C 439 (1) TO TOTTENHAM TOTTENHAM'S HEALTH 1954 TOTTENHAM'S HEALTH 1954 The Annual Report of the Medical Officer of Health. Borough of Tottenham. Health Department, Town Hall, N. 15. To the Worshipful the Mayor, Aldermen and Councillors of the Borough of Tottenham. Mr. Mayor, My Lady, Ladies and Gentlemen, I have the honour to submit my report on the health of the Borough for the year ended the 31st December, 1954. In addition to a summary of the work of the department, the report includes an appendix giving an account of local administration of the personal health services. Vital statistics The population as estimated by the Registrar-General at mid-1954 was 123,200, a deficit of 1,200 on the figure supplied for mid-1953. The birthrate per 1,000 population was 12.37 and the number of registered live births 1,524; of which 1,141 occurred in institutions. There were 36 (44 in 1953) still-births giving a still-birth rate of 23.08 per 1,000 total births. The total number of civilian deaths - 1,187 - was lower than last year's figure of 1,347 and the general death rate of 9. 63 per 1,000 estimated population, proved to be near a new low record. Of the causes of death 21% were due to cancer: the death rate from this disease having increased from 0.42 to 2.04 during the past fifty years. Nearly half the total deaths were classified as caused by 'diseases of the heart and circulation' of which 33.8% were due to coronary disease. The infant mortality rate of 17.7 was a new low record as also was the maternal mortality rate of 0. 64. Infectious diseases The number of notifications during the year was the lowest ever recorded in the thorough. No serious outbreak occurred. Of the thirty-one notified cases of food poisoning, thirteen were confirmed as salmonella typhi-murium infections. One case of Enteric Fever occurred and in this case the wife of the patient was found to be a "carrier" of the disease. Food Control This occupied the close attention of the Department; particular attention being given to school canteens and kitchen premises. Interest in food hygiene was maintained by regular and systematic visits to food premises and publicity through health education procedures. Decontrol of slaughtering of meat in 1954 resulted in the opportunity to reopen private slaughterhouses. In three cases licence to slaughter was refused and in another was made conditional upon carrying out extensive repairs and redecoration. The volume of meat inspection work now carried out in the Borough is placing a considerable burden upon the inspectorial staff of the department who have to undertake much of this work out of normal working hours. Housing Intensive effort has continued during the year in the task of improving local housing conditions. The shortage of suitable building land, the existing high density of population per acre, and large number of applicants still on the live housing register adds considerably to the problem of preparing further programmes for clearance of unfit properties. The Housing Repairs and Rents Act, 1954 places new emphasis on clearance or reconditioning of unfit houses; and in submitting proposals to the Minister, account has been taken of the need for careful planning to provide suitable areas of redevelopment which will allow for a scheme of decanting and redevelopment stage by stage. Atmospheric Pollution The Borough's first "smokeless zone" made under the Tottenham Corporation Act, 1952 was approved during the year. Confined in the first instance to a declaratory area of major war damage it is intended to expand the boundaries of the 'smokeless zone' as redevelopment proceeds. Care of the Aged Year by year this subject grows in importance, and with increasing knowledge and experience of the problems involved we are fortunate in Tottenham in having the active co-operation of all the statutory and voluntary agencies concerned. To the Chairman and members of the various Committees concerned with the health services of the Borough, I wish to express my indebtedness for the encouragement they have continued to show me at all times. Also to thank sincerely the Chief Officers of the Corporation and my colleagues in all departments of the health service for their help and co-operation. I am, Your Obedient Servant, G. : HAMILTON HOGBEN.: Medical Officer of Health. 28 th July, 1955. 1 MEMBERS OF THE COUNCIL Alderman Mrs. A.F. Remington, J.P. MAYOR Councillor F.G. Bohringer, DEPUTY MAYOR Alderman E.J. Field " R.W.H. Ford " W. S. Herbert " Mrs. A, Kitchener " Mrs. J.D. Lynch Councillor Miss S.A. Berkery " Mrs. E.M. Bohringer " E. Brown " J. W.H. Brown " E.J.J. Carter " Douglas Clark " E. J. Clook " C.H. Colyer " E. Cooper " A.J. Davies " J.A.S. Dipple " T.A. Dutton " " J. Egdell " E.S. Ellis " K.A. E, Gregg " Mrs. F. E. Haynes Alderman J.J. Pagin " A Reed, A.C.I.I. , J.P. " A R. Turner " H. W. Turner " R.H. Warren Councillor J.W. Hollingsworth (Resigned 22.7.54) " Mrs. F.C. Ilsley " T.R. Izzard " F. A. F. Keay, J.P. " Mrs. W. A. Kent " H. Langer " Mrs. A.A.- Miller " M.T. Morris " S. C. Mo rri s " The Lady Morrison " I.L. Peirce " Mrs. M.E. Protheroe " T.A. Riley " P.H. Roberts " E.C. Smith " Mrs. A. Wise Town Clerk: M. Lindsay Taylor, LL.B. 2 HEALTH AND HOUSING COMMITTEE Alderman R.H. Warren Chairman His Worshipful the Mayor, Alderman Mrs. A. F. Remington, J.P, The Deputy Mayor, Councillor F.G. Bohringer (ex- offico members) Alderman A Reed, A.C.I.I. , J.P. Councillor Mrs. E.M. Bohringer " E. Brown " E. J J. Carter " E. J. Clook " E Cooper Alderman A R Turner Councillor J.A.S. Dipple " Mrs. F. E Haynes " Mrs. M E. Protheroe " T.A. Riley " P. H. Poberts Councillor E C Smith METROPOLITAN WATER BOARD Council's representative - 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. 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) A, E. Clarke (Q) (b) (c) (d) D.R. Howe (a) (Left 3.10. 54) C.J. Johnson (a) (b) W.P. Kent (a) (b) L.J. Kerridge (a) (b) E. Kipping (a) (b) G.W. Maidlow (a) (b) W. Openshaw (a) F.J. Parsons (a) (b) NOTE: (a) Certificate of the Royal Sanitary Institute and Sanitary Inspectors' Joint Examination Board, (b) Meat Inspectors' Certificate. (c) Institution of Sanitary Engineers" Certificate. (d) Sanitary Science Certificate. Shops Acts Inspector F.T.G. Lock Public Health Nurse Mrs. W. Mathias, S.R.N. (Retired 30.9.54) Clerical Staff W. E. Lawson (Senior Clerk: General) C.J. Lemon R.G. Hull Mrs. E. D. Whittle (left 19.4.54) Miss J. Whillock (left 31.10.54) H.C.B. Wheal (Senior Clerk: Housing) C. S. Clark B. Brill Mrs. I. M. Cul1en (commenced 31. 5. 54) M. Moore (commenced 19. 11. 54) Outside Staff Foreman Disinfecting Van Driver Drain Testers S. H. Reid E. E. Mannel1 A.E. Crow F. T. Dowse R. E. Hobbs B. Joscelyn F. J. Slater R. C. Wi1son Disinfectors: W. Butcher Apparatus A. Dowse Attendants A. E. Moon Rodent J. Lawrence Operatives: G. W. Percival Labourer A. Ferridge 4 GENERAL STATISTICS AREA OF DISTRICT IN ACRES 3,013 POPULATION: Census 8th April, 195 1 126,929 Estimate of Registrar General of Population - Mid-year, 1954 123,200 APPR3XIMATE NUMBER OF DWELLINGS IN DISTRICT 30,641 RATEABLE VALUE OF DISTRICT at 1st April, 1954 £1,011,293 SUM REPRESENTED by PENNY RATE at 1st April, 19 54 £4,070 LIVE BIRTHS - Legitimate 1,462 1, 524 Illegitimate 62 Birth Rate (per 1,000 population) 12.37 STILL BIRTHS 36 DEATHS 1, 187 Death Rate (per 1,000 population) 9.63 Infantile death rate (per 1,000 live births) 17.72 Maternal death rate (per 1,000 live and sti1I-births) 0.641 COMPARABILITY FACTORS - Deaths 1.03 Births 0.95 (NOTE: Detailed vital statistics appear on pages 61 to 69 in the Statistical Summary). 5 CONTENTS PAGE PART I CONTROL OF DISEASE 6 » II FOOD CONTROL 19 III SANITARY CIRCUMSTANCES OF THE AREA 29 IV FACTORIES AND SHOPS 47 " V GENERAL 51 VI STATISTICAL SUMMARY 61 APPENDIX STATISTICAL RETURN OF THE WORK OF THE LOCAL AREA HEALTH COMMITTEE No. 3 OF THE MIDDLESEX COUNTY COUNCIL 70 \ 6 PART I CONTROL OF DISEASE The number of notifications of infectious disease was 819, the lowest figure ever recorded in the Borough. The reduction was largely due to the reduced incidence of measles during this year; but most other infectious diseases also show a reduction. Unfortunately the same cannot be said of non-infectious diseases such as cancer and coronary disease. Though we have no accurate information as to the incidence of the latter, the mortality figures show a slow but steady increase. Some of this increase is no doubt attributable to improved methods of diagnosis and to an ageing population, but it appears unlikely that this is the whole explanation; and that there are unknown factors in our environment which are bringing about this changing pattern of the incidence of disease. Tuberculosis There is now no statutory obligation for the Medical Officer of Health to keep a tuberculosis register. It is our practice, however, to keep one and to notify other authorities when known tuberculous persons are moving into their districts. The number of cases on the register on 31st December, 1954, was 1710, an increase of 61 on the previous year. This increase is not due to a higher incidence of tuberculosis, but due to survival of patients who might have died but for modern surgical and chemotherapeutic measures. Thus new cases notified (131) and deaths (25) recorded in 1954 are lower than last year (163 and 26 respectively). The 131 new cases of tuberculosis notified during 1954 (126 pulmonary and 5 non-pulmonary) corrpared wi th 163 in 1953 (143 pulmonary and 20 non-pulmonary). The Mass Miniature X-ray unit did not visit the Borough during the year, but came early in 1955. 7 Distribution of New Tuberculosis Cases notified during 1954 Age Periods New Cases Deaths Pulmonary Non-Pulmonary Pulmonary Non-Pulmonary Male Female Male Female Male Female Male Female Under 1 year 1 - - - - - - - 1 - 4 years 3 2 - - - - - - 5-9 " 3 2 1 - - - - - 10-14 " - 3 - - - - - - 15-19 " 6 5 - 1 - - - - 20 - 24 " 8 11 1 - - 1 - - 25-29 " 3 13 - - - - - 1 30-34 " 5 9 1 - 1 2 - - 35-39 " 6 3 - 1 - - - - 40-44 " 7 3 - - 1 - - - 45 - 49 " 1 2 - - 1 3 - - 50 - 54 " 4 1 - - 4 - - - 55 - 59 " 6 1 - - 1 - - - 60 - 64 " 1 2 - - 2 1 1 - 65-69 " 6 1 - - 3 1 - - 70-74 ” 4 1 - - 1 - - - 75 Years and over 3 - - - 1 - - - Total 67 59 3 2 15 8 1 1 The following is an analysis of non-pulmonary tuberculosis cases notified during 1954:- Male Female Total Bones and Joints 1 1 2 Genito-urinary system 2 1 3 3 2 5 Changes in Tuberculosis Register during 1954:- Details Pulmonary Non-Pulmonary Total Male Female Male Female Number on Register at 1st January, 1954 810 663 80 96 1,649 New cases notified during 1954 67 59 3 2 131 Transfer into Tottenham 19 17 - 1 37 Transfer from non-pulmonary to pulmonary - 1 - - 1 896 740 83 99 1,818 Cases removed from Register: Deaths of cases on register 24 11 1 1 37 Transfer out of Tottenham 26 31 2 2 61 Recovered 1 - 1 - 2 Transfer from non-pulmonary to pulmonary - - - 1 1 Lost sight of 2 2 2 1 7 53 44 6 5 108 Number on Register at 31st December, 843 696 77 94 1,710 8 Ward Distribution of Cases of Tuberculosis on the Register at 31st December, 1954 Ward Estimated Population Male Female Total Rate per 1,000 population Pulmonary NonPulmonary Pulmonary NonPulmonary White Hart Lane 11,925 108 10 116 9 243 20.4 Park 11,426 77 13 78 15 183 16.0 Coleralne 11,697 61 5 62 6 134 11.5 West Green 11, 383 65 3 61 11 140 12.3 Bruce Grove & Central 11,124 73 5 44 4 126 11.3 High Cross & Stoneleigh 11,262 86 13 58 9 166 14.7 Green Lanes 10,857 80 4 60 7 151 13.9 Chestnuts 11,390 69 6 58 8 141 12.4 Seven Sisters 10,456 75 6 52 6 139 13.3 Town Hall 10,918 70 8 64 12 154 14.1 Stamford Hill 10,762 79 4 43 7 133 12.4 Total 123,200 843 77 696 94 1,710 13.9 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. Prevention of Tuberculosis During the year a memorandum was received from the Ministry of Health calling for close co-operation between those responsible for the prevention of tuberculosis and the care and after care of the tuberculous patient, This in fact has been the routine practice for many years in this borough. Responsibility for the control, treatment and rehabilitation of tubercu losis is divided among a number of authorities and individuals. Perhaps one of the most important functions of the Medical Officer of Health is the co-ordination of these activities by acting as a liaison officer. The following is a summary of the functions of those concerned, and shows in parenthesis the names of the responsible authorities. General Practitioner (Executive Council) The family doctor is usually the first to discover the possibility of a case of tuberculosis, and it is to him that the family look for immediate advice and treatment. The doctor is required to notify the Medical Officer of Health of any tuberculosis cases coming to his notice. 9 Chest Physician (Hospital Board and County Council jointly) The Chest Clinic under the control of the Chest Physician has a dual function, firstly to provide local specialist facilities for diagnosis, treatment and advice, and secondly to safeguard the welfare of the tuberculous. Hospitals and Sanatoria (Hospital Board) These should be solely concerned with the treatment and cure of active cases, but often beds are occupied by chronic infectious cases because of the inadequate home facilities. Domestic Help Service (County Council) Provides domestic help on recommendation of Chest Clinic. School Health Service (County Council) Concerned with cases occurring among school children and teachers, with testing school groups and providing B. C. G. inoculation for school children. Mass Radiography Unit (Hospital Board) Periodic visits of mobile unit provides facilities for miniature X-rays of large groups of population. Occupation Centres (County Council) Gives chronic cases opportunity to train for and carry out work within limitation of their physical condition. Disablement Resettlement Officer (Ministry of Labour) Endeavours to place in suitable employment those cases referred by Chest Physician and, if necessary, arranges for patient to receive course of training for new occupation. National Assistance Board Provides additional financial assistance on recommendation of Chest Physician. Medical Officer of Health (Borough Council) Receives official notification as cases arise, passes on information to others concerned, and compiles overall epidemiological information. Deals with environmental problems such as repairs to premises and recommendations to Housing Lettings Sub-Committee. Takes action to prevent spread of disease by food handlers and to ensure disease-free food by proper inspection of meat and supervision of production and distribution of other goods. Disinfection is carried out when required. 10 Hie facilities available in Tottenham for dealing with tuberculosis are probably as good as anywhere in this country. The chest clinic which was recently moved to a newly constructed block of buildings at St. Ann's General Hospital, is provided with all modern equipment now considered essential for the proper diagnosis and treatment of the disease. Miniature X-ray equipment has been installed which enables the chest physician to undertake a wide exanination of contacts and suspected cases without incurring the considerable expense which would be associated with the taking of full-size plates. B.C. G. inoculations are offered to susceptible contacts as a means of controlling the spread of the disease amongst the households of known cases. In addition, the School Health Service is making available in 1955 facilities for all suitable school children at age of 13 to receive B.C.G. inoculations. For control to be really effective it is essential that every case should be notified. To assist in the discovery of "missed" cases the Mass Radiography Unit makes periodic visits to the Borough when large groups of the population are X-rayed. One drawback of this method, however, is that it is mainly the same groups which submit themselves for examination whilst other sections are never X-rayed. Another and perhaps more profitable method of discovering cases which is adopted in Tottenham in infant welfare centres is to test young children and to follow-up the home contacts of those who show a positive reaction. In this way many cases have been traced and brought under treatment at the earliest possible moment. 1 A major problem at the present time is the incidence of tuberculosis in elderly persons. These are often chronic infectious cases who are not suitable for the radical treatments used in younger persons. Often these older persons do not realise the infectious nature of thenr condition which is so dangerous to others in the home, and it is difficult for them to understand the need for the utmost personal hygiene. In cases like this where married children with young families share the home, rehousing should receive a high priority. Tottenham Chest Clinic I am indebted to Dr. T.A.C. Mc Quiston for the following report on the work of the Tottenham Chest Clinic during the past year. "The outstanding event of the year was the transfer of the Chest Clinic from its old premises in Somerset Road to the new Clinic in the grounds of St. Ann's General Hospital. This took place in July and went very smoothly, the continuity of the Clinic work being disrupted for only a day or two. The new Clinic has more accommodation and is much brighter, airier and more cheerful both for staff and patients. Since the Clinic is now in the hospital 11 precincts it is much easier to integrate the in-patient and out-patient work. The Clinic staff has been increased by the appointment of an additional consultant in place of two sessional appointments. The Chest Unit beds at St. Ann's Hospital have recently been increased to 150. The use of the miniature X-ray unit at the Clinic has been extended and working patients may now attend an evening session without prior appointment. We feel that there is no obstacle in the way of any person in the area having a chest X-ray, and we would like our colleagues in general practice to use the service as much as they please. They have all been supplied with forms to give to patients stating times when they may attend for miniature X-ray without previous appointment. The new Clinic has a small fitted canteen for supplying light refreshment to patients. We are very grateful to the members of the local Red Cross Society who run the canteen, and the service is much appreciated by patients, especially those who attend evening clinics on their way home from work. An Occupational Therapy class is held weekly on the Clinic premises. At the last annual Sale of Work the use of the in-patient recreation room, and the help from the catering staff at the hospital, were greatly appreciated and in consequence a much more satisfactory result was obtained and the event made a social success. " CHEST CLINIC STATISTICS,' 1954 (Tottenham & Wood Green) Total Number of Attendances . 28,732 Total Number of X rays (including miniature films) 18, 315 Total Number of Refills 10,089 Total Number of Sessions Held 1, 143 Total Attendances of Contacts (new contacts 781) 5,201 Number on Register Notified 2,021 New Cases Notified during 1954 162 Number of Deaths during 1954 43 Number Vaccinated with B.C.G. 124 Diphtheria There were no confirmed cases of diphtheria in the borough during the year. In 4 suspected cases the diagnosis was amended as follows:- Tonsillitis 2 Infective mononucleosis 1 Glandular Fever 1 12 Facilities for diphtheria immunisation are provided at all clinics under the control of the local County Area Health Committee as well as at general practitioners surgeries. The immunisation against whooping cough is usually carried out at the same time by the use of a combined vaccine. Details of this service for the year in the area (Tottenham and Hornsey) are shown in the Area Medical Officer's report, which is given as an appendix to this report. Scarlet Fever There were 92 cases of scarlet fever notified during the year, but no deaths were attributed to the disease. Of the 42 cases admitted to hospital the diagnosis was amended in 5 instances. Details of cases admitted to hospital were as follows:- Hospital Diagnosis confirmed and Cases treated to a conclusion Diagnosis amended Number of cases Average stay in hospital (days) Number of cases Average stay in hospital (days) St. Ann s General 30 16.6 5 9.6 Other Hospitals 7 25 8 No amendments Three of the cases admitted to hospital were complicated one by chicken pox, one by broncho-pneumonia and the other with cervical adenitis and chicken pox. Whooping Cough In common with other infectious diseases this year, the incidence of whooping cough was low 144 cases being notified as against 360 in 1953. There were no deaths from this disease The whooping cough vaccine trials conducted by the Medical Research Council were concluded during the year, The earlier trials had shown that a satisfactory vaccine could be made and its later trials were to compare the efficiency of vaccines produced by various methods. Preliminary results indicate that all the vaccines tested produced a high degree of immunity to infection. Measles There were 149 notifications of measles during the year. This is the lowest figure recorded in the borough since the disease was made notifiable m 1940. Eight cases were removed to hospital with complications. 13 Poliomyelitis One case of paralytic poliomyelitis occurred in a pregnant woman of 25.1 The illness was mild and the paralysis was slight. This patient was later delivered of a normal healthy child, and the mother has completely recovered from her paralysis. Seven suspected cases of poliomyelitis were notified, but the diagnosis was amended as follows: - Influenza 1 Meningism 1 Pyelitis 1 Meningo-encephalitis 1 Infective Polyneuritis 1 Catarrhal sore throat 1 Toxi c Po lyn eu ri ti s 1 In July 1954 the Ministry of Health issued a menorandum giving an outline of what is known about poliomyelitis and its spread, and suggesting possible methods of control. As a result of this a letter was prepared setting out precautions to be observed by contacts. This was handed to contacts of suspected cases when the premises in which the case had occurred were visited. Food Poisoning There were 31 cases of food poisoning notified, but only one was removed to hospital. Ten cases occurred in the first quarter of the year, twelve in the second quarter, six in the third quarter and three in the fourth quarter. These were all single cases - no outbreaks being recorded. The causal organism was identified as Salmonella typhi murium in thirteen instances, but no cause was discovered in the remaining eighteen cases. Dysentery There were 124 cases of dysentery notified during the year, of which 21 were located in hospital. The number of cases occurring must have been much larger as illustrated by the fact that only a small fraction of the cases in the school outbreak reported below were notified to this department. Dysentery Outbreak in an infants' school An outbreak of Sonne dysentery occurred in an infants' school inmediately following the return of the children from the Easter holidays. The department was informed of the outbreak at the end of the week, when there were 16 absentees from this cause - 4 of them had been admitted to hospital. 14 It was established that two children had been suffering from a gastrointestinal upset on the day of their return from holiday, and it is presumed that they were the original source of the infection. On the Monday of the following week, that is six days after their return to school, there were some 66 absentees, the majority of whom had dysenteric symptoms. The following day the laboratory reported that all the specimens which had been submitted from suspected cases before the week-end were positive to Shigella sonnei. Further absences were reported throughout the rest of the month of May, and each was investigated by the staff of the department. Some proved to be due to chicken-pox, which was prevalent at the time, whilst others were kept from school because the parents had heard that there was an outbreak of dysentery in the school. The high absentee rate was maintained throughout May. Of 358 on the roll there were 75 absent on May 7th and 86 on May 21st, though it is not certain that all of these were true cases of dysentery or positive contacts. By the end of May there were very few new cases being reported, and by the 25th June there were only 5 known cases to be cleared. These figures include children who were diagnosed as dysentery on bacteriological grounds only as well as a few who showed the characteristic symptoms without returning a positive stool. This latter type of case was more frequent in the later stages of the epidemic either because it was a mild infection or one which came to our notice later in the course of the illness. An effort was made during the epidemic to obtain faecal specimens from all family contacts, but this was not wholly successful as the parents did not fully co-operate. There were 25 families, however, in which a positive stool was obtained from individuals whose only contact with the infants' department was through a child in that part of the school. There were 18 adults (14 mothers, 3 fathers, 1 adult sister) 5 in the junior department of the same school, 5 pre school children and 5 in other schools. It is interesting to note the high proportion of mothers anongst the adult positive contacts, although it must be noted that there were less fathers submitting specimens. Another interesting feature is the fact that no secondary cases were reported from the positive contacts attending other schools. These were all schools for higher age groups. The almost explosive nature of the outbreak in its early stages suggested at once the possibility of a food-borne infection originating in some way from one or other of the first cases. Enquiries showed, however, that only about two-thirds of the first week's cases had school dinners and in any case the children had no part in serving the meal. 15 There is, however, a possibility that the infection may have been spread by contaminated milk drinking straws. It is the practice for the older children to take the caps off the bottles and to distribute the straws. As it is likely that the original ones may have done this, a probable mode of spread is by this means. It is noteworthy that this epidemic was practically confined to the infants' department of the school, and that such cases as did occur elsewhere did not give rise to secondary cases. This was also a feature of the epidemic reported in my last annual report. It is perhaps to be expected that an infants' school would be the type of community in which intestinal infections would spread most rapidly. The children are ignorant of the principles of hygiene and it is extremely difficult for the staff to see that all children wash their hands after using the toilet and more so to see that some 350 children wash their hands before their school dinner, especially as the facilities provided for washing are usually woefully inadequate. Typhoid Fever There was one case of typhoid during the year in a married man aged 41. Investigations showed that his wife, although quite well, was a carrier of the disease. She gave a history of inoculation against typhoid fever some five years ago. Since her carrier state was discovered she has had several courses of treatment in an effort to clear up the infection, but at the time of writing she was still excreting the organism. She is being kept under regular supervision, and investigations are being made at intervals to ascertain whether she is still a carrier. She is a qualified nurse and, as such, is fully aware of the implications of her condition from a public health point of view. It is inpossible at this stage to say whether the wife infected her husband, or whether they both acquired their infection from a common source. In the absence of other cases, either in the borough or in the districts in which the husband worked, the most likely explanation would be that the wife has been a carrier for some time and the husband contracted the disease from her. Paratyphoid Fever One case of paratyphoid B in a child of 2 years was notified during the year. 16 Puerperal Pyrexia Hiring the year the form of notification was amended to include information of the cause of pyrexia if known. One case of puerperal pyrexia was notified during the year. Cancer There were 1,187 deaths in the borough from all causes, and of these 251 or 21% were due to cancer. In considering the sexes male deaths were 640 with 139 from cancer, and female deaths were 547 with 112 from cancer. An analysis of the principal sites shows the following:- Male Female Digestive organs 53 54 Respiratory system 52 7 Breast and Genito urinary system 16 35 Cancer is a disease which is taking an ever increasing toll of the community. Figures for the past few years have shown a steady rise in the number of deaths from this cause. If, however, the death rates per 1,000 of the population over the past fifty years are examined, the increase in mortality is striking - from 0.42 per 1,000 in 1904 to 2.04 per 1,000 in 1954. It is probable that some of this increase is due to improved diagnosis and an ageing population. Further, the figures for earlier years may not be strictly comparable with those of later years owing to the adoption of the International Statistical Classification of Diseases, Injuries and Causes of Death in 1948. However, bearing in mind all these facts, there would appear to have been a real increase in the incidence of cancer over the past halfcentury, and it is not unreasonable to suppose that this is in some way associated with the changing environment and habits of individuals and the community over that period. Cancer Deaths over past 50 years Year Number of Cancer Deaths Population Rate per 1,000 1904 52 121,279 0. 42 09 100 149, 283 0. 66 14 125 149,495 0.83 19 135 152, 508 0.88 24 166 156,000 1. 06 29 195 168,000 1. 17 34 215 152,694 1. 39 39 209 136,000 1. 54 44 236 108, 180 2. 16* 49 264 130,040 2.03 54 251 123, 200 2 04 * Population depleted of young healthy adults on war service and evacuated children, resulting in higher proportion of population in age groups where cancer deaths usually occur. 17 CANCER DEATHS OVER PAST 50 YEARS Diseases of the heart and circulation This group of diseases still accounts for the greatest number of deaths. From 1946 to 1952 the figure had risen steadily from 540 to 648. In 1953 there was a drop to 532, and the figure for 1954 is 553. There appears to be no obvious reason for the rise in the immediate postwar years and the return to the 1946 level in the last two years. Coronary disease accounted for 189 deaths (115 male and 74 female), an increase of 26 over the previous year. Vascular disease of the central nervous system caused 152 deaths (67 male and 85 female). The mortality was again highest in females, but the sex difference is less than it has been for the past few years. SUMMARY OF DISINFECTION WORK DURING 1954 Rooms disinfected after occurrence of Infectious disease 178 Bedding disinfected after occurrence of infectious disease or death 121 library books disinfected 165 18 19 PART II FOOD CONTROL As will be seen from the list of inspections carried out, premises concerned with the manufacture and/or sale of food continue to receive the closest supervision. During the year particular attention has been given to school canteens and kitchens, and recommendations were made to the Education Authority. In collaboration with the Hospital Authorities special visits were made to the kitchens of Tottenham s two large hospitals. Extensive reports were submitted containing recommendations for some reorganisation. Interest in food hygiene is being sustained by talks to various organisations and by regular and systematic visits to food premises. Registered Premises Section 14 Food and Drugs Act, 1938; provides that premises may not be used for the following purposes unless they are registered by the local authority, nanely:- (a) The sale or manufacture for the purpose of sale of ice cream or the storage of ice cream intended for sale. (b) The preparation or manufacture of sausages, or potted, pressed, pickled or preserved food intended for sale (preparation of meat or fish by any process of cooking is deemed to be preservation thereof). At the 31st December, 1954 the following premises were registered in accordance with the above provisions, namely:- For the sale only of ice cream 337 Manufacture and sale of ice cream 6 Storage of ice cream 3 Cooking of hems and other meats 41 Fish frying 13 Sausage manufacture 55 Preparation of jellied eels 3 Boiling shell fish 2 20 These premises are regularly visited by the district sanitary inspectors and samples of ice cream collected from time to time from ice cream manufacturers, also certain samples were taken of loose ice cream which was on sale in the borough. The following is an analysis of the bacteriological grading of the ice cream samples taken:- Results Total Grade 1 Grade 2 Grade 3 Grade 4 Samples of ice cream produced in Tottenham 7 3 1 1 12 Samples of ice cream produced outside of Tottenham 9 2 1 - 12 Total 16 5 2 1 24 Middlesex County Council Act, 1993: Section 11: Registration of Hawkers Section 11 of this Act, requires the registration of all food hawkers and their storage premises. One new application was investigated by the sanitary inspectors in 1954 and found to be satisfactory. Three registrations were cancelled where it was found that the business had been discontinued. The following is a summary of the registered hawkers and their storage premises at the 31st December, 1954:- Articles Number of persons registered Number of registered storage premises Fruit and vegetables 97 93 Shellfish 13 9 Pish 7 7 Ice cream 3 3 Peanuts 2 2 Light refreshments (Mobile Canteen) 3 3 Total 125 117 Milk and Dairies All milk sold in Tottenham must be specially designated, and every milk dealer in the Borough holds a licence under the Milk (Special Designation) Regulations. The following is a summary of licences issued during 1954, namely:- Designation No. of Licences No. of Supplementary Licences Pasteurised 68 14 Sterilised 153 16 Tuberculin Tested 33 14 * Accredited 3 1 * The term 'accredited milk' ceased to be a special designation on the 1st October, 1954 and these licences lapsed on that date. Meat Inspection in progress at local Slaughterhouse 21 During the year 15 applications for registration as milk distributors were dealt with. No applications were received in respect of dairies. Of the 15 new registrations 11 were for new premises and the other 4 were in respect of the change of proprietorship of previously registered premises. The number of premises and distributors registered at 31st December, 1954, was as follows:- Distributors 168 Dairies 11 The Chief Officer of the Public Control Department of the Middlesex County Council (which is the licensing authority for premises at which milk is processed) reported that "Up to May, 1954. there was one dealer/steriliser licensed by my Council in Tottenham the firm then ceased operations. From January to May the premises were regularly inspected and in all 13 samples of sterilised milk taken and submitted to examination- All samples proved satisfactory". Slaughterhouses and Knackers Yards The work of the department in connection with slaughter-houses has assumed a new significance during this year. For the first time, since 1939, my annual report has to deal with the subject of meat inspection other than horse slaughtering. Until December 1953 there were 5 licensed slaughter houses in the Borough. When it became known that decontrol of the meat industry was to take place in 1954 applications for licences in respect of 3 of these slaughterhouses were refused. Appeals against these refusals were lodged in the Magistrates Court, but were subsequently withdrawn. There are therefore now only two licensed slaughterhouses operating in Tottenham: (1) Messrs. Smith & Spalding Markfield Road N. 15. (2) Messrs. Allen, Philip Lane, N.15. the latter having been re licensed after extensive repairs and redecorations were carried out. Aliens slaughter cattle, sheep and pigs, and the table shows the extent to which the work has developed. The figures in respect of horses slaughtered at Messrs. Smith & Spalding are for the full year i.e. January to December but the remainder cover the period from July 3 when control was removed, to December 1954. The normal hours of slaughtering are from 7 a.m. to 7 p.m. Monday to Saturday inclusive, but owing to limited hanging and refrigerated space the evening times of slaughtering have to be extended. To ensure that an adequate" and efficient meat inspection service is maintained, it has been necessary to introduce a rota of inspectors. The rota covers Summary of Carcases Inspected and Condemned Donkeys Horses Cattle Excluding Cows Cows Calves Sheep and Lambs Pigs Excluding Sows Sows Number Killed 2 1,677 301 118 2, 356 3,031 5,022 336 Number Inspected 2 1,677 301 118 2, 356 3,031 5,016 336 All Diseases except Tuberculosis Whole Carcases Condemned - 10 - 6 4 2 5 1 Carcases of which some part or organ was condemned 1 139 23 29 8 299 557 26 Percentage of number inspected affected with disease other than tuberculosis 50.0 8.88 7.64 29.66 .51 9.93 11.20 8.04 Tuberculosis only Whole Carcases Condemned - 1 1 1 - _ 1 1 Carcases of which some part or organ was Condemned - 1 26 24 1 - 126 31 Percentage of number inspected affected with tuberculosis - 12 8.97 21.19 .04 - 2.53 9.52 22 23 morning, afternoon and the evening periods and all inspectors take part. The staff have co-operated to the full, although it involves working additional hours, - sometimes at no small inconvenience to the individual - with comsatory time off when this can be arranged. The meat inspection is carried out in accordance with the recommendations of Memo 3/Meat. This is a memorandum published by the Ministry of Food in 1952 and sets out the criteria and methods of meat inspection. It replaces the old Memo ,62/Foods. The slaughterhouse is operated with a minimum of inconvenience to the occupiers of the adjoining houses and in spite of its being sited in a mainly residential area little or no nuisance arises. The quality of the meat is - on the whole - very good and a competent team of slaughtermen ensures that carcases are properly dressed in a hygienic manner. The meat is distributed over a large area of North London, and the home counties." Satisfactory arrangements exist for the disposal of condemned meat and offal. The departmental van calls at the slaughterhouse every day and the condemned meat is collected in marked dustbins and taken to the disposal works for processing or for destruction. Hiring the year 15 licences to slaughter were issued under the provisions of the Slaughter of Animals Act, 1933. Condemned Food From time to time the department has been called in to examine at a local warehouse stocks of concentrated orange juice where deterioration is suspected because of the time the juice has been in storage. 47,218 gallons of tinned orange juice were examined and of this quantity 2,538 gallons (approximately 5%) were condemned by the inspector. In addition, a stock of orange juice in casks (approximately 4, 400 gallons) was examined and practically the whole was found to be unfit because of fermentation. These stocks were disposed of at the local sewage pumping station. The following is a summary of other articles which were surrendered by local food traders and condemned by the Public Health Department during the year, namely:- Tinned articles: Bacon 1 Cream 58 Coffee 24 Pish 625 Crab Paste 3 Fruit 3,299 24 Food Sampling The Public Control Department of the Middlesex County Council has supplied the following information of food and drugs sampling in the Borough during 1954:- FOOD AND DRUGS ACT, 1938 List of samples procured in the Borough of Tottenhan during the year 1954 Article Total samples procured Unsatisfactory Milk, various 130 2 Beer 4 - Butter 4 -- 25 Article Total samples procured Unsatisfactory Cakes and biscuits 96 1 Cooked Meats 25 - Cooking Fat 1 - Cream 22 1 Curry Powder 1 - Drugs, various 7 - Eggs 1 - Fish 17 1 Fish Cake 1 - Fish Paste 3 - Flour 3 - Fruit Juice 1 - Fruit Squash 1 - Ground Almonds 1 - Ice Cream 7 - Iced Lollies 22 - Jam 4 - Margarine 5 - Meat 8 - Meat Paste 1 - Meat Pie 7 - Minced Meat 15 - Non brewed Condiment 6 2 Oranges 12 - Pickled Herrings 1 1 Salad Cream 2 - Sausages and Sausage Meat 56 - Soups 3 - Suet 2 - Sweets 9 3 Tinned fruit 2 - Victoria Plums 1 - Vinegar 29 8 Wines and Spirits 35 - Totals 545 19 With regard to the 19 samples noted as unsatisfactory, the following brief comments may be of interest. Milk The 2 samples of milk were each of bottled milk on retail sale by different dairymen. One was slightly deficient in fat, the other slightly 26 deficient in solids-not fat but the absence of added water was confirmed. The vendors were informed and no further action was taken except that subsequent samples were procured and found genuine. Cakes and Biscuits A sample of biscuits designated "Cream Filled Chocolate Biscuits". The designation was objected to on the grounds that the filling was not cream. Upon the manufacturers' undertaking to alter the designation in a sati sfactory way no further action was taken. Cream A sanple of what was sold and described as "Thick Cream" was procured and found to be sterilised cream having a fat content of 23% instead of at least 48%. It was imported tinned food. The importers were prosecuted and fined £10 0,0d. and ordered to pay £2,2.0d. costs. Fish A fishmonger labelled and sold dab fillets as "plaice fillets". He was prosecuted and fined £4. 4.0d. with £2. 2 Od, costs. Non-brewed Condiment Two samples of non-brewed condiment were sold slightly deficient in acetic acid The retailer was informed and as a consequence a subsequent sample procured has been found of proper strength. Pickled Herrings A sample of "Pickled Herrings in Wine Sauce" was found to be pickled herring in sauce containing no alcohol. It is possible that alcohol had originally been added but had disappeared. A warning letter was sent to the manufacturers who undertook to alter the designation. Sweets Three samples of butter flavoured sweets, each from a different manufacturer, were procured and in each case objection was taken to the obscurity of the indication that the sweets were butter flavoured and not butter sweets. In each case the word or abbreviation used to indicate the flavouring was inconspicuous and/or misplaced in relation to the rest of the designation. 27 In each case the manufacturer has agreed in all cases where the designation is printed to put the word "flavoured" in its correct place and in the same type as the other words of the designation. Vinegar Of the eight unsatisfactory vinegar samples two were found to be deficient in acetic acid, the other six samples being non-brewed condiment. These eight samples were sold in all by four retailers, one of whom was prosecuted and fined £2.0.0d. with £317.0d. costs. In two other cases the follow up proved genuine and no further action was taken, and in the remaining case, an official caution was issued Merchandise Marks Act, 1926: Imported Food Orders During the year 246 premises were visited and 1,051 displays of meat, apples tomatoes poultry and dried fruit were examined. Three caseg arose of displaying imported food not marked with the country of origin. The first concerned Australian and South African apples and Canary Island tomatoes, and the retailer was fined £2.0„0d. on each of two summonses and ordered to pay £3.3.0d. costs. A second prosecution was for displaying Canary Island tomatoes not marked with country of origin, and a fine of £2.0.0d. "was imposed in this case. The third case was for displaying Australian and New Zealand apples not so marked and an official caution was issued Labelling of Food Order 192 premises were visited and 430 different articles examined. No infringements of substance arose Defence (Sale of Food) Regulations, 1943 Investigations under the above Regulations resulted in the following cases:- Three firms of greengrocers falsely described potatoes other than King Edwards as "King Edwards" An official caution was given in each case. There were two separate cases of false description of apples, In one case Laxton apples were described as "Cox's"; in the other, South African Pearmain apples were described as "Newtowns", The greengrocers were fined £5,0.0d. and £2.0.0d respectively. There were two separate cases of false description of plums. In one case Belle De Louvain plums were described as "Victorias" - the greengrocer 28 was fined £1.0.0d and £2. 2.0d. costs. In the other case, Giant Prune plums were falsely described as "English Victorias", and the firm was fined £2,0.0d. and ordered to pay £l. l.0d. costs." Food and Drugs Act, 1938: Legal Proceedings Legal proceedings were taken in 1 case in respect of contaminated food, namely:- Section 9. Mice dirts in bread. Defendant pleaded guilty and was fined £2.0.Od. on each of two summonses with £2.0.0d. costs. 29 PART III SANITARY CIRCUMSTANCES OF THE AREA Water Supply I am indebted to the Director of Water Examination of the Metropolitan Water Board for the following report upon water supplied to the borough during 1954:- 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. A contact tank was brought into operation at the Hornsey works in July, 1954 (b) River Thames water stored in Walton Reservoir and treated at the Board's filtration works at Walton, Samples are collected on five days in every week, or more often if required, at each stage of the purification process and tests include physical, chemical and microbiological examination. The water supplied to this area is not plumbo-solvent. All new and repaired mains are chlorinated before being restored to use and samples of water from them are tested bacteriologically to ensure that its quality is up to that normally supplied. Drainage and Sewerage Separate systems of soil and surface water drainage continue to operate in the Borough. Co-operation with the Borough Engineer's department enables complaints relating to stoppages to be dealt with expeditiously. Some success has been achieved in dealing with pollution in the Moselle and Lesser Moselle but investigations with regard to the Stonebridge brook will have to be intensified. Average Results of the Chemical and Bacteriological Examinations of the Water Supplied to the Borough of Tottenham for the Year 1954 Parts per Million (Unless otherwise stated) Description of the Sample No. of Samples Amnioniacal Nitrogen Albuminoid Nitrogen Oxidised Nitrogen (Nitrate) Chlorides as C1 Oxygen abs- from Permanganate 4 hrs. at 27°C 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 Si02 Magneslum Mg. Sulphate as so4 Conductivity  New River water filtered at Hornsey works 225 0.033 0.073 6.2 36.4 0.73 0.2 7 307 80 7.7 1.04 13 5.2 53 550 New River water filtered at Stoke Newington works 225 0.036 0.076 6.2 36.6 0.76 0.2 8 305 79 7.8 1.01 13 550 River Thames derived filtered water 1,585 0.021 0.092 3.9 26.7 1.20 0.3 12, 269 70 7.9 0.65 11 5.0 50 450 Bacteriological Results Description of Sample No. of Samples No. of microbes per ml Colonies counted on agar after 20-24 hrs at 37°C. Bact. coli Test Percentage of samples negative to Bact. coli in 100 ml. Bact. coli per 100 ml. New River water filtered at Hornsey 257 12.6 100. 0 Nil New River water filtered at Stoke Newington works 258 13.7 100.0 Nil River Thames derived filtered water 3,604 8.8 99. 8 0.004 30 31 Closet Accommodation The water carriage system is in operation throughout the Borough. It has not been necessary during the year to use the provisions of the Tottenham Corporation Act, 1952. It would appear that the provision of sanitary conveniences in houses let in lodgings or occupied by members of more than one family could be resolved by the provisions of Section 11 Housing Repairs & Rents Act, 1954 There is however a proviso in Section 11 (1) (b) that in default of carrying out the work, the owner is entitled to secure a reduction in the number of persons or households. To do this, he can seek the assistance of the Courts. Atmospheric Pollution In my annual report of last year I made brief comment on the Beaver Committee's interim report. The final report of that committee has now been published and I set out a summary of its recommendations. (1) With some exceptions (special trades) dust and smoke should be prohibited by law. (2) Use of grit and dust arresting plant to be obligatory if more than 10 tons of solid or pulverised fuel is burnt per hour. (3) Provision in local acts for "prior approval" e.g. Tottenham Corporation Act, 1952 - should be included in general legislation - as should the power to create Smokeless Zones. (4) The law to control smoke from railways to be brought up to date and strengthened. (5) Financial assistance to be given in certain cases - reduction in purchase tax for approved appliances. (6) Local authorities to enforce the general provisions and to submit an annual report to the Minister. Other recommendations include codes of practice - standard specifications for smoke indicators and recorders etc. The control of pollution by motor vehicles and finally the appointment of a "Clean Air Council" to co-ordinate research and review progress. All that remains is for the Government to accept and act on the Beaver report and introduce the legislation necessary to implement the recommendations. Given the powers, local authorities will find more enthusiasm for dealing atmospheric pollution than could reasonably have been expected of them in ' the past. 32 Tottenham's application to the Minister for the establishment of a Smokeless Zone in the Mark field area was submitted and approved during the year. The order will come into operation in January, 1955. Housing The main preoccupation of the Council in matters of housing has, hither to, been concerned with providing houses for the many applicants on the list. Emphasis in the near future must, however, be "new houses for old," if the tempo of slum clearance is not to be retarded. Circular 30/54 issued by the Ministry of Housing & Local Government in March states that it is an essential part of Government housing policy that local authorities should regard the work of slum clearance as "a matter of urgency". With the full approval of the Council the department has gone ahead in these matters, and two further areas were represented during the year. The first dealt with White Hart Lane and the adjoining area involving some 130 houses. The second area dealt with the next phase of the Tewkesbury redevelopment and includes over 70 houses. A total of over 300 houses have been represented since the work of slum clearance recommenced. Nothing is more frustrating than to receive complaints from the occupants of insanitary and worn out houses knowing that nothi ng can put them right. It is therefore with much satisfaction that we shall be able to deal with these black spots as clearance areas. While in the past we have deal t with this class of property purely as clearance areas on public health grounds, future schemes must have regard to planning requirements. Building land in the Bbmugh is almost non-existent and some effort will be required to deal with areas which allow room for a favourable balance of houses. An increased density of redevelopment would assist in this. A public inquiry in connection with the Hale Clearance Area was held in July - the result is not yet known. In addition to ascertaining the unfit houses requiring to be dealt with, it has been necessary to review all aspects of housing so that clearance schemes can be co-ordinated with the building programme. As Tottenham is fully built up it is necessary to plan for the rehousing of families displaced from clearance areas in dwellings to be erected on previously cleared sites. Other obstacles which have to be met are the need to provide accommodation for urgent cases requiring rehousing and the rehousing of families in requisitioned houses. 33 Provision of Municipal Houses and Flats The erection of dwellings in the borough since the war has been dependent upon the utilisation of bombed sites and clearance areas, so that it has been necessary for the Council to seek building sites outside the borough. This has proved extremely difficult, but it has been possible to build an estate at Cheshunt and 21.6 acres of land are being acquired at Potters Bar for housing purposes. The following statement of units of accommodation erected by the Council shows the scattered nature of the post-war schemes consequent upon the shortage of land:- Scheme Type of Dwelling Total 1 Bed 2 Beds 3 Beds 4 Beds 5 Beds Pre-war Permanent Dwellings 1919 Scheme (Coombes Croft & White Hart Lane) - 32 380 16 - 428 1924 Scheme (White Hart Lane) - 28 359 - - 387 1938 Scheme (Scotland Green) - 20 16 - - 36 *1936 Scheme (Weir Hall, Edmonton) 40 174 120 22 - 356 40 254 875 38 - 1,207 Post-war Permanent Dwellings Allington 32 - 108 12 - 152 Asplins 4 - 43 6 - 53 Burbridge Way 4 42 32 - - 78 * Cheshunt (Waltham Cross) 8 47 100 24 - 179 Cornwall Road 20 8 42 - - 70 Devon Road 24 - 89 8 - 121 Kathleen Ferrier Court 3 - 13 2 1 19 Lawrence Road 4 17 4 - - 25 Love Lane 4 16 - - 20 Lydford Road 10 - - - 10 Reynardson Court - 16 - - - 16 Tewkesbury I 6 40 14 - - 60 Tewkesbury II 21 20 10 - - 51 *Weir Hall (Edmonton) - 14 16 - - 30 140 220 471 52 1 884 Post-war Temporary Bungalows - 309 - - - 309 Miscellaneous Properties acquired for housing purposes 2 4 16 - - 22 TOTAL 182 787 1,362 90 1 2,422 * Estates outside the Borough. 34 At the end of 1954 the following housing schemes were in hand or at some planning stage, namely:- Type of Dwellings Total 1 Bed 2 Beds 3 Beds 4 Beds Sites in Possession of Council Dwellings in course of erection Markfield 20 48 24 - 92 Manor Road - 12 - - 12 Penshurst Road 12 - 12 - 24 Rheola House 6 16 8 - 30 High Road/Northumberland Park 1 34 4 1 40 West Green Road - 26 16 - 42 Tewkesbury - 44 23 - 67 Total 39 180 87 1 307 Building not yet started Roads & Sewer work in hand Tewkesbury 10 3 11 - 24 Asplins - 6 - - 6 Schemes at Tender stage *Cheshunt 4 2 - - 6 West Green - 19 8 1 28 Schemes at Planning Stage Rectory Farm 68 40 28 - 136 Chesnut Road - 12 - - 12 Forster Road 12 - - - 12 High Road 24 24 - - 48 Total 118 106 47 1 272 Sites not in Possession of Council Schemes at Planning Stage Markfield 8 16 32 - 56 Hale 42 46 30 - 118 *Potters Bar 45 99 149 8 301 Total 95 161 211 8 475 Total Number of Dwellings in Course of Erection or planned at 31.12.54. 252 447 345 10 1,054 * Sites outside the Borough. The Council also manage 879 requisitioned properties which accommodate 1,098 families. Allocation of Accommodation The following statement of families on the Council's general housing lists, which has been supplied by the Housing Manager, gives some indication 35 of the problem confronting the Council in its endeavour to deal with needy cases on the lists, and at the same time keep sufficient accommodation available for the essential decanting of families from clearance and redevelopment areas:- Number requiring cne bedroom type dwelling 2,266 " " two " " " 5,244 " " three””” 1,816 " " four ” ” ” 97 " ”old people's " " ” 707 10,130 During 1954, 222 units of accommodation were let by the Council, and these were allocated to families in the following way:- From general housing lists 59 From "Halfway Houses" 24 From clearance areas 71 From areas acquired for redevelopment under Part V of the Housing Act, 1936 52 From individual unfit houses 7 From requisitioned property prior to de-requisitioning 5 From temporary bungalows prior to redevelopment of sites 4 Total 222 New and Expanded Towns During 1954 170 families went from Tottenham to new and expanded towns, and of this number 110 had applied to the Council to be rehoused, 34 of the families were nominated by the Council- The families went to the following towns:- Basildon 14 Bracknell 7 Crawley 2 Harlow 98 Hatfield and Welwyn 3 Hemel Hempstead 2 Stevenage 14 Swindon 30 36 Slum Clearance Since the war 7 areas have been represented for clearance under Part III of the Housing Act, 1936, and Clearance and Compulsory Purchase Orders submitted to the Ministry of Housing and Local Government. Decisions are outstanding in 4 cases. The following table shows the position at the 31st December, 1954. Area Number of Dwellings Date Represented Inquiry Confirmation Rehousing Occupants Completed Demolition of Premises Completed Arthur Road 19 28.11.50 13.11.51 19.1.52 10.53 1.54 Markfield No, 1 17 28.10.52 5. 5. 53 13.8. 53 - - " No. 2 18 28.10. 52 5. 5. 53 13.8. 53 - - The Hale 65 2. 2.54 6.7.54 - - - White Hart Lane No. 1 4 1. 6.54 - - - - " No. 2 123 1. 6.54 - - - - Tewkesbury No. 2 71 29. 6.54 - ' - - - Medical Aspects of Housing Medical certificates are frequently submitted in respect of housing applications. Those submitting these certificates are usually under the impression or at least very hopeful, that this will automatically give them priority in rehousing. This is not the case. The housing department consults this department on receipt of medical certificates and advice is given in committee on these matters. The guiding principles for priority on medical grounds are:- 1. Is the present accommodation a factor in aggravating or perpetuating the illness; and 2. Whether new accommodation which may be available will be suitable for the family's need and be a factor in assisting the patient's recovery. With physical illness it is usually relatively easy to assess these matters but in the sphere of mental illness the problem is usually less clear cut. In broad terms one can say that neuroses may benefit whilst psychoses are unlikely to. Another difficult type of case is that in which there is incompatability between tenants and sub-tenants. It cannot be denied that considerable domestic stress and strain can occur in these cases and that such tensions may initiate a neurosis in a susceptible individual. 37 The causes of incompatibility are many. In order for there to be harmony between families occupying the same premises there must be give and take on both sides, but unfortunately this is often lacking. The tenant, in a gesture of goodwill and neighbourliness, may have taken in another family not realising perhaps that such an action calls for a continuance of this goodwill and some restriction of the freedom hitherto enjoyed. Although these cases assume prominence we do not really know what proportion of such households are in a state of stress and what proportion do achieve a state of equilibrium. Housing Repairs & Rents Act, 19 54 This important Act became law in 1954, it is in three parts. Part I:- deals mainly with clearance - redevelopment - reconditioning of unfit houses. Part II:- deals with repairs, increases in the rents of controlled dwelling houses. Part III:- contains a few mi seel 1 aneous provisions. As indicated in my last year's annual report, the Act now requires local authorities to submit within one year their proposals for dealing with slum clearance. This programme is now being prepared and will be submitted to the Council for approval before being sent to the Minister. The one section of the Act which has made it necessary for us to modify our interpretation of unfitness is Section 9. This section specifies the matters which must now be taken into consideration It further states that "the house shall be deemed to be unfit if, and only if, it is so far defective in one or more of these items that it is not reasonably suitable for occupation." Complainants have hitherto come to expect the department to serve notices on owners in matters of decorative repairs. The Housing Repairs & Rents Act has made this no longer possible, except in extreme cases. Where it is attempted no doubt we shall find notices being challenged in the Courts and, in due time, new case law being established. That part of the Act dealing with repairs increases has resulted in many inquiries at the rent advice bureau. Although applications for certificates of disrepair have been numerous, they were not as heavy as was expected. Many of the large property owning estates did not take advantage of the provisions to increase rents. Others undertook repairs before charging the increases. Reactions to the issue of certificates of disrepair have not been so violent in Tottenham as have been heard elsewhere. 38 Some owners have complained that certain items included in notices have been of a trivial character. Others complain that no prior notice of the defects have been received from the tenants. Experience shows that whilst many tenants are content to live in given conditions and to pay what they regard as a reasonable rent, notice of an increase brings the immediate reaction of wanting something better for the extra rent. The result is an application for a certificate of disrepair, and as the figures show the majority of these applications have been successful. It should be noted that the majority of owners making increases also take advantage of the provisions of Section 30 and serve on the tenant a notice of declaration, that the owner has opted not to be responsible for internal decorative repairs. Such a notice does not however place the responsibility on the tenant. The owner is still responsible for keeping the house reasonably suitable for occupation and in my view this will include internal decorative repairs where the state of these renders the house unfit. The provisions of Sections 9 and 10 of the Housing Act, 1936 have continued to be operated, although in the modified form made necessary by the new definition of fitness. In view of the clearance programme less use is made of these sections in respect of houses in proposed areas. Complaints received from these areas are dealt with under the nuisance sections of the Public Health Act, 19 36 but where the matter is urgent the provisions of the Tottenham Corporation Act, 1952, dealing with defective premises, is used. Hiring the year under review it has again been necessary to take action under Sections 11 & 12 of the Housing Act, 1936. A number of basements and other rooms were closed under Section 12 and in certain cases Section 10, of the Local Government (Miscellaneous Provisions) Act, was used to close terraced houses. In one case dealt with under Section 10 of the Local Government (Miscellaneous Provisions) Act, an appeal against the closing order was lodged in the County Court. In this case the Council refused to accept an undertaking from the owner to repair, taking the view that the proposed repairs would not render the house fit. The appellant was successful in his action and the learned judge gave him 3 months in which to carry out his work. 39 HOUSING ACT, 1936: SECTION 11 Premises the subject of Demolition Orders not demolished as at 31st December, 1954. Premises Date of Order 31, Langham Road 6. 8. 52 46, Love Lane 15. 7. 54 * 1, Stanley Grove 2. 4. 54 * 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. 54. Premises demolished during 1954 Premises Date of Order Date demolished 9, Avenue Road 3. 2. 54 May, 1954 10, The Hale 5. 4. 50 February, 1954 12, The Hale 21. 5. 52 February, 1954 16, The Hale 2. 3. 51 February, 1954 1, Kings Road 1. 12. 53 May, 1954 3, Kings Road 1. 12, 53 May, 1954 42, Love Lane 28. 10, 53 March, 1954 44, Love Lane 28. 10. 53 March, 1954 2, Moselle Street 1. 12. 53 February, 1954 LOCAL GOVERNMENT (MISCELLANEOUS PROVISIONS) ACT,' 1953: SECTION 10 Closing Orders made during 1954 in respect of whole houses Premises Date of Order 172, Markfield Road 23. 11. 54 174, Markfield Road, 2. 4. 54 4, Moselle Street 7. 5. 54 40 HOUSING ACT, 1936: SECTION 12 Closing Orders made during 1954 in respect of parts of Houses Premises Part of Premises Concerned Date of Order 2, Brereton Road Basement Front & Rear Rooms 7. 10. 54 5a, Moselle Street Ground Floor Front & Back Rooms 2. 4. 54 18, Moselle Street Basement Front & Rear Rooms 2. 4. 54 4, Walton Road Ground Floor Back addition Room 22. 12. 54 Robin's Mission, West Green Road, Caretaker's Flat 2. 4. 54 HOUSING ACT, 1936: SECTIONS 9 AND 10 Work in Default Year Number of Houses Cost £ s. d. 1940 3 25 4 4 1941 19 319 7 0 1942 21 543 4 10 1943 114 2,559 7 3 1944 45 1,026 6 9 1945 17 658 3 11 1946 152 7,329 16 8 1947 241 14,272 16 9 19 48 181 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 1953 33 1,918 8 0 1954 30 1,347 4 2 The Housing Consolidated Regulations, 1925 - 1932 The following is a summary in accordance with the above Regulations of action taken during 1954 to deal with unfit houses in the Borough, namely:- 41 (1) The number of houses which on inspection were considered to be unfit for human habitation 995 (2) The number of houses the defects in which were remedied in consequence of informal action by the Local Authority or their Officers 526 (3) The number of representations made to the Local Authority wi th a view to (a) the serving of notices requiring the execution of works 535 (b) the making of demolition or closing orders 12 (c) the declaration of clearance areas 288 835 (4) The number of notices served requiring the execution of works 231 (5) The number of houses which were rendered fit after service of formal notices 211 (6) The number of demolition or closing orders made 11 (7) The number of houses in respect of which an undertaking was accepted under subsection (2) of Section 11 of the Housing Act, 1936 1 (8) The number of unfit houses demolished in accordance with (a) demolition orders 9 (b) clearance orders 7 16 Certificates of Disrepair During 1954, after the Housing Repairs and Rents Act, 19 54, came into force on the 31st August, the following applications for certificates of disrepair in respect of rent increases under the 1954 Act were dealt with under section 26 namely:- Applications received 208 Aplications withdrawn by applicants 2 Certificates refused by Council 10 Certificates revoked on completion of repairs 39 51 Certificates in force at 31st December, 1954 157 42 In addition, one certificate was granted in respect of an increase under the 1920 Act, and later revoked upon completion of repairs by the landlord. Public Health Act, 1936; Section 154 On three occasions during the year dealers were reported by the Police to have been seen giving toys to children in exchange for rags. The offenders were prosecuted, in two cases the defendants were fined £1 on each of two summonses with 10/6 costs, and in the third case the defendant was fined £3 with 1 guinea costs. Rag Flock and other Filling Materials Act, 1951 At the 31st December, 1954, one establishment was licensed for the manufacture of rag flock and 25 premises registered for the use of filling materials. Regular visits were made by the district sanitary inspectors to the licensed and registered premises to ensure that only clean filling materials were used and to inspect the records which the occupiers are required to keep. Pet Animals Act, 1951 At the 31st December, 1954, seventeen premises were licensed as Pet Shops in accordance with the Pet Animals Act, 1951. Regular visits were made to the premises by the district sanitary inspectors to ensure that the requirements of the Act and licensing conditions were complied with. Rodent Control The work of rodent control is carried out in accordance with the approved Ministry methods. During the year the two operatives attended refresher courses to ensure that they are kept abreast of new developments and technique. The Council is represented at the quarterly meetings of the Workable Area Committee and in this way an exchange of information and experience is made possible. Sewer maintenance treatments were again carried out during the months of April/May and October/November. Treatments to private dwellings and business premises have been undertaken as and when necessary. 43 Sewer Maintenance - Results of baiting manholes Poison take at Manholes Treatment No. 19: April/May Treatment No. 20: Oct. /Nov. Complete - - Good 131 130 Small 257 268 Nil 612 594 Estimated number of rats killed 4,335 4,380 Poison used 2½% zinc phosphide 10% arsenious oxide The following is a summary of dwelling houses and business premises treated during 1954:- (1) Dwelling houses 580 (2) Business and Factory premises 167 (3) Total charge for (2) above £128. 13. 7 Insect pests The department continues to use a 5% solution of D. D. T. for dealing with insect pests, but a water emulsion is now used instead of kerosene.' For certain insects a 5% D. D. T. power is used in addition to spraying round the infested area. Cause Private Houses Houses Rooms Council Houses Houses Rooms Other Premises Totals Houses Rooms Others Ants 10 8 - - 1 school 10 8 4 2 shops 1 nursery Bees - - - - 1 office - - 1 Beetles 29 33 - 4 canteens 1 school 29 33 5 Bugs 93 209 5 12 - 98 221 - Earwigs 1 - - - 1 - - Fleas 4 12 - - - 4 12 - Flies 4 5 - - 4 5 - Insects - - - - 2 flats - - 2 Maggots 1 2 - - - 1 2 - Moths - - - - 1 school - - 1 Silverfish 1 2 - - 1 2 - Wasps 6 - - _ - 6 . - Woodworm 6 3 - - - 6 3 - Bedding disinfested: 15. 44 Disinfestation was carried out upon removal to council houses in 98 instances, but later in the year the Council modified their policy which was hitherto to require all new tenants to have their effects disinfested with hydrogen cyanide. The present practice is for households to be visited by sanitary inspectors prior to removal, and only those cases which are found to be verminous are disinfested. 38 inspections of this nature were carried out by sanitary inspectors. Inspections Carried out by the Sanitary Inspectors Appointments and Interviews 1,0 26 Cinemas and Halls 69 Complaints Investigated 3,98 3 Conveniences and Urinals 69 Drains Defective 266 Drains Tested 409 Factories with Mechanical Power 539 Factories without Mechanical Power 63 Food Poisoning 15 Food Premises Bakehouses 116 Butchers 239 Cafes 165 Dairies 214 Factories 73 Factory Canteens 35 Fishmongers 103 Greengrocers 95 Ice Cream Premises 138 Slaughterhouses 591 Other food Premises 291 House to House 229 Improvement Grants 2 Infectious Disease 393 Other Visits 2,695 Outworkers 320 Rat Infestation 918 Re-inspections 9,606 Schools 23 S. D. A. A. and Housing Act Advances 95 Smoke Observations 70 Stables and Mews 39 Tuberculosis 2 Workplaces 28 45 Defects Remedied Drains reconstructed 41 Drains rep aired 315 Drains cleared 17 2 W. C. Cisterns rep aired or renewed 181 W. C. Pans renewed 122 W. C. Pans cleansed 57 Waste Pipes repaired or renewed 129 Rainwater pipes repaired or renewed 326 Roofs repaired or renewed 7 15 Eaves gutters repaired or renewed 506 Drinking water cisterns renewed 11 Drinking water cisterns covered 6 Water service pipes repaired 123 Water supply reinstated 59 Yards repaired or reconstructed 92 Sinks renewed or provided 42 Floors repaired or renewed 38 4 Floors ventilated 171 Dampness remedied by insertion of damp proof courses 99 by pointing of brickwork 169 by internal rendering 337 by miscellaneous remedies 224 Window frames and sashes repaired or renewed, or painted 465 Coppers repaired or renewed, or provided 12 Fireplaces, stoves and ovens repaired or renewed 323 Flues and chimney stacks repaired 177 Brickwork of walls repaired and walls rebuilt 169 Ventilated food stores provided 9 Rooms cleansed 780 Staircases, passages and landings cleansed 210 Staircases, balconies and steps repaired or renewed 107 Noxious Accumulations removed 36 Nuisances arising from animals abated 8 Miscellaneous defects remedied 962 46 Work carried out in default or by agreement with the owners during 1954:- Housing Act, 19 36: £ s." d. Section 9 30 premises 1, 347 4 2 Public Health Act, 1936; Section 24 8 premises 321 5 9 " 39 9 " 250 4 11 " 45 2 9 19 0 " 94 7 " 214 8 6. Tottenham Corporation Act, 1952 Section 36 1 premises 30 15 0 " 38 2 " 1 1 10 "43 2 0 " 130 14 7 Tottenham Local Board Act, 1890 Section 14 2 premises 54 2 9 £2, 359 16 6 Notices Served Statutory:- Housing Act, 1936; Section 9 211 119 " 12 5 225 Local Government (Miscellaneous Provisions Act 1953) Section 10 3 3 Public Health Act 1936 Section 24 8 " 39 33 " 42 2 45 15 " 94178 " 287 6 242 Tottenham Corporation Act 1952 Section 36' 7 " 43 56 54 1 64 Tottenham Local Board Act 1890 Section 14 3 3 537 Informal 1.759 Repair of Houses by the Council 47 PART IV FACTORIES AND SHOPS In my annual report for 1952, I gave an account of a pilot survey of occupational health carried out locally in an industrial area in the Borough, Mention was made here that there was no organised system of safeguarding the health of workers in the majority of factories and workshops in the district and that the need for a local occupational health service, largely supervisory and advisory, was apparent. In my annual report for 1953, I commented on the draft proposals put forward by the Home Office for legislation based on the Gowers report on health and welfare of workers in non industrial employment. These proposals suggested that the enforcement of such legislation should rest with local authorities concerned with environmental health. In November 1954 the Government announced that it had set up an Industrial Health Advisory Committee and at the same time the Minister of Labour announced that he was taking steps to encourage the development of an Industrial Health Service in workplaces covered by the Factories Acts, Since it has been suggested that local authorities should inplement legislation in respect of non industrial employment, it is reasonable that similar proposals should be extended to cover those industrial undertakings not able to make adequate provision themselves. Already the local authority has control of services which directly affect the health of the worker in industry: the record of school medical examinations and transfer of information to the Youth Employment Officer when the child starts work; concern in many spheres with the welfare and employment of handicapped persons; and statutory duties in connection with sanitary and other health matters in industry. The local authority is also vitally concerned with matters affecting the health and well-being of the worker outside the factory. It is logical, therefore, to suggest that the Medical Officer of Health should be the officer to co-ordinate any services set up to provide an occupational health service for the industrial as well as non-industrial worker in his area. 48 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 Sections 1,2,3,4 and 6 are to be enforced by Local Authorities 67 66 1 - (ii) Factories not included in (i) in which Section 7 is enforced by the Local Authority 660 536 20 - (iii) Other Premises in which Section 7 is enforced by the Local Authority (excluding out=workers" premises) 8 8 - - Total 735 610 21 - 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) 1 1 - - Overcrowding (S.2) - - - - Unreasonable temperature (S.3) - - - - Inadequate ventilation (S.4) - - - - Ineffective drainage of floors (S. 6) - - - - Sanitary Conveniences (S. 7) - - - - (a) Insufficient 8 8 - 1 (b) Unsuitable or defective 50 50 - 5 (c) Not separate for sexes - - - - Other offences against the Act (not including offences relating to Outwork) - - - - Total 59 59 - 6 ] Outwarkers (Sections 110 and 111) Regular visits were 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. 49 The following is a summary of the types of outwork carried on in the Borough:- Wearing apparel 414 Hausehold linen 1 Curtains and furniture hangings 1 Artificial flowers 17 Paper bags 2 The making of boxes or other receptacles or parts thereof made wholly or partially of paper 86 Brush making 9 Carding, etc., of buttons, etc. 4 Stuffed toys 3 Cosaques Christmas crackers, Christmas stockings, etc. 21 Lampshades 2 560 During the year 328 visits were made to outworkers' premises. No contraventions of the Factories Acts were reported. Shops Act, 1950 The supervision of shops and effective administration of the legislation relating thereto are secured by systematic visitation. The Health Department maintains a register of all classes of shop premises in the Borough. In the general administration of the Shops Act 2,295 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: 331 verbal warnings and notices were issued Subject to exemptions all shops in the Harringay area are closed for the weekly half-holiday on Wednesday In the remainder of the Borough early closing is on Thursday with the exception of butchers who close on Monday throughout the Borough Qose supervision is exercised in order to see that the weekly half-holiday is correctly observed, 169 visits being made for this purpose Welfare Provisions The requirements in respect of shop assistants meal times are as follows:- Dinner; If the hours of employment include the hours from 11. 30 a.m. to 50 2.30 p.m., every assistant must be allowed an interval of at least threequarters of an hour within that time, 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 p.m. to 7 p.m. each assistant must be allowed an interval of half-an-hour within that time. No assistant shall be employed more than 6 hours (5 hours if under 18) without an interval of at least 20 minutes being allowed during the course there of. It has become the practice in many shops to allow assistants a tea break of 10 minutes during the morning and afternoon. Sunday Trading The provisions of the Act are effectively enforced by means of investigation and observation. 74 visits were made for this purpose, and 7 warning notices were sent in respect of contraventions. Shops Act and Young Persons Employment Act, 1938 Inspection and enquiry under these Acts, 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. 239 visits were made. In general shopkeepers are desirous of taking reasonable measures to comply with statutory requirements, and willing to seek and act upon the advice and instructions given by the Shops Inspectors. 51 PART V GENERAL Health Services provided by other Authorities (a) Hospitals:- North-East Metropolitan Hospital Regional Board The hospitals in the Borough are locally administered by the Tottenham Group Hospital Management Committee whose offices are at the Prince of Wales's General Hospital. The Group Secretary is Lt. Col. J C. Burdett, D.S.O., M.C. The Group comprises the undermentioned hospitals:- Hospital Bed Complement Beds Open Remarks Bearsted Memorial Hospital 38 38 Maternity Hospital Annexe at Hempton Court 33 33 St. Ann's General Hospital 716 502 Includes Infectious Disease Wards Prince of Wales's General Hospital 228 220 Annexe at Nazeing (Princess Louise Convalescent Home) 20 20 Tottenham Chest Clinic A table giving details of the out-patient clinics provided by the Prince of Wales's General Hospital is set out on the following page. 52 PRINCE OF WALES'S HOSPITAL Timetable of Out-Patient Clinics Monday Tues. Wed. Thurs. Friday Sat. Medical P.M. A. M. - P.M. A. M. & P.M. - Surgical P.M. P.M. A. M. - P.M. - Diseases of Women - P.M. r P.M. - - Children (Medical) - A. M. - A. M. - - Eye - - A. M. - - - Throat, Nose & Ear P. M. - - P. M. - - Skin - - P. M. - ' A. M. - Teeth - - - A. M. - A.M. Neurological P.M. - - - - - Genito-Urinary - A. M. - - - - Psychiatric P.M. - - - P.M. - Physical Medicine 9-5 9-5 9-12 9-5 9-5 9-12 X-ray 9-8 9-8 9-8 9-8 9-8 9-5 Orthopaedic - A. M. - A. M. - - Fractures A. M. A.M. A. M. A.M. A. M. - Allergy - - - P.M. - - Venereal Diseases Medical Officer Males 5-7 - 5-7 10-12.30 & 5-7 - 10-12.30 Females - 5-7 - 10-12.30 2-4.30 10-12.30 Intermediate Treatment 9-7 9-7 9-7 9-7 9-7 9-12.30 Doctors' Letters required All patients seen by appointment The Casualty Department is always open for medical and surgical emergencies. (b) Personal Health Services The personal health services which since 1948 have been controlled by the County Council are administered from the Area Health Office, Somerset Road, Tottenham, N. 17. (c) Area Welfare Services The Welfare service of the County Council is administered in Tottenham by the Area Welfare Officer, 5, Lansdowne Road, Tottenham, N. 17, telephone number TOTtenham 1212, and it is to this officer that enquiries should be directed regarding the admission of persons to residential homes provided by the Middlesex County Council. 53 (d) Lunacy and Mental Treatment Acts The Authorised Officers for the purpose of these Acts have their offices at 5, Lansdowne Road, Tottenham, N. 17, telephone number TOTtenham 1211. (e) Ambulance Service Ambulances are stationed at the Edmonton Fire and Ambulance Station, but vehicles are retained at the Tottenham Central Fire Station and at Coombes Croft for accident and emergency cases. Telephone number EDMonton 5544 or, for emergency calls, did 999. 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 at the Town Hall, and providing they reach there not later than 3.0 p.m. on Monday to Friday and 11.0 a.m. on Saturday, they will be sent on the same day by special messenger to the Hornsey branch laboratory. As it is not possible to send a second messenger on any one day, it is essential that specimens be delivered to the Town Hall before the times stated Alternatively, specimens may be sent direct to the Hornsey branch 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 1954, namely:- Record of Examinations Throat/Nose Swabs:- Total Specimens 120 Diphtheria Bacilli Haemolytic Streptococci 31 Vincents Angina 1 Negative 88 54 Faeces:- Total Specimens 1,939 Shigella 551 Salmonella Typhi Murium 47 " Eastbourne 3 " Paratyphi 'B' 11 Negative 1,327 Sputum:- Total Specimens 4 T. B. Smear Other Organisms 2 Negative 2 Pertussis:- Total Specimens 37 Positive 1 Negative 36 Ice Cream:- Total Specimens 24 Water:- Total Specimens 10 Ebmestic Supplies 1 Swimming Pools 7 Other 2 Miscellaneous Specimens 25 Total Number of Specimens 2,159 THE PUBLIC BATHS AND WASH-HOUSE SERVICE The following information has been supplied by the Baths Superintendent, Mr. G. Swarbrick, M.N.A.B.S., M.I.E.C. This Municipal Service is very important to the health of the community, providing private baths for maintaining personal cleanliness, public wash-houses, whereby the family washing can be undertaken in a speedy and labour saving manner, and swimming baths, for healthy indoor and open air recreation. The Council readily realise the value of these services as indicated by the many citizens attending, and intend to maintain the establishments on the most hygienic principles. In conformity with this, the Council have, during the past two years, modernised the private baths at three establishments and re-tiled the two indoor swimming pools. The private baths at another establishment are also under consideration for improvement. It is interesting to note that the water supply for the private baths and wash-houses is pre-softened, a distinct advantage over the main water supply. Regarding the water supplied to the swimming pools, this is maintained 55 at all times in a clear and sterile condition by the most modern filtration and chlorination units, and is periodically checked by analytical tests under the direction of the Medical Officer of Health. The following details of attendances for the year ended 31st March,1955, are an indication of the value of the services, though it must be understood that weather conditions are an important factor in regard to attendances at the swimming pools, particularly so in respect of the open air pool:- Private Baths: 195,373, Swimming Pools: 203,664, Wash-Houses: 40,852, making a grand total of 439,889 patrons. The establishments of the Baths and Wash-Houses Service administered under the control of the Baths and Entertainments Committee are:- (1) The CENTRAL ESTABLISHMENT, with 2 swimming Pools (100ft x 35ft and 75ft x 25ft), 30 Private Baths, 2 Foam Baths and the Municipal Hall (which is available during the winter months - October to March). (2) The CONWAY BOAD ESTABLISHMENT, with 18 Private Baths. (3) The TIVERTON ROAD ESTABLISIMENT, with 22 Private Baths, and Public Wash-House consisting of 9 Rotary Washing Machines, 3 Hydro extractors, 20 drying racks, 9 power mangles and electric irons. (4) The BROMLEY ROAD ESTABLISHMENT, with 14 Private Baths and Public Wash-House similar to Tiverton Road Establishment. (5) The LIDO (Mid-May to Mid-September) Open air bathing pool, with a capacity of 470,000 galls., providing accommodation for 1,200 bathers, sun-bathing terraces, Children's paddling pool and Restaurant. CHARGES:SWIMMING: Indoor Baths: Large Pool - Adults 8d; Juniors 4d; Spectators 3d Small Pool - " 4d; " 3d; " 3d Lido open air Pool: Weekdays - " 8d; " 4d; " 6d Week-ends - " l/6d; " 9d; " l/-d PRIVATE BATHS: Adults 9d. Children (at certain times only) 2d. 56 WASH-HOUSES: 2/9d per machine plus Id. per½ hour for use of dryers, irons, mangles, etc. (For the average person the total charge is about 3/3d the entire process of washing, drying and ironing taking about 3 hours). Care of the Aged Throughout the period under review the department has continued to deal with problems of the aged sick and infirm The co-operation of the various statutory and voluntary bodies concerned with this problem has been readily forthcoming so that the lot of many of the aged and infirm has been to some extent alleviated. It has not always been possible to do all that one would like owing to pressure on hospital and hostel accommodation and sometimes even to the unwillingness of the individual concerned to accept assistance. So much has been said since the war concerning the ageing population that one tends to think that it is only in the last decade that the problem has been recognised. It was, therefore, interesting to read what was written by one of my predecessors, Br, Butler-Hogan in his Annual Report for 190 3. He was commenting on the birth-rate and wrote as follows, 'The continued decline in the birth-rate (it was then 29.5 and is now 12.37) is as subject for serious consideration mA lower birth rate continued for a series of years means an older population.' Provision of Laundry facilities for old people As intimated in my last report, with the co-operation of the Tottenham Group Hospital Management Committee, a laundry service has been established to deal with bed linen and other articles soiled by bedridden incontinent aged persons. The efficient working of the service is due to the excellent assistance received from all concerned, notably the home helps, who carry out preliminary cleansing of articles before their despatch to the laundry. The scheme provides for all soiled articles to be steeped in a disinfectant, any faecal matter having first been sluiced off. Twice a week the laundry is collected in laundry nets by the Public Health Department's disinfecting van, the articles are listed, and a copy of the list is given to the householder. The nets are identified by means of numbered laundry pins and placed in bins carried in the van, the bins being cleansed and disinfected after use. At the Town Hall the articles are examined by the sanitary inspector and a certificate at the foot of each list is completed in accordance with Section 84 of the Public Health Act, 1936. The laundry is then taken to St. Ann's Hospital Laundry where after a cold rinse it is boiled for 15 minutes and then laundered. The clean laundry is returned 3 days later. The service came into operation in April 1954, and 211 collections were made during the remainder of the year. 57 At no time did the number of current cases exceed 7. Old People's Welfare The following brief summary of the work of the Old People's Welfare Committee has been extracted from the Annual Report of the Chairman of the Committee, The Lady Morrison. 1954-1955 has seen a further increase in the work of the Committee, including the opening of an Old People's Club in the Harringay area. (a) Christmas Parcels This year 750 parcels were packed and delivered into the homes of the sick and housebound aged, and there was no doubt that the parcels brought Xmas cheer to many lonely people. The Worshipful the Mayor, (Alderman Mrs. A.F. Remington, J.P. ) kindly gave a donation of £25 and in addition despatched a further 100 parcels to old people who would otherwise have been disappointed (b) Chiropody Service The demand for this essential service which is doing so much to keep the old people 'on their feet' has greatly increased again this year, and so popular and beneficial is this service that four sessions are held weekly now, but in spite of this there is still a seven weeks' waiting list. 1,930 patients received treatment during 1954/55. The charge to old people is one shilling per foot, the remainder of the cost being borne by the Welfare Committee. (c) Visiting Optical Service This is a new service which has started this year, and approximately 50 housebound and bedridden old people have been visited for eye testing and provided with new glasses. Knowing how many of these aged people depend on reading to pass away many lonely hours, it will be appreciated the need this service is meeting and its value to the old people concerned. (d) Meals -on-Wieels Due, no doubt, to the severe winter and the consequent increase in sickness amongst the old people, this service also shows an increase and voluntary workers have been very active in often carrying more meals than the containers could hold, so that this year 4,104 meals have been taken to the homes of the sick old people. Co-operation exists between the Committee, the W. V. S. , and the Home Help Department of the Area Health Service, to ensure that the most needy of these old people are covered for meals during the greater part of the week. 58 (e) Club Meals The demand for meals at the Old People's Clubs has not been so great, the reason for this no doubt, is because food is now varied and more plentiful, and the more active old people can often cook for themselves. This year, however, 9,895 meals were served at the Clubs. The charge continues to be one shilling for main meal and sweet. (f) Holidays The arrangements made with the Women's Holiday Fund have been very successful and 75 old people applied for and benefited from a seaside holiday. As the cost is approximately 32/6 a week (including full board and fare) it can be understood why so many are eager to avail themselves of this opportunity, and thanks are due to the Secretary of the Fund for the kind acceptance of applications. In addition to these, many couples have made satisfactory arrangements for holidays at recommended private addresses held at the Old People's Welfare Office, (g) Shoe Repairs 49 Ebckets were issued for cheap repairs, with an average saving of 3/a pair. (h) Harvest Festival The old people benefited by gifts of Harvest Festival Produce, and parcels were despatched to 219 old people, including 129 bedridden cases, due to the generosity of various Churches and Schools who made this possible. (i) Wireless The 'Wireless for the Bedridden Society' have been very helpful towards housebound old people. In addition the Committee keep and maintain six portable sets which are available from the Organiser. (j ) Old People's Clubs The old people's clubs remain popular and during the year it was possible by reorganising the opening days of the existing 4 clubs to provide for a fifth club to be opened in the Harringay area, without incurring any additional financial expenditure. (k) General Welfare The Old People's Welfare Office is firmly established as a central point where the old people can bring their troubles, and a solution can nearly always be found. The following statistics will give some idea of the work involved:- HOME VISITS OFFICE INTEHVIEWS 403 4,135 59 Many of the problems are not. settled with just one visit or interview, but often involve much correspondence and enquiries in the follow-up procedure before a case can be satisfactorily concluded, and excellent cooperation exists in Tottenham between the Welfare Committee and statutory and voluntary organisations, who give much time and thought to smooth the path for the older members of the community. (1) Parties and outings Several events were organised during the year. In addition a number of free Concerts have been provided at the Clubs by the Ehtertainments Comnittee of the Council. (m) Voluntary workers Several helpers have come along and given their time after working-hours to visit the lonely old people and to date they have made over X)0 visits, also voluntary ladies help regularly at the Clubs with the Meals Services, act as Receptionists at the Chiropody Clinics, and also deliver the Meals-on-Wheels. Without them the existing Services could not run so smoothly, but there is still room for more helpers. Anyone willing to devote a few hours to this very worthy cause should get in touch with the Old People's Welfare Organiser at the Town Hall, Tottenham, who will be pleased to give them further particulars National Assistance Act, 19 48, Section 47. One case was dealt with under this Act as amended by the National Assistance (Amendment) Act of 1951. This latter Act enables the Medical Officer of Health to deal with cases quickly in an emergency. Mrs J.L. was a widow of 81 living alone in a six roomed house in which every room was crammed full of furniture, papers and other valued rubbish. The old lady had been known to the department for several months before her removal to hospital She was an independent individual who was able to go out and do her own shopping. She slept on the floor in the kitchen and rarely undressed or washed. She refused all offers of help although she once relented sufficiently to allow a sanitary inspector to go and start to remove some rubbish but she soon changed her mind and forebade further action. Eventually she became more feeble, although still able to get about, so it was decided to apply for an order from the Court under Section 47 of the National Assistance Act, 1948. Before the necessary formalities could be completed she was found lying on the floor of her scullery by officers of the department, who were visiting the house. She had evidently tripped and fallen She was still adamant however in her refusal to go to hospital so an order for removal under the National Assistance (Amendment) Act, 1951, was 60 applied for and she was admitted to hospital the same day. In hospital she settled down for some weeks and improved physically. Later however she became violent and had to be removed to a mental hospital where she died some months later. When her premises were cleared, some fifteen loads of rubbish were removed from the house by the Cleansing Department, National Assistance Act, 1948, Section 50: Burials During the year it was necessary to arrange four burials where deaths occurred and suitable arrangements for burial would not otherwise have been made. Establishments for Massage and Special Treatment At the 31st December, 1954, 11 licences were in force in the borough. Periodic visits are made to these establishments by the Deputy Medical Officer of Health to ensure that they are properly conducted and that the bye-laws are complied with. Medical Examinations of Council's Staff During the year 108 candidates were examined for purposes of the superannuation scheme, 12 persons failed to pass the examination. The principal causes of rejection in these cases were:- Heart and circulation 5 Chronic bronchitis 3 Tuberculosis 1 Ear disease 1 Hernia 2 12 In addition five of these individuals suffered from other defects. 9 employees were examined in connection with the Sick Pay Scheme. 61 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 19 48 under the auspices of the Warld Health Organisation. 1953 1954 Area of District (in acres) 3,013 3,013 Population: Census, April, 1951 126,929 Mid year Registrar General's estimate 124,400 123,200 Rateable Value £1,011, 380 £1,011,293 Sim represented by penny rate £4,040 £4,070 Births: Registered live-births (a) Legitimate: Males 812 752 Females 755 710 Total 1, 567 1,462 (b) Illegitimate: Males 38 36 Females 37 26 Total 75 62 (c) Total Live-births: Males 850 788 Females 792 736 Total 1,642 1,524 Birth-rate per 1,000 estimated population 13.20 12,37 Stillbirths- (a) Legitimate: Males 22 17 Females 20 14 Total 42 31 62 (b) Illegitimate: Males 2 3 Females 0 2 Total 2 5 (c) Total: Males 24 20 Females 24 16 Total 44 36 Stillbirth rate per 1,000 toteil (live and still) births 26.10 23.08 Deaths: Males 659 64) Females 688 547 Total 1,347 1,187 Death-rate per 1,000 estimated population 10.83 9.63 Maternal Deaths: Puerperal Sepsis 0 0 Other puerperal causes 3 1 Total 3 1 Maternal Death rate per 1,000 total (live and still) births 1.779 0.641 Deaths of Infants under 1 year of age (a) Legitimate: Males 25 13 Females 14 10 Total 39 23 (b) Illegitimate: Males 1 3 Females 3 1 Total 4 4 (c) Total Infantile Deaths; Males 25 16 Females 17 11 Total 43 27 Infantile Death-rate per 1,000 live births 26. 19 17.7 2 63 LIVE BIRTH AND DEATH RATES FOR PERIODS 1918 -1927 AND 1945-1954 Birth-rate Death-rate Table of Cases of Infectious Diseases coming to the knowledge of the Medical Officer of Health during the year 1954, in the Borough of Tottenham, classified according to Diseases and Agesc DISEASE Under 1 1 2 3 4 5 - 9 10 - 14 15 - 19 20 34 35 - 44 45 - 64 65 & up Total Total cases removed to hospital M F M F M F M F M F M F M F M F M F M F M P M F Scarlet Fever - - - 1 6 2 2 1 6 3 34 24 4 6 - 2 - 1 - - - - - - 92 37 Measles 3 2 10 6 4 6 9 6 9 6 46 39 - 2 - - - - - 1 - - - - 149 8 Whooping Cough 7 6 3 7 7 6 7 5 13 9 34 34 2 2 - 1 - 1 - - - - - - 144 10 Pneumonia 1 - 1 1 2 1 - 1 - - 2 5 1 1 2 1 4 7 4 9 15 14 17 8 97 27 Erysipelas - - - - - - - - - - - - - - - 1 - 2 1 1 5 2 3 1 16 7 Pood Poisoning 1 1 - - 1 - 2 2 1 1 5 - 2 - 1 - 3 2 5 1 1 2 - - 31 1 Puerperal Pyrexia - - - - - - - - - - - - - - - - - 1 - - - - - - 1 - Ophthalmia Neonatorum 1 2 - - - - - - - - - - - - - - - - - - - -- -- - 3 3 Acute Encephalitis Infective - - - . - - - - 1 - - - - - - - - - - - - - - - 1 1 Post-infectious - - - - - - - - - - - - - - - - - - - - - - - - - -- Acute Poliomyelitis Paralytic - - - - - - - - - - -- - - - - - - 1 - _ _ _ - _ 1 1 Non-paralytic - - - - -- - - - - - - - - - - - - -- - - - - - - - — Meningococcal Infection - 1 - 1 1 1 - - - - - - - - - - - - - - - - - - 4 4 Diphtheria - - - - - - - - - - - - - - - - - - - - - - - - - - Typhoid - - - - - - - - - - - - - - - - - - 1 - - - - - 1 1 Paratyphoid - - - - 1 - - - - - - - - - - - - - - - - - - - 1 1 Dysentery 2 2 4 4 3 4 3 2 5 7 30 34 5 1 - - 4 5 2 3 - 3 - 1 124 21 Malaria - - - - - - - - - - - - - - - - - - - - - - - - - - Scabies - - - - - - - - 1 1 9 5 1 3 - - - - - 2 - - 1 - 23 - Tuberculosis - - - - - - - - - - - - - - - - - - - - - - - - - - Respiratory 1 - - 1 2 - - 1 1 - 3 2 - 3 6 5 16 33 13 6 12 6 13 2 126 - Meninges & C. N.S. - - - - - - - - - - - - - - - - - - - - - - - - - - Other - - - - - - - - - - 1 • - — - 1 2 - - 1 - - — — 5 — TOTAL 16 14 18 21 27 20 23 18 37 27 164 143 15 18 9 11 29 53 26 24 33 27 34 12 819 122 64 INFANTILE DEATHS IN AGES AND SEXES DURING THE YEAR 19 54 CAUSE of DEATH DAYS Total Under 4 Weeks MONTHS Total Deaths Under 1 Year Males Females 0 1 2 3 4 5 6 7- 14- 21- 1 2 3 4 5 6 7 8 9- 11- Whooping Cough - - - - - - - - - - - - - - - - - - - - - - - -- Pneumonia and Bronchitis - - - - 1 - - - - - 1 2 - - - - - - - - - 3 3 - Gastroenteritis and Diarrhoea - - - - - - - - - - - - - - - - - - - - - - - - Congenital Malformation. Birth Injuries Atelectasis 10 - - 1 - - - - - 1 12 1 - 1 1 - - - - - - 15 6 9 Prematurity 2 - 1 - - - - 1 1 - 5 - - - - - - - - - - 5 3 2 Other Causes 1 - - - - - - - - - 1 1 1 - - - - 1 - - - 4 4 - Total 13 - 1 1 1 - - 1 1 1 19 4 1 1 1 - - 1 - - - 27 16 11 65 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 15 8 - - - - - - - - - 1 1 2 1 _ 5 3 3 1 4 1 1 - • - Tuberculosis other 1 1 - - - - - - - - - - - 1 - - - - 1 - - - - - - - Syphilitic disease 4 1 - - - - - - - - - - - - 1 - 2 - - - 1 - - 1 - - Diphtheria - - - - - - - - - - - - - - - - - - - - - - - - - - Whooping Cough - - - - - - - - - - - - - - - - - - - - - - - - -- - -Meningococcal infections - - - - - - - - - - - - - - - - - - - - - - - - - - Acute poliomyelitis - - - - - - - - - - - - - - - - - - - - - - - - - - Measles - - - - - - - - - - - - - - - - - - - - - - - - - - Other infective & parasitic diseases 4 - - - - - - - 1 - - - - - - - 1 - - - 1 - 1 - - - Malignant neoplasm of stomach 19 17 - - - - - - - - - - - - 1 - 1 1 4 7 5 6 8 3 - - Malignant neoplasm of lung, bronchus 50 7 - - - - - - - - - - - - 1 - 11 1 16 - 16 2 6 3 - 1 Malignant neoplasm of breast - 25 - - - - - - - - - - - - - 4 - 6 - 5 5 - 4 - 1 Malignant neoplasm, uterus - 6 - - - - - - - - - - - - - - - 1 - 1 - 3 - 1 - - Other Malignant & lymphatic neoplasms 70 53 - - - - - - - - 1 - 1 - 1 1 11 6 13 12 21 19 18 13 4 2 Leukaemia & Aleukaemia - 4 - - - - - - - - - 1 - - - - - - - 2 - 1 - - - - Diabetes 1 8 - - - - - - - - - - - - - - - - - 3 - 3 1 1 - 1 Coronary disease, angina 115 74 - - - » - - - - -• - - - 3 - 20 5 26 9 37 30 27 25 2 5 Vascular lesions of nervous system 67 85 1 - - = - - - - - - - - 1 2 4 13 7 28 33 21 31 2 9 Hypertension with heart disease 15 17 - = - - - - - « - = - 1 - - - 4 3 6 6 3 4 1 4 Other heart diseases 57 75 - - - - = - - - 1 - - - 4 2 6 6 3 13 16 27 28 9 17 Other circulatory diseases 28 20 - = 1 1 - - - 1 - - - - - 1 2 3 4 13 5 6 5 2 4 Influenzal chill 1 - - - - - = - - - - - - - - - - - - - - 1 - - - Pneumonia 28 24 1 - - - - - - - - - - 2 - 5 2 2 2 4 4 11 8 3 8 Bronchitis 61 37 - - - - - - - - - - - - - - 4 1 12 4 22 10 18 15 5 7 Other diseases of respiratory system 5 - - - - - - - - - - - - 1 - - - 2 - 1 - 1 - - - Ulcer of stomach & duodenum 11 8 - - - - - - - - - - - - - 1 4 - 2 1 2 3 3 1 - 2 Gastritis, enteritis & diarrhoea - 2 - - - - - - - - - - - - - - - - - - - 1 - 1 - - Nephritis & Nephrosis 3 8 - 1 - - - - - - - - - - - 1 1 2 - 1 2 1 - 1 - 1 Hyperplasia of prostate 9 - - - - - - - - - - - - - - - - - - - 3 - 6 - - - Pregnancy, childbirth, abortion - 1 - - = - - - - - - - - - - 1 - - - - - - - - - - Congenital malformations 3 5 2 4 1 - - - - - - - - - - - - 1 - - - - - - - - Other defined & ill defined diseases 46 43 10 8 - - - - - - - 1 2 1 2 2 8 2 7 4 6 6 8 11 3 8 Motor vehicle accidents 8 3 - - 1 - 1 - 1 - 1 1 1 - 1 - 1 1 - - - - 1 1 - - All other accidents 11 11 4 - - - 1 - - - - 1 - 1 - - 1 1 - 1 2 3 1 4 2 - Suicide 7 4 - - - - - - - - - 2 - 3 1 - 1 - 1 1 1 1 - - - Homicide 1 - 1 - - - - - - - - - - - - - - - - - - - - - - - TOTALS 640 547 19 13 3 - 3 - 2 - 3 6 7 5 18 16 80 46 114 71 188 159 170 161 33 70 66 CANCER DEATHS 1954 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 P M F M F M F M F M F M F M F Buccal cavity and pharynx 4 - - - - - - - - - 1 - - - - - 1 - 1 - - - 1 - - - Digestive Organs and Peritoneum 53 54 - - - - - - - - - - - - 1 - 4 4 11 16 18 21 17 13 2 - Respiratory system 52 7 - - - - - - - - - - - - 1 - 11 1 16 - 17 2 7 3 - 1 Breast and Genitourinary system 16 35 - - - - - - - - - - - - - 4 3 9 1 6 5 8 6 7 1 1 Other and unspecified sites 8 7 - - - - - - - - - 1 - 1 - 1 - 2 2 2 2 1 1 - 2 Lymphatic & Haematopoietic Tissues 6 9 - - - - - - - - - 1 - - - 1 3 1 2 3 - 3 - - 1 - TOTAL 139 112 - - - - - - - - 1 1 1 - 3 5 23 15 33 27 42 36 32 24 4 4 67 Statistics of Tottenham for the last Twenty Years Year Population Deaths Death Rate Births Birth Rate Infantile Deaths Infant Death Rate Number of Cases Puerperal Fever and Puerperal Pyrexia Scarlet Fever Diphtheria Typhoid Fever Smallpox 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*) (136,000 ) 1,406 10.3 (1,776*) (1,739 ) 12.5 66 37.95 15 335 60 - - 1940 119,400 1,703 14. 26 (1,666*) (1,559 ) 13.95 64 41.05 20 103 28 5 - 1941 105, 620 1,418 13. 43 (1,560*) (1,316 ) 14.77 61 46. 35 13 103 73 4 - 1942 110,100 1,349 12. 25 1,819 16.52 79 43.43 12 295 75 1 - 1943 110, 350 1,513 13.71 1,970 17.85 86 43.65 9 340 107 - - 1944 108.180 1,356 12. 53 2,066 19.09 87 42.11 13 206 44 - _ 1945 110, 600 1,371 12. 40 1,988 17.97 78 39.24 14 214 47 - - 1946 124,830 1,491 11. 94 2,580 20.67 88 34.11 13 323 83 _ _ 1947 129,140 1,461 11. 31 2,785 21.57 76 27.29 24 272 22 1 - 1948 130,000 1,377 10. 59 2,233 17.18 53 23.73 5 260 3 - _ 1949 130,040 1,440 11.07 2,009 15.45 50 24.89 15 251 4 _ _ 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 - - _ 1953 124.400 1,347 10. 83 1,642 13.20 43 26.19 1 215 1 _ - 1954 123.200 1,187 9.63 1,524 12.37 27 17.72 1 92 - 1 - * 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. 68 69 COMPARATIVE STATISTICS IN MIDDLESEX FDR THE YEAR 1954 District Population mid-1954 Birth rate per 1000 population Death rate per 1000 population Specific death rates per 1000 population Infant mortality per 1000 live births Maternal mortality per 1000 total births (a) Crude Adjusted Crude Adjusted Pulmonary tuberculosis (a) Cancer (a) Infant (a) Neo-natal (a) (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (ID Acton 67, 150 14. 5 13. 5 9.7 9.5 0.16 (11) 2.0 (135) 17.4 (17) 11.3 (11) - (-) Brentford & Chiswick 59, 160 13. 6 12.6 11. 2 10.6 0.07(4) 2.7 (159) 26.2 (21) 18.7 (15) - (-) Ealing 185,000 12. 5 12.0 9.5 10.0 0.10 (19) 2. 1 (385) 14. 2 (33) 11.2 (26) - (-) Edmonton 100, 300 12.6 12.0 8.0 8.9 0.12 (12) 1.8 (185) 15.8 (20) 11.9 (15) 0.77 (1) Enfield 109, 200 12.6 12.5 11.3 12.2 0.16 (18) 2. 4 (261) 17.4 (24) 14.5 (20) - (-) Peltham 48, 200 15.8 15.6 5.9 8.7 0.10 (5) 1.4 (66) 17.1 (13) 13.2 (10) 1.30 (1) Finchley 70,030 12,5 11.9 10.7 9.5 0.09 (6) 2.2 (153) 18. 2 (16) 14.8 (13) 1.12 (1) Priern Barnet 28,680 9.6 10.1 15.1 14.2 0.24 (7) 2.3 (65) 21 9 (6) 18. 2 (5) - (-) Harrow 217,700 12.6 12.9 8.3 9.5 0.13 (28) 1.7 (365) 16.7 (46) 11.3 (31) 0.71 (2) Hayes & Har]ington 64 ,960 14.4 13.5 7.1 10.7 0.15 (10) 1.5 (95) 21. 4 (20) 19.2 (18) - (-) Hendon 154, 800 13.0 12 .2 9.0 9.4 0.07 (11) 1.9 (295) 20.9 ( 42) 16.9 (34) 0.98 (2) (b) Heston & Islewort.h 10 5, 600 11 .2 11.1 9 6 9.9 0.11 (12) 2.1 (220) 26 2 ( 31) 18.6 (22) - (-) Hornsey 98,210 13.8 12.7 10.3 9.1 0.18 (18) 2. 2 (215) 19. 2 (26) 15.5 (21) 1.45 (2) Potters Bar 17,620 14.0 13.4 7. 4 8.3 0.06 (1) 1 8 (32) 12.1 (3) 8.1 (2) - (-) Ruislip & Northwood 72,070 12.7 12.8 7.6 8.9 0.06 (4) 1.7 (123) 20.8 (19) 9.9 (9) 1.08 (1) Southall 54,440 12.9 12.8 12.2 13.1 0.22 (12) 2. 1 (114) 18.5 (13) 14.3 (10) 1.41 (1) Southgate 72 ,290 11.3 12. 3 11.2 8.8 0.08 (6) 2. 4 (175) 16.0 (13) 14.7 (12) 1.21 (1) Staines 41,050 17.0 16. 3 7.8 8.7 0.10 (4) 1.7 (70) 18.7 (13) 12,9 (9) - (-) Sunbury 24 ,460 18.8 17.7 9.0 10.1 0.04 (1) 1.7 (42) 13.0 (6) 6.5 (3) 2. 15 (1) Tottenham 123,200 12.4 11.8 9.6 9.9 0.19 (23) 2.0 ( 247) 17.7 (27) 12.5 (19) 0.64 (1) Twickenham 104,700 12.7 13.0 11.1 10.2 0.21 (22) 2.1 (222) 14.3 (19) 12.8 (17) - (-) Uxbridge 56,840 16.6 15. 4 8.6 10. 2 0.05 (3) 1.8 (101) 26.6 (25) 20.2 (19) 1.05 (1) Wembley 129,500 11. 4 11.4 8 6 9. 5 0.12 (15) 1.8 (228) 18.2 (27) 14.2 (21) 0.66 (1) Willesden 177,300 14.7 13.2 8.9 9.6 0.19 (34) 1.9 (331) 19.2 (50) 14. 2 (37) - (-) Wood Green 51,090 11.0 10.8 10.4 9.6 0.12 (6) 2.2 (114) 26.6 (15) 17.7 (10) - (-) Yiewsley & W. Drayton 22,450 20. 0 18.4 8 0 10.3 0.04 (1) 1. 5 (33) 26.7 (12) 24.4 (11) - (-) NOTES: (a) Absolute numbers are given in parenthesis in addition to rates to afford valid comparison. (b) The interval between the maternal condition and the date of death in one case exceeded 1 year. 1 APPENDIX COUNTY COUNCIL OP MIDDLESEX AREA HEALTH COMMITTEE (HORNSEY AND TOTTENHAM) REPORT OP THE AREA MEDICAL OFFICER FOR THE YEAR 19 54 70 MEMBERS OF THE LOCAL AREA COMMITTEE AS AT 31st DECEMBER, 1954 MEMBERS OF MIDDLESEX COUNTY COUNCIL County Councillor Mr, J.W. Barter County Councillor Mr. M. W. Burns, J. P. County Councillor Mr. R.A. Clarke County Councillor Mr. VV. East County Councillor Mrs. H.C. Norman, J.P. County Councillor Mrs. M. E. Soall MEMBERS OF HORNSEY BOROUGH COUNCIL Councillor Miss O. R. Anderson Councillor Miss J. Richardson (Vice-Chairman) Councillor Mr. C. V. Tipping Councillor Miss M. E. West Councillor Mr. C. R. Williams MEMBERS OF TOTTENHAM BOROUGH COUNCIL Alderman Mr. A. Reed, A. C.I. I., J.P. Alderman Mrs. A. F. Remington, J.P. Councillor Mrs. E. M. Bohringer Councillor Mr. H. Langer Councillor Mr. P.H. Roberts (Chairman) Councillor Mr. E. C. Smith MEMBER NOMINATED BY APPROPRIATE HOSPITAL MANAGEMENT COMMITTEE Mrs. R.M. Fry PERSONS WHO MAY ALSO ATTEND IN AN ADVISORY CAPACITY Dr. G.D.S. Briggs (Middlesex Local Medical Committee) Dr. I. S. Fox (Deputy) Mr. R. W. D. Brownlie (Middlesex Local Dental Committee) Mr. L. Hayward (Middlesex Local Pharmaceutical Committee) Miss M. McEwan (Royal College of Nursing) Miss V. Eady (Royal College of Midwives) 71 Area Health Staff 1954 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. (Resigned 16th January, 1955) A. Yarrow, M. B.Ch.B. , D. P. H (Appointed 17th January, 1955) Senior Assistant Medical Mrs. J.H. Garrow, M. B. , Ch.B. ,D.P.H. Of fi cer 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. Non-medical Supervisor of Miss F. E. Curtis, S. R. N. , S„ C. M. , H. V. Midwives and Home Nursing M.T.D. Superintendent Supervisory Matron of Day Miss J. Pearse, S.R.C.N. Nurseri es Home Help Organiser Mrs. D. Edwards, S. R. N. , Dip. Soc. Sc. Assistant Home Help Organisers Mrs. W. E. Pickard, S.R.N. 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. Classification of Staff Full-time Part-time Medical Officers 8 7 Dental Officers 8 3 Supervisory Nursing Staff 3 - Administrative and Clerical Staff 34 8 Health Visitors/Schoo1 Nurses 24 2 Clinic Nurses 9 1 Midwives 10 - Home Nurses 18 10 Speech Therapists 2 Phy siotherapists 1 4 Chiropodists - 2 Gramophone Audiometrician - 1 Orthoptist - 1 Dental Attendants 9 1 Day Nursery Staff 37 - Home Help Service 9 159 Manual workers, domestic grades, etc. 10 23 182 225 72 CARE OF MOTHERS AND YOUNG CHILDREN (SECTION 22) Ante-natal Clinics There are six ante-natal clinics in Hornsey and three in Tottenham. Each clinic holds from one to three sessions a week, and midwives also hold sessions at which they continue supervision of their "booked" cases. The average attendance at an ante natal clinic is 15.4 per session. This gives doctor and patient time to discuss the patient's problems. Expectant mothers reach the clinic in three different ways. Firstly, they may attend the clinic of their own accord. Secondly, they may be referred to the clinic by their general practitioner. Thirdly, they may be sent by the general practitioner to the hospital first in order to book a bed; the hospital then refers them back to the clinic for routine supervision. Those patients who attend the clinic before making arrangements for confinement are advised on health or social grounds either to book a midwife for home confinement, or a bed at the Alexandra Maternity Home or a hospital. In the case of patients who are booked at a hospital, a record card is made out at the hospital giving all relevant details, and this is sent to the clinic. At the 32nd week of pregnancy the patient is seen again at the hospital and returns to the clinic with a report on her condition. In this way, liaison is maintained between clinic and hospital which makes for greater security and the confidence of the patient is helped by the knowledge that continued care and interest is being taken. Patients who are to be confined at home (558 births out of 2,996 or 18.6% during 19 54) sometimes attend their medical practitioner only, sometimes the clinic, or both. It is always possible and easy to get another opinion in these cases at the hospital, and if considered advisable, the mother admitted to hospital. The reasons why women prefer to be confined in hospital are numerous and varied. Mainly the mother feels safer, and the husband feels happier with his wife in hospital. Also as a rule the mother gets more rest than at home, and it is still cheaper for the mother to have her baby in hospital. The following table shows that the average attendance per session was maintained at the 1953 level. This had been achieved by a reduction of one session a week at the Hornsey Town Hall clinic towards the end of 1953. 73 TABLE 1 Ante-natal Clinic No. of sessions held No. of new cases Total Attendances Average attendance per session A. N. P.N. A.N. P. N. Burgoyne Road 47 110 86 777 98 18.6 Church Road 75 151 64 1,063 65 14.7 Fortis Green 99 219 153 1,668 163 18.5 Hornsey Town Hall 160 287 165 2,436 184 16.4 Mildura Court 64 177 74 1,382 75 22.8 Stroud Green 52 154 66 940 68 19.4 The Chestnuts 250 447 243 3,215 247 13.8 Lordship Lane 206 334 167 2,364 173 12.3 Park Lane 104 339 159 1,659 184 17.7 Totals 19 54 1,057 2,218 1,177 15,504 1, 257 15.4 1953 1,085 2,284 1,326 15,733 1, 406 15.8 1952 1,078 2, 461 1, 333 17,063 1, 377 17.1 1951 1,038 2, 439 1, 330 16, 999 1, 332 17.7 Midwives Ante-natal Clinics This service has been extended by the addition of a fortnightly session at the Hornsey Town Hall Clinic, The following table shows the attendances made at all clinics during the year:- TABLE 1A Midwives Clinic No. of sessions held Total No. of attendances Average attendance per session Burgoyne Road 45 135 3.0 Fortis Green 46 290 6.3 Hornsey Town Hall 24 140 5.8 Mildura Court 48 200 4.2 Stroud Green 50 237 4.7 Park Lane 148 1,209 8.2 Total 361 2,211 6.1 Ante- and Post-Natal Clinic, Park Lane Medical Centre Miss Margaret Salmond, M. B. E., M. D. F. R. C. S. consultant obstetrician, reports as follows:- "During the past year these clinics have been well attended and there have been steady and regular bookings of new patients, the majority of whom desire hospital confinements. As usual, there has been very happy cooperation between the clinic and the hospitals concerned, who have also done husbands' blood groupings for us on request. Serious abnormalities have fortunately been few in number; minor degrees of toxaemia and early potential essential hypertension are 74 frequent. A large number of mothers work until quite late in pregnancy and this very often precludes them from obtaining sufficient rest during the day time and may be a contributory factor towards these abnormalities. There is a marked improvement in the realisation of the importance of dented hygiene and care during pregnancy. The majority of the mothers have been most co-operative and have attended regularly. Those who do not appreciate the value of ante-natal care are now in the minority. The mothercraft and exercise class is of great value and would probably be better attended if many mothers did not have to work during the early months of pregnancy. I cannot speak too highly of the excellent work done by the health visitors, midwives and clerical staff. No trouble is spared and their interest in and care of the patients is devoted. I should also like to express my thanks to the staff of the dental department who do such very good work." Maternity Hospitals. Those serving the locality are North Middlesex Hospital, Mothers' Hospital, Clapton, Wiittington Hospital, City of London Maternity Hospital, Bearstead Memorial Hospital and the Alexandra Maternity Home. The latter only takes normal deliveries. The Alexandra Maternity Home has 30 beds and is a training school for midwives. It is staffed by Dr. Harris and Dr. Briggs, both of whom work at the ante-natal clinics in the Hornsey area. The pupil midwives also attend the clinics and get instruction. In this way a very close bond is kept between the Home, the clinics, and the domiciliary midwives who take these pupils for their cases in. the district. Any patient considered unsuitable for the Home is referred to Mr. Scott, Obstetrician at the St. Mary's Wing, Archway Group of Hospitals. Mothercraft Classes, These are held at all the centres by health visitors. They consist of simple exercises, breathing exercises and relaxation, the last being considered very important. Talks are given and questions answered and finally the mothers are introduced to the gas and air machine which most of them use when they are actually in labour. This last talk is given by a midwife and each expectant mother can try out the apparatus for herself before she comes to have to use the instrument while in labour. Every woman is apprehensive about her confinement and the mothercraft classes do a great deal to reduce the rising anxiety. The hazards of child bearing today are much reduced by the better feeding of the school girl, by the open air life and games which so many of them enjoy, and by the knowledge gained of the psychological approach to child birth. 75 The following table shows the attendances made at mothercraft classes during the year. Towards the end of the year approval was given to the adaptation of part of the former Lordship Lane day nursery premises as a Mothercraft and Health Education Unit. TABLE 2 Clinic No. of sessions held No. of new cases Total No. of Attendances Average Attendance per session Burgoyne Road 40 25 196 4.9 Church Road 45 46 250 5.6 Fortis Green 47 54 430 9.2 Hornsey Town Hall 50 90 286 5.7 The Chestnuts 51 99 556 10.9 Lordship Lane 51 76 480 9.4 Park Lane 50 43 331 6.6 Totals 334 433 2, 529 7.6 Handicapped Mothers A survey has been made by the health visitors which gives a picture of the extent and type of handicap affecting mothers of pre-school children in Tottenham and Hornsey, Though the numbers are comparatively small, the most important single conditions causing hardship are pulmonary tuberculosis and mental disorders. This gives concern as the mothers are often in and out of hospital causing possible hardship and mental upset to the children. The problem of mental disorder in both sexes and all age groups assumes ever larger importance in our complex civilisation. The group of diseases involving limitation of mobility is a large and important one. It can be seen however that, surprisingly enough, rheumatoid arthritis is not an important cause of disability in our young mothers. Handicapped Mothers (of Children under 5 years) DISABILITY Muscular - Skeletal System Central Nervous System Rheumatoid arthritis 3 Disseminated Sclerosis 2 Congenital Deformity 1 Epileptic 1 3 Muscular Deformity 3 Poliomyelitis 4 Special Senses T.B. Joint 5 16 Deaf 3 Deaf and Dumb 5 Cardio-vascular System 8 Blind 1 Deaf and Blind 1 10 Systemic Diseases Mental Conditions Diabetes 1 Mental Defective 3 Miscellaneous Pulmonary 1 Psychotic ) 11 Pulmonary Tuberculosis 13 Psycho-neurotic ) 14 Cancer 1 Duodenal Ulcer 1 17 Totals 68 76 Another group of the handicapped is the mother suffering from sensory defects, blindness deafness or both. The number referred to include only those deaf persons with a severe degree of hearing loss. From the point of view of the Local Health Authority, the surest way of tackling these problems is by prevention, and many are preventible. Tuberculosis, both pulmonary and of joints may be expected to be stamped out in our lifetime. Because of the improved health of school children, otitis media causing deafness is already becoming less common. Much mental disorder, too, is preventible and here again the school health service is doing valuable work for it is in childhood that such disorders are best dealt with. Other methods by which the Local Authority can help these mothers are, for example, by placing the child in need in a day nursery, or nursery school or class. The Local Health Authority can also supply a Home Help and, in fact, some of these women are being assisted in this way. More must be done to meet the rehabilitation needs of the rheumatic and other chronic orthopaedic defects. Child Vfelfare Sessions These sessions have been well attended, though there is a slight falling off in numbers. Many of the hospitals with maternity departments ask the mothers to bring back the babies for a routine check up once a month, and in such cases it is only when the baby is six months or perhaps a year old that the mother comes to the clinic. Some will attend their own general medical practitioner for advice as required. It would appear that the reduction in numbers will continue, especially where the general practitioners hold a clinic in their own surgeries for their patients. The reason for the Local Authority child welfare clinic in the past, was to give help to mothers of young children who could not afford the fees of a private doctor. Now this barrier has been removed by the National Health Service, there is no reason why general practitioners should not carry out this function of health education from their own surgeries. The following table shows details of attendances made at the infant welfare clinics during the year:- 77 TABLE 3A Name of Centre No, of sessions held No. of First attendances under 1 year No. of attendances Total attendances No. of cases seen by M.O. Average attendance per session Under 1 year Over 1 but under 2 years Over 2 but under 5 years Burgoyne Road 156 198 4.042 657 93 4,792 1,085 30.7 Church Road 154 208 3 136 680 153 3.969 1,604 25.8 Fortis Green 160 247 3,724 746 403 4,873 1,759 30.5 Hornsey Town Hall 204 384 5.909 1,061 541 7,511 3,090 36.8 Mildura Court 104 190 3,349 864 330 4,543 1,732 43.7 Stroud Green 103 158 2,501 602 284 3 387 833 32.9 The Chestnuts 259 555 7 326 1, 182 466 8,974 2,719 34.6 Lordship Lane 256 391 5.456 1 146 402 7,004 1,543 27.4 Park Lane 208 344 5,448 1,025 387 6,860 1,659 32.5 Totals 1954 1,604 2,675 40,891 7,963 3,059 51,913 16,024 32.4 1953 1,622 2,769 42, 213 8,645 3,551 54, 409 16,444 33.5 Toddlers Clinics These clinics are held for children over two years of age, and the mothers get a special appointment to come and bring their young children. It is important that the numbers attending the clinic are kept low, giving at least 15 minutes for each mother. The children generally are heed thy, well fed, and well clothed and very little departure from the normal is found. In spite of this, most mothers have a complaint, that the child won't eat, is thin, is afraid of the dark, or some other personal difficulty in child rearing. Here is the beginning of anxiety on the mother's part about to be transferred to the child, and at some future date it may blossom forth as a disabling defect in the young adult. To combat this anxiety takes time and experience on the doctor's part and it is becoming more generally recognised that help is needed by the medical officers in this task of allaying anxiety. A beginning has been made towards greater contact between the Child Guidance team and these doctors and we hope before another year has passed that a firm programme can be reported. TABLE 3B TODDLER SESSIONS Name of Centre No. of sessions held Total Attendances No. of cases seen by M, 0, Average Attendance per session Burgoyne Road 25 460 460 18 4 Church Road 48 470 457 9 8 fortis Green 24 313 313 13. 0 Hornsey Town Hall 60 726 726 12. 1 Mildura Court 51 810 667 15. 9 Stroud Green 25 365 365 14. 6 ine Chestnuts 52 681 681 13. 1 Lordship Lane 52 862 862 16. 6 "ark Lane 52 509 509 9. 6 Totals 1954 389 5, 196 5,040 13.4 1953 429 5, 408 5, 239 12. 6 78 Parent Guidance The Area Committee recommended a scheme to deal with behaviour problems in children under five, and the County Council agreed that the North East and North West Metropolitan Regional Hospital Boards should be asked jointly to arrange for the employment, as an experiment, of a psychiatrist for one session a week in this Area to advise medical and health visiting staff in the method of helping parents of children with behaviour problems and to deed with cases specially referred to him. Experimental Play Group for Children under Five As an adjunct to the scheme for dealing with behaviour problems it is further proposed to set up at Park Lane Clinic and Day Nursery during 1955 an experimental "play group" where children with such problems can mix and play with other children. The scheme envisages the co operation of the Child Guidance staff and it is hoped to report progress at an early date. Daily Guardian Scheme The supervised daily minding of children under school age, whose mothers are in full-time enployment was established in this Area in 1947, It commenced very modestly with three married women who were prepared to take into their own homes, children whose mothers could not make any other satisfactory arrangements for minding by the day. Each guardian is paid one shilling a day for each child placed with her, irrespective of payment received from the mother. There are no retaining fees and payment commences after registration and evidence of the receipt of the child. No guardian may accept more than two children. The selection of guardians is limited to those who are prepared to keep to the rules of the scheme and are approved by the health visitor for the district. The health visitor is also responsible for visiting the child after placement. The high standard expected of a guardian and the care health visitors have taken in keeping to the standard, have no doubt largely contributed to the success of this scheme The scheme has gradually increased year by year. There is no local difficulty in obtaining applicants for this type of work* on the contrary, more apply than are registered and we are in the happy position of having more registered guardians than children who require daily minding. At the close of 1954 where were 144 daily guardians on the register, of whom 82 were minding 89 children. 79 The number of individual children minded during the year was 189 and they were in the care of guardians for 19,527 days. These figures compare with 174 and 17,559 respectively for 1953. Day Nurseries At the beginning of the year the number of day nurseries in the Area was reduced from six to three by the closure of Red Gables, Stonecroft and Lordship Lane nurseries. Stonecroft Day Nursery was subsequently re-opened and Ladywell was closed. Arrangements were made for the children attending the closed nurseries to be transferred to those remaining open and in some cases transport was provided between the children's home and their new nurseries. These arrangements have been continued and at the end of the year 24 children were being transported. Hiring the year 12 students sat for the exanination of the Nursery Nurses Exanination Board and all were successful in obtaining their certificates. The to the closure of three day nurseries, three of the matrons left the service. Two were offered and accepted posts as home nurses in the Area and one obtained a post outside the Area. All other nursing staff were absorbed into the remaining nurseries with the exception of one who retired on a superannuation allowance, and the establishment has been reduced to its new level by normal wastage. Admissions to the nurseries are increasingly from families with domestic difficulties and tend also to be from a moving population. These factors and the uncertainty of retention in the nurseries have made the work increasingly difficult and the constructive work which should be a feature of the service is declining as help is given to parents and children over a shorter period. The average daily attendance has been 139.3 and the number on the register at the end of the year was 158. This shows that the attendances have been well maintained and absenteeism from infection has been negligible. Park Lane Day Nursery had a slight epidemic of chicken pox, otherwise there have only been isolated cases of infection. The nurseries have remained open throughout the year apart from public holidays. The following table shows the attendances at individual nurseries during the year. 80 TABLE 4 Name of Day Nursery No. of approved places at end of year No. of children on register at end of year Total No. of Attendances Average daily Attendance ks Under 2 2-5 Under 2 2 - 5 Under 2 2-5 Total Ladywell - - - - 2,397 5,561 7,958 55.7 Closed 23.7.54. Red Gables " ~ - - 222 252 474 14.0 Closed 17. 2. 54. Stonecroft 15 53 16 52 1,598 5,079 6,677 46.2 Closed 12. 2.54, Re-opened 26.7. 54. Lordship Lane - - — - 25 148 173 5.6 Closed 12.2.54, Park Lane 20 30 20 24 3,469 6,057 9,526 37. 2 Plevna 20 30 16 30 3,681 7, 181 10,862 42.4 Totals 1954 55 113 52 106 11,392 24, 278 35,670 139.3 1953 112 208 66 131 14,670 30,041 44,711 175.4 1952 112 208 83 153 20,521 46, 166 66,687 260.0 Problem Families In November 1954 the Ministry of Health issued Circular 27/54 to local health authorities on the subject of problem families and thought was given to the question of dealing with such families known to exist in Hornsey and Tottenham. In February 1955, the following report was considered by the Area Committee who recommended to the County Health Committee that steps be taken for the implementation of a scheme in this Area on the lines suggested. The following extract from a booklet issued by Family Service Units describes very clearly the subject of this report:- "Problem family conditions are characterised by dirt, disintegration and disorder. They are often shiftless, lazy and irresponsible to an almost incredible degree. Financial mis-management is rife. The husband often retains a disproportionate share of income an excessive amount may be spent on drink, cigarettes or the cinema or wasted on children's pocketmoney. As a result of this mis-spending they are constantly in debt and in arrears with their payment for rent, clothing clubs, gas, electricity and insurances". "They sleep too many to a room and many to a bed, meals are irregular and badly prepared; their homes are often devoid of cooking facilities or utensils seldom are there enough chairs, crockery or cutlery for the whole family. The staple diet of tea, bread, margarine, jam, cheap cake and chips is taken standing up. Neither the parents nor the children have any underclothing, night clothing or change of clothing and such as they have is rarely washed or mended ." In Tottenham and Hornsey there are known to be not less than 100 problem fanilies, though some are naturally much worse than others. 81 The majority of these families continue to be problem families for years and receive the attention of a number of social workers, voluntary organisations and the assistance of local authority services. This support is a heavy burden on the community involving the time of workers, expensive residential acconmodation and financial assistance of various kinds. Ministry of Health Circular 27/54 This Circular to Local Health Aithorities points out that:- "Children in the 'problem families', where one or both parents are often handicapped by physical ill-health or are of low intelligence or suffering from mental instability, are peculiarly exposed to physical neglect and risk of mental illness such as psychological disturbance and retarded mental development. Problem families thus tend to reproduce themselves in the next generation and cost the community an expense out of all proportion to their numbers. Action to break this vicious circle by preventive measures would, in the Minister's view, be a proper exercise of the local health authorities', powers under Section 28 of the National Health Service Act, 1946. "The health visitor whose work now extends to cover the whole field of prevention of ill-heedth, including prevention of mental ill-health, is by reason of her close contact with families with young children, particularly well placed to recognise the early signs of failure in the family which may lead to disruption of normal home life with consequent risk to the mental health of the children". The Minister also "suggests that authorities should consider whether their health visiting service can be redeployed on a more selective basis and if necessary increased so that more time is devoted to those families where problems are likely to arise, or are known to exist". The Scheme for this Area The Circular adds considerable support to the following plan which I had intended to submit for the Committee's consideration before becoming aware of its contents:- The health visitor, although the obvious person to tackle problem families and to endeavour to improve their outlook and behaviour, because of her many and varied duties, is normally unable to devote sufficient time to this part of her work. As an experiment, therefore, it is suggested that the following steps should be taken with the object of re-educating families in their own homes instead of (as is often the case) separating them:- 82 1. Che health visitor in Hornsey and one in Tottenham shall be detailed to take over specialised work with problem families. 2. The case load for each of the two health visitors shall generally not exceed 15 families at one time. 3. Each of the two health visitors shall be granted a car allowance at the casual user rate. 4. These health visitors shall not have their hours of duty prescribed because they will need to undertake evening work. 5. Financial provision to be made available so that inmediate requirements of equipment, cleaning materials and food, not exceeding 25s.Od. per fanily, may be purchased for the family where necessary. Duti es of the Health Visitors The duties of the Problem Family Health Visitors will obviously vary from case to case, but the following are set out as an example of the type of duties which the work will entail: 1. Receive the case information which is known to the department or forwarded to it by the Sanitary Inspector, the Health Visitor for the District, the Probation Officer or other social worker. 2. Family difficulties. Deal first with the difficulties of the family itself even if these difficulties are not regarded by the reporting agency as the most urgent. By this means the Health Visitor will get on to the right footing with the family and obtain its confidence. Other problems connected with the family can be dealt with afterwards. 3. Health. Make arrangements for the improving of the health of each individual in the family. If necessary, accompany the mother or children to the clinic, private doctor or hospital, or mind the children while the parent goes to hospital, etc. Put into motion the arrangements for convalescence if necessary. 4. Conditions in the home. Improve the cleanliness of the family and home by helping the mother to do the washing and cleaning in order to show the mother how. Encourage the father to undertake repairs and redecorations. 5. Equipment. Help to improve the family bedding, cooking equipment etc. by encouraging the family to buy small equipment itself and obtaining large equipment from local charities (British Red Cross Society or W.V.S. etc.). 83 6. Finance Make arrangements week by week for the settlement of debts such as arrears in rent, gas and electricity payments. Collect the money from the family at the most favourable time and pass it on to the creditor. Help with the budgetting. Be familiar with current prices, etc. 7. Care of Children. Supervise the care and sufficiency of clothing, food and cleanliness. Prevent older children from staying away from school in order to mind younger children or for some other reason. Accompany children to school or clinic and make arrangements for the minding of younger children if necessary. Encourage thrift for children's clothing, etc. 8. Parents' Attitude to Children. Try to improve this and help them to understand the children and their needs. Encourage parents to allow their children to join suitable activities outside the home. Do anything possible to upgrade the family and keep it united. 9. Return to normal or near normal. Pass the case back to the health visitor for the district when the problems have been solved and the family is able to stand on its own feet. Distribution of Welfare Foods At the end of June responsibility for the distribution of National Dried Milk, Orange Juice, Cod Liver Oil and Vitamin Tablets, was taken over from the Ministry of Food. The distribution points at the Food Offices in Hornsey and Tottenham were replaced by new distribution points at the School Clinic, rear of Hornsey Town Hall and the Area Health Office respectively. Distribution from the infant welfare centres continued as hitherto, and valuable assistance also continued to be given by the Women's Voluntary Services in both Boroughs. The changeover was effected quite smoothly and no real difficulties have been experienced in the operation of this additional responsibility. To assist in the distribution at the two new points the County Council approved the appointment of two temporary General Division clerks. Two redundant clerks, one from each Food Office, were accordingly appointed. The following table shows distributions in the Area during the six months ended 31st December, 1954:- National Dried Milk (tins) Orange Juice (bottles) Cod Liver Oil (bottles) Vit. A & D. Tabs. 36,986 76, 120 13, 842 5,599 84 Priority Dental Service for Mothers and Young Children The dental service as a whole is discussed later in this report under the school health service. Mothers. There has been a falling-off in attendance of ante-natal cases and it is estimated that nearly half of those referred by the clinics do not attend when given appointments. This decline seems to be general and may be due to the facilities now obtainable under the general dental service, though such an assumption should not be made until confirmed or otherwise by a systematic "follow-up". Pre-school Children referred from infant welfare and toddler clinics also show a slight reduction as compared with the previous year. TABLE 5 19 5 4 19 5 3 19 5 2 Expectant and Nursing Mothers Children Under 5 Expectant and Nursing Mothers Children under 5 Expectant and Nursing Mothers Children under 5 No. examined by dental officer 253 590 388 833 226 1,127 No. referred for treatment 241 534 349 750 211 992 New cases commenced treatment 233 603 298 745 179 876 Cases made dentally fit 50 246 113 380 77 663 Forms of dental treatment provided: - Teeth extracted 389 541 478 610 200 879 Anaesthetics:- (a) Local 132 115 126 148 64 192 (b) General 42 206 85 217 40 308 No. of fillings 553 1,278 637 1,323 234 1,562 No. of root fillings - - 2 - - - No. of inlays 1 - 1 1 2 - Scalings and gum treatment 148 - 156 - 72 " Silver nitrate treatment - 758 - 791 - 1,165 Dressings 133 560 141 547 81 752 Other operations 40 159 20 207 11 106 No, of Radiographs: - (a) at County Council clinics 10 6 18 3 5 2 (b) at hospital - - - - 2 - Denture dressings 100 - 168 - 73 - Dentures fitted: - (a) full 17 - 14 - 5 - (b) partial 22 - 45 - 14 - No. of attendances 930 1,732 1,133 1,827 468 2,114 No. of appointments not kept 258 349 321 326 170 306 No. of 14 days devoted to treatment 343 365 300 85 MIDWIFERY SERVICE (Section 23) At the end of 1954 there were ten midwives employed directly by the County Council and one midwife in private practice in the Area. Of the County Council midwives seven work in Tottenham and three in Hornsey. Seven midwives are approved teachers of district midwifery and six pupil midwives are received every three months throughout the year for training. It is hoped to extend the teaching work in the Area in the future as it is an important factor in maintaining a high standard of midwifery practice. It also necessitates the midwives keeping themselves informed of the methods of modern practice and advances. The number of confinements has remained at a similar level to that of 1953. There were 524 deliveries by the domiciliary midwives in 1954 compared with 572 for 1953. The average number of cases per midwife was 51.2. In addition to conducting confinements the midwives attend ante-natal clinics and thus have an opportunity of examining their own 'booked' cases. Several visits are paid to each patient's home during the ante-natal period in order that the midwife may advise on points regarding preparation for confinement and also to afford the patient an opportunity of getting to know the midwife. Psychologically it is valuable for a good midwife patient relationship to exist and everything is done to foster this. Analgesia is available for use by all the midwives and every patient is introduced to and instructed in the use of the gas-air apparatus before confinement. It is anticipated that during the coming year midwives will be fully trained in the administration of Trilene, which is a more effective analgesia. Sterilised maternity outfits were supplied throughout the year for use at all home confinements. The following table shows an analysis of the midwives' work:- TABLE 6 No. of deliveries attended 524 No. of visits made 9, 491 No. of hospital confinements discharged before 14th day 15 No. of visits made 129 No. of cases in which medical aid was summoned 130 No. of cases in which gas and air analgesia was administered 420 No. of cases in which pethidine was administered 191 86 HEALTH VISITING SERVICE (Section 24) The Health Visitor is the all-purpose visitor to the home. She visits the expectant mother, the young baby, the toddler, school children, young people and the aged of both sexes. The principle of one visitor to the home is an economy and is much more acceptable to the family than a number of visitors for different purposes. Hospital almoners, family doctors and voluntary agencies concerned with the health and welfare of individuals seek the assistance of the health visitor as a member of the team which provides co-ordination of information and help to those in need. The health visitor also gives advice at Infant, Toddler, Ante-natal, Mothercraft and other clinics associated with the work of the health centres. The continuity of advice given in home-visiting and clinics is very valuable and is a means of providing friendly support and care for the mothers, children and others in this Area. The range of the work of the health visitor/school nurse has assisted in the exposure of the special needs of certain groups, e.g. school leavers, the aged and problem families. The visiting of the two latter groups has taken up more of the health visitor's time than formerly. TABLE 7 No. of visits paid by Health Visitors working in the Area: - 1954 1953 Expectant Mothers First Visits 1,986 2,013 Total Visits 3,324 3,278 Children under 1 year of age First Visits 3,042 3,227 Total Visits 14,391 14,448 Children age 1-2 Total Visits 7,449 8,343 Children age 2-5 Total Visits 14,036 14,522 Other cases - Total Visits as Health Visitor 4, 112 4,478 Total Visits as School Nurse 1,098 1,326 Health Education It is with the awareness of the changing needs connected with the health and future well-being of the population that in 1954 the health visitor gave more time than in previous years to the teaching of Parentcraft and Health Education to school girls and some boys in the fourteen plus age group. This instruction was given so as to prepare the next generation for their approaching parenthood and to avoid, if possible, the ignorance which leads to so many problems. 87 Two hundred and forty nine talks were given to school children in 1954 as conpared with one hundred in 1953. The assistance of clinic nurses has helped to relieve the health visitor of some of her duties, so as to maintain the existing services and develop the wider conception of health teaching. School Nursing Infestation of school children has lessened to a remarkable degree during the last four years. This is probably due to the exclusion of all those found to be infested instead of only those showing a marked degree of infestation. The number of children examined in 1951 was 99,066 of whom 1,231 (1.2%) were infested as compared with 113,320 examined in 1954 of whom 594 (0.5%) were infested. Health Visitors and Hospitals Good liaison exists between health visitors, almoners and other personnel connected with the hospitals, particularly in relation to expectant mothers, discharged from hospital, who are in need of further care and attention and others who should attend hospital and fail to do so. A health visitor regularly attends the Paediatric Department of the Prince of Wales's Hospital. Daily telephone enquiries and information is received and sent out to hospitals in the London and Metropolitan Area as well as written health visitors' reports to these and other agencies concerned with health and welfare. Health Visitors and Family Doctors The Superintendent Health Visitor was invited to speak on "The Work of the Health Visitor" to the North Middlesex Branch of the British Medical Association on the 28th May, 1954. This was followed by questions, comments and a good deal of discussion. On the 17th July an informal meeting of health visitors, medical officers and family doctors was held at Lordship Lane Clinic. This year there has been an increased number of requests from family doctors for health visitors to follow-up or give assistance to patients or families in their care. Reporting back to the family doctor is recognised as being of supreme importance if good liaison between both parties is to be achieved. 88 School Health Service A lecture on "Cerebral Palsy" was given to parents of children attending the School for the Physically Handicapped on the 4th August by Dr. W.F. Dunham, Medical Director of the Spastic Unit. There were 54 parents and health visitors present. Training of Health Visitor Students Eight student health visitors were given practical training in the Area as part of their Health Visitors' Course. Four of these were sponsored by the Royal College of Nursing for short term experience, of the four others from Battersea Polytechnic three attended for three terms and one for her first term. Visitors and Students Overseas visitors, visitors from this country and parties of students attended clinics to see maternity and child welfare and school nursing in action. These included students from Barnardo's Staff College, student teachers, post-graduate health visitors and student ward sisters from King Edward's Fund Staff College. Lectures to Student Nurses The Superintendent Health Visitor gave eight lectures on "The Social Aspect of Disease" to student nurses at the Prince of Wales's Hospital during the year. A number of other lectures were given to Barnardo's Students, The British Red Cross, and other bodies, and two members of the health visiting staff acted as examiners for the British Red Cross and St. John Ambulance Brigade in their own time. HOWE NURSING (Section 25) With the closing of the Queen's District Nurses Home, Bruce Grove, Tottenham, all the nurses previously employed on an agency basis were transferred to direct employment by the County Council. The Superintendent of the Home retired on account of ill-health and of the three nurses who were resident in the Home, one left the service and the remaining two found alternative accommodation. 89 Twenty eight nurses were employed at the end of the year including three male nurses and ten part-time staff. All requests for the services of a nurse are now received at the Area Health Office during office hours, and at the Superintendent's house at all other times. The service is used mainly by general practitioners, hospitals and the chest clinics. There has been a substantial increase in the number of calls made upon the service during the past year and about 4, 3)0 more visits were made than in 1953. Shortage of hospital staff and the difficulty in gaining admission for patients has resulted in more sick persons, particularly the aged sick, being nursed at home and these latter usually resolve into very long term patients. There has been an increase also in the number of surgical cases sent home to the care of the home nurse for the final stages of healing of operation scars. These measures relieve the pressure on hospital beds Much time is spent on the administration by injections of antibiotics among both adults and children. A steady flow of work is received from the chest clinic, and in Hornsey the London County Council has opened a hostel for men suffering from tuberculosis. All the treatment required at this hostel is carried out by the home nursing service. The home nurse works closely with the general practitioners, health visi tors and home helps and there i s a free interchange of information between this team of workers. As in previous years the various voluntary services have afforded great help to the nurses and requests are always met promptly. Many lonely old people are referred to the voluntary services for social visits. With the increasing calls on the service the question of transport is important and from observation it seems that a good deal of the nurses' time is spent getting from visit to visit. In bad weather the time required is longer and the amount of actual work can take less time than is used for the journey on foot or cycle. Much more work could be undertaken by the existing staff if better transport facilities were available. The following tables show (a) the number of cases attended and the number of visits paid by home nurses and (b) an analysis of treatments given under three broad headings. It is significant that almost half the new cases attended during the year required injections of one kind or another. 90 TABLE 8A Type of Case No. of new cases attended by home nurses during year No. of cases remain ing on register at end of year No. of visits paid by home nurses during year M F Total M P Total Medical 917 1,638 2,555 184 387 571 65,914 Surgical 114 136 250 20 11 31 6,323 Infectious disease - 1 1 - - - 1 Tuberculosis 62 23 85 7 2 9 3,389 Maternal complications - 32 32 - 1 1 296 Totals 1954 1,093 1,830 2,923 211 401 612 75,923 1953 1, 122 1,945 3,067 182 356 538 71,452 TABLE 8B Analysis of treatment given to new cases during 1954 General Nursing 679 Other treatments 849 Injections 1,395 Totals 2,923 VACCINATION AND IMMUNISATION (Section 26) Vaccination The percentage of children under one year of age vaccinated in 1954 was 48%. This is still better than the 1947 figure (41%) when vaccination was compulsory, but slightly lower than the figure for 1953 (51%). It is hoped that this slight fall, which is probably associated with the falling birthrate, will prove to be temporary. The following table records the number of persons known to have been vaccinated or re-vaccinated during 1954, by general practitioners and clinic medical officers:- TABLE 9 Under 1 year 1 year 2-4 years 5-14 years 15 years and over Total No. of persons primarily vaccinated 1, 409 53 29 42 80 1,613 No. of persons re-vaccinated - 1 14 31 314 360 91 Immunisation against Diphtheria and Whooping Cough Immunisation of Children under 1 year of age As mentioned in my last Annual Report, a new policy was implemented in May 1953, with the aim of securing the immunisation of at least 75% of babies before the end of the first year of life. This is all the more important as, for the first time in nine years, a diphtheria death occurred in this area in a child of eleven who had never been immunised. The new policy has met with some success as shown by the following figures:- Immunisation of Children under 1 Period No. of Children who received a full course of immunisation January to June 1953 492 July to December 1953 854 January to June 1954 875 July to December 1954 892 The increase in the number of children under 1 year of age immunised has been achieved in spite of a falling birth-rate and the above figures translated into percentages of the estimated child population under 1 year of age are shown in the following table. Period % January to June 1953 31.6 July to December 1953 54.9 January to June 1954 59.5 July to December 1954 60.7 It will be noted that we are still some way from achieving the desired figure of 75% and continuing efforts are being made towards this end. In an attempt to establish the reasons why some children are not immunised before reaching 1 year of age, an investigation has been made of a sample group of children with the following results:- Of 173 children born in the Area who had not completed a course of immunisation before reaching 1 year of age:- 92 18 were in the process of being immunised. 49 were said by their parents to be going to receive or had already received a course of immunisation from their own doctors. 33 had removed from the Area. 12 immmisation refused. 1 immunisation inadvisable. 1 combined immunisation refused but agreed to make arrangements for diphtheria immunisation only. 54 had not kept appointments for various reasons though in some cases the parents professed to be willing to attend. 8 no information 173 Mention was made in my last Annual Report of the high rate of removals from the Area of children under six months old and it can be seen that in the above sample group more than 17% of children born in the Area had removed before reaching 1 year of age. The defaulters who for one reason or another do not keep appointments appear to be the most fruitful field for further improving the number of children immunised. Some have good reasons for not having attended (e.g. illness of child or parent) but the remainder, although some parents profess to be willing for their children to be immunised, just do not come. It is hoped that by continual follow-up by health visitors, and by clinic doctors offering the opportunity to immunise children whenever they may attend a centre for whatever purpose, to make some progress with this group but in the end this will depend on the parents themselves. Immunisation of Children under 5 years of age Although every endeavour is made to ensure that children are protected before reaching 1 year of age. there are inevitably some who receive immunisation between 1 and 4 years of age. Record cards of completed courses of immunisation are filed in the Area Health Office by year of birth and the following table compiled from these records shows the total number of children immunised according to year of birth:- Born in No, of live births No, of children immunised at any time before 31st December. 1954 Children immunised as percentage of births 1950 3, 204 2,043 63.8% 1951 3,088 1,921 62.2% 1952 3, 233 2,027 63.3% 1953 3,107 2,022 65.1% 12,602 8,013 63.6% 93 It will be appreciated that it is not strictly correct to compare the number of immunisations with the number of births in a particular year as this takes no account of removals out of and in to the Area, but as no reliable up to date figures of child population of these ages are available, these have been used to enable some comparison of one year with another. It will be seen that the new policy for immunising infants under 1 has had the effect of increasing the percentage of immunised children born in 1953 as against preceding years. Reference to children born during 1954 has been excluded as it was only possible for a small proportion to have been immunised by the end of the year. Boosting Immunisation in School Children The scheme to secure that all children receive a boosting injection against diphtheria during their first year at school which was introduced at the same time as the arrangements for dealing with children under 1, has had satisfactory results as can be seen by the following table:- Boosting Immunisation 1952 1953 1954 Age 4 351 395 556 Age 5 569 1,372 1,291 920 1,767 1,847 The increase has been achieved in spite of a considerable fall in the birth rate in the years 1947 to 1950. The opportunity is taken when doctors visit the schools to give boosting injections, to give primary immunisations to any unimmunised child whose parents agree. Summary The following table shows the total number of immunisations of all age groups carried out during 1954:- 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 106 1,661 11 - - One 105 443 16 - - Two 32 88 22 - 2 Three 22 39 22 3 3 Four 53 42 12 527 29 Five to Nine 439 15 5 1,691 31 Ten to Fourteen 5 1 - 48 5 Total 762 2,289 88 2,269 70 94 PREVENTION OF ILLNESS, CARE AND AFTER CARE (Section 28) Tuberculosis Vaccine Clinical Trials (Medical Research Council) These trials were begun for young people leaving school at Christmas 1951 and Easter 1952. During 1954 71% completed their Mantoux Test and 27% of the previous defaulters attended for X-ray. Health visitors assist in the yearly survey by the home-visiting of each young person, and one health visitor was in attendance at the five evening sessions held at Lordship Lane Centre between the 13th and 19th July. Recuperative Holiday Homes The number of applications for recuperative holidays received during 1954 was 279 compared with 329 the previous year. Of the 279 applications received, 202 were approved, 72 were not approved and 5 were withdrawn before action could be taken. DOMESTIC HELP SERVICE (Section 29) The demand on this service continued to grow during 1954, almost entirely due to the need of the chronic sick, including aged and infirm. The number of new cases provided with help was 881 compared with 742 in 1953. At the end of the year 809 cases were being provided with help compared with 618 at the end of 1953. This trend has continued and difficulty is being experienced in recruiting and maintaining staff at an adequate level. The following table shows details of the cases served during the year:- TABLE 11 Cases provided with help No. of new cases provided with help No. of old cases for which help was continued from 1953 Total No. of cases provided with help during year Total No. of cases still being provided with help at end of year Maternity (Including expectant mothers) 127 10 137 9 Tuberculosis 28 58 86 48 Chronic sick (including aged and infirm) 569 512 1,081 734 Other 157 38 195 18 Total 881 618 1,499 809 95 SCHOOL HEALTH SERVICE In the following pages will be found a record of the work of the school health service for the past year. The work of the specialist clinics is fully detailed and affords ample evidence of the integration of local authority and hospital board services. The same is true of the rheumatism supervisory centre. The record of the two schools for handicapped children is one of steady progress. At Vale Road School for Physically Handicapped Children there has been an expansion in the facilities available for cases of cerebral palsy and a special consultant appointed to advise on the work. The needs of the very smallest of these handicapped children have still to be met but it is hoped to do this in the new accommodation for which building approval has been given At the School for Deaf Children the expansion of nursery class facilities has been of the utmost value. The opening of a unit for partially deaf children in 1955 will go far to solve the problems of a group of children who did not really fit in either at the school for the deaf or at the ordinary school. Higher education for deaf children has always been a problem as Mary Hare Grammar School has only been able to admit a small proportion of children considered suitable. This year has seen the coming to fruition of plans for a Technical School in Surrey, and several children from the Tottenham School have been entered for scholarships there. Routine medical examination of school children has continued. The enthusiastic attendance of parents is a tribute to their belief in its value. The commonest complaint of a serious nature is one of maladjustment, often associated with broken or unhappy homes. But the children on the whole are healthy, happy and well-clad. The function of routine medical inspection today is no longer one of merely segregating fit from unfit, but an attempt to assess individual optimum health of the children attending this periodic health overhaul. Details of defects found at routine medical inspections are set out in the tables at the end of this report. It is hoped that the introduction of B.C.G. vaccination will further help to preserve the health of our young people when they leave school. Dental Service Mr. V. Sainty, L.D. S. Area Dental Officer reports:- "The staff at the end of 1954 consisted of eight full-time and two parttime dental officers, and one part-time orthodontist. One of the full-time the two part-time dental officers and the orthodontist were appointed at 96 various dates during the last six months of the year. There was one resignation of a full-time dental officer early in the year and some months elapsed before this post could be filled. At present the orthodontic clinic is worked seven sessions per week and it is intended that this shall be increased to a full-time service should the scope of the work justify it, but it is too soon yet to know when this may be. A new dental clinic was opened in August at Cornwall Road, N.15. It is an extension of an existing clinic. Very little space was available and consequently the rooms are smaller than usual, but the equipment is very good. At the time of writing we have nine dental surgeries in full use, one of these being shared between the orthodontist and a part-time dental officer. This is our whole accommodation and so far, with existing staff, it has not been possible to provide annual inspections for all children in all parts of the Area, though there should be some improvement in this respect in 1955, provided we can keep all the surgeries in full operation without any closing due to changes in staff." Details of the work of the dental officers are included in the tables at the end of this Report. Rheumatism Supervisory Centre The Rheumatism Supervisory Centre has now been in operation since August 1951, under the overall direction of Dr. I.M. Anderson, Consultant Paediatrician, Prince of Wales's General Hospital, with the close co-operation of the local Public Health and Area Health Departments. The total number of cases seen in each year are tabulated below under the appropriate headings. Taking Tottenham first it can be seen that the number of children attending for the first time has declined in each year. There are several reasons for this. Firstly, the number of children referred was larger in the first year because previously no such special provision had been made for children who had had rheumatic fever. Some of these children were not acutely ill but merely required supervision. Once this catchment had been made the numbers automatically declined. As can be seen this applies to children with congenital heart disease as well as rheumatic heart disease. There can be little doubt however that there has been a substantial decline in the number of children newly developing rheumatic fever. This trend has been noticeable in national statistics for many years but seems to have accelerated recently. Thus it can be seen that the number of children admitted to hospital for rheumatic fever has declined from 33 to 19 to 15 in each year since 1951. This decline is confirmed by the clinical staff at the Supervisory Centre who have noticed the same thing in other areas. 97 The reasons for the decline are probably two-fold. The first is the improved standard of living, and in particular improved nutrition and housing. One of the few facts known about rheumatic fever is its association with poverty and over-crowding. The second is probably the decline in virulence of the haemolytic streptococcus, the causal organism of rheumatic fever. In this connection it behoves us to be extremely wary as this organism tends to have a virulence which rises and falls. At one time in this country, and that only about 50 years ago, it caused severe epidemics of scarlet fever. We must therefore be on guard in case its virulence increases. While the Supervisory Centre was not set up for children with congenital heart disease, inevitably some with an unexplained heart condition are seen there. Some of these have been found to have remediable congenital heart disease and after admission to hospital have been operated upon, giving them, in more than one sense of the word, a new lease of life. The same trends can be seen in the statistics for children coming from other areas, but these statistics are less reliable because of the fact that they rep resent a smaller selection of the children involved. Tottenham 1952 1953 1954 No. of Cases Rheumatic Fever 17 12 6 Rheumatic Carditis 22 3 7 Chorea alone 6 1 - Chorea with Carditis 2 1 1 Chorea with Rheumatic Fever - - 1 "Rheumatic Pains" 6 1 - Rheumatic Fever Relapse 1 - - Rheumatoid Arthritis - 3 - Total Rheumatic 54 21 15 Congenital Heart Disease 26 4 6 Miscellaneous - 2 1 80 27 22 Admitted to hospital 33 19 15 98 Other Areas 1952 1953 1954 No. of Cases Rheumatic Fever 7 9 8 Rheumatic Carditis 11 2 3 Chorea alone 1 1 - Chorea with Carditis 1 - - Chorea with Rheumatic Fever - - - "Rheumatic Pains" 1 - 1 Rheumatic Fever Relapse - 1 - Rheumatoid Arthritis - - 2 Total Rheumatic 21 13 14 Congenital Heart Disease 18 5 5 Miscellaneous 1 - - 40 18 19 Admitted to hospital 21 13 14 The Handicapped Child In this Area we are fortunate in having long-established provision for the special educational treatment of the handicapped child. Tottenham Day Special School for the Deaf The school, which accommodates 100 children, covers an age range from three to sixteen years and admits children from a wide area of Middlesex, who in most instances travel to and from the school by transport provided by the Local Education Authority. The nursery class was fully occupied during the year and stresses the importance of commencing education for this class of handicapped child as early as possible. Parental co operation in speech training especially in very young children is essential, and it is hoped in the near future to see established in this Area an Audiology Unit concerned with the early diagnosis and training of children under two years of age in co-operation with their parents. The importance of separating the partially deaf from the totally deaf at this special school has again received consideration; and it is anticipated in the new year that all partially deaf children needing special educational provision will be accommodated in a special class for the deaf at the Devonshire Hill School, Tottenham. 99 At the close of the year the headmistress - Miss 0. Beatson - retired after a distinguished career of 34 years at the school and its head since 1943. She has been succeeded to the headship by Mr. T. Brown. Day Special School for Physically Handicapped This school, which has been established for many years at Vale Road, Tottenham, now accommodates approximately 90 children between the ages of four and sixteen. As in the case of the School for the Deaf the children are drawn from a wide area in the County and transport to and from the School provided by the Local Education Aithority. During 1954 a new prefabricated extension was made to the school buildings providing a suite of classrooms and amenities for the younger age group of children. Also with the setting up of special facilities for the treatment of children suffering from cerebral palsy (spastics), authority was given during the year for additional accommodation to be provided for therapy facilities and overall classroom expansion for up to 20 children suffering from this birth handicap. Building extensions, also to include improved indoor sanitation for the whole school, are expected to commence during the coming year. After long and devoted service to the school the retirement of Miss C. Wakefield was received with deep regret by all associated with her in the work of the school. She was succeeded to the headship by Mr. Ives, a former teacher in the school and well conversant with its problems and aspirations. Swimming Exercises A special and popular feature of the school during the year was the weekly visit to the Municipal Swimming Baths. With the aid of volunteer helpers to dress and undress those unable to do so for themselves and with others to help in the water, these handicapped children are able to enjoy an exercise which comes to them more easily than in most other forms of disability. The buoyancy of the body in the water neutralises the effect of gravity and enables weak muscles to function more freely. The physical benefit derived is accompanied by a development of the child's confidence and sense of well-being. One is struck by the complete absence of fear that most of these children have in the water. If a little timid at first they are quickly re-assured when they see some of their fellows, whose movements on land are slow and awkward, swimming with confidence if not highly skilled. Though it is not always possible to teach a handicapped child to swim by the methods used for the normal child, most of them learn to float and quite a number are able to swim in a short time the width of the bath and a few the whole length. 100 Cerebral Palsy Dr. William Dunham, Consultant in charge of the cerebral palsy unit, on his appointment early in the year, immediately sought the co-operation of all concerned. A meeting at which all parents of children with cerebral palsy attending the School were invited was held at the Lordship Lane Medical Centre on the 4th August, 1954. Teachers, school medical officers and medical auxiliary staff also attended and general principles were fully discussed with Dr. Dunham as leader of the team. Those who have the care of the spastic child were reminded by Dr. Dunham that "in any child during his formative years every activity serves to fix more firmly habitual positions and habits of movement of the body. In the child with cerebral palsy there is a natural tendency for those to be faulty and a constant watch must therefore be kept to see that good habits of posture and movement are formed For this the co-operation of all in contact with the child throughout the day must be obtained. Periodical interviews with parents to discuss individual problems are held and advice given as to what provision is required in the home. In the School new furniture, built to measure for each child, is being provided. For children with cerebral palsy some activities are difficult or impossible and special training is required to ensure that they shall make the most of their possibilities. This is the special province of the physiotherapist though here too she works in close co-operation with teachers and parents, an arrangement which makes it possible for progress to continue uninterrupted during school holidays" When accommodation is available it is hoped to widen the scope of the cerebral palsy unit by providing for the examination and supervision of babies and children too young to be accepted in the School so that they may receive the benefit of skilled handling before reaching school age. The majority of the children attending this School suffer from orthopaedic handicaps and are under the supervision of the visiting consultant, Mr. E. Hambly, F. R. C. S., who also works closely with Dr. William Dunham in relation to the cerebral palsy unit. Routine medical care of all the children at the School is undertaken by one of the whole-time school medical officers and a school health visitor is in daily attendance. Physiotherapy and speech therapy are arranged for on a sessional basis as required. The following table sets out the various disabilities of children in attendance at the end of the year:- Right Hemiplegia 8 Amputations 1 Left Hemiplegia 2 Nephritis 1 Spastic Diplegia 8 Eunuch 1 Spastic Qiadriplegia 6 Dwarf 1 Athetoid 5 Amyotonia 1 101 Poliomyelitis 13 Imperforate Anus 1 Heart Cases 10 Cerebral Agenesis 1 Muscular Dystrophy 8 Myopathy 1 T.B. Limbs 4 Perthes' Hips 1 Congenital Deformities 7 Debility 1 Fragilitas Ossium 4 Craniostosis 1 Haemophili a 2 88 The Parent Teacher Association has continued its activities during the year and the Association has been able to provide the following for the children of Vale Road P.H. School:- A day's outing at Southend-on-Sea by Eagle Steamer; Christmas Party with Tree and Presents; provided a display cabinet to start a school museum, supplemented the School Recorder Band by buying extra instruments; supplied a set of handbells for the children; purchased clothing and swimming gear for necessitous cases. Educationally Sub-Normal Children Provision has long been made with the School for Educationally Sub-Normal Children at Oak Lodge, Finchley and more recently with Durants School, Enfield, to meet the special educational needs of these handicapped children. At the end of the year 41 Hornsey children were attending Oak Lodge School and 7 children were awaiting admission, while at Durants School, 63 children from Tottenham were in attendance and there were 20 awaiting admission. Hospital School, St. Ann's General Hospital, Tottenham This school, which was opened at the end of 1952, has continued throughout the year. It caters for an age range from 5 to 15 years and the average attendance during the year was 19. This work is of particular value in long stay cases, thereby preventing the children from becoming educationally backward during their stay in hospital. It is useful, also, as an ancillary means of providing the children with occupational therapy. Ear, Nose and Throat Clinics The visiting Aural Surgeon, Dr. F.P.M Clarke, reports that as in previous years, there were three clinical sessions in this department held weekly - two at Tottenham and one at Hornsey. These clinics were first established in 1922 under the supervision of Mr. A.R. Friel, F. R. C. S., the well-known consultant who did pioneer work in the clearing up of chronic. 102 suppurative otitis media and its allied complications, by his introduction, for the first time of the zinc ionization method of treatment. At that period there were in these areas, as in many others throughout the country, an enormous number of chronic discharging ears among the school population for whom there was little or no effective treatment. These areas with one or two others in outer London (Wood Green and Walthamstow), became the pioneer centres for the establishment of this new method of treatment under the care of Mr. Friel. The excellent and rapid results obtained by ionization, indeed in very many instances, spectacular, in the clearing up of the majority of those hitherto 'incurable' cases of chronic otorrhoea are now well known and have been widely published in medical journals and in leading text books both here and in America. In the course of a few years the many cases of chronic discharging ears among school children in these Boroughs had considerably lessened. Since that time and with the marked reduction almost disappearance - of chronic otorrhoea, the scope of the work of these special aural clinics has extended into a much wider field. A very important advance was made when it was decided to include in the scope of the E.N.T. Clinics, the pre-school child. While the early work of these clinics was concerned mainly with the most urgent problem of clearing up the existing mass of chronic ear disease it was also apparent that its cause and chronicity was closely related to general ill health and abnormal conditions of the nose and throat. In a large number of instances these complicating conditions required attention and correction before it was possible to effect a permanent cure of the chronic ear disease. In order to maintain the success now achieved of practically freeing the school population of chronic otorrhoea and its disabilities it became necessary that the work of the clinics should be widened to include the treatment of any diseased conditions of the ear, nose and throat common among children. Among the abnormalities referred to here and common among school and pre-school children are 'nasal obstruction' and its many wide-spread effects; infection of the nasal sinuses; rhinitis in its different forms; recurring sore throats (usually secondary to untreated nasal disease); acute infection of the ear with or without external discharge. At present and for a number of years past the work of these aural clinics has included the examination and treatment of the common affections of the ear, nose and throat in school and pre-school children. Cases requiring operative in-patient treatment, of which there are relatively few, are referred to hospital. Reviewing the work of the aural clinics during the year 1954, I find that the nature of the defects found among those children referred to the clinic, and the methods of investigation and treatment follow much along the lines of previous years. One very noticeable fact in these clinics is the extremely few cases now seen of chronic otorrhoea. This is a most important advance in 103 the reduction and prevention of deafness. Certain factors have materially contributed to this near disappearance of chronic otorrhoea, namely, the discovery and successful treatment of acute cases the treatment of any predisposing or complicating condition that might be likely to produce a recurrence; also the administration of new drugs such as the antibiotics and penicillin, in the very early stage of otitis thus preventing a considerable number of cases of acute inflammation of the ear becoming chronic with purulent discharge; and finally the rapid and successful treatment of a chronic case when it is discovered. Treatment of Discharging Ears. The correct treatment of an early acute discharging ear is vitally important for two reasons, first to prevent the condition from becoming chronic, and second, to save the hearing, for the longer the ear continues to discharge the greater the danger to the recovery of the hearing. Many cases of serious deafness in later years are directly due to inadequate or neglected treatment of the affected ear in its early stage. The application of ear suction with the Snith's tube as advised by Levine of New York is a very valuable method and the only one that can be relied on to cleanse the middle ear of discharge and to ensure the entry of the selected antiseptic into the middle ear cavity, which is essential for quick recovery of the infected ear. Children seen at the clinic during the year, as in previous years, were referred from the school medical inspections, minor ailment clinics and infant welfare centres as suffering from nose and throat infections, and a certain number of cases of impaired hearing. Such common distressing complaints as nasal obstruction, mouth breathing, recurring colds and sore throats, nasal discharge and deafness (in the absence of present or previous ear discharge) in children, form a large percentage of the cases referred. These conditions are usually secondary, and mainly due to primary diseased conditions in the naso-pharynx and nasal accessory sinuses. It is important to recognise this fact if treatment is to be successful, and essential for the successful correction of any abnormal condition to trace the primary cause and correct this, since treating a secondary result alone, is treating only a 'sign' and will not cure the original disease. Audiometry. The question of impaired hearing in children and its relationship to disease in the naso-pharynx or nasal sinuses is one that requires the most careful attention, since correct diagnosis and adequate treatment of the cause is the first step in the prevention of permanent deafness later on. It is here that the regular audiometric testing of the hearing in school children is of such great value. This method will detect accurately the smallest loss in hearing which could quite easily go unnoticed by parents or teachers or by the usual hearing tests available at routine 104 medical inspections. Usually by the time a child's deafness is noticeable to the parent or teacher and is brought to the notice of the medical officer it will be found by audiometric and clinical tests that at this stage the hearing loss is well advanced and the prospect of full recovery much less certain. This is particularly so when only one ear is affected as the loss here is m asked by the normal hearing in the other ear and may not be noticeable to the parents. The audiometer is especially useful in these cases and a school audiometric survey is the most certain method of detecting any such likely unnoticed deafness. In relation to deafness in children it is well to note here that sinus disease, often overlooked, can be a very potent factor in causing serious deafness and until the sinus infection is cleared up there will not be any improvement in the hearing. The last audiometric survey in the schools in Tottenham and Hornsey has been reported in the Annual Report to the Committee for 1951. Nasal Obstructions. A number of children have been seen at the clinics suffering from nasal obstruction and its wide-spread effects, e.g mouthbreathing, sore throats, chest affections, nasal sinus disease, neuroses, etc. Nasal obstruction is, clinically, a very big subject in itself and can only be referred to briefly. But it is perhaps the most important defect we see because of the many and serious consequences which it produces. A very large number of children suffering from certain forms of nasal obstruction have been successfully treated at the clinics by Professor Gautier's (French) method of 'diastolization'. Diastolization, when the author's technique is carefully carried out, ranks as one of the most successful advances in nasal therapeutics in the last 25 years. It is particularly effective in certain forms of nasal obstruction, such as hypertrophic rhinitis, and in deafness in children due to lesions in the naso-pharynx. For many years this has been a standard method of treatment at our clinics and the results in suitable cases have been exceptionally good and lasting. Sinus Infection. This is quite common among children of all ages. Its recognition is vitally important because it is the primary source of many other affections, and any treatment for these secondary effects, not directed to the primary sinus disease, is misdirected therapy and will end in failure. For the confirmation of the diagnosis and for the treatment of children with sinus disease, Professor Proetz' method of 'sinus displacement' has been extensively employed; but it is necessary to emphasise that the technique devised by Proetz must be correctly used; indeed, if mi sapplied it can have very serious consequences. Among the very large number of children who have been treated by 'displacement' very few have been found who did not respond successfuly to this method. Exceptions were the very chronic cases where the sinuses were seriously affected by profuse purulent suppuration of long standing. cases required operative treatment and were referred to hospital. 105 Enlarged Tonsils and Adenoids. On the question of 'tonsils and adenoids' we maintain a conservative outlook towards their removal. This is a subject of vital importance particularly in the case of children and it is absolutely essential to be quite clear, clinically on the significance of the physiology and pathology of the ring of lymphatic tissue of which the tonsils and adenoids are part, surrounding and guarding the entrance to both the chest and alimentary tract. The wholesale removal of tonsils and adenoids merely on such grounds as 'enlarged tonsils and adenoids', 'chronic nasal catarrh' 'chronic colds in the head', 'adenoid facies', need only to be mentioned to be rejected. Lists of rules and indications for the removal of tonsils and adenoids are clinically meaningless. Every case is a law unto itself and must be decided on its own merits. It is important, also, to remember that adenoids and tonsils differ in their pathological effects. Adenoids can become, when greatly hypertrophied, a 'mechanical' factor in causing nasal respiratory obstruction, whereas tonsils can be, when clinically diseased, a source of 'toxaemia'. 'Unhealthy' tonsils and adenoids are usually the 'sign' of a disease which must be sought elsewhere and removal of the sign will not cure the disease. There are, however, instances where removal of adenoids (when they cause nasal obstruction) and, much less frequently, tonsils (chronically diseased) are clearly indicated and the results very satisfactory. Nevertheless the operation should be limited to those cases where the effect of their removal is beyond doubt. In conclusion the standard of general health of the children seen at the clinics during the year has been very good. In only a few instances could it be considered as below normal and it is in marked contrast to, say, 20 years ago. Audiometry Scheme Under the present County arrangements a gramophone audiometrician is shared between this Area and that comprising the Boroughs of Finchley and Hendon. Mrs. Perry, whose appointment was reported in my last annual report, resigned during the year, and was replaced by Mrs. M. Diffy in October. Die to this change in staff the initial survey in Finchley and Hendon has taken longer than anticipated, so that the services of the gramophone audiometrician were not available at all in this Area during 1954. Consideration will be given, once the routine audiometry testing of seven year old children has been brought up-to-date to testing children in 'C' streams at school to ascertain whether or not their lack of educational progress may be associated with some degree of deafness. 106 Orthopaedic Service Hornsey Mr. Guy Rigby-Jones, F.R.C.S. (Edin), reports that the continuing demand for treatment is a clear indication of its value and the numbers attending would make it quite impossible for these children to be transferred to local hospitals for their orthopaedic care. It would be a great pity if these services were allowed to be taken out of the hands of the local authorities who control the welfare and school clinics and have a far better organisation for inspecting the home circumstances which often play a large part in the postural defects of children. The great advantage to the child is that minor ailments and defects can be dealt with outside the hospital atmosphere and the child is never allowed to think that it is in any way abnormal. Cases seen at the Hornsey Orthopaedic Clinic Under 5 Over 5 Total New Cases 65 134 199 Total Cases 117 321 438 Re-examinations 85 362 447 Total Attendances 202 683 885 Tottenham Mr. E. Hambly, F.RC.S., reports that cases are sent early through the school health and maternity and child welfare services. Connection with the School for the Physically Handicapped at Vale Road continues with every co-operation from the Headmaster, Mr. Ives, and his staff. Dr. Dinham's appointment to the Spastic Section has been a great acquisition and the consultants work as a team, so far as common ground is concerned. All operations on children seen at the orthopaedic clinics are done by Mr. Hambly at St. Ann's General Hospital, Tottenham, which has excellent wards for orthopaedic work. This is a tie-up between the work of the clinics and the Hospital Group, which makes for continuity of treatment and enables parents of the children easily to visit both the Consultant and their children. Cases seen at the Tottenham Orthopaedic Clinic Under 5 Over 5 Total New Cases 62 342 404 Total Cases 95 586 681 Re-examinations 41 280 321 Total Attendances 136 866 1,002 107 Ophthalmic Service Tottenham Dr. T.G. Kletz, M.B. , Ch.B, D.O.M.S., reports as follows on the work of the Ophthalmic Clinic at the Lordship Lane Medical Centre:- "Refraction clinics are held on three sessions a week and the annual attendances are approximately 1,750. Cases of manifest and suspected strabismus are being seen at frequent and regular intervals. These are referred to the Prince of Wales's General Hospital for orthoptic reports and treatment. The growing demand for this service may necessitate the employment of our own orthoptist in the future. There have been no new cases registered as blind or partially sighted during the past year" Hornsey Dr. Marian Lones. M.B., D.P.H., D.O.M.S., has submitted the following comments on the work of the Ophthalmic Clinic at Hornsey Town Hall:- "Since the Health Service was introduced, fewer cases of disease of the eye reach the clinic. These are treated either by the general practitioner or in hospital. Refractive errors investigated consist of hypermetropia, astigmatism and myopia, the first being the most numerous. Children with strabismus receive orthoptic treatment by our own orthoptist often with very good result. Those who do not respond to these exercises are referred to hospital and may be considered for operation. An increasing number of fathers attend with their children. Parents are always very co- operative and show great interest. Spectacles are now supplied quickly by opticians and repairs are carried out promptly". B.C.G. Vaccination of School Children In November 1954 the Area Committee agreed to a scheme for giving B.C.G. vaccination to thirteen year old school children and the Divisional Executives of Hornsey and Tottenham subsequently agreed to the scheme being carried out in the schools. Detailed preparation of the scheme and the purchase of the necessary equipment is: now in hand and vaccinations will be started soon after Easter 1955. 108 Bacille-Calmette-Guerin, better known as B.C.G., is a living organism related to the tubercle bacillus which can be injected into the skin without causing tuberculosis and after a few weeks it produces a reaction, so that the body tissues become sensitive to the toxin of the tubercle bacillus. This special sensitivity is revealed by the fact that the tuberculin reaction (Mantoux) is changed from negative to positive in four to six weeks after administration of B.C.G. Experience in other countries has shown that a person is less likely to develop clinical tuberculosis if his Mantoux tuberculin reaction has been converted from negative to positive, though this changed reaction does not necessarily imply immunity from tuberculosis. In practice B.G.G. does provide a considerable degree of safeguard against tuberculosis and the protection can last for approximately six years By vaccinating with B.C.G. children aged thirteen may obtain a degree of protection during the period of adolescence when most vulnerable to pulmonary tuberculosis. B.C.G. has been used in this country during recent years for exposed susceptible groups of people such as nurses, medical students, and family contacts of infectious tuberculosis cases. Also in selected areas, including Tottenham, B.C.G has been given during the last three years to school leavers in a trial survey conducted by the Medical Research Council. The B C. G , is administered by injection of one drop into the skin to children who are Mantoux negative. It is estimated that in this Area about 30% of thirteen years olds will be Mantoux Positive which means that such children will already have had a very mild infection of tuberculosis sufficient in most cases to give them protection against the disease. Children who are strongly Mantoux Positive will have an X-ray of the chest to exclude the presence of the disease. There are two stages in the accepted procedure. First, a skin test to see if B.C.G., vaccination is necessary. Secondly, the actual vaccination when an injection is made into the skin. There are about 2,400 children aged thirteen attending schools in Tottenham and Hornsey, and on the assumption that 75% of parents will accept vaccination with BGG., some 1,800 children will have to be skin-tested and of these approximately 1,200 may need B.C.G. Parents will be given an explanatory leaflet, general practitioners will be informed and a short time before the vaccinating team visits a school the parents will be invited to sign a consent form. Skin tests will be carried out on Tuesdays and tests read on Fridays, when negative reactors will receive an injection of the B.C.G. vaccine. The work will be done during term time. 109 Meetings have been held with head teachers of secondary schools in Hornsey and Tottenham to seek their co operation and to ensure the success of the scheme. Tuberculin "Patch Tests" and School Entrants During the year the Area Committee agreed that routine patch testing of children should be carried out during their first year at school, subject to the approval of Hornsey and Tottenham Education Committees. This has since been obtained. Tuberculin testing of children at the age of five years can be carried out very simply by the so called "jelly patch" method. Fewer than 5% of children of five years of age are likely to be "patch positive" though, this may vary from school to school and from time to time. It should, however, provide an excellent means of assessing the progress made in the drive against tuberculosis. A five year old child who is "patch positive" may have been infected at home, and arrangements will be made for a follow-up investigation of the home contacts of such children. It has been said that from such investigations one case of undiagnosed infectious tuberculosis is discovered for every 250 children patch tested. Speech Therapy There are two whole time and three part-time speech therapists employed in the Area, equivalent to three whole time staff. The following comments on the work of the department have been made by the Head Speech Therapist, Miss J. Came, L.C.S.T.:- "The value of preventive work with the toddlers has again been demonstrated in 1954 Thanks to parent co-operation, many children with delayed speech development or primary stammer were found to show improvement when reviewed after a few months. Several have later achieved normal speech without clinic attendance. In the older age groups, stammerers form the highest proportion of children attending speech clinics. Environmental factors and the surprising number of popular misconceptions on the nature of this distressing handicap may seriously jeopardise successful treatment. Here, too, the co-operation of parents and teachers is essenti al, and the therapist uses every opportunity to educate the general public on its responsibilities towards the stammerer. Staff changes in Hornsey last autumn have not seriously interrupted continuity of treatment, owing to speedy re- appointments. 110 Work at Vale Road School for Physically Handicapped Children has provided much opportunity for research. The following table may be of interest in showing the variety of disorder found:- Total Number treated 17, (Boys 11, Girls 6). Spastic/Athetoid Dysarthria 5 Spastic/Athetoid Dysarthria with hearing loss (particularly for high frequencies) 2 Dysphonia 1 Aphasia 1 Pseudo-bulbar hypogenesis 1 Dystatic 1 Stammer with right hemiplegia 2 Interdental lisp 1 Delayed speech development 3 Tuberculosis in School Children Results of recent epidemiological investigations following cases of tuberculosis occurring in schools are set out below:- (i) A secondary grammar school in Hornsey A case of infectious pulmonary tuberculosis was notified at this school and in February a total of 343 boys were patch tested. The patch test showed 271 boys negative and 69 positive to tuberculin. A chest X-ray was advised for the 69 patch positive boys and 55 attended the mass X-ray unit in March together with seven masters who accepted the offer of an X-ray, The parents of the other 14 boys were advised and made private arrangements for X-rays of their boys. The Chest Specialist has now reported that the seven masters and 55 boys who attended for X-ray showed no evidence of chest disease. (ii) A secondary modern school in Tottenham During April 1954 a case of pulmonary tuberculosis of an infectious type was notified in a schoolgirl. Investigations were made at the school during May 1954. Her 15 class contacts were X-rayed and one other child was found suffering from tuberculosis. Patch testing was subsequently carried out on 94 possible contacts in other classes. Of these, 86 were negative and eight were patch positive. 111 The eight patch positive children were X-rayed together with 17 members of the staff, and the results of these examinations revealed that one other girl, a friend but not a classmate of the original case, was also suffering from pulmonary tuberculosis. Statistical Information Statistics relating to the work of the school health service during 1954 are contained in the tables following this Report. 112 COUNTY COUNCIL OF MIDDLESEX HORNSEY AND TOTTENHAM SCHOOL HEALTH SERVICE STATISTICAL RETURN FOR THE YEAR ENDED 31st DECEMBER, 1954 113 SCHOOL HEALTH SERVICE STATISTICS FOR 1954 TABLE 12 - PERIODIC MEDICAL INSPECTION Periodic Medical Inspections Other periodic inspections Other Inspections Entrants Second Age Group Third Age Group Total Special Inspections Re-inspections 4,079 3,784 2, 343 10.206 3, 515 4,702 4,496 TABLE 13 - CLASSIFICATION OF TOE GENERAL CONDITION OF PUPILS Age Groups No. of pupils inspected A (Good) B (Fair) C (Poor) No. % No. % No. % Entrants 4,079 1,850 45.3 2,209 54.2 20 0.5 Second Age Group 3,784 1,610 42.5 2,149 56.8 25 0.7 Third Age Group 2,343 849 36.2 1,472 62.8 22 1.0 Other periodic inspections 3,515 1, 263 35.9 2,210 62.9 42 1.2 Total 13,721 5, 572 40.6 8,040 58.6 109 0.8 TABLE 14 - DEFECTS POUND BY MEDICAL INSPECTION Defect or Disease Periodic Inspections Special Inspections No. of defects No. of defects 1. 2. 1. 2. Skin 235 152 886 12 Eyes a. Vision 658 438 206 12 „ b. Squint 104 53 16 1 „ c. Other 77 69 256 10 Ears a. Hearing 36 71 23 6 „ b. Otitis Media 34 148 17 1 „ c. Other 19 27 119 4 Nose and Throat 230 570 177 5 Speech 48 77 41 3 Cervical Glands 13 140 13 - Heart and Circulation 15 162 51 8 Lungs 81 213 131 14 Developmental - a. Hernia 4 14 - 1 b. Other 9 147 22 - Orthopaedic - a. Posture 76 291 24 5 b. Flat Foot 125 223 17 3 c. Other 235 340 252 5 Nervous System - a. Epilepsy 6 12 3 - b. Other 7 47 35 4 Psychological - a. Development 5 27 80 10 b. Stability 16 129 34 10 Other 167 28 5 1,655 110 1. Requiring Treatment. 2. Requiring to be kept under observation but not requiring treatment. 114 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 40 457 486 Second Age Group 267 458 679 Third Age Group 144 175 302 Total (prescribed groups) 451 1,090 1,467 Other periodic inspections 207 357 543 Grand Total 658 1,447 2,010 TABLE 16 - MINOR AILMENTS A. Diseases of the Skin (excluding uncleanliness) Number of cases treated or under treatment during the year By the County Council Otherwise Ringworm - (i) Scalp - - „ - (ii) Body 3 - Scabies 24 - Impetigo 96 7 Other skin diseases 1,148 11 Total 1,271 18 B. Other treatment given (not covered by tables 16a, 17 18 19 and 20 (a) Miscellaneous minor ailments 861 18 (b) Other (specify under one of following headings) 1. Nervous System 34 12 2. Digestive System 28 26 3. Respiratory System 77 248 4. Skeletal system - - 5. Circulatory System 15 19 6. Infectious Disease 13 58 7. Pyrexia of unknown origin 4 3 8. Ductless Glands - 2 9. Psychogenic 23 3 10. Helminthiasia 14 1 11. Developmental 14 1 12. Excretory System 4 34 13. Debility 65 1 14. Colds and Rheumatism 75 17 15. Minor Injuries 667 5 16. Miscellaneous Surgical 30 3 Total 1,924 451 115 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 283 266 Errors of Refraction (including squint) - 2, 306 Total 283 2, 572 Number of pupils for whom spectacles were:- (a) Prescribed - 1,477 + (b) Obtained - 733 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 - 41 (c) for other nose and throat conditions - - Received other forms of treatment 224 442 Total 224 483 TABLE 19 - ORTHOPAEDIC AND POSTURAL DEFECTS (a) Number treated as in-patients in hospitals 4 By the Authority Otherwise (b) Number treated 30 1,128 116 TABLE 20 - CHILD GUIDANCE AND SPEECH THERAPY No. of pupils treated Child Guidance Speech Therapy (i) By the Authority - 214 (ii) Otherwise 94 - 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 + 332 191 183 5-16 and over 17,196 12,251 12,153 Specials 4,516 4,248 4,246 Total 22,044 16,690 16,582 + Nursery Schools only iv. Number of pupils commenced treatment 10,639 iva. Number of pupils treatment completed 8,148 v. Number of attendances made by pupils for treatment 23,652 vi. Number of appointments not kept 4,526 vii. Number of half days devoted to (a) Inspection 125 (b) Treatment 2,964 Total 3,089 viii. Fillings. Permanent Teeth 13,069 Temporary Teeth 4,630 Total 17,699 ix. Number of teeth filled. Permanent Teeth 11,345 Temporary Teeth 4,334 Total 15,679 x. Extractions. Permanent Teeth 1,283 Permanent Teeth for Orthodonture 199 TOTAL Permanent Teeth 1,482 Temporary Teeth 8,464 Total 9,946 xi. Anaesthetics (a) General 1,785 (b) Local 3,314 (c) Regional 434 Total 5,533 xii. Other operations (a) Permanent Teeth 2,770 (b) Temporary Teeth 6,030 Total 8,800 117 TABLE 21 (cont.) - SPECIAL DENTAL TREATMENT UNDERTAKEN BY DENTAL OFFICERS Number of impressions, etc. 338 Number of Dentures fitted 82 Number of crowns and bridges 41 Number of inlays 4 Number of radiographs (a) at Dental Clinics 258 (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 - 3 5 9 15 20 8 7 6 6 79 Number of pupils selected for - 2 5 8 14 19 5 7 6 6 72 Number of pupils commenced treatment (first attendance) 142 Number of attendances made for treatment 2,910 Number of consultations 57 Number of impressions, etc. 676 Number of fixed appliances fitted 14 Number of removable appliances fitted 259 Number of radiographs (a) at Dental Clinics 225 (b) at Hospitals 1 Number of pupils treatment complete 43 Number of orthodontic sessions (½ days) 232 118 TABLE 23 - INFESTATION WITH VERMIN Total number of examinations 113, 320 Total number of pupils found to be infested 594 Total number of individual pupils found to be infested for the first time during the current year 193 Number of individual pupils in respect of whom cleansing notices were issued. (Section 54/2, Education Act, 1944). - Number of individual pupils in respect of whom cleansing orders were issued. (Section 54/3, Education Act, 1944). - TABLE 24 - EMPLOYMENT OF CHILDREN AND YOUNG PERSONS 1. Number of children medically examined in order to ascertain whether they were physically fit to undertake employment of a light nature outside school hours 221 2. Number of instances in which the state of health was found to be such that certificates were withheld. - 3. Number of children examined as to fitness to take part in entertainments 2 4. Number of cases in which certificates to take part in entertainments were withheld - TABLE 25 - EDUCATION ACT, 1944 - SECTIONS 57( 3), 57( 4) and 57(5) Cases dealt with under Section 57, Education Act, 1944:- Sub Section 3: 21 Sub-Section 4: - Sub-Section 5: 5 Cases de-notified under Section 8, Education (Miscellaneous Provisions) Act, 1948:- 1 TABLE 26 - MEDICAL EXAMINATION OF TEACHERS (a) Number of Teachers examined as to fitness for appointment 10 (b) Number of Students examined as to fitness for first appointment 64 (c) Number of Students examined as to fitness to undertake Training Course 89 119 RETURN OF HANDICAPPED PUPILS, YEAR ENDED 31st DECEMRER, 1954 ASCERTAINMENT DISTRIBUTION (as at last day of year) CATEGORY No. of ascertained Cases known first 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 and Secondary Schools In Independent Schools Not at School TOTAL B G B G B G B G B G B G B G B G B G Blind Pupils 4 5 1 1 4 6 1 - 3 6 - - - - - - 4 6 Partially-Sighted Pupils 10 12 - - 8 7 6 7 1 - - - - - 1 - 8 7 Deaf Pupils 13 5 1 3 13 8 6 7 7 1 - - - - - - 13 8 Partially Deaf Pupils 41 21 1 1 36 15 5 4 3 1 28 10 - - - - 36 15 Delicate Pupils 25 20 16 14 19 20 2 4 14 14 2 2 1 - - - 19 20 Educationally Sub-normal Pupils 72 62 21 17 83 70 52 49 14 3 15 18 - - 2 - 83 70 Epileptic Pupils 2 4 - - 1 3 - - 1 2 - 1 - - - - 1 3 Maladjusted Pupils 26 7 11 3 23 6 - - 19 6 4 - - - - - 23 6 Physically Handicapped Pupils 23 15 3 1 20 12 13 12 3 - - - 1 - 3 - 20 12 Pupils with Speech Defects 136 62 80 22 189 66 1 1 3 - 170 58 3 2 12 5 189 66 Pupils with Multiple Defects 11 7 2 3 12 8 5 5 3 3 3 r. - - 1 - 12 8 Totals 363 220 136 65 408 221 91 89 71 36 222 89 5 2 19 5 408 221 Grand Totals 583 201 629 180 107 311 7 24 629 Children not ascertained as H.P. but recommended convalescence in a Holiday Home or Camp School during Year ended 31st December, 1954. B G 49 48 120 ORTHOPTIC TREATMENT Number of New Cases Number of Cases receiving treatment Total Attendances 158 114 1,172 90 children were referred to the Royal Eye Hospital for Orthoptic treatment CHIROPODY Expectant and Nursing Mothers and School Children Ages Expectant and Nursing Mothers BOYS GIRLS 0 5 5-10 10-15 Total 0-5 5-10 10-15 Total Attendances - FIRST 39 7 23 63 93 11 36 132 179 - SUBSEQUENT 85 3 68 286 357 21 133 664 818 CONDITIONS - Cases treated at Clinic Plat Feet 4 1 - 1 2 - - - - Callosity 59 3 3 6 2 13 25 40 Corns 57 6 15 15 36 10 24 55 89 Hallux Valgus 2 - - 1 1 - - - - Foot Wart 26 - 37 155 192 7 56 469 532 Hyperhidrosis - - - 1 1 - - 4 4 Ingrowing Nail 15 5 11 16 2 5 2 9 Metatarsalgia 30 - - - - - - - - Pes Cavus - - - 1 1 - - - - Inflammation of Toe Nail - - - - - - - 1 1 Foot Strain 3 - - - - - - - - Athlete's Foot - - - - - - - 2 2 Chilblains - - - - - - 1 1 2 Toes Clawed 3 - 1 - 1 - - - - Nails Club 11 1 3 - 4 2 3 2 7 Valgus Ankles - 1 4 3 8 4 1 4 9 CONDITIONS - Cases referred to Orthopaedic Clinic Valgus Feet - - - - - - - 2 2 Knock Knees - - 2 1 3 3 1 4 8 Valgus Ankles Pol 1 nr. J J. - 1 3 1 5 3 1 4 8 callosity 1 - - - - - - - - Corns 1 - - - - - - - - Metatarsalgia - - - - - 1 - - 1 Pes Cavus - - - 1 1 - - - - flat Feet - 1 - 1 2 - - - - Toes Clawed - - - - - - - 1 1 121 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 5 3 2 Hornsey 3 1 2 Edmonton 3 3 - Hendon 4 2 2 Wood Green 3 3 - Enfield 3 5 1 Friern Barnet 1 1 - Southgate - 1 - Totals 22 19 7 Tottenham School for the Deaf Tottenham 1 2 - Harrow 1 1 - Hendon - 1 - Wood Green 2 1 1 Totals 4 5 1 122 INDEX Page Aged,care of 56 Ambulance Service 53 Ante Natal Clinics 72, 73 Area Health Service 52, 70 Area Welfare Service 52 Atmospheric Pollution 31 Audiometry Scheme 105 Baths and Washhouse Service 54 B.C.G. Vaccination 10,107 Births and Deaths 61 Burials 60 Cancer 16, 18, 67 Certificates of Disrepair 37, 41 Chest Clinic 10 Child Guidance 116 Child Welfare 76 Chiropody Service - Old People's 57 School Children and Expectant Mothers 120 Circulatory Diseases 17 Clearance Areas 32, 36 Closet Accommodation 31 Closing Orders 38, 39, 40 Comparability Factors 4 Coronary Disease 17 Council, Members of 1 Daily Guardian Scheme 78 Day Nurseries 79 Deaf, School for 98 Deaths, Classification of 66 Defects Remedied 45 Demolition Orders 39 Dental Service, Priority 84 School 95 Diphtheria 11 Diphtheria Immunisation 91 Disinfection 17 123 Disinfestation 43 Domestic Help Service 94 Drainage and Sewerage 29 Dysentery 13 Ear, Nose and Throat Clinics 101 Educationally Sub-Normal Children 101 Expectant Mothers, Care of 72 Factories 47 Food - Condemned 23 Hawkers 20 Labelling 27 Legal Proceedings 28 Poisoning 13 Registered Premises 19 Sampling 24 Guardian Scheme, Daily 78 Handicapped Children 98 Handicapped Mothers 75 Hawkers of Food 20 Health and Housing Committee 2 Health Education 86 Health Services provided by other Authorities 51 Health Visiting Service 86 Heart and Circulation, Diseases of 17 Holiday Homes, Recuperative 94 Home Nursing Service 88 Hospitals 51 Hospital School, St. Ann's General Hospital 101 Housing 32 Consolidated Regulations 1925-1932 40 Housing Act, 1936, S.9 38, 40 " " " S.11 and 12 38, 39 " " " Part III 36 Housing Repairs and Rents Act, 1954 37 Medical Aspects 36 Ice Cream 19, 20 Immunisation, Diphtheria and Whooping Cough 91 124 Infantile Deaths 62, 65 Infectious Diseases, Table 64 Insect Pests 43 Knackers' Yards 21 Laboratory Service 53 Laundry Facilities for Old Persons 56 Lunacy and Mental Treatment Acts 53 Massage and Special Treatment Establishments 60 Maternal Deaths 62 Maternity Hospitals 74 Meals on Wheels 57 Measles 12 Meat Inspection 21 Medical Examination of Staff 60 Metropolitan Water Board 29 Midwifery Service 85 Midwives' Clinic 73 Milk and Dairies 20 Mothercraft Classes 74 Mothers and Young Children, Care of 72 National Assistance Act, 1948, S.47 59 S.50 60 New and Expanded Towns 35 Notices served 46 Nurseries, Day 79 Nursing, Home 88 Occupational Health 47 Old People's Clubs 58 Holidays 58 Optical Service 57 Welfare 57 Ophthalmic Service 107 Orthopaedic Service 6 Orthoptic Treatment 120 Out-Patient Clinics at Prince of Wales Hospital 52 Outworkers 48 125 Parent Guidance 78 Paratyphoid Fever 15 Persons in need of Care and Attention 59 Pet Animals Act, 1951 42 Physically Handicapped Children, Special School 99, 110 Play Group for children under five 78 Poliomyelitis 13 Post-natal Care 73 Preserved Foods 19 Prevention of Illness, Care and After-care 94 Prince of Wales' Hospital, Out-patient Clinics 52 Problem Families 80 Public Health Act, Section 154 42 Public Health Department, Staff 2 Puerperal Pyrexia 16 Rag Flock and other Filling Materials Act, 1951 42 Recuperative Holiday Homes 94 Repairs in Default 46 Rheumatism Supervisory Centre 96 Rodent Control 42 Sanitary Inspectors, Summary of Inspections 44 Scarlet Fever 12 School Health Service 95 Statistics 113 Sewerage and Drainage 29 Shops 49 Slaughterhouses 21 Slum Clearance 36 Smokeless Zones 32 Speech Therapy 109 Statistical. Summary 61 Stillbirths 61 Toddlers' Clinics 77 Tuberculosis 6 In School Children 110 Vaccine Clinical Trials 94 Typhoid Fever: 15 Vaccination 90 126 Water Supply 29, 30 Welfare Foods, Distribution of 83 Welfare Service, Area 52 Whooping Cough 12 Vaccination 91 Work in Default 46