439(1)TOTTEN HAM TOT27 TOTTENHAM'S HEALTH 1952 The Annual Report of the Medical Officer of Health. Borough of Tottenham. TOTTENHAM'S HEALTH 1952 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, Ladies and Gentlemen, I have the honour to present my Annual Report on the health of the Borough and the work of the Public Health Department for the year ended the 31st December, 1952. The Statistics as shown in this Report help us to assess past progress and promote future endeavour in a changing pattern of health and disease. The birth rate of 13.24 though lower than the national figure 15.3 (per thousand population) continues, as it has done in the past three years, to show a stabilising trend towards the level noted before the last World War. The infantile death rate fell to 20.41 per thousand live births, the lowest ever recorded in this Borough. The general death rate showed a slight fall, as spread over the whole year, from 11.99 to 11.25 per thousand of the population. There was, however, a sharp rise in the last quarter of the year of deaths among elderly people, in particular, and associated with the toxic effects of one of the severest fogs experienced in the Greater London area. The main causes of death otherwise were cancer, coronary disease, and other cardio-vascular conditions. Deaths from Cancer numbered 271 (158 males, 113 females). This showed a rise over the previous year of 19 in the number of males, the increase reflecting deaths from cancer of the lungs. Coronary disease again showed an upward trend, 180 deaths (107 males, 73 females) from this cause. Deaths from heart disease numbered 422 (214 males, 208 females showing a decrease on the figure of 467 for the previous year. Deaths from tuberculosis were the lowest (28) ever recorded in the Borough, though there was no diminution in the number of new cases notified to the Department. Control of infectious disease continued to be satisfactory. No confirmed case of Diphtheria was notified during the year, and no death has occurred from this disease during the past seven years. The number of notified cases of scarlet fever was above the average but infection was of a mild character and no deaths were recorded. An epidemic of measles occurred during the year but the nature of the illness gave no cause for alarm and no deaths following an attack of measles were recorded. Other infectious diseases notified during the year such as food-poisonini (9) and poliomyelitis (8) called for careful investigation and prompt action by the public health department. The tables shown in Part III of this Report give a clear picture of the progress made in the improvement of housing conditions including the welcome resumption of "clearance area" procedure; and vigorous action to secure the repair of unfit and insanitary houses under sections 9 and 10 of the Housing Act, 1936. The Tottenham Corporation Act, 1952 will give additional powers to the health department in accelerating procedure for the remedy of urgent sanitary defects. Also new powers in combating atmospheric pollution including the setting up of certain specified areas as "smokeless zones". Special consideration has been given during the year to the subject of occupational health. A pilot survey of occupational needs in factory premises has been carried out in active cooperation with the Tottenham Chamber of Commerce and the management of firms concerned. Its finding are included in the body of this Report. Mention too is made of the growth of the work of the Old Peoples' Welfare Committee and its close link with the functions of the Health Committee in relation to the local operation of sections of the National Assistance Acts. Again I take this opportunity of warmly thanking all members of the Health Department for their excellent work during the year. To the Chairman (Alderman R.H, Warren) and members of the Health and Housing Committee I wish to express my appreciation of their helpful support in a service of expanding functions and interest. I am, Your obedient Servant, G. HAMILTON HOGBEN, Medical Officer of Health. 1st September, 1953- 1 MEMBERS OF THE COUNCIL Councillor K.A.E. Gregg, J. P. MAYOR Alderman The Rt. Hon. The Lord Morrison, P.C., D.L., J.P. DEPUTY MAYOR Alderman E.J. Field Alderman J.J. Pagin " W.S. Herbert " A. Reed, A. C. 1.1., J. P. " Mrs. M. C. Irving " A. R. Turner " Mrs. A. Kitchener " H. W. Turner Mrs. J. D. Lynch " R.H. Warren Councillor F. G. Bohringer Councillor Mrs. F.C. Ilsley " E. Brown " F. A. F. Keay, J. P. J.W.H. Brown " S.E. Kemp " E.J.J. Carter " H. Langer " A.W. Catley " Mrs. A. A. Miller " A. Clark " The Lady Morrison " Douglas Clark " I.L. Peirce " P.F. Collins " A. A. Pawson " E.J. Clook " P. Readings " C.H. Colyer " Mrs. A.P. Remington " A.J. Davies " W. T. Richards " T.A. Dutton " T. A. Riley R.W.H. Ford " P.H. Roberts Mrs. F.E. Haynes " G. W. Rowley " Mrs. M.W. Holland " A. E. Soall " J.W. Hollingsworth " C. Wise Town Clerk: M. Lindsay Taylor, LL. B. 2 HEALTH AND HOUSING COMMITTEE Alderman R.H. Warren Chairman His Worshipful The Mayor, Councillor K.A. E. Gregg, J.P. The Deputy Mayor, Alderman The Rt. Hon. The Lord Morrison, P.C., D.L., J. P. (ex-offico members) Alderman A. Reed, A.C. 1.1. J. P. Alderman A. R. Turner Councillor P.G. Bohringer Councillor The Lady Morrison " J.W.H. Brown " Mrs. A.F. Remington " E.J. Clook " T. A. Riley " R. W. H. Ford " P.H. Roberts " Mrs. M.W. Holland " G.W. Rowley Councillor A. E. Soall METROLPOLITAN WATER BOARD Council's representive - Alderman E. J. Field STAFF OF THE PUBLIC HEALTH DEPARTMENT Medical Officer of Health G. Hamilton Hogben, M.R.C.S., D.P.H. Deputy Medical Officer of Health F. Summers, M.B., B.S., D.P.H. (Commenced 1/12/1952) Chief Sanitary Inspector E.T.Jenkins, F.S.I.A. Chief Clerk 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) L.J. Kerridge (a) (b) A.E. Clarke (a) (b) (c) (d) E. Kipping (a) (b) D.R. Howe (a) G.W. Maidlow (a) (b) C.J. Johnson (a) (b) W. Openshaw (a) W.P. Kent (a) (b) 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: D.J. McLintic, B.Com., (Senior General) Clerk: Housing) C.J. Lemon F,K52 Parter C. S. Clark Mrs. C. E. Moody Mrs. E.D. Whittle R. Hull Miss J. Whillock (Commenced 26/11/52) Outside Staff Foreman S.H. Reid Disinfectors: Apparatus Disinfecting Attendants W. Butcher Van Driver E.E. Mann ell A. Dowse Drain Testers A.E. Crow A.E. Moon F. T. Dowse Rodent R.E. Hobbs Operatives J. Lawrence B. Joscelyn G.W. Percival F.J. Slater Labourer A. Ferridge R. C. Wilson 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, 1952 125,800 Pre-War Population 144,400 Approximate Number of Dwellings in District 29,277 Rateable Value of District at 1st April, 1952 £1,018,284 Sum Represented by Penny Rate at 1st April, 1952 £4,000 Live Births - Legitimate 1,589 1,666 Illegitimate 77 Birth Rate (per 1,000 population) 13. 24 Still Births 36 Deaths 1,415 Death Bate (per 1,000 population) 11. 25 Infantile death rate (per 1,000 live births) 20. 41 Maternal death rate (per 1,000 live and still-births) 1.175 Comparability Factors - Deaths 1.06 Births 0.93 (note: Detailed vital statistics appear on pages 64 to 76 in the Statistical Summary). 5 CONTENTS page Part I Control of Disease 6 " II Food Control 19 " III Sanitary Circumstances of the Area 27 " IV Factories and Shops 41 " V General 58 " VI Statistical Summary 64 Appendix Statistical Return of the Work of the Local Area Health Committee No. 3 of The Middlesex County Council 77 6 PART I CONTROL OF DISEASE The present century has seen a reduction in the incidence of many infectious diseases and in the case of some, such as smallpox, typhoid fever and diphtheria, an almost complete disappearance. The occurrence however of small epidemics of these diseases points to the need for the public health services to be ever mindful of a possible outbreak and to keep before the public the known means for protection against them. Other infectious diseases such as food-poisoning and poliomyelitis have shown an increase in recent years; calling for prompt recognition and action by the public health department. Many non-infectious diseases also appear to be on the increase particularly cancer and such "stress" diseases as peptic ulcer, coronary thrombosis and psychoneurosis. The actual increase is difficult to assess as none of them is notifiable and mortality figures alone cannot give a true picture of their incidence. The underlying cause of the "stress" diseases is not fully understood but lies within the social and working environment of the individual. Control necessitates study of the social and economic environment''as well as the physical. Tuberculosis The Public Health (Tuberculosis) Regulations, 1952, came into force on the 1st May, 1952, replacing those made in 1932. The statutory obligation for the Medical Officer of Health to keep a 7 tuberculosis register was removed but in the accompanying Ministry circular the hope was expressed that the register would continue to be maintained. As the requirements for the notification of the transfer of cases from one district to another was removed at the same time, it seemed unlikely at first that an accurate register could be maintained. Medical Officers of Health generally have continued to exchange information on cases and, in Tottenham, the Chest Physician (Dr. T. A. C. McQuiston) continues to co-operate fully so that there has been little change in the information reaching the Department, ensuring that an approximately accurate register remains. The principal diffulty experienced continues to be in respect of those cases who fail to maintain contact with the Chest Clinic. These may move from the district or may die from a cause other than tuberculosis without the information coming to the notice of the department. For this reason a review is made periodically of the register and in all cases where no recent entry is recorded the name is checked against the register of electors. Where it is found that the person is no longer registered, the Chest Clinic is notified and the register corrected. In this way 102 cases were removed from the register during 1952. The number of cases on the register continues to rise. At the 31st December there were 1,682 (1,503 pulmonary and 179 nonpulmonary) which represented an increase of 87 on the previous year. There were 179 new cases of tuberculosis notified in 1952, 163 being pulmonary cases, compared with 201, 192 of which were pulmonary cases in 1951. 8 Distribution of New Tuberculosis Cases notified during 1952 Age Periods New Cases Deaths Pulmonary Non-pulmonary Pulmonary Non-Pulmonary Male Female Male Female Male Female Male Female Under 1 Year - 1 - - - - - - 1 to 4 Years 1 5 1 - - - - - 5 to 9 " - 3 1 1 - - - - 10 to 14 " 2 3 2 - - - - - 15 to 19 „ 7 10 1 - - - - - 20 to 24 „ 10 18 3 2 - - - - 25 to 29 " 14 12 - - - - - - 30 to 34 " 13 6 1 1 1 - - - 35 to 39 " 9 5 - 2 3 - - - 40 to 44 " 3 2 - - 1 1 - 45 to 49 " 7 2 - 1 2 - - - 50 to 54 „ 6 - - - 1 - - - 55 to 59 „ 7 1 - - 5 - - - 60 to 64 " 8 - - - 5 - 1 - 65 to 69 " 3 - - - 4 - 1 - 70 to 74 " 3 1 - - - - - - 75 years and over 1 - - - 1 1 1 " Total 94 69 9 7 23 2 3 - The following is an analysis of new cases of non-pulmonary tuberculosis notified during 1952:- Male Female Total Peritoneum - 1 1 Genito-urinary system 2 1 3 Sternum - 1 - 1 Meninges 1 1 2 Spine 2 2 4 Glands 1 2 3 Hip 2 - 2 9 7 l6 9 Ward Distribution of Cases of Tuberculosis on the Register at 31st December, 1952. Ward Est imated Population Male Female Total Rate per 1,000 populat ion Pulmonary NonPulmonary Pulmonary NonPulmonary White Hart Lane 12,211 123 7 119 12 261 21.4 Park 11,799 80 19 73 15 187 15.8 Coleraine 12,021 52 7 55 2 116 9.7 West Green 11,665 58 8 60 11 137 11.5 Bruce Grove & Central 11,311 71 5 45 3 124 10.9 High Cross & Stoneleigh 11,137 77 12 56 8 153 13.7 Green Lanes 11,179 77 7 61 5 150 13.4 Chestnuts 11,556 65 5 49 10 129 11.2 Seven Sisters 10,678 80 8 52 7 147 13.8 Town Hall 11,175 75 5 50 12 142 12.7 Stanford Hill 11,068 80 4 45 7 136 12.3 Total 125,800 838 87 665 92 1,682 13.4 Note: To obtain the estimated population for each ward, the Registrar General's 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. Mass Radiography In 1952 Mass Radiography Unit No. 6A of the North East Regional Hospital Board visited Tottenham and conducted a general survey in the Borough. The unit was set up at the Territorial Drill Hall and in addition to sessions for organised groups from factories, schools etc., many sessions were arranged for the general public. With the co-operation of the Corporation's Public Relations Officer the visit was widely publicised and the response of the public was most gratifying. Altogether 15,582 Persons were X-rayed and I am indebted to Dr. Hugh Ramsey, the Medical Director of the Unit, for the following analysis of the Survey, namely:- Total number X-rayed 15,582 Recalled for large film 591 10 Pinal Analysis of Figures Groups Male Female Total Schoolchildren No. of miniature films 941 710 1651 No. of large films 19 7 26 School Staffs No.- of miniature films 18 30 48 No. of large films 1 1 2 Organised Groups (including local factories) No. of miniature films 6,329 4,223 10,552 No. of large films 252 118 370 Public Sessions No. of miniature films 1,303 2,028 3,331 No. of large films 87 106 193 Cases of Pulmonary Tuberculosis found Active primary 1 - 1 Active post primary IS 11 26 Inactive primary 98 55 153 Inactive post primary 103 61 164 Pleural effusion (refused to attend clinic) - a 1 Among interesting abnormalities discovered Bronchiectasis 6 2 8 Pulmonary fibrosis 25 5 30 Cardiovascular lesions (acquired) 22 37 59 Cardiovascular lesions (congenital) 3 3 6 Diaphragmatic hernia 1 - 1 Transposition of Viscera - 1 1 Pneumokoniosis 2 - 2 Pneumotocoele 1 - 1 Calcified aortic aneurysm - l 1 Cystic disease R. upper lobe - 1 1 Sarcoidosis 1 1 2 Carcinoma of bronchus 2 1 3 Neoplasm - 1 l 11 The cases of active pulmonary tuberculosis were discovered in the following groups:- Male Female Total Organised Groups (active post primary) 7 9 & 1 pleural 16 & 1 effusion Public Sessions (active post primary) 8 2 10 Schoolchildren (active primary) 1 1 B.C.G. Inoculation A unit of the Medical Research Council continued their investigations and the scheme for B.C.G. inoculation of the volunteer school leavers at the Lordship Lane Medical Centre, Tottenham. Follow-up of the children after leaving school was carried out by health visitors. (Details of this service are set out in the appendix under the work of the Area Health Committee - page 100 ). Diphtheria During 1952 there was not a single confirmed case of Diphtheria, and it is over 7 years since the last death occurred from this disease. 12 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, 1; Tonsillitis, 10; Tonsillar Abscess, 1. Diphtheria immunisation facilities are provided at all the health centres under the control of the local County Area Health Committee and arrangements have also been agreed between the majority of general practitioners and the County Council for the family doctor to give the injections. The following table shows the number of children of each age group who have had a complete course of injections:- 12 Number of Children at 31.12.52. who had completed a course of immunisation at any time before that date Age at 31. 12. 52. i.e. Born in year Under 1 1952 1 1951 2 1950 3 1949 4 1948 5 1947 6 1946 7 1945 8 1944 9 1943 10 1942 11 1941 12 1940 13 1939 14 1938 Number Immunised 141 825 1025 1219 1492 1889 1730 1469 1674 1426 1448 1101 1056 1198 1381 Group Totals 4.702 8, 188 6. 184 Grand Total 19.074 Scarlet Fever The number of cases of scarlet fever notified during 1952 was above the average. The total of 356 cases exceeded the previous year's figure by 111, However, the illness continued to be mild in character, and no deaths were attributed to the disease. 158 confirmed cases were admitted to hospital, The diagnosis in 36 other cases admitted as suffering from scarlet fever was amended as follows:- Bronchitis, 2; Broncho-Pneumonia, 1; Catarrhal Sore Throat, 1; Chickenpox, 2; Crystalluria, 1; Enteritis, 1; Erythema, 2; Measles, 4; Meningococcal Meningitis, 1; Mumps, 1; Osteomyelitis 1; Otitis Media, 1; Rubella, 10; Tonsillitis, 6; No obvious disease, 2. 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 129 15.9 34 10.6 Other Hospitals 29 20.9 2 13.0 13 14 Measles There were 1739 cases of measles notified during 1952, the highest figure recorded for the Borough since the disease was made notifiable in 1940. This reflects the increased susceptible child population resulting from the high birth rate at the end of the war. As the principal sufferers of this disease are 5 year old children and the birth rate reached its peak five years ago it is to be expected that future years will see a diminution in the number of cases notified. Ninety cases of measles with complications were removed to hospital and the average length of stay in hospital was just over 15 days. No death was attributed to this disease. 15 Whooping Cough During the year 139 notifications of this disease were received. In the case of one baby girl aged 10 months the illness proved fatal. Free whooping cough vaccination is available at all County Council immunisation clinics. Further details on this subject will be found in my report as Area Medical Officer which is printed as an appendix to this report. (See page 93). Whooping Cough - Age and Sex Distribution 16 Poliomyelitis 8 cases of poliomyelitis were confirmed during 1952, and in seven there was associated paralysis. In two cases the disease was of a mild character and was only discovered when they attended hospital as out-patients with "stiffness in the limbs". In one case there was a history of an inoculation about two weeks before the commencement of the illness. Details of Cases of Poliomyelitis during 1952 Date of Notification Date of Commencement Illness Sex Age (Years) Site of Paralysis Recent History of Inoculations 4. 2. 52 30. 12. 51 (Approx). F 18 Right shoulder Nil 5. 8. 52 30.7. 52 F 5½ Left shoulder and arm some weakness in right arm Inoculated 11.7. 52 15.8. 52 12. 8. 52 F 5 Left hand and right leg Nil 18.8.52 15.8.52 F 5 Non-paralytic Nil 1. 9. 52 24. 8. 52 M 14 Left leg Nil 25.9. 52 14. 9. 52 M 2 Legs Nil 13.10. 52 10. 10. 52 F 25 Left arm and both legs Nil 1. 11. 52 Mid. Oct.52 (Approx) M 55 Right arm Nil Puerperal Pyrexia Only one case of puerperal pyrexia was notified during 1952. Dysentery II During the year there were nine confirmed cases of sonne dysentery, six of which were treated in hospital. Paratyphoid Fever Three cases of paratyphoid "B" were notified during 1952. All three cases occurred amongst Army Cadets after a period of training at camp at the beginning of August. Upon examination of faeces specimens from the remainder of the cadets who were at the camp, a fourth Tottenham boy was found to be infected. All 4 boys were treated in hospital. 17 Food Poisoning There were nine notified cases of food poisoning during 1952. The cases were scattered and seven occurred in the third quarter of the year and the remaining two in the second quarter. Four cases were confirmed as salmonella infections but in the remainder no organism was isolated. In one case a duck egg which was implicated was traced back to a farm in a nearby district. It was subsequently learned that the Medical Officer of Health of the district had traced 2 other cases connected with the consumption of duck eggs from the same farm. Cancer of the Lung In 1952 there were 57 deaths in the Borough from this disease. Of these 46 were males as against 11 females. There is some evidence to show that there is a relationship between smoking and cancer of the lung but the exact nature of this relationship is as yet unknown. In any case many years of tobacco smoking are believed necessary before the responsible factor can give rise to the disease. This might explain the higher incidence of cancer of the lung amongst men; but in view of increased smoking in recent years amongst women the incidence of cancer of the lung amongst females may be expected to rise in the course of years. Deaths from Cancer of the Lung - 1952 18 Coronary Disease This affection of the heart has shown a steady rise over the past few years. Whilst some of the increase may result from improved diagnosis it is certain that there is a real increase in the incidence of the disease. The following chart of deaths from coronary disease in Tottenham in 1952 shows a preponderance of males. Too much reliability cannot be placed on the age distribution figures. Death may not occur for a number of years after an initial attack. Diagnosis is sometimes made only in the post-mortem room after death has occurred from some intercurrent disease. Deaths from Coronary Disease PART I I FOOD CONTROL During the year the Health Department has paid particular attention to the needs of Health Education in all matters concerning food hygiene, and talks and demonstrations have been arranged with various organisations in the Borough. Of first importance is the routine work of the sanitary inspector in his supervision of food establishments, which brings him into direct contact with the management and the food handler. The value of such practical work on the spot is becoming increasingly evident in this Borough. Food Premises Systematic visits are made to all food establishments in the Borough and inspections are made to ensure that a good general standard is maintained in the premises. Co-operation with the local office of the Ministry of Food enables the Department to ensure that new food premises are satisfactory at the outset. During the year improvements have been noticeable in wet fish shops and competition has served to eliminate some of the less desirable premises. All catering establishments have been regularly visited and notable improvements in some of the premises have taken place. Milk and Dairies On the ist October, 1951, a Ministry of Food Order came into force specifying that all milk sold by retail within the Greater 19 20 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 1952, namely:- Milk (Special Designation) (Pasteurised and Sterilised Milk) Regulations, 1949 Dealers' Licences - "Pasteurised" 65 Dealers' Licences - "Sterilised" 145 Dealers' Supplementary Licences - "Pasteurised" 14 Dealers' Supplementary Licences - "Sterilised" 16 Milk (Special Designation) (Raw Milk) Regulations, 1949 Dealers' Licences - "Tuberculin Tested" 34 Dealers' Licences - "Accredited" 3 Dealers' Supplementary Licences - "Tuberculin Tested" 14 Dealers' Supplementary Licences - "Accredited" 1 During the year 22 applications for registration as milk distributors were dealt with. No applications were received in respect of dairies. Of the 22 new registrations 18 were for new premises and the other 4 were in respect of the change of proprietorship of previously registered premises. The sale of milk from 3 premises was discontinued during the year. The number of premises and distributors registered at 31st December, 1952, was as follows:- Number of Distributors registered . 153 Number of Dairies registered 11 The Middlesex County Council is the licensing authority for premises at which milk is processed. Ice Cream More and more ice cream is now being sold as a pre-packed article. During recent months two large manufacturers have ceased production altogether. One other manufacturer devotes almost the whole of his plant to the production of ice lollies. The following ice cream premises were registered in accordance with Section 14 of the Food and Drugs Act, 1938, during 21 1952, namely:- Sale only 29 Manufacture and Sale 0 Total 29 5 premises which ceased to be used for the sale of ice cream were removed from the register. In one case registration was refused. The total number of premises on the register at 31st December, 1952 was as follows:- Sale only 261 Manufacture and Sale 34 Storage 2 Total 297 Samples of Ice Cream submitted for Bacteriological Examination Results Total Grade 1 Grade 2 Grade 3 Grade 4 Samples of ice cream produced in Tottenham. 13 1 1 — 15 Samples of ice cream produced outside of Tottenham. 40 3 1 - 44 Total 53 4 2 -- 59 Preserved Foods 110 premises used in connection with the manufacture and/or preparation of preserved foods are registered under Section 14 of the Food and Drugs Act, 1938. During the year 9 new registrations were made. One registration was cancelled when it was found that the business had been discontinued. The following is a summary of the processes carried on at the registered premises, namely:- 22 Cooking of Hams and other Meats 39 Fish Frying 12 Sausage Manufacture 55 Preparation of Jellied Eels 2 Boiling Shell Fish 2 Total 110 Middlesex County Council Act, 1950: Section 11 Registration of Hawkers Section 11 of the Middlesex County Council Act,1950, requires the registration of all food hawkers and their storage premises. 10 new applications were investigated by the sanitary inspectors in 1952 and found to be satisfactory. 14 registrations were cancelled where it was found that the businesses had been discontinued The following is a summary of the registered hawkers and their storage premises at the 31st December, 1952:- Articles Number of persons registered for sale Number of registered storage premises Fruit and Vegetables 110 106 Shell Fish 14 9 Fish 7 7 Ice Cream 2 2 Peanuts 2 2 Light Refreshments (Mobile Canteen) 2 2 Total 137 128 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 five years is as follows:- 1948 1949 1950 1951 1952 3,189 2,889 2,750 2,856 2,454 23 Another section of the premises is licensed as a knacker's yard and during 1952, 2,442 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 Apple Pulp 6 Greens 21 Plums 1. 046 Apple Puree 3 Hams 371 Pork Brawn 4 Apple and Blackcurrant 1 Ham Loaf 2 Potted Meat 18 Apples 139 Hearts 1 Prunes 226 Apricot Pulp 114 Herring Roes 12 Raspberries 50 Apricots 62 Herrings 12 Rhubarb 8 Baby Pood 83 Irish Stew 10 Rhubarb Pudding 18 Beans 391 Jam 96 Roes 1 Beetroot 19 Kidneys 7 Salmon 62 Blackberries 84 Lobster 11 Sardines 116 Blackcurrants 49 Loganberries 2 Sausages 23 Br awn 7 Luncheon Meat 702 Silds 5 Brislings 32 Macaroni 18 Soup 177 Broth 5 Macedoine 2 Soup Powder 11 Carrots 31 Marmalade 11 Spaghetti 38 Celery Hearts 2 Milk 1, 279 Spinach 8 Cherries 416 Minced Beef Loaf 128 Steak Pudding 1 Chicken 33 Oranges 122 Stewed Steak 205 Christmas Pudding 5 Orange Juice 34 Strawberries 69 Corned Beef Hash 1 Parsnips 19 Tomato Juice 7 Crabmeat 12 Peaches 48 Tomatoes 529 Damsons 80 Peach Pulp 22 Tomato Paste 9 Fruit Salad 91 Pears 386 Tomato Pulp 2 Gherkins 11 Peas 963 Tomato Puree 105 Gooseberries 32 Pease Pudding 2 Tongue 15 Grapefruit 29 Pilchards 84 Tunny Pish 1 Grapefruit Juice 18 Pineapple 122 Veal 83 Grapes 13 Pineapple Jelly 1 Veal and Ham Loaf 9 Grape Juice 103 Pineapple Juice 9 Veal, Pork and Beef Loaf 3 Greengages 100 Pineapple Pulp 2 Veal Loaf 31 Vegetables, Mixed 58 24 Other articles of food condemned were as follows Apricots 1 jar Macaroons 199 Apricots, Dried 554-lbs. Marmalade 1 jar Beef 1,301- lbs. 10 oz. Matzos 1 pkt. Biscuits 97ft-lbs. Milk Chocolate Crunch 4—lbs. Butter 2-lbs. Milk Chocolate Tea Cakes 519 Cake 68-lbs. Mutton 312½- lbs. Cake Mixture 3 pkts. Noodles 8 oz. Cashew Nuts 1-lb. 3oz. Oats 6ft-lbs. Cheese 231bs. 4 oz. Orange Juice 2,920 gallons Cheese Spread 7 boxes Pastry Mixture 12 oz. Chocolate 40 lbs. 6oz. Peaches 16 jars Chocolates 5-lbs. Peanuts 4-lbs. Chocolate Caramels 8-lbs. Pears 185 jars Christmas Pudding 2-lbs. Piccalilli 10 jars Cocoa 2-lbs. Pickles 7 jars Cod 9 stone Pigs' Heads 13-1bs. Cod Roes 9 stone Pigs' Maw 70-lbs. Coffee 7½-lbs. Pineapple 1 jar Conger Eel 6 stone Pork 96½ lbs. Desiccated Coconut 2-lbs. Prunes 3,172½ lbs Dogfish 5½ stone Pudding Mixture 8 pkts. Eggs 260 Puffed Wheat 8 oz. Pigs 11-lbs. 4oz. Rice Mb. Flour 48-lbs. Rock Ee 1 9 stone 3 lbs. Fruit Cocktail 1 jar Rock Salmon 3 stone Fruit Pastilles 4ft lbs. Salad Cream 39 jars Haddock 10 stone Sandwich Spread 1 jar Ham 27½-lbs. Sausages 1½-lbs. Hearts 103ft-lbs Semolina 6-lbs. Horseradish Cream 1 jar Skate 15 stone Ice Cream Cones 2,700 Sponge Mixture 10 pkts. Jam 31 jars Tapioca 3-lbs. Lamb 45-lbs. 4 oz. Tomato Ketchup 1 bottle Lemon Squash 1 bottle Tongue 8½- lbs. Liver 118-lbs. Veal 4-lbs. Lollies 10 Vitawheat' 2 Pkts. Macaroni 10 lbs. Walnuts 102-lbs. Whiting 8 stone 25 Legal Proceedings Legal proceedings were taken in 3 cases in respect of contaminated foods, namely:- (1) Paper in Bread. Defendants pleaded guilty and were fined £2.0.0. with £1.1.0. costs. (2) Ants in Sponge Cake. Defendants pleaded guilty and were discharged absolutely on the payment of £3.3.0. costs. (3) Cockroach in Bread. Defendants pleaded guilty and, in view of the fact that it was a first offence, the justices granted an absolute discharge on the payment of £2.2.0. costs. Food Sampling v The Public Control Department of the Middlesex County Council has supplied the following information of food and drugs sampling in the Borough during 1952:- FOOD AND DRUGS ACTS, 1938 - 1950 Lists of samples procured in the Borough of Tottenham during the year 1952 Article Total samples procured Unsatisfactory Milk (Various) 172 3 Beer 1 — Cakes 26 — Cheese 1 — Cinnamon 1 _ Cooked Meats 7 - Curry Powder 1 — Drugs 21 5 Pish 17 - Fish Paste 1 - Flour 1 - carried forward 249 8 26 Article Total samples procured Unsatisfactory brought forward 249 8 Ice Cream 4 - Jams 3 - Jelly 7 - Meat Paste 2 - Meat Pie 7 - Mincement 3 - Non-Brewed Condiment 1 - Pickled Herrings in Wine Sauce 1 1 Salad Cream 2 - Sausages 26 - Soup (Tinned) 1 - Sweets 1 - Tomato Ketchup 1 - Victoria Plums 4 1 Vinegar 21 5 Whisky 25 - White Pepper 1 - Yogurt 8 - Total 367 15 The Chief Officer of the Public Control Department makes the following comments on the samples listed as unsatisfactory "The 3 milk samples were each slightly deficient in fat, which on investigation I was satisfied were natural deficiences. The 5 drug samples were all cases of camphorated oil deficient in camphor. Two official cautions were issued by my Council. The sample of pickled herrings in wine sauce was unsatisfactory because the amount of proof spirit was so small as to make the description 'in wine sauce' false. The packers were cautioned. The sample of Victoria plums proved to be Pond's Seedling plums. An official caution was issued. In the 5 cases of vinegar, non-brewed condiment was sold for the genuine article. There was one prosecution which resulted in a fine of 3 guineas and an award of £i.i5.od. costs, and three official cautions were issued by my Council". 27 PART III SANITARY CIRCUMSTANCES OF THE AREA Water Supply The Metropolitan Water Board has continued 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 1952. Details of the analytical results of the water passing into supply are given in the tables appended. 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 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 bacteriologically to ensure that its quality is up to that normally supplied. '28 Average Results of the Chemical and Bacteriological Examinations of the Water Supplied to the Borough of Tottenham for the Year 1952 Parts per Million (Unless otherwise stated) Description of the Sample No. of Samples Ammoniacal Nitrogen Albuminoid Nitrogen Oxidised Nitrogen Chlorides as CI. Oxygen at from Permanganate 3hrs at 27ºc Turbidity in Terms of Silica Colour, m. m brown 2ft. Tube Burgess's Tintometer Hardness (Total) Hardness (Noncar bonate) PH. Value Phosphate as P.O. 111 4 Silica as Sio2 Conductivity New River water filtered at Hornsey works 240 0.038 0. 072 6.2 36.4 0. 66 0. 1 7 302 78 7.7 0. 36 13 600 New River water filtered at Stoke Newington works 243 0.038 0.075 6.1 36.5 0.68 0. 1 7 300 75 7.8 0.35 13 600 River Thames water filtered ,at Walton works 245 0.032 0.096 4.3 25.3 1.18 0.2 13 252 60 7.8 0. 34 11 475 Bacteriological Results Description of Sample 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. eoii per 100 ml. New River water filtered at Hornsey works 17.4 100.0 Nil New River water filtered at Stoke Newington works 27.3 100.0 Nil River Thames water filtered at Walton works 15. 9 99.6 0.008 29 Defective Water Pipes and Fittings A problem which for many years has confronted the Health Department is to obtain the prompt reinstatement of the water supply to private houses, where the Water Board have exercised their power to cut off the supply because of waste taking place due to burst pipes and/or faulty fittings. Under the powers given to the Council by the Tottenham Corporation Act, 1952, the Council may now remedy the defect and recover the cost of the work from the owner. The following is a copy of the relevant section of the Act, namely:- "Where the Metropolitan Water Board in the exercise of "their right to cut off the water supply to any inhabited "house cease to supply any such house in the Borough by "reason of the defective state of a supply pipe or fittings "the Corporation may execute such works as they think "expedient in the circumstances of the case to remedy the "defect and the expenses reasonably incurred by the Corporation in executing repairs shall be recoverable by them "summarily as a civil debt from the owner of the premises "supplied but without prejudice to the rights and obligations as between themselves of the owner and the occupier "of the premises" Drainage and Sewerage Soil and surface water drainage continues to be operated throughout the Borough in separate systems. Surface water pollution in the Moselle and Stonebridge Brooks continues to engage the attention of the Health Department staff. With the heavily industrialised portions of the Borough, tracing such pollution is frequently a matter of extreme difficulty. We are glad to acknowledge the assistance and forbearance of the Lee Conservancy Board in this connection. Closet Accommodation The water-carriage system operates throughout the Borough. Steps are now being taken to deal with the lack of closet accommodation in houses which are sub-let. Section 44 of the Public Health Act, 1936, provides power to deal with buildings without "sufficient" closet accommodation. Further assistance 30 to the Department is given by the Tottenham Corporation Act, 1952, which provides that where two or more parts of a building are occupied as dwellings by separate families, each part shall be treated as a separate building. During the year there was one appeal by an owner against the requirements of a notice under section 45 of the Public Health Act for the repair of a water closet. The appeal was dismissed. Atmospheric Pollution Cases of atmospheric pollution by factory chimneys continue to occupy the attention of the department. The most consistent offenders are still the factories where the fuel is wood waste. Intermittent complaints arise from time to time which involve plants burning coal. In our experience the cause is usually to be found in the fact that the normal output of the plant is not enough to meet the demand. Efforts to meet the increased demand result in the plant being overworked or forced and, whilst some increase in output is obtained,a resultingloss in combustion efficiency is evident by the emission from the chimney. In order to minimise the smoke nuisance in any future redevelopment of the Borough, powers for the adoption of positive measures for preventing atmospheric pollution are now contained in the Tottenham Corporation Act, 1952. This provides for:- (i) Prior approval by the Corporation of solid fuel burning appliances; and (ii) The setting up of certain specified areas as Smokeless Zones. Housing The Council's responsibilities as a Housing Authority are many and varied and the Public Health Department continues to make its contribution with increasing endeavour. While the provision of new housing accommodation is still much needed, the repair of unfit and insanitary houses is of paramount importance if the health and well-being of the community is to be maintained. As has been pointed out in my previous Annual Reports, some 31 of the operative provisions of the Housing Act, 1936, appear unrelated to many of the problems of the present time. Housing Act, 1936: Sections 9 and 10 These sections which enable the Council to secure the repair of unfit and insanitary houses continue to be used. It is surprising, how infrequently appeals are lodged against the requirements of notices served under these sections and against demands made for payment. Consistent with rendering the house fit for human habitation the requirements of the notices are kept to a minimum and this may well be the reason for the lack of litigation. In some cases where work has been carried out in default, the Council have made orders under section 10 making the cost repayable by owners over g. period of years. Legal proceedings were instituted in four cases in respect of sums outstanding and judgement was obtained in each case. Two appeals were made during the year against notices under section 9,but one was later withdrawn and the Corporation's costs, £7.15.od. paid by the appellant. In the other case the Judge ruled that as both parties had agreed that all the work properly required had been carried out, he was not prepared to order either party to pay the other's costs and that there seemed to be no purpose in proceeding with the hearing. The following is a summary of work carried out under sections 9 and 10 in the owners' default during the past 15 years, namely:- The following is a summary of work carried out under sections 9 and 10 in the owners' default during the past 15 years, namely:- 32 Year Number of Houses Cost £ s. d. 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 1,0'26 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 1952 47 2,445 1 9 The steady decrease in the value, of work done in default noticeable since 1948 has continued during the year. The reasons for this are not at first sight obvious, but if any conclusions can be drawn, they are:- (i) The vast amount of war damage repairs carried out has served to improve many houses; (ii) The work done by the department immediately following the end of the war in overcoming arrears (in 1947 and 1948 some £27,000 was spent in work in default); (iii) The bulk of the complaints are probably made in respect of the older houses, which are dealt with under the Public Health Act provisions. Housing Act, 1936: Sections 11 and 12 The provisions of section 11 enable the Council to secure the demolition of insanitary houses not repairable at reasonable cost. This section has not been applied so extensively as hitherto. Piecemeal demolition of isolated houses is unsatisfactory where such houses are in areas which require re-development as a whole and the question of clearance area procedure must shortly arise. 33 Repeated complaints from The Hale area for instance are causing the department concern, particularly where the complaints concern houses in terraces. PREMISES THE SUBJECT OF DEMOLITION ORDERS - NOT DEMOLISHED AS AT 31ST DECEMBER, 1952 PREMISES DATE OF ORDER 10, The Hale 5. 4.50. 12, The Hale 25.1.52. 16, The Hale 2.3.51. 16a, The Hale 7.7.52. 55, The Hale 2.4.48. 57, The Hale 2.4.48.* 31, Langham Road 6.8.52.* 8a, Lawrence Road 13.10. 48. 4, Stanley Grove 1.6.43.* 5, Union Row 11.8.48. 6, Union Row 11.8.48. 7, Union Row 11.8.48. 8, Union Row 11.8.48. *These premises were still occupied at 31.12.52. PREMISES DEMOLISHED DURING 1952 PREMISES DATE OF ORDER DATE DEMOLISHED 9, Charles Street 7.1.52 13.8.52 1, Railway Terrace 3.2.50 6.3.52 2, " " 3.2.50 6.3.52. 3, " " 32.50. 6.3.52. 4, „ „ 3.2.50. 6.3.52. 180, Tewkesbury Road 31.7.51. 2.52. 22, Whitehall Street 31.7. 51. 10.4.52. PREMISES THE SUBJECT OF CLOSING ORDERS MADE DURING 1952 PREMISES PART OF PREMISES CONCERNED DATE OF ORDER 183, Clyde Road Basement front and rear rooms 7.7.52 34 Housing Act, 1936" Part III In my Annual Report for last year I emphasised the need for reviving procedure for the clearance of areas under Part III. Confirmation of the Arthur Road Clearance Order was received during the year and it is gratifying to know that a start has been made. My official representations this year dealt with parts of Broad Lane, Newton Road and Victoria Road. These were submitted in October. The lack of land for re-development makes it difficult to submit a planned programme, and it is necessary to stress that redevelopment as a whole must have regard to the areas which are in urgent need of clearance. It is hoped that proposals for re-development in the Markfield Area will provide a basis on which the work of dealing with other clearance schemes can be carried out. Tottenham Corporation Act, 1952 My Annual Report for the year 1952 would be incomplete without special mention of the Tottenham Corporation Act, 19S2, in relation to the operation of the Public Health Act, 1936. Administration of the Public Health Act, 1936, may at times be slow and ) t the procedure for securing the remedy of certain conditions not so speedy as could be desired. In the Tottenham Corporation Act, 1952, which received Royal Assent in August of that year, powers were taken to assist in the speeding up process, without at the same time, depriving the Council of its prerogatives. Part V of the local Act applies in particular to sanitation and buildings and here certain functions are delegated to the Medical Officer of Health or the Sanitary Inspector. By virtue of these new provisions the Medical Officer of Health or the Sanitary Inspector can now deal with stopped-up drains and have them remedied within 48 hours. Further provisions enable the Council to deal with defective premises by serving on the person concerned a notice that the Corporation themselves intend to remedy the defect. The section also makes provision for the owner to serve a counter notice. While the use of this section must be exercised with discretion, its effectiveness has already been demonstrated. 35 Abatement Notices - Legal Proceedings 20 Summonses were issued in respect of Abatement Notices, as follows:- Case No. No. of days allowed in Order Fine Costs Remarks 1. - 5.5.0. Adjourned Sine Die as work commenced. 2. 3. 4. 5. 28 - 1.1.0. 6. 28 5.0.0. 2.2.0. Daily penalty of £2 if order not complied with. 7. 28 - 1.1.0. 8. 42 2.0.0. 2.2.0. 9. 28 - 2.2.0. 10. 28 - 2.2.0. 11. 28. 1.0. 0. '2.'2.0. 12. '28. 2.0. 0. 3.3.0. 13. - 104.10.0. 10.l0.0. Two summonses against owner were heard in respect of failure to comply with a nuisance order. A daily penalty of 10/- imposed. Also fined £30 for failing to attend Court on 2 previous hearings and a tenant who acted surety fined £5. 14. 28 - 2. 9. 6. 15. 28 2.'2.0. 16. 28 - 2.2.0. 17. - - 2. '2.0. Adjourned Sine Die as work completed. 18. 28 10.0. 1.7.6. 19. - - 2.2.0. Withdrawn on payment of costs as work completed. 20. 36 Rodent Control Ministry of Agriculture and Fisheries methods of rodent control continue to be observed in all treatment carried out. The Health Department is glad to acknowledge the help and advice of the Ministry's officers and to voice its appreciation of the technical information obtained at the workable area committee. Meetings of this Committee are held three or four times a year and two representatives from the department attend. From the figures below it will be seen that there is no great variation in the work done as compared with previous years. It would, however, be right to assume that the systematic sewer treatment carried out twice per year helps to keep surface infestations down to reasonable limits. The introduction of a new poison, Warfarin, has enabled us to adopt a new technique in dealing with surface infestations. Sewer Maintenance - Results of Baiting Manholes Poison take at Manholes Treatment No, 15. April/May, 1952. Treatment No. 16. Oct,/Nov. 1952. Complete - - Good 177 165 Small 257 301 Nil 575 544 Total treated 1,009 1,010 Estimated number of rats killed 5,300 5,305 The following is a summary of dwellinghouses and business premises treated during 1952: (1) Dwellinghouses 619 (2) Business and Factory Premises 113 (3) Total charge for (2) above £93-6.9d. Insect Pests Insect pests continue to be dealt with by the use of D.D.T. and we are satisfied that its application is both cheap and efficient when compared with earlier methods. 37 From complaints and enquiries received in the department there appears to be an increase in the activities of the wood beetle family. One of the difficulties in dealing with this pest is the unawareness of its presence until the damage has been done. SUMMARY OF DISINFESTATION WORK DURING 1952 Cause Private Houses Council Houses Other Premises Totals Houses Rooms Houses Rooms Houses Rooms Other Premises Ants 7 1 - - 1 School Canteen 7 1 1 Beetles 34 39 - - 3 Bakehouses 34 39 8 2 Schools 2 Clubs 1 Canteen Bugs 224 471 29 72 - 253 543 Fleas 10 24 - - 1 Shop 10 24 1 Flies 3 5 - - - 3 5 - Lice - - - - 1 Hbspital Cubical - - 1 Slugs 1 4 - - - 1 4 - Wasps 9 - - - 9 - - Wood Beetle 5 6 - - - 5 6 - Totals 293 550 29 72 11 322 622 11 Disinfestation upon removal to Council dwellings was carried out in 165 instances- Inspections Carried out by the Sanitary Inspectors Appointment and Interviews 1,131 Cinemas and Hals 53 Complaints Investigated 4, 158 Conveniences and Urinals 88 Drains Defective 331 Drains Tested 508 Factories with Mechanical Power 568 Factories without Mechanical Power 65 Food Poisoning 20 Food Premises Bakehouses 149 Butchers 282 38 Cafes 278 Dairies 242 Factories 37 Factory Canteens 64 Fishmongers 147 Greengrocers 147 Ice Cream Premises 301 Slaughterhouses 60 Other Food Premises 524 2,231 House to House 46 Infectious Disease 429 Other Visits '2,797 Outworkers 469 Rat Infestation 864 Reinspections 11,761 Schools 37 S.D. A. A. and Housing Act Advances 177 Smoke observations 103 Stables and Mews '25 Tuberculosis '23 Workplaces 43 Notices Served, Statutory:- Housing Act, 1936: Section 9 344 " 11 5 " 12 2 Public Health Act, 1936: Section 24 12 " 39 44 "45 19 " 79 2 "84 1 "94 243 Tottenham. Corporation Act, 1952: Section 35 1 "36 1 "43 2 ".46 1 39 brought forward 677 Tottenham Urban District Council Act, 1900: Section 48 '2 679 Informal 2,096 Defects Remedied Drains reconstructed 45 Drains repaired 293 Drains cleared 194 W. C. Cisterns repaired or renewed 229 W,C. pans renewed 164 W.C. Pans cleansed 53 Waste pipes repaired or renewed 159 Rain water pipes repaired or renewed 393 Roofs repaired or renewed 898 Eaves gutters repaired or renewed 544 Drinking water cisterns renewed 15 Drinking water cisterns covered 14 Water service pipes repaired 115 Water supply reinstated 57 Yards repaired or reconstructed 129 Sinks renewed or provided 59 Floors repaired or renewed 498 Floors ventilated 198 Dampness remedied by insertion of damp-proof courses 147 by pointing of brickwork 153 by internal rendering 318 by miscellaneous remedies '250 Window frames and sashes repaired or renewed or painted 619 Coppers repaired or renewed or provided 26 Fireplaces, stoves and ovens repaired or renewed 376 Flues and chimney stacks repaired 168 Brickwork of walls repaired and walls rebuilt 192 Ventilated food stores provided 3 Rooms cleansed 1,322 Staircases, passages and landings cleansed 312 40 Staircases, balconies and steps repaired or renewed 130 Noxious accumulations removed 33 Nuisances arising from animals abated 5 Miscellaneous defects remedied^ 839 Repair of Houses by the Council Work carried out in default or by agreement with the owners during 1952:- Housini Act, 1936: £ s d Section 9 47 premises 2,445. 1. 9. " 11 l " 70. 3. 4. Public Health Act, 1936: " 39 13 " 231. 5. 2. " 45 2 " 5.18.2. " 79 1 " 12.0. " 94 1 " 3.12.10. £2,756. 13.3. 41 PART IV FACTORIES AND SHOPS Tottenham has a large number of diverse industries in its area. Altogether there are 726 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 Acts which are enforceable by the local authority.; Factories Acts,, 1937 and 1948 Inspections for purposes of provisions as to health (including inspections made by Sanitary Inspectors) Premises Number on Register Number of Inspections Written notices Occupier prosecuted (i) Factories in which Section 1, 2,3,4 and 6 are to be enforced by Local Authorities 65 65 2 (ii) Factories not included in (i) in which Section 7 is enforced by the Local Authority 661 568 20 (ill) Other Premises in which Section 7 is enforced by the Local Authority (excluding out workers' premises) 3 3 Total 729 636 22 42 During the year 6 non-mechanical and 63 mechanical factories were found to have been discontinued, and 47 mechanical and 10 non- mechanical factories were started. Summary of Defects found in Factories Particulars Number of cases in which defects were found Found Remedied Referred to Factories Inspector Referred by Factories Inspector Want of cleanliness (S. 1). 3 3 3 Overcrowding (S. 2). Unreasonable Tempera ture (S.3). Inadequate Ventilation (S.4). Ineffective drainage of floors (S-6). Sanitary Conveniences (S.7). (a) Insufficient 2 2 1 (b) Unsuitable or defective 25 25 2 (c) Not separate for sexes Other offences (not including offences relating to Outwork) 5 5 Total 35 35 6 Outworkers (Sections 110 and 111) Regular visits are made by the Sanitary Inspectors to the homes of persons notified to the Department as outworkers. It has been found that the home conditions are generally satisfactory and that the cleanliness in such homes is usually above average.. The following is a summary of the types of outwork carried on in the Borough:- 43 Wearing apparel 262 Artificial flowers 18 The making of boxes or other receptacles or parts thereof made wholly or partially of paper 50 Brush making 5 Feather sorting 3 Carding, etc., of buttons, etc, 12 Stuffed toys a4 Cosaques, Christmas crackers, Christmas stockings, etc.; 4 Lampshades 1 Total 369 During the year, 469 visits were made to outworkers' premises. No contraventions of the "Factory Acts" were reported. A Pilot survey of occupational health In order to better understand the occupational health needs of employees in local industry, a pilot survey, covering only a part of the Borough, has been carried out by members of the Public Health Department. The locality selected has seventy three factories employing from two or three to a thousand and more men and women. The survey covers a variety of industries ranging from motor garages to furniture factories, from chocolate manufacturers to brass founders,. No heavy industry is included other than a firm of civil engineering contractors. In assessing the number of employees, office staff has been excluded, and employers included only if taking an active part in production. Employment of Women A large amount of female labour is employed in work which is light and clean such as gown manufacturers and in the production of radio valves. Many of the women are married and generally do not work a full day. Opinion expressed as to the advisability of employing married women varied.; Some firms preferred them on account of their greater sense of responsibility while others complained that the curtailed working day, irregular time keeping and absenteeism for domestic reasons created administrative and production problems. 44 Employment of Young Persons The employment of young persons is general, but the proportion varies according to the nature of the industry.; In only two instances has mention been made of an apprentice system. This may be a reflection of the unwillingness of young people to commit themselves to one class of employment over a period of years, and in the case of boys to the realisation of the possible disruption of their subsequent career by compulsory military service. The relatively low wages paid to apprentices no doubt also influence young people in this respect.; It must be said, however, that it is likely in this survey that the majority of industries studied did not lend themselves to the apprentice system. Employment of Old People No accurate figure has been obtained of the number of employees over pensionable age in the various factories covered by this survey. Some industries do not lend themselves to the employment of aged persons except in such capacities as watchmen, cleaners or caretakers.; One light engineering firm, however, has some 5% of its employees over pensionable age. This is a firm of which the founder recently died. Up to the time of his death he had taken an active part in the running of the firm and no doubt influenced the policy of retention of aging employees. The work carried out in this firm is highly skilled and it may be assumed that the experience of older men is of utmost value in an advisory or supervisory capacity. Two other firms employing a high proportion of elderly women, on such jobs as sorting and packing, find it better to group them together rather than have them dispersed amongst younger workers of dissimilar interests and abilities. One of these firms before the last World War employed juvenile labour for packing but now finds it more expedient to employ elderly women on this task. Though the wages expected are more than those paid to juveniles and the work generally carried out more slowly, elderly people are said to be more steady and reliable. One firm making screws tried as an experiment to employ mainly elderly men, but abandoned the scheme on account of the poorer vision and slower reactions of these workers.; Employment of Disabled Persons The percentage of disabled is in general above the statutory quota. 45 No firm appears to have a system of job placement based upon medical examination, though it must be assumed that the employment of disabled persons is influenced by the nature and degree of disability. In fact one firm in which the post of factory nurse is combined with that of welfare officer, an attempt is made by the nurse to put disabled persons in suitable employment. In another instance a works manager has adapted a machine so that it could be used by a crippled person. It was reported that this employee had been crippled for many years and after a period at the adapted machine she slowly gained confidence and a brighter outlook on life. The manager said he had been assured by efficiency experts that her output was as good as any in the factory. By co-operation between engineer, works foreman and a qualified medical man others might receive similar benefit.; Arrangements for Medical Attention The appointed factory doctor visits all factories employing "young persons"; and he also visits periodically those factories where there is a statutory requirement for him to do so in respect of industrial hazards,; (a) Firms with One Hundred Employees and Over Some eight factories out of the twenty-three in this group have no first aid room and of these four have no trained first-aid personnel available. No firm covered by this survey has a fulltime medical officer. One receives a weekly visit by the wholetime medical officer of the parent company outside the Borough. The same firm has a trained nurse (S.R.N.) who shares her time between the firm and another subsidiary,.; In another instance two contiguous factories share doctor and nurse-consisting of a weekly visit by a local general medical practitioner and the services of a full time trained nurse and a full-time Red Cross worker. The same firms have an arrangement with the local hospital for emergency treatment. Two other firms in this group have first-aid rooms with a trained (S.R.N.) nurse in charge, but in both cases the nurse undertakes other duties in connection wirh welfare and personnel management. In the remaining ten firms of this group, four of the firstaid rooms are staffed by persons with first-aid certificates and undertaking other duties. The other six firms have no fixed staffing for first-aid purposes, and rely on a number of employees having first-aid training. No extra pay is given for possession Of a first-aid qualification. 4 6 (b) Firms with Fifty to Ninety-nine Employees Of the nine factories in this group none has any first-aid room and none employs a doctor or nurse to visit the factory. Seven provide a first-aid box in the charge of an employee holding a first-aid certificate. Two have first-aid boxes but no trained personnel. One of these factories has cutting and stamping machinery and the other carries out processes involving risk of serious burns. (c) Firms with Twenty to Forty-nine Employees Of the twenty factories in this group only one has a firstaid room with trained person in charge. Seven have a first-aid box in the charge of a first-aid trained employee. The remainder have a first-aid box but no trained person in charge. One of these factories employing, over 40 men is carrying out welding of heavy equipment and sheet metal work. (d) Firms with Ten to Nineteen Employees Of the six factories in this category two have a first-aid box with a trained employee in charge and the remaining four have a first-aid box but nobody trained. (e) Firms with Five to Nine Employees All provide first-aid boxes but in four out of the six factories in this group there is no first-aid trained person in charge. (f) Firms with Under Five Employees All provide first-aid boxes but in only one of the nine factories in this group is there a first-aid trained person responsible. With one or two notable exceptions first-aid arrangements appear haphazard and the employment of persons holding a first-aid certificate fortuitous rather than a matter of policy. In only two instances is a medical examination on entry required by the firm, and in both cases the factories are branches of larger concerns and the examination necessary for purposes of a pension scheme. Welfare and Personnel Management In the factories covered by this survey the functions of welfare and personnel management generally devolve on employer or 47 works manager. In two instances the nurse includes some of these functions in her duties.; The interest of employers in the welfare of workers, outside their occupation, varies from the employer who appears to regard his employees as so many units for production and the one who knows all his ninety employees by their Christian names and much of their personal history - more frequently in an old established firm with the family tradition. Policy with regard to. pension and sick-pay schemes varies from firm to firm. Two at the time of visit contemplated starting such schemes in conjunction with insurance companies. A few of the larger firms already have schemes in operation, others a pension scheme only and usually after a qualifying period.; In some cases sick employees are paid for a varying period at the discretion of the employer. Generally, however, the sick employee receives only his national insurance benefits, the attitude of the employer being that he had already contributed to the National Insurance Fund. Wages and Bonus Schemes Wage levels are difficult to compare. Many employers were at pains to point out that union rates or above are always paid. The principal difficulties in comparing wage levels are due to varying methods of payment, time work, piece work and the operation in some cases of bonus schemes. The latter varies from a few pence a week to as much as two to three pounds.; Some firms give a bonus of a week's wages at Christmas time, others give a production bonus twice a year. As one employer pointed out the basic wage is the sum which employees use in comparing their wages with those obtainable elsewhere. The same employer adopts a scheme whereby small increments are given quarterly instead of a larger sum biannually or annually, Labour Turnover and Absenteeism In trying to assess these two factors it has been found impracticable to examine but a few of the records necessary for accurate information. The view generally expressed by employers is that the numbers are "low". Most of the firms made the point that they have a solid core of long standing employees with the remainder a constantly changing population. In the case of firms whose records were made available to us the labour turnover is high. No sickness records or other causes of absenteeism were available.• 48 Industrial Hazards Occupational risks cover a wide field and the standard of the precautions taken against them varies from minimal statutoryrequirements to taking every possible means to safeguard the health and safety of employees. Dust In those factories where dust is produced, in general, every effort is made to extract it. The process where this is most difficult of achievement is sanding of wood in furniture factories There does not appear to be at the moment a really satisfactory solution to this problem. Fumes In factories where cellulose spraying is carried out as a routine process, spraying booths are in general use but in only one case masks were being worn. Other fumes and liquids encountered include ammonia, nitric acid, tar and bitumen, cyanide, carbon monoxide, sulphuric acid and trichlorethylene. The special risks associated with these agents are in general fully understood and statutory notices concerning them posted in the various work-shops. Eyes The industrial hazards likely to affect the eyes of workers may be divided into:- (a) traumatic (physical and chemical) (b) physiological (a) includes such conditions as foreign bodies from grinding and splashes of corrosive liquids. (b) includes conditions resulting from considerable ocular strain. Two examples encountered in this survey concerns the manufacture of radio valves and the process of cutting dies. In the case of radio valves, lenses are provided for inspection of the assembled "stems"; but no such aid is given to those assembling the stems. Another important eye hazard met with is "arc eye" in welding. Both employers and employees appear well aware of this risk. Noise Processes involving excessive noise, observed during the survey, include sanding wood, metal beating and engine testing. 49 This hazard could be mitigated by better segregation of the process which in the case of engine testing is to some extent being achieved. In other cases such suggestion may be impracticable owing to possible interruption of the work cycle. Workers appear to acquire a surprising tolerance to the noise. Weight Lifting In a number of factories considerable weights have to be lifted from place to place. Special apparatus is installed in many cases ranging from mobile cranes to hand trolleys. Exposure to Weather Two firms, a civil engineering contractor and a welding firm have employees exposed to bad weather conditions; and in both cases the firm provides protective clothing. Dermatitis The incidence of occupational dermatitis appears to be low, the chief risk occurring in the factories observed, appears to be with synthetic glues. One firm dealing with dyes made the point that dermatitis was a risk of using the agents provided to remove the stains. Several firms using cutting oils recorded no cases of dermatitis in recent years. All the firms in which this hazard exists appear to be very “barrier cream conscious” Buildings and Plant With the exception of a few mainly small workshops the factory premises are generally in modern type buildings in a good state of maintenance and repair. In all cases where accommodation is old or of rambling development, the management are making the best of the facilities at their disposal. Overcrowding No overcrowding of plant or personnel appears to exist, though in some instances there is a certain amount of congestion due to finished and partly finished work awaiting removal.; This is said to be due to seasonal demands. Sanitary Accommodation In all cases the facilities provided are in accordance with the Sanitary Accommodation Regulations, 1938, although in some instances the number of water closets appears insufficient. 50 Washing Facilities In all cases some provision is made for washing. This ranges from a single basin with a cold tap to elaborate arrangements including provision of shower-baths. For drying the hands the majority of firms have roller towels and in some, individual towels are provided. One firm has installed electric hand driers and another, individual paper towels. In some of the engineering firms we were told that the men preferred to have a bucket of really hot water in the workshop for washing their hands rather than use the normal facilities. Lighting Natural or artificial lighting is generally good in the factories under review, and mostly above statutory requirements. Managements seem fully conscious of the need for efficient illumination. In some cases the colour schemes of decoration materially affect the brightness ratios and the environment is appreciably improved. Cleanliness of Premises Having in mind the processes and trades being carried on the standard of cleanliness is generally high. GENERAL Special Clothing In most instances the employee has to find his own overalls although in a few very dirty jobs overalls are provided by the employers. One firm allows an annual sum to employees for the purchase of overalls. Protective clothing of other types is provided where necessary. Seating Where seating is practicable it is provided and used. Only one firm appears to have considered the relation of the seat to production and the comfort of the worker. Smoking Generally speaking smoking on factory premises is not allowed where it constitutes a risk of fire as in paint works, furniture and paper factories. One furniture factory however does allow smoking, their argument being that employees would smoke anyway either in the lavatory or surreptitiously at the job. The 51 prefers to take the risk of fire from permitted smoking rather than from a hurriedly discarded cigarette end. Another firm with a lesser fire risk permits smoking up to 1½ hours before finishing work so that any likely fire would be spotted before closing the premises. Social Activities The smaller firms have little or nothing in the way of social activities. The larger firms vary widely in the facilities provided. One works manager stat.ed their social club was a failure because of the situation of the firm's premises some distance from public transport. In the same road however another firm has a very flourishing social club. Major considerations in the success of social activities appear to be suitable premises, canteen facilities and enthusiasm on the part of some member or members of the firm,; Canteens The provision of works canteens as might be expected varies with the size of the firm. Most of the large firms provide well equipped kitchens and dining rooms usually run by an outside caterer. One firm expressed the view that the canteen was worth while in ensuring that employees could have at least one square meal a day. This firm has made a special effort in decorating and constructing the dining room in such a way as to avoid the factory atmosphere, The standard of hygiene in the canteen kitchens is generally high. Some firms share canteen facilities and one firm arranged a "meal voucher scheme" at a local restaurant.; Summary of Findings (1) Positive methods for safeguarding the health of employees in many factories particularly the smaller ones, is at present haphazard and unorganised. (2) First-aid equipment is very nearly useless unless associated with trained personnel to use it, (3) In the smaller factories particularly, there is evidence of the need for health education in matters relating to industrial processes and working environment, (4) The useful employment of able aged persons in local factories shows there is scope for further discussion with managements in tackling this problem on a broader scale.; 52 (5) While not attempting to give a complete picture of factory conditions generally in the Borough, the findings of this small pilot survey give clear evidence of the need for further inquiry and ultimate action. (6) The need for an organised local industrial health service, largely supervisory and advisory is apparent.; There is evidence too that such a service would be welcomed and used,; 53 Appendix (i) List of Industries Covered by the Survey Furniture 4 Ladies Clothing 8 Footwear 4 Illuminating engineers and light engineering 1 Light engineering and woodwork 1 Motor repairs and light engineering 4 Precision machinery and fine machine tools 1 Engineers (Internal Combustion Engines) 1 General Engineering 1 Sheet Metal and general engineering 1 Engineers and foundry 1 Civil Engineering contractors 1 Screw machine products, plastic mouldings 1 Welding 1 Metal Containers 1 Saws 1 Die Sinker 1 Screws 1 Electric cables and accessories 1 Electrical switchgear assembly 2 Electrical power engineers 1 Repair of heavy electrical equipment 1 Servicing petrol pumps and bulk meters 1 Accumulator makers and repairers 1 Carbon papers, ribbons and inks 2 Cartons and colour printing 2 Household stationery 1 Paper goods (albums, "jigsaw puzzles, etc.) 1 Magazine binding 1 Book binding 1 Paper bags 1 Moulded fibre goods 1 Luggage manufacture 1 Leather dressers 1 Paints and varnishes 2 Pianos 1 Coopers 1 Beer bottling 1 Bread and Confectionery 1 Chocolates 1 Pencils 1 Radio Valves 1 Fur Dressers and dyers 1 Buttons 1 Loose covers (car seats) 1 Mirrors 1 Brilliant cutting 1 Shop fitter 1 Advertising display manufacturer 1 Wholesale motor factors 1 Store (packing and dispatch of toys) 1 Toy maker 1 Tiled fireplace maker 2 Total 73 54 Appendix (ii) POPULATION OF FACTORIES Population Mechanical Factories Mechanical Bakehouses Factories Total Population Total Population Total Population Under 5 9 26 - - 9 26 5-9 6 40 - - 6 40 10 - 19 6 106 - - 6 106 20 - 49 19 596 1 30 20 626 50 - 99 9 586 - - 9 586 100 and over 23* 6451* - - 23* 6451* Total 72 7805 1 30 73 7835 * This includes a civil engineering contractor's depot with a "resident" population of just over 200 and a population of over 1000 based on the depot. Both figures are included in the total 55 Appendix (iii) FIRST AID WITHIN FACTORIES Service Provided 100 and over 50 - 99 20 - 49 10 - 19 5-9 Under 5 Total First Aid Room - Trained nurse (SRN), visiting Medical Officer 3* - - - - - 3 First Aid Room - trained nurse (SRN) 2 - - - - - 2 First Aid Room - first aid trained person - room staffed 4 - - - - - 4 First Aid Room - first aid trained person available in works 6 - 1 - - - 7 First Aid Boxes - first aid trained person responsible 4 7 7 2 2 1 23 First Aid Boxes - no trained person responsible 4 2 12 4 4 8 34 TOTALS 23 9 20 6 6 9 73 * Two of these factories share facilities so that the actual number of first aid rooms is one less than shown in the table. 56 Shops The supervision of shops and effective administration of the Shops Act are secured by systematic visitation by the Shops Act Inspector, who maintains a register of all classes of shop premises in the Borough. In the general administration of the Shops Act 2,603 inspections were made during the year. Most contraventions recorded have been of a minor character, such as failure to exhibit statutory notices and keep proper records of the hours of employment of young persons. Verbal warnings and notices to the number of 320 were issued in this connection. Shops in Tottenham (Remainder) Area are closed for the weekly half-holiday on Thursday, and in the Harringay Area on Wednesday at 1.0 p.m., with the exception of Butchers who close on Monday at 1.0 p.m, throughout the Borough, subject to the alternative day (Saturday) in all cases. Close supervision is exercised in order to see that the weekly half-holiday is correctly observed, 201 visits being made for this purpose. Half-Holidays for Shop Assistants Every shop assistant must be allowed a half-holiday once a week commencing not later than 1.30 p.m. The rule applies whether the shop is 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 a.m. to 2.30 p.m., every assistant must be allowed an interval of ¾ 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 7.0 p.m., each assistant must be allowed an interval of half-an-hour within that time. No assistant shall be employed more than 6 hours (5 hours if under 18) without an interval of at least 20 minutes being allowed during the course thereof. It has become the practice in many shops to allow assistants a tea break of 10 minutes during the morning and afternoon. 57 General Closing Hours An order in Council was made by the Secretary of State revoking the provisions of the Shops Act, 1950, relating to the general closing hours of shops during the winter months. There was no suspension of the General Closing Hours during the Christmas period 1952. Sunday Trading The provisions of the Shops Act restricting Sunday trading are effectively enforced by means of investigations and observations. 78 visits were made for this purpose, and 3 warning notices were sent in respect of contraventions. Shops Act and Young Persons Employment Act, 1938 Regular investigations and inspections were made in connection with these Acts, and it has been ascertained that the conditions of employment have improved, both as to the hours of employment of young persons and the arrangements made for the health and comfort of shop workers generally. 236 visits were made in connection with these Acts. It is gratifying to note that the provisions of the Act have been well observed. 58 PART V GENERAL Medical Examination of Council's Staff During the year 168 candidates were medically examined for the purposes of the superannuation scheme. Six persons failed to pass the examination. Nine employees were medically examined in connection with the Sick Pay Scheme. 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 chiropody; or (b) electric treatment or radiant heat, light, electric, vapour or other baths for therapeutic treatment; or (c) other similar treatment. Five new establishments were licensed during the year and at the 31st December, 1952, there were twelve licences in force in the Borough. A proposal to make byelaws prescribing qualifications on the lines recommended in the Cope Report on Medical Auxiliaries, failed to gain Home Office approval. Rag Flock and other Filling Materials Act, 1951 At the 31st December, 1952, one establishment was licensed for the manufacture of rag flock. Samples of the rag flock product submitted for laboratory examination were found to pass all 59 the tests prescribed in the regulations. 24 premises were registered for the use of filling materials. Pet Animals Act, 1951 At the 31st December, 1952, 13 premises were licensed as Pet Shops in accordance with the Pet Animals Act, 1951. Regular visits are made to the premises by the district sanitary inspectors to ensure that the requirements of the Act and the licensing conditions are complied with. 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 am 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 Saturday.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. The following is a summary of the work carried out during 1952, namely:- 60 Record of Examinations Throat/Nose Swabs: Total Specimens 180 Diphtheria Bacilli - Haemolytic Streptococci 41 Negative 139 Faeces: Total Specimens 201 Shigella 7 Salmonella 6 Negative 188 Sputum: Total Specimens 7 T. B. Smear - Other Organisms 6 Negative 1 Pertussis: Total Specimens 79 Postnasal Swabs 15 Negative 64 Ice Cream: Total Specimens 59 Water: Total Specimens 9 Domestic Supplies, etc. 3 Swimming Pools 6 Miscellaneous Specimens 289 Total Number of Specimens 824 Old People's Welfare The welfare of the aged is of growing concern to local authorities. In Tottenham, to meet this need, the Council sponsored the establishment of an Old People's Welfare Committee. Serving on this Committee, in addition to members of the Council, are representatives of all voluntary and religious organisations who have some function in the welfare of the community. The Town Clerk acts as Honorary Secretary and, in addition, the Council have appointed a full-time Old People's Welfare Officer. The work of the Committee is financed by donations and money raised by various activities, such as concerts and garden parties, but the major portion of the cost is met by a grant to the Committee by the Tottenham Borough Council, which amounted to just over £2,000 in the year ended 31st March, 1953. 61 The following brief summary of some of the work carried out by the Committee has been extracted from the annual report of the Hon. Secretary for the year ended 31st March, 1953:- (a) Clubs Three clubs are organised by the Committee and these have maintained a steady and active membership of about 200 each. Members are charged a weekly subscription of 2d. Meals, charged at one shilling per meal, are served at the clubs on Tuesdays and Thursdays and an average of 300 are served each week. Film shows, socials, concerts, etc., have been arranged, the artistes giving their services voluntarily. The old people take an active interest in the clubs, which play an important part towards the happiness and well-being of the elderly. (b) Outings and Parties A number of outings were organised during the summer and,in the winter, theatre and circus visits were arranged. The cost in each case was met either by the individuals or out of the club funds. Three very successful Christmas parties were arranged by the clubs. (c) Chiropody Service This very successful service which commenced during the year is greatly appreciated by the aged and there is a heavy demand for appointments. Since starting in May, 680 patients have received treatment, the charge being one shilling per foot. Sessions are held twice weekly at Lordship Lane Medical Centre, and Lealand House, High Road. (d) Boot and Shoe Repairing Service This is another service which has started during the year. With the co-operation of the "St. Crispin Group" of Shoe Repairers it is now possible for all aged folk in the Borough to have footwear repaired at reduced prices. The seven repairers are well spread around the Borough, making it possible for the old people to take the footwear to the shop nearest their homes. (e) Christmas Parcels Over 600 parcels were packed and despatched to the sick and housebound at Christmas. The flood of letters of thanks received showed how the old people appreciated the contents. 62 (f) Holidays A number of holidays at reduced rates were arranged through the medium of the Committee. (g) Handicrafts Old people are encouraged to continue their handicrafts which are a great factor in helping them to lead an active and interested life. Exhibitions of the work produced is evidence of the skill and craftmanship of many of the aged. Although they may not be as quick as younger persons, there is little doubt that this is largely offset by the pride they take in their work. (h) General Welfare The problems of the aged are varied and during the year 1,557 interviews took place at the office of the Old People's Welfare Officer and 522 domiciliary visits were made by this Officer. In addition to this figure many visits were made by voluntary effort. A very large number of problems by letter and telephone are not included in these figures. Three local hospitals have co-operated by giving notification of any aged person likely to need help after being discharged. Many visits are paid to hospital to discuss these problems with the Almoners and the patients. The individual help given to the old people by voluntary effort should not be forgotten. the helpers on the "Meals on Wheels" Service and Club meals, "Knights of St. George" and local -Scouts in digging up gardens and carrying coal, also the tradesmen of the Borough for their various gifts. Persons in need of Care and Attention The number of cases investigated as persons likely to be in need of care and attention was 190. The actual visits made were much in excess of this number. As in the past, these cases are notified to the department from various sources but the majority have been visited at the request of or in conjunction with St. Ann's Hospital. In work of this kind a very close liaison is observed between the department and the Old People's Welfare Organiser also with the Home Help Service and the Area Welfare Officer of the Middlesex County Council. 63 National Assistance Acts, 1947 and 1951. The following are details of the only two cases where it was necessary to take formal proceedings under these acts, namely:- Case 1. Information was received from a resident that an old lady, aged 76 years, was ill and refusing to eat or to see her doctor. The house was generally in a filthy condition. The old lady was visited and persuaded to see her doctor who advised removal to hospital on the grounds of senile exhaustion, but she refused to agree and repeated visits failed to change her mind. An application was finally made to a magistrate under the National Assistance (Amendment) Act, 1951, and the old lady was admitted to hospital where she subsequently agreed to stay as a voluntary patient. Case 2. A voluntary society notified the department that two females, mother and daughter, were living in a ground floor flat which was filthy, dirty and infested with vermin. The daughter, although only 35, was bedridden and crippled, the mother, aged 76, was hard put to cope with household duties and care for her daughter. In an effort to help, visits were made and it was suggested that the daughter should go into hospital while the flat was cleansed and decorated. Discussions took place with the owners and they agreed to carry out the work. In spite of every effort, both mother and daughter were obstructive and often abusive and it finally became necessary to apply to the Court for an order to remove the daughter to hospital. This was done and the flat was cleansed and redecorated and the daughter finally discharged and returned home. A home help is now visiting regularly, National Assistance Act, 1948, Section 50: Burials During the year it was ccessary to arrange six burials where deaths occurred and suitable arrangements for burial would not otherwise have been made. 64 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. 1951 1952 Area of District in acres 3,013 3,013 Population Census, April, 1951 126.921 Mid year Registrar General's estimate 126,800 125,800 Rateable Value £1,017,402 £1,018,284 Sum represented by penny rate £4,076 £4,000 Births: Registered live-births - (a) Legitimate: Males 844 815 Females 751 774 Total: 1,595 1,589 (b) Illegitimate: Males 37 37 Females 41 40 Total 78 77 (c) Total Live-births: Males 881 852 Females 792 814 Total 1,673 1,666 Birth-rate per 1,000 estimated population 13. 19 13.24 65  1951 1952 Stillbirths: (a) Legitimate: Males 21 24 Females 21 10 Total 42 34 (b) Illegitimate: Males 1 1 Females 1 l Total 2 2 (c) Total Stillbirths: Males 22 25 Females 22 11 Total 44 36 Stillbirth rate per 1,000 total (live and still) births 25.63 21.15 Deaths Males 795 786 Females 725 629 Total 1,520 1,415 Death-rate per 1,000 estimated population 11.99 11.25 Maternal Deaths Puerperal Sepsis 0 0 Other puerperal causes 3 2 Total 3 2 Maternal Death-rate per 1,000 total (live and still) births • 1.747 1.175 Deaths of Infants under 1 year of age (a) Legitimate: Males 24 23 Females 17 11 Total 41 34 Rate per 1,000 legitimate live births 25.70 21.40 lb) Illegitimate: Males 2 0 Females 0 0 Total 2 0 Rate per 1,000 illegitimate live births 25.64 0.00 (c) Total Infantile Deaths; Males 26 23 Females 17 11 Total 43 34 66  1951 1952 Infantile Death-rate per 1,000 live births 25.70 20.41 Neo-Natal Deaths Deaths of infants under 4 weeks 30 27 Neo-natal Death-rate per 1,000 live births 17.93 16.21 Comparability Factors Births 0.93 0.93 Deaths 1.06 1.06 67 The Great Fog In common with the whole of the Greater London area, Tottenham suffered from the effects of a very severe fog which lasted from Friday, 5th December until the following Tuesday. The particularly toxic nature of this fog was associated with a sharp rise in the sickness rate as compared with the previous week. The number of deaths registered in the Borough was nearly trebled,the increase being almost entirely due to deaths from respiratory and circulatory diseases. The following table shows the age distribution of recorded deaths compared with the same period last year. 68 THE FOG, 5th-9th DECEMBER, 1952 Deaths of Tottenham residents from Influenza, Pneumonia and Bronchitis for the fortnight, 7th-20th December, 1952, compared with average for previous Winter months. AGE GROUP DEATHS DURING PREVIOUS WINTER WEEK ENDED 13. 12.52 WEEK ENDED 20.12.52 TOTAL FOR FORTNIGHT NOV. DEC. JAN. TOTAL FORTNIGHTLY AVERAGE M F M F M F M F Total M F Total M F M F M F Total Under 1 - - - - - - - - - - - - - - - - - - - 1 year - - - - - - - - - - - - - - - - - - - 2-4 - - - - - - - - - - - - - - - - - - - 5-14 - - - - - - - - - - - - - - - - - - - 15 - 24 - - - - - - - - - - - - - - - - - - - 25 - 34 - - - - 1 - 1 - 1 .15 - .15 - - - - - - - 35 - 44 - - 1 - 3 - 4 - 4 .62 - .62 1 - 1 - 2 - 2 45 - 54 1 - 1 - 2 - 4 - 4 .62 - .62 - - - - - - - 55 - 64 3 3 1 1 1 7 2 9 1.08 .31 1.38 7 - 2 - 9 - 9 65 - 74 7 1 7 1 2 2 16 4 20 2.46 .62 3.08 8 6 5 3 13 9 22 75 - 84 4 1 4 9 6 4 14 14 28 2.15 2.15 4.31 5 5 - 4 5 9 14 85+ - - 1 2 - 4 1 6 7 .15 .92 1.08 1 2 3 - 4 2 6 TOTAL 15 2 17 13 15 11 47 26 73 7.23 4.00 11.23 22 13 11 7 33 20 53 69 The Fog, 5th-9th December, 1952. Deaths of Tottenham residents from Influenza, Pneumonia and Bronchitis for the fortnight, 7th-20th December, 1952, compared with average for previous winter months. 70 DEATHS REGISTERED IN 1952. (NOTE: This chart shows the number of deaths which actually occurred in the Borough during each 4-weekly period. It does not show the number of deaths of Tottenham residents 71 Birth- rates, Death-rates, Analysis of Mortality, Maternal Mortality and Case rates for Certain Infectious Diseases in the year 1952 for Tottenham compared with the Registrar-General's provisional figures based on Quarterly Returns England and Wales 160 County Boroughs and Great Towns (including London) 160 Smaller Towns (Resident Population 25,000 50,000 at 1951 Census) London Administrative County Tottenham Rates per 1,000 Home Population BIRTHS Live births 15.3 16.9 15.5 17.6 12.31(c) Still births ( 0.35 0,43 0.36 0.34 0.29 (22.6(a) 24.6(a) 23.0(a) 19.2(a) 21.15(a) DEATHS All causes 11.3 12.1 11.2 12.6 11.92(c) Typhoid and paratyphoid 0.00 0.00 0.00 - - Whooping Cough 0.00 0.00 0.00 0.00 0.01 Diphtheria 0.00 0.00 0.00 0.00 - Tuberculosis 0.24 0.28 0.22 0.31 0.22 Influenza 0.04 0.04 0.04 0.05 0.05 Smallpox 0.00 - - - - Acute poliomyelitis (including polioencephalitis) 0.01 0.01 0.00 0.01 - Pneumonia 0.47 0.52 0.43 0.58 0.51 NOTIFICATIONS (CORRECTED) Typhoid fever 0.00 0.00 0.00 0.00 - Paratyphoid fever 0.02 0.02 0.03 0.01 0.02 Meningococcal infection 0.03 0.03 0.03 0.02 0.03 Scarlet fever 1.53 1.75 1.58 1.56 2.83 Whooping Cough 2.61 2.74 2.57 1.66 1.10 Diphtheria 0.01 0.01 0.03 0.01 - Erysipelas 0. 14 0.15 0.12 0.14 0.10 Smallpox 0.00 0.00 0.00 - - Measles 8.86 10.11 8.49 9.23 13.82 Pneumonia 0.72 0.80 0.62 0.57 0.64 Acute poliomyelitis (including polioence Phalitis) Paralytic 0.06 0.06 0.06 0.06 0.06 Non paralytic 0.03 0.03 0.02 0.03 0.01 Pood poisoning 0.13 0.16 0.11 0.18 0.07 Puerperal Pyrexia 17.87(a) 23,94(a) 10.22(a) 30.77(a) 0.01 Rates per 1,000 Live Births DEATHS All causes under 1 year of age 27.6(b) 31.2 25.8 23.8 20.41 (a) Per 1,000 Total (Live and Still) Births (b) Per 1,000 related Live Births (c) Corrected by comparability factors 72 Statistics of Tottenham for the last Twenty Years Year Population Deaths Death Rate Births Birth Rate Infantile Deaths Infant De ath Rate Number of Cases Puerperal Fever and Puerperal Pyrexia Scarlet Fever Diphtheria Typhoid Fever Smallpox 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 - (1,559) 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 34 107 - - 1944 108,180 1,356 12.53 2,066 19.09 87 42.11 13 206 44 - - 1945 110,600 1,371 12.40 1,988 17.97 78 39.24 14 214 47 - - 1946 124,830 1,491 11.94 2,580 20.67 88 34.11 13 323 83 - - 1947 129,140 1,461 11.31 2,785 21.57 76 27.29 24 272 22 - - 1948 130,000 1,377 10.59 2,233 17.18 53 23.73 5 260 2 1 - 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 - - - 1952 125,800 1,415 11.25 1,666 13.24 34 20.41 1 356 - - - * For the years 1939 1941 alternative birth figures were given by the Registrar General:- (a) for calculation of birth rates; and (b) for calculation of death rates or the incidence of notifiable diseases. Likewise for the year 1939 only, two population figures were given:- (a) for calculation of birth rates; and (b) for calculation of death rates, etc. 73 INFANTILE DEATHS IN AGES AND SEXES DURING THE YEAR 1952.; 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 - Gastroenteritis and Diarrhoea - - - - Congenital Malformation. Birth Injuries Atelectasis 4 2 1 1 1 1 10 1 1 12 8 4 Prematurity 5 2 1 1 3 1 13 13 10 3 Other Causes 2 1 1 4 1 1 1 7 4 3 Total 9 4 2 3 3 1 1 1 1 2 27 2 3 1 1 34 23 11 74 CLASSIFIED DEATHS OF TOTTENHAM RESIDENTS SHEWING AGE-GROUP AND SEX DISTRIBUTION DISEASE TOTAL 0-4 5-9 10-14 15-19 20-24 25-34 35-44 45-54 55 64 65 74 75-84 85 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 Tuberculosis, respiratory 23 2 - - - - - - - - - - 1 - 4 1 3 - 10 - 4 - 1 - - Tuberculosis, other 3 - - - - - - - - - - - - - - - - 1 - 1 - 1 - - Syphilitic disease 3 2 - - - - - - - - - - - - - - - - 1 2 2 . _ - - Diphtheria - - - - - - - - - - - - - - - - - - - - - - . - - Whooping cough - 1 - 1 - - - - - - - - - - - - - - - - - - - - - Meningococcal infections - - - - - - - - - - - - - - - - - - - - - --- - - - Acute poliomyelitis . . - . - - - - - - - - - - - - - - - - . . - - - Measles - - - - - - - - - - - - - - - - - - - - - - - - - Other infective and parasitic diseases 2 - 2 - - - - - - - - - - - - - - - - - - - - - - Malignant neoplasm, stomach 23 18 _ - - - - - - - - - - - 2 - 2 2 6 2 10 7 3 - - Malignant neoplasm, lung, bronchus 46 11 - - - - - - - - - - - - 1 3 10 2 19 2 12 2 3 2 1 Malignant neoplasm, breast - 21 - - - -- - - - -= = - - - - - - 5 - 3 - 6 - 5 - Malignant neoplasm, uterus - 11 - «= - - - - - - - - - - - 1 - 2 - 4 - 2 - 2 - Other malignant and lymphatic neoplasms 89 52 1 - - - - - - 1 1 - 1 1 1 4 10 11 20 10 26 15 27 9 2 Leukaemia, aleukaemia 4 2 - - 1 - 1 1 - 1 - - . - . .. . 1 1 - - Diabetes 3 i 4 - - - - - - - - - - - - - - - - 1 2 2 1 - 1 - Vascular lesiors of nervous syst em 72 101 1 - - - - - - - - - - - 2 1 6 3 12 15 18 38 27 35 6 Coronary disease, angina 109 74 . - - - - - - - - - - = 6 1 16 1 18 13 40 30 27 22 2 Hypertension with heart disease 13 14 - - - - - - - - - - - - - 1 - - 1 1 6 3 5 9 1 Other heart disease 92 120 - - - - - - 1 - - - - 1 1 1 5 7 12 7 22 27 32 46 19 Other circulatory diseases 31 22 - - - - - - - - - - - - - - -_ - 5 - 8 10 13 - 5 Influenza 3 3 - - - - - - - - - - - - - - - - 1 - - - 2 - - Pneumonia 41 23 2 - - - - - - - - - 2 - 2 1 3 1 7 3 9 6 13 10 3 Bronchitis 82 55 1 - - - - - - - - - 1 - 3 - 19 6 35 19 19 21 5 Other diseases of respiratory system 12 3 - - - - - - - - - - - - 3 1 1 - 3 1 2 - 3 - - Ulcer of stomach and duodenum 14 7 - - - - - - - -- - - - - - - 2 1 4 - 6 4 2 2 - Gastritis, enteritis and diarrhoea 1 5 - - - - - - - - - - - - - 1 - 1 - 1 1 - - 2 - Nephritis and nephrosis 7 6 1 - - - - - - - 1 1 1 1 1 2 1 1 - 1 2 - - - Hyperplasia of prostate 12 - - - - - - - - - - - - - - - - - - - 6 - 5 • 1 Pregnancy, childbirth, abortion - 2 - - - - « - - - 1 - 1 - - - - - - • • Congenital malformations 6 2 5 2 1 - - - = - - - - - - - - - - - - Other defined and ill-defired diseases 65 45 17 7 - - 1 - 1 - - - 2 1 1 1 13 6 9 5 13 7 7 13 1 Motor vehicle accidents 10 3 - - - 2 - - 1 - - - 2 - 1 1 - - 2 - - 3 - 1 All other accidents 10 12 1 1 - - - - - - 2 . 1 - 1 1 2 3 3 5 Suicide 10 8 - -- - - - -- - - - 1 1 - 1 1 1 8 2 3 Homicide and operations of war TOTAL 786 629 30 . .. 12 L 2 2 2 1 3 1 2 1 10 6 28 21 78 44 161 80 227 186 196 200 41 75 CANCER DEATHS 1952 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 P M F m F M F M F m F M F Buccal cavity and pharynx 6 1 1 1 3 Digestive Organs and Peritoneum 69 50 1 1 2 3 9 6 20 7 19 18 18 14 1 Respiratory system 47 13 1 1 3 9 3 18 3 12 2 5 2 1 - Breast and Genitourinary system 20 42 2 8 4 9 10 12 4 9 2 2 Other and unspecified sites 11 8 1 4 5 1 2 4 2 Lymphatic & Haematopoietic Tissues 9 2 1 1 1 1 1 1 3 1 1 TOTAL 162 115 1 1 1 1 1 2 1 1 4 8 22 22 45 21 49 33 33 25 3 3 76 Table of Cases of Infectious Disease coming to the knowledge of the Medical Officer of Health during the year 1952, in the Borough of Tottenham, classified according to Diseases and Ages Under 1 1 2 3 4 5-9 10 14 1519 20 34 35 44 45 64 65 & UP Total Total cases removed t0 llosp it III m F m F m F m F m F m F m F m F m[ f 1 1 m F m F m f Scarlet Fever 1 1 3 6 9 4 17 18 28 17 106 117 3 21 1 2 - 2 - - - - - 356 158 Measles 25 26 79 57 95 98 118 102 123 121 426 439 5 15 1 3 3 3 - - - - - - 1739 90 Whooping Cough 9 9 4 9 8 10 8 11 5 8 23 31 - - - - - 3 - - - - - 1 139 13 Pneumonia 1 3 1 2 3 - - 1 - 1 3 3 2 - 1 - 5 5 5 4 8 5 17 11 81 16 Erysipelas - - - - - - - - - - - - - - 1 - 1 - 1 1 1 4 - 3 12 5 Scabies - - - - - - - - - - - - - 1 - 1 1 1 - - - 1 - - 5 - Food Poisoning - - - - - - - - - - - - 1 - - - 1 - - 1 2 3 - 1 9 3 Puerperal Pyrexia - - - - - - - - - - - - - - - 1 - - - - - - 1 • Meningococcal Infection 1 - - - - 1 - - 1 - - - - - 1 - - - 4 4 Acute Encephalitis- Infective - - - - - - - - - - -■ - - - - - - - - » • ■ Post-Infectious - - - - - - - - 1 - - 1 - - - - - - - - - - - - 2 2 Acute Poliomyelitis - Paralytic - - - - 1 - - - - - - 2 1 = - 1 - 1 - - 1 - - - 7 5 Non-paralytic - - - - - - - - - - 1 - - - - 1 1 Diphtheria - - - - - - - - - - - - - - - - - - - - - - - - - Paratyphoid - - - - - - - - - - - - - - - - - - - - - - - 3 3 Dysentery - - - - 1 - - - - - - 2 - ~ 1 - 1 - 1 - - - 1 2 9 6 Ophthalmia Neon atorum - - - - - - - - - - - - - - - - - - - - - - - - - - Tuberculosis, - - - - - - - - - - - - - - - - - - - - - - - - - - Pulmonary - 1 1 - - 2 - 1 - 2 - 3 2 3 7 10 37 36 12 7 28 3 7 1 163 Tuberculosis, Other forms - - - - - - 1 - - - 1 1 2 - 1 - 4 3 - 2 - 1 ■ 16 TOTAL 37 40 88 74 117 115 144 133 157 150 559 600 16 40 16 17 53 55 20 15 40 17 25 19 2547 306 A P P E N D I X MIDDLESEX COUNTY COUNCIL LOCAL AREA HEALTH COMMITTEE No. 3 (HORNSEY AND TOTTENHAM) STATISTICAL RETURN FOR THE YEAR ENDED 3 1 S T DECEMBER 1952 JOINT POPULATION OF AREA 224,940 77 MEMBERS OF LOCAL AREA COMMITTEE NO. 3 AS AT 31ST DECEMBER, 1952 MEMBERS OF MIDDLESEX COUNTY COUNCIL County Alderman Mrs. K.M. St.P, Crump. County Councillor Mr. M.W. Burns, County Councillor Mr. R. A. Clarke. County Councillor Mr. W. - East. County Councillor Mr. E. Harrison, S.de L., F. R. G. S., A. G. S. A. County Councillor Mrs. J. Thexton. MEMBERS OF HORNSEY BOROUGH COUNCIL Councillor Miss O.R. Anderson (Vice-Chairman). Councillor Mrs. D.F. Nott. Councillor Miss J. Richardson, Councillor Mr. C.V. Tipping. Councillor Miss M. Toyne. MEMBERS OF TOTTENHAM BOROUGH COUNCIL Alderman Mr. A. Reed, A.C.I.I., J.P. Councillor Mr. R. W. H. Ford. Councillor The Lady Morrison. Councillor Mrs. A.F. Remington (Chairman), Councillor Mr. P.H. Roberts. Councillor Mr. G.W. Rowley. NOMINATED MEMBERS MEMBERS NOMINATED BY APPROPRIATE HOSPITAL MANAGEMENT COMMITTEES Mrs. P. M Fry MEMBER WITH KNOWLEDGE AND EXPERIENCE OF HOME NURSING Mr. A.. E. Stevens. 78 MEMBER NOMINATED BY ROYAL COLLEGE OF MIDWIVES Miss V. Eady. 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. Hay ward. AREA HEALTH STAFF 1952 Area Medical Officer G. Hamilton Hogben, M.R. C. S., D.P.H. Deputy Area Medical Officer J.L. Patton, M,B., Ch.B., D.P.H. Senior Assistant Medical Officer Mrs J.H. Garrow, M.B., Ch.B., D.P.H. Area Dental Officer V. Sainty, L.D.S., R.C.S. Superintendent Health Visitor Miss H. Townsend, S. R. N., S. C. M., H. V. Deputy Superintendent Health Visitor Miss E. Lloyd, S. R.N., S. C.M., H.V. Non-medical Supervisor of Midwives and Home Nursing Superintendent Miss. F. E. Curtis, S. R.N., S. C.M. ,H. V. Supervisory Matron of Day Nurseries - Miss J. Pearse, S.R,C.N. Home Help Organiser Miss A. G. Alcock Assistant Home Help Mrs. W.E. Pickard, S.R.N„ Organisers Mrs. F. G. Wills. Area Chief Clerk W.L.N. Relleen, T.D., D.P. A. Deputy Area Chief Clerk T.W. Hadley. Sectional Heads N. P. Child. G. Cree. H.J. Dunham, B.A. 79 CARE OF MOTHERS AND YOUNG CHILDREN (SECTION 22) Care of the Expectant Mother The well-being of the expectant mother from early pregnancy until confinement is the aim of all in attendance at ante-natal clinics. In this we have the co-operation locally of general medical practitioners, regional hospital obstetric consultants, almoners and others concerned in this service and who recommend mothers to attend local clinics to save time and unnecessary travelling. Abnormal cases are few in number and are referred to hospital for treatment. Where necessary, appointments can be made for X-ray and dental care and an ambulance booked to convey a mother between clinic and home. The card report system which was extended to Clapton Mothers' Hospital last year has operated successfully. Arrangements for domiciliary confinement or the reservation of a hospital bed are made for the mother at each local clinic. The services of a home help are available if required for all domiciliary confinements and temporary nursery accommodation can be provided for preschool children in certain cases. In Hornsey, where the majority of hospital cases are booked for the Alexandra Maternity Home, there is a useful link in that two part-time ante-natal clinicians are also medical officers to the Home and general practitioners in the town. The health visitor in attendance at the clinic discusses arrangements with each mother and makes known to her the various services which are available to her during her pregnancy, confinement and puerperium. The maintenance of all these aids does much to prevent unnecessary worry and ill-health at a time when the mother is m most need of relief and support. Blood Tests All expectant mothers attending ante-natal clinics have specimens of blood taken for Wasserman reaction, blood grouping and determination of Rhesus factor. At some clinics patients 80 have their haemoglobin estimated at the first visit and regularly every four weeks thereafter whether they are hospital or home confinements. The haemoglobin estimation is done by the Sahli method in the clinic by the same health visitors and checks are made on the accuracy of the estimations from time to time by cooperation with the Pathologist of the Post-Graduate Medical School, Ducane Road, W. 12. The results have been accurate within 5%. A record is kept of the patient's ability to take iron and the type most easily tolerated. Relaxation and Mothercraft Classes This service is now operating in three Hornsey and three Tottenham Clinics and is much appreciated by expectant mothers. The group teaching is in all cases given by a health visitor whose aim is to dispel fears associated with pregnancy and confinement and to instruct mothers on those matters associated with the wellbeing of themselves, normal childbirth and the preparation for the care of their children. The classes are kept as informal as possible and time is allowed for questions and answers as well as for a cup of tea. Many mothers return post-natally for exercises and to consult the Health visitor. Notification of Births - Home and Institutional Confinements It will be observed from the table set out below that more than 80% of the births which occurred last year were in hospital and nursing homes. The number of home confinements has dropped steadily since the peak birth rate year of 1947. It is interesting to note that this drop continued over the last three years even though the number of births has remained fairly steady. It would appear that while the hospitals are able to provide a sufficient number of beds for maternity cases, mothers are being discouraged from having their babies at home, especially as it is less expensive for them to go into hospital. Because of the lack of discrimination in favour of admission to hospital on purely obstetric or social grounds difficulty sometimes arises in finding a bed m an emergency, as all hospital accommodation has been taken up. 81 The number of institutional confinements in Hornsey is undoubtedly increased by the existence in that borough of the Alexandra Maternity Home which accommodates over 600 Hornsey births each year. In Tottenham, on the other hand, there is evidence that hospital accommodation is more limited and is always taken up. The Tottenham patients make use largely of the North Middlesex Hospital and the Mothers' Hospital, Clapton. These, together with the Alexandra Maternity Home, take nearly two-thirds of the institutional births of the area, and with all of them there is close co-operation. The majority of the remainder of the institutional confinements take place in hospitals in Central London, although some 47 mothers were last year confined at private or voluntary assisted nursing homes in Hornsey. The trend to hospital confinements is a National one and the Minister of Health issued a circular on the subject in August 1951 stating that though it was not possible to lay down a proportion of births for which hospital or maternity home beds should be provided, in general, hospital provision is required on medical or social grounds for about half the confinements. In this area well over half of the confinements are in institutions, but at the same time some of the 17% of home confinements should have been in hospitals and closer co-operation than already exists is needed to ensure that the.right patients are admitted to maternity beds. TABLE 1 1952 1951 1950 1949 1948 1947 Total Births (Live and Still) 3265 3162 3261 3672 40 59 4935 Institutional Births .2679 2487 2394 2706 2754 2684 % age of Total 8 2. 1 78. 6 73. 4 73. 7 67.8 54.4 Domiciliary Births 586 675 867 966 130 5 2251 % age of Total 17. 9 21. 4 26.6 26. 3 3 2. 2 45.6 Ante-natal Clinics The average attendance at ante-natal clinics continues to decline but has not yet reached the stage where any curtailment in the number of sessions held is desirable. The following table 82 shows the attendance at clinics during 1952 and the totals for the preceding three years are given for purposes of comparison. Separate post-natal clinics are not held. TABLE 2 Ante-natal Clinic No. of sessions held No. of new cases Total attendances Average attendances per session A. N. P.N. A. N. P.N. Burgoyne Road 50 141 87 987 91 25. 6 Church Road 78 145 58 1287 62 17.3 Portis Green 61 223 148 1540 161 27. 9 Hornsey Town Hall 211 313 177 2893 181 14. 6 Mildura Court 62 199 64 1363 64 23.0 Stroud Green Road 51 158 72 891 74 18. 9 The Chestnuts 256 511 253 3326 265 14.0 Lordship Lane 206 405 228 2758 233 14. 5 Park Lane 103 366 246 2018 246 21. 9 Totals 1952 1078 2461 1333 17063 1377 17. 1 1951 1038 2439 1330 16999 1332 17. 7 1950 1082 2594 1303 19006 1331 18.7 1949 1074 2714 1438 20617 1491 20. 6 Midwives Clinics Domiciliary midwives assist at all but two of the ante-natal clinics. An attempt is made to ensure that this work is done by the midwife who is likely to deliver the patient in each case. In four centres separate midwives clinics are held and the following table shows the attendances made during the year. TABLE 2a Midwives Clinics No. of sessions held No. of new cases Total No. of attendances Average attendance per session Burgoyne Road 49 15 239 4. 9 Portis Green 42 5 278 6. 4 Park Lane 101 - 1145 11.3 Stroud Green Road 47 2 304 6. 5 Totals 239 22 1966 8. 2 83 Post-natal Care An appointment is made for each mother to attend for a postnatal examination at the clinic which she attended as an expectant mother, approximately six weeks after the confinement. Here she is seen by the doctor who undertook her ante-natal care and who knows her and any, special features connected with the case. The hospital's or midwife's report on the confinement is held in readiness for this examination so that the examining doctor knows all the facts connected with the case. Each mother is encouraged to keep this appointment so that any defects which may have resulted from her confinement are detected and treated at once so as to avoid future disability. Care of Premature Infants There is an agreement with the North Middlesex Hospital for the admission of any woman in premature labour, to avoid delivery at home and later transfer to hospital. The hospital will admit the case on a midwife's or doctor's request, and this applies also to the need to transfer a premature child born at home. Premature babies delivered at home. The case is graded according to the baby's requirements. More frequent visits and a special nurse, if necessary, special clothing, hot water bottles and breast milk (when available) are loaned out. Special cots are not provided. Supervision of the infant is continued for as long as required. Infant Welfare Centres In nine centres doctors and health visitors with special qualifications in child health attend to give advice to mothers of healthy infants on normal development and progress. Regular weighing and physical examination brings to light the smallest deviations from normal growth and well-being, and these deviations are investigated with the mother so that they can be' remedied. In the early months of life advice on feeding is frequestly sought, particularly for infants who are artificially fed and those who have reached the weaning age. This service does much to ensure the growth of a healthy child and is a means of educating mothers on the proper care of their children. 84 Sessions are also held at which the Health Visitor alone is in attendance and where time can be given to test-feeding, etc. These clinics have a vital part in promoting child health. Attendances have been well maintained during the year and the first attendances of children under one year of age represent 87% of the notified live births. All children, especially new babies, are followed-up by health visitors'home visits. The inter-relationship of infant welfare clinics and home visiting are obvious as is also the fact that with the present staff of health visitors it would be impossible to supervise the health of so many children by visiting only. Toddlers Clinics Toddlers clinics are now held at all nine centres. This is an increase of one over 1951. Appointments are made for a six monthly or more frequent medical overhaul for those children who do not receive medical examination at other clinics or at day nurseries, nursery schools or classes. Appointments are welcomed by parents. The purpose of these examinations is to detect and correct mental or physical defects and maintain t,he good health of children in the 2-5 years age group so that they are in good condition before attendance at school. 85 TABLE 3 Infant Welfare Centres No. of sessions held First Attendances Total Attendances Seen by Doctor Average attendances Under 1 Over 1 Under 1 Over 1 Bursoyne Road 156 205 16 3771 959 1325 30. 3 Church Road 153 199 10 3619 969 1656 29.9 Port is Green 203 250 2 4271 1116 1555 26. 5 Hornsey Town Hall 208 402 25 5709 2206 3323 38.0 Mildura Court 106 166 8 3005 1469 1675 42. 2 Stroud Green 104 187 8 2963 997 802 38.8 The Chestnuts 257 566 34 7204 1804 2349 35.6 Lordship Lane 258 432 35 6391 1773 1480 31. 2 Park Lane 207 379 14 5530 1362 1571 32. 3 Toddlers Sess ions Burgoyne Road 24 - 7 - 439 439 18. 3 Church Road 46 - 8 - 486 480 10. 5 Fort is Green 26 - 15 - 378 378 14. 5 Hornsey Town Hall 50 . 27 - 584 575 11. 7 Mildura Court 41 - 17 - 721 607 17.6 Stroud Green 6 - 9 - 89 88 14.8 The Chestnuts 53 - - - 698 698 13.1 Lordship Lane 51 - 16 - 822 822 16. 1 Park Lane 106 - 2 - 897 892 8.5 Totals 1952 2055 2786 253 42463 17769 207 1 5 29. 3 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 Child Life Protection The Area Children's Officer and his staff are responsible for adoption arrangements and the care of children deprived of a normal home life, but there are border-line cases of child neglect which are watched carefully by health visitors in the normal course of the supervision of child health and well-being- This usually acts as a deterrent but if necessary the health visitor warns careless or neglectful mothers of the consequences of their behaviour. Only a few of these cases deteriorate and those and any doubtful cases are reported to the Area Children's Officer or the N.S.P = CoC. 86 Daily Guardian Scheme This scheme, by which working and other special categories of mothers are assisted in finding suitable daily minders for their children, operates exceedingly well. In spite of a certain wastage in daily guardians, the number of women who offer their services, considerably exceeds the present demand. At the end of 1952 there were 161 daily guardians on the register of whom 76 were minding 88 children. The number of individual children minded during the year was 148 and they were in the care of guardians for 18,876 days. These figures compare with 129 and 15,710 respectively for 1951. Health Visitors undertake to approve guardians for registration and are responsible for vigilance in seeing that the scheme's safeguards are carried out. Day Nurseries The County Council's new policy on the admission of children to day nurseries and the charges for admission, which came into operation on the 1st December, had the effect of drastically reducing the numbers on the registers and the daily attendances by the end of the year. The following table shows the number of children on the registers at the end of the year and the attendances during the year. Comparative totals for 1951 are also shown. TABLE 4 Day Nursery No. of approved places at end of year No. of children on register at end of year Attendances Average daily attendances 0 - 2 years 2 - 5 year s 0 - 2 years 2-5 years 0-2 years 2-5 years 0-2 years 2-5 years Ladywell 24 50 19 33 4672 10367 18 40 Stonecroft 15 45 13 27 3155 9652 12 38 Red Gables 23 23 14 16 4317 5623 17 22 Park Lane 20 30 16 21 3408 6131 13 24 Lordship Lane 10 30 9 22 2452 5419 10 21 Plevna Crescent 20 30 12 34 2517 8974 10 35 Totals 1952 112 208 83 153 20521 46166 80 180 1951 112 208 114 232 21867 45479 85 177 87 Priority Dental Service The following table shows the work carried out by the dental officers during the year. The work done during 1951 is also given for purposes of comparison. TABLE 5 1952 1951 Expectant & Nursing Mothers Children under 5 Expect ant & Nursing Mothers Children under 5 No. examined by dental officer 226 1127 43 879 No. referred for treatment 211 992 42 795 New cases commenced treatment 179 876 37 715 Cases made dentally fit 77 663 21 462 Forms of dental treatment provided: - Teeth extracted 200 879 53 893 Anaesthetics: - (a) Local 64 192 10 196 (b) General 40 308 9 275 No. of fillings 234 1562 35 1005 No. of root fillings - - 1 - No. of crowns and bridges - - - - No. of inlays 2 - - - Scalings and gum treatment 72 - 16 - Silver nitrate treatment - 1165 - 944 Dressings 81 752 6 687 Other operations 11 106 1 94 No. of Radiographs:- (a) at County Council Clinics 5 2 - 2 (b) at hospital 2 - - - Denture dressings 73 - 55 - Dentures fitted:- (a) full 5 - 6 - (b) partial 14 - 8 - No. of attendances 468 2114 104 1663 No. of appointments not kept 170 306 23£ No. of ½ days devoted to service 379½ 212 88 It has not been considered necessary to replace them as the decline in the number of home confinements, to which reference was made in my annual report for 1951, has continued. Supervision of Midwives. Inspections of registers of births, equipment and drug books are carried out at six-monthly intervals. Once yearly a visit is made to the midwife's home by the senior assistant medical officer and routine inspection carried out. Supervision of practical work at six-monthly intervals, also attendance of non-medical supervisor at any confinement where the midwife becomes anxious or is out over a period of many hours. A weekly meeting of domiciliary midwives is held for the purpose of general discussion of cases, problems connected with the work and matters of interest connected with midwifery. In addition, the non-medical supervisor is in touch with each midwife daily, either personally or by telephone. Co-operation with ieneral practitioners„ New general practitioners are visited by the midwife working in his area, or by the non-medical supervisor, and his wishes regarding care of ante-natal patients ascertained. The degree of care of practitioners' cases by the midwife is based on the individual requirements of each doctor. In Hornsey most of the practitioners® cases attend the local authority clinics. This is also done in Tottenham but to a lesser degree. Relations between doctors and midwives in this area are extremely cordial. 89 TABLE 6 Maternity cases attended by County Council Domiciliary Midwives:- 1952 1951 1950 As Midwife 496 589 708 As Maternity Nurse Totals 59 71 154 555 660 862 Administration of Gas and Air Analgesia by County Council Domiciliary Midwives:- 1952 1951 1950 As Midwife 360 368 352 As Maternity Nurse 36 30 89 Totals 396 398 441 Medical Aid:- 1952 1951 1950 (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 services under the National Health Service 34 12 24 (ii) Others 100 166 162 (b) For cases in institutions 11 13 5 Totals 145 191 191 90 Institute of Child Health, and have provided other reports for no less than twenty-two different hospitals in or near the London area. Health visiting in schools also takes up a proportion of each health visitor's time. This includes attendance at routine hygiene examinations and medical inspections. Requests for health education in schools are increasing and during the year no less than 73 talks were given by health visitors to classes of school leavers at secondary modern schools in the area. Health talks were also given to outside bodies such as Young Wives Clubs, Wesley Guilds, the Women's Branch of the British Legion and the Girls Life Brigade. Clinic nurses have undertaken some of the routine work in clinics and schools to give health visitors time for their more essential duties. TABLE 7 No. of visits paid by all Health Visitors working in the area to; - 1952 1951 First Visits Total Visits First Visits Total Visits Expectant Mothers 2077 3332 1721 4544 Children under 1 year 3204 15241 3158 13825 Children 1-5 years 15 20804 27 18146 Children of school age 1 3417 5 2367 Other persons 3101 4010 1969 3253 Tot als 46804 42135 No. of health visitors employed at end of 1952:- (a) Whole time on health visiting (b) Part time on health visiting 29 (c) Equivalent whole time health visiting service provided under (b) including attendances at clinics 22 Co-operation of General Medical Practitioners One factor which must influence the working of the local health services is the growing co-operation between the family doctor and health visitor. This is developing in the following 91 ways. Health visitors have called upon or contacted general medical practitioners by telephone on such matters as feeding difficulties of babies, illness of mothers, including mental disturbances, illness of aged persons, to discuss departures from normal health of mothers and children of pre-school or school age, to report the illness of a child suspected of neglect. General medical practitioners have assisted the Health Department by referring expectant mothers to local clinics for additional ante-natal care, by requesting the services of home helps for sick people or for the aged, by referring cases for convalescence, by reporting cases of persons who were not able to care for themselves properly and for whom hospital accommodation was unobtainable, and also for passing on advice or information to the health visitor on those cases in which the health visitor sought the family doctor's advice. In my opinion this interchange of information and assistance is to be commended as providing a better service for the public and more cordial relations between members of the local health service. Ministry of Health Food Survey This survey was undertaken with the assistance of health visitors in January and about 25 Tottenham mothers took part in it with the field workers of the Ministry, Virus Infection During Pregnancy Health visitors and medical staff are assisting in keeping records of a group of mothers in this and other areas from pregnancy until the child's second birthday. This information is being obtained for the Ministry of Health investigation of virus infections during pregnancy. HOME NURSING (SECTION 25) The demands on the home nursing service continued to increase during 1952 and at the end of the year the nursing staff was very nearly up to full establishment. It was not found any easier to recruit resident nurses to live in Bruce Grove Nurses Home, Tottenham and, in fact, by the end of the year, the numbers in residence (including the Superintendent) had fallen from 6 to 4. 92 TABLE 8 Males over 14 Females Over 14 M. & F. 14 & under Total Cases on register on 1.1. 52. 136 304 9 449 New cases during the year 869 1632 237 2738 Cases completed during the year 867 1584 244 2695 Cases remaining on register on 31. 12. 52. 138 352 2 492 Total No. of visits during 1952 - 77113 Total No. of visits during 1951 - 62124 Co-operation with general practitioners. Work from the doctors is received at Bruce Grove Nurses Home or the Area Health Office and the visits are distributed from those points. Cooperation is good and the doctor is able to make any special point when he requests the services of a nurse. A message sheet is left at the patient's house for the exchange of notes between doctor and nurse. No service has been arranged for night work but requests have been very few. The emergency calls for a nurse between the hours of, say, 7 and 10 p.m. are also few and have been met without great difficulty. VACCINATION AND IMMUNISATION (SECTION 26) Vaccination During the year the Minister of Health approved an amendment to the County Council's Proposals as to Vaccination and Immunisation made under the National Health Service Act to the effect that facilities would be made available at the clinics for infant vaccination by medical officers in addition to the service provided by general practitioners. This scheme has been well received by the mothers and it is hoped that with its gradual development the percentage of infants vaccinated will steeply rise; but even more intensive education of parents on the importance of vaccination is required. Vaccination is being carried out on infants, preferably at four months but not over 12 months old. The following table records the number of persons known to have been vaccinated or re-vaccinated during 1952:- TABLE 9 Under 1 year 1 year 2 - 4 years 5-14 years 15 years and over Total (1) No. of persons primarily vaccinated 937 55 38 54 135 1219 (ii) No. of persons re-vaccinated - - 10 101 379 490 Immunisation As stated in my last annual report the County Council agreed to make available free whooping cough vaccination at all immunisation clinics following the success achieved by the controlled experiments carried out in this and other districts by the Medical Research Council at the request of the Ministry of Health from 1950 to 1952. The introduction of the new combined diphtheria pertussis vaccine suspension now gives protection against diphtheria and a degree of protection against whooping cough in a total of three injections. This reduced total of injections is very popular with the mothers and it is anticipated that the percentage of immunised children will show a satisfactory increase during 1953* The series of three injections is commenced at the age of six months wherever possible. The mothers are informed that while a degree of protection against whooping cough will be obtained it is less certain than protection against diphtheria. It is felt that this warning is necessary to prevent immunisation against diphtheria falling into disrepute should the child subsequently develop an attack of whooping cough. The following table records immunisations carried out by area medical staff as well as general medical practitioners during 1952:- 93 94 TABLE 10 Age at date of Immunisation No. of Children immunised No. of children given re-inforcing injections Diphtheria only Combined Diphtheria & Whooping Cough Whooping Cough only Diphtheria only Combined Diphtheria & Whooping Cough Under One 1094 115 218 - - One 690 77 642 - - Two 96 3 98 - - Three 52 4 41 5 - Four 41 1 23 347 4 Five to Nine 66 3 10 868 7 Ten to Fourteen 14 - - 42 - Totals 20 53 203 1032 1262 11 PREVENTION OF ILLNESS, CARE AND AFTER CARE (SECTION 28) Recuperative Holiday Homes During the year, area health staffs continued to be responsible, on behalf of the County Health Department, for dealing with applications for admissions to recuperative holiday homes. The following table y ear:- shows the cases dealt with during the Applications received Admissions to recuperative holiday homes recommended Adults 323 '266 Children '21 12 314 '278 DOMESTIC HELP SERVICE (SECTION 29) The County Council's scheme for the provision of home help in accordance with the rules governing priorities is being 95 operated. There has been a falling off in the demand for this service which was sharply accentuated in 1952. There is good liaison with the Old People's Welfare Committees in Tottenham and Hornsey and with the W.V.S. regarding the provision of meals on wheels. The following table is of interest in demonstrating the falling demand in new applications coupled with the increase in the number of old cases being served. TABLE 11 Maternity T. B. Others Total 1952 Comparative Totals 1951 1950 1949 No. of approved applications for service of home help received. 126 39 514 679 853 925 1013 No. of new cases in which help has been provided. 93 35 510 638 812 884 1011 No. of old cases in which help has been provided. 4 74 527 605 531 430 372 No. of helps employed at 31.12.52. (whole-time) 7 No. of helps employed at 31.12.52. (part-time) 116 Equivalent No. of whole-time helps employed at 31.12.52. 70 MENTAL HEALTH SERVICES (SECTION 51) During the year the County Council delegated to the Area Committee, for an experimental period of twelve months, certain functions relating to the day-to-day administration of the Hornsey Occupation Centre. It is considered that the arrangement has worked satisfactorily and it provides a link between the Mental Health Sub-Committee and the Area Committee. SCHOOL HEALTH SERVICE Routine Medical Inspections Three times in the child's school career the routine medical inspection brings together child, parent, teacher, nurse and doctor and the routine medical examination achieves best results 96 when first, the child is seen by the nurse; second, the doctor interviews the head teacher, and finds out if the head teacher from his or her day to day observation of the child suspects any deviation from normal health. The doctor, having the nurse's report, then interviews parent and child, questions are invited and problems relating to health explored, the child is examined and if a defect is discovered the parent is advised.1 However, in most cases the doctor and parent agree that the child is healthy, sometimes the mother needs to be re-assured that her anxieties are unfounded. The mother is advised to accept the first year of school life as a period when upper respiratory tract infections are common and to accept that the apparent thinness of the junior school child (ages 8, 9 and 10) is compatible with good health. When the routine medical inspection is completed the doctor reports relevant findings to the head teacher and makes any necessary arrangements for the disposal, treatment or follow—up observation of defects found. Dental Service During 1952 the dental staff was increased to seven fulltime dental surgeons so that all dental surgeries were fully staffed. It is hoped that during 1953 two additional dental clinics may be set up and staffed so as to allow a complete school dental and priority dental service for expectant and nursing mothers and children under school age to be maintained. The scheme for evening dental sessions which commenced on the 1st January 1952 enabled a total of 136 additional treatment sessions to be held at which 890 attendances were made. This contribution was equivalent to another full time dental surgeon being employed for three months during the year, Tottenham Day Special School for the Deaf The nursery block was completed during the year and 11 deaf children of nursery school age are now being accommodated. Vale Road Day Special School for Physically Handicapped Children Spastic Unit The formation of the spastic unit at Vale Road Special 97 School for Physically Handicapped Children, by building additional classrooms, has not yet materialised owing to unforeseen building difficulties. It is hoped that a start will soon be made on the building work so that the unit may come into full operation. During the year in spite of many difficulties more physiotherapy and speech therapy sessions have been devoted to cerebral palsy cases attending the school. In addition, arrangements were made for some of the children to receive physiotherapy during the school holidays.'; Children whose parents were agreeable, were transported by the ambulance service during the Christmas holiday to a school clinic, thus ensuring continuity of treatment. It is hoped to continue these holiday arrangements during 1953., Some of the special equipment required for the use of the unit has been obtained. Other equipment, including special desks and chairs, will be obtained when the additional accommodation is available.1 Physiotherapy The approved establishment of physiotherapists for the area is three. Their work is not only concerned with orthopaedic cases attending one or other of the clinics, but is essential for the needs of spastic children attending the special school for physically handicapped children. Between February and June 19S2, two full-time and two part-time physiotherapists were employed, equivalent to two and seven-elevenths full-time staff. At the time of writing the strength is one and nine-elevenths, the children at Vale Road are now receiving totally inadequate treatment and the inability to fill the vacancies is causing grave concern to the orthopaedic surgeons and the staff of the school. Speech Therapy A second speech therapist for Tottenham was appointed in April 1952: Two others work part-time in Hornsey This increase in staff has made possible a daily session at Vale Road Special School for Physically Handicapped Children, where two therapists, one with specialist training, treat children suffering from cerebral palsy. The importance of the preventive aspect of the work is becoming increasingly recognised. More pre-school children are seen. An indirect approach, through parent education, has proved 98 of value in the treatment of early stammer, or delayed speech development, while suspected sensory loss or organic lesion requiresthe earliest expert investigation. Work with a recording apparatus has shown the possibilities of such equipment as an aid to treatment. Report on the Rheumatism Supervisory Scheme for the year ist August 1951 to 31st July 1952 This rheumatism supervisory scheme was inaugurated on 1st August 1951 under the overall direction of Dr. I.M. Anderson, Paediatrician, Prince of Wales's Hospital, with the close cooperation of the local Public Health and Area Health Departments. The children are referred to the clinics by their private doctors and through the School Health Service, A number of children are also admitted directly to the paediatric wards of the Prince of Wales's Hospital and St, Ann's General Hospital suffering from acute rheumatic fever and allied conditions, After discharge from hospital these patients attend the supervisory clinic. The supervisory clinics for follow-up are held on alternate Monday mornings in the Out patients Department of the Prince of Wales's Hospital. The routine examinations are carried out by the paediatric registrar and an assistant medical officer,assisted by a sister-in-charge and a clerk from the Area Health Office. Both new and old patients are seen at each session In the case of new patients a full history is taken and a complete clinical examination is carried out. The various forms are then completed and other investigations, where necessary, such as X-rays and electrocardiographs are performed. After these preliminary procedures the patients are seen by Dr. Anderson on Tuesday and Thursday mornings at the Prince of Wales's Hospital. At this examination and from the results and reports previously obtained the diagnosis and clinical assessment are made and recommendations regarding future schooling are sent to the School Health Authorities. After this initial assessment the patients are seen at regular intervals at the supervisory clinic by the paediatrician °r local authority medical officer and should any significant change appear in the clinical condition they are again referred t0 Dr. Anderson for further discussion regarding treatment or 99 special educational requirements. During the year 37 patients suffering from acute rheumatism, chorea or recurrences were treated in the wards. While the number of long-stay in-patients was increasing it became apparent that some educational provision would become necessary and arrangements were made through the Borough Education Officer for Tottenham to provide a hospital teacher. The following table gives details of the patients referred to the supervisory centre during the year:- Rheumatism and allied disorders Congenital heart lesions No. of patients - Male 35 27 Female 40 20 75 47 Resident in Area 3 (Tottenham and Hornsey) 56 30 Resident in other areas 19 17 Diagnosis - 1. Rheumatic pains without heart disease 18 - 2. Rheumatic heart disease (active) (a) Alone 12 - (b) With polyarthritis 13 - (c) With chorea 3 - 3.Rheumatic heart disease (quiescent) 24 - 4. Rheumatic chorea (alone) 5 - Referred by - Family Doctor 54 27 School Health Service 20 19 Hospital 1 1 Reason for reference to clinic - Symptoms Accidental 69 11 finding 6 36 Health in 1st year of life - Satisfactory 55 21 Unsatisfactory (chiefly respiratory infections) 20 25 No record - 1 Disposal - Admitted to hospital (St. Anns) 37 17 „ „ „ (pre-scheme) 3 2 Out-patient supervision only 35 28 School Attendance - Ordinary - Full 60 29 Limited 10 1 Special - Day 2 3 Residential - 1 Pre-school 3 10 Still in-patient in hospital - 3 100 Child Guidance A proposal to establish a child guidance centre in Tottenham, within the existing accommodation at the Cornwall Road School Clinic, was approved during the year, The necessary alterations to the premises have, at the time of writing, been almost completed and it is anticipated that the centre will commence operations in April, 1953. Such a centre will be of great benefit to Tottenham mothers and children and will save them the long journey to the Child Guidance Training Centre in London.V Mass Radiography of School Children In February, 1952 the Mass Radiography Unit visited Tottenham. 1651 school children (941 boys and 710 girls) attended for miniature chest films. Of these, 26 (19 boys and seven girls) were recalled for large films. Of these, one boy was found to be suffering from active primary tuberculosis. B.C.G. Inoculations The Medical Research Council continued their investigation ANALYSIS OP SOME FACTORS IN THE RHEUMATIC GROUP Significant family history of rheumatic disorders 25 Housing conditions - Satisfactory 33 Unsatisfactory 16 No report 26 Psychosomatic assessment (by clinical judgement and school reports) Stable, well-balanced personality 54 Emotionally disturbed or unstable 21 Health in 1st year of life - Satisfactory 55 Unsatisfactory (chiefly respiratory infections) 20 Significance of blood anti-s.treptococcal titres No. of patients suffering from non-rheumatic disease Titres between 1/40 and 1/80 20 No. of patients suffering from rheumatic fever or recurrence, of the following titres:- 1/40 1 1/160 3 1/320 4 1/640 4 1/1280 3 101 in the area into the prevention of tuberculosis by B.C.G. vaccination. In 1951 the investigation had been concerned with accepting "school leaver" volunteers into the scheme. In 1952 the important task of following up the inoculated and the control groups was commenced. It can easily be appreciated that the success of the trial depends on the completeness of the follow-up, for without being able to assess the results of B.C.G. vaccination by comparing a large inoculated group with a control group no estimate of the value of the vaccine can be obtained. The follow-up is carried out in three ways:- 1. An annual X-ray and skin test:- Sessions are held at a convenient centre between 4.30 p.m. and 8 p.m. to enable young people who are at work to attend with the minimum of disruption to their employers. The employers themselves are encouraged, by means of letters sent out by the Youth Employment Officer, to release any of their employees who are included in the trials. Publicity is also given in the press and by slides at local cinemas. 2. Visits by Health Visitors:- Prior to the annual X-ray the health visitors visit the volunteers to complete questionnaires concerning their state of health. Particular regard is paid to illnesses of more than two days duration and to any visits to hospitals or clinics. The opportunity is also taken to remind them of the importance of attending for annual X-ray. 3. Co-operation with Chest Clinics:- The Chest Physicians supply information to the Medical Research Council with regard to children in the age groups covered by the investigation who are known to the Chest Clinics. In 1952 the Lordship Lane Medical Centre was used for the follow-up and out of 213 children who left school at the end of the 1951 summer term, 172 returned for X ray. This represents a figure of 81% and in the words of Dr. Pollock who is in charge of the trials on behalf of the Medical Research Council "is a very good figure and we have every reason to be pleased with the success achieved". 102 COUNTY COUNCIL OF MIDDLESEX AREA NO. 3 - HORNSEY AND TOTTENHAM SCHOOL HEALTH SERVICE STATISTICAL RETURN FOR THE YEAR ENDED 31ST DECEMBER 1952 103 SCHOOL HEALTH SERVICE STATISTICS FOR 19 52 TABLE 12 - Periodic Medical Inspection Other inspections Periodic Medical Inspections Second Third Other Soecial Entrants Age Age Total Periodic Inspections Rerinspections Group Group Inspections 3533 2248 2319 8100 3413 5515 6239 TABLE 13 - Classification of the General Condition of Pupils Age Groups No of pupils inspected A (Good) B (Fair) C (Poor) No. % No, % No. % Entrants 3533 1195 33.8 2294 64.9 44 1.3 Second Age Group 2248 726 32.3 1478 65.8 44 1.9 Third Age Group 2319 737 31.8 1559 67.2 23 1.0 Other periodic inspections 3413 1025 30.0 2329 68.3 59 1.7 Total 11513 3683 31 9 7660 66.6 170 1.5 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 130 35 782 10 ISyes a. Vision 410 219 233 4 b. Squint 67 18 32 4 c. Other 46 34 360 9 Ears a. Hearing 23 22 70 1 b, Otitis Media 12 30 44 - c. Other 17 36 238 f Nose and Throat 156 237 246 3 Speech 30 34 34 3 Cervical Glands 14 83 58 2 Heart and Circulation 22 79 31 2 Lungs 51 106 248 4 Developmental a. Hernia 4 9 2 - b. Other 1 22 21 - Orthopaedic- a. Posture 50 100 21 3 b. Plat Foot 95 67 25 1 c. Other 196 111 243 9 Nervous System- a. Epilepsy 2 5 3 - b. Other 16 22 33 3 Psychological- a. Development 1 30 84 1 b. Stability 8 62 92 13 Other 207 238 2390 39 1- Requiring treatment, 2, Requiring to be kept under observation but not requiring treatment 104 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 12 297 303 Second Age Group 108 252 341 Third Age Group 122 207 310 Total (prescribed groups) 242 756 954 Other periodic inspections 167 303 434 Grand Total 409 1059 1388 TABLE 16 - Minor Ailments Number of cases treated or under treatment during the year (a) Diseases of the Skin by the Authority Otherwise (excluding uncleanliness) Ringworm - (i) Scalp - - (ii) Body 9 - Scabies 4 - Impetigo 48 2 Other skin diseases 916 14 Total 977 16 Number of cases treated (b) Other treatment given no covered by other Tables by the Authority Otherwise (i) Miscellaneous minor ailments 2237 67 (ii) Other (Specify) Heart Circulation 30 33 Lungs 251 117 Psychological 128 25 Developmental 15 4 Total 2661 246 105 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 459 228 Errors of Refraction (including squint) 558 1550 Total 1017 1778 Number of pupils for whom spectacles were (a) Prescribed 288 * 807 * (b) Obtained 268 Ø 458 Ø * Including cases dealt with under arrangements with the Supplementary Ophthalmic Services Ø 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 - 99 (c) for other nose and throat conditions Received other forms of treatment 990 470 Total 990 569 TABLE 19 - Orthopaedic and Postural Defects (a) Number treated as inpatients in hospital 9 (b) Number treated by the Authority 553 Otherwise 863 (c) Council Orthopaedic Clinics Clinics No of new cases No of cases receiving treatment Total Attendances 2 1332 1900 7092 106 TABLE 21 - Dental Inspections and Treatment Age Groups:- No. inspected (i) No. found to require treatment (ii) No. referred for treatment at the County Council's Dental Clinics (iii) Under 5 * 394 199 164 5 - 16 and oyer 13594 9016 5830 Specials 4583 4426 4411 Total 18571 13641 10405 * Nursery Schools only iv. Number of pupils commenced treatment 8990 iva. Number of pupils treatment completed 7369 v. Number of attendances made by pupils for treatment 19383 vi. Number of appointments not kept 4105 vii. Number of half days devoted to (a) Inspection 111 (b) Treatment 2595 Total 2706 viii. Fillings. Permanent Teeth 9026 Temporary Teeth 3377 Total 12403 ix. Number of teeth filled. Permanent Teeth 8045 Temporary Teeth 3163 Total 11208 x. Extractions. Permanent Teeth 1274 Permanent Teeth for Orthodonture 148 TOTAL Permanent Teeth 1422 Temporary Teeth 9657 Total 11079 xi Anaesthetics (a) General 1743 (b) Local 4123 (c) Regional 704 Total 6570 xii. Other operations (a) Permanent Teeth 2933 (b) Temporary Teeth 5295 Total 8228 TABLE 20 - Child Guidance and Speech Therapy No. of pupils treated Child Guidance Speech Therapy (i) by the Authority 41 232 (ii) Otherwise 30 1 107 TABLE 21 (cont.) - Special Dental Treatment undertaken by Dental Officers Number of impressions, etc. 269 Number of Dentures fitted 43 Number of crowns and bridges 30 Number of inlays 2 Number of radiographs (a) at Dental Clinics 146 (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 - - 2 11 18 8 4 6 7 5 61 Number of pupils selected for treatment - - 2 11 17 8 4 6 7 5 60 Number of pupils commenced treatment (first attendance) 88 Number of attendances made for treatment 1429 Number of consultations 30 Number of impressions, etc 275 Number of fixed appliances fitted 8 Number of removable appliances fitted 103 Number of radiographs (a) at Dental Clinics 13 (b) at Hospitals - Number of pupils treatment complete 24 Number of orthodontic sessions (½ days) 101 TABLE 23 - Infestation with Vermin Total number of examinations 108879 Total number of pupils found to be infested 1038 Total number of individual pupils found to be infested for the first time during current year 491 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) - 108 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 257 2. Number of instances in which the state of health was found to be such that certificates were withheld, 1 3. Number of children examined as to fitness to take part in entertainments. 20 4. Number of cases in which certificates to take part in entertainments were withheld. - TABLE 26 - Medical Examination of Teachers (a) Number of Teachers examined as to fitness for appointment 24 (b) Number of Students examined as to fitness for first appointment 10 (c) Number of Students examined as to fitness to undertake Training Course 32 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: 14 Sub Section 4: - Sub-Sect ion 5: 8 Cases de-notified under Section 8 Education (Miscellaneous Provisions) Act 1948: RETURN OF HANDICAPPED PUPILS, YEAR ENDED 31st DECEMBER 1952 ASCERTAINMENT DISTRIBUTION (as at last day of year) CATEGORY No of ascertained 2ases 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 2 6 2 1 4 6 - - 4 6 - - - - - - 4 6 Partially Sighted Pupils 5 11 3 4 7 14 5 11 - 2 2 - - - - 1 7 14 Deaf Pupils 13 5 - - 12 5 8 4 3 1 - - - - 1 - 12 5 Partially Deaf Pupils 35 32 20 10 44* 29 0 6 4 3 2 35* 22 0 - - - 1 44* 29 0 Delicate Pupils 32 23 28 17 21 13 3 3 14 10 4 - - - - - 21 13 Diabetic Pupils - - - - - - - - - - - - - - - - - - Educationally Sub Normal Pupils 73 51 12 17 64 58 35 41 7 1 21 14 - - 1 2 64 58 Epileptic Pupils 3 4 1 - 2 3 - - 2 2 - 1 - - - - 2 3 Maladjusted Pupils 64 20 5 3 41 13 - - 10 5 31 8 - - - - 41 13 Physically Handicapped Pupils 27 23 10 1 29 16 23 16 - - 2 _ - - 4 - 29 16 Pupils with Speech Defects 158 58 113 46 196 74 - - - - 178 73 2 - 16 1 196 74 Pupils with Multiple Defects 8 4 1 1 9 4 3 4 2 - 3 - - - 1 - 9 4 Totals 420 237 195 100 429* 235 Ø 83 _ 83 45 29 276* 118 Ø 2 - 23 5 429* 235 Ø Grand Totals 657 295 664 * Ø 166 74 394 * Ø 2 28 664 * Ø Children not ascertained as H.P. but recommended convalescence in a Holiday Home or Camp School during Year ended 31st December, 1952. B G * Includes 33 boys ascertained during the year as result of Audiometry Survey and recommended a favourable position in the class. Ø Includes 19 girls ascertained during the year as result of Audiometry Survey and recommended a favourable position in the class 99 77 109 110 ORTHOPTIC TREATMENT Number of New Cases Number of Cases receiving treatment Total Attendances 68 97 771 30 children were referred to the Royal Etye 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 Attendance - FIRST 11 10 20 43 73 6 25 154 185 - SUBSEQUENT 62 14 73 222 309 18 86 671 775 Plat Feet 4 1 CONDITIONS . Cases treated at Clinic 1 2 - 3 10 13 Callosity 32 - - 8 8 1 3 34 38 Corns 34 6 15 16 37 3 17 57 77 Bursa of Heel - - - - - - - 1 1 Deviation of Great Toe 1 - 1 - 1 - - 13 13 Foot Wart 35 2 40 141 183 4 54 450 508 Pain in Forefoot 17 - - 1 1 - - 1 1 Ingrowing Nail 9 2 1 6 9 3 - 12 15 Pain in Hallux Joint - - - - - - - 3 3 Hooked Nail - - - 1 1 - 1 - 1 Exostosis of Heel - - 1 - 1 - - 1 1 Valgus Feet - - 1 - 1 - 1 2 3 Ramshorn Nail - - - - - - 1 1 2 Hammer Toes - - - - - - - 1 1 Epidermophytosis - - - - - - - 2 2 Club Foot - - - 1 1 - - - - Toes Clawed - - - 1 1 - - 5 5 Excessive Perspiration - - 1 1 1 - - - - Nails Club 1 1 4 3 8 1 2 1 4 Valgus Ankles 1 1 1 2 4 1 2 12 15 Knock Knees - 1 1 - 2 - - 1 1 Flat Foot CONDITIONS Cases referred to Orthopaedic Clinic 1 - 2 3 - 3 10 13 Deviation of Great Toe - - - - - - - 6 6 Pain in Hallux Joint - - - - - - - 3 3 Valgus Feet - - 1 - 1 - 2 2 Hammer Toes - - - - - - - 1 1 Knock Knees - 1 2 - 3 - - 1 1 Retracted Toes - - - 1 1 - — 2 2 Pain in Forefoot - - - 1 1 - - - 13 Valgus Ankles - 1 2 1 4 1 2 10 - Club Foot - - - 1 1 - - - - Polydactylism - - 1 - 1 - - - - 1ll 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 Vale Road School for Physically Handicapped Children Tottenham 6 11 2 Hornsey 3 3 - Edmonton 1 - 1 Hendon 6 6 3 Wood Green 4 3 1 Enfield 5 4 2 Friern Barnet 1 - 1 Southgate 2 2 1 Totals 28 29 11 Tottenham School for the Deaf Tottenham - 4 1 Hornsey 2 5 - Edmonton 3 4 - Enfield 1 3 - Hendon 5 2 2 Wood Green - 1 - Friern Barnet 1 2 - Southgate 1 2 - Uxbridge 1 1 Totals 14 24 3 AUDIOMETRY Children tested by Gramophone Audiometer School Population (31. 12. 52) 33000 Total tested 5372 Absentees 377 Referred to Medical Officer at Minor Ailment Clinic 76 Referred direct to Aurist 36 Referred by Medical Officer to Aurist 39 Children referred to Medical Officer at Minor Ailment Clinic Referred to Aurist 39 Cleared up without reference to Aurist 27 Waiting further gramophone audiometer test after attending Minor Ailment Clinic 1 Investigation incomplete (Parents unwilling, left school, left district, etc.) 9 112 INDEX Page Ante Natal Clinics 81 Area Health Service 77 Atmospheric Pollution 30 B.C.G. Inoculation 11,100 Births and Deaths 71 Burials 63 Cancer 75 of the Lung 17 Catering Establishments 19 Child Guidance 100 Child Life Protection 85 Closet Accommodation 29 Closing Orders 33 Confinements - Home and Institutional 80 Coronary Disease 18 Council, Members of 1 Daily Guardian Scheme 86 Day Nurseries 86 Deaf, School for 96 Deaths 74 Defects Remedied 39 Demolition Orders 32 Dental Service, Priority 87 School 96 Diphtheria 10 Diphtheria Immunisation 93 Disinfestation 37 Domestic Help Service 94 Drainage and Sewerage 29 Dysentery 16 Expectant Mothers, Care of 79 Factories 41 Fog, The Great 67 Food - Condemned 23 Hawkers 22 Hygiene 19 113 Page Food Legal Proceedings 25 Poisoning 17 Premises 19 Preservation 21 Sampling 25 Guardian Scheme, Daily 86 Hawkers of Food 22 Health & Housing Committee 2 Health Visiting 89 Holiday Homes 94 Home Nursing 91 Horses, Slaughter of 22 Housing 30 Housing Act, 1936, s.9 31 s.11 & 12 32 Part III 34 Ice Cream 20 Immunisation, Diphtheria 93 Infant Welfare Centres 83 Infantile Deaths 73 Insect Pests 36 Knackeri Yards 22 Laboratory Service 59 Legal Proceedings 25,35 Mass Radiography 9 Massage and Special Treatment Establishments 58 Maternal Deaths 65 Measles 14 Medical Examination of Staff 58 Metropolitan Water Board 27 Midwifery Service 87 Midwive's Clinics 82 Milk and Dairies 16 Mothercraft Classes 80 Mothers and Young Children, Care of 79 114 Page National Assistance Act, 1948, s.47 63 s.50 63 Notices served 38 Nurseries, Day 86 Nursing, Home 91 Occupational Health, Pilot Survey 43 Old People's Welfare 60 Outworkers 42 Paratyphoid Fever 16 Persons in need of Care and Attention 62 Pet Animals Act, 1951 59 Physically Handicapped Children, Special School 96, 109 Physiotherapy 97 Poliomyelitis 16 Post-natal Care 83 Premature Infants 83 Preserved Foods 21 Prevention of Illness, Care and After-care 94 Public Health Act, Part III 34 Public Health Department, Staff 2 Puerperal, Pyrexia 16 Rag Flock and other Filling Materials Act, 1951 58 Repairs in Default 31,40 Rheumatism Supervisory Scheme 98 Rodent Control 36 Sanitary Inspectors, Summary of Inspections 37 Scarlet Fever 12 School Health Service 95 Statistics 103 Sewerage and Drainage 29 Shops 56 Slaughterhouses 22 Smoke Nuisances 30 Spastic UnitSpeech Therapy 97 Statistical Summary 64 Stillbirths 4 115 Page Toddler Clinics 84 Tottenham Corporation Act, 1952 34 Tuberculosis 6 Vaccination and Immunisation 92 Virus Infection during Pregnancy 91 Water Supply 27 Defective Pipes and Fittings 29 Whooping Cough 15 Vaccination 92 Work in Default 40