TOTTENHAN TOTTENHAM'S HEALTH 1955 TOTTENHAM'S HEALTH 1955 The Annual Report of the Medical Officer of Health, Borough of Tottenham. Health Department, Town Hall, Tottenham, N. 15. 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 the Annual Report on the Health of the Borough for the year ended the 31st December. 1955. This report is the 102nd in the series submitted annually since the appointment of Dr. William Hall in 18 53 as Tottenham' s first Medical Officer of Health; and the 20th which it is my privilege to present to the Council. A hundred years ago Tottenham was an exclusive and quiet little suburban town. The introduction of the railways in the mid nineteenth century led to rapid expansion of the population; and a twist to the character of the district; setting it off to swallow up the whole of the ancient rural parish and later to face problems of unplanned urbanisation. Years of endurance, failure and success in Local Government followed this rapid expansion of population which in the year 1934 had reached its peak of 154,000. It was in this year the Town received a Royal Charter of Incorporation, and with a strong and vigorous sense of civic responsibil i ty the newly constituted Borough took as its motto "Do well and doubt not" embossed in English on the Borough Arms so that its meaning and significance could be readily understood by all its citizens. Since the opening of the present century Tottenham has deservedly earned a high reputation for progressive and efficient public administration and many dramatic and striking improvements have been made over the whole range of Local Government activities. In the provision of services for the prevention of disease and the promotion of health in the community, full advantage has been taken of the powers, obligatory and permissive, given by successive health and welfare legislation. It came, therefore, as a severe blow to the prestige of this Borough when in 19 48, under the provisions of the National Health Service Act, Tottenham came to lose its full autonomy in the administration of the school health and personal health services. The newly constituted Local health Authority had good reason, however, to be grateful to the Borough Council for the completeness of the services handed over to them in 1948. Among the buildings and services so transferred may be mentioned: the modern and well equipped clinics and welfare centres; a residential nursery in Hertfordshire; a residential open-air school at Hayling Island; day nurseries, nursery schools and nursery classes; day special school for the physically handicapped child; day special school for the deaf child; occupational centre for the mentally handicapped; well established domicilary midwifery, health visiting, district nurs ing, home helps and ambulance services and a full range of specialist clinics, including dental and orthodontic services for the priority classes. Today the state provides measures of the utmost value in helping to promote and maintain high standards of health: notably by its comprehensive protection against many of the economic hazards of life - sickness, unemployment and infirmity of old age: and by the payment of family allowances, an important step towards removing the reproach that children can be a principal cause of poverty. But there is still much to be done in the spheres of disease prevention and health promotion: a challenge accepted by Local Government more than a century ago. The following pages, of this my Annual Report for 19 55, set out many of the health services provided in the Municipality; together with such statistical information as is necessary to measure failure or success and to indicate fresh avenues of endeavou r. To the professional and lay staffs of the Borough and Area Health Departments I wish to express my gratitude for their loyal support throughout the year; and in particular my thanks to Dr. F. Summers, Deputy Medical Officer of Health; Dr. A. Yarrow, Deputy Area Medical Officer; Mr. E. T. Jenkins, Chief Sanitary Inspector: Miss H, Townsend, Superintendent Health Visitor; Miss P. E. Curtis, Home Nursing and Midwives Superintendent; Mr A W, Lawrence, Chief Clerk and Mr. W.L.N. Relleen, Area Chief Clerk; for their invaluable help and co-operation in the preparation of this Report. In conclusion, I wish to express my indebtedness for the encouragement shown me at all times by the Chairman and Members of the various Committees concerned. I am, Your obedient servant, G. HAMILTON HOGBEN Medical Officer of Health. 1st June, 1956. 1 MEMBERS OF THE COUNCIL MAYOR Councillor F. G. Bohringer, J. P DEPUTY MAYOR Alderman C.H. Colyer Alderman E.J Field „ R. W.H. Fbrd „ W S Herbert „ F. A. F. Keay, J. P. „ The Lady Morrison Councillor Miss S A Bericery „ Mrs. E. M Bohringer „ E. Brown (Died 21st January, 1956) „ J IIH Brown „ E.J J. Carter „ A. W, Catley „ Mrs. I„R. Cato „ EJ. Clook „ E. Cooper „ A. J. Davies „ J.A.S. Dipple „ T A. Dutton „ E. V. Garwood „ K.A E. Gregg „ Mrs F. E. Hayn es „ Mro I? P T1 ol ov Aldeiman A Reed, A C,I I , J „ Mrs. A. F Remington „ A. R Th m er „ H. W. Himer „ R.H Warren Councillor T R Izzard „ Mrs. W A Kent „ H Lan ger „ Mrs A. A Miller „ M. T. Morris „ S. C. Morris „ J. J. Pagin „ I.L. Peirce „ M rs. M. E. Pro til eroe „ T. A. Riley „ P H. Roberts „ F. S. Sharp „ E C. Smith „ J. Watkins „ Mrs. A. Wise „ J. Wolsey Town Clerk: M. Lindsay Taylor, LL.B 2 HEALTH AND HOUSING COMMITTEE Chairman Alderman R. H. Warren His Worshipful the Mayor, Councillor F. G. Bohringer, J. P. The Deputy Mayor, Alderman C.H. Colyer (ex-offico members) Alderman A. Reed, A.C.I.I. J P Councillor Mrs. EM. Bohringer „ E Brown „ E. J. Clook „ E Cooper „ J At S Dipple Alderman Mrs. A. P. Remington Councillor Mrs RE Haynes „ Mrs. M E. Protheroe „ T.A. Riley „ E. C Snith „ J. Watkins Councillor Mrs. A. Wise. METROPOLITAN WATER BOARD Council's representative - Alderman E.J. Field STAFF OF THE PUBLIC HEALTH DEPARTMENT Medical Officer of Health Deputy Medical Officer of Health Chief Sanitary Inspector Chief Clerk G. Hamilton Hogben, M. R. C. S., D. P. H. F. Summers, M. B., B. S., D. P. H. E. T. Jenkins, P.S.I.A. A.W. Lawrence, M.S.I.A. i 3 Sanitary Inspectorial Staff Senior District Sanitary Inspector - E.s. Glegg (a) (b) (c) c.j. Catteii (a) (b) A. E. Clarke (a) (b) (c) (d) A.J. Hattersley (a) (b) (commenced 1.1.55) 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) P.J. Persons (a) (b) Note: (a) Certificate of the Royal Sanitary Institute and Sanitary Inspectors' Joint Examination Board. (b) Meat inspectors' Certificate. (c) Institution of Public Health Engineers' Certificate. (d) Sanitary Science Certificate. Shops Acts Inspector F. T. G. Lock (retired 15.8.55) Clerical Staff W. E Lawson (Senior Clerk; General) C.J. Lemon R. G. Hull Miss E. Sawyer (commenced 19.12.55) J Tedore (commenced 17.6.55 Forces 24.11.55) M Moore (Forces H.C.B. Wheal (Senior Clerk Housing) C. S. Clark B. Brill (left 2.10.55) Mrs. I. M. Cullen (left 28.8.55) Miss M. Blackwell (commenced 5.10. 55) 19.3.55) Outside Staff Foreman Disinfectin g Van Driver: Drain Testers: S.H. Reid EE. Mann ell A. E. Crow F. T. Dowse R. E. Hobbs B. Joscelyn F.J. Slater R. C. Wi1 son Disinfectors, Apparatus Attendant Rodent Operatives: W. Butcher A. Dowse A. E. Moon J. Lawrence G. W. Percival 4 GENERAL STATISTICS AREA OP DISTRICT IN ACRES 3,013 POPULATION: Census 8th April, 1951 126,929 Estimate of Registrar General of Population- Mid-year, 1955 122,100 APPROXIMATE NUMBER OP DWELLINGS IN DISTRICT 30,710 RATEABLE VALUE OP DISTRICT at 1st April, 1955 £1,019,313 SUM REPRESENTED by PENNY RATE at 1st April, 1955 £4,070 LIVE BIRTHS- Legitimate 1,445 1, 511 Illegitimate 66 Birth Rate (per 1.000 population) 1238 STILL BIRTHS 30 DEATHS 1,331 Death Rate (per 1,000 population) 10.9 Infantile death rate (per 1,000 live births) 16 55 Maternal death rate (per 1,000 live and still-births) 0.649 COMPARABILITY FACTORS - Deaths 103 Births 0.95 (NOTE: Detailed vital statistics appear on pages 55 to 63 in the Statistical Summary.) 5 CONTENTS PAGE PART I CONTROL OP DISEASE 6 „ II POOD CONTROL 14 „ III SANITARY CIRCUMSTANCES OF THE AREA 25 „ IV FACTORIES AND SHOPS 41 „ V GENERAL 45 „ VI STATISTICAL SUMMARY 55 APPENDIX WORK OF THE LOCAL AREA HEALTH COMMITTEE 64 No. 3 OF THE MIDDLESEX COUNTY COUNCIL 6 PART I CONTROL OP DISEASE After a record low number of notifications of infectious disease - 8 19 in 1954, the number of notifications was up in 19.55 to 2,373. This was to a great extent accounted for by an epidemic of measles in the early months of the year Tuberculosis The number of cases on the tuberculosis register on 31st December, 1955 was 1,825 an increase of 115 on the previous year. There were 144 new cases of tuberculosis notified during 1955 (126 pulmonary and 18 non-pulmonary) compared with 131 in 1954 (126 pulmonary and 5 non-pulmonary) Distribution of New Tuberculosis Cases notified during 1955 Age Periods New Cases Deaths Pulmonary Non-Pulmonary Pulmonary Non-Pulmonary Male Pemale Male Female Male Pemale Male Femal e Under 1 year - - - - - - - - 1-4 years 2 3 2 2 - - - - 5-9 „ 2 4 1 - - - - - 10 - 14 „ 1 - 2 1 - - - - 15 - 19 „ 2 7 - - - - - - 20 - 24 „ 4 14 - 1 - - - - 25 - 29 „ 7 9 2 1 - - - - 30 - 34 „ 13 9 - - 1 1 - - 35 - 39 „ 5 6 - - 1 1 - - 40 - 44 „ 5 3 1 - 1 1 - - 45 - 49 „ 1 3 1 1 - - - - 50 - 54 „ 5 1 - 1 2 - - - 55 - 59 „ 4 1 - 1 3 - - - 60 - 64 „ 7 1 - - 3 3 - - 65 - 69 „ 1 2 - - 4 - - - 70 - 74 „ 3 1 - - - 1 - - 75 Years and over - - - 1 1 - - - Total 62 64 9 9 16 7 - - The following is an analysis of non-pulmonary tuberculosis cases notified during 1955:- 7  Male Female Total Bones and Joints 4 3 7 Genito-urinary system 2 - 2 Central nervous system 1 1 2 Other sites 2 5 7 9 9 18 Changes in Tubercalosis Register during 1955 Details Pulmonary Non-Pulmonary Total Male Female Male Female Number on Register at 1st January, 1955 843 696 77 94 1,710 New cases notified during 1955 62 64 9 9 144 Transfer into Tottenham 23 23 2 4 52 Return to District 3 1 - - 4 Restored to Register - 3 - - 3 931 787 88 107 1,913 Cases removed from Register: Deaths of cases on register 23 5 - 1 29 Transfer out of Tottenham 22 28 - 3 53 Recovered 2 - - 1 3 Lost sight of 1 1 - 1 3 48 34 - 6 88 Number on Register at 31st December, 1955 883 753 88 101 1,825 Ward Distribution of Cases of Tuberculosis on the Register at 31st December, 1955 Ward Estimated Population Male Female Total Rate per 1,000 population Pulmonary NonPulmonary Pulmonary NonPulmonary White Hart Lane 11,628 117 10 112 8 247 21.2 Park 11,551 81 14 87 13 195 16.9 Coleraine 11,705 69 7 68 6 150 12.8 West Green 11,186 70 3 65 12 150 13.4 Bruce Grove & Central 11,046 74 6 45 6 131 11.9 High Cross & Stoneleigh 11,102 88 14 60 10 172 15.5 Green Lanes 10,833 74 7 71 7 159 14.7 Chestnuts 11,256 74 6 68 10 158 14.0 Seven Sisters 10,417 77 8 61 7 153 14.7 Town Hall 10,686 73 8 68 13 162 15.2 Stamford Hill 10,690 86 5 48 9 148 13.9 Total 122,100 883 88 753 101 1,825 14.9 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. 8 Mass Miniature Radiography Unit - N E Metropolitan Regional Hospital Board This unit visited the Borough in 19 55 holding public sessions at the Area Health Offices early in the year. In addition visits were paid to a number of industrial concerns and other organised groups In all 14,402 miniature films were taken and of these 464 were recalled for further investigation. A total of 19 new cases of tuberculosis were notified as a result of the survey. A further 113 cases were noted but not notified of individuals with healed pulmonary lesions or who were already known to the authorities. In the public sessions 3, 177 persons were x-rayed and 7 new cases discovered, (2,2 cases per 1,000) and in organised group sessions 12 cases were found (just over 1 per 1,000) in the 11,225 films taken. Analysed by sex there were 10 female cases from 5 841 examinations (1.7 per 1,000) and 9 male cases from 8,561 examinations (1.05 per 1,000) As the majority of persons seen were undoubtedly of working age this finding is probably a reflection of the differing age incidence of tuberculosis in the two sexes The disease affects women in the younger age groups and men in the older' age groups. Tottenham Chest Clinic This clinic which is in the grounds of St Ann's General Hospital serves the boroughs of Tottenham and Wood Green. The Chest Physician, Dr T A C McQuiston, has kindly supplied the following report on the work during 1955 of the clinic and the associated Chest Unit in St. Ann's General Hospital. "Tuberculosis deaths are down on the previous year, and although the number of new cases notified is not significantly less than during the previous 12 months, the total number of cases seen to find this number was an increase on the previous year. There is still a large demand for the 150 chest beds which we administer at St. Ann's Hospital, Most cases prefer going into local beds when these are available, and, of course, it is possible for us to carry out any treatment which may be required. 9 There is visiting at some time during every day of the week, and the expense involved is much less than is the case when treatment is carried out at a distance from the London area. Since we have a cubicle arrangement in the In-patient Unit it is always possible for us to take any case requiring investigation which cannot be done as out-patient, and n on - tubercu1ous chest cases may be admitted for short periods for treatment which cannot easily be given at home either on account of the nature of this treatment or on account of lack of amenities on the social side. We have a good liaison with the thoracic surgical department at the North Middlesex Hospital, where surgery on our tuberculous cases is carried out, and also where special investigation and treatment of non - tu bercul ou s thoracic disease can be done with a minimum of delay. I should like again to emphasise the importance of an easy liaison between the Unit and the general practitioners in the area which the Clinic serves, and also with the Medical Officer of Health and staff concerned with the area health services" Chest Clinic Statistics, 1955 (Tottenham and Wood Green) Total number of attendances 30,998 No of sessions held 1,261 No. of x-rays: Large films 13,183 Miniature films 6,692 19,£75 No. of new cases seen 5,642 No. of new contacts seen 1,064 No. of new contacts found to be tuberculous and formally notified. 14 No. of persons vacinated with B. C. G. 366 Scarlet Fever There were 75 cases of scarlet fever notified during the year but no deaths were attributed to the disease. Of the 43 cases admitted to hospital the diagnosis was amended in 11 instances. Details of cases admitted to and the hospitals to which they were admitted were as follows:- 10 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 13. 3 11 9. 6 Other Hospitals 2 19 No amendments. Diphtheria There was one confirmed case of diphtheria in the Borough during the year This occurred in a girl aged 9 and was diagnosed as the result of a positive throat swab Investigation of the organism cultured from the throat swab showed it to be a nonvirulent type There were no secondary cases arising from this. In 6 suspected cases the diagnosis was amended as follows:- Tonsillitis 4 Stomatitis 1 Quinsy 1 Measles There were 1837 cases notified during the year 63 cases were admitted to hospital Of these the diagnosis was amended in one instance and one, a female aged 1 year 9 months, died from broncho pneumonia complicating the illness one day after admission to hospital. Whooping Cough There were 98 cases of whooping cough notified during the year There was one fatal case in a child of 3 months complicated by broncho pneumonia Poliomyelitis 19 cases of poliomyelitis were confirmed during the year -9 paralytic, 10 non paralytic. This is the highest number of cases recorded in the Borough, but compares favourably with the incidence in other authorities in the London area. During the year the North East Metropolitan Regional Hospital Board set up a special poliomyelitis unit at St. Ann's General 11 Hospital, Tottenham for the treatment of poliomyelitis and the Medical Officer of Health was appointed a member of the Subcommittee concerned with this unit. The modern treatment of emergencies likely to arise during the course of poliomyelitis calls for special apparatus and special medical and nursing skills. It was therefore thought advisable to concentrate the facilities for treatment and maintenance of special equipment at a few points in the Region and bring those who might need it to those points rather than spread the apparatus and specialists staff throughout the Region to be transported to the emergency when it arose. The established "unit" leads to much greater efficiency but it does mean that patients outside Tottenham may have to be treated at some distance from their homes. Locally the knowledge that so many cases of poliomyelitis are being treated in St. Ann's General Hospital may give the public a wrong impression of the incidence of the disease in the Borough These objections, however, cannot begin to outweigh the advantages of centrali sed treatment. Confirmed Cases of Poliomyelitis during 1955 Date of Notification Date of commencement of illness Sex Age in Years Remarks Recent History of Inoculations 20.7.55 16. 7.55 (Approx.) F 14½ Non-paralytic Nil 23.7.55 21.7.55 M 18 Paralytic Nil 9.8.55 22.7.55 F 4¾ Non-paralytic Nil 30.8.55 24.8.55 F 36 Paralytic (Expectant Mother) Nil 2.9.55 31.8.55 F 37 Non-paralytic Nil 3.9.55 29.8.55 M 17½ Non-paralytic Nil 5.9.55 30.8.55 F 2¼ Paralytic Anti-tetanus serum 6 8 weeks before onset 8.9.55 6.9.55 M 5 Non-paralytic Nil * 8.9.55 6.9.55 M 6 Non-paralytic Nil 12.9.55 7.9.55 M 10½ Non-paralytic Nil 20.9.55 15.9.55 M 10½ Non-paralytic Nil 26.9.55 21.9.55 M 28 Paralytic Nil 3.10,55 30.9.55 M 10 Non-paralytic Nil 6.10.55 13.9.55 (Approx.) F 5 Paralytic Nil 24.10.55 14.10.55 (Approx.) F 4 Paralytic Nil 23.11.55 16.11.55 M 8 Non-paralytic Nil 30.11.55 23.11.55 F 25 Paralytic (Expectant Mother) Nil 29.12.55 29.12.55 M 14 Paralytic Nil 31.12.55 31.12.55 M 2½ Paralytic Nil * Brothers 12 In 19 suspected cases the diagnosis was amended as under. Tonsillitis 6 Fibrositis 1 Upper Respiratory Osteomyelitis 1 Tract Infection 2 Influenza 1 Bronchitis 1 Pyrexia of Unknown Acute Pharyngitis 1 Origin 1 Weils Disease 1 Upper Respiratory Infection and Rheumatic Fever 1 Atelectasis 1 Viral Respiratory Disease 1 Viral Infection 1 Dysentery There were 52 cases of dysentery notified during the year, of which 14 were admitted to hospital. Of these one was complicated with measles and four others rediagnosed as follows:- Enteritis - Non-Specific 2 Toxic Food Poisoning 1 Ischiorectal Abscess 1 Paratyphoid Fever One case of paratyphoid was notified during the year. Scabies There were 25 cases of scabies notified during the year Food Poisoning Twenty-three cases of food poisoning were notified Of these one occurred in the first quarter five in the second, thirteen in the third and four in the fourth quarter of the year. Weil's Disease (Leptospirosis icterohaeiorrhagica) Three confirmed cases of this disease were reported during the year and one suspected There was no apparent connection between the confirmed cases but one of the confirmed cases and the suspect were near neighbours. In addition there was a history of 13 another resident in the street having had an attack of jaundice some months previously. This disease is primarily a disease of rats and the organism is found in their excreta. Rats were reported in the locality in which the first case and the suspect case occurred but no signs of recent infestation were found nor were baits taken. One rat however was eventually trapped in the vicinity but was not found to be infected with the disease. The two other cases would appear to have been associated with water contaminated by infected rats. The first patient was thought to have contracted the disease while fishing in some disused gravel pits. The second patient worked at a wharf on the River Lee and was in the habit of bathing frequently in the river during the hot weather which prevailed at that time. SUMMARY OF DISINFECTION WORK DURING 1955 Rooms disinfected after occurrence of infectious disease 159 Bedding disinfected after occurrence of infectious disease or death 131 Library books disinfected 177 14 PART II FOOD CONTROL Interest in the control of food and food premises has been mainly centred on the new legislation passed by Parliament at the end of the year, The new Pood and Drugs Act which came into force on the 1st January, 19 56 amends and consolidates the law on this subject. It is hoped that the strengthening of the law governing hygiene in food transactions will enable advances to be made in the control of food-borne disease and at the same time save waste of food due to careless handling and storage. The time has come when health education as a means of improving hygienic practices in the food trade must be reinforced by a vigorous and regular inspection of the premises. Whilst officers of the local authority are at all times ready to advise and bring to the notice of the public the dangers of improper handling of food, they also have a duty to enforce the provisions of byelaws and other legislation dealing with the control of food. The Pood Hygiene Regulations, 1955 modify and extend the hygiene requirements of section 13 of the Pood and Drugs Act, 19 38 and include a number of provisions affecting stalls and vehicles and also certain general requirements that apply wherever food is handled. They apply to the supply of food in the course of a business which is defined so as to include canteens, clubs, schools, hospitals and other institutions, as well as undertakings carried on by public and local authorities. The Regulations generally came into force on the 1st January, 1956, but certain provisions which may involve alterations to premises or other substantial changes are deferred until the 1st July, 1956. The main new provisions are as follows:- (i) No food business may be Carried on in any insanitary premises and the equipment used must be non-absorbent and maintained in a thoroughly clean condition. (ii) Preparation or packing of food must not be undertaken in domestic premises other than those of the person carrying on 15 the business. This will prohibit the practice of outworkers being employed by certain food trades. (iii) Pood may not be placed where there is risk of contamination. (iv) There is a strict control of personal cleanliness and cuts and abrasions must be covered with waterproof dressings. Food handlers must refrain from spitting or from smoking while they are handling any open food or are in any room in which there is open food. (v) Care must be taken in the transport and wrapping of food and only clean wrapping material may be used. In particular, newspaper or other printed material must not come into contact with any food other than uncooked vegetables. (vi) Notice must be given to the Medical Officer of Health of any persons who handle food and who are suffering from or are carriers of certain infections. (vii) Food premises must comply with certain structural requirements and must be provided with:- (a) a constant supply of clean and wholesome water; (b) wash-hand basins with an adequate supply of hot and cold water for the persons engaged in handling food Soap, nail brushes and towels must also be available; (c) First aid equipment readily accessible for the use of persons handling food; (d) Suitable accommodation for clothing; (6) Sinks for washing food and equipment; (f) "Wash Hands" notices exhibited in W.C s. (viii) Certain foods for immediate consumption must be kept at temperatures designed to secure conditions normally to be found in a cool larder, or else above a point at which heat-susceptible organisms would be killed. (ix.) Stalls selling meat or fish must be suitably covered and screened at the sides and back in such a manner as to prevent contamination and must have suitable waste receptacles. (X) Stalls selling food for immediate consumption must be Provided with washing facilities and there must be an adequate suPPly of hot and cold water for this purpose. 16 (xi) Provision is made in regard to the transport and carrying of unwrapped meat. The Local Authority is empowered to issue certificates of exemption in certain cases where compliance with the Regulations cannot reasonably be required because of restricted accommodation or some other special circumstance. In a covering letter the Ministry of Health state that this provision is included for exceptional use to meet special circumstances and the Minister does not doubt that it will be used with circumspection, A certificate may be issued for a specific period or to run indefinitely until withdrawn. The penalties for offences against either the new Act or Regulations has been raised to a fine not exceeding £100 or to imprisonment for a term not exceeding three months, or to both. In the case of continuing offences there may be a further penalty not exceeding £5 a day. If a caterer is convicted by a Court of an offence against the Pood Hygiene Regulations, the Court may, in certain cases, disqualify him from using the premises for catering purposes for a period not exceeding two years. Registered Premises In future the applications for the registration of premises to be used for the manufacture, storage or sale of ice cream, or for the preparation of sausages or preserved foods must specify the particular rooms or accommodation to be used and registration will be restricted to those parts of the premises. At the 31st December, 1955, the following premises were registered:- For the sale only of ice cream 356 Manufacture and sale of ice cream 6 Storage of ice cream 4 Cooking of hams and other meats 42 Fish frying 37 Sausage manufacture 56 Preparation of jellied eels 3 Boiling shell fish 3 These premises are regularly visited by the district sanitary inspectors and samples of ice cream collected from time to time 17 from ice cream manufacturers; also certain samples were taken of loose ice cream which was on sale in the Borough. The following is a summary 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 3 1 2 1 7 Samples of ice cream produced outside of Tottenham 7 1 1 1 10 Total 10 2 3 2 17 Middlesex County council Act, 1950 Registration of Hawkers Section 11 of this Act requires the registration of all food hawkers and their storage premises. Two new applications were investigated by the sanitary inspectors in 1 955 and found to be satisfactory. The following is a summary of the registered hawkers anc their storage premises at the 31st December, 1955:- Articles Number of persons registered Number of registered storage premises Fruit and vegetables 97 93 Shell fish 14 10 Pish 7 7 Ice Cream 3 3 Peanuts 2 2 Light refreshments (Mobile Canteen) 4 4 Total 127 119 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 1955, namely:- 18 Designation No. of Licences No. of Supplementary Licences Pasteurised 71 14 Sterilised 129 16 Tuberculin Tested 34 15 During the year 12 applications for registration as milk distributors were dealt with. No applications were received in respect of dairies. Of the 12 new registrations 7 were for new premises and the other 5 were in respect of the change of proprietorship of previously registered premises. The number of premises and distributors registered at 31st December, 1955 was as follows:- Distributors - 153 Dairies - 8 There are now no premises in the Borough at which milk is pasteurised or sterilised. Slaughterhouses There are two licensed slaughterhouses in the Borough at which regular slaughtering takes place, although one of these is mainly concerned with the slaughter of horses. The work of meat inspection continues to occupy a major place in the work of the department and the accompanying table shows the large numbers of animals slaughtered in Tottenham during 1955 The inspectorate constantly work in the slaughterhouses outside normal office hours and allowing compensatory time off is not. always possible, particularly during the normal annual leave period, when further depletion of staff cannot be permitted, During the year 16 licences to slaughter were issued under the provisions of the Slaughter of Animals Act,.1933. Knacker's Yard There is one licensed knackers yard in the Borough During the year the Council adopted byelaws under section 58(1) of the Pood and Drugs Act, 1938 for securing that knacker's yards are kept in a sanitary condition and are properly managed and requiring that records should be kept of the animals brought to the yard and of the manner in which those animals were disposed of. 19 SUMMARY OF CARCASES INSPECTED Goats Horses Cattle Excluding Cows Cows Calves Sheep and Lambs Pigs Excluding Sows Sows Number killed 2 1.760 323 155 2,599 2,662 15, 638 506 Number inspected 2 1,760 323 155 2, 599 2, 662 15, 638 506 All Diseases Except Tuberculosis Whole carcases condemned - 1 - 3 1 1 7 - Carcases of which some part or organ was condemned - 142 35 25 11 226 1, 578 28 Percentage of number inspected affected with disease other than tuberculosis - 8. 12 10. 84 18.06 . 46 8. 53 10. 14 5. 53 Tuberculosis Only Whole carcases condemned - -- 6 3 - - 7 1 Carcases of which some part or organ was condemned - - 51 24 1 - 398 28 • Percentage of number inspected affected with tuberculosis - - 17. 65 17.42 .04 - 2. 59 5.73 No case of Cysticercosis was found in the carcases inspected. 20 Condemned Food The following is a summary of articles which were surrendered by local food traders and condemned by the Public Health Department during the year, namely:- Tinned articles: Chocolate Spread 2 Dextrose Maltose 2 Coffee 2 Egg (Frozen) 1 Crab 8 Fish 217 Cream 73 Fruit 2,050 Cucumber 10 Fruit Juice 195 Custard Powder 1 Ham 147 Jam 26 Roes 8 Lemon Curd 1 Sandwich Spread 2 Liver Puree 21 Soup 195 Lobster 4 Spaghetti 73 Macaroni 2 Strained Food 17 Marmalade 61 Syrup 3 Meat 201 Tomatoes 2,437 Milk 697 Tomato Juice 2 Nuts 38 Tomato Paste 12 Pease Pudding 1 Tomato Pulp 5 Pork 7 Tomato Puree 97 Processed Meat 544 Tongue 13 Raviolli 1 Vegetables 1,129 Rice 8 Other articles of food condemned: - Beef 1,014 lbs Fish 10 stone Beef Puree 8 jars Fondant 31 1bs Biscuits ½ lbs. Fruit 413½lbs. Butter ¾ lbs. Fruit Juice gallons Cake 4 lbs. Ginger 5 packets Cheese 2, 449¼ lbs. Ground Cloves 20 packets Cheese Spread 34 packets Ham 34 lbs Chocolate 60 lbs. Herbs 2 packets Chocolate 12 packets Lemon Curd 1 jar Chocolate Sandwich 6 packets Meat 274½ lbs. Cooking Fat 6 packets Milk Powder 840 lbs. Dates 2½ lbs. Nuts 86 packets Dessicated Coconut 56 lbs. Nuts & Raisins 7 packets Dried Egg 23 lbs. Orange Sandwich 2 packets 21 Pickles 1 jar Rennet 1 packet Pork 16 lbs. Roe 4 stone Potatoes 2 tons Suet 1 packet Raisins 27 lbs. Spaghetti 10 lbs. 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 1955:- Milk. Two samples of hot milk from a cafe contained added water, due to the method of heating the milk An official caution was issued. A sample of milk, taken on delivery to the same cafe, was found to be slightly deficient in fat but as the deficiency was found to be due to natural causes no further action was taken. Cakes. A cake, described and sold as a "cream filled roll", contained only imitation cream. A letter of warning was sent to the retailer. Drugs. A sample of camphorated oil was found to be deficient in camphor.' The follow-up samples proved genuine and no further action was taken. Iced Lolli es. Two samples of "fruit lolly" had no fruit juice present; letters of caution were sent to the manu facturers. Liver. Two samples of "lamb's liver" obtained from a firm of butchers were found to be pig's liver. An official caution was issued. Later two samples obtained from the same firm and sold as "lamb's liver" were found to be a mixture of pig's' and lamb's liver. Proceedings were instituted and the firm was fined £4.4. Od. and ordered to pay £3.3.0d. costs. Two further samples of "lamb's liver" - from a different firm - were found to be pig's liver. Proceedings were authorised in this case and the firm fined £2. 2.0d. and ordered to pay £4.4.0d. costs. Pears . Imported Italian pears contained an excess lead content due to the Italian use of poisonous insecticides. In this particular instance the importer could not be traced; but the same state of affairs was disclosed in sampling throughout the County and appropriate representations have been made with a view to preventing re-occurrence of the trouble with the next Italian crop. 22 Sausages. A sample of pork sausages contained undeclared preservative and an official caution was issued. Soup. "Cream of Tomato Soup" was found to be deficient in fat. Proceedings were authorised The Magistrates granted an absolute discharge on payment of £5.5.0d. costs. Sweets. This sample, described as "Rum and Butter Whipped Cream Bo'n-Bons" contained no whipped cream and no rum. A letter of caution was sent to the manufacturers Victoria Plums, These proved to be Giant Prunes and a letter of caution was sent to the retailers Merchandise Marks Acts, 1887-1926. 276 inspections of shops were undertaken to ensure that the Marking Orders relating to certain imported foodstuffs made under the Merchandise Marks Act, 1926 were complied with. 836 separate displays of meat, apples, tomatoes, poultry, dried fruit and butter were examined. Verbal cautions were given in respect of minor infringements not being found so serious as to warrant more stringent action. In two more serious cases proceedings were authorised one, a firm of fishmongers falsely described dab fillets as "plaice fillets". They were fined £2.2.0d. and ordered to pay £1 1 Od. costs, The other case was of a firm of butchers exposing for sale Argentine beef not marked with the country of origin They were fined £3.0 Od and ordered to pay £2.2 Od costs Food Standards (General Provisions) Order 1944. Imported tins of "Thick cream" failed to comply, with the provisions of this Order in that the contents were deficient in fat The importers were prosecuted and fined £10 0 Od, and ordered to pay £2 2 Od. co sts , The Labelling of Pood Order, 1953. This Order requires that in general pre-packed foods shall bear on the label a clear statement of the designation of the food and, in the case of compound foods, the ingredients. It also requires that the name and address of the packer or labeller appears. At 245 premises 1,063 articles of pre-packed food were examined No substantial infringements were discovered of sufficient seriousness to warrent the authorisation of proceedings, but in respect of infringements found see paragraph "False or Misleading Descriptions" below False or Misleading Descriptions, In addition to the foregoing activities which arise specifically from inspections in Tottenham a considerable amount of work has been done for the 23 benefit of all districts of Middlesex equally in scrutinising advertisements and the labels of pre-packed foods and correcting false or misleading descriptions or errors in statement of composition found therein. Corrective action during the year in question included biscuits, confectionery, spirits, sausages in brine, cereals, fruit squashes, margarine, ginger wine, imitation cream, liver puree, iced lollies, cheese spreads, tinned fruit and vegetables." Food and Drugs Acts List of samples procured in the Borough of Tottenham during the year 1955 Article Total samples procured Unsatisfactory Milk, various 130 3 Bacon and Beans 1 - Baking Powder 1 - Butter 10 - Cakes 35 1 Cake Mix 1 - Carrot Juice 1 - Cereal 1 - Cheese 8 - Cooked Meats 17 - Crab Meat 2 - Cream 14 - Curry Powder 1 - Drugs 31 1 Eggs 1 - Pish 5 - Pish Cake 3 - Fruit Drink 1 - Fruit Squash 2 - Fruit Juice 2 - Ground Almonds 2 - Ice Cream 10 - Iced Lollies 18 2 Lard 1 - Liver 12 6 Margarine 2 - Marzipan 1 - Meat 13 - 24 Article Total samples procured Unsatisfactory Meat Pie 5 - Meat Paste 1 - Minced Meat 11 - Oranges 3 - Pears 1 1 Pickles 1 - Preserves 4 - Sausages 2 3 1 Soup 3 1 Sausage Meat 1 - Sweets 4 1 Tomato Ketchup 2 - Tomato Puree 2 - Victoria Plums 3 1 Vinegar H -* Wines and Spirits 29 -- To tals 430 18 25 PART III SANITARY CIRCUMSTANCES OP 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 1955. "The supply to the Tottenham area has been satisfactory both in quantity and quality during the year 19 55. Details of the analytical results of the water passing into supply are given in the tables. 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 in July, 19 54, and the construction of a similar tank at Stoke Newington is in an advanced stage. (b) River Thames water stored in Walton reservoir and treated at the Board's filtration works at Walton. A contact tank was brought into operation in April 1953. 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 - so1vent. 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". 26 Average Results of the Chemical and Bacteriological Examinations of the Water Supplied to the Borough of Tottenham for the Year 1955 Parts per Million (Unless otherwise stated) Description of the Sample No. of Samples Ammoniacal Nitrogen Albuminoid Nitrogen Oxidised Ni trogen (Nitrate) Chlorides as C1 Oxygen abs. from Permanganate 4 hrs. at 27ºC Turbidity in Terms of Silica Colour m. m. brown 2ft. Tube Burgess's Tintometer Hardness (Total) Hardness (Noncar bonate) pH. Value Phosphate as P.O. 11 4 Silica as Sio2 Copper as Cu Sulphate as so4 Conductivity New River water filtered at Hornsey works 231 0.012 0.064 6.2 37 0.66 0.2 7 308 79 7.7 0.90 14 - -- 525 New River water filtered at Stoke Newington works 232 0.0 10 0.070 5.9 37 0.70 0. 1 7 305 79 7.7 0.85 13 0.02 57 525 River Thames derived filtered water 1, 663 0.014 0,085 3.8 26 1.04 0. 2 12 258 65 7.8 0. 50 10 0.03 49 450 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 258 9.7 100.0 Nil New River water filtered at Stoke Newington works 257 18. 4 100.0 Nil River Thames derived filtered water 3. 561 7.8 99.9 0.002 27 Drainage and Sewerage Separate systems of soil and surface water drainage continue to operate in the Borough, but the East Middlesex drainage scheme is likely to have some future bearing on the matter. The preparation of plans is nearing completion and it is probable that work on the Tottenham portion of the scheme will start in 19 56. The operation of a dual drainage system gives rise to repeated problems in the prevention of pollution of streams by the surface water sewers discharging into them. The following paragraph outlines the steps that have been found necessary in tracing sources of surface water pollution, Stonebridge Brook Pollution Following further complaints from the River Lee Conservancy Catchment Board of pollution of the Stonebridge Brook, it was decided by the Health Committee to intensify investigations into the possible sources of pollution. At first it was thought possible to carry out this work with existing staff but later it was found necessary to employ additional staff. Samples taken at a number of points on the surface water drainage system showed that sewage pollution was occurring. In addition traces of cyanide were discovered indicating that industrial waste was finding its way into the surface water drains Intensive efforts were made to locate, if present, any general pollution caused by soil connections wrongly discharging into the surface water sewers; and special visits made where it was known that trade processes involved the use of cyanide, eg electroPlating and case hardening. In no industrial premises was it established that drains were wrongly connected; and the more probable cause of industrial pollution was the misuse of the drains, e.g by workmen throwing waste matter into the surface water drains or floor washings being brushed into them. In the investigations into the presence of general pollution, 2,538 visits were made and 160 illegal connections to the surface water drainage system discovered. Preliminary notices were served requiring these connections to be made to the soil drainage system and, where necessary, statutory action was taken. 28 Orders have been placed for chemicals enabling tests to be made locally in connection with the complaints of cyanide pollution and when these are obtained, it is hoped, by frequent sampling, to be able to locate the source of cyanide pollution, known to be intermittent. Closet Accommodation The water carriage system continues in operation throughout the borough. Particular attention has been given to closet accommodation in factories shops and in premises licensed by the County Council for entertainment. Atmospheric Pollution In July 1955 the Government published the "Clean Air Bill", the object of which is to implement the principal recommendations of the Beaver Committee's report. Whilst the Bill is welcomed as the first step in a positive approach to air pollution, much criticism has been made against many of its provisions. Clauses may be amended - perhaps strengthened - in its passage through Parliament; and final comment must therefore be reserved until it becomes law Sites have been fixed locally for atmospheric pollution gauges - two sites for deposit gauges and one site for a sulphur dioxide recording instrument. Housing Representations in respect of three clearance areas, viz:White Hart Lane Nos 1 and 2 and Tewkesbury No. 2, were reported in my annual report for last year. A public inquiry in respect of the White Hart Lane areas was held in February, 1955 when objections in respect of 50% of the properties were heard. An inquiry dealing with the Tewkesbury area was held in March, 1955 when objections representing over 50% of the properties were heard. In both areas confirmation was subsequently received from the Ministry of Housing and Local Government. Confirmation with some modification was also received in respect of the Tottenham Hale clearance area and demolition of the houses in this area is proceeding. 29 The 1st day of August, 19 55 was the date set by the Ministry of Housing and Local Government for submission of proposals under section 1, Housing Repairs and Rents Act, 1954. This section requires local authorities to submit proposals for dealing with houses which appear to the local authority to be unfit for human habitation and which ought to be included in clearance areas. In addition to assessing the number of houses to be included in future areas, the Minister required to be informed of the time in which it was estimated the areas could be cleared. Consultations with the Borough Engineer made it possible to work out the full proposals which were approved by the Council and sent to the Minister on the 12th April, 1955, as follows:- Part 1 The total _probl em (i) Estimated number of houses unfit for human habitation within the meaning of section 9 of the Housing Repairs and Rents Act, 19 5 4, and suitable for action under section 11 or section 25 of the Housing Act, 1936 2,189 (ii) Period in years which the Council think necessary for securing the demolition of all the houses in (1) 10 - 15 yrs. Part 2 Orders already made, etc (iii) Number of houses in (i) in clearance areas and already covered by operative clearance or compulsory purchase orders or owned by the local authority 98 (iv) Number of houses which are already in clearance areas and for which clearance or compulsory purchase orders have been submitted to the Minister but have not yet become operative 223 Part 3 Action in the first five years (v) Number of houses which are already in clearance areas and for which clearance or compulsory purchase orders are to be made or which are to be purchased by agreement within the five years Nil (vi) Number of houses which are to be included in clearance areas still to be declared and which within the five years will be owned by the local authority or will have been included in a clearance order or a compulsory purchase order submitted to the Minister 1,280 30 (vii) Number of houses under (iii), (iv), (v) and (vi) to be patched (if necessary) and retained within the five years under section 2 of the Housing Repairs and Rents Act, 1954, for temporary accommodation Nil (viii) Number of houses under (iii), (iv), (v) and (vi) to be demolished in the five years 925 (ix) Number of houses (including those already comprised in operative demolition orders) to be demolished in the five years as a result of action under section 11 of the Housing Act, 1936. 40 The Minister, in approving this programme, asked for details of the first year's proposals and it is to this schedule the department will work during the year ending 31st August, 1956 First Year Programme beginning 1st September, 1955 Area 1 Comprising parts of Plevna Crescent and St. Ann's Road Area 2 Comprising part of Hartington Road Area 3 Comprising 75/97 82/100 Northumberland Park Area 4 Comprising parts of Northumberland Park, Northumberland Grove and Park Lane in the triangle formed by these roads. Area 5 Comprising parts of Northumberland Park, Willoughby Lane and Willoughby Park Road. Area 6 Comprising parts of Victoria Road, Newton Road and Walton Road. It is not inappropriate that I should comment here on the selection of areas for this first year's work. The urgent need for dealing with unfit houses has been stressed, but we must not lose sight of the fact that if the problem is to be resolved, a long term view must be taken. 31 However urgent it may be to pull down unfit houses, it will not be possible to do so if there are no new houses in which to rehouse the occupants. The crux of the problem is therefore the availability of building land - land which will make it possible to carry out the already agreed policy of decanting The choice of areas in this first year's programme must, therefore, have regard not only to the fitness or otherwise of the houses but also to the existing density of development It is expected that the areas now scheduled for redevelopment will make it possible to provide a favourable balance of houses when existing occupiers have been rehoused. Six areas comprising 48 houses were represented during the year and the following table shows the position at the 31st December, 1955: - POST WAR CLEARANCE AREAS 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 7. 55 8.55 " No. 2 18 28. 10. 52 5. 5.53 27. 7.53 - - The Hale 65 2. 2.54 6 7.54 9. 3.55 - - White Hart Lane No. 1 4 1. 6.54 22. 2.55 9. 7.55 • " " No. 2 123 1. 6,54 22. 2, 55 9. 7. 55 - - Tewkesbury No. 2 71 29. 6 54 28. 3.55 27. 10 55 - - " No. 3 2 30, 8. 55 - - - - Plevna Crescent No. 1 13 29, 11. 55 _ _ " " No. 2 6 29. 11, 55 - - - - " " No. 3 7 29. 11. 55 - - - St. Ann's Road 5 29. 11. 55 - - - - Hartington Road 15 29. 11. 55 - - - - The repair sections of the Housing Act, 19 36 have been used whenever necessary but when the complaints concern houses in any of the scheduled areas - as indeed many of them do - provisions of the Public Health Act or the Tottenham Corporation Act are used The complaints which present a problem are those from tenants occupying houses in clearance areas already confirmed by the Ministry of Housing and Local Government 32 In some cases the difficulty has been overcome by rehousing the tenant on receiving an undertaking from the owner not to relet Closing or demolition orders have again had to be made in respect of certain individual properties. In none of these cases has the owner put forward proposals or given any undertakings HOUSING ACT, 1936 - SECTION 11 Premises the subject of Demolition Orders not demolished as at 31st December, 1955. Premises of Order 46 Love Lane 15. 7. 54 4 Stanley Grove 1. 6.43 / 5 Union Row 11. 8.43 6 Union Row 11. 8,43 7 Union Row 11. 8.43 8 Union Row 11. 8.43 490 West Green Road 29. 12. 55 / These premises were still occupied at 31.12.55. Premises demolished during 1955 Premises Date of Order Date Demolished 31 Langham Road 6. 8. 52 March, 19 55 1 Stanley Grove 2. 4. 54 June, 1955 LOCAL GOVERNMENT (MISCELLANEOUS PROVISIONS) ACT. 1953 SECTION 10 Closing Orders made during 1955 in respect of whole houses Premises Date of Order 186 Tewkesbury Road 5. 4. 55 60 Stamford Road 5. 4, 55 62 Stamford Road 5. 4.55 6 Chapel Place 4. 7. 55 (otherwise known as 6 White Hart Lane) 33 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 1948 181 13, 160 8 4 1949 106 6, 593 6 5 1950 77 4,035 8 5 1951 72 3, 186 3 4 1952 47 2, 445 1 9 1953 33 1,918 8 0 1954 30 1, 347 4 2 1955 26 1,042 3 3 CERTIFICATES OF DISREPAIR The number of applications for certificates of disrepair under the Housing Reparis and Rents Act, 1954, although quite heavy at the beginning of the year, fell off during 19 55 and towards the end of the year an average of two a week were being received. The following statement shows the number of cases dealt with during the year and the number remaining in force at the 31st December, 1955. Certificates outstanding at 1st January, 1955 157 Applications received during 1955 153 310 Applications withdrawn by applicants 1 Certificates refused by Council 13 Certificates revoked on completion of repairs 175 189 Certificates in force at 31st December, 1955 121 34 Overcrowding Survey = White Hart Lane Estates During 19 55 a survey was carried out to obtain information as to the degree of overcrowding in the London County Council White Hart Lane Housing Estate and the Borough Council estates in the same polling areas The method adopted was by service of a statutory notice on the occupier requiring a return to be made of the number sex and age groups of the occupants of each dwelling The limitations of such method were realised in that it would only show where statutory overcrowding existed in dwellings as a whole It would not disclose information as to sub letting and the possible overcrowding of sub-tenants To get this information would have required additional time and staff to carry out a house-to-house investigation Nevertheless the enquiry has elicited certain worthwhile information and an analysis of the returns shows that of the 2,040 occupied dwellings on the London County Council estate 22 were overcrowded (1 1%) and of the 940 Borough Council dwellings 23 were overcrowded (2 4%) It is of interest to note that in the 1936 overcrowding survey it was found that in the same London County Council estate 10 9 dwellings were overcrowded (5 3%) The present inquiry further shows the degree of under occupa tion on the two estates In 384 London County Council and 135 Borough Council dwellings the actual number of occupants is less than one third of the permitted number A complete analysis of the density of occupation shown in the enquiry is given in the following tables 35 OVERCROWDING SURVEY: DENSITY OF OCCUPATION LONDON COUNTY COUNCIL DWELLINGS Perm itted No. No. of Houses OCCUPATION LESS THAN PERMITTED NO. BY:- Fully Occupied OVERCROWDING BY: - 9½ 9 8½ 8 7½ 7 6½ 6 5½ 5 4½ 4 3½ 3 2½ 2 1½ 1 ½ ½ 1 1½ 2 2½ 3 5½ 3 10 6 - - - - - - - - - - - . - - . 42 1 60 2 1 - - - - - - - 5 570 - - - - - - - - - - - 79 1 179 26 175 25 54 10 14 3 2 2 - - - 5½ 2 - - - - - - - - - - - 1 - 1 - . - - - - - - - - - - - 6 105 - - - - - - - - - 1 - 24 1 26 8 23 6 9 2 . 3 1 - 1 - - 6½ 64 - - - - - - - - - - 14 -- 17 4 12 4 7 2 3 . 1 - - - - - - 7 142 - - - - - - - 3 - 30 - 31 8 22 9 19 2 14 - 2 1 - 1 - - - - 7½ 553 - - - - - - 40 - 134 10 136 47 94 30 29 12 11 1 4 - 3 1 - 1 - - - 8 51 - - - - - 1 - 9 1 13 3 8 3 4 2 3 - 2 1 1 - - - - - - 8½ 183 - - - - - - 28 1 36 8 44 8 21 4 13 6 8 4 1 _ 1 _ _ 9 215 - - - 5 - 24 1 36 9 41 14 22 7 17 5 14 6 7 5 1 - - - - - - - 9½ 43 - - 1 - 4 - 10 - 6 3 9 3 1 - 1 2 1 1 1 - - - - - - - - 10 4 - - - - - 1 - 2 - - - - - 1 - - - - - - - - - - - - - 11 1 - - - - - - - - - 1 - - - - - - - - - - - - - - - - - 11½ 1 1 - -- - - - - - - - - - - - - - - - - - - - - - - - - 2,040 1 - 1 5 4 26 79 51 186 107 220 223 153 288 105 300 67 154 29 19 12 4 3 3 - - - TOTTENHAM BOROUGH COUNCIL DWELLINGS 3 31 - - - - - - - - - - - - - - - 11 - 20 - - - - - - - - - 5 60 - - - - - - - - - - - 2 1 20 4 17 3 7 4 2 - - - - - - - 6½ 394 - - - - - - - - 1 - 39 4 65 27 100 35 44 26 20 13 9 9 - 1 - - 1 7½ 24 - - - - - - - - 2 1 3 - 9 2 1 3 2 - - - - 1 - - - - - 8 8 - - - - - - - - - 1 - 3 1 2 1 - - - - - - - - - - - - 8½ 16 - - - - - - - - 1 - 4 4 3 1 - 2 1 - - - - - - - - - - 9½ 381 - - 5 1 34 2 53 18 73 38 50 20 35 12 23 4 7 3 - 1 1 1 - - - - - 10 6 - - - - - - - - - - . - 2 1 - 1 1 1 - - - - - - - - - 10½ 16 1 - - - 1 - 2 1 3 - 3 1 3 - - 1 - - - - - - - - - - - 9 36 1 - 5 1 35 2 55 19 80 40 99 34 119 65 129 74 58 57 24 16 10 11 - 1 - - 1 36 Rag Flock and Other Filling Materials Act 1951 At the 31st December, 1955 one establishment was licensed for manufacture of rag flock and 24 premises were 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, 19 55, 17 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 Sewer maintenance treatments have been undertaken during the year these took place in May and November Business premises and dwelling houses have been treated where necessary The use of "Warfarin" as a poison bait has been increased This poison has the advantage of reducing the number of visits made by the operatives Sewer Maintenance - Results of baiting manholes Poison take at Manholes Treatment No. 21 April/May Treatment No. 22 Oct/ Nov. Complete - 37 Good 119 151 Small 264 363 Nil 636 448 Estimated number of rats killed 4, 145 5,330 Poison used 2½% zinc phosphide 10% arsenious oxide The following is a summary of dwelling houses and business premises treated during 1955:- (1) Dwelling houses 626 (2) Business and Factory premises 212 (3) Total charge for (2) above £135-1-4 37 Insect Pests The department continues to use a 5% solution of D. D. T. in water for dealing with insect pests For certain insects a 5% D D.T. powder is used in addition to spraying round the infested area. Households are visited by sanitary inspectors prior to removal to Council houses and those cases which are found to be verminous are disinfested before removal. Inspections were carried out by the sanitary inspectors and di sin testation was required in 11 instances. Cause Private Houses Council Houses Other Premises Totals Houses Rooms Houses Rooms Houses Rooms Others Ants 7 - - - 2 nurseries 7 - 2 Bees 1 - - - 1 school 1 - 1 Beetles 42 37 3 shops 1 public house 1 club 2 school canteens 1 factory 2 schools 42 37 11 Bugs 83 195 3 15 3 schools 86 200 3 Earwigs 2 - - - 2 - - Fleas 9 22 - - 1 public house 9 22 1 Flies 5 9 - 1 slaughterhouse 1 factory 5 9 2 Lice 2 5 - - 1 ambulance 1 cell 2 5 2 Maggots - - - - 1 yard - - 1 Red Mite 2 - - - 11 flats 2 - 11 Scabies 1 1 - - 1 1 - Wasps 8 - - - Summer Theatre 8 - 2 Woodworm 3 8 - - 3 8 - 38 Inspections Carried out by the Sanitary Inspectors Appointments and Interviews 1,053 Cinemas and Halls 56 Complaints Investigated 3,688 Conveniences and Urinals 80 Drains defective 243 Drains Tested 443 Factories with Mechanical Power 486 Factories without Mechanical Power 48 Food Poisoning 9 Food Premises Bakehouses 102 Butchers 190 Cafes 182 Dairies 272 Factories 44 Factory Canteens 55 Fishmongers 136 Greengrocers 100 Ice Cream Premises 150 Slaughterhouses 900 Other Food Premises 28 4 House to House 52 Improvement Grants 9 Infectious Diseases 237 Other Visits 2,759 Outworkers 309 Rat Infestation 1,133 Re-inspections 8,999 Schools 22 S. D. A. A. and Housing Act Advances 186 Smoke Observations Stables and Mews Tuberculosis Workplaces 39 Defects Remedied Drains reconstructed 28 Drains repairs 252 Drains cleared 17 3 W. C. Cisterns repaired or renewed 125 W. C. Pans renewed 149 W. C. Pans cleansed 2 2 Waste Pipes repaired or renewed 126 Rainwater pipes repaired or renewed 216 Roofs repaired or renewed 599 Eaves gutters repaired or renewed 380 Drinking water cisterns renewed 6 Drinking water cisterns covered 10 Water service pipes repaired 77 Water supply reinstated 35 Yards repaired or reconstructed 84 Sinks renewed or provided 37 Floors repaired or renewed 296 Floors ventilated 123 Dampness remedied by insertion of damp proof courses 62 by pointing of brickwork 79 by internal rendering 280 by miscellaneous remedies 165 Window frames and sashes repaired or renewed, or painted 4 15 Coppers repaired or renewed, or provided 11 Fireplaces, stoves and ovens repaired or renewed 254 Flues and chimney stacks repairs 93 Brickwork of walls repaired and walls rebuilt 118 Ventilated food stores provided 7 Rooms cleansed 633 Staircases, passages and landings cleansed 187 Staircases, balconies and steps repaired or renewed 83 Noxious Accumulations removed 31 Nuisances arising from animals abated 4 Miscellaneous defects remedied 861 40 Notices Served Statutory:- Housing Act, 19 36 Section 9 185 " 11 1 186 Public Health Act, 1936 Section 24 2 " 39 38 " 45 10 "79 2 "94 203 Tottenham Corporation Act 1952 255 Section 35 2 " 36 8 " 43 83 93 534 Informal 1, 428 Repair of Houses by the Council Work carried out in default or by agreement with the owners during 1955- Housing Act 1936 £ s d Section 9 26 premises 1,042 3 3 Public Health Act 1936 Section 24 2 premises 7 7 4 " 39 6 " 185 19 5 " 45 1 " 7 19 5 " 9 4 5 " 234 3 9 Tottenham Corporation Act, 1952 Section 36 2 premises 8 6 3 " 43 25 " 341 16 1 1,827 15 6 41 PART IV FACTORIES AND SHOPS Tottenham has a large number of industries in its area and in addition to a general scatter of factories throughout the district there is a concentration of industry between the River Lea and the High Road. Systematic and regular inspections are carried out and close co-operation is maintained with H.M. Inspectors of Factories. During their inspections the Sanitary Inspectors take the opportunity of visiting factory canteens and discussing with canteen staff the various aspects of food hygiene It is now a general practice for workers to have their meals in the works canteen and it is of the utmost importance that the high standards of hygiene should be maintained in the han dl in g, p repa ration and serving of food Factories Acts, 1937 and 1948 Inspections for purposes of provisions as to health (including inspections made by Sanitary Inspectors) Premises No. 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 65 48 1 - (ii) Factories not included in (i) in which Section 7 is enforced by the Local Authority 682 486 8 - (iii) Other Premises in which Section 7 is enforced by the Local Authority (excluding out workers premises) 6 6 - - Total 753 540 9 - 42 Summary of Defects found in Factories Particulars Number of cases in which defects were found Pound Remedied Referred to Factories Inspector Referred by Factories Inspector Want of cleanliness (S. 1) - - - - Overcrowding (S. 2) - - - - Unreasonable temperature (S. 3) 1 1 - - Inadequate ventilation (S. 4) - - - - Ineffective drainage of floors (S. 6) - - - - Sanitary Conveniences (S. 7) (a) Insufficient 5 5 - 3 (b) Unsuitable or defective 9 9 - 2 (c) Not separate for sexes - - - - Other offences against the Act (not including offences relating to Outwork) - - - 2 Total 15 15 - 7 Outworkers The following is a summary of the types of outwork carried on in the Borough Wearing apparel 39 1 Household linen 12 Curtains and furniture hangings 2 Piles 5 Fur-pulling 1 Umbrellas 3 Artificial flowers 10 Paper bags 3 The making of boxes or other receptacles or parts thereof made wholly or partially of paper 81 Brush making 2 Feather sorting 1 Carding, etc. of buttons, etc. 4 Stuffed toys 8 Sweetmeats 1 Cosaques Christmas crackers, Christmas stockings, etc 33 Lampshades 4 561 During the year 309 visits were made to outworkers' premises No contraventions of the Factories Acts were reported 43 Administration of Shops Act Supervision of shops and the effective administration of the legislation relating thereto is secured by systematic visits to traders, The Health Department maintains an up-to-date register of all classes of shop premises in the Borough. In general shop-keepers are desirous of taking reasonable measures to comply with the requirements of the Shops Act, and are willing to seek and act upon the advice and instructions given by the Shops Inspector. Weekly Half Holidays The Borough is divided into two districts for the purposes of early closing. In the Harringay area the weekly half holiday is on Wednesday and elsewhere Thursday is the early closing day. with the exception of butchers' shops which is on Monday Certain trades are exempt from the early closing provisions of the Act but any assistants employed must be granted a weekly half holiday commencing not later than 1 30 p.m on one week-day. Hours of Employment of Shop Assistants Subject to certain exceptions persons under 18 years of age must have a break of eleven consecutive hours between noon and noon the following day, to include the hours of 10 p.m to 6 a.m., and the maximum hours for the employment of young persons is as follows - (a) Under 16 years 44 hours maximum (Christmas week may be increased to 48, but total with week before or after must not exceed 88) (b) 16 - 18 years 48 hours maximum (Overtime may be worked in a shop for not more than 6 weeks a year. Maximum for individual young person is 50 hours a year, and must not exceed 12 hours in a week.) (Catering trade may work 96 hours a fortnight with 60 hour week maximum for not more than 12 fortnights a year.) 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 2.30 p.m., every assistant must be allowed an 44 interval of at least three-quarters 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 may be employed more than 6 hours (5 hours if under 18) without an interval of at least 20 minutes being allowed during the course thereof It has become the practice in many shops to allow assistants a tea break of 10 minutes during the morning and afternoon If an assistant is required to work on Sunday for more than four hours he must be granted an additional whole day s leave in the following week If employed for less than four hours an additional half holiday must be granted Sunday Trading Six traders are registered in accordance with Section 53 of the Shops Act 1950 as persons of the Jewish faith Their shops close for the whole of Saturday and are allowed to remain open until 2 p.m. on Sunday There are two licensed Kosher butchers in the Borough whose shops are closed on Saturday and are permitted to remain open on Sunday During the year one prosecution took place for an offence under Section 53(5) of the Shops Act 1950 A hairdresser of the Jewish faith whose shop in the County of London was registered by the London County Council under Section 53(1) was observed to be employed on Saturdays by another hairdresser in Tottenham The offender was convicted and fined £15 and £5 50 costs. 45 PART V GENERAL Health Services provided by other Authorities (a) Hospitals:- North-East Metropolitan Regional Hospital 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. 0. , M. C. The Group comprises the undermentioned hospitals:- Hospital Bed Complement Beds Open Remarks Bearsted Memorial Hospital 38 38 Maternity Hospital Annexe at Hampton Court 33 33 St. Ann's General Hospital 716 478 Includes Infectious Disease Wards and Special Poliomyelitis Unit 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. 46 PRINCE OF WALES' S HOSPITAL Time-table 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. - 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. - - - - - Geni to-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 1012-30 & 5-7 - 10-12. 30 Females - 5-7 - 1012 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 19 48 have been controlled by the Middlesex 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, Local County Offices, Somerset Road, Tottenham, N. 17, telephone number TOTtenham 4500, 47 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, (d) Lunacy and Mental Treatment Acts The authorised Officers for the purpose of these Acts have their offices at the Local County Offices, Somerset Road, Tottenham, N. 17, telephone number TOTtenham 4500. (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, dial 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 1 aboratory., 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 Col in dale. 48 The following is a summary of the work carried out during 19 55, namely:- Record of Examinations Throat/Nose Swabs Total Specimens 84 Diphtheria Bacilli 2 Haemolytic Streptococci 2 Vincents Angina 2 Negative 78 Faeces:- Total Specimens 427 Shigella 69 Salmonella Typhi 10 Salmonella Typhi Murium 14 Negative 334 Sputum:- Total Specimens 1 Positlve 0 Negative 1 Pertussis:- Total Specimens 6 Positive 0 Negative 6 Ice Cream Total Specimens 17 Water:- Total Specimens 10 Domestic Supplies 1 Swimming and Paddling Pools 3 Other 6 Miscellaneous Specimens 26 Total Number of Specimens 571 Care of the Aged The welfare of the aged continues to be a matter of great concern to the Department, A number of factors are blamed for the unhappy conditions found all too frequently when investigating the circumstances of old people. Apparent neglect of the old folk by their sons or daughters is one which immediately comes to mind though often this is unavoidable. There may be only one or two children to share the responsibility of aged and infirm parents and only too often the housing circumstances of these children with their families make it impossible to take on the added responsibility. Difficulties, too, are not always one 49 sided, many old people become set in their ways and resent dependence on their children whom they do not always look upon as adults. Cases which attract most attention are those which come to the notice of the department by reason of a breakdown in care of the aged person. But it is a pleasant surprise to come across instances in which sons and daughters and neighbours look after the aged and infirm at great personal inconvenience. These instances are not publicised, and it is usually only by chance that they become known. The practice of close co-operation with the geriatric department of St. Ann' s General Hospital has continued, in particular, in the arrangement whereby lists of patients noted for admission are sent to the Health Department, visited and a report on the home circumstances sent back to the Hospital Almoner, These are then considered in conjunction with the particulars of the case supplied by the general practitioner and priority of admission assessed by the hospital authorities. The turnover of beds in the hospital is small and even quite urgent (but not acute) cases have to wait some time for a bed, This is due to the fact that the provision of places both in old people's homes and hospitals is not sufficient to meet the need, especially in the winter months, A number of cases in hospital recover sufficiently to go to a welfare home, but not to their own homes. Often, however, there are no vacancies in the welfare homes. The result is that the already inadequate number of hospital beds is still further reduced because a number are blocked by welfare home cases which cannot be moved The Regional Hospital Board has contractual arrangements with certain nursing homes throughout its area to take chronic sick as vacancies become available. Provision of Laundry facilities for old people The scheme outlined in my report for 1954 has been continued and it has been found that this service for dealing with bed linen and other articles soiled by bed ridden incontinent aged persons has met a real need. But for this service it would have been impossible for those looking after many of the cases to have coped with the difficulties of keeping the patient at home and it is felt that in this way it has been possible to relieve the demand for beds in hospitals or for the admission of old people to homes. During the year 536 collections were made. 50 Old People's Welfare Since Tottenham's Old People's Welfare Committee was estab lished some years ago it has steadily extended its activities to improve the lot of the aged in the Borough. Six members of the Council serve on the Committee and representatives are also appointed by the majority of local organisations who are in some way concerned with old people's welfare., A full-time Old People' s Welfare Organiser and an assistant are employed by the Committee and the following brief summary of the work has been extracted from the annual report of the Committee's Chairman, The Lady Morrison. (a) Chiropody Service Again the year has seen a steadily growing demand for this most essential service and seven sessions are now held weekly. The 2,550 appointments booked during the year was an increase of 620 on the previous year. All appointments are dealt with centrally at the Welfare Department's office at the Town Hall ( b) Visiting Optical Service Forty cases of housebound bedridden cases in need of spect acles were visited by the optician, and all benefited by this service. ( c) Meals on Wheels There was a further increase this year in the number of meals served, to 4 198 Whilst the Committee organises the delivery of meals on one day each week (Wednesday), all needy cases are also covered by the W V, S, deli very on Fridays, This service is largely dependent on the voluntary workers who assist with the meals delivery, and who by their kind, cheerful manner bring a little brightness into the lives of the aged sick. ( d) Old People's Clubs The membership of the five clubs remains steady and during the year 8,711 meals were served at them. Many concerts and socials have taken place and the Corporation's Entertainments Committee have helped in this direction It is good to note the active interest taken by the old people themselves in helping to run the Clubs, aided, of course, by 51 the voluntary workers who give so much of their time in serving the meals and assisting generally. (e) Holidays Another increase this year in applications for a fortnight's seaside holiday resulted in 83 old people being sent away during the summer at an approximate cost of 32/6d. a week each (including full board and fare). All were delighted with the holiday arrangements, and thanks are due to the Women's Holiday Fund for their acceptance of applications submitted by the Old People's Welfare Organiser. (f) Shoe Repairs Seventy six dockets were issued for shoe repairs at reduced rates. (g) Christmas Parcels At Christmas time 7 50 parcels were packed and delivered into the homes of the sick and housebound aged, and from the flood of letters of thanks received from the old people there can be no doubt that the work involved in this great task proved worthwhile. Thanks are due to the many voluntary helpers who loaned transport on this occasion, and also those who assisted with packing,, The Worshipful The Mayor (Councillor F, G Bohringer, J, P.) received hundreds of letters of request for parcels which were handed to the Welfare Committee and he kindly donated £50, 0.0. towards the cost (h) Harvest Festival During September several Churches and schools made gifts from their Harvest Thanksgiving, This enabled the Committee with the help of voluntary workers, to arrange the packing and delivery of gifts to 3,30 old people. (i) Clubs Sports' Sections During the year each Club played their various games and put forward a team to play in the finals for a shield donated by Mr. Shuttl eworth, to be competed for annually. The finals took place at the Central Library Hall and was won by the High Cross Club Alderman E.J. Field helped with the arrangements and Alderman A, Reed, A. C. I.I., J P., acted as referree. The shield was presented 52 to the winning team by Mr. D. Blanch flower, Captain of the Spurs' Football Team, (j) Outings Each of the five Clubs had two outings during the summer months, and on the first outing each member received 4/- from the Club Funds towards the cost of their lunch. During the autumn each Club visited a local factory where they were supplied with tea by the Directors; each person receiving a very useful parcel of groceries, etc. on leaving. At Christmas the Club members held a very successful Christmas Dinner at the Municipal Hall, followed by an excellent enter tainment. Each old person received a gift on leaving, (k) General Welfare It would not be possible in a brief survey to place on record the many problems that are dealt with by the Welfare Officer. It will be appreciated how lengthy the follow up procedure can be before a case can be suitably settled, especially so with old people who are badly in need of help but sometimes are reluctant to co operate. In some cases where due to senility an old person has been unable to attend to ordinary affairs such as payment of rents, rates, etc. it has been necessary to make arrangements with the owners through a third party to receive this direct, and so avoid further worry and confusion to the old person concerned, Where legal action has been needed much correspondence and visit inf has been necessary The following figures do not include the hundreds of problems and enquiries dealt with by letter and telephone. HOME VISITS OFFICE INTERVIEWS 294 4, 285 In addition, well over a hundred visits have been made by voluntary visitors, (1) Finance Although efforts are made to raise funds for the work of the Committee, the main financial support comes in the form of a grant from the Tottenham Borough Council, Last year the net expenditure of the Committee amounted to about £3,430, towards which the Council made a grant of just over £3, 200. 53 National Assistance Act, 1948, Section 47 During the year three cases were dealt with under this Act. Mrs. E. 0. , aged 80. The department was informed by a neighbour that this person appeared to be in need of care and attention. A visit was paid to the premises in which she was living alone in dirty and insanitary conditions. She was obviously ill although she had not taken to her bed. She had no private doctor and refused to call one or go into hospital. In view of the urgency of the matter, application was made to a magistrate for an Order under this Act as amended by the National Assistance Act, 19 51, which enabled the old lady to be removed without the usual seven days' notice to all concerned. She was removed immediately, but died in hospital 24 hours later with broncho-pneumonia, Mrs. E. I. , aged 77. This old lady had been known to the department for many months and had been receiving attention from the home nursing and home-help services. Her condition gradually deteriorated and the services provided were unable to cope with the insanitary conditions which developed Application was made to the Court for an Order for removal to a Welfare Home, This was obtained and removal effected. She died about a fortnight later, Mrs. F. B. Aged 66. This old lady had been known to the department and had in fact been admitted to hospital in 1951 and 1952 at the instigation of this department, Her living conditions had always been of a low standard but temporary improvements had been effected from time to time following visits by the district sanitary inspector. Eventually however, the conditions under which she was living became so bad that removal to a home was the only effective method of dealing with her. An Order for removal was obtained and she was taken to a home where she died some five weeks later, National Assistance Act, 1948. Section 50: Burials During the year it was necessary to arrange eight burials where deaths occurred and suitable arrangements for burial would not otherwise have been made. 54 Establishments for Massage and Special Treatment At the 31st December, 1955, 10 licences were in force in the Bo rough. 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 Examination of Staff During the year 9 1 candidates were examined for purposes of the superannuation scheme. 7 persons failed to pass the examination. 13 employees were examined in connection with the sick pay scheme. 5 5 PART VI STATISTICAL SUMMARY The classification of deaths is in accordance with the International List of Diseases, Injuries and Causes of Death as revised under the auspices of the World Health Organisation, 19 54 1955 Area of District (in acres) 3,0 13 3, 0 13 Population: Census, April, 19 51 126,9 29 Mid year Registrar Gerneral’s estimate 123, 200 122, 100 Rateable Value at 1st April £1, 011, 293 £1,019, 313 Sum represented by penny rate £4, 07 0 £4, 070 Births: Registered live-births (a) Legitimate: Males 752 772 Females 710 673 Total 1.462 1,445 (b) Illegitimate: Males 36 34 Females 26 32 Total 62 66 (c) Total Live-births: Males 788 806 Females 736 705 Total 1.524 1,511 Birth-rate per 1,000 estimated Population 12 37 12.38 Stillbirths: (a) Legitimate: Males 17 16 Females 14 13 Total 31 29 56  1954 1955 (b) Illegitimate: Males 3 1 Females 2 - Total 5 1 (c) Total: Males 20 17 Females 16 13 Total 36 30 Stillbirth rate per 1,000 total (live and still) births 23,08 19.47 Deaths: Males 6 40 701 Females 547 630 Total 1,187 1,331 Death-rate per 1,000 estimated population 9.63 10.9 Maternal Deaths. Puerperal Sepsis 0 0 Other puerperal causes 1 1 Total 1 1 Maternal Death rate per 1,000 total (live and still) births 0.641 0.649 Deaths of Infants under 1 year of age (a) Legitimate Males 13 10 Females 10 14 Total 23 24 (b) Illegitimate: Males 3 1 Females 1 - Total 4 1 (c) Total Infantile Deaths Males 16 11 Females 11 14 Total 27 25 Infantile Death-rate per l,000 live births 17.72 16.55 57 LIVE BIRTH AND DEATH RATES FOR PERIODS 19181928 AND 19451955 Table of Cases of Infectious Diseases coming to the knowledge of the Medical Officer of Health during the year 19 55, in the Borough of Tottenham, classified according to Diseases and Ages Disease Under 1 1 2 3 4 5 9 10 14 15 19 33 34 35 44 45 64 65 up Total Total cases removed to hospital M F M F M P M P M P M P M P M P M P M P M P M F Scarlet Fever 1 - 2 1 2 4 3 2 6 3 21 14 7 7 - - 1 - 1 - - - - 75 32 Measles 31 22 91 67 139 111 102 114 153 155 411 407 11 12 - 3 1 5 2 - - - - - 1,837 62 Whooping Cough 4 6 7 7 6 4 3 6 5 6 19 24 - 1 - - - - - - - - - - 98 6 Pneumonia 2 2 - 1 1 - - 1 - - 2 2 1 - 1 2 5 2 2 3 16 13 17 11 84 - Erysipelas - - - - - - - - - - - - - - - - 1 - - 1 4 - 3 9 4 Food Poisoning 1 - - - 1 - 1 1 1 - - - 1 1 - 1 3 1 - 2 4 4 - 1 23 3 Puerperal Pyrexia - - - - - - - - - - - - - - - - - 1 - - = - - - 1 - Ophthalmia Neonatorum - - - - - - - - - - - - - - - - - - - - - - - - - - Acute Encephalitis Infective - - - - - - - - - - - - - - - - - - - - - - - - - - Post-infectious - - - = - - - - - - - - - - - - - - - - - - - - - - Acute Poliomyelitis Paralytic - - - 1 1 - - - - 1 - 1 1 - 1 - 1 1 - 1 - - - - 9 9 Non-paralytic - - - - - - - - - 1 3 - 3 - 1 1 - - - 1 - - - - 10 10 Meningococcal Infection - - 2 - - - - - - - 1 1 - - - - - - - - - - - - 4 4 Diphtheria - - - - - - - - - - - 1 - - - - - - - - - - - - 1 - Typhoid - - - - - - - - - - - - - - - - - - - - - - - - - Paratyphoid - - - - 1 - - - - - - - - _- - - - - - - - - - - 1 1 Dysentery 2 - 3 - 1 2 4 5 3 - 5 7 1 - 2 - 3 6 4 1 1 1 - 1 52 14 Malaria - - - - - - - - - - - - - - - - - = - - - - - - - Scabies - - - 1 1 - 1 - 1 - 3 5 2 3 2 1 - 1 1 1 1 1 - - 25 - Tuberculosis Respiratory - - 1 1 1 2 - - - - 2 4 1 - 2 7 24 32 10 9 17 6 4 3 126 - Meninges & C. N. S. - - - 1 1 - - - - - - - - - - - - - - - - - - - 2 - Other - - - - - 1 - - 1 - 1 - 2 1 - - 2 2 1 - 1 3 - 1 16 - TOTAL 14 30 106 80 155 124 114 129 170 166 468 466 30 25 9 15 41 51 21 18 41 32 21 20 2,373 140 58 INFANTILE DEATHS IN AGES AND SEXES DURING THE YEAR 1955 CAUSE ATH 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 - - - 1 1 1 - 1 6 - 1 2 - 1 - - - - - 10 3 7 Gastroenteritis and Diarrhoea - - - - - - - - - - - - - - • - - - - - - - - - Congenital Malformation. Birth Injuries Atelectasis 4 - 1 1 - - - - - 1 7 - - - - - - - - - - 7 6 1 Prematurity 1 - - 1 - - - - - - 2 - - - - - - - - - - 2 - 2 Other Causes 3 - 1 - - - - - 1 - 5 - - 1 - - - - - - - 6 2 4 Total 9 1 2 2 - 1 1 1 1 2 20 - 1 3 - 1 - - - - - 25 11 14 59 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 P M P M P M P M P M P M P M F Tuberculosis respiratory 16 7 - - - - - - - - - - 1 1 2 2 2 - 6 3 5 1 - - - - Tuberculosis other - - - - - - - - - - - - - - - - - - - - - - - - - - Syphilitic disease 5 - - - - - - - - - - - - - - - - - - - 2 - 1 - - - Diphtheria - - - - - - - - - - - - - - - - - - - - - - - - - - Whooping Cough - - - - - - - - - - - - - - - - - - - - - - - - - - Meningococcal infection - 1 - - - 1 - - - - - - - - - - - - - - - - - - - - Acute poliomyelitis - - - - - - - - - - - - - - - - - - - - - - - - - - Measles - 1 - 1 - - - - - - - - - - - - - - - - - - - - - - Other infective & parasitic diseases 2 1 - - - - - - - - _- - - - - - 1 - - - - - _1 1 - - Malignant neoplasm of stomach 27 24 - - - - - - - - - - - - - - 2 2 11 4 5 10 9 7 - 1 Malignant neoplasm of lung, bronchus 61 10 - - - - - - - - - - - - 3 1 11 3 18 2 21 4 7 - 1 l Malignant neoplasm of breast 1 27 - - - - - - - - - - - - 1 5 - 6 - 6 - 9 - - - 1 Malignant neoplasm of uterus - 8 - - - - - - - - - - - - - - - 3 - 1 - 9 - 4 - - Other malignant & lynphatic neoplasns 74 73 - - - - - - - - - - - 2 5 2 9 10 11 14 25 21 19 22 5 2 Leukaemia & Aleukaemia 1 2 - - - - - - _- - - - - - - 1 2 - - - - - - - - Diabetes 1 6 - - - - - - - - - - - - - - - - 1 1 - 1 - 3 - 1 Vascular lesions of the nervous system 65 77 - - - - - - - - - - - - - - 4 2 9 9 31 27 17 28 4 11 Coronaiy disease, angina 124 82 - - - - - - - - - - 1 - 1 - 19 2 25 10 45 33 32 28 1 9 Hypertension with heart disease 15 10 - - - - - - - - - - 1 - - - 1 - 3 - 4 8 6 1 - 1 Other heart diseases 53 90 - - - - - - - - - - - 3 1 1 2 5 8 5 16 12 20 36 6 28 Other circulatory diseases 23 27 - = - - 1 - - - - - 1 - 1 - 2 2 4 4 6 10 7 6 1 5 Influenza - 3 - - - - - - - - - - - - - - - 1 - 1 - - - 1 - - Pneumonia 35 31 1 3 - - - - - = - - - - 1 - - 1 6 5 7 5 17 12 3 5 Bronchitis 92 50 - - - - - 1 - - - - - - 1 1 5 1 17 5 38 8 22 24 9 10 Other diseases of respiratory system 6 9 - - - - - - - - 1 - - - 1 - 1 1 - 2 1 8 8 1 - 2 Ulcer of stomach & duodenum 16 7 - - - - - - - - - - 1 - - - 1 - 2 2 9 2 2 2 1 1 Gastritis, enteritis & diarrhoea 5 4 1 - - - - - - - - - - - - - 1 1 - 1 1 1 2 1 - - Nephritis & Nephrosis 6 4 - - - - - - - - - - - - - 1 - 1 - - 2 1 2 1 2 - Hyperplasia of prostate 10 - - - - - - - - - - - - - - - - - 2 - 4 - - - 1 - Pregnancy, childbirth & abortion - 1 - - - - - - - - - - - - - 1 - - - - - - - - - - Congenital malformations 5 2 3 1 - - - - - - - - 1 - - - - 1 - - 1 - - - - - Other defined & ill defined diseases 32 61 7 11 1 - 1 - - - - - - 1 2 3 4 4 6 0 7 16 4 10 - 10 Motor vehicle accidents 9 2 - - - - - - - - 1 - 3 1 - 2 - - - 1 - 1 2 - - All other accidents 9 7 - - - - - - - - - - - - 1 - 2 - 1 - 1 - 2 6 3 1 Suicide 8 3 - - - - - - - - 1 - 3 - 1 1 2 1 1 - - 1 - - Homicide - - - - - - - - - - - - - - - - - - - - - - - - - - TOTALS 701 630 12 16 1 1 2 1 - - 2 - 10 7 24 17 73 49 132 82 232 172 176 197 37 88 60 CANCER DEATHS 1955 Classification of Deaths showing Age and Sex Distribution and System affected CLASSIFICATION TOTAL 0-4 5-9 10- 14 15-19 20-24 25-34 35-44 45-54 55-64 65-74 75-84 85 & up M F M F M F M F M F M F M F M F M F M F M F M F M F Buccal cavity and pharynx 3 3 - - - - - - - - - - - - - - - 1 - 1 2 - 1 1 - - Digestive Organs and Peritoneum 71 68 - - - - - - - - - - - 1 4 - 5 9 18 10 19 22 22 25 3 1 Respiratoiy system 62 15 - - - - - - - - - - - - 3 1 11 3 18 5 21 6 7 - 2 - Breast and Genitourinary system 18 45 - - - - - - = - - - - - 2 5 2 10 2 9 7 13 4 6 1 2 Other and unspecified sites 9 11 - - - - - - - - - - - 1 - 2 4 1 2 2 2 3 1 1 - 1 Lymphatic & Haematopoietic Tissues 1 2 - - - - - - - - - - - - - - 1 2 - - - - - - - - TOTAL 164 144 - - - - - - - - - - - 2 9 8 23 26 40 27 51 44 35 33 6 4 61 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 1936 148,600 1,600 10,8 1,931 13,0 100 51.8 37 430 227 5 - 1937 146,200 1,617 11,1 1.973 13.5 126 63.9 36 306 236 7 - 1938 144,400 1,512 10,5 1,893 13.1 89 47.0 23 186 221 - - 1939 (142, 400*) 1,406 10.3 (1,776*) 12.5 66 37.95 15 335 60 - - (136,000) (1,739) 1940 119,400 1,703 14.26 (1,666*) 13.95 64 41.05 20 103 28 5 - (1,559 ) 1941 105,620 1,418 13.43 (1,560*) 14.77 61 46.35 13 103 73 4 - (1,316) 19 42 110,100 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 - 1955 122,100 1,331 10.9 1,511 12.38 25 16.55 1 75 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. 62 63 COMPARATIVE STATISTICS IN MIDDLESEX FOR THE YEAR 1955 District Population mid- 1955 Birth rate per ]D00 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) (11) Acton 66, 720 12,7 11.8 10.4 10.2 0.16 (11) 2.3 (151) 20.0 (17) 9.4 (8) - (-) Brentford & Chiswick 58,750 13.4 12.5 10.9 10.4 0.12 (7) 2.3 (136) 12.7 (10) 10.2(8) - (-) Ealing 184, 600 12.4 11.9 10. 2 10. 7 0.09 (17) 2.0 (369) 22.7 (52) 15,3 (35) 0.43 (1) Edmonton 99, 200 12.1 11.5 8.6 9.5 0.08 (8) 1.7 (165) 17.5 (21) 14. 2 (17) 1.63 (2) Enfield 109,000 12.5 12.4 10.7 11.6 0.13 (14) 2.0 (223) 19. 1 (26) 16 9 (23) 0.72 (1) Fel than 48,870 16.0 15.8 7,1 10.5 0.10 (5) 1,2 ( 61) 15,3 (12) 7.7 (6) - (-) Finchley 69,860 12,8 12.2 10,7 9.5 0.10 (7) 2.1 (146) 21.3 (19) 16.8 (15) - (-) Friern Barnet 28,560 11.1 11.7 16.6 15.6 0.14 (4) 2.4 (69) 25. 2 (8) 18.9 (6) - (-) Harrow 217, 100 12,7 13.0 9,0 10.3 0.06 (13) 1.9 (413) 17. 1 (47) 12.0 (33) 0.36(1) Hayes & Harlington 65,400 14.2 13,3 7.4 11.1 0.17 (11) 1 5 (96) 21.5 (20) 150. (14) 1.05(1) Hendon 154,000 12.6 11.8 10.1 10.5 0.07 (11) 2. 1 (326) 20.7 (40) 16.0 (31) 0.51 (1) Heston & Isleworth 105, 500 11.0 10.9 10.6 10. 9 0.13 (14) 2.0 (209) 24. 1 (28) 17.2 (20) 0.51 (1) Hornsey 97,600 13,9 12.8 10.8 9.5 0.03 (3) 2.1 (203) 18. 5 (25) 13.3 (18) 1.45 (2) Potters Bar 17, 790 13.6 13.1 8.0 9.0 0,06 (1) 1. 5 (27) 8. 3 (2) 4.1 (1) - (-) Ruislip & Northwood 72, 700 12. 7 12. 8 8. 1 9. 5 0. 11 (8) 2.0 (142) 22.8 (21) 18.5 (17) - (-) Southal1 53, 840 13.0 12.9 11.9 12.7 0,15 (8) 2.0 (109) 17.2 (12) 10.0 (7) - (-) South gate 71,870 10.8 11.8 11.3 8,9 0,11 (8) 2.3 (168) 19.3 (15) 11.6 (9) - (-) Staines 42,330 17. 3 16.6 8.4 9.3 0.09 (4) 1.6 (67) 19.1 (14) 13.3 (9) 1.32 (1) Sun bury 25,460 17.8 16.7 8.1 9.1 0.16 (4) 1.5 (37) 19.9 (9) 17.7 (8) - (-) Tottenham 122,100 12.4 11.8 10.9 11.2 0.19 (23) 2.5 (305) 16.5 (25) 13. 2 (20) 0. 65 (1) Twickenham 104,300 12.1 12.3 11,1 10.2 0.14 (15) 2.2 (231) 22.9 (291 17.4 (22) - (-) Uxbridge 57,940 17.1 15.9 8,7 10.4 0.16 (9) 1.9 (108) 14, 2 (14) 11.1 (11) - (-) Wembley 129,000 10.8 10.8 8.1 8.9 0.04 (5) 1.8 (234) 17 2 (24) 14.3 (20) -(-) 0.70 (1) Willesden 176,000 14,9 13.4 9.6 10.4 0.14 (25) 2,1 (366) 20.2 (53) 14.5 (38) 0.37 (1) Wood Green 50,610 117 11.5 10.3 9.5 0.12 (6) 2.1 (105) 23 6 (14) 16.9 (10) 0.37 (1) Yiewsley & W. Drayton 22,900 16.9 15.5 6.9 8.9 0.13 (3) 1.3 (29) 23. 2 (9) 18.0 (7) 2. 50 (1) 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 two cases exceeded 1 year. APPENDIX MIDDLESEX COUNTY COUNCIL AREA HEALTH COMMITTEE (TOTTENHAM AND HORNSEY) REPORT for the year 19 5 5 64 MEMBERS OF THE LOCAL AREA COMMITTEE AS AT 31st DECEMBER, 1955 MEMBERS OF MIDDLESEX COUNTY COUNCIL County Alderman Mr. R„ A. Clarke County Councillor Mr. J.W. Barter, M. P. County Councillor Mr M . W, Burns. J, P County Councillor Mr. V Butler County Councillor Mr W. East County Councillor Mrs. H, C Norman, J.P MEMBERS OF HORNSEY BOROUGH COUNCIL Alderman Miss J Richardson (Chairman) Councillor Miss 0. R. Anderson 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 Councillor Mrs. E. M. Bohringer Councillor Mr. H. Langer Councillor Mrs. M. E. Protheroe (Vice-Chairman) Councillor Mr. E. C. Smith MEMBERS NOMINATED BY APPROPRIATE HOSPITAL MANAGEMENT COMMITTEES Mrs. R. M. Pry Mrs H.M. Franklin PERSONS WHO MAY ATTEND IN AN ADVISORY CAPACITY Dr. L. Hornung (Middlesex Local Medical Committee) Mr R WD Brownlie (Middlesex Local Dental Committee) Mr. L, Hayward (Middlesex Local Pharmaceutical Committee) Miss M McEwan (Royal College of Nursing) Miss V. Edey (Royal College of Midwives) 65 AREA HEALTH STAFF 1955 Deputy Area Medical Officer A Yarrow, M B, Ch. B. , D, P,H„ Senior Assistant Medical Officer Mrs. J H. Garrow, M B, , Ch. B. , D P H Area Dental Officer V. Sain ty, L D S R C S Superintendent Health Visitor Miss H Townsend S. R. N. , S CM, H V Non-medical Supervisor of Midwives and Home Nursing Superintendent Miss P E Curtis S R N. , S.C.M. H V , M T D Supervisory Matron of Day Nu rseri es Miss J Pearse S. R C.N, (Resigned 31st August, 1955) Home Help Organiser Mrs D Edwards, S.R.N., Dip.Soc. Sc. Assistant Home Help Organisers Mrs WE Pickard S R.N. Mrs. P. 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 2 Supervisory Nursing Staff 2 Administrative and Clerical Staff 36 8 Health Visitors/School Nurses 25 3 Clinic Nurses 7 1 Sponsored Student Health Visitors - 4 Midwives 8 Home Nurses 21 8 Speech Therapists 2 2 Physiotherapists 1 2 Occupational Therapist 1 Chiropodists - 2 Gramophone Audiometrician - 1 Orthoptist - 1 Dental Attendants 9 1 Day Nursery Staff 34 Home Help Service 9 159 Manual workers domestic grades etc. 9 24 180 225 66 CARE OP MOTHERS AND YOUNG CHILDREN (Section 22) Notification of Births The following table shows the births notified during the year compared with previous years. The percentage of hospital confinements rose to 88 9% during 1955, thus continuing the steady increase noted in previous years. 1955 1954 1953 Live Births (a) Domiciliary 429 553 599 (b) Hospital or Nursing Home 2,509 2,387 2,508 Still Births (a) Domiciliary 4 5 9 (b) Hospital or Nursing Home 53 51 58 Totals 2,995 2,996 3,174 Antenatal Clinics The only change made in clinic sessions during the year was a reduction at The Chestnuts Centre from five to four sessions a week owing to a fall in demand As a consequence there was a fractional increase in the average attendance throughout the Area to 15.7 per session The total number of new patients who attended ante-natal clinics during the year was 2,003 which is the lowest for many years The following table gives details of attendances at all clinics in the Area:- No. of sessions held No. of new cases Total attendances Average attendance per session A.N. P.N. A.N. P. N. Burgoyne Road 49 134 96 995 99 22.3 Church Road 72 131 76 1,077 78 16.0 Fortis Green 100 216 134 1,654 141 18.0 Hornsey Town Hall 149 274 149 2,098 165 15.2 Mildura Court 62 171 58 1,146 63 19.5 Stroud Green 51 125 79 811 80 17.5 The Chestnuts 225 389 236 2,980 239 14.3 Lordship Lane 204 294 176 2,147 181 11.4 Park Lane 104 269 183 1,744 215 18.8 Totals 1955 1,016 2,003 1,187 14,652 1,261 15,7 Totals 1954 1,057 2,210 1,177 15,504 1,257 15.4 Totals 1953 1,085 2,284 1,326 15,733 1,406 15.8 67 Midwives Ante natal Clinics This service suffered during the year owing to the shortage of midwives in Hornsey An appointment has now been made and the position restored The following table shows the attendances made at all clinics during the year:- Midwives Clinic No. of sessions held Total No. of attendances Average attendance per session Burgoyne Road 23 68 3.0 Fortis Green 44 176 4.0 Hornsey Town Hall 14 47 3.3 Mildura Court 18 67 3.7 Stroud Green 25 86 3.4 Park Lane 144 913 6.3 Total 268 1,357 5.1 Maternity Services in the Tottenham Clinics Miss Esther Rickards, M.S.P.R.C.S Consultant for many years in Tottenham reports as follows:- "The services emanating from the clinics have a threefold purpose (1) they supervise the health of the mothers (2) they co ordinate the treatment they need and (3) they educate the mothers in the Art of Living As a supervising service it is our aim to work in close co operation with the general practitioners with the midwives of the district and with the hospitals We like the mothers to come to the clinics as soon as they realise they are pregnant. Then a general medical overhaul is undertaken the blood is grouped (unless the patient is going into hospital), the haemoglobin is estimated and the chest is X-rayed Consideration is given at the first visit on the choice of a home confinement or a hospital booking and the earlier a patient comes the less disappointment there is in providing the booking of choice General advice is given on personal health and hygiene, on diets and on clothing The National Health Service Act can be used for the prevention of ailments in this way for instance, the early signs of varicose veins can be found and the disorder arrested by ordering the splendid two way stretch elastic stockings now within every mother's reach and so a major disability can be Prevented. Similarly minor troubles can be recognised and treated By frank discussion on fears and doubts the dread and aPPrehension of many an inexperienced patient can be eased or" removed and knowledge can be spread. 68 Though the clinics are busy, time must always be found to explain various instructions or changes that worry the mothers, but it is here that the health visitors do such excellent work. They carry on the same advice in the clinics, in the home and above all in the Mothercraft Classes they run so efficiently. There they deal in greater details with all these matters and in this way the educational work is blended with the supervisory. At these talks all the changes occurring in motherhood are explained and the development of the baby outlined. This is followed by demonstrations such as baby bathing and the taking of "Gas and Air" during home confinement. They are taught exercises and how to relax completely and are instructed how to use these methods when labour starts. In this way they are. in most cases, assisted in securing an easy, natural confinement. This has been going on many years in Tottenham and the service is there for every woman to use and enjoy. When one reads of a great foreign power lauding such methods we should not forget that we have been practising them in our midst for years The co-ordinating work of the clinics is vital. If we find a patient ailing in any way it is our general rule to refer to their own doctors for care and treatment If a patient is booked for hospital and an abnormality arises again she is immediately put in touch with the hospital consultants Also if a patient is booked for a home confinement and any abnormality develops which might bring a hazard to normal delivery at home, she is referred to hospital forthwith We encourage patients to return to our clinics after delivery first with the new baby and then for her post natal examination Many minor ailments are found in that way and are put right We also like mothers to return to the mothercraft classes and tell the other patients about their confinements. This we find gives the mothers confidence and makes a more natural performance of delivery As one young mother said to me when she had had her first baby - a son weighing 8 lbs - "I breathed deeply as I had learnt in the class and relaxed completely It was all over in 20 minutes - there's nothing to it, Doctor". Well, that may have been an extra easy case but it was by no means isolated and it shows what knowledge, instruction and the removal of fear can do. This service is available to every mother of the Area andno one should be denied all the help and encouragement the clinic can gi ve. 69 Our aim is easy natural childbirth, fine babies and happy, healthy mothers". Health Teaching Groups for relaxation exercises and mothercraft are held at special sessions at all except two maternity and child welfare clinics The groups are intentionally small so that they are informal and in order that health visitors who give the instruction and demonstrations and lead discussion can give individual attention to members of each group, A film strip projector and film strips were purchased to give greater variety to the methods used. This additional visual aid has promoted considerable interest amongst the mothers attending the centres. The value of relaxation exercises for expectant mothers has been generally accepted as being of considerable help to the mother during her delivery if they have been practised during the ante natal period That the mothers themselves both appreciate the teaching of relaxation and benefit from it is disclosed by the large number of mothers who have orally expressed their gratitude and recognition of the benefit that these classes has given to them. Many too have written to health visitors in similar terms. An extract from one of these illustrates these points:"Now that the great event is over I should very much like to tell you how helpful I found the Relaxation classes. Comparing this confinement with my first I find there is no real comparison, because this one was so simple and the other so awful. The difference. I believe was largely due to the knowledge you gave us and to the exercises". These classes are available to all expectant mothers including those who are in receipt of ante-natal care by hospitals and family doctors. Clinic No, of sessions held No. of new cases Total No. of attendances Average attendance per session Burgoyne Road 45 20 284 6.3 Church Road 46 42 267 5.8 Fortis Green 48 73 541 11.3 Hornsey Town Hall 44 76 241 5.5 The Chestnuts 52 92 459 8.6 Lordship Lane 49 83 609 12.4 Park Lane 52 41 323 6.5 Totals 336 427 2,724 8.1 70 Child Welfare Clinics The forecast made in last year's report that the reduction in the number of attendances at these clinics would continue is borne out by the fall in the average attendance per session during 1955. Nevertheless the proportion of children under one year of age who attended for the first time during the year showed a slight" improvement. The slight reduction in the attendance at the welfare clinics is due to the improvement in child health generally. Parents have more knowledge about child management and grandparents have themselves attended welfare centres. Children are not the constant anxiety that they used to be, when rickets, anaemia and infectious fevers were a menace. Most women's journals carry a well written and well informed article on "Baby", his diet, clothing and management, which helps the young mother, and so it is that a rare visit to the centre is enough to keep the mother confident about her methods of managing the child. The following table shows details of attendances made at all centres during the year 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 153 236 3,971 631 142 4,744 1,328 31.0 Church Road 154 216 2,914 580 136 3,630 1,570 23.6 Fortis Green 155 228 3,518 644 280 4,442 1,523 28.7 Hornsey Town Hall 201 367 5,135 1,064 496 6,695 2,864 33.3 Mildura Court 102 179 2,992 791 206 3.989 1,481 39.0 Stroud Green 104 198 2,888 381 189 3,458 848 33.3 The Chestnuts 257 552 7,359 1,143 446 8,948 2,430 34.8 Lordship Lane 256 394 6,152 1,031 384 7,567 1,795 29.6 Park Lane 205 339 5,425 911 380 6,716 1,806 32.8 Totals 1955 1,587 2,709 40,354 7,176 2,659 50,189 15,645 31.6 Totals 1954 1, 604 2, 675 40,891 7,963 3,059 51,913 16,024 32.4 Totals 1953 1,622 2,769 42,213 8,645 3,551 54,409 16,444 33.5 Toddlers Clinics The value of these clinics in supervising the health and well-being of children between the ages of two and five years has not diminished since they were inaugurated in part of this Area in 1938. 71 For these clinics an appointment is sent to the parent every six months after the age of two years. The children who are brought to the clinic are in good health usually. An opportunity is afforded for the early detection of defects such as squint, stammer and dental caries. The children are referred to the appropriate clinics for the correction of such defects, which are treated much more quickly in the early stages, thus saving the loss of a great deal of school time. Some children may have had a set back due to illness, or the birth of a baby brother or sister, and are therefore suffering from anxiety. There is an improvement in knowledge of how to help these children over their difficulties This knowledge has been acquired through discussions with the doctor and health visitor at the clinic session and is followed up by a visit in the home by the health visitor. If the anxiety is too great and1 the child is not getting well, then the parent is referred to the child guidance clinic. In addition regular medical examination in day nurseries provides a close supervision of this age group. A considerable number of children are sent to school between the ages of four and five years and medical record cards are forwarded to the Child Health Section to ensure continuity of medical supervision The following table gives details of attendances at the individual clinics:- Name of Centre No. of sessions held Total attendances No. of cases seen by M.O. Average attendance per session Burgoyne Road 29 448 448 15.4 Church Road 52 479 445 9.2 Fortis Green 24 343 343 14.3 Hornsey Town Hall 58 664 664 11.4 Mildura Court 50 724 623 14.5 Stroud Green 24 323 323 13.5 The Chestnuts 52 686 686 13.2 Lordship Lane 52 719 719 13.8 Park Lane 51 518 518 10.2 Totals 1955 39.2 4,904 4,769 12.5 Totals 1954 389 5,196 5,040 13.4 Totals 1953 429 5,408 5,239 12.6 Parent Guidance in the Welfare Clinics It has been felt for some time now that there is too big a gap between the Child Guidance and Infant Welfare Centres. In order to overcome this, Dr. Phillips, the visiting psychiatrist 72 mainly dealing with school children, was asked to work with medical officers at infant welfare clinics, and help them to advise mothers of children under five years of age. It is generally understood that the approach of the "doctor" in the welfare clinic to problems of the mother is direct and authoritative The mother brings her problem and the doctor supplies an answer on the spot. This is not the approach of the psychiatrist He listens to the mother and tries to get her to solve her difficulties for herself. This method may be quite new to the "doctor" trained in preventive medicine, and be very difficult to apply. It is also very time-consuming, consequently fewer children are seen and results difficult to gauge. If we could recognise at an early stage the problem of behaviour which the children are not going "to grow out of", then we could concentrate on those parents who are unconsciously making their children into problems But it will only be with the help of the skilled psychiatrist that we can begin to deal with this Play Group in Park Lane Day Nursery As an ancillary to helping the disturbed parent and child, we have begun a play group at the Park Lane Day Nursery Seven children have been referred for behaviour problems. The person in charge of this small group needs special qualifications and experience in handling such children and especially the parents. Daily Guardian Scheme The number of children minded by the day under this scheme has fallen slightly during the year. Those minded by this method are children under school age (whose mothers are working) who do not qualify for admission to a day nursery and for whom other satisfactory arrangements for minding cannot be made. The success of the scheme depends on the satisfactory selection of women who are prepared to undertake daily minding and keep the rules, the placing of a child in a home of a type similar to its own and one that is within reasonable distance of the child s home or the mother' s workplace. The approval before and subsequent supervision of the child after placing is undertaken by the health visitor for the district on which the guardian resides. 73 The number of guardians on the register at the end of 1955 was 114, of whom 62 were minding 70 children. The number of individual children minded during the year was 163 and they were in the guardians' care for 19,514 days. Day Nurseries The average daily attendance at the three nurseries was 121.8 and the number of children on the register at the end of the year was 150. The standards of nursery care are very good indeed and there has been very little absence resulting from infectious disease. Two students entered for the examination of the Nursery Nurses Examination Board and both were successful. The following table shows the attendances at individual nurseries during the year:- 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 Under 2 2.5 Under 2 2.5 Under 2 2.5 Total Stonecroft 15 53 14 48 3,410 9,713 13,123 51.7 Park Lane 20 30 12 32 3,045 4,949 7,994 31.5 Plevna 20 30 13 31 3,514 6,301 9,815 38.6 Totals 1955 55 113 39 111 9,969 20,963 30,932 121.8 Totals 1954 55 113 52 106 11,392 24,278 35,670 139.3 Distribution of Welfare Foods This work which was taken over from the Ministry of Food in June 1954, continued throughout the whole of 1955 Very few comPlaints were received from beneficiaries concerning the quality of the welfare foods and each was referred to the Ministry of Health who investigated and subsequently reported the result of analysis to the complainant and this Department The Women's Voluntary Service continued to give valuable assistance in both Boroughs by undertaking distribution from the homes of some of their members for the convenience of the public The following table shows distributions in the Area during the year:- National Dried Milk (tins) Orange Juice (bottles) Cod Liver Oil (bottles) Vit. A & D. Tabs. (packets) 61,975 154,596 25,560 10,564 74 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. The following table gives details of attendances made and treatment given during the year. Taking into account the fall in the number of expectant mothers who attended ante-natal clinics during the year, the number examined by the dental officers is equivalent to a 2% increase over 1954. 1955 1954 1953 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 271 657 253 590 388 833 No. referred for treatment 260 624 241 534 349 750 New cases commenced treatment 240 573 233 603 298 745 Cases made dentally fit 67 317 50 246 113 380 Forms of dental treatment provided:- Teeth extracted 352 479 389 541 478 610 Anaesthetics - (a) Local 142 77 132 115 126 148 (b) General 48 203 42 206 85 217 No. of fillings 414 1,247 553 1,278 637 1,323 No. of root fillings 3 - - - 2 - No. of inlays - - 1 - 1 1 Scalings and gum treatment 136 - 148 - 156 - Silver nitrate treatment _ 512 - 758 - 791 Dressings 144 519 133 560 141 547 Other operations 70 194 40 159 20 207 No. of Radiographs:- (a) at County Council clinics 14 1 10 6 18 3 (b) at hospital 1 - - - - - Denture dressings 226 - 100 - 168 - Dentures fitted:- (a) full 46 - 17 - 14 - (b) partial 59 - 22 - 45 - No. of attendances 984 1,606 930 1,732 1,133 1,827 No. of appointments not kept 218 370 258 349 321 326 No. of ½ days devoted to treatment 338 343 365 75 MIDWIFERY SERVICE (Section 23) The work of the domiciliary midwifery service has continued its downward trend during the past year Although the number of cases booked for 19 56 appears to be showing a slight increase, it is too early at this stage to predict any appreciable rise. The number of midwives practising in the Area has been reduced to eight, six working in Tottenham and two in Hornsey The number of deliveries conducted by County Council midwives was 421 an average of 52 6 although the number of deliveries for each midwife was considerably higher, as owing to prolonged sickness of one midwife, and delay in filling a vacancy, only six midwives were working for the greater part of the year. The pupil midwives from the Alexandra Maternity Home have continued to receive their district training in the Area and a high standard of midwifery has been maintained. Every midwife, whether or not employed by the County Council, has attended an actual demonstration on the use of trichloroethylene One such apparatus has been in use for the latter six months of the year and has been used with success, It is too early to forecast whether or not this machine will be issued to every midwife. An apparatus designed for the resuscitation of the new born has been purchased with a view to its experimental use by means of introducing oxygen into the infant's stomach. Nitrous oxide and air analgesia was used in 80% of cases and pethidine is now used generally for district midwifery It will be gathered from the above paragraphs that more responsibility is being placed upon the midwife and a great deal of judgment is called for in the.safe handling of modern methods of analgesia. The importance of refresher courses increases with the introduction of new methods and new drugs. Two midwives from this Area attended one week's residential refresher course in 1955 The courses are approved by the Central Midwives' Board. The following table shows an analysis of the midwives' work:- No. of deliveries attended 421 No. of visits made 7,816 No. of hospital confinements discharged before 14th day 26 No. of visits made 239 No. of cases in which medical aid was summoned 97 No. of cases in which gas and air analgesia was administered 327 No. of cases in which pethidine was administered 176 76 HEALTH VISITING SERVICE (Section 24) The growth and development of health visiting is unfortunately constricted in this Area as elsewhere by the limited number of qualified women available. In Hornsey and Tottenham the number of health visitors is well below the establishment and in order to keep the school health services operating satisfactorily, clinic nurses are employed, mainly to relieve health visitors of this part of their work. The assistance which is given to health visitors by this means is limited to clinical aid and does not relieve them of the preventive and sociological part of their work. New entrants to the profession barely make up the normal wastage occasioned by retirement or resignation and at the same time the growing range of health visiting places a heavier load on each health visitor On this account old standards of health visitor establishment should be discarded and an increase made in the ratio of health visitors to the population if the requirements of the service are to be met This may entail improved conditions for the profession if a serious attempt at recruitment is envisaged The number of home visits to children in the 0-1 year age group has increased slightly during the year; there has been a small fall in the number of visits to expectant mothers and children in the 1-5 year age group and children of school age An increase is also shown in the number of visits to homes for other purposes This is accounted for by a larger percentage of visits to the aged and by follow-up B,C,G visits. The total number of visits to homes for all purposes shows a slight rise No. of visits paid by Health Visitors working in the Area:- 1955 1954 Expectant Mothers First Visits 1,858 1,986 Total Visits 2,955 3,324 Children under 1 year of age First Visits 3,149 3,042 Total Visits 15,392 14,391 Children aged 1-2 Total Visits 7,025 7,449 Children aged 2-5 Total Visits 13,953 14,036 Other cases Total Visits as Health Visitor 4,686 4,112 Total Visits as School Nurse 1,144 1,098 77 Health Visitors, Family Doctors. Hospitals and Voluntary Organisations An informal meeting of health visitors and general practitioners was held in Hornsey on 27th October, 1955. The response to the invitation was very good indeed; 29 local general medical practitioners attended as well as ten health visitors and several members of the Area medical staff. During the year follow-up of cases reported by family doctors has enabled health visitors to visit a number of patients and deal with their particular problems. Team work with hospital almoners and ward sisters has been excellent. 126 health visitors reports have been sent to hospitals at the request of almoners during the year and 167 to other bodies, excluding 43 3 B C, G follow-up reports for the Medical Research Council. Co-operation and assistance from statutory and voluntary organisations have been of considerable value to health visitors in their work We should like to mention the Children's and Social Welfare Departments, the local offices of the National Assistance Board the N.S.P.C.C., I. C. A. A., W. V. S. Old Peoples' Welfare and Diocesan Moral Welfare Clinic voluntary workers in the Hornsey part of the Area have given regular, reliable and very valuable services in infant welfare clinics and in managing the sale and distribution of welfare foods. Health Education and Parentcraft Apart from home visiting for such purposes as advice to expectant mothers infant care and feeding follow-up for hospital admissions and discharges, family doctors cases clinic attenders, special surveys including the recent one for the Ministry of Health on National Dried Milk, care of the aged, problem families, etc., when educational advice is given, health education is a continuous process for health visitors wherever their duties take them. During the past few years a special feature of health education has been the talks on home making and parentcraft to school children especially during their last year at school. This year all the secondary modern girls schools except one have received this type of instruction from a school health visitor who spends 78 the major part of term time on this work In Tottenham health visitors undertake this important task in schools. In all 348 talks, films and demonstrations of one hour each have been given in schools. Training of Health Visitor Students 13 student health visitors received practical training for varying periods in the Area during the year. Eight of these were taking their training under the auspices of the Royal College of Nursing, one at Battersea Polytechnic and four through the County Council "Sponsored Scheme". The latter commenced their training in September and will remain in the Area for three terms. Student Nurses Four student nurses from the Middlesex Hospital, W. 1., came to the Area to see the work of health visitors and stayed for three days each On the Saturday following their visit a discussion group was held in the hospital at which student nurses gave a report on their experience and asked questions of the Superintendent Health Visitor who was invited to be present. 13 student nurses including one man from the Prince of Wales's Hospital also accompanied health visitors for one day each for a similar purpose as observers. Student Nurses Lectures Eight lectures were given to three groups of students by the Superintendent Health Visitor on the Social Aspects of Disease at the Prince of Wales's Hospital The Superintendent and other members of the health visiting staff gave lectures on Home Nursing and The Health Services to a number of organisations including St John Ambulance Brigade The Townswomen's Guild, Barnardos and British Red Cross in their own time and in some cases acted as examiners. Overseas and Other Visitors Several visitors from overseas including the Reeve of Tottenham, Canada, and a number of groups of post-graduate and other students came to Tottenham and Hornsey during the year to observe the work of the personal health services and in particular the activities of health visitor/school nurses. 79 The groups included health visitors, student ward sisters, student teachers, student house mothers from Barnardos Homes, school children and members of the Townswomen's Guild. Family Planning Association Two evening sessions each week were held in the Clinic at the rear of Hornsey Town Hall. National Blood Transfusion Service Premises at the School Clinic, rear of Hornsey Town Hall were made available for the above-named organisation for six days during the year. HOME NURSING SERVICE (Section 25) The past year has been an extremely busy one for the home nurses. The service has operated smoothly from the Area Health Office, all messages being received there during office hours and the Superintendent s home at all other times as in previous years A combination of pressure of work increased holiday periods and a high incidence of sickness amongst the staff have added difficulties to the administration of this service during 1955. Provision of Hospital Beds The provision of hospital beds for the aged sick has seemed more readily available this year and less difficulty has been encountered in getting the aged and ill patients, particularly those who live alone into hospital. This was a very pressing Problem in 1953 and 1954 Nevertheless the requests for care of the aged continue to form a large portion of each nurse's daily work. Injection of Drugs Injection of drugs continues to form an ever increasing part of the work of the service and it is necessary for the home nurse to have a very up to date knowledge of modern drugs. Requests are frequently made for twice daily visits and late night visits for relief of pain interfere considerably with the planning of each day's work. 80 Nursing of Sick Children at Home An analysis of work done for children at home showed that the greatest part consisted of administering drugs (mainly penicillin), very often in the early stages of illness. Relief of constipation and the occasional nursing of measles or whooping cough form the rest of the work. In the latter condition nurse is usually called in because the mother has a large family or may for some reason be unable to nurse the child satisfactorily. A good deal of teaching of mothers is carried out for the application of poultices and minor treatments. Co-operation with Other Services As before, the nurses have worked closely with general practitioners, health visitors and home helps, and the exchange of information between these bodies is very valuable to all concerned. The British Red Cross Society and the Old People's Welfare Committees have also given the service every assistance. The Ambulance Service is always very ready to help and on two particular occasions, when the nurse was in difficulty with heavy and unconscious patients they arrived within a few minutes of the request to help carry one patient upstairs and one was lifted from the floor These two unusual requests were met unhesitatingly. Transport Lack of transport other than bicycles still causes much delay. A puncture requires the whole of the nurse's work to be re-arranged. A great deal of time is lost in travelling and much discomfort endured by the nurses in wet and cold weather. Analysis and Table of Visits Undoubtedly the Home Nursing Service is becoming an ever increasingly important part of the National Health Service and the expansion increases at a greater rate each year. In 1955 12,000 more visits were paid than in 1954. 81 Type of Case No. of new cases attended by hone nurses during year No. of cases remaining on register at end of year No. of visits paid by home nurses during year M F Total M F Total Medical 907 1,679 2, 586 172 452 624 76,572 Surgical 79 128 207 17 14 31 6,410 Infectious Disease - 1 1 - - - 4 Tuberculosis 77 57 134 8 12 20 4,630 Maternal complications - 19 19 - 1 1 158 Totals 1955 1,063 1,884 2,947 197 479 676 87,774 Totals 1954 1,093 1,830 2,923 211 401 612 75,923 Analysis of treatment given to new cases during 1955 General Nursing 655 Other treatments 840 Injections 1,452 Total 2,947 VACCINATION AND IMMUNISATION (Section 26) Vaccination The percentage of children under one year of age vaccinated in 1955 was 54.5%. This is the best it has ever been and justifies the efforts of the medical and nursing staff in emphasising to parents the importance of vaccination and in offering vaccination in the clinics. The following table records the number of persons known to have been vaccinated or re-vaccinated during 1955, by general practitioners and clinic medical officers:- Under 1 year 1 year 2-4 years 5-14 years 15 years and over Total No. of primary vaccinations 1,60 2 41 21 36 72 1,772 No. of re-vaccinations - - 4 27 266 297 immunisation against Dipttheria and Whooping Cough In spite of continual efforts to secure the immunisation of at least 75% of babies in the Area before their first birthday, it has not yet proved possible to achieve this target. In fact 32 there was a slight recession last year to 57.8%, and in order to counteract this fall an intensive publicity campaign has been arranged in both Boroughs to take place in February and March 1956. The following table shows the total number of immunisations of all age groups carried out during 1955:- 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 76 1,622 - - - One 34 334 3 - - Two to Four 74 109 17 542 16 Five to Fourteen 275 17 6 906 21 Fifteen and over - 1 - 13 - Total 459 2,083 26 1,461 37 PREVENTION OP ILLNESS, CARE AND AFTER-CARE (Section 28) Recuperative Holidays The Area health staff continued to be responsible for dealing with applications for recuperative holidays and during 1955, 235 applications were received compared with 279 the previous year. Of these 188 were approved 41 were not approved and six were withdrawn before action could be taken. DOMESTIC HELP SERVICE (Section 29) The total number of cases provided with home help during the year was 1623. This shows an increase from 1,499 during 1954. This increase occurred in spite of a slight fall in new cases which were 67 less than 1954 It can be seen from the table below that by far the greatest provision of help is to the chronic sick, who include the aged and infirm. Once service is provided to these patients it has very often to be continued over a long period, generally until the patient dies or is admitted to hospital, and it is this factor which is causing the total number 83 of cases receiving service to rise, In short, the cases are not ceasing at as high a rate as they are commencing. At the end of the year there were approximately 170 cases who had been receiving help for more than three years. The considerable increase in the volume of the work of the service can be illustrated by the following figures for the past three years:- December 1953 December 1954 December 1955 No. of cases being provided with help 618 809 894 No. of home helps employed (part-time and full-time) 145 165 175 Equivalent whole-time establishment 78.6 89.2 102.0 The policy of the department is to provide at least a little amount of help to all needy cases and it will be appreciated that the task of providing help, week by week to nearly 900 cases calls for careful planning, particularly taking into account absences of staff owing to sickness in the winter and holidays during the summer months. It should be stated that as each new case is visited by the organising staff, enquiries are made to establish whether the necessary help can be provided by any other means, e. g. by adult children or other relatives, but it has become increasingly evident that many married daughters who would in the past have been able to help their aged parents are themselves going out to work and are unable to assist. The following table shows details of the cases served during the year:- Cases provided with help No. of new cases provided with help No. of old cases for which help was continued from 1954 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) 105 9 114 8 Tuberculosis 24 48 72 38 Chronic sick (including aged and infirm) 531 734 1,265 828 Other 154 18 172 20 Total 814 809 1,623 894 84 INSPECTION OP CHILDREN S HOMES An important part of the work of the assistant medical officers is the visiting of the several children's homes in the Area These homes are organised by the County Council for children in their care There are six such homes in Tottenham and Hornsey, five mixed with a total of 23 boys and 26 girls, and one other home for 18 boys. The homes are staffed by housemothers with the exception of the home for boys only which has both a full-time house-mother and house-father. Each child is registered with a local general medical practitioner just as are children in their own homes. The assistant medical officers visit monthly, to supervise the children's general progress and to report on conditions generally at the home. SCHOOL HEALTH SERVICE Introduction The work of the school health service follows the pattern built up in past years. The routine medical inspection or periodic health overhaul of school children continues to be the foundation of the Service During the year some minor but not unimportant innovations became part of the regular routine of examination These were the colour vision testing of pupils in the intermediate age group, and more important, the vision testing by means of 'E-cards' of school entrants not yet able to read The valuable results of such testing are referred to later in the ophthalmologist's report. During the year the Committee was asked to recommend the setting up of an orthoptic clinic at Lordship Lane, and the appointment of an orthoptist, as the system of referring children for such treatment to hospital was proving unsatisfactory and inconvenient to the parents. Approval was given and at the end of the year preparations were complete to start the clinic during January 19 56 under the general direction of Mr. Kletz, visiting ophthalmologist. In this year's report, too, reference is made to various other school activities with a bearing on health, in particular the school meals service. 85 School Dental Service Mr V. Sainty, L.D. S., Area Dental Officer, reports that all surgeries were fully staffed during the year. Early in the year a visit to the Area was made by Miss E.M. Knowles, 0 B E„ , P. D. S., H.D.D., a Senior Dental Officer of the Ministry of Health who visited all the clinics and talked with the Dental Officers mainly on matters concerned with the priority dental service. The orthodontic clinic (7 sessions a week) has now been operating for a year but there still remains a long waiting list of children requiring treatment, and consequently it has become necessary to stop the reference of any more cases at present apart from those in a special category due to age and/or severity of malocclusion. It is hoped that it will be possible to extend the number of sessions to make a full-time appointment but as the services of the orthodontist are shared with another Area and as the number of these specialists is insufficient for the large amount of this kind of work, it is doubtful whether this can be done in the near future. The dental officers continue to treat a number themselves. Parents are increasingly conscious of the value of this branch of dentistry and are generally anxious that their children should have the treatment, and often are worried by the prospects of a long wait before a start can be made. As regards the school dental service in general the records of routine inspections show that over 25 000 children out of a school population of 30,000 were dentally inspected during the year so that the ideal of an annual dental inspection is coming within sight of attainment. The following tables show the work carried out during the year:- 86 DENTAL INSPECTIONS AND TREATMENT Age Groups No. inspected No. found to require treatment No. referred for treatment at the County Council's Dental Clinics Under 5 411 276 275 5-16 and over 20,798 15,476 15,018 Specials 4,163 4,027 4,010 Total 25,372 19,779 19,303 Number of pupils treatment commenced 10,672 Number of pupils treatment completed 7,908 Number of attendances made by pupils for treatment 24,671 Number of appointments not kept 5,190 Number of half days devoted to (a) Inspection 168 (b) Treatment 3,414 Fillings. Permanent Teeth 15,537 Temporary Teeth 4,640 Number of teeth filled. Permanent Teeth 13,867 Temporary Teeth 4,333 Extractions. Permanent Teeth 1,217 Permanent Teeth for Orthodonture 145 Temporary Teeth 7,509 Anaesthetics (a) General 1,837 (b) Local 3,648 (c) Regional 447 Other operations (a) Permanent Teeth 3,152 (b) Temporary Teeth 4,723 SPECIAL DENTAL TREATMENT UNDERTAKEN BY DENTAL OFFICERS Number of impressions, etc. 263 Number of Dentures fitting 58 Number of crowns and bridges 71 Number of inlays 1 Number of radiographs (a) at Dental Clinics 260 (b) at Hospitals - ORTHODONTIC EXAMINATION AND TREATMENT AGE GROUPS TOTALS 5 6 7 8 9 10 11 12 13 14 Number of pupils examined 2 20 36 36 47 41 25 17 26 250 Number of pupils selected for treatment _ 2 20 32 29 38 40 20 15 16 212 Number of pupils commenced treatment (first attendance) 329 Number of attendances made for treatment 3,603 Number of consultations 378 Number of impressions etc. 1,964 Number of fixed appliances fitted 106 Number of removable appliances fitted 462 Number of radiographs (a) at Dental Clinics 1,876 (b) at Hospitals - Number of pupils treatment complete 63 Number of orthodontic sessions (½ days) 455 87 General Health and Infectious Diseases In general the children as seen at routine medical inspection are healthy, wel1-nourished and well-clad and the following tables show the results of inspection. Diseases of squalor such as pediculosis and scabies are, except for a hard core of cases, becoming a thing of the past. The commonest problems met with today are mental rather than physical and this subject is taken up later in this report. PERIODIC MEDICAL INSPECTION Periodic Medical Inspections Other periodic inspections Other Inspections Entrants Second Age Group Third Age Group Total Special Inspections Re-inspections 2,806 2,571 3,056 8,433 5,156 4,671 4,601 CLASSIFICATION OF THE GENERAL CONDITION OF PUPILS Age Groups No. of pupils inspected A (Good) B (Pair) C (Poor) No. % No. % No. % Entrants 2,806 1,162 41.4 1,635 58.3 9 0.3 Second Age Group 2,571 1,084 42.2 1,477 57.4 10 0.4 Third Age Group 3,056 1,248 40.8 1,785 58.4 23 0,8 Other periodic inspections 5,156 2,027 39.3 3,103 60.2 26 0.5 Total 13,589 5,521 40.6 8,000 58.9 68 0.5 As far as infectious diseases are concerned, the most notable feature of the past year has been the rise in the number of cases of measles notified Measles is a disease normally occurring in epidemics every other year and there would normally have been a decrease in notifications in 19 54 This took place however, to such an extent that the number of susceptible children in the Population was very large and the disease swept through the whole country in the early months of 19 55 Fortunately it is no longer the serious disease it once was partly due no doubt to chemotherapeutic agents, partly to improved health of the child population Possibly due to decreased virulence In Hornsey and Tottenham ln 19 55 there were 1,6 24 cases notified but no deaths were recorded Only one case of diphtheria occurred during the year; fortunately the organism was not virulent and the child had a very mild infection. 88 Poliomyelitis has been widespread in this country during the past year although fortunately with an unusual preponderance of non-paralytic cases In Tottenham and Hornsey there were 13 cases confirmed, of which three were paralytic, with no deaths. At no time was it found necessary to stop the immunisation campaign. There was only one important outbreak of dysentery in the schools in 19 55, namely at Stroud Green School where, as is usual, it affected mainly the infant and junior departments The expedient followed in recent years was used again, namely, the twice daily disinfection of toilet seats and chains coupled with extra attention by the teacher concerned to the washing of hands by the children after the use of toilets The outbreak was quickly brought under control. Treatment in school health clinics The following table shows details of the cases treated at the clinics during the year and comments will be found in the appropriate sections throughout this report:- TREATMENT TABLE No. of new cases treated during the year by the Authority Otherwise Minor Ailments 3,083 368 Eye disease, defective vision and squint 218 2,597 Diseases of ear, nose and throat (a) Received operative treatment - 10 (b) Received other forms of treatment 213 444 Orthopaedic and postural defects 42 1,372 Child Guidance - 63 Speech Therapy 254 - Orthoptic Treatment 158 - Sunlight treatment 131 - Chiropody 398 - Tuberculosis in Schools The years since the inception of the National Health Service have seen a dramatic change in the whole picture of tuberculosis in the community. The mortality rate has fallen dramatically from approximately 50 deaths per 100,000 population to under 20 per 100,000 population per annum. 89 Patch Testing During the autumn term of 19 55 it was decided to start routine patch testing of school entrants, and 177 children in Hornsey were tested. Of these only six were patch positive. The children and their families were invited to the Chest Clinic for X-rays The father of one of these children was found to be a case of infectious tuberculosis and is now in hospital regaining his health and no longer a source of danger to the community. It is intended to patch test the remainder of the Hornsey school entrants and the Tottenham children during the rest of the school year. B. C. G Vaccination Now that so few school children come in contact with tuberculosis while they have less chance of succumbing to the infection they also have less chance of building up any resistance It was decided to begin vaccination against tuberculosis by means of the avirulent B C G vaccine, offering it to all children in the 13-14 year age group whose parents gave consent. A very successful start was made as can be seen by reference to the accompanying table. Parents approached 1,373 Parents accepting 956 (69.6%) Mantoux tested and read 826 Mantoux positive 71 (8.6% of those tested) Mantoux negative 755 (91.4% of those tested) Total vaccinated 752 (54.8% of children in group approached) 70% of parents consented to the procedure. Some children had to be excluded because of contact with a tuberculous patient or for intercurrent infection Of the 826 who were tested (Mantoux 1/ 1000) 8 6% were tuberculin positive and 91.4 tuberculin negative The latter were vaccinated and the former referred to the Chest Clinic for investigation; in no case was a child found to have tuberculosis The vaccination reactions were entirely uncomplicated - no case of excessive ulceration or abscess formation being seen. The pock does not seem to cause any interference with school work or play. 90 General practitioners in the Area have been fully informed of the working of the scheme and are notified of the resultsof mantoux testing and informed when the child is vaccinated. The campaign is carried out by a team consisting of a doctor, school nurse and a clerk. The doctors concerned have been trained in the technique of mantoux testing and vaccination with the co-operation of Dr McQuiston and Dr. Butterworth of the Tottenham and Hornsey Chest Clinics respectively The Chest Physicians have throughout been consulted and have shown the utmost consideration and co-operation. Mass X-ray in Tottenham During the year the Mass Radiography Unit visited Tottenham, with the following results so far as school children were concerned:- Male Female Total Miniature Films 9 12 932 1,844 Recalled for Large Films 12 13 25 Cases notified - 1 1 Cases not notified 1 - 1 Other abnormalities Pneumonitis 1 - 1 Cardio-vascular Lesion (acquired) 1 - 1 Cases of Tuberculosis in Schools During the year a number of school children were notified as cases of tuberculosis and two school teachers were in addition so notified These cases were discussed with the appropriate chest physicians and where no source of infection was known or discovered in the home, epidemiological investigations were carried out at the school Details of these cases are given below. (i) A secondary grammar school in Hornsey A senior pupil at a girls grammar school in Hornsey was found to have pulmonary tuberculosis. The girl had worked for a time as a pupi1-teacher at a primary school. A 'screening' patch test was performed on all children whose parents gave consent at both schools; those children found positive were given a further test. 30 2 children at the grammar school and 180 at the primary school were so tested As a result of these procedures 23 of the girls at the grammar school were found to require X-ray, Each was chest X-rayed and nothing 91 abnormal found 19 of the teaching staff and seven of the school meals and domestic staff were X-rayed and found to have nothing abnormal. (ii) A secondary grammar school in Tottenham A case of pulmonary tuberculosis in a girl at this school was picked up on the Mass Radiography Survey which took place in Tottenham during January. As 190 of the 20 3 girls over 14 years of age had visited the unit and the only abnormality was this case, in agreement with the Chest Physician it was decided that patch testing would not be necessary However, 20 teachers who had not attended the mass radiography unit were X-rayed as well as the entire school meals staff of ten persons. All these X-rays were within normal limits. (iii) A primary school in Tottenham Following a case of pulmonary tuberculosis in a ten year old girl at this school, 428 children were patch tested, of whom nine were positive. Three of these children were already known to the Chest Clinic The other six attended the clinic for X-rays and mantoux test All the chest X-rays were normal, but three children are being kept under observation at the clinic. 19 teaching and kitchen staff attended for chest X-ray and all were normal. (iv) A secondary grammar school in Hornsey A 14 year old girl at this school was notified as suffering from pulmonary tuberculosis 420 pupils were patch tested, of whom 13 were positive One of these left the district and the other 12 had chest X-rays at the Chest Clinic. All were within normal limits, 15 teachers and eight domestic staff had chest x-rays and all were negative In addition it was thought advisable, as the case was an infectious one; that all her classmates should be mantoux tested These 31 girls were invited to attend the Pinchley Chest Clinic, and 17 attended, of whom two were 'mantoux positive'. These two girls were X-rayed, with normal results. (V) A secondary modern school in Hornsey A teacher at this school contracted pulmonary tuberculosis and investigations at the school were undertaken at the end of the summer term, 188 girls were skin tested and as a result 49 of them were found to be positive. All but one of these girls (whose parents refused) and 21 of the teaching and domestic staff were X-rayed and all were negative. 92 Tuberculosis Vaccine Trials During 19 55 the Medical Research Council continued the follow-up of children who volunteered as school leavers in 1951 to take part in this trial. Dr. T. M. Pollock, the physician in charge of the trials reports as follows:- "We have now completed the figures for our last visit to Tottenham The young people concerned were those being seen for the third time Of the 397 invited, 266 attended for X-ray, i.e 67%, and of these 73% completed their skin tests In addition, 33% of the 51 who failed to attend last time had an X-ray on this occasion ". The Handicapped Child Distribution as at 3lst December, 1955 Category In Special Day Schools In Special residential Schools In Maintained Primary & Secondary Schools In Independent Schools Not at School Total B G B G B G B G B G B G Blind Pupils 1 - 4 5 - - = - - - 5 5 Partially Sighted Pupils 7 7 1 - - 1 - - 1 - 9 8 Deaf Pupils 5 7 5 1 - - - - - 1 10 9 Partially Deaf Pupils 5 8 3 1 22 7 - - - - 30 16 Educationally Subnormal Pupils 44 50 12 5 14 4 1 1 4 - 75 60 Epileptic Pupils - - - 3 - - - - - - - 3 Maladjusted Pupils - - 24 5 3 2 - - 1 - 28 7 Physically Handicapped Pupils 16 11 3 - - 1 1 - 1 - 21 12 Pupils with Speech Defects 12 1 1 - 180 67 4 2 1 2 188 72 Delicate Pupils 3 5 16 11 - 1 - - - - 19 17 Pupils with Multiple Defects 6 6 3 4 3 - - - - - 12 10 Totals 89 95 72 35 222 83 6 3 8 3 397 219 Grand TOtals 184 107 305 9 11 616 Broadly 1 in 60 children are ascertained handicapped pupils A great deal of thought is devoted to their accurate placement whether this be in a day or residential special school, or preferably in an ordinary school. Ideas on these subjects are constantly changing as medical knowledge increases and demands a constant watchfulness on the part of school medical officers Reference to these changes will be found in the following paragraphs. 93 Blind and Partially Sighted Pupils There are ten blind pupils in Tottenham and Hornsey, of whom nine attend residential special schools. In March 19 55 the Ministers of Health and Education issued circular 4/55 and memo No 49 3 respectively. These discussed the criteria to be used by ophthalmologists when making recommendations regarding special education to local authorities and by local education authorities when placing the child As a result of these alterations in criteria, which reflected a more optimistic approach to the problem of myopia in school children, two children were returned from the Walthamstow special school for partially sighted children to ordinary schools. In the case of a third child it was considered that although his vision would allow him to take his place with normal sighted children, yet he had not matured sufficiently emotionally to overcome his handicap It was decided that he should remain at the Walthamstow school for a time during which his stability has so improved that he is to return to an ordinary school at Easter 19 56. Deaf and Partially Deaf Children During the past year the partially deaf class at Devonshire Hill School has been started and its value was immediately apparent, so much so that a second class is to be started forthwith A number of children previously incorrectly placed either with deaf children or in ordinary schools, are now receiving appropriate education. A number of children are still arriving at the School for the Deaf who have been diagnosed at a late stage, or who, despite early di agno si s, h ave not received sufficient training at hospital, it is felt that the sooner these children can enter into the nursery class at the School for the Deaf the better will be their Progress, Their exact diagnosis as deaf or partially deaf could be delayed until it is possible to see the results of training In any case the various units should not be regarded as watertight compartments rather should the educational system for deaf children be regarded as flexible and a deaf child should be moved from a deaf school to a partially deaf or even ordinary school as his progress warrants it. Of course, it may be that his progress WIll be in the reverse direction. 94 School for the Deaf Mr. T. Brown, Headmaster, reports that the School now serves the whole of the Administrative County and started the year with 68 severely deaf children on the roll divided into nine classes with an age range of 2 to 16 years. The children under five are accommodated in the Nursery building and most important section of the school This ensures a sound start at an early age when an infant is "speech ready" and is reflected in his work throughout school life Unfortunately the need for this early start is not fully appreciated by everyone; the problem may be further aggravated by parents being assured that their children were partially deaf and would speak normally after a short time, whereas in actual fact these children were educationally severely deaf and only clinically partially deaf, Early in the year three boys took the entrance examination of the newly opened Burwood Park Technical School for severely deaf boys. All passed, the school thus taking three of the' thirtythree places available to the United Kingdom, a laudable effort as the school roll is only approximately 1.5% of the deaf school population of the country Throughout the year close co-operation with parents has been maintained and the Parent-Teacher Association flourished This is quite an essential part of the education of a deaf child and much can be done by such co-operation A most interesting Parent-Teacher Association lecture was given by Mr Pierre Gorman, an Australian, born severely deaf, who already holds two degrees of Melbourne University and is studying at Cambridge for his doctorate. Under the care of Dr. F. P. M. Clarke the aural health has been excellent and there remains but one child requiring further treatment for suppurative otitis media This is incredibly good for a school for the deaf. Educationally Sub normal Children The second largest category of ascertained handicapped children, and the largest important group, is that of the E.S.N (135 out of 6 16). Most of these children attend day special schools but where the home circumstances are difficult, and this 95 is not unusually the case, then the child attends a residential special school. It will be seen by reference to the Handicapped Pupils Table that 22 children were either not at school or attending an ordinary school; of these, six were not of age to attend a special school, i.e seven years, but the rest were on the waiting list for admission and in fact there has of late been some difficulty in securing early placement of these children The position should be eased somewhat, however, fairly soon by the opening of two new day special schools in Middlesex. The Maladjusted Child During the year the Committee on Maladjusted Children set up by the Minister of Education issued its report which contains much valuable guidance for those who have to deal with this problem Apart from the worst cases there is no great difficulty locally in securing residential placement for maladjusted children. There are no day schools or classes for these children but (to a large extent) tbe Opportunity Classes in Tottenham subserve such a function for the younger maladjusted children as educational backwardness is an almost invariable symptom in such cases. An attempt is being made in the field of prevention at the infant welfare clinics by non-specialist medical staff In addition there is no doubt that additional sessions are required for actual treatment of pre-school children by a psychiatrist While it is not my province to comment on the organisation and working of the Child Guidance Centres in Tottenham and Hornsey. the following comments by Dr. C. Phillips, the visiting psychiatrist, are of special interest - "On the subject of delinquency and psychological illness in children, the contribution that bad parenthood makes towards this social problem is, in my opinion, paramount here There is a good deal that is unknown of this subject but two things are outstanding (l) There is a partial, and quite often complete, failure of the parents, particularly the mother in the earliest years, to adapt to the child' s needs, so that the aggressive and destructive impulses present in small children do not become moderated as in healthy persons and may, in fact, be stimulated to the point where the child's personality is destroyed by them. (2) The parents, however, commonly have an unconscious participation in the child's delinquent acts, that is, to put it crudely, they get a quiet, perhaps not even realised, satisfaction at the- 96 anti-social behaviour. The children work off some old scores for the parents. Parents are commonly not aware of this, but one comes up against this powerful motive in parents when there is an attempt to give advice or deal with the child. One is quite frequently met with the overtly expressed desire of the parents to co-operate in every possible way, but they often manage to find some "reason" for not doing the one thing that has been recommended This is not because of original wickedness on the part of the parents but because they, themselves, so commonly have a similar character structure because of their own childhood exp eri en ces This leads us to a consideration of what we might begin to do about these widespread problems It surely follows that we must attempt to get, as an important goal for the community, a generation of healthy children so that we may, in the distant future, get a generation of healthy adults I am pleased to report that a start has been made, on a necessarily small scale In October 19 55, a weekly psychiatric clinic was started in this Area. in which difficulties of children under five could be investigated and dealt with We have been given a considerable amount of freedom as to how this may be organised, and the present arrangement is that the visiting psychiatrist and each of the medical officers who are working in the schools and maternity and child welfare services, hold a joint clinic session for this purpose, so that their combined knowledge is at the service of the family, and each kind of doctor can have some worthwhile contact with the knowledge and experience of the other related field of work For the most part, emphasis is on seeing children between the ages of a few months and about three years in order that the earliest developmental processes can be studied, and mothers taught how to adapt themselves to the child's needs at this stage so that development can take place in a healthy way Our knowledge of what goes on in the child between these ages has extended enormously, largely as the result of psycho-analytic investigations, but our understanding has only acquired much depth within the last few years, is still fragmentary, and there is much we still do not understand However, sufficient is known of extreme value The problem of making sure that these discoveries become common knowledge is one of our immediate tasks Similar clinics are starting in other parts of the country, but it may still be described as pioneer work The general principle is that the ordinary, healthy new-born baby can quite reasonably be expected to grow into 97 an ordinary, healthy adult if, first his mother, and later, both parents have the knowledge of how to provide a suitable setting in which the child can grow up. He becomes ill as a reaction to the failure of maternal (parental) understanding, their failure to adapt to his needs, and often active interference with each stage of his development This last is because of failure to realise that each child has its own natural speed of acquiring skill, control and knowledge, and that it should be allowed to go at that speed and not at one decided upon by the parents. Several factors may bring this about The parents themselves may be mentally sick, they may be misadvised, or commonly, uninformed, though they are willing and eager to do their best within the limits of their knowledge. Quite often, parents act on what they think is knowledge but which quite often turns out to be popular mythology; for these parents, and those who have difficulty because of their anxieties, help is provided in the clinic during the interview For those whose difficulties are greater because of a more severe emotional disorder, adequate facilities for psychiatric treatment must ultimately be provided elsewhere. We think that this new venture is the beginning of a really worthwhile fusion of therapeutic and preventive medicine". Epileptic Children In December 19 53 the Minister of Health issued Circular 26/53 concerning the special welfare needs of epileptics and spastics Statistics published in this circular gave an estimate of the number of epileptics in the British population as 2.0 per 1,000 which in the school population of Tottenham and Hornsey means an expected finding of approximately 60 epileptics. Similar statistics for the number of epileptic children severe enough to be ascertained are 0 2 per 1,000 which would give an expected number in Tottenham and Hornsey of six children The actual number of epileptic children known to the school health service is 61 As a result of the issue of the Ministry circular certain steps were taken. Firstly, it was decided to keep a record of all cases of epilepsy coming to the notice of the school health service General practitioners in the Area were circularised and requested to inform the borough school medical officer of all known and suspected cases as soon as possible after the age of two; secondly, to continue the practice previously employed 98 of assessing the educability and educational needs of all known cases as soon as this could reasonably be undertaken; lastly, that each epileptic child should receive special consideration as to employment needs at the school-1eaving medical examination and for the young person to consult the Youth Employment Officer with a view to registration as a Disabled Person where this is thought to be necessary The British Epilepsy Association arranges an annual holiday for those epileptic children whose parents cannot make other arrangements for them to have a holiday Through the school health service two children from this Area were nominated and accepted, and spent two weeks holiday at Eversley Hall Brackley No rth an ts Physically Handicapped Pupils During 19 55 work was begun on the new medical unit at the School for Physically Handicapped Children Vale Road, Tottenham When completed this will consist of a medical examination room (both for routine inspections and for diagnostic interviews), an orthopaedic room and a room for speech therapy In the past all this has been done in one room Dr W F Dunham Medical Director of the Spastic Unit at the School gave a talk to the medical and health visiting/ school nursing staff in May on the early diagnosis of cerebral palsy. The spastic unit is completely full and Dr Dunham has submitted the following account of progress in this field:- "Out of the total of 93 pupils at the school 27 have cerebral palsy, and of these only five now receive treatment outside the school As always our aim has been to obtain from each child, through the collaboration of all who in any way influence his behaviour the best performance of which he is capable "Therapy" therefore must mean that teachers, instructors and parents, as well as therapists must appreciate what are the child's physical capabilities,, and must so enlist his interest and, where necessary, so help him that his achievements are the best possible to him at that time. In this, there has been a most happy collaboration between teachers instructors and medical staff Where appropriate, the children take part in woodwork, metal-work, cookery and swimming For school work, furniture of exactly the right size for each child has been made, and this is altered as necessary as 99 the child grows This provides the child with a secure sitting posture and so makes his work easier, helps him to learn to steady his trunk for standing and walking, and discourages the development of deformi ty . Collaboration with the parents has been achieved both at medical clinics and by visits (both in term time and in the holidays) by the Therapist, Miss Wilson, who joined the school at the beginning of the autumn term to replace Mrs. Kinnaird who has left to take up an appointment elsewhere. An interesting experiment, carried out with the collaboration of the Crowland Secondary Modern School has been the enlistment of some 20 pupils from this school for normal children to act as helpers and instructors for swimming for the physically handicapped children from Vale Road School, of whom eight have been children with cerebral palsy The experiment has been a great success, the normal children gaining in sense of responsibility and citizenship, and the handicapped children in enjoyment, enthusiasm and ability Supervision is by the Borough Swimming Instructor and school teaching and medical staff. During the year, two cerebral palsied children left the school, one entering a unit for vocational assessment prior to undergoing further training, and one entering a factory where she is employed on equal terms with the other workers, with no concession s The Consultant has been called upon to give an opinion on the capabilities of seven children not attending the school, and on the most suitable provision to be made for them The ages of these children ranged from two years and four months to eleven years; it is hoped that as the availability of this service becomes more widely known babies and younger children may be referred also, as it is the handling which palsied children receive early in life which determines the difficulty of their subsequent treatment and to a considerable extent the success with which they are able eventually to lead a normal life" Delicate Pupils This is an omnibus term covering children with a number of different conditions but who have in common one characteristic at least, namely a failure to thrive in their ordinary environment. Thus a number of these children are asthmatics, others suffer from frequent upper respiratory infection and one is a diabetic. Of 100 the 36 children concerned, 27 attend a residential open air school and eight a day open air school. Speech Defects There are two whole-time and two 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 "Early treatment of the stammerer remains our aim, and is essential if speech anxiety and consequent secondary stammer are to be prevented In this context, the result of research recently published by Miss M Jameson L C. S. T., speech therapist to the Royal Victoria Hospital Newcastle on-Tyne, is relevant She found "There is a greater chance of speech recovery if the mother attends for advice when the child is still under five years of age, or if the child begins treatment within one year of the onset of the stammer" The majority of children receiving regular speech therapy at Vale Road School for the Physically Handicapped suffer from cerebral palsy or other neurological defect Several have a major speech handicap, requiring intensive treatment The invaluable co-operation of the headmaster and his staff is much app reci ated" Rheumatism Supervisory Centre Report for year 1st August 19 54 to 31st July 19 55 This clinic has continued with fortnightly sessions held at the Prince of Wales's Hospital in association with the Children's Out-Patient Department under the control of Dr I M Anderson. Consultant Paediatrician Total Children on Rheumatic Register (previously) 206 New Cases added during year 11 217 Total Cases removed from Register since 1951 58 Children remaining on Register 159 Analysis of these cases:- Tottenham Outside Area Total Rheumatic Fever 33 17 50 Rheumatic Carditis 23 11 34 Rheumatic Fever with Chorea 1 - 1 Chorea (uncomplicated) 3 1 4 Chorea with Carditis 3 - 3 Rheumatoid Arthritis 3 3 6 Rheumatic Limb Pains 1 - 1 Congenital Heart Disease 30 20 50 Other cases 8 2 10 Total 105 54 159 Male - 79, Female - 80 101 Although the number of new cases has been relatively small, old cases have remained under review, and during the year 10 3 patients have attended making a total of 2 32 attendances. (This total does not include attendances in the Children's Out-Patient Department on other days than Supervisory Clinic Sessions). New Cases These are distributed:- Tottenham Outside Area Total Rheumatic Carditis - 1 1 Rheumatoid Arthritis - 2 2 Non-rheumatic Limb Pains 4 - 4 Innocent Cardiac Murmur 1 1 2 Paroxysmal Tachycardia 1 - 1 Congenital Heart Disease 1 - 1 7 4 11 All regarded as fit for full school activities Prom all children on the Rheumatic Register, the following changes have occurred during the year:- Admitted to hospital 11 Discharged from clinic (full recovery or on leaving school) 12 Transferred to other Hospitals 7 Lapsed 12 Deaths (Child from Tottenham Area) 1 The Clinic has continued to assist the School Medical Officer (a) to decide which children with rheumatic symptoms required limitation of school activities and other forms of treatment; (b) to assess children found to have cardiac murmurs at routine school medical examinations, (c) to supervise and treat children with chorea and distinguish them from children with similar symptoms of emotional origin. As a result of grouping these problems together, much school absence and unnecessary restriction has been avoided Hospital School The hospital school in the Paediatric wards at St. Ann's General Hospital, Tottenham, has continued the work started in 1952. The average number of children being taught per session was 19 The value of such work in maintaining the educational standard of long term cases cannot be over-estimated 102 Convalescent Holidays On the advice of the school medical officers or general practitioners, school children recovering from an acute illness or operation may be sent for a recuperative holiday of two to four weeks at no expense to the parents During 19 55, 60 boys and 44 girls were sent for such a holiday All the children are seen on their return so that their progress may be noted and any special educational recommendation made Orthopaedic Service Mr E. Hambly F. R. C. S reports that this has been an active year in the orthopaedic service. The clinics have been well attended and the parents and children have proved most cooperative in carrying out the treatment suggested. The orthopaedic work in Tottenham has the advantage of being a comprehensive scheme, as Mr Hambly, who undertakes the clinic sessions, is able to carry out any operations or further investigations that may be necessary at the Prince of Wales's Hospital and St Ann's General Hospital Tottenham In addition, there is complete co-operation with the Vale Road School for Physically Handicapped Children Equally so, with Dr Dunham, who is Medical Director of the Spastic Unit there, and with the Headmaster, teaching, nursing and physiotherapy staff wholly or part-time attached to the school Ophthalmic Service Tottenham Dr. T. G. Kletz, MB Ch B. D. O. M. S. reports as follows on the work of the Ophthalmic Clinic at the Lordship Lane Medical Centre:- "Number of cases who attended during the year - 1,739 Number of cases of strabismus - 220 During the year cases for orthoptic investigation and treatment have been referred to the Prince of Wales's Hospital but arrangments, at the end of the year, were well advanced for the appointment of an orthoptist at Lordship Lane. Cases of strabismus requiring surgical treatment were referred to Moorfields Eye Hospital. 103 During the year three cases were registered as partially sighted, whilst two cases were recommended to be returned to normal schooling", Hornsey Dr Marian Lones, M B, , D. P. H. , D.O.M.S., reports as follows on the work of the Ophthalmic Clinic at Hornsey Town Hall:- "The total attendances at the clinic have been increased during this year by some 3% and the waiting list for new cases was nil at the end of the year Children's glasses are very vulnerable to damage and before the National Health Service Act patients found this an expensive item The scheme for free repair of glasses is much appreciated, 238 repair forms were issued during the year A number of children from an infant school were referred following 'illiterate E- card' testing This test does not require reading ability on the part of the child but does require patient and kindly attention by the school nurse or else children may merely fall silent and be thought to have poor vision. In actual fact almost all those cases referred were the "true bill' and a number of myopes were found.whose vision was say 6/12 but which might have been 6/36 by the time of the intermediate medical examination". School Meals Service This service performs an invaluable health and educational function, providing as it does one balanced meal a day to all who use it, and in addition teaching the value of eating together in clean and healthy surroundings. Under the supervisory eye of the teacher many small children rapidly improve their table manners and the faddiest of children usually loses his fads when away from over-anxious parents Of course the daily feeding of so many thousands of children in Tottenham and Hornsey places a formidable responsibility upon the shoulders of the school meals staff Every precaution must be taken to prevent the spread of food-borne infection. During March and April 1955 a comprehensive survey was undertaken by the medical staff of every school canteen in the two 104 boroughs It must be said at once that the standards of hygiene set are exceptionally high. The supervisory staff are indefatigable in their efforts to ensure that food, food containers and premises are protected from infection It must albeit be said that in some cases either the premises were unsuitable for a canteen site or too cramped, or that toilet facilities were inadequate Strenuous efforts are being made by the divisional education executives concerned to put these defects right As an example, it was noted in one large canteen that there was no running hot water in the toilet and it was suspected that the staff used a kitchen sink and nearby towel This has now been remedied by the installation of a gas heater and no fault can now be found in that canteen. Further details of the work of the School Meals Service are given in the following report contributed by the Borough Education Officer, Tottenham EDUCATION SERVICE I am indebted to Mr J Power, M A Borough Education Officer, Tottenham, for the following reports on various aspects of the work of his department closely related to the health of the school child. School Meals Service Food During the past year, particular care has been taken in the planning of meals having special regard to the protein and calorie requirements as laid down by the Ministry of Education. The cooking of food in self-contained kitchens is staggered to provide, as far as possible, freshly cooked food and additional transport has facilitated a later despatch of container meals from Central Kitchens Container meals are now packed in readiness for despatch between 10 45 a.m and 11 30 a.m throughout the Area The weekly menu contains three fresh meat meals, the remaining two being either bacon, cheese, fish, liver, pilchards, sardines, eggs, sausages Corned beef or luncheon meat salad except in very cold weather, is served once a week and consists of 105 6-9 ingredients. Fresh vegetables are served three or four times per week and fruit appears on the menu at least twice a week. All meat, including roasting meat, is now cooked on the day of consumption. No reheated dishes are served. Hygiene The standard of hygiene in all kitchens and dining centres is excellent. A programme for the provision of sterilising sinks in all centres is now well advanced and the plant for sterilising all insulated containers before use has been introduced into the central kitchens. All plastic plates are being withdrawn from use and are being replaced with china ware. General Assistants engaged on the service of the meal have been provided with white overalls for serving, in addition to the green uniform used for washing up and cleaning duties. Buildings Improved working conditions naturally assist in protecting the standards of the meal service and great strides have been made in this direction. Already two kitchens have been considerably enlarged and work will shortly commence on a third. In addition, numerous minor alterations, such as the provision of staff cloakrooms and store rooms, have been carried out, and washing and toilet facilities for all meals staff have been made available in all the meals centres The redecoration of all meals premises has been arranged to take place every three years Physical Education in Schools Primary The content of the Physical Training Lesson has changed considerably since the war The Ministry of Education publications Moving and Growing "and "Planning the Programme" have helped to stimulate a new approach. 106 Emphasis is now placed on the development of the individual through the practice of movements which are wider in range and quality than those based on the 19 33 syllabus. Opportunities are now provided for the development of the individual according to his or her own ability: for the development of self-expression, self-control and for harnessing the natural desire to climb - so often thwarted in a built-up area This has led to the introduction of climbing apparatus The results of this broader and less rigid approach can be seen in the pupils' confidence, self-reliance and adaptability. The use of apparatus necessitates the wearing of heel-less rubber shoes or bare feet where floor conditions permit and it is advisable to have the minimum amount of clothing on - factors which considerably aid the standard of cleanliness and hygiene, so necessary to maintain Much attention has been paid also to floor surfaces, again with an eye on safety and cleanliness. The Organisers of Physical Education have given special assistance to the Primary Schools by means of lecture demonstrations, courses and personal visits to schools. Secondary Physical Training forms the most important and regular feature of all schools, where facilities are adequate. These regular lessons when followed by a shower bath are found to be very helpful to the formation of health giving habits Unfortunately some schools have inadequate facilities and the pupils' full development suffers accordingly. The secondary lesson is changing in its pattern and is becoming wider in its content Formal and isolated movements are giving way to larger movements which incorporate the larger muscle groups Emphasis is placed on qualities of movement performed within varied ranges. The local Parks Committee have provided additional hockey pitches for girls and much use is made of public tennis courts Swimming Regular visits are made by all schools to the Baths but instruction suffers owing to the facilities having to be shared with the public. Owing to inadequate facilities, all pupils from nine onwards cannot make regular visits to the Baths The two 107 instructors employed by the Local Authority work with great enthusiasm to foster and maintain a high standard of swimming and personal hygiene. The provision of a closed instructional Bath for schools only would provide more beneficial instruction for a greater number of pupils, Indeed it would also provide for remedial classes, for example, for those suffering from asthma or other ailments Special Schools Assistance and suggestions have been given by the Organisers in the introduction of a new approach to the Physical Activities in these Schools Further interest has been stimulated and confidence and courage has been developed, through the introduction of some climbing apparatus at the School for the Deaf. Swimming is a special feature in both schools for certain sections of the children for whom it is possible Dance On the girls' side, there is a growing interest in movement training in dance form and a Course in Basic Movement Training held during the year created much interest This type of movement training has links with mime, music, drama and gymnastics and it is hoped to develop further this aspect of the work. Employment of Children Ontside School Hours During the year ended 31st December 19 55 applications were made by the parents of 88 children for licences enabling them to be employed part-time Of these applications six were refused; four were under age, and two were refused because of their unsatisfactory attendance at school. Analysi s 60% employed in the delivery of newspapers. 20% employed in the delivery of milk. 10% employed in delivering goods. 7% assisting in shops. 3% miscellaneous. 108 Youth Service Youth Athletics Meetings Each year a Youth Athletics Meeting is held locally and members of youth organisations, both boys and girls, take part in this activity The events cover all the usual field and track events The standard reached at these local meetings is very good In connection too with athletics, training classes are held during the summer season which a large number of young people attend Here they are given basic training in track and field events. In addition to the local meetings a County Youth Athletics Meeting is also held at which representatives from all the Middlesex areas take part. The standard of these meetings is very high Swimming Facilities A swimming gala is held each year for members of youth organisations in the borough, the attendance of which varies from year to year However, the standard of achievement in swimming is reasonably good In addition to the swimming gala, coaching classes are held to which young people may go and they are given instruction in swimming and life-saving Camping A few youth organisations in Tottenham have camping as an activity and it usually takes the form of weekend camps and in some cases for longer periods A Youth Camping Association has recently become affiliated to the local Youth Committee and this club is a branch of the Youth Camping Association of Great Britain In addition to actual camping there is a scheme through which young people and leaders can obtain awards for proficiency in this activity. The applicants submit to a practical test and if they are able to satisfy the examiners from the campcraft point of view an award is made to them Organised Games Games for the members of youth organisations in the Borough are organised on a league basis, and include netball, table-tennis, tennis and basketball In addition to these, several boys' clubs take part in football leagues Coaching classes are arranged for both boys and girls in these games and are well supported 109 INDEX Page Aged, care of 48 Ambulance Service 47 Ante Natal Clinics 66 Area Health Service 46, 64 Area Welfare Service. 46 Atmospheric Pollution 28 B. C. G. Vaccination 89 Births and Deaths 55 Blind and Parti ally Sighted Children 93 Burials 53 Cancer 61 Certificates of Disrepair 33 Chest Clinic. 8 Child Guidance 70 Child Welfare Clinics 70 Chiropody Service - Old People's 50 Children' s Homes, Inspection of. 84 Clearance Areas. 31 Closet Accommodation 28 Closing Orders 32 Comparability Factors. 4 Convalescent Holidays for School Children 102 Council, Members of 1 Daily Guardian Scheme 72 Day Nurseries 73 Deaf and Partially Deaf Children 93 Deaf, School for 94 Deaths, Classification of 60 Defects Remedied 39 Delicate Pupils 99 Demolition Orders 32 Dental Service, Priority 74 School 85 Diphtheria 10 Diphtheria Immunisation 81 Disinfection 13 110 Disinfestation 37 Domestic Help Service 82 Drainage and Sewerage 27 Dysentery 12 Education Services 104 Educationally Sub-Normal Children 9 4 Employment of Children outside school hours 107 Epileptic Children 97 Expectant Mothers, Care of 66 Factories 41 Food - Condemned 20 Hawkers. 17 Hygiene Regulations, 19 55 14 Labelling 22 Poisoning 12 Registered Premises 18 Sampling 21 Guardian Scheme, Daily 7 2 Handicapped Children 92 Hawkers of Food. 17 Health and Housing Committee 2 Health Education. 77 Health Services provided by other Authorities 45 Health Visiting Service 76 Holidays, Recuperative 82 Home Nursing Service 79 Hospitals 45 Hospital School, St, Ann' s General Hospital 101 Housing 28 Clearance Area Programme 29 Housing Act, 1936. S. 9. 33 " " " S 11 and 12 32 " " " Part III 28 Housing Repairs and Rents Act, 19 54 Ice Cream 16 Immunisation, Diphtheria and Whooping Cough 81 Infantile Deaths 59 Infectious Diseases, Table Insect Pests 37 111 Knackers' Yards 18 Laboratory Service 47 Laundry Facilities for Old Persons 49 Lunacy and Mental Treatment Acts 47 Maladjusted Children 95 Massage and Special Treatment Establishments 54 Mass Radiography. 8 Maternal Deaths 56 Maternity Services 67 Meals on Wheels 50 Measles. 10 Meat Inspection 19 Medical Examination of Staff 54 Merchandise Marks Acts, 1887-1926 22 Metropolitan Water Board 25 Midwifery Service 75 Midwives' Clinic 67 Milk and Dairies 17 Mothercraft Classes. 68, 69 Mothers and Young Children, Care of 66 National Assistance Act, 19 48, S. 47 53 S. 50 53 Notices served 40 Nurseries, Day 13 Nursing, Home 79 Old People's Chiropody Service 50 Clubs 50 Holi days 51 Meals on Wheels. 50 Optical Service 50 Wel fare. 50 Ophthalmic Service 102 Orthodontic Clinic 85 Orthopaedic Service 102 Orthoptic Treatment 84 Out-Patient Clinics at Prince of Wales Hospital 46 Outworkers. 42 Overcrowding Survey 34 112 Parent Guidance 71 Paratyphoid Fever 12 Patch Testing 89 Personal Health Service 46 Persons in need of Care and Attention 53 Pet Animals Act, 19 51 36 Physical Education in Schools. 105 Physically Handicapped Children, Special School 98 Play Group for children under five 7 2 Poliomyelitis 10 Preserved Foods 16 Prevention of Illness, Care and After-care 82 Prince of Wales' Hospital, Out-patient Clinics 46 Public Health Department, Staff. 2 Rag Flock and other Filling Materials Act, 1951 36 Recuperative Holidays 82 Repairs in Default 40 Rheumatism Supervisory Centre 100 Rodent Control 36 Sanitary Inspectors, Summary of Inspections 38 Scabies 12 Scarlet Fever 9 School Health Service 84 Statistics 86 School Meals Service 10 3 Sewerage and Drainage 27 Shops 41 Slaughterhouses 18 Slum Clearance 28 Speech Defects 100 Staff Medical Examinations. 54 Statistical Summary 55 Stillbirths. 55 Stonebridge Brook Pollution 27 Toddlers' Clinics Tuberculosis 6 In Schools Patch Testing 89 B. C. G. Vaccination 89 Vaccine Trials 92 113 Vaccination 81 Water Supply 25 Weil's Disease 12 Welfare Foods, Distribution of 73 Welfare Service, Area 46 White Hart Lane Estates: Overcrowding Survey 34 Whooping Cough 10 Vaccination 81 Work in default 33 Youth Service 108