 to 14 years 15 years and over Total (i) No. of persons primarily vaccinated 961 147 65 191 1364 (ii) No. of persons re-vaccinated - 21 99 674 794 Immunisation against Diphtheria. The immunisation of the 6-9 month old baby has gone on steadily, and is sustained by the work done by the health visitors. "T.A.F." immunising material is used still in some clinics while "A.P.T." is used in others Schick testing has been given up entirely as a routine. 'Boosting' doses are always done with "T.A.F." and no adverse reaction has been observed, The following table records immunisations carried out by area medical staff as well as general medical practitioners during 1951. Table 10 - Immunisation - 1951- Age at Date of Notification No. of Children Immunised No. of Children Re-inforeing Injection Diphtheria Only Combined Diphtheria and Whooping Cough Whooping Cough Only Under One 1147 55 293 - One 907 51 756 — Two 111 4 144 - Three 54 1 104 4 Four 48 2 71 213 Five to Nine 47 4 25 458 Ten to Fourteen 9 _ 50 TOTAL 2323 117 1393 725 75 Whooping Cough Vaccination Trials. An intensive investigation into the value of whooping cough vaccines in this and other districts, carried out by the Medical Research Council at the request of the Ministry of Health, has shown that the disease can be prevented or modified by the use of suitably prepared vaccines. At the beginning of 1951 new trials began in Tottenham to assess the potency of various types of vaccine and the parents of children between six months and four years of age who had not already had whooping cough or been inoculated against it were invited to let their children take part in the trials. The main difference between this and earlier trials is that all children now receive a whooping cough vaccine and there is no "control" uninoculated group. The inoculations are given at infant welfare clinics by the area medical staff and the follow-up in the children's homes is done by a health visitor employed by the Medical Research Council. The trials have worked smoothly during the year and a total of 1,084 children were inoculated. The County Council has now agreed to make available free whooping cough vaccination at all immunisation clinics in the Area. This will meet the increasing demand made by the public following the interest stimulated by the local trials. PREVENTION OF ILLNESS, CARE AND AFTER-CARE (SECTION 28) (a) Recuperative Holiday Homes. During the year, area health staffs were made responsible for dealing with applications for admission to recuperative holiday homes under the above section of the National Health Service Act. The scheme covers adult patients of any age, children under 5 and children of school age attending private schools who are recommended for admission to a recuperative holiday home for a short period of rest. Applications are received from hospitals, general practitioners and voluntary organisations and involve the medical, health visiting and administrative staff. 76 The following table shows the cases dealt with up to the end of the year. 1st May, 19S1 to 31st Dec. 1951 Applications Received Admission to Recuperative Holiday Home Recommended Adults 188 184 Children 37 32 Total 225 2l6 (b) Loan of Nursing Equipment. During the year an arrangement was made for the Middlesex branch of the British Red Cross Society to operate a scheme for the loan of nursing equipment on behalf of the County Council The scheme came into force on the 1st November 1951 and nursing equipment required for patients is now obtainable from the depots in Hornsey and Tottenham. DOMESTIC HELP SERVICE (SECTION 29) This service is growing rapidly and is primarily to provide domestic help for maternity cases, when the mother has her baby at home, and to patients suffering from tuberculosis. In the latter case many women are ordered complete, or partial, "bed rest" for six or twelve months. Where there are children to care for, and a house to clean and meals to cook, the domestic help provides a vital service. In addition to the needs of the aged sick other urgent requests have to be met as far as possible. Patients are assessed to pay for the service according to their financial circumstances and in many cases no charge is made, The demand for home helps is constant and many people would like to have more help than they are given but a constant watch must be kept so that everyone, after the priority cases, gets a fair share of the available pool of workers. 77 Table 11-Domestic Help Service. Maternity T. B. Others Total 1951 Comparative Totals 1950 1949 No. of approved applications for service of home help received 166 44 643 853 925 1013 No. of new cases in which help has been provided 155 47 610 812 884 1011 No. of old cases in which help has been provided 6 83 452 531 430 372 No. of helps employed at 31.12.51. (whole time) 14 No. of helps employed at 31.12.51. (part time) 131 Equivalent No. of full time helps employed at 31.12.51. 88.5 78 B. EDUCATION ACT 194 4. SCHOOL HEALTH SERVICE Dental Service. In this area there is accommodation at present for seven dental surgeons. During 1951 the staff consisted of five, including the Area Dental Officer. Although this is insufficient for the needs of the larger school and priority population, it is an unexpected improvement on the position in 1950. Despite difficulties of staffing the service locally has not deteriorated to the extent of becoming largely occupied with emergency treatment as in many parts of the country Regular inspections in most of the schools in the Area are carried out though it is no longer possible to make an annual visit to each school as was the local custom before the introduction of the National Health Service The bulk of the time of the dental officer is spent on conservation treatment and quite a large number of orthodontic cases are treated in the clinics; the appliances for this work are made to our specifications by the technicians in the County Council's laboratory at Hendon . Conditions now obtaining have regrettably made it necessary to reduce the work previously carried out for the expectant and nursing mothers. It has been found necessary to concentrate on the pre-school and school child since it is easier for adults to obtain dental treatment under the National Health Service than it is for children During the year the County Council decided, in an effort to offset the shortage of dental officers' to inaugurate a scheme of evening work on a voluntary basis; in the first instance this is to be given a three months trial with a maximum of three sessions per dental officer to be worked per week, commencing on 1st January 1952. Tottenham Day Special School for the Deaf. This school, situated in Philip Lane, Tottenham, was established many years ago and now accommodates over 80 deaf and partially deaf 79 children, The partially deaf children are in the minority and virtually constitute a separate group as, for various reasons, it is not desirable to have both types of child in the same teaching group. The children, whose ages range from 5 16, attend daily from a very wide area of Middlesex The child who has the longest journey to make at present comes from Harrow There are still a few children in the school who live in parts of Essex and Hertfordshire. Most children who live at a distance from the school travel by coach. A number travel independently by public transport. A waiting list of Middlesex children is kept for children awaiting admission to this school and before names are added to this list there is a full consultation on the medical and educational aspects between the staffs of the two departments. The teaching of the school is by oral method, i.e. the aim is to produce speech as opposed to communication by the manual method Each year one or more pupils gain admission to the Mary Hare Grammar School for Deaf Children at Newbury by competitive examination Nursery Class for Deaf Children. Up to date the school has had two difficulties from the administrative point of view:- (i) the mixing of partially deaf with deaf children. (ii) the admission of children at varying age -levels. The latter is inevitable, owing to the possibility of the occurrence of deafness in children who have been treated for tuberculous meningitis with streptomycin; but the former could be largely obviated by the inception of a nursery class admitting children at the age of 3 years. The addition of nursery class accommodation has been accepted and building is in progress. This will mean that younger children can be admitted to the school and the partially deaf child can be identified at an earlier age and admission sought if necessary in other types of special school. It will thus be seen that the nursery class is not only highly desirable per se, but will assist in the organization of the remainder of the school, ensure the more accurate future placement of deaf and partially deaf children, and what is more important, ensure the initiation at the earliest possible age of training in speech. 80 Vale Road Day Special School for Physically Handicapped Children. This school accommodates over 80 children suffering from physical disabilities. Like the School for the Deaf, it is a day special school where children attend from all parts of North-East Middlesex and are transported by motor coach, A waiting list is kept for this school, consultation taking place between the medical and educational staffs before adding to the list. There is a school nurse attached to the school and a school medical officer visits the school at intervals during each term for routine inspection of the children. The physiotherapist from Lordship Lane Clinic attends for two sessions weekly and the speech therapist once weekly. At present, children suffering from the following defects are in attendance:- Cerabral palsy. Muscular dystrophies. Anterior poliomyelitis (effects of) Rheumatic heart disease. Congenital heart disease. Disease of bones and joints. One child who formerly attended this school owing to congenital heart disease, was successfully operated upon and now takes part in full activities at an ordinary school There is another child in the school for whom a similar result is anticipated. Handicapped Pupils-Leavers' Conference. Each term a conference is held at the school, at which the Head Teacher, the Youth Employment Officer and School Medical Officer attend to discuss the future employment of pupils who are leaving at the end of the term. This conference takes place before the Youth Employment Officer holds his usual interview with the pupil in the presence of the parent. Spastic Unit. By far the largest single group of children in attendance at Vale Road School are cases of cerebral palsy. Approval has now been given for the formation of a "spastic unit" at the school when two new classrooms are built. Recommendations for this spastic unit, the purpose of which is to increase and co-ordinate the existing medical and educational services for the ascertainment and special educational treatment of spastic children, included the following 8i additional appointments:- (i) a full time physiotherapist (ii) a part time speech therapist (iii) a male attendant and handyman Approval has also been given for the purchase of special equipment for dealing with these children. This equipment falls into two main groups (i) for the use of the physiotherapist (ii) school equipment The school equipment includes special desks and chairs, which will assist the children in sitting in the correct position, in encouraging relaxation and in controlling involuntary movement. A start is being made in the formation of this unit by ordering adjustable relaxation chairs, two typewriters (which are of considerable importance in teaching and training these children) and the construction, of wooden skis for walking instruction. The latter are being made at the Tuberculosis Workshops. Full co-operation in the provision of a spastic unit and in the selection of children suitable for admission is assured by the association with the Orthopaedic service under Mr. E.Hambly, F.R.C.S. Speech Therapy. The number of cases referred during 1951 has kept both speech therapists busy. Treatments have been mainly individual, with a few small groups for stammerers. The services of the otologist, audiometrician, educational psychologist, physiotherapist and child psychiatrist have all, at times, been valuable supplementary aids to treatment. Both parents and teachers have shown appreciation of the results obtained. The importance of speech therapy for the child suffering from cerebral palsy has become apparent from the work at Vale Road School. Audiometry Survey. Following previous experience of routine audiometry testing of the school population in Tottenham, this Area is now one of three in Middlesex in which there is being conducted a gramophone audiometry survey into the incidence and causes of deafness in school children. Miss Harper, the gramophone audiometrician, commenced her survey in 82 January, 1950. By the end of May, 1951 she had tested all the Tottenham school children aged 7 or over and in June 1951 she commenced testing the children in the Hornsey schools. Up to 3% of school children fail to pass the gramophone tests when group-testing takes place in schools, About half of these have the simpler causes of deafness, such as wax in the ears, removed at the Minor Ailments Clinic. The remaining 1-1.5% are seen by Dr. Clarke, the Aurist, at the Special Clinic for further investigation and treatment, A number of children tested early are still under treatment at his clinic as a result of the survey. Many of these children have suffered from the effects of old ear infections and Eustachian catarrh. The Audiometry Survey confirms past experience here in revealing children with minor degrees of deafness, which would otherwise have passed unnoticed, or, in certain instances the children have been regarded as backward. In some cases it is necessary to recommend that the child has a front seat in the classroom. It will thus be seen that children have been working under a handicap which might have escaped notice but for the survey, and so stresses the importance of making routine audiometry testing a permanent feature of the School Health Service Rheumatism Supervisory Centre. On August 1st 1951, a Rheumatism Supervisory Centre was inaugurated. The local practitioners were circularised and children believed to be suffering from rheumatism are now referred to the Centre at the Prince of Wales's Hospital where they are seen at a special clinic by the consultant paediatrician (Dr Ian Anderson) By special arrangement between the Borough Public Health Department and the Area Education and Health Administration, reports are obtained from (i) sanitary inspectors, (ii) health visitors and (iii) head teachers. In this way a full record of the child's clinical and environmental condition is obtained The child remains under the clinical supervision of the paediatrician and special recommendations are made to the school health service and public health departments.. There is a ward at St. Ann's Hospital for inpatient cases and the provision of a hospital school for long term cases is anticipated The integration of hospital and local authority supervision of the children is assisted by the fact that the paediatric registrar at the Prince of Wales's Hospital is employed for three sessions a week at local authority clinics and one of the assistant medical officers works at the hospital as a clinical assistant for two sessions a week. 83 Not only is the Rheumatism Supervisory Centre a means of supervision of children in the Area with rheumatism, but it serves as a consultant diagnostic centre for all cases of heart disease in school children. Application to the Minister of Health for a local order making Acute Rheumatism compulsorily notifiable will be receiving consideration. Ophthalmic Services and the Fitting of Spectacles. In 1950 the North East Metropolitan Regional Hospital Board assumed responsibility for the provision of specialists in the clinics in this Area. In November 1950 Dr. Stafford Steen was appointed Ophthalmologist for three sessions a week at the Lordship Lane Clinic which is in the Board's area. Continuing along the lines of this trend for the Regional Hospital Board to supply all specialist services, Mrs Grover, a dispensing optician, was appointed by the Hospital Management Committee to attend at the clinic for Dr. Steen's three sessions. The dispensing optician, since July 2nd, 1951, has fitted the child with spectacles after the ophthalmologist has prescribed. Prior to this, the child attended at any optician of the parents' choice. The new system is advantageous from the school health service point of view in that a complete check can now be kept on the prescription and actual date of supply of all spectacles ordered for school children The ophthalmic service continues to be a service of prime importance in the school health service for routine and special inspections, and the means whereby many otherwise unnoticed defects are brought to light, Orthoptic Treatment. At present there is a vacancy for an orthoptist at the Lordship Lane Clinic, and those children for whom the ophthalmic surgeon has recommended orthoptic exercises are attending Moorfields Hospital Out-patients Department, which is accessible from Tottenham by trolley-bus. In Hornsey the local health authority's orthoptist (Miss Marmion) was in attendance for four sessions weekly to carry out orthoptic exercises for those children recommended treatment In August 1951, Miss Marmion resigned and hence there is a vacancy for an orthoptist at Hornsey also. 84 Mass Radiography of School Children. In March 1951 the Mass Radiography Unit visited Hornsey. 961 schoolchildren (356 boys and 605 girls) attended for miniature chest films. Of these 9 (5 boys and 4 girls) were recalled for fresh films. 5 (3 boys and 2 girls) were referred to the Chest Physician. Of these 5, 2 boys were found to be fit. B.C.G. Inoculations. The Medical Research Council are conducting an investigation into the efficacy of B.C.G. inoculation in the prevention of tuberculosis. Among the groups being investigated is the "schoolleaver" group. The scheme entails the circularisation of parents of schoolleavers, explaining the objects of the scheme and asking for volunteers. In their last term but one the volunteers are tuberculintested and X-rayed The tuberculin negative reactors are divided into two groups by a statistical method, and one of the two groups is vaccinated with B.C.G. In their last term, all the children who were found to be tuber culin-negative the previous term (whether vaccinated or not) are re-tested with tuberculin and re-X-rayed Those negative to 1/3000 tuberculin are re-tested with 1/100 tuberculin All three groups (i.e. (i) those initially tuberculin-positive, (ii) those who were tuberculin negative and not vaccinated and (iii) those who were tuberculin negative and vaccinated) are being followed up by X-ray, tuberculin test and home visit for at least three years, The home visits will be twice yearly by the health visiting staff So far the response in Tottenham has been good The following figures have been provided by the Medical Research Council Anti-Tuberculosis Vaccine Clinical Trials Attendances-1951 Spring Term Summer Term Autumn Term Totals No. of School Leavers 410 350 233 993 No. of Acceptances 235 207 165 607 Percentage of Acceptances 57.3 59.0 70.8 61.1 No. attending 1st test 221 175 156 552 Total positive 74 33 56 163 Total inoculated with B. C. G. 57 54 36 147 No. of controls 73 62 42 177 85 SCHOOL HEALTH SERVICE STATISTICS FOR 1951 Table 12 - Periodic Medical Inspection. Periodic Medical Inspections Other Periodic Inspections Other Inspections Entrants Second age group Third age group Total Special Inspections Re-inspections 2, 703 1, 735 2, 250 6, 688 2, 299 5, 143 6, 2 36 Table 13-Classification of the General Conditions of Pupils. Age Groups No. of Pupils Inspected A (Good) B (Fair) C (Poor) No. % No. % No. % Entrants 2, 703 993 36.7 1,681 62 - 2 29 1.1 Second Age Group 1, 735 588 33. 9 1, 112 64 1 35 2.0 Third Age Group 2, 250 6 56 29.1 1, 552 69.0 42 1.9 Other periodic inspections 2, 299 622 27.1 1, 6 38 712 39 1.7 Total 8, 987 2, 859 3 1.8 5, 983 66 6 145 1.8 Table 14 - Defects Found by Medical Inspection. Defect or Disease Periodic Inspections Special Inspections No. of Defects No. of Defects 1. 2. 1. 2. Skin 50 12 390 17 Eyes (a) Vision 336 143 209 2 (b) Squint 25 27 23 - (c) Other 14 12 262 7 Ears (a) Hearing 22 22 87 -- (b) Otitis Media 13 15 45 1 (c) Other 10 9 203 10 Nose and Throat 137 143 302 8 Speech 23 32 45 2 Cervical Glands 4 49 57 4 Heart and Circulation 37 52 39 1 Lungs 22 78 233 2 Developmental (a) Hernia 1 1 1 - (b) Other - 11 25 10 Orthopaedic (a) Posture 52 91 11 4 (b) Flat Foot 57 77 2 - (c) Other 137 56 260 28 Nervous Systems (a) Epilepsy 1 3 2 - (b) Other 3 18 43 Psychological (a) Development - 25 97 15 (b) Stability 5 27 86 20 Other 51 128 2219 568 1. Requiring Treatment. 2, Requiring to be kept under observation but not requiring treatment. 86 Table 15-Pupils Found to Require Treatment Number of individual pupils found at periodic medical inspection to require treatment (excluding dental disease and infestation with vermin). Group For defective vision (excluding squint) For any of the other conditions recorded Total individual pupils Entrants 11 225 229 Second Age Group 91 102 185 Third Age Group 122 170 279 Total (prescribed groups) 224 497 693 Other periodic inspections 112 154 256 Grand Total 336 651 949 Table 16-Minor Ailments. (a) Diseases of the Skin (excluding uncleanlinessi Number of cases treated or under treatment during the year. by the Authority Otherwise Ringworm (i) Scalp - - (ii) Body 16 - Scabies 7 - Impetigo 68 - Other skin diseases 389 7 Total 480 7 (b) Other treatment given not covered by other Tables Number of cases treated by the Authority Otherwise (i) Miscellaneous minor ailments 3,001 140 (ii) Other (Specify)— Heart Circulation 32 25 Lungs 194 88 Psychological 144 29 Developmental 19 4 Total 3, 390 286 87 Table 17-Eye Diseases, Defective Vision and Squint. Number of cases dealt with by the Authority Otherwise External and other, excluding errors of refraction and squint 304 42 Errors of Refraction (including squint) 785 1,448 Total 1,089 1, 490 Number of pupils for whom spectacles were- (a) Prescribed 529 * 622 * (b) Obtained 502 # 613 # *Including cases dealt with under arrangements with the supplementary Ophthalmic Services. # Known to be incomplete as glasses supplied direct to patients by National Health Service Opticians. Table 18-Diseases and Defects of Ear, Nose and Throat. Number of cases treated by the Authority Otherwise Received operative treatment (a) for diseases of the ear - - (b) for adenoids and chronic tonsillitis - 196 (c) for other nose and throat conditions - - Received other forms of treatment 1,085 55 Total 1, 085 251 Table 19-Orthopaedic and Postural Defects. (a) Number treated as in-patients in hospitals * 11 (b) Number treated * by the Authority Otherwise 1,245 21 (c) Council Orthopaedic Clinics. Clinics No. of new cases No. of cases receiving treatment Total Attendances 2 1,313 2, 063 6, 658 * Not previously recorded in a return for the current year. 88 Table 20-Child Guidance and Speech Therapy. No. of pupils treated. Child Guidance Speech Therapy (i) by the Authority 55 247 (ii) Otherwise 39 3 Tahle 21-Dental Inspections and Treatment. Age Group No. inspected No. found to require treatment No. referred for treatment at the County Council's Dental Clinics (i) (ii) (iii) Under 5 * 212 114 95 6-16 and oyer 7, 908 5, 430 3, 507 Specials 4, 158 4,068 4,046 Total 12, 278 9, 612 7, 648 * Nursery Schools only. iv. Number of pupils commenced treatment 6,733 iv. Number of pupils treatment completed 5,407 v. Number of attendances made by pupils for treatment 13, 543 vi. Number of appointments not kept 2,247 vii. Number of half days devoted to (a) inspection 55 (b) treatment 1, 8 32 Total 1,887 viii. Fillings. Permanent Teeth 5, 595 Temporary Teeth 2, 296 Total 7,891 ix. Number of teeth filled. Permanent Teeth 4, 943 Temporary 2,153 Total 7, 096 x. Extractions Permanent Teet h 995 Permanent Teeth for Orthodenture 191 Total Permanent Teeth 1,186 Temporary Teeth 7,781 Total 8,967 xi. Anaesthetics (a) General 1, 507 (b) Local 3, 311 (c) Regional 391 Total 5, 209 89 xii. Other operations (a) Permanent Teeth 2, 122 (b) Temporary Teeth 4, 314 Total 6, 436 Table 21 (contd) Special Dental Treatment Undertaken by Dental Officers. Number of impressions, etc. 179 Number of Dentures fitted 41 Number of crowns and bridges 41 Number of inlays - Number of radiographs (a) at Dental Clinics 103 (b) at Hospitals - Table 22-Orthodontic Examination and Treatment Age Groups Totals 5 6 7 8 9 10 11 12 13 14 Number of pupils examined _ _ 5 5 7 6 2 3 4 _ 32 Number of pupils selected for treatment _ _ 5 5 7 6 _ 3 4 _ 30 Number of pupils commenced treatment (first attendance) 86 Number of attendances made for treatment 758 Number of consultations 9 Number of impressions, etc. 138 Number of fixed appliances fitted 28 Number of removable appliances fitted 55 Number of radiographs (a) at Dental Clinics 20 (b) at Hospitals _ Number of pupils treatment complete 20 Number of orthodontic sessions (½ days) 404 90 Table 23-Infestation with Vermin. Total number of examinations 99, 066 Total number of pupils found to be infested 1,231 Total number of individual pupils found to be infested for the first time during current year 541 Number of individual pupils in respect of whom cleansing notices were issued. (Section 54/2, Education Act 1944) _ Number of individual pupils in respect of whom cleansing orders were issued. (Section 54/3, Education Act 1944) _ Table 24 - Employment of Children and Young Persons 1. Number of children medically examined in order to ascertain whether they were physically fit to undertake employment of a light nature outside school hours. 145 2 Number of instances in which the state of health was found to be such that certificates were withheld. _ 3. Number of children examined as to fitnes to take part in entertainments. 35 4. Number of cases in which certificates to take part in entertainments were withheld. _ Table 25-Education Act 1944 - Sections 57(3), 57(4) and 57(5)- Cases dealt with under Section 57, Education Act 1944:- Sub-Section 3 10 Sub-Section 4 1 Sub-Section 5 3 Cases de-notified under Section 8, Education (Miscellaneous Provisions) Act 1948: 1 Table 26 - Medical Examination of Teachers. la) Number of Teachers examined as to fitness for appointment 54 (b) Number of Students examined as to fitness for first appointment _ 91 Return of Handicapped Pupils, year ended 31st December, 1951- CATEGORY ASCERTAINMENT DISTRIBUTION (as at last day of year) No. of ascertained Cases known 1st day of year No. of New Cases ascertained during year No. of ascertained Cases known last day of year In Special Day Schools In Special Residential Schools In Maintained Primary & Secondary Schools In Independent Schools Not at School Total B G B G B G B G B G B G B G B G B G Blind Pupils 4 5 _ 2 2 6 _ _ 2 4 _ _ _ _ _ 2 2 6 Partially-Sighted Pupils 7 12 _ 1 5 11 5 10 _ 1 _ _ _ _ _ _ 5 11 Deaf Pupils 11 6 2 _ 13 5 9 4 3 1 _ _ _ _ 1 _ 13 5 Partially Deaf Pupils 11 6 26* 35# 35 32 7 6 2 _ 23 25 _ _ 3 1 35 32 Delicate Pupils 34 28 35 25 32 23 3 5 19 13 10 5 _ _ _ _ 32 23 Diabetic Pupils _ _ _ 1 _ 1 _ _ _ _ _ 1 _ _ _ _ _ 1 Educationally sub-normal Pupils 67 49 19 10 73 51 40 34 7 _ 22 16 1 _ 3 1 73 51 Epileptic Pupils 1 7 3 _ 3 4 _ _ 2 2 1 2 _ _ _ _ 3 4 Maladjusted Pupils 62 17 13 4 64 20 _ _ 7 4 57 16 _ _ _ _ 64 20 Physically Handicapped Pupils 30 29 7 5 27 23 20 22 1 _ 1 _ _ _ 5 1 27 23 Pupils with Speech Defects 153 56 67 22 158 58 _ _ _ _ 149 54 1 _ 8 4 158 58 Pupils with Multiple Defects 4 2 6 3 8 4 3 3 1 1 2 _ _ _ 2 _ 8 4 TOTALS 384 217 178* 108# 420 238 87 84 44 26 265 119 2 - 22 9 420 238 GRAND TOTALS 601 286 658 171 70 384 2 31 658 Children not ascertained as H. P. but recommended convalescence in a Holiday Home or Camp School during Year ended 31.12,51. B G 137 126 *Includes 16 boys ascertained during the year as result of Audiometry Survey and recommended a favourable position in the class. #Includes 15 girls ascertained during the year as result of Audiometry Survey and recommended a favourable position in the class. 92 Orthoptic Treatment Number of New Cases Number of Cases receiving treatment Total Attendances 25 191 340 54 children were referred to The Royal Eye Hospital for Orthoptic treatment. Chiropody Expectant and Nursing Mothers and School Children. Expectant and Nursing Mothers BOYS GIRLS Ages 0-5 5-10 10-15 Total 0-5 5-10 10-15 Total Attendances FIRST 27 2 21 69 92 7 42 148 197 SUBSEQUENT 51 13 58 284 355 4 142 691 8 37 CONDITIONS Cases treated at Clinic Club Foot _ _ _ _ _ _ _ 1 1 Pes. Planus 5 1 2 8 11 3 11 26 40 Ulcer _ _ _ 2 2 _ _ _ _ Callosity 42 2 2 7 11 _ 3 32 35 Deviation of Great Toe 8 _ _ _ _ _ 1 2 3 Corns 49 3 12 30 45 2 11 63 76 Excessive Perspiration 1 _ _ 4 4 _ _ 4 4 Epidermophytosis _ _ _ 9 9 _ _ _ _ Valgus Feet _ _ _ _ _ _ _ 1 1 Hallux Valgus 3 _ _ _ _ _ _ 2 2 Ingrowing Bullae _ - _ _ _ _ _ 1 1 Nail, ingrowing 11 _ 1 14 15 1 1 9 11 Infected Bullae 1 _ _ _ _ _ _ 3 3 Toes, clawed 3 _ _ 1 1 _ 1 2 3 Painful Heel _ _ _ 1 1 _ _ _ _ Foot Wart 8 11 47 184 242 6 114 392 512 Rigid Great Toe 3 5 _ _ 5 _ _ _ _ Nails, Club 5 _ 6 1 7 1 1 3 5 Pain in Forefoot 13 _ _ _ _ _ _ 3 3 Metatarsa lgia 16 _ _ _ _ _ _ 3 3 Hammer Toe 3 _ _ _ _ _ _ _ _ CONDITIONS Cases referred to Orthopaedic Clinic. Pes. Planus _ _ 2 5 7 2 11 14 27 Knock Knees _ _ 1 1 2 1 5 4 10 Valgus Feet _ _ _ 1 1 _ 1 1 2 Deviation of Great Toe _ _ _ _ _ _ 1 1 2 Fractured Instep _ _ _ _ _ _ 1 1 2 93 County Council Day Special Schools. County District in which children reside No. of new recommendations received during year No. of children admitted during year No. of children on waiting list on last day of year Yale Road School for Physically Handicapped Children Tottenham 6 6 12 Hornsey 2 2 _ Hend on 3 _ 4 Enfield 1 1 2 Southgate 2 _ 2 Out-County (London County Council) _ 1 _ TOTALS 14 10 20 Tottenham School for the Deaf Tottenham 3 1 7 Hornsey 1 _ 5 Edmonton 1 _ 2 Enfield _ _ 4 Wood Green _ 1 2 Friern Barnet 1 _ 1 Southgate _ _ 2 Harrow 2 _ 2 Potters Bar 1 1 _ TOTALS 9 3 25 Rheumatism Supervisory Centre Number of children referred to the Centre:- (a) Through the school health service 14 (b) By general practitioner 31 Reason for referral:- (a) Rheumatism 23 (b) Other causes 22 Recommendations made:- (a) Special educational treatment (i) In special schools 2 (ii) In ordinary schools - (b) Normal school activities 37 Number of children admitted to hospital 5 Recommended period of convalescence before decision re schooling 1 94 Audiometry Scheme 1950-51 Children tested by Gramophone Audiometer School Population (7 or over) 20,698 (as at 31.12.51) Total tested 16,605 Absentees 429 Referred to Medical Officer at Minor Ailment Clinic 431 Referred by Medical Officer to Aurist 247 Children referred to Medical Officer at Minor Ailment Clinic Referred to Aurist 247 Cleared up without reference to Aurist 97 Waiting examination at Minor Ailment Clinic 15 Waiting further gramophone and test after attending Minor Ailment Clinic 10 Investigation incomplete (Parents unwilling, left school, left district, etc.) 62 Children seen by Aurist Already known at E.N. T. Clinic 24 Already known at Hospital Out-Patients departments:- Attending 13 Attendance ceased 37 Not previously known 144 Attending Aurist at end of year 64 Failed to complete treatment 12 Provisionally discharged by Aurist 142 Children awaiting Aurist's examination 29 95 INDEX Page Ante Natal Clinics 61, 65 Area Health Service 59 Atmospheric Pollution. 28 Audiometry Survey 81, 94 B.C.G. Inoculation 9, 84 Births and Deaths 55 Burials 45 Cancer 16, 58 Catering Establishments 17 Child Welfare Centres 62 Closet Accommodation 28 Closing Orders 31 Council, Members of 1 Daily Guardian Scheme 69 Day Nurseries 67 Deaf, School for 78 Deaths 52 Demolition Orders 31 Dental Service Priority 68 " " School 78, 88 Diphtheria 10 Diphtheria Immunisation 74 Disinfection 16 Disinfestation 37 Domestic Help Service 76 Drainage and Sewerage 28 Dysentery 14 Expectant Mothers, Care of 61 Factories 38 Food-Condemned 22 Hygiene 17 Poisoning 15 Preservation 20 Sampling 24 Hawkers 21 Health and Housing Committee 2 96 Page Health Visiting 70 Holiday Homes 75 Home Nursing 72 Horses, Slaughter of 21 Housing 28 Housing Act, 1936, S.9 29 Housing Act, 1936, S. 11 30 Housing Act, 1936, Part III 32 Ice Cream 19 Immunisation, Diphtheria 74 Infant Welfare Clinics 63 Infantile Deaths 53 Infectious Diseases 5 Influenza 15 Knackers' Yards 21 Laboratory Service 43 Legal Proceedings 25, 30,33 Massage and Special Treatment Establishments 45 Maternal Deaths 50 Measles 11 Medical Examination prior to staff appointments 43 Metropolitan Water Board 26 Midwifery Service 69 Milk and Dairies 18 Mothers and Young Children, Care of 61 National Assistance Act, 1948, S. 47 45 National Assistance Act, 1948, S. 50 45 National Health Service Act, 1946: Part III Services 61 Notices Served 35 Nursing, Home 72 Loan of Equipment 76 Ophthalmic Services 83 Orthoptic Treatment 83,92 Outworkers 39 Persons in need of Care and Attention 44 Pet Animals Act, 1951 46 97 Page Physically Handicapped Children, Special School 80,91 Poliomyelitis 14 Preserved Foods 20 Public Health Act, Part III 32 Public Health Department, Staff 2 Puerperal Pyrexia 14 Rag Flock and other Filling Materials Act, 1951 46 Repairs in Default 29, 36 Rheumatism, Acute 15 Rodent Control 34 Sanitary Inspectors, Summary of Inspections 34 Scarlet Fever 9 School Health Service 78 School Health Service Statistics 85 Sewerage and Drainage 28 Shops 40 Slaughterhouses 21 Spastic Unit 80 Speech Therapy 81 Statistical Summary 49 Toddler Clinics 64 Tuberculosis 6 Vaccination and Immunisation 73 Water Supply 26 Whooping Cough 11 Whooping Cough Vaccination Trials 11 Winter Epidemics 15 Work in Default 29, 36