TOT 31 AC 439(1) TOTTENHAM TOTTENHAM'S HEALTH 1956 The Annual Report of the Medical Officer of Health, Borough of Tottenham. TOTTENHAM'S HEALTH 1956 The Annual Report of the Medical Officer of Health, Borough of Tottenham. Health Department, Town Hall, Tottenham, N. 15. 31st July, 1957 To His Worshipful the Mayor Aldermen and Town Councillors. Mr. Mayor, My Lady, Ladies and Gentlemen, I have the honour to submit this my 21st Annual Report on health conditions in the Borough for the year ended the 31st December, 1956. Of special interest is that publication of this Report coincides with the jubilee year of the School Health Service introduced by the Education (Administrative Provisions) Act, 1907. Tottenham, like other large non-county boroughs in outer London, lost its autonomy under post-war legislation; but not before it had achieved a system of completeness, productive of such excellent results that the new system of remote control has not yet been able to better what it has superseded. Present discussions on reorganisation of local government services is a matter of vital interest to a town the size of Tottenham with its past record of progress. Details of the work of the public health department are set out in the appropriate sections of the Report. As in previous years particular attention has been paid to housing repairs, demolition or closing of individual unfit houses and to further progress in slum clearance. In the department's endeavour to operate "clean food" provisions of recent legislation, acknowledgement is made of the active co-operation of the Tottenham Chamber of Commerce and the local food traders. By the introduction of the Clean Air Act prompt action is anticipated for an extension of the smoke controlled area already in operation under powers previously obtained by the Tottenham Corporation Act. The new statutory change in disignation of sanitary inspector to public health inspector must generally be regarded as more in keeping with the wide expansion in recent years of this officers contribution to the solution of our many environmental health Problems. The pilot survey of occupational needs in factory Premises published in my 1952 Report has been extended during the Past year and the findings recorded in the body of this Report. It is gratifying to be able to refer again to the increasingly close relationships and exchange of views between the three arms of the national health service hospital, medical practitioner and local government services. As your Medical Officer of Health I am grateful for the opportunity to serve on the local liaison committees with general practitioners and to be a member of the local hospitals consultants medical advisory committee. Such opportunities for mutual understanding and goodwill can do much to strengthen the arms of a truly comprehensive local health service. To Dr. Epsom, my deputy, Mr. E. T, Jenkins,, chief public health inspector and Mr. Lawrence, chief clerk and all other members of the staff of the health department I acknowledge my indebtedness as also for their loyal support throughout the year. In conclusion I wish to express my appreciation for the continued support and encouragement shown me by the Chairmen and members of the various Committees with which I and my department are concerned. I am, Your obedient servant. G. HAMILTON HOGBEN Medical Officer of Health 1 MEMBERS OF THE COUNCIL MAYOR Alderman C.H. Colyer, J.P. DEPUTY MAYOR Alderman H.W. Turner Alderman E.J. Field " R.W.H. Ford " W.S. Herbert " F, A. F. Keay, J. P. " The Lady Morrison Councillor Miss S.A. Berkery " Mrs. E. M. Bohringer „ F. G. Bohringer " Mrs. E. E. Brown „ E. J. Brown " J. W. H. Brown " E J. J Carter " A. W. Catley „ Mrs. I.R. Cato " D. Clark " E. J. Clook „ E Cooper „ A. J. Davies " J. Egdell „ E. V Garwood W. K. Gomm Alderman A. Reed, A. C.I. I., J.P. " Mrs. A. F. Remington „ A. R. Turner " R.H. Warren Councillor Mrs. F. E. Haynes " Mrs. F. C. Ilsley " H. Langer " Mrs. A. A. Miller „ M. T. Morris " S. C. Morris " J. J. Pagin " I.L. Peirce " A. T. Protheroe " Mrs. M. E. Protheroe " J. R. Ramshaw " T. A. Riley " P. H. Roberts " J. Watkins „ J. L. Williams " Mrs. A. Wise Councillor J. Wolsey Town Clerk: M. Lindsay Taylor, LL. B. 2 HEALTH AND HOUSING COMMITTEE Chairman Alderman R. H. Warren His Worshipful the Mayor, Alderman C.H. Colyer, J.P. The Deputy Mayor, Alderman H, W. Turner (ex-officio members) Alderman A, Reed, A, C. I.I., J.P. Councillor F. G. Bohringer " E. J. Clook " E. Cooper " Mrs. F. E. Haynes " M.T. Morris Alderman Mrs„ A. P. Remington Councillor Mrs. M. E. Protheroe „ J. R. Ramshaw " T. A. Riley " J. Watkins " J.L. Williams 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 0ffieer of Health Chief Public Health Inspector Chief Administrative Assistant G Hamilton Hogben. M.R.C.S., D.P.H. F. Summers M.B.,B. S., D.P.H. (left 22, 5 56.) J. Epson. M. R. C. S., D.P.H., D. I. H. (commenced 1.6.56) E. T. Jenkins, F.A.P.H.I. A. W. Lawrence, M.A.P.H.I. 3 Public Health Inspectors Senior District Public Health Inspector E.S. Glegg (a) (b) (c) C.J. Cattell (a) (b) W,P. Kent (a) (b) A. E. Clarke (a) (b) (c) (d) L.J. Kerridge (a) (b) C.J. Cooley (a) (b) E. Kipping (a) (b) (commenced 1.3.56) G. W. Maidlow (a) (b) A. J. Hattersley (a) (b) W. Openshaw (a) C., J Johnson (a) (b) (left 13 10.56) F.J. Parsons (a) (b) Note: (a) Public Health Inspectors' Statutory qualification. (b) Meat Inspectors' Certificate (c) Institution of Public Health Engineers' Certificate (d) Sanitary Science Certificate Shops Inspector L. H. Williams (commenced 3.4,56) Clerical Staff W.E. Lawson (Senior Administrative H.C.B. Wheal (Administrative Assistant) Assistant) C.J. Lemon C.S. Clark R.G. Hull Miss E. Sawyer Miss M. Blackwell J. Gates (commenced 25.6. 56) B. Mott (left 23.6.56) Outside Staff Foreman: Disinfecting Van Driver: Disinfectors, Apparatus Attendant: Rodent Operatives: S.H. Reid E.E. Mannell W. Butcher A. Dowse A. E. Moon J. Lawrence G.W. Percival Drain Testers: A.E. Crow F.T. Dowse R.E. Hobbs B. Joscelyn F.J. Slater R.C. Wilson 4 GENERAL STATISTICS AREA OP DISTRICT IN ACRES 3,013 POPULATION Census 8th April, 1951 126,929 Estimate of Registrar General of PopulationMid-year, 1956 120,700 APPROXIMATE NUMBER OF DWELLINGS IN DISTRICT 30,688 RATEABLE VALUE OF DISTRICT at 1st April, 1956 ... £1,827,527 SUM REPRESENTED by PENNY RATE at 1st April, 1956 £7,285 LIVE BIRTHS: Legitimate 1,480 1,560 Illegitimate 80 Birth Rate (per 1,000 population) 12.92 STILL BIRTHS 37 DEATHS 1,252 Death Rate (per 1,000 population) Infantile death rate (per 1,000 live births) 24,36 Maternal death rate (per 1,000 live and still-births) 1,252 COMPARABILITY FACTORS Deaths 1.09 Births 0.97 (NOTE Detailed vital statistics appear on pages 69 to 77 in the Statistical Summary.) 5 CONTENTS PAGE PART I CONTROL OP DISEASE 6 „ II FOOD CONTROL 17 " III SANITARY CIRCUMSTANCES OP THE AREA 26 " IV FACTORIES AND SHOPS 41 " V GENERAL 58 " VI STATISTICAL SUMMARY 69 APPENDIX WORK OF THE COUNTY AREA HEALTH COMMITTEE 78 (HORNSEY & TOTTENHAM) 6 PART I CONTROL OF DISEASE The total number of notifications for the year was 812, which is the lowest ever recorded figure. Measles only accounted for 158 cases whereas the year previously there were 1,837 cases. Tuberculosis The number of cases on the tuberculosis register on 31st December, 1956 was 1,854 an increase of 29 on the previous year. There were 101 new cases of tuberculosis notified during 1956 (92 pulmonary and 9 non pulmonary) compared with 144 in 1955 (126 pulmonary and 18 non pulmonary). Distribution of New Tuberculosis Cases notified during 1956 Age Periods New Cases Deaths Pulmonary Non Pulmonary Pulmonary Non Pulmonary Male Female Male Female Male Female Male Female Under 1 year - - - - - - - - 1 - 4 years 2 1 - - - - - - 5-9 " - 1 - 1 - - - - 10-14 " 2 - 1 - - - - 15 - 19 " 5 6 1 - - - - - 20 - 24 " 3 3 - - - 1 - - 25 - 29 „ 7 1 - 1 - - - - 30 - 34 „ 1 8 - 3 - - - - 35 - 39 " 3 4 - - - - - - 40 - 44 " 5 3 1 - - - - - 45 - 49 " 4 1 - - 3 1 - - 50 - 54 " 5 1 - - 1 1 - - 55 - 59 " 4 - - - - . - - 60 - 64 " 5 4 1 - - 2 - - 65 - 69 " 5 1 - - 2 - - - 70 - 74 " 4 1 - - 4 - - - 75 Years and Over - 2 - - 2 1 - - Total 55 37 3 6 12 6 - - The following is an analysis of non-pulmonary tuberculosis cases notified during 1956:- 7  Male Female Total Bones and Joints - 1 1 Genito-urinary system 2 - 2 Central nervous system - - - Other sites 1 5 6 3 6 9 Changes in Tuberculosis Register during 1956 Details Pulmonary Non-Pulmonary Total Male Female Male Female Number on Register at 1st January, 1956 883 753 88 101 1825 New cases notified during 1956 55 37 3 6 101 Transfer into Tottenham 33 16 3 5 57 Return to District 1 1 - - 2 Restored to Register 1 2 - - 3 973 809 94 112 1988 Cases removed from Register Deaths of cases on register 20 5 - - 25 Transfer out of Tottenham 34 29 2 3 68 Recovered 18 14 1 3 36 Lost sight of 1 4 - - 5 73 52 3 6 134 Number on Register at 31st December, 1956 900 757 91 106 1854 Ward Distribution of Cases of Tuberculosis on the Register at 31st December 1956 Ward Estimated Population Male Female Total Rate per 1,000 population Pulmonary NonPulmonary Pulmonary NonPulmonary White Hart Lane 11,359 120 12 107 8 247 21.7 Park 11,341 77 15 90 15 197 17.4 Coleraine 11, 507 65 7 67 6 145 12.6 West Green 11,103 67 4 64 12 147 13.2 Bruce Grove & Central 10,893 66 5 47 6 124 11.4 High Cross & Stoneleigh 11,006 94 13 63 10 180 16.4 Green Lanes 10,678 81 6 69 8 164 15.4 Chestnuts 11,160 78 6 72 9 165 14.8 Seven Sisters 10,356 79 8 59 7 153 14.8 Town Hall 10,608 80 8 65 13 166 15.6 Stamford Hill 10,689 93 7 54 12 166 15.5 Tbtal 120,700 900 91 757 106 1,854 15.4 NOTE To obtain the estimated population for each ward, the Registrar General's estimate for the Borough has been divided in the same proportions as number of persons on the Register of Electors for each ward. 8 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 1956 of the clinic and the associated Chest Unit in St. Ann's General Hospital. "No. of attendances during 1936 33,686 No. of patients seen for the first time 5,910 No. of "Contact" attendances 7,085 No. of "Contacts' diagnosed as tuberculous 19 No. of sessions held at the Clinic during 1956 1,259 No, of persons inoculated with B.C.G. during 1956 299 As wide use as possible is made of the diagnostic Miniature film, and it is our wish that local practitioners use this service as fully as possible. The total number referred in 1956, and the findings are as follows:- Miniature X rays Total number of miniature films taken on the Odelca Camera during 1956 7,349 Total number of above recalled for large film and clinical examination 1,017 Total number of "recalls" Diagnosed as (a) Pulmonary Tuberculosis 21 (b) Bronchial Carcinoma 10 The proven number of Bronchial Carcinomas seen in the year and their disposal is given in the following table:- Bronchial Carcinomas No. of Bronchial Carcinomas, 1956 36 No. of Bronchoscopies, 1956 33 No, of Thoracotomies. 1956 13 No. of Pneumonectomies 1956 7 No. of Lobectomies, 1956 4 9 The position with regard to beds for tuberculous cases within the North East Metropolitan Region has eased considerably within recent times and some of the small units in the region are now being closed down and the bed complement is being reduced. Up to now, no reduction has been made in the number of beds in St. Ann's Hospital, where there are still 150. (90 Male and 60 Female). These are available for cases not only in the Tottenham and Wood Green areas, but for districts in the London area within the North East Region. The Chest Clinic is less accessible in St. Ann s Hospital than it was in the premises in Somerset Road, and I consider that a very useful service would be performed to the Chest Clinic patients if some sort of shelter were erected by the 'bus stop at the junction of St. Ann's Road, and Black Boy Lane. It is a great hardship to many standing there in all sorts of weather waiting for the infrequent 'buses, and I am sure that whatever small expense such a facility incurred would be more than justified." Welfare of the Tubercular Patient During 1956 917 tubercular patients resident in Tottenham and Wood Green were assisted by the Chest Clinic Welfare Officer who has kindly supplied the following summary of some of the subjects dealt with, Problem Cases The past year has been marked by a special effort to deal with problem patients, with varying degrees of success and failure. An example is that of a young man who, after many years in hospital, badly crippled with rheumatoid arthritis and tuberculous bones and chest, had in addition many serious personal problems. His rehabilitation was begun at the local Red Cross Handicrafts Class held daily, with Club attached. Later he was accepted for a course at the North West Regional Hospital Board's Camden Medical Rehabilitation Centre which comprises six months daily full time attendance at the Centre, the end of the year found him established in comfortable lodgings with many problems resolved; he was learning to drive a Ministry of Health Invalid Car, and the Disablement Rehabilitation Officer had a job earmarked for him. 10 Housing Of 104 families recommended for rehousing 40 were rehoused during 1956 as follows:- Tottenham Borough Council, rehoused in Tottenham 18 Tottenham Borough Council, rehoused in Potters Bar 1 Tottenham Borough Council, transferred to smaller (1) and larger (1) accommodation 2 Wood Green Borough Council, rehoused in Wood Green 5 L.C C Housing Estate, rehoused into other areas 2 Rehoused to New Towns, Hatfield 2, Harlow 2, Basildon 1, Welwyn Garden City 1, Laindon 1, Hemel Hempstead 1, Luton 1 9 To other London Boroughs 3 40 Re-employment of Patients The appended survey on work for patients, was compiled by Mrs. Porter who helps at this Clinic (from Finchley Chest Clinic) on two days a week whenever possible. Patients re trained at Ministry of Labour Government Training Centres and afterwards placed 19 Placed by Youth Employment Bureau from school, etc. all either as trainees or jobs with further education arranged for 5 Returned to same employers either in a different capacity or to same jobs on a part time basis to begin with 37 Patients who changed their jobs 37 Returned to similar work with different firms 12 Patients who completed course at Egham and were placed 10 Miscellaneous 18 138 Grants Grants were given by many Voluntary Societies to assist individual cases. Altogether 42 cases were helped and the total amount subscribed was £590. In addition grants from the Tottenham Hospital Management Committee amounted to £114. 11 168 individual patients referred to the National Assistance Board for grants, received assistance for the following purposes:- (a) Bedding 15 (b) Clothing 22 (c) Extra Nourishment 47 (d) Any other purposes 121 (i.e. maintenance grants etc.) Handicraft A Handicrafts Exhibition and Sale held in December demonstrated the abilities of many of the patients who have received training in various forms of handicraft. There was a singular success in dealing with a Mongol boy of 15. Home tuition from the County was delayed for a considerable time, and many hours of infinite patience were spent in teaching this lad basket work and other handwork. Now a considerable number of articles are being sold. Summer Outing for Patients Two coach loads of patients were taken to Bognor Regis in August, to their great pleasure and satisfaction. They were all chronic patients including several cripples. Three Health Visitors and the Welfare Officer were in charge, the Hospital gave the food for the day, and the Staff contributed towards extra expenses. Most of the patients paid their own fare. A special effort was made by the Health Visitors to raise money for next year's outing. The local factory loaned a "Tombola" at the Sale of Work, when £21 was collected for this purpose. Poliomyelitis The number of cases throughout the year was 27, of these, 12 were of the paralytic type. The three adul ts affected were paralytic. Paralytic Non-Paralytic Male Female Male Female 8 4 7 8 Two cases of the twenty seven were treated in their own homes by the family doctor. The remaining twenty five were admitted to the special Poliomyelitis Unit of St. Ann's Hospital. 12 During January two cases occurred one of which was paralytic. The main outbreak commenced during the early days of June when the Anti-Polio Vaccination campaign had just begun. Much publicity was given to the first notified case since the child had been vaccinated against the disease only five days previously. However it was obvious that this chi1d was already incubating poliomyelitis before the injection was given. Fourteen cases followed during the rest of June and a further eight were notified during July. The last case occurred on the 24th July, 1956. The interesting aspect of this outbreak was the multiple cases occurring in the same family. Poliomyelitis usually picks no more than one from a family. In this attack five separate families had more than one case, two of these families had three cases each, A Medical Officer of the Ministry of Health visited the district and discussed these cases with members of the local health department. Finally the remaining three cases occurred at the beginning of winter, two cases in November and the last on 9th December, 1956, Recent work on the nature of poliomyelitis suggests that the causative virus inhabits the alimentary canal for long periods after an attack, one source suggests as long as 8 to 10 weeks. It can be clearly seen that personal hygiene is of the greatest importance to all age groups. Measles There were 158 notifications of measles during the year. Six cases were removed to hospital with complications. There were no deaths. Dysentery There was a total of 63 cases notified, Of these 10 cases were admitted to hospital. Food Poisoning There were 30 notified cases. In only 9 of these were the agents identified (8 Salmonella typhi-murium; 1 Salmonella enteriditis). 2 cases were admitted to hospital, both confirmed Salmonella typhi murium infections. Included in the 30 notified cases were two small outbreaks: 3 people in one family; and the illness of 3 individual children classed as an outbreak, the common 13 factor being that each child had had school meals at the same centre on a particular day. On investigation of the meal concerned all tests were negative and no real cause was discovered. Diphtheria A girl aged 6 years was notified by St. Ann's Hospital as suffering from diphtheria mitis of the ear. A virulence test revealed that the bacteria were non-pathogenic. This was the only notified case of diphtheria during 1956. Psittacosis A woman aged 56 admitted to hospital was found to have Psittacosis. Upon investigation it was found that she had been in contact with two budgerigars. However, the birds had not been ill and specimens of excreta from them were examined with negative results. Paratyphoid Two cases of paratyphoid "B" were notified in two females aged 9 years and 16 years. The cases were unconnected and no trace of the source of infection was found in either case, although the elder girl was said to have visited a seaside resort for the day a fortnight previously and may have eaten something there. Both cases were treated in hospital. Scarlet Fever There were 80 cases of scarlet fever notified during the year, but no deaths were attributed to the disease. Of the 25 cases admitted to hospital the diagnosis was amended in one instance. Hospital Diagnosis confirmed & 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 21 12.5 1 6 Other Hospitals 3 14.3 No amendments 14 One of the cases admitted to hospital was complicated by Impetigo. The one amended case was diagnosed as acute tonsillitis Whooping Cough The number of notified cases during the year was 243, No deaths were attributed to the disease. Of the 34 cases admitted to hospital the diagnosis was amended in 5 instances. Hospital Diagnosis confirmed & 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 24 26.5 5 26.8 Other Hospitals 5 27.4 No amendments Three of the cases admitted to hospital were complicated, one by bronchitis, one by acute bronchitis and one by chicken pox. Diseases of Arteries and Cancer These two disease groups account for a very large proportion of yearly deaths I Disease of Arteries (a) Coronary Heart Disease, Angina (b) Vascular Diseases of the Nervous System II Cancer (a) Cancer of Lung (d) Cancer of other sites Year Population Death from Diseases of Arteries Deaths from Cancer (Total) Deaths from Cancer of lung No. of Deaths Rate per 1000 No. of Deaths Rate per 1000 No. of Deaths Rate per 1000 National Figures 1952 43 9 5 5 000 130,817 3.0 87,642 2.0 14,218 .32 1953 44 109. 000 129,820 2.9 87,924 2.0 15,132 .34 1954 44. 274,000 140,043 3.2 90,095 2.0 16,331 .37 1955 44 441.000 144,749 3.3 91,339 2.05 17,272 .39 Tottenham 1952 125, 800 356 2.8 277 2.2 57 .45 1953 124,400 298 2.4 284 2.3 68 .55 1954 123, 200 341 2.8 251 2.0 57 .46 1955 122, 100 348 2.9 308 2.5 71 .58 1956 120,700 361 3.0 281 2.3 85 .70 15 Although there has been a sharp rise in the number of deaths from lung cancer there also has been a rise in the number of deaths due to diseases of arteries, and a smaller rise due to cancer as a whole. Diseases of Arteries Recently the World Health Organisation published reports from various research workers in the field of Human Nutrition. Their main problem is one of shortage of food in certain areas of the world but also brought to light is the fact that over feeding can have a deleterious effect, especially the consumption of the wrong sorts of food. Suspicion has fallen on certain hard fats (animal fats) commonly used in the leading Western countries, where arterial disease is so prevalent. The mechanism of how these fats are harmful has not been shown but it is known that a fatty substance (cholesteral) is found deposited on the lining of the diseased arteries. Its incidence is highest in the countries where these animals fats are used and overused. Where vegetable oils are used instead the incidence is said to be lower. Another authority lays emphasis on the fact that we do not get sufficient of the essential fatty acids that are present in wheat embryo, vegetable oils etc. It is thought that these protect the lining of the arteries from the deposits of harmful fats. Lung Cancer The rise in deaths from lung cancer over recent years has set innumerable research workers and statisticians to look for a possible cause. Attention has been particularly focussed on the habit of smoking and it appears from the evidence supplied that smoking must be suspect as a contributory cause of the disease. It is said that heavy smokers are much more liable to develop cancer of the lung. One survey has shown that cancer of the lungs was twenty times more common in heavy smokers than in non smokers. Another survey put the incidence as forty times commoner in those who smoked over 25 cigarettes a day compared with non-smokers. Investigations into atmospheric pollution and its possible relation to lung cancer continues. 16 SUMMARY OF DISINFECTION WORK DURING 1956 Rooms disinfected after occurrence of infectious 175 disease Bedding disinfected after occurrence of infectious 94 disease or death Library Books disinfected 112 17 PART II POOD CONTROL A fresh impetus in the control of food handling premises was provided at the commencement of the year by the application of the Food Hygiene Regulations 1955 1956. A resume of these Regulations was given in my annual report for last year, With approval of the Health Committee it was decided that the best way of introducing the Regulations to the people most affected was by a series of meetings with the traders. Accordingly, meetings were arranged at which Alderman R.H. Warren as Chairman of the Health Committee presided and invitations were sent out to the traders in groups. Attendances at all meetings were good and those present were given an outline of the Regulations, together with the views of the officials concerned as to their interpretation of the various requirements. Following these meetings surveys have taken place., commencing with cafes, restaurants and other places where food is eaten by the public. The reception given to the Public Health Inspectors during their visits has been gratifying and the traders have proved most co operative. In many of the registered food premises the purpose for which they are registered is ancillary to the main purpose, e.g., those premises where sausages are manufactured are, in the main, butchers, in the case of cooking ham, the main business is a grocers. In addition to regular visits to the premises special visits have been made under the Food Hygiene Regulations, The number of shops in Tottenham selling food is 1,054, Several shops have more than one trade, and the following list shows the number of shops dealing in each food trade. Baker and Confectioner 52 Butcher 94 Coffee Stall and Cafe 24 Confectioner 331 Dairyman 32 18 Dining Rooms 94 Domestic Stores 124 Fishmonger 48 Fruiterer and Greengrocer 126 Grocer and Provisions 289 Ham and Beef Dealer 5 Off Licence 80 Public House 58 Registered Food Premises At the 31st December, 1956, the following premises were registered under the Food and Drugs Act, 1955, for the manufacture, storage or sale of ice cream, or for the preparation of sausages or preserved foods:- Sale of Ice Cream 357 Mfr, and Sale of Ice Cream 3 Storage of Ice Cream 1 Cooking of hams and other meats 36 Fish Frying 37 Sausage Mfr. 50 Preparation of jellied eels 3 Boiling shell fish 2 Heat treatment of ice cream is now restricted to two manufacturers, one of which is the Lido, in both places a good standard of hygiene has long been established. 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 1 1 2 Samples of Ice Cream produced outside of Tottenham 2 2 1 5 Total 3 3 1 7 19 Middlesex County Council Act, 1956: Registration of Hawkers The following is a summary of hawkers and their storage premises registered at the 31st December, 1956, under section 11 of the Middlesex County Council Act, 1950:- Articles No. of persons Registered for sale No. of storage premises Fruit and vegetables 100 100 Shellfish 14 13 Fish (incl. 2 jellied eels) 8 7 Ice Cream 3 3 Peanuts 2 2 Light refreshments (mobile canteen) 4 2 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) Regulatins. The following is a summary of licences issued during 1956 namely:- Designation No. of Licences No, of Supplementary Licences Pasteurised 72 9 Sterilised 152 11 Tuberculin Tested 35 9 During the year 7 applications for registration as milk distributors were dealt with. No applications were received in respect of dairies. Of the 7 new registrations 1 was for new premises and the other 6 were in respect of the change of proprietorship of previously registered premises, The number of premises and distributors registered at 31st December, 1956 was as follows:- No. of distributors 153 No. of dairies 8 20 SUMMARY OP CARCASES INSPECTED 1956 Horses Cattle Excluding Cows Cows Calves Sheep and Lambs Pigs excluding Sows Sows Number Killed 1622 273 356 1905 3185 15931 1667 Number Inspected 1622 273 356 1905 3185 15931 1667 All Diseases except Tuberculosis & Cysticercosis Whole carcases condemned 4 - 4 1 - 7 - Carcases of which some part or organ was condemned 171 40 48 6 227 1923 179 Percentage of number inspected affected with disease other than tuberculosis & Cysticercosis 10,73 14,65 14,61 .37 7.13 12,11 10.74 Tuberculosis Only Whole carcases condemned . - 5 - - - 3 Carcases of which some part or organ was condemned - 23 48 1 - 388 69 Percentage of number inspected affected with tuberculosis - 8,42 14,89 05 - 2,44 4.32 Cysticercosis Only Whole carcases condemned - - - - - - - Carcases of which some part or organ was condemned - 1 - - - - - Percentage of number inspected affected with cysticercosis - .37 - - - - - 21 Meat Inspection There is no reduction in the work carried on in connection with meat inspection. The two slaughterhouses continue to operate and maintain their output of carcase meat. Although there is a slight reduction in the number of horses killed for human consumption this firm have revived their export trade to the continent. In addition some slaughtering of cattle now takes place and this has involved some Sunday work. The quality of the meat dealt with in the slaughterhouse dealing only in farm animals is of the highest standard and the condemned portions are generally confined to offals. The cattle dealt with in the other slaughterhouse is poor and weight for weight a higher percentage of the meat is condemned. The staff engaged in the work of meat inspection still operate a rota system and their co operation to ensure an efficient service must be recognised. The one knackers yard in the Borough is regularly visited to ensure compliance with the byelaws and inspection of records. Condemned Food The bulk of the condemned tinned food comes from the wholesale provision merchants and disposal of this foodstuff, as with condemned meat, is dealt with at the Council disposal works. 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 Crab 7 Macaroni 5 Crab Paste 24 Marmalade 13 Cream 23 Meat 114 Fish 364 Meat Past 7 Fruit 1,872 Milk 69 2 Fruit Juice 106 Milo 3 Gherkins 19 Processed meat 491 Ham 98 Paste 13 Jam 8 Pease pudding 2 22 Rice 11 Sweet corn 2 Roes 7 Tomatoes 1, 259 Salmon 3 Tomato juice 4 Salmon salad 3 Tomato Paste 19 Sausages 10 Tomato Puree 5 Soup 230 Tomato Pulp 3 Spaghetti 106 Tongue 17 Strained food 15 Vegetables 1 299 Syrup 1 Unlabelled tins 11 Other articles of food condemned Bacon 7 23 1 bs. Kidney 22 lbs. Biscuits 1½ IbS. Malyos 21 pkts. Biscuits (chocolate) 1 pkt. Meat 9 38¼ lbs. Calves plucks 14 1 bs. Marm1ade 1 jar Cake 9 lbs. Mincemeat 7 jars Cake mix 13 pkts. Oats 1 pkt. Cakes 2 Pickle 5 bottles Cabbage 1 jar Processed meat 78 lbs. Cereal 114 pkts. Processed wheat 10 pkts. Cheesespread 10 pkts. Puddings 5 Cheese 1 pkt. Onions 6 jars Chicken 1 Rice 17 lbs. Cooking fat 1 l b. Ryvita 2 pkts. Cordial 1 Bottle Sauce 21 bottles Custard 5 pkts. Suet 21ft lbs. Dried fruit 80 lbs. Salt 1 pkt. Dates 25 pkts. Salt 2 blocks Fish 27 stone 8 lbs. Stuffing 11 pkts. Flour 11 bags Vegetables 56 lbs. Flour 248 lbs. Vegetables 14 jars Gherkins 5 jars Vinegar 1 jar Grapes 35 lbs. Vita Wheat 3 pkts. Icing Sugar 7 pkts. Yeast 56 lbs. Livers 22 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 1956, 23 Milk. Three samples of milk obtained from one farmer contained added water. Proceedings were authorised and a fine of £4. 0, 0d„ plus £4. 18, 0d. costs imposed. Five cases of glass in milk, all connected with one firm of processors, were reported. In two cases the evidence was insufficient to prove when the glass entered the milk and therefore no action was taken. In one case proceedings were authorised, but the magistrates dismissed the case and ordered £5, 5. 0d costs against the County Council. An official and a verbal caution were given in the remaining two cases. Cheese. Four samples of "cream cheese" were found to be processed cheese. In one case an official caution was given; verbal cautions were given in two cases, and in the remaining case the follow up samples were declared to be processed cheese and no further action was taken. Ice Cream, A sample of ice cream was deficient in fat: an official caution was issued. Meat and Meat Products. Roasting beef was found to contain preservative, The butchers were issued with an official caution. Two tins of stewed steak were found to be unfit for human consumption. Official cautions were issued to the provision merchants. Cakes and biscuits, A sample of "macaroons" were found to have a coconut base and not almond as should be the case in true macaroons. The manufacturers agreed to amend their description. Vinegar. A sample of "vinegar" was found to be non-brewed condiment. An official caution was issued. Sweets, A sample of confectionery, described by label as "Cream Filled Eggs", contained no cream. The firm displaying the confectionery had written their own display cards, and upon being communicated with immediately agreed to amend this false description. Wines and Spirits. A sample of whisky contained a small percentage of added water. Further samples proved to be genuine and no further action was taken. The Food and Drugs Act, 1955, in section 47, contains new provisions concerning the descriptions which can be applied to certain substances which resemble cream in appearance but are not cream. This has necessitated the making of many inspection visits and the giving of advice to all traders likely to be concerned to ensure that they were fully aware of these new requirements. 24 Merchandise Marks Acts, 1887 1926. 255 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. 851 separate displays of meat, apples tomatoes, poultry, dried fruit, bacon and butter were examined. Verbal cautions were given in respect of minor infringements not being found so serious as to warrant more stringent action. Six summonses were issued against three retail butchers for failing to mark imported meat with the prescribed indication of origin, the total of fines and costs imposed amounting to £20.8,0d. The proprietor of a hardware store was summoned for selling short measure paraffin a fine of £2„0,0d. plus £2,2,0d, costs being imposed. 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 Cu.se of compound foods, the ingredients. It also requires that the name and address of the packer or labeller appears At 267 premises 1,186 articles of pre packed food were examined. No proceedings were taken in respect of any of the infringements and manufacturers took immediate steps to correct unsatisfactory labels as soon as their attention was drawn to them. False or Misleading Descriptions. As I mentioned in my letter to you of 4th May, 1956 a considerable amount of work is carried out each year in scrutinising advertisements and the labelling of pre packed food and taking such action as is possible to secure satisfactory amendments in those cases where a 1abel or advertisement contains a false or misleading description of the food to which it relates. This work is of benefit to all districts of Middlesex, irrespective of where the offending advertisement or label is discovered, and during the year under review corrective action has been taken in respect of cherry wine, biscuits, chocolate Easter eggs, flour and sugar confectionery, imitation caviare,, blackcurrant punch, fruit juice drinks and creme de menthe. The Milk Special Designation) (Pasteurised and Sterilised Milk) Regulations 1949. A milk dealer was officially cautioned for breaches of conditions of his Dealer s licence in respect of the use of the special designation "pasteurised" He delivered milk in a churn not marked with the designation "pasteurised milk and also put the milk into the churn at premises different from those at which the milk had been pasteurised. 25 Food and Drugs Act, 1955 List of Samples procured in the Borough of Tottenham during the year 1956 Article Total Samples Procured Unsatisfactory Milk, new 4 3 Milk, various 97 5 Bu11er 4 - Cakes and biscuits 60 1 Cheese 7 4 Cream 14 - Cooked meats 24 - Coffee 3 - Drugs 8 - Pish and fish products 9 - Fruit, fresh and canned 3 - Ice cream 13 1 Liver 5 - Margarine 2 - Meat and meat products 32 3 Preserves 8 1 Sausages 22 - Sweets 8 1 Vinegar 17 1 Wines and spirits 50 1 Miscellaneous 16 - Totals 406 20 26 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 1956. "The supply to the Tottenham area has been satisfactory both in quantity and quality during the year 1956. Details of the analytical results of the water passing into supply are given on the attached sheet. The Borough of Tottenham is supplied from two main sources:- (a) Water from the New River consisting of a mixture of River Lee water and well water treated at the Board" s filtration works at Hornsey and Stoke Newington. A contact tank for the efficient treatment by chlorine was brought into operation at Hornsey in July 1954 and a similar tank will be in operation at Stoke Newington the week immediately after Easter 1957, (b) River Thames water stored in the Board s reservoirs and treated at the Board's filtration works in the Thames Vailey, Samples are collected on five days in every week or more often if required at each stage of the purification process and from the distribution system. Tests include physical, chemical and microbiological examination, 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. The water supplied to this area is not plumbo solvent. 27 Average Results of the Chemical and Bacteriological Examinations of the Water Supplied to the Borough of Tottenham for the Year 1936 Parts per Million (Unless otherwise stated) Description of the Sample No. of Samples Ammoniacal Nitrogen Albuminoid Nitrogen Oxidised Nitrogen (Nitrate) Chlorides as CI Oxygen abs from Permanganate 4 hrs. at 27°C Turbidity in Terms of Silica Colour m. m. brown 2ft. Tube Burgess's Tintometer Hardness (Total) Hardness (Noncar bonate) PH. Value Phosphate as P.0. 111 4 Silica as Si02 Sulphate as S04 Conductivity New River water filtered at Hornsey works 215 0.021 0.068 6.0 36 0.76 0.2 7 304 84 7.7 1.00 13 - 600 New River water filtered at Stoke Newington works 213 0.017 0.069 5.8 36 0.80 0.1 8 302 82 7.8 0.95 13 62 575 River Blames derived filtered water 1598 0.036 0.086 4.3 30 1.16 0.3 13 258 72 7.7 0.90 10 58 500 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 251 21.7 99.6 0.032 New River water filtered at Stoke Newington works 260 15.2 100.0 Nil River Thames derived filtered water 3,736 5.0 99.9 0.002 28 Drainage and Sewerage There is no change to report in the method by which drainage and sewage is conveyed. The separate system of soil and surface water continues to operate. Pollution of water courses continues to occupy attention and investigations are carried out in the affected areas. Work on the East Middlesex drainage scheme is now proceeding in the borough and preparatory work on the Stonebridge Scheme is in hand. Flooding in Tottenham The heavy rains in July and August gave rise to flooding in the Borough on the 9th July and again on the 6th August, 1956. In addition to the surcharging of the surface water sewers, the soil sewers and drains also overflowed in many places and one of the most serious aspects of the flooding from a public health point of view was the sewage contaminated residue left by the flood water below floors and covering the gardens. Disinfectant was distributed as required by householders for use in cleansing their homes and wherever possible articles were collected for drying at the Disinfecting Station, The more seriously affected areas were (1) Broad Lane area Markfield Road Broad Lane Cunningham Roarl Spondcn Road, and part of Antill Road.. (2) Culvert Road area Parts of Braemar Road, Culvert Road, Elizabeth Road, Grove Road, Henry Road, Kent Road, Russell Road, St. Ann's Road. St. George" s Road Seven Sisters Road, Sutton Road and Victoria Crescent, {3 Harringay Road and Colina Road (1) Broad Lane Area The flooding in this area was very severe on the 9th July, but fortunately on the second occasion the flooding was limited to the roadway only in Markfield Road. The July flooding, however, was very serious in Markfield Road,, particularly as the flood water 29 was heavily contaminated with crude sewage, with consequent danger to health. The houses which suffered most heavily were Nos, 50 118 which are on the East side of Markfield Road and are zoned for industrial redevelopment. Nos. 50 98 had already been dealt with as unfit houses and the Council s action confirmed by the Minister of Housing and Local Government, It was agreed that the occupants should be rehoused and the houses then demolished at an early date. As a result of official representations of the Medical Officer of Health with respect to Nos. 100 118 Demolition Orders were made and it was agreed to give priority to rehousing tenants. The houses in Cunningham Road and Spondon Road are of moderate construction and most of them have no damp proof courses. They are subject to a certain degree of dampness which had been aggravated by the flood conditions. It was decided to deal with one block of five houses as a small clearance area, (2) Culvert Road area The houses in this area were flooded to depths varying between a few inches to one and a half feet and the flooding on the 6th August was the more severe and took longer to subside. Heavy contamination of the flood water with sewage occurred in many instances where drains W Cs, and soil manholes overflowed. With certain exceptions the houses in this area are of moderate construction. Dampness to some degree exists floor construction in some cases is poor, joists resting on the sub-soil. The standard of maintenance varies considerably with ownership. Particular attention was drawn to Nos„ 16 38 Braemar Road and Nos. 28-44 Rent Road, These houses are 75 80 years old. with ground floors below the road level. They are exceedingly damp and poorly constructed, The general standard of maintenance is low. These houses were in an area scheduled for representation in 1958 for clearance and redevelopment. It was considered that more immediate action was required and it was agreed to bring forward the area in the programme. As the area was scheduled for housing it was dealt with by a clearance area compulsory purchase order. The Order is now awaiting the Minister s approval, (3) Harringay area Some of the houses in Harringay Road were flooded to depths between 3 and 4 feet in the back rooms of the houses. The houses 30 are, however, of better construction than in any of the other areas. Flood Relief Schemes Government authority has been obtained to proceed with the Stonebridge Brook Improvement under the Tottenham Corporation Act, 1952 and detailed plans and contract drawings are in course of preparation. Application has also been made for approval of the Heybourne Ditch flood relief scheme. In addition the Lee Conservancy Board are proceeding with the Pymmes Brook improvement and this work is making good progress. These schemes, when completed, should prevent any serious flooding in the future. General Observations The Public Health Staff made frequent visits to the flooded areas and assisted with immediate first aid measures. A detailed house to house inspection was carried out on the more severely affected properties as soon as these were sufficiently dried out. Notices were served to deal with any defects found. In addition a survey was carried out on the flooded areas and inspectors obtained full information from householders on the nature of the flooding and the extent of the damage caused. Health Visitors in each area visited the victims paying particular attention to children, and continued to do so at regular intervals until it was considered the danger of infection had passed. The report of the Superintendent Health Visitor indicated that the health of the children remained good. Closet Accommodation The water carriage system is in operation throughout the Borough and regular visits by the Public Health Inspectors ensures that satisfactory provision i s made in factories and other buildings. Atmospheric Pollution In my last Annual Report mention was made of the "Clean Air Bill" then before Parliament. 31 ATMOSPHERIC POLLUTION RECORD, 1956 Park Lane St.. Ann's Tottenham Technical College Rainfall Insoluble Deposit Soluble Deposit Rainfall Insoluble Deposit Soluble Deposit Snake Sulphur Dioxide Monthly Average Highest Daily Average Monthly Average Highest Daily Average (ins) (Tons per square mile) (ins) (Tons per square mile) (Mg/m3) (Mg/m3) (Parts per Million) January 2.98 8.43 8.31 2.76 6.75 6.34 .55 1.75 .13 .38 February 0, 22 7.47 4.89 0.24 6.31 4.55 .37 1.93 .11 .46 March 0.80 8.45 5.20 0.84 11.25 5.61 .23 .66 .09 .18 April 1.10 8.84 5.18 1.20 9.81 5.20 .19 .72 .09 .19 May 0.59 5.76 2.68 0.53 7.12 2.38 .08 .12 .04 .10 June 2.47 5.51 3.58 2.7 6.17 3.98 - - - - July 4.45 1.92 5.76 4.65 6.24 5.43 .04 .10 .02 .05 August 4.40 2.28 4.60 5.57 4.38 8.44 .09 .17 .02 .05 September 2,08 5.23 6.98 2.23 6.66 6. 35 .09 .19 .03 .11 October 2.04 4.83 3.97 2.19 4.42 4.82 .23 .65 .08 .17 November 0.35 4.96 3.66 0.34 5.09 3.16 .33 .95 .10 .44 December 2.56 7.94 7.38 3.49 9.17 8.18 .38 1.72 .09 .37 32 The Bill has now become an Act known as the Clean Air Act 1956 and received Royal Assent in July, 1956. The main purposes of the Act can be summarised as follows (1) To prohibit the emission of dark smoke (2) To prohibit the installation of industrial furnaces which do not consume their own smoke. (3) To minimise the emission of grit and dust from existing and new industrial furnaces, (4) The establishment of Smoke Control Areas, The various provisions of the Act will come into force, as and when "appointed days'" are fixed by the Minister. Since the Act received Royal Assent certain of its provisions became law on 31st December, 1956 viz Section 3. Requirement that new furnaces shall so far as practicable, be smokeless, Section 4. Gives the Minister power to make regulations regarding apparatus for measuring the density of smoke. Section 10, Enables the Local Authority to regulate the height of chimneys, Section 11 12 etc. Empowers Local Authorities to declare their area or part of it, Smoke Control Areas, It would appear to be the Minister's intention that the appointed day in respect of the emission of "dark smoke" from chimneys shall not be until 1958. In this respect therefore the Clean Air Act will not produce any spectacular results. Persistent offenders will continue to enjoy the apparent weakness of existing law. The new powers available for creating Smoke Control Areas will require to be carefully considered. They are in a measure, similar to the power in the Tottenham Corporation Act 1952, The Clean Air Act however recognises that complete smokelessness in an area may not be possible, This part of the Act contains important financial provisions whereby the local authority are required to make grants for the conversion or adaptation of fireplaces. In turn the local authority will obtain financial assistance from the Exchequer. 33 Housing The tempo of "clearance area" work has been maintained during the year. Public Inquiries were held during the year in respect of five clearance areas represented in 1955. Objections were received against the inclusion of some 70% of the houses involved in the areas. Four clearance areas were officially represented in 1956 and in respect of one of them a Public Inquiry took place at the end of the year. Consequent upon severe flooding some amendments have been made in the clearance area programme. As indicated in another part of my report two areas Kent/Braemar Roads and Cunningham Road have been brought forward and were the subject of official representations. POST WAR CLEARANCE AREAS Area Number of Dwellings Date Represented Inquiry mation Rehousing Occupants Completed Demolition of Premises Completed Arthur Road 19 2 8.11.50 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 Markfield No, 2 18 28.10.52 5.5.53 27.7.53 5.56 7,56 The Hale 65 2.2.54 6.7.54 9.3.55 5.56 8.56 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 Purchased by agreement Plevna Crescent No., 1 13 29.11.55 11.10.56 Not confirmed No. 2 6 29,11.55 11.10.56 Not confirmed No. 3 7 29.11.55 11.10.56 Not confirmed St. Ann s Road 5 29.11.55 11.10.56 14.2.57 Hartington Road 15 29 .11.55 11.10.56 14.2.57 Northumberland Parte 26 28.2.56 19.12.56 Markfield No. 3 80 3.7.56 Braemar Road/ Kent Road 21 2.10.56 Cunningham Road 5 27.11.56 34 Sections 9 and 10 It is inevitable that the majority of complaints concerning houses and repairs should come from the older houses. Where complaints relate to other houses the repair sections are used. There has been a reduction in the amount of work done in default under the Housing Act, but this is balanced by the increase in work done under the Public Health Act, 1936 and/or the Tottenham Corporation Act, 19 52, One of the major problems continues to be the complaints from the occupiers of houses in confirmed clearance areas. In many cases the owners continue to draw rents before acquisition by the Council but are reluctant to expend monies on repairs. This is very evident where the owners interest is only leasehold and his compensation likely to be nominal. As an expedient undertakings not to relet have been accepted and the occupiers rehoused. The policy of letting empty houses in confirmed clearance areas is to be deplored in such cases the house should be closed or demolished HOUSING ACT 1936 SECTIONS 9 and 10 WORK IN DEFAULT YEAR NUMBER OP HOUSES COST £. s. d. 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 1956 19 489 10 8 35 Section 11 etc. This section which enables the local authority to make a demolition order in respect of an individual unfit house, has been used during the year. Included in the houses dealt with was a terrace of houses in Markfield Road which again were subject to severe flooding. One aspect of dealing with individual unfit houses now arises out of the Slum Clearance (Compensation) Act. This Act provides for well maintained payments to be made under Section 42 of the principal Act. In the case of clearance areas these applications are dealt with by the Central Authority but the local authority deal with them for individual unfit houses. One such application was received during the year. HOUSING ACT 1936:-SECTION 11 Premises the subject of Demolition Orders not demolished as at 31st December,, 1956 PREMISES DATE OP ORDER 87, Hennitage Road 29.3.56. 46, Love Lane 15.7.54. 100, Markfield Road 5.10.56 102, Markfield Road 5.10.56 104, Markfield Road 5.10.56 106. Markfield Road * 5.10.56. 108, Markfield Road * 5.10.56. 110, Markfield Road * 5.10.56. 112, Markfield Road 5.10.56. 114, Markfield Road 5.10.56. 116. Markfield Road * 5.10.56. 118 Markfield Road * 5.10.56. 250, St. Ann s Road * 31.10.56. 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. 382, West Green Road 30.1.56. 490, West Green Road 29.12.55. * These premises were still occupied at 31.12.56. 36 Certificates of Disrepair There is a marked reduction in the number of applications for certificates of disrepair. Property owners and others will, however, be aware of the Government's intention to introduce legislation into Parliament dealing with rents, A rent bill was, in fact, introduced in the House of Commons in the latter part of the year. The provisions of this Bill are well known and have already led to much controversy. It will be sufficient for me to comment on one aspect only that part dealing with certificates of disrepair. The present method is reasonably straight forward. but whatever the merits of the proposed new system it is certainly much more involved and likely to lead to much criticism in its operation. The following statement shows the number of cases dealt with during the year and the number remaining in force at the 31st December 1956, Certificates outstanding at 1st January 1956 121 Applications received during 1956 48 169 Applications withdrawn by applicants 2 Certificates refused by Council 0 Certificates revoked on completion of repairs 51 53 Certificates in force at 31st December, 1956 116 Rag Flock and Other Filling Materials Act, 1951 At 31st December, 1956 one establishment was licensed for the manufacture of rag flock and twenty-three premises were registered for the use of filling materials. Pet Animals Act 1951 At 31st December, 1956 fourteen premises were licensed as pet shops in accordance with the Pet Animals Act, 1951, Rodent Control Rodent control methods in use in the Borough continue to be 37 those approved by the Minister of Agriculture and Fisheries. Sewer treatments were carried out during the months of April/ May and October/November. Certain variations in the method of baiting were adopted during the sewer treatment and it is expected that further modifications will be introduced after certain investigations by the Ministry technical staff are concluded. Complaints from private dwelling and from business premises have been dealt with and the use of Warfarin has continued. Sewer Maintenance Results of baiting manholes Poison take at Manholes Treatment No. 23 April/May Treatment No. 24 Oct/Nov. Complete - - Good 198 120 Snail 319 432 Nil 503 438 Estimated number of rats killed 6,085 5,280 Poison used 2½% zinc phosphide 10% arsenious oxide The following is a summary of dwelling houses and business premises treated during 1956 (1) Dwelling houses 605 (2) Business and Factory premises 191 (3) Total charge for (2) above £ 129-5-6 Insect Pests The use of 5% D. D. T. solution in an emulsion form has been retained together with the application of DDT powder in certain cases. This is found to be an efficient and a reasonably cheap form of insecticide. 184 inspections prior to removal to Council houses have been made on notification by the Housing Manager, and disinfestation was required in seven cases. 38 Cause Private Houses Council Houses Other Premises Total Houses Rooms Houses Rooms Houses Rooms Others Ants 19 5 schools 19 5 Beetles 9 8 4 schools 1 public house 1 shop 9 6 Bugs 78 168 1 79 168 Cock roaches 14 12 2 schools 14 12 2 Earwigs 1 1 Fleas 7 17 7 17 Flies 2 3 2 shops 1 factory 2 3 3 Lice 1 2 1 2 Red Mites 3 3 Sliders 2 2 Wasps 8 8 Woodworm 1 1 Inspections carried out by the Public Health Inspectors Appointments and Interviews 1 072 Cinemas & Halls 54 Complaints Investigated 3,883 Conveniences and Urinals 93 Drains defective 273 Drains tested 433 Factories with Mechanical Power 447 Factories without Mechanical Power 27 Food Poisoning 32 Food Premises Bakehouses 107 Butchers 264 Cafes 476 Dairies 175 Factories 41 Factory Canteens 60 Fishmongers 130 Greengrocers Ice Cream Premises 114 Slaughterhouses 886 Other Food Premises 304 House to House — 215 31 Improvement Grants Infectious Disease 237 Other Visits 3,660 39 Out workers 253 Rat Infestation 933 Re-inspections 8,706 School 31 S. D. A A. & Housing Act Advances 187 Smoke Observations 81 Stables and Mews 34 Tuberculosis 5 Workplaces 31 Defects Remedied Drains reconstructed 21 Drains repaired 317 Drains cleared 239 W. C. Cisterns repaired or renewed 151 W. C. Pans renewed 164 W. C. Pans cleansed 28 Waste Pipes repaired or renewed 225 Rain water pipes repaired or renewed 235 Roofs repaired or renewed 735 Eaves Gutters repaired or renewed 446 Drinking Water Cisterns renewed 13 Drinking Water Cisterns covered 9 Water Service Pipes repaired 119 Water Supply reinstated 64 Yards repaired or reconstructed 113 Sinks renewed or provided 37 Floors repaired or renewed 289 Floors ventilated 88 Dampness remedied by insertion of damp proof courses 67 by pointing of brickwork 140 by internal rendering 315 by miscellaneous remedies 172 Window Frames and Sashes repaired or renewed, or painted 458 Coppers repaired or renewed, or provided 8 Fireplaces, Stoves & Ovens repaired or renewed 181 Flues and Chimney Stacks repaired 153 Brickwork of Walls repaired and Walls rebuilt 119 Ventilated Food Stores provided 4 Rooms cleansed 543 Staircases, Passages & Landings cleansed 50 40 Staircases, Balconies and Steps repaired or renewed 68 Noxious Accumulations removed 43 Nuisances arising from Animals abated 5 Miscellaneous Defects remedied 1,020 Notices Served Statutory Housing Act, 1936 Section 9 161 174 " 11 13 Public Health Act, 1936 Section 24 19 407 " 39 56 " 4 20 " 56 2 " 79 1 " 94 309 Tottenham Corporation Act, 1952 Section 36 14 163 " 43 148 " 54 1 744 informal notices 1 759 Repair of Houses by the Council Work carried out in default or by agreement with the owners during 1956 Housing Act 1936 £ s. d. Section 9 19 premises 489 10 8 Public Health Act 1936 Section 24 19 premises 116 17 0 " 39 5 " 115 1 10 " 45 3 " 28 3 6 " 94 3 " 30 9 5 8 Tottenham Corporation Act, 1952 Section 36 4 premises 48 3 8 " 38 1 " 2 7 9 " 43 71 " 892 8 1 " 54 1 " 13 2 2,002 11 4 41 PART IV FACTORIES AND SHOPS There is a general scatter of industry throughout the Borough, with concentrated industrial areas to the east of the High Road in the vicinity of the River Lea. The 725 registered factories vary in size from those employing only 2 or 3 people to the larger concerns with 2,000 to 3.000 employees. Regular systematic inspections are carried out by the public health inspectors to ensure compliance with those parts of the Factories Acts which are enforceable by the local authority. Factories Acts 1937 and 1948 Inspections for purposes of provisions as to health (including inspections made by Public Health Inspectors) NUMBER OF Premises Number on Register Inspections Written Notices Occupier Prosecuted (i) Factories in which Sections 1,2, 3 4 and 6 are to be enforced by Local Authority 59 27 - - (iii) Factories not included in (i) in which Section 7 is enforced by the Local Authority 666 447 21 - (iii) Other premises under the Act excluding Outworkers premises; 9 9 - - TOTAL 734 483 21 - 4 2 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) - - - - Inadequate ventilation (S.4) - - - Ineffective drainage of floors (S.6) - - - - Sanitary Conveniences (S.7) (a) Insufficient - - - - (b) Unsuitable or defective 33 27 - 23 (c) Not separate for sexes 1 1 - - Other offences against the Act (not including offences relating to Outwork) 1 1 - - TOTAL 35 29 - 23 Outworkers Regular visits were made by the public health inspectors to the homes of persons notified to the department as outworkers in accordance with the provisions of sections 110 and 111 of the Factories Act 1937, The following is a summary of the types of work undertaken by outworkers in the borough Wearing apparel 363 Household linen 8 Curtains and furniture hangings 2 Files 3 Umbrel1as 3 Artificial flowers 3 Nets other than wire nets 8 Paper bags 4 The making of boxes or other receptacles or parts thereof made wholly or partially of paper 62 Brushes 1 Feather sorting 1 Carding, etc. of buttons, etc. 7 Stuffed Toys 4 Cosaques Christmas crackers, Christmas stockings, etc. 17 Lamp shades 7 TOTAL 491 253 visits were made during 1956 to outworkers premises, No contraventions were reported. 43 Survey of Industrial Health Services in a Ward in the Borough A report on a pilot survey of occupational health in an industrial area of the Borough was presented in my Annual Report for 1952. As an extension to the first report a survey has now been completed in the Chestnuts Ward. All registered factories therein were visited and inspected after a preliminary explanatory letter had been sent out. Pull co operation in all instances was given by the varying managerial staffs and proprietors, making for full co operation in the task of inspection. A total of 66 factories came under this second survey: and are listed as follows THE FACTORIES Type No Type No. Bakehouses 2 Leather Belting Mfrs. 1 Battery (Wet) Charging and Repairs 1 Liquid Soap & Antiseptic Spray Mfrs 1 Battery (Dry) Mfrs. 1 Masons Builders Yards (Joinery) 3 Metal Crafts (Shopfitting, Aircrafts) 1 Button & Buckle Mfrs. 1 Cardboard Box Mfrs. 1 Metal Polishing 1 Chemists (Manufacturing 1 Optical Mfrs. 1 Clothing Mfrs. 8 Perfumery & Cosmetics Mfrs. 1 Electric Equipment Mfrs 3 Printer 1 Engineering, Light 6 Rubber Surgical Appliances Mfrs. 1 Pishing Tackle Mfrs 1 Sign Writers 2 Furniture and other woodwork Mfrs, 7 Slaughterhouses 1 Spraying & Enamelling 1 Foundry 1 Stationer (Mfrg,) 1 Garages (Service and Repairs) 5 Tiled Fireplace Mfrs. 2 Hospital Equipment Mfrs. 1 Timber Works & Joiners 1 Jewellery (Imitation) Mfrs, 1 Vulcanised Fibre Case Mfrs 1 Laundries 3 Size of Factory The above mentioned factories have been grouped in sizes according to the number of workers actually employed. No account has been taken of office staff. 44 Factory employing No. of Factories Total Population 1 person 3 3 2-4 persons 10 27 5-9 " 14 87 10-24 " 15 219 25-49 " 13 406 50-99 " 4 228 100-249 " 5 7 35 250-300 " 2 563 66 2,268 In more general terms it is convenient to classify the factories as small, medium and large. Factory employing No. of Factories Total Population (small) Under 25 Persons 42 336 (medium) Above 25 but under 100 17 634 (large) Above 100 7 1,298 66 2,268 or more generally still 59 factories with less than 100 persons each, employ 970 persons 7 factories with more than 100 persons each, employ 1„ 298 persons Employees The factory population consists of 1,244 male persons 1,024 female persons Total 2,268 Included in the above figures are Young Persons (under 18 years-95 (62 male, 33 female) Aged Persons (over 60 female, 65 male) 84 (47 male, 37 female Disabled Persons (on disabled register 49 (38 male, 1) female 45 Women A high number of women were employed in the various industries and generally gave a good account of themselves, as compared with men. However, it was agreed that despite good service that on the whole there was always the greater liability to absenteeism in the case of women. This occurred not so much through personal illness as through illness in other members of the family or other purely domestic reasons, e.g. being at home to let the sweep in. Naturally, married women were susceptible to such considerations to a greater degree than the unmarried. Young Persons Young persons were found to be generally scattered through the various trades and there was not sufficient grouping of them in particular occupations to call for any special comments. Accidents among young persons were very low but it was found that where 1 arge numbers of young persons were employed together, accident rates went up this being due to 1ack of experience and "sky larking" attitude of many of them. It seems that young persons scattered in with more experienced workers are given a better chance for gaining sound experience and a more responsible attitude. Aged Persons The older group of employees carried out very useful work. Those who had to leave their previous occupation for less arduous tasks adapted themselves well. Most however, were able to continue in their former occupation and to bring their experience and skill to bear in an exemplary fashion. One firm continued to employ 15 men well over pensionable age, and this was to the benefit of all concerned each was a well respected personality and their work was of interest and pleasure. It was found that elderly female persons were employed in comparatively large numbers in laundries. Disabled Persons The numbers encountered were small i.e. 1-3% of the total factory population. However, in factories employing more than 20 persons (that is those factories required by statute to take a percentage of disabled persons) the figure is l.9%. The statutory percentage is 3%. 46 Medical Arrangements One firm only, possessed a full time medical officer who supervised other branches as well as the Tottenham Factory, Pour factories had the part time services of an industrial medical officer. The remaining sixty-one factories had no arrangements what so ever for a visiting medical officer. Surgery accommodation The five above mentioned factories staffed by a medical officer had suitable surgery accommodation for the carrying out of medical advice or treatment. In one case where there was a full time medical officer there was also a qualified nurse in charge of the surgery. The remaining four factories shared a communal surgery as their premises were close to each other with a qualified nurse in charge. At the surgeries accidents and illnesses were treated as they occurred by the doctor or the nurse as the case may be. Where necessary patients were referred to their own general practitioner or, in an emergency to hospital, The medical officer concerned kept his eye on each factory as a whole and advised on general health problems and any potential industrial hazard, Pre employment medical examinations Other than the statutory medical examinations carried out by the appointed Factory Doctor on young persons pre employment examinations were almost non existent. Only one firm had this facility. Only where an obvious physical defect existed in a person about to be employed was a medical examination arranged before acceptance. The importance of pre employment examinations cannot be overstressed. The benefits are three fold, 1. to the employer, fitness for the particular job is assessed 2. to the employee it is an advantage to know his health is in good order 3. to the community early detection of communicable and other diseases'prevents spread of infection and facilitates early treatment. 47 The absence of this type of medical examination in industry is to be deprecated. Routine Medical Examinations No firm had commenced routine periodic health inspections for their employees,, for example, a full examination every year or every two years This type of health overhaul is slow in becoming popular with employers and employees but is necessary especially for persons over 40 years of age. First Aid Boxes On the whole the situation concerning first aid boxes was unsatisfactory. Thirty four factories had no person earmarked to look after the box itself and keep its contents replaced. In two cases there was no first aid equipment at all. In 15 other instances although persons were earmarked to look after the equipment they possessed no training in first aid nor did anyone else on the premises. Only 9 factories had trained personel to give first aid as required. Six factories had qualified nurses (SRN) on their staff and five of these had a visiting doctor. Tabulation of the provision of first aid boxes and Trained Personnel Factories No arrangements 2 Very unsatisfactory First aid box 'nobody earmarked for 34 Unsatisfactory trained First aid box untrained person in 1-4 Of doubtful value charge) First aid room (untrained in charge) 1 Of doubtful value First aid box (trained person in charge) 9 Satisfactory First aid room (S R N. in charge) 1 Highly satisfactory First aid room (S.R.N. and visiting 5 Excellent doctor) 48 Type and Condition of Premises As may be expected in a part of the Borough where industry is scattered amongst residential property the premises occupied varied considerably. For most part old buildings have been adapted for the purpose required. Instances of this were buildings constructed and probably used in the past as stables being adapted for use as garages or monumental masons: large private houses for the manufacture of children s hose and shop premises used for light engineering. Generally, the alterations had been carried out so as to give the maximum working space and buildings on the whole were reasonably suitable for the purpose. Larger factories such as foundries and timber merchants appeared to have been constructed for the purpose for which they are now being used. In many cases room for expansion was non existent and problems arose from time to time because of the close proximity of residential and industrial properties. Analysis of the inspection of premises yielded the following results Disrepair Old but suitable Satisfactory Very good 3 30 27 6 Overcrowding The only instance of congestion observed appeared to be due to finished products awaiting removal. This was particularly noticeable in firms making bulky furniture such as wardrobes and kitchen cabinets. Generally the arrangement of machinery and work benches seemed to have been carefully planned to avoid congestion. Lighting Although natural lighting was often found to be insufficient artificial lighting was generally found to be good. Even small firms occupying old or adapted buildings frequently had fluorescent lighting so arranged as to give good light with absence of shadow or glare. Many machines were observed to have individual lighting direct on the working area. It was noticeable that managements in some cases had given careful consideration to working amenities such as lighting seating, height of work benches, in order to minimise fatigue. 49 Heating and Ventilation Generally, heating and ventilation appeared to be adequate. In a small number of factories where the process was relied upon to supply sufficient heat in the winter the difficulty of keeping the atmosphere at a reasonable temperature during the summer months was apparent at the time of the survey, Some effort had already been made by means of extractor fan systems and ducting to overcome an overheated atmosphere. Managerial advice had been given in one instance on the use of saline drinks to overcome the dehydrating effect of working in heat for long periods. Advice was also given on the use of coke stoves and in one case attention was drawn to a defective flue pipe which constituted a hazard the danger of which had not been appreci ated. Sanitary Accommodation The sanitary accommodation regulations 1938 were in all cases found to have been complied with. In some factories however where the minimum requirements were observed the number of w. c s. appeared to be insufficient. A number of firms, in which the employees were working with oil or other substances difficult to remove from the hands supplied barrier creams or substances such as Swarfega and Rozalex for removing oil and grease. Labour Turnover and Absenteeism As accurate figures would have entailed considerable work on the part of managements it was thought reasonable to ask only for a general impression of these two points. With notable exceptions the answers in the majority of enquiries were 'very low1'. One firm employing a large number of married women remarked on the frequent absence of women owing to family and domestic reasons. Another firm employing elderly female labour stated that the sick ness rate was Bas could be expected", rather high. Some firms mentioned that although the labour turnover appeared high this was due to a quick turnover of a small section whereas a solid core of workers had been with them for a considerable number of years. Generally, it appeared that labourers and semi skilled workers changed their jobs much more frequently than the tradesman and other skilled worker. 50 Welfare and Personnel Management In most of the factories visited no hard and fast rules had been laid down as to welfare of employees, but works managers or proprietors used their discretion with regard to problems which arise from time to time having in mind circumstances including the time the worker had been with the firm. This principle seemed to apply to payment for time off, sick pay and pensions. In only five of the sixty-six firms visited were pension schemes in operation and these varied considerably in the amount of contribution, if any, from the workers and also in the benefits conferred. Wages and Working Conditions In every case information was readily given on weekly earnings of skilled, semi-skilled and unskilled workers. Comparison, however, was extremely difficult owing to the operation of bonus schemes which were based on such varying factors as production, years of service, work carried out by individuals in excess of standard amounts, overtime, etc. From a comparison of the wage levels and general conditions of working, however, it was noted that where the. envi ronment was poor and the working conditions comparatively unpleasant the wages were correspondingly high. INDUSTRIAL HAZARDS Accidents Fortunately these were not frequent occurrences, and major accidents extremely rare. Hands Injury to hands was the commonest form of accident sustained by workers throughout these industries. Cuts and crush injuries mainly occurred from machinery. Eyes Injuries to eyes were next in frequency and these arose from fragments of metal, particles of stone and sand and splashes from dangerous or hot fluids. No case of "arc welders eye" was reported or any cataract due to infra red radiation. Falls caused a few accidents but were rare as compared with the above mentioned injuries. 51 Fencing of Machinery was of only a fair standard on the whole, but there were notable exceptions either way. Some firms had the most up-to-date method of fencing and safety devices, whereas others had the minimum. Noise Most factories experienced a tolerable amount of noise. The noisiest however were not so serious as to render a permanent injury to the hearing mechanism. Noises of over 100 decibels were not encountered and it is above this intensity that trouble may arise. Weight Lifting No instance of over weight lifting was recorded. Experience in the artof weight lifting and use of mechanical devices prevented this hazard. Exposure to Weather This aspect was well taken care of by the employees and the managements. All workers out of doors were suitably clad. However, certain workers in an electrical firm were exposed to overheating and this in turn cause sweating and consequent dehydration and loss of salt from the body. In this respect (special fruit flavoured) saline drinks are necessary to maintain the body fluid balance. We were able to advise the names of manufacturers of such drinks. Toxicological Hazards Dusts Harmful dusts were not encountered in any great quantity. (a) Siliceous particles arose from fettling and sanding machines which had dust extractors at source. No person working in such occupations was reported as suffering as a result and x rays of chest were likewise reported as clear. In respect of these particles, those which are not seen cause the damage. It is estimated that particle size less than 5 Microns (5 thousanths of a millimetre) may cause trouble deep in the lungs. Talc powder was not shown to cause trouble. X rays of chest 52 in a worker employed in handling this substance were reported to be clear. (b) Asbestos particles One firm employed a man in a temporary occupation drilling asbestos sheets, for two half days per week in an open atmosphere. Should this work increase the firm stated they were intending to install an extractor plant. Fumes Lead burning in the repair of accumulators was carried on in a small way as a part time occupation. This case was under observation by the appointed factory doctor. Small quantities of fuming nitric and other acids were used by some firms but were handled with great care in fume extraction cabin ets. Gases Vapours and Liquids (a) Carbon monoxide Its dangerous properties were well known to the garages visited and suitable ventilation was provided with reduction of engine running to a minimum. But its danger was certainly not realised by one firm where a metal chimney inside the factory was fractured in many places. This was immediately pointed out to the manager and arrangements for repairs put under way at once. (b) Carbon tetrachloride and Carbon bisulphide These were used as rubber solvents and cold curing of rubber respectively. Proper precautions were taken by the firm handling these substances and the away draught fume cabinet was entirely satisfactory. (c) Trichlorethylene was used by one laundry for cleaning purposes. The modern enclosed process was very satisfactory, Nevertheless it was still possible to faintly smell this substance in the atmosphere of the room. (d) Cellulose Spraying was carried out strictly according to regulations Spraying Booths providing a satisfactory method with their extraction fans and ducting to the outside atmosphere. In one instance the ducting could have been extended high above the 53 building. An upstairs workroom had a faint smell of the substance when the wind was in the wrong direction. (e) Thinners of various types The use of these for cleaning hands of painters, etc. was known to be a hazard and not risked. Dermatitis This condition of the skin was a rarity in the firms visited. Primary irritants such as strong acids, and alkalis were handled., with great care. No case from this cause was recorded. Sensitlzers It was once said that "One can become sensitive to everything under the sun including sun". This puts in a nutshell the liability of any person at any stage of their lives suddenly becoming sensitive to a substance they may have been using for 20 years or more. It is an altered reaction on the part of the body to the substance. It begins usually with irritation of the skin over the exposed parts and where volatile substances are concerned the soft tissues about the eyes often swell. Common sensitizers are primulae and other plants, nickel, mineral oiE contaminants, antiseptics and medicated soaps. The few cases reported to us had all left their particular occupations where some substance had caused the sensi tivi ty. These, in the main, were attributed to mineral greases, paraffin, cutting oils or a mixture of them. "Barrier Creams" were widely supplied and used. Meals on Premises Canteens 8 Mess Room 18 Tea only 34, No provision 6. The 8 canteens provided excellent mid day meals and provided for morning and afternoon tea breaks. Mess rooms provided a place where employees could take their own midday sandwich lunch. In those factories where no provision for meals was made sandwich midday meals, in some instances, were eaten in the workroom. Summary of Findings As on the occasion of the previous survey ( 1952) the conclusions to be stressed are:- (1) In many factories, particularly the smaller ones, first aid and other medical treatment is at present haphazard and unorgani sed. 54 (2) First aid equipment is very nearly useless unless associated with trained personnel to use it. (3) While there are notable exceptions, there is ample evidence of the need for education in matters relating to industrial processes and working environment. (4) The useful employment of able aged persons in local factories shows scope for further discussion with managements and others in tackling the problem on a broader scale. (5) The need for an organised local industrial health service, largely supervisory and advisory, is apparent. Shops In April of this year the Council appointed a full time Shops Inspector to work under the supervision of the Chief Public Health Inspector. The control of shops and effective administration of the legislation relating thereto are secured by systematic visita tion„ Investigations and visits were made on the weekly half holiday, after the general closing hour and on Sundays at certain times throughout the year. Complaints were promptly dealt with. Verbal and written advice and information has been given to many shopkeepers in the Borough, andithas been found that the majority of them are willing to fulfil their obligations as required by the Act. In an endeavour to ensure that the prescribed forms and notices are maintained and exhibited in the proper manner, the system of buying forms and notices in bulk and selling them to the shopkeepers has been adopted. This method means that contraventions of this nature are immediately rectified. A new Shops Bill has been introduced in the House of Lords by the Government and if enacted in its present form will produce important administrative changes. The Bill incorporates many reforms recommended by the Gowers Committee which dealt with anomalies that exists in the present legislation. The following is a summary of inspections patrols and observations made during 1956 and relevant action taken. Inspections 1,261 shops have been systematically inspected prescribed notices records of employment, etc., have been examined and the 55 necessary information obtained for keeping an up to-date register of shops in the Borough. During these inspections the following contraventions were no ted. Section 17(2): Assistants weekly half holiday notice not affixed in the shop 247 Section 32(2) Record of hours of employment of young person not being maintained 67 Section 32(3) Abstract of provisions relating to the employment of young persons not exhibited 62 Section 37(1) Seats for females not provided 3 Section 37(2) Notice re seats not displayed 183 In order to draw the attention of occupiers to these cdntraventions 274 informal notices were served and 180 re inspections were made to ensure compliance. In this connection 404 forms and notices were sold. 583 male, 1 168 female adult assistants, and 54 male and 113 female young persons, under the age of 18 yearswere employed at the premises inspected their hours of employment, meal-times and working conditions received special attention. Weekly Half Holiday The following contraventions were observed Section 1(1) Shops not closed at 1 p.m. 20 Section 1(2) Alternative closing notice not dlsp1ayed 13 Section 13(1) Exempted trade notices not displayed or in possession of the occupier 75 In eleven of the cases where shops had failed to close at 1 P.m. on the weekly half holiday no transactions were seen to take place and informal notices were sent. In the remaining nine cases eight warning 1etters were sent and legal proceedings were instituted against the other offender. Informal letters were also sent to occupiers where notices were not displayed. In this connection 53 notices were sold, and one occupier was prosecuted for failing to display the prescribed exempted trade notice on the weekly half holiday, 56 General Closing Hours The following contraventions were observed:- Section 2 The sale after 8 p.m. of articles not exempted by the 2nd Schedule 6 Section 12 Trading after closing hours elsewhere than in shops 1 Warning letters were sent to four shopkeepers for offences under Section 2, Legal proceedings were instituted against two offenders under that section and against the offender under Section 12, Sunday Trading The following contraventions were observed:Section 22(1) Compensatory holidays not being allowed for Sunday employment 10 Section 22(3) Record of Sunday employment not kept 18 Section 47 Sale of goods not exempted by the 5th Schedule 21 Section 50 Sunday trade notices not displayed or in possession of the occupier 118 Informal notices were sent to the occupiers of shops with regard to holidays for Sunday employment and for not keeping a record. Re inspections were made to ensure that the requirements of this part of the Act were being carried out. For failing to keep a record one shopkeeper was prosecuted and one warning letter was sent. 13 Form VII (Record of Sunday employment) were sold. Warning letters were sent to 15 shopkeepers for illegal Sunday trading, and in the remaining six cases legal proceedings were instituted. 77 notices were sold to occupiers under Section 50, Informal notices were sent to all requiring them to exhibit these notices on Sunday, It was found necessary to prosecute 4 shopkeepers for failing to do so. Section 53: Jewish Traders During the year the names of two traders were removed from the register and one was added; the total on the register now being five. 57 One trader was prosecuted under this section for being open after the commencement of the Jewish Sabbath contrary to the conditions of his registration. Prosecutions Details of prosecutions held at the Tottenham Magistrates Court were as follows:- Offence Section Fine Costs Total Case 1. Selling fruit and vegetables after 8 p.m. from a van 12 £1. 10. 6d £1. 10. 6d Case 2. Selling cigarettes after 8 p.m. 2 £1. 10. 6d £1. 10. 6d Case 3. Selling non-exempted goods on a Sunday. (4 Summonses) 47 £4. £1. 1. 0d £5. 1. 0d Case. 4. (1) Selling flour on a Sunday (2) Non-exhibition of Notices (2 Summonses) 47 & 50 £2. £2. 2. 0d £4. 2. 0d Case 5. (1) Selling pine disinfectant on weekly half holiday (2) Non-exhibition of Notices (2 Summonses) 1 & 13 £2. £2. 2. 0d £4. 2. 0d Case 6. Selling a non exempted article * a Sunday 47 £1. 1. 0d 10 6d £1. 11. 6d Case 7. Non exhibition of Notices on a * Sunday 50 £1. 1. 0d 10. 6d £1. 11. 6d Case 8. Selling non-exempted articles * after 8 p.m. 2 £1. £2. 2. 0d £3. 2. 0d Case 9. Open after commencement of Jewish * Sabbath 53 £3. £2. 2. 0d £5. 2. 0d Case 10. (1) Failure to keep record of * Sunday employment (2) Twice selling on Sunday nonexempted articles (3) Non exhibition of Notices on a Sunday (4 Summonses) 99 47 & 50 £6. £2. 2. 0d £8. 2. 0d Case 11. (l) Twice selling on Sunday nonexempted goods (2) Non-exhibition of Notices on a Sunday (3 Summonses) 47 & 50 £5. £2. 2. 0d £7. 2. 0d £27. 2. 0d £15. 15. 0d. £42. 17. 0d * Proceedings taken in 1957 for offences occurring in 1956 58 PART V i 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 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 697 516 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 patients clinics provided at the Prince of Wales s General Hospital is set out on the following page. 59 Prince of Wales s Hospital Time table of Out Patient Clinics Monday Tuesday Wednesday Thursday Friday Saturday Medical P.M. A.M. P.M. P.M. A.M. - Surgical P.M. P.M. P.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 - - - - - Genito-Urinaiy - A.M. - - - - Psychiatric P.M. - - - P.M. - Physical Medicine 9-5 9-5 9-12 9-5 9-5 9-12 X-ray 9-8 9-8 9-8 9-8 9-8 9-5 Orthopaedic - A.M. - A.M. - - Fractures A.M. A.M. A.M. A.M. A.M. - Allergy - - - P.M. - - Venereal Diseases Medical Officer Males 5-7 - 5-7 10-12.30 & 5-7 - 9-11.30 Females - 5-7 - 10-12.30 2-4.30 9-11.30 Intermediate Treatment 9-7 9-7 9-7 9-7 9-7 9-11.30 Doctors' Letters required All Patients seen by appointment The Casualty Department is always open for medical and surgical emergencies 60 (b) Personal Health Services The personal health services which since 1948 have been con trolled by the Middlesex County Council are administered from the Area Health Offices 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. 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 W, 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 Laboratory. As it is not possible to send a second messenger on any one day, it is essential that specimens be delivered to the Town Hall before the times stated. Alternatively, specimens may be sent direct to the Hornsey branch laboratory which remains open until 5.0 p.m. on Monday to Friday and 12 noon on Saturday. The address is:- 61 Public Health Laboratory, Coppett's Wood Hospital, Coppett's Road, N. 10. A 24 hour emergency service is maintained by the Central Laboratory at Colindale. The following is a summary of the work carried out during 1956, namely:- Record of Examinations Throat/Nose Swabs:- Total Specimens 157 Diphtheria Bacilli 0 Haemolytic Streptococci 7 Vincents Angina 1 Negative 149 Faeces:- Total Specimens 636 Polio Type one 1 Shigella 161 Salmonella Entereditis 2 Salmonella Typhi Murium 17 T. Saginata 2 Negative 453 Sputum:- Total Specimens 5 Positive 0 Negative 5 Pertussis:- Total Specimens 15 Positive 2 Negative 13 Ice Cream:- Total Specimens 7 Water: - Total Specimens 2 - Domestic Supplies 0 Swimming Pools 0 Flood Water 2 Miscellaneous Specimens 37 Total Number of Specimens 859 62 Aged Persons It is estimated that there are in the Borough approximately 14,000 persons of pensionable age. Most of them live a normal happy life of retirement in their own homes, Some continue at full time work others in part time occupations. Our attention is focussed on (i) The lonely aged (ii) The infirm aged and (iii) The sick aged These important groups have at their disposal the service of the following, (a) General Practitioners (b) Personal Health Services Under the Medical Officer of Health (c) Environmental Health Services (d) The Welfare Officer (Statutory (e) The Voluntary Welfare Services (f) The Hospitals (g) The Pensions and National Insurance Department(h) The National Assistance Board (i) Various other bodies such as Dental and Ophthalmic Services . (a) General Practitioners In the first instance the practitioner treats the minor and serious ailments of his aged patients. He may request: (i) The District Nurse (ii) The Home Help. (iii) For Sick Room appliances e.g. commode wheelchair etc, (iv) Meals on Wheels. (v) The person to attend an out-patient Clinic of a Hospital (vi) The Welfare Officer to see cases with a view to admission to a Welfare Home. 63 64 (vii) A hospital bed for an acute or chronic case (viii) Advice from the Medical Officer of Health who in addition to the numerous services under hiscontrol acts as the centre of liaison in most matters, (b) The Local Area Health Authority (i) The District Nurses (ii) The Home Helps (iii) Sick Room appliances Civ) Health Visitors (c) The Borough Public Health Authority (i) Soiled Linen Laundry for incontinent aged (ii) Housing for aged (iii) Visiting on behalf of the hospital the aged sick awaiting admission (iv) Removal of aged in need of care and attention, (Sec. 47 National Assistance Act) (v) Fumigation and disinfestation services where necessary (vi) Free use of slipper baths (vii) Library book delivery service (d) The Welfare Department Under its Welfare Officer carried out numerous visits to aged persons, The shortage of Welfare Homes for aged persons was a grave disadvantage. Numerous beds in chronic sick hospitalshave been occupied throughout the year by cases suitable for welfare homes. 65 (e) The Voluntary Welfare Services In addition to the services organised by the Old People's Welfare Committee, the Womens Voluntary Service, the British Red Cross Society and the Old Age Pensioners Association all do valuable work among the aged. Old People s Welfare Committee This Committee was established to provide for the welfare of the old people of Tottenham. Six members of the Council serve on the Committee and representatives are also appointed by the majority of local organisations who in some way are concerned with old people s welfare. A full time organiser and an assistant are employed on the work of the Committee. The following information has been extracted from the Annual Report of its Chairman. The Lady Morrison The activities of the Committee include the provision of chiropody and visiting optical services, delivery of Meals on Wheels organisation of old peoples clubs, distribution of gifts, and arranging assisted holidays.. In addition there is a considerable amount o f general wel fare vi si ting and advice by the Welfare Organiser who maintains a close liaison with all who have official responsibilities for health and welfare in the borough. The chiropody service provided by the Old Peoples Welfare Committee for elderly people helps to cover a gap in the local health services caused by the refusal of the Ministry of Health to approve any extension ofthe chiropody service provided under section 28ofthe National Health Service Act 1946. The following figures illustrate the growing demand for this type of,clinic. Year 1952 1953 1954 1955 1956 (8 months) No. of appointments 680 1,660 1,930 2,550 3,270 SUMMARY OF OLD PEOPLE S WELFARE SERVICES Home Visits 267 Office Interviews 3 368 Chiropody appointments 3 270 Optical Service Visits 22 Meals served by Meals on Wheels 4 860 Holidays arranged 114 Shoe repair dockets issued 42 66 Christmas and Other parcels distributed 1 388 Clubs 5 Club membership 620 Club Meals served 8,433 Women's Voluntary Services 3,360 meals have been cooked and served in connection with Fridays Meals on Wheels service and 3 022 meals have been cooked and served at the Luncheon Clubs on Fridays, Visitation of old people and much assistance in many ways is given to those in need of help. British Red Cross Society Organise three Evergreen Clubs with a membership of 370 who meet once weekly, and where summer outings and Christmas Parties are arranged and sick members visited. During the year 284 of their members have received foot care at their clinic which is held once a fortnight also 9 old people are visited once a week by the H, H. Service. O.A.P. Associations Six branches of this Association meet once weekly in the Borough where outings, socials are arranged and again valuable work is done by the visitation of their sick members, (f) The Hospital Services These offered a variety of out patient clinics of great benefit to the aged. In addition acute beds, medical and surgical, are always available. Chronic sick beds however were in great demand and more of them are urgently wanted. The Hospital Almoners carried out very good work in making welfare arrangements whilst the patients were in hospital and before their return home. (g) The Pensions and National Insurance Office The Officers of this Department keep in touch with aged persons and help in ensuring correct and regular payments are made. 67 (h) The National Assistance Board The Board's Officers help in numerous matters where need is established. Additional payments for nutritous foods in illness, extra coal, extra blankets etc., are often made. (i) Various other bodies play an important part in the health and welfare of the aged. The dental and ophthalmic services are avail able as and when required. Contribution of the Borough Health Services The Public Health Department under the Medical Officer of Heal th has been responsible for liaison between the various components of the services provided, as listed previously. Inparticular the work of the Department is concerned with (i) Arrangements for the laundering of soiled linen from incontinent aged. Collections and deliveries are made from door to door. This is of great help to those who have to care for the sick and infirm aged. A total of 662 collections and deliveries were made in 1956. (ii) The special requirement for housing the aged (iii) Visiting the Aged and Chronic Sick in relation to Hospital Admissions and discharges Ail names placed on the waiting list of the special wards in St. Ann s General Hospital at the request of the family doctors are forwarded by the Hospital Almoner to the Medical Officer of Health. Each case is visited and a report returned assessing all the environmental factors to elicit the degree of urgency for admission e.g. help from relatives, neighbours, friends district nurse and home helps is the person alone by day or night ? Is he mobile or bedridden ? Is he incontinent ? Who provides for feeding him ? The hospital is thus able to assess all aspects of each case as well as family doctor s medical diagnosis priority is then given to the really urgent cases. At the same time as his visit the Medical Officer is able to arrange any further services required pending the patient s admission if the case will not be immediately admitted. A total of 171 such cases were visited during 1956., 68 (iv) Urgent cases of lonely, infirm and sick occasionally come to light. Many of these have deteriorated on their own; and some refuse all medical attention, occasionally the patient has not even registered with a general practitioner. Their condition is usually deplorable and their rooms filthy and verminous. A hospital bed for some of them is found somehow at short notice through the local hospitals or the Exergency Bed Service. If the old person refuses to be admitted to hospital or a welfare home and is living in insanitary conditions, and is in need of care and attention, it is necessary to apply for a magistrates order for removal under Section 47 of the National Assistance Act, 1948. During the year it was not necessary to resort to this Act it being possible in each case to make alternative arrangements, (v) Disinfestation of premises is carried out when necessary after the Public Health Inspector s visit. This mostly applies to the deplorable cases as referred to above. 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. Superannuation Medical Examinations 92 persons were examined during the year for entry into the Council's Superannuation Scheme. 83 of these were passed as fit to carry out their respective duties with efficiency. 9 persons were found unfit. The causes of the unfitness are listed as follows:- (i) Chronic Bronchitis emphysema 2 (ii) High Blood Pressure 2 (iii) Tuberculosis Active 1 (iv) Heart Disease 1 (v) Liver Disease 1 (vi) Bowel Disease 1 (vii) Kidney Disease 1 69 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. 1955 1956 Area of District (in acres) 3, 013 3,013 Population: Census, April, 1951 126,929 Mid-year: Registrar General's estimate 122 100 120.700 Rateable Value at 1st April £1,019. 313 £1 827,527 Sum represented by penny rate £4070 £7 28 5 Births Registered live-births (a) Legitimate Males 772 737 Females 673 743 Total 1,445 1,480 (b) Illegitimate Males 34 37 Females 32 43 Total 66 80 (c) Total Live-births Males 806 774 Females 705 786 Total 1,511 1, 560 Birth-rate per 1 000 estimated population 12,38 12,92 Still births (a) Legitimate: Males 16 19 Females 13 18 Total 29 37 70  1955 19 56 (b) Illegitimate Males 1 - Females - - Total 1 - (c) Total Males 17 19 Females 13 18 Total 30 37 Stillbirth rate per 1 000 total (live and still) births 19. 47 23. 17 Death s Males 701 687 Females 630 565 Total 1,331 1, 252 Death-rate per 1 000 estimated population 10.9 10.4 Maternal Deaths Puerperal Sepsis 0 0 Other puerperal causes 1 2 Total 1 2 Maternal Death rate per 1 000 total (live and still) births 0. 6 49 1. 252 Deaths of Infants under 1 year of age (a) Legitimate Males 10 21 Females 14 12 Total 24 33 (b) Illegitimate: Males 1 2 Females - 3 Total 1 5 (c) Total Infantile Deaths Males 11 23 Females 14 15 Total 25 38 Infantile Death rate per 1 000 live births 16.55 24.36 71 COMPARABILITY FACTORS To enable local vital statistics to be compared with other districts or with national figures the Registrar General issues comparability factors for correcting crude birth and death rates. The Registrar General has intimated that the factors for certain areas, where rapid increase or reduction in the population has materially affected its composition by sex or age groups have been adjusted on that account. In addition, the death rate area comparability factors have this year for the first time been adjusted specifically to take account of the presence of any residential institutions in each area. Tottenham s factors have been increased as follows Birth rate factor from 0.95 to 0.97 Death rate factor from 1.03 to 1.09 72 Table of Cases of Infectious Diseases coming to the knowledge of the Medical Officer of Health during the year 1956 in the Borough of Tottenham, classified according to Diseases and Ages Disease Under 1 1 2 3 4 5-9 10 - 14 15 - 19 20-34 35 -44 45-64 65 & up Total Total Cases removed to hospital M F M F M F M F M F M F M F M F M F M F M F M F Scarlet Fever - 1 1 - 1 4 1 4 10 8 18 23 4 4 - - 1 - - - - - - - 80 24 Measl es 3 1 7 8 8 11 9 15 14 11 28 40 2 1 - - - - - - - - - - 158 6 Whooping Cough 19 11 6 10 10 12 10 12 15 15 44 66 2 7 1 - - - - 2 - 1 - - 243 29 Pneumonia 3 1 - 1 1 - 1 1 - 1 2 1 - - 1 - 1 1 4 3 14 14 13 7 70 17 Erysipelas - - - - - - - - - - - - - - - 3 2 - 1 3 - 7 16 10 Food Poisoning - - 2 - 1 - - - 1 - 4 2 3 3 1 - 1 4 - 1 2 5 - - 30 2 Puerperal Pyrexia - - - - - - - - - - - - - - - - - 1 - - - - - - 1 1 Ophthalmia Neonatorum 1 2 - - - - - - - - - - - - - - - - - - - - - - 3 1 Acute Encephalitis Infective - - - - - - - - - - - - - - - - 1 - - - - - - - 1 1 Post-infectious - - - - - - - - - - 1 1 - - - - - - - - - - - - 2 2 Acute Poliomyelitis Paralytic - - - - 2 - 1 - 3 2 1 - - - - - 1 2 - - - - - - 12 12 Non-paralytic - - 1 - 2 - - 3 - 3 4 2 - - - - - - - - - - - - 15 13 Meningococcal Infection - - - - - - - - - - - - - - - - - - - - - - - - - - Diphtheria - - - - - - - - - - - - - - - - - - - - - - - - 1 1 Typhoid - - - - - - -- - - - - - - - - - - - - - - - - - - - Paratyphoid - - - - - - - - - - - 1 - - - 1 - - - - - - = 2 2 Dysentery 1 1 2 2 - 3 2 8 1 2 9 7 2 1 - 2 3 3 3 3 3 3 1 1 63 10 Scabies - - - - - - - - - - 3 3 3 - 1 9 2 1 - - - - - 1 14 - Tuberculosis Respiratory - - - 1 - - 1 - 1 - - 1 2 - 5 6 11 12 8 7 18 6 9 4 92 - Meninges & C.N. S. - - - - - - - - - - - - - = - - - - - - - - - - Other - - - -- - - » - - - - 1 - 1 1 - - 4 1 - 1 - - 9 - Total 27 17 19 22 25 30 25 43 45 42 114 149 18 17 10 9 21 31 18 16 39 32 23 20 812 131 73 INFANTILE DEATHS IN AGES AND SEXES DURING THE YEAR 1956 CAUSE OF DEATH DAYS Total Under 4 Weeks MONTHS Total Deaths under 1 Year Males Females 0 1 2 3 4 5 6 7- 14 21- 1 2 3 4 5 6 7 8 9- 11- Broncho pneumonia - - - - - 1 - 1 - - 2 - - - - - - - 1 » - 3 3 - Other diseases of respiratory system - - - - - - - - - - 1 - - - - - - - - - 1 1 - Gastritis, enteritis and diarrhoea - - - - - - - - - - - - 1 - - = - - - -- - 1 1 - Congenital malformations 2 " 1 - - - - 1 - 1 5 - - - - - - - 1 - 6 3 3 Prematurity 9 1 1 1 - - 1 - - - 13 - - - - - - - - - - 13 7 6 Atelectasis 3 2 1 - - - - - - - 6 - - - - - - - - - - 6 3 3 Birth injuries 2 - - - - - - 1 - - 3 - - - - - - - - - - 3 2 1 Other causes 4 - - - 1 - - - - 5 - - - - - - . - - 5 3 2 Total 20 3 3 1 1 1 1 3 - 1 34 1 1 - - - - 1 1 - 38 23 15 74 CLASSIFIED DEATHS OF TOTTENHAM RESIDENTS SHEWING AGE GROUP AND SEX DISTRIBUTION DISEASE Total Under 1 year 1-4 5-14 15-24 25-44 45-64 65-74 75+ M F M F M F M F M F M F M F M F M F Tuberculosis, respiratory 12 6 - - - - - - - 1 - - 4 4 6 - 2 1 Tuberculosis, other - - - - - - - - - - - - - - - - - Syphilitic disease 1 2 - - - - - - - - - - 1 - - 1 - 1 Diphtheria - . - - - - . - - - - - - - - - - - Whooping Cough - - - - - - - - - - - - - - - - - - Meningococcal infections - - - - - - - - - - - - - - - - - - Acute poliomyelitis - - - - - - - - - - - - - - - - - - Measles - - - - - - - - - - - - - - - - - - Other infective & parasitic diseases - 2 - - - - - - - 1 - 1 - - - - - - Malignant neoplasm, stomach 26 20 - - - - - - - - - 1 9 5 10 10 7 4 Malignant neoplasm, lung bronchus 74 11 - - - - - - - - 2 - 32 2 31 7 9 2 Malignant neoplasm, breast - 18 - - - - - - - - - 3 - 4 - 7 - 4 Malignant neopoasm, uterus - 10 - - - - - - - - - 2 - 4 - 3 - 1 Other malignant & lymphatic neoplasms 61 53 - - - 1 2 _ _ . 6 2 14 19 19 14 20 17 Leukaemia, Aleukaemia 3 5 - - - - 1 - - - 1 - - - 1 3 - 2 Diabetes 4 5 - - - - - - - - 1 2 1 - 1 2 1 1 Vascular lesions of the nervous system 76 94 - - - - - - - - 2 - 15 13 26 27 33 54 Coronary disease, angina 126 65 - - - - - - - - 2 1 43 21 46 18 35 25 Hypertension with heart disease 8 17 - - - - - - - - - - - 2 2 10 6 5 Other heart disease 54 80 - - - - - - - - - 2 6 11 12 17 36 50 Other circulatory disease 24 24 - - - - - - 1 - - - 5 4 7 11 11 9 Influenza 1 2 - - - - - - - - - - 1 - - 1 - 1 Pneumonia 35 21 3 - - - - - - - - - 2 4 8 1 22 Bronchitis 60 36 - - - - - - - - - - 16 4 20 6 24 26 Other diseases of respiratory system 7 5 - 1 - - - - - - - 1 3 - 2 - 2 3 Ulcer of stomach & duodenum 17 7 - - - - - - - - 1 1 4 - 5 3 7 3 Gastritis, enteritis & diarrhoea 2 3 1 - - - - - - - - - 1 1 - 2 - - Nephritis & Nephrosis 6 4 - - - - - - - l 1 - 3 2 2 1 - - Hyperplasia of prostate 3 - - - - - - - - - - 1 - - • 2 - Pregnancy childbirth & abortion - 2 - - - - - - - - - 2 - - - - - - Congenital malformations 7 4 3 3 1 - l - - - 1 - - - 1 1 - - Other defined & ill defined diseases 51 49 16 11 2 - - 1 - - 2 1 11 11 7 7 13 18 Motor vehicle accidents 6 - - - - - - - - - 3 - 1 - 1 - 1 - All other accidents 16 50 - - - - - - - - 2 2 5 1 1 1 8 6 Suicide 6 8 - - - - - - - - 2 2 2 4 1 2 1 - Homicide & operations of War 1 2 - - - - - 1 1 - - 1 - - - - - - Total 687 565 23 15 3 1 4 2 2 3 26 24 180 116 209 155 240 249 75 CANCER DEATHS 1956 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 1 - - - - - - - - - - - - - - - - - - - 1 - - - - - Digestive Organs and Peritoneum 56 50 - - - - - - - - - - - - 1 2 5 4 11 12 21 18 18 12 - 2 Respiratory system 75 11 • - - - - - - - - - - 2 - 4 - 28 2 30 7 10 2 - - Breast and Genito urinary system 18 39 - 1 - - - - - - - - - 1 2 4 2 6 2 5 5 13 7 6 - 3 Other and unspecified si tes 8 8 - 1 - - - • - - - - - 3 - - 1 2 1 2 3 1 3 • - Lymphatic & Haematopoietic Tissues 6 9 - 1 - 1 - 4 - - - - 1 1 - - 2 1 1 2 3 - 2 - - TOTAL 164 117 - 1 2 - 1 - - - - - - 2 9 6 11 13 44 21 61 44 36 25 - 5 76 Statistics of Tottenham for the last Twenty Years Year Population Deaths Death Rate Births Birth Rate Infantile Deaths Infant Death Rate Number of Cases Cancer Deaths Puerperal Fever and Puerperal Pyrexia Scarlet Fever Diphtheria Tuberculosis Respiratory Other Forms 1937 146 200 1,617 11.1 1,973 13.5 126 63.9 36 306 236 178 34 237 1938 144 400 1,512 10.5 1,893 13.1 89 47.0 23 186 221 178 38 207 1939 (142,400*) (136,000 ) 1,406 10.3 (1.776*) (1.739 ) 12.5 66 37.95 15 335 60 182 30 209 1940 119, 400 1,703 14.26 (1,666*) (1,559 ) 13.95 64 41.05 20 103 28 178 19 225 1941 105, 620 1,418 13.43 (1, 560*) (1,316 ) 14.77 61 46.35 13 103 73 161 28 194 19 42 110,100 1, 349 12.25 1,819 16.52 79 43.43 12 295 75 164 21 229 1943 110 ,350 1, 513 13.71 1,970 17.85 86 43.65 9 340 107 174 24 232 1944 108 ,180 1,356 12.53 2 ,066 19.09 87 42.11 13 206 44 169 20 236 1945 110,600 1, 371 12.40 1,988 17.97 78 39.24 14 214 47 139 16 213 1946 124.830 1,491 11.94 2,580 20.67 88 34.11 13 323 83 198 24 266 1947 129 140 1,461 11. 31 2,785 21.57 76 27.29 24 272 22 171 18 223 1948 130 000 1,377 10.59 2,233 17.18 53 23.73 5 260 3 184 19 272 1949 130,040 1,440 11.07 2,009 15. 45 50 24.89 15 251 4 210 22 264 1950 129 400 1,382 10.68 1,727 13. 35 41 23.74 9 356 3 161 13 262 1951 126 800 1,520 11.99 1,673 13. 19 43 25.70 5 245 - 192 9 273 1952 125, 800 1,415 11. 25 1,666 13.24 34 20.41 1 356 - 163 16 277 1953 124 400 1,347 10.83 1,642 13.20 43 26.19 1 215 1 143 20 284 1954 123 200 1,187 9.63 1,524 12.37 27 17.72 1 92 - 126 5 251 1955 122 100 1,331 10.9 1,511 12.38 25 16.55 1 75 1 126 18 308 1956 120 700 1,252 10.4 1,560 12.92 38 24.36 1 80 1 92 9 281 * 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. 77 CERTAIN VITAL STATISTICS FOR THE YEAR 1936 District Population mid 1956 Birth rate per 1000 population Death rate per 1000 population Specific death rates per 1000 popuiation Infant mortality per 1000 live births Maternal mortality per 1000 total births (a) Crude Adjust ed Crude Adjust -ed Pulmonary tuberculosis (a) Cancer (a) Infant (a) Neo-natal (a) (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) Acton 66,240 13.8 12.8 11.0 11.4 0.14 (9) 2.2 (149) 23.0 (21) 13.1 (12) - (-) Brentford & Chiswick 58,330 14.1 13. 1 10.9 11.1 0.07 (4) 2.8 (150) 18.2 (15) 15.6 (12) - (- ) Ealing 184,200 13.6 13. 1 10.4 11.4 0.11 (21) 1.8 ( 329) 13.9 (35) 10.7 (27) - (-) Edmonton 98,110 12.9 12.6 9.8 11. 2 0.13 (13) 2. 2 (214) 22.9 ( 29) 15.8 (20) - (-) Eh field 109, 000 12.4 12.4 11.0 9.4 0.09 (10) 2.1 (229) 24. 3 (33) 17.7 (24) - (=) Pelt ham 49,230 16.7 16. 2 6.6 10.6 0.06 (3) 1. 3 (65) 21.9 (18) 18.2 (15) - (-) Finchley 69,800 13.0 12.4 11.9 10.9 0.11 (8) 2. 2 (152) 13.2 (12) 8.8 (8) 1.08 (1) Friern Barnet 28,570 11.6 12. 2 17.7 9.7 0.04 (1) 2. 2 (62) 21. 1 (7) 15.1 (5) - (-) Harrow 216,200 12.9 13. 2 8.8 10.6 0.06 (13) 1.9 ( 409) 21. 1 (59) 16.8 (47) 0.70 (2) Hayes & Harlington 66,460 15. 2 14.3 7.5 12.2 0.08 (5) 1.6 (106) 14.8 (15) 11.8 (12) 0.97 (1) Hendan 153,200 13.0 12.4 10. 2 10.7 0.11 (17) 2. 2 (332) 18.0 (36) 15.5 (31) -(-) Heston & Isleworth 105,100 11.8 11.7 10.8 11.4 0.30 (11) 2.0 (215) 17.8 (22) 14.6 (18) - (-) Homsey 97,220 15.0 14.0 11.5 10.4 0.12 (12) 2.2 (217) 23.3 (34) 15.8 (23) 1.34 (2) Potters Bar 18,910 15.7 14.8 9. 2 11.7 - (-) 1.8 (34) 27.0 (8) 20.3 (6) - {-) Ruislip Northwood 73,930 13.7 13.8 7.3 9.3 0.01 (1) 1.6 (119) 15.8 (16) 11.8 (12) 0.98 (1) Southall 53,220 13.4 13.4 12. 3 10.5 0.17 (9) 2.4 (127) 18.2 (13) 14.0 (10) 1.39 (1) Southgate 71,670 11.2 12. 2 11.8 9.9 0.03 (2) 2.6 (184) 13.8 (11) 7.5 (6) - (-) Staines 44,200 17.2 16. 2 8.8 10.7 0C 07 (3) 1.9 (82) 23.7 (18) 22.4 (17) - (-) Sunbury 26,700 19.6 17.8 7.6 9.6 0.04 (1) 1.3 (36) 19.1 (10) 11.5 (6) - (») Tottenham 120,700 12.9 12.5 10.4 11. 3 0.15 (18) 2.3 (273) 24.4 (38) 21.8 (34) 1.25 (2) Twickenham 104,000 12.8 13. 2 11.4 10.9 0.14 (15) 2. 1 (223) 10.5 (14) 6.8 (9) 0.74 (1) Uxbridge 59,640 17.8 16.4 8. 2 10.6 0.07 (4) 1.6 (94) 17.9 (19) 11.3 (12) - (-) Wembley 128,300 11.6 11.7 9.0 10.6 0.06 (8) 2.1 (265) 16.8 (25) 12.7 (19) 1.32 (2) Willesden 174,900 15.3 13.9 9.9 11.4 0.14 (25) 2. 1 (372) 22.8 (61) 17.9 (48) 1.83 (5) Wood Green 50,100 11.5 11. 5 10.7 10.5 0.02 (1) 2.5 (123) 17.3 (10) 15.6 (9) - ( -) Yiewsl ey & W Drayton 23,070 18.5 17.0 6.5 9. 1 - (-) 1.1 (26) 16.4 (7) 14. 1(6) - (-) COUNTY 2,25 1 000 13.6 13. 2 10.0 10.8 0.10 (214) 2.0(4587) 19.1(586) 14.6(448) 0.58(18) Note (a) Absolute numbers are given in parenthesis in addition to rates to afford valid comparison APPENDIX COUNTY COUNCIL OF MIDDLESEX AREA HEALTH COMMITTEE ( HORNSEY AND TOTTENHAM) JOINT POPULATION 217 920 REPORT OP THE AREA MEDICAL OFFICER FOR THE YEAR 19 5 6 78 MEMBERS OF THE LOCAL AREA COMMITTEE AS AT 31st DECEMBER 1956 MEMBERS OF MIDDLESEX COUNTY COUNCIL County Alderman Mr, R A. Clarke County Alderman Mr. M.W. Burns, J.P. County Councillor Mr. V. Butler County Councillor Mr, H.H. Godwin Monck County Councillor Mrs. H.C. Norman J.P. County Councillor Mrs. M.E. Soail MEMBERS OF HORNSEY BOROUGH COUNCIL Alderman Miss J. Richardson Councillor Miss O.R. Anderson Councillor Miss M.E. West Councillor Mr. J. T. Wilkins Councillor Mr, C. R. Williams (Vice Chairman MEMBERS OF TOTTENHAM BOROUGH COUNCIL Alderman Mr. A Reed A C I I J P Alderman Mrs. A.P. Remington Councillor Mr. H. Langer Councillor Mr. M. T. Morris Councillor Mrs, M. E. Protheroe Chairman) Councillor Mr. J R Ramshaw MEMBER NOMINATED BY APPROPRIATE HOSPITAL MANAGEMENT COMMITTEE Mrs. R. M. Fry PERSONS WHO MAY ATTEND IN AN ADVISORY CAPACITY Dr. L. Hornung 'Middlesex Local Medical Committee) Mr, R. W. D. Brownlie (Middlesex Local Denta Committee) Mr. L. Hayward (Middlesex Local Pharmaceutical Committee) Mrs. E. A. Lee (Royal College of Nursing) Miss V. Edey (Royal College of Midwives) G HAMILTON HOGBEN M. R. C. S. D. P H Medical Officer of Health and Area Medical Officer 79 AREA HEALTH STAFF 1956 Deputy Area Medical Officer A. Yarrow. M B. Ch. B. D. P. H. Senior Assistant Medical Mrs. J, H Garrow, M.B, Ch. B. D. P. H. Officer Area Dental Officer V. Sainty. L. D. S. R. C. S. Superintendent Health Visitor Miss H Townsend. S. R. N. , S. C. M. H. V. Non medical Supervisor of Miss F E Curtis. S.R.N,, S C. M Midwives and Home H. V. M.T.D. Nursing Superintendent Home Help Organiser Mrs. D, Edwards. S. R.N., Dip.Soc. Sc. Assistant Home Help Mrs. W. E. Pickard. S. R. N. Organisers Mrs. F. G. Wills Area Chief Clerk W L N Relleen, T.D,, D. P. A. Deputy Area Chief Clerk T. W. Hadley, LL. B. Sectional Heads A. Balls N.P. Child H. J. Dunham B. A. Classification of Staff Full time Part time Medical Officers 8 7 Dental Officers 7 3 Supervisory Nursing Staff 2 - Administrative and Clerical Staff 36 8 Health Visitors School Nurses 27 1 Clinic Nurses 8 1 Sponsored Student Health Visitor 1 Midwives 8 - Home Nurses 22 8 Speech Therapists 2 2 Physiotherapists 1 3 Occupational Therapist 1 - Chiropodists - 2 Gramophone Audiometrician - 1 Orthoptists - 2 Dental Attendants 8 1 Day Nursery Staff 30 1 Home Help Service 6 185 Manual workers domestic grades, etc. 9 25 175 252 80 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 number notified last year was the highest for four years and as most of the additional births took place at home the percentage of hospital confinements fell to 83.1% as compared with 88.9% in the previous year. 1956 1955 1954 Live Births (a) Domiciliary 534 429 553 (b) Hospital or Nursing Home 2,589 2,509 2,387 Still Births (a) Domiciliary 4 4 5 (b) Hospital or Nursing Home 56 53 51 Totals 3 183 2 99 5 2,996 Ante natal Clinics The percentage of expectant mothers making at least one attendance at an ante natal clinic was 69% during 1956 compared with 66% the previous year. This has halted the steady decline noted in previous years but it is too early as yet to draw any conclusion from it. As a matter of interest the percentages for the years 1949 to 1956 were, 74%, 79%, 77%. 75%. 72% 74%, 66% and 69% respespectively. The following table gives details of attendances at all clinics in the Area Clinic No, of sessions held No. of new cases Total attendances Average attendance per session A.N. P.N. A.N. P.N. Burgoyne Road 49 162 91 1054 94 23.4 Church Road 76 155 78 1213 89 17.1 Fortis Green 97 219 131 1687 138 18.8 Hornsey Town Hall 153 342 146 2300 150 16.0 Mildura Court 63 183 81 1365 82 23.0 Stroud Green 51 151 65 700 65 15.0 The Chestnuts 202 392 210 2789 222 14.9 Lordship Lane 204 286 173 2167 177 11.5 Park Lane 102 302 157 1533 176 16.7 Totals 1956 997 2192 1132 14808 1193 16.0 Totals 1955 1016 2003 1187 14652 1261 15.7 Total s 1954 1057 2210 1177 15504 1257 15.4 81 Investigation of Anaemia at the Ante natal Clinic Church Road Highgate About 140 new cases are registered every year at this clinic they are drawn from a wide cross section of the population and the five social classes of the Registrar General are represented more or less equally. They also include women of many nationalities i.e. Irish, Jamaican, African, Swedish German French Italian. Greek, Polish and American. A medical officer of the Department Dr. H. Gunn, reports that the estimation of haemoglobin levels in expectant mothers has been carried out at this clinic since 1953. For the first few months the Tallquist Haemoglobin Scale was used but this was later abandoned for the Sahli Haemoglobinometer which was found to be more accurate and easier to read in artificial light. At their first visit to the ante-natal clinic, all patients who are to be confined at home or in the Alexandra Maternity Home have samples of blood taken for determination of Blood Group, Rh Factor and Haemoglobin. Approximately 86% of these women make their first visit at or before the 18th week of pregnancy. Of the remaining 14% the majority are seen before the 18th week but there are a few who make their first visit much later either because they have recently moved into the district or because they have neglected to make any arrangements for their confinement or antenatal care. In almost all of these cases the Hb has not been determined previously and their figures are included with the "first visit" estimations given below. Although some authorities are concerned that the so-called "physiological anaemia of pregnancy" is a true hypochromic anaemia and that the Hb s of pregnant women can be maintained at or above 90%, with adequate iron therapy, 80% has been taken as the dividing line in this clinic. To all women with Hb levels below 80% is given a month s supply of Fersolate Tablets (l T. D S ) and they are asked to collect further supplies at each visit until they are told to discontinue. If they report severe constipation abdominal pains or vomiting as a result of taking the tablets an alternative iron preparation is offered A second Hb estimation is made at the 34th week and treatment is stopp ed i f the Hb has reached 80%, It is not possible, however, to follow up all the original cases as a number are lost owing to miscarriage moving out of the district or transfer to hospital 82 clinics. Some of the results obtained, after what should be adequate dosage with iron are disappointing but on close questioning of these it has been found that the tablets have been taken erratically or in very inadequate doses. Some women give them up for weeks at a time or reduce the dose to one a day because of various unpleasant symptons said to have resulted from them. Others admit that they often forget them "because they have to be kept out of reach of the children and are put out of sight". The results obtainable for the last three years are set out below. These readings were all obtained at the first visit and although several of the women had been given iron tablets during a previous pregnancy, only one was actually having them at the time. Total 100% 90%- 99% 80%-89% 70%-79% 60%- 69% 50%- 59% 1954 93 1. 1 4.3 46.2 30. 1 17,2 1.0 1955 99 - 6.0 37.0 42,0 11.0 2,0 1956 86 2.3 19.7 48.8 24.4 2.3 - These figures suggest that there may have been a gradual improvement in Hb levels over the last few years. Thus in 1956 70,8% of those attending for the first time did not require iron therapy as against 43% in 1955 and 51% in 1954. There has also been a marked reduction in the number of readings below 70% 1954 18.2% 1955 13. 0% 1956 2. 3% and there is an increase in the number of readings over 90% 1954 5.4% 1955 6. 0% 1956 22.0% If there has been a real improvement in the Hb levels of this section of the population It is no doubt due to a general improvement in their nutritional state. It is probable that people have become used to the high prices of foodstuffs and it is also worth noting that eggs have been cheaper and more stable in price during the past eighteen months. 83 Midwives Ante natal Clinics Owing to the shortage of midwives it has not been possible to hold clinics at Burgoyne Road and Mildura Court, and clinics elsewhere have been on a somewhat reduced scale. The following table shows the attendances made during the year. Midwives Clinics No. of sessions held Total No, of attendances Average attendance per session Fortis Green 26 159 6.1 Hornsey Town Hall 13 59 4.5 Stroud Green 26 94 3.6 Park Lane 139 758 5.5 Total 204 1070 5.2 The Alexandra Maternity Home. Hornsey The Alexandra Maternity Home was. opened in 1944 and in 1948 it was transferred from the Hornsey Borough Council to the Regional Hospital Board in accordance with the National Health Service Act. The number of beds is now 30. The Home 1. Gives ante-natal care for those women who require rest or treatment. 2. Cares for them during confinement. 3. Co operates with the domiciliary midwives who take nurses from the Home as pupils to confinements on the district. 4'. Trains nurses in midwifery so that they can get the midwives certificate. Women wishing to be confined at the Alexandra Maternity Home attend one of the Council' s ante natal clinics. and a card with the patient s history blood group etc. is sent to the Home, Visiting staff Mr. J M Scott, 0 B E T D Whittington Hospital, Archway Group. Dr. G. D S, Briggs Dr. D M. Wilkins Matron Miss S. Howell 84 1956 1955 1954 Admissions 702 640 640 Live Births 659 599 611 Delivered by Doctors 8 11 11 Emergencies during Labour 19 - - Transferred to St Mary s 10 - - Still Births 2 4 5 Infants' Deaths - - 3 Infants completely breast fed 581 509 545 Health Education and Parentcraft The teaching of positive health is the full time occupation of every health visitor wherever her duties take her particularly in homes clinics, schools and to a smaller extent in a voluntary capacity in giving evening talks and lectures to organisations outside the health service. Her work is more than the teaching of the prevention of disease such as the popularising of prophylactic measures to combat ill health. It is the day to day help and advice given to promote mental and bodily health, the prevention of deterioration of families and the working out of family management and difficulties. Education for health is one of the most important of the personal health services and is concerned with individuals of all ages and types. It commences with advice and guidance to the expectant mother and the mother of a new baby. It continues through childhood until the child enters school and comes within the purview of the school health services with routine examinations and follow-up home visits for defects and general care. The continuity of the pattern of her work with these groups and with discharges from hospital, the elderly and others. does much to extend education by practical assistance to individuals and families when they are most in need o'f it and gives them support which undoubtedly contributes to the establishment of individual and community health. Social factors cannot be separated in the work of the health visitor where family difficulties social problems and health are so interlaced, but the health visitor, as the general purpose family visitor, calls on the advice and help of other services when these can be of assistance to members of the public. Account is taken of the different interests of mother and other groups to satisfy inclination and desires to acquire knowledge of health and practical methods connected with parentcraft. 85 Relaxation and Mothercraft Classes are given weekly at eight Maternity and Child Welfare Clinics. This is an increase of one weekly session over those reported for the previous year. The following table shows attendances at Mothercraft Clinics during the year:- Clinic No. of sessions held No. of new cases Total No. of attendances Average attendance per session Burgoyne Road 41 33 241 5.9 Church Road 45 24 224 5.0 Fortis Green 42 81 465 11.1 Hornsey Town Hall 51 102 487 9.5 Mildura Court 32 18 116 3.6 The Chestnuts 51 101 585 11.5 Lordship Lane 51 98 723 14.2 Park Lane 52 62 453 8,7 Totals 365 519 3294 9.0 Home making and Parentcraft talks in schools Health visitors and one school nurse have given talks, demonstrations and films to secondary modern girls in the area. In all, 378 talks and discussions were given in schools. The lively interest of the pupils makes this part of the work very worth while. Child Welfare Clinics The percentage of children under one year of age who attended for the first time during the year continued the improvement noted in 1955. During the past four years this figure has risen from 89.1% to 94.3%. The total attendances made by children under five years were slightly up on the figure for the previous year due to the opening of the Somerset Road Centre, Tottenham, which increased the number of sessions held during the year in the Area as a whole by 73 as compared with 1955. To some extent attendances at the other three centres in Tottenham have fallen since the opening of the Somerset Road Centre, but it has not yet been considered necessary to recommend any adjustment in sessions as a result. 86 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.0. Average attendance per session Under 1 year Over 1 but under 2 years Over 2 but under 5 years Burgoyne Road 151 218 4051 509 235 4795 1407 31,8 Church Road 145 228 2980 566 120 3666 1526 25.3 Fortis Green 151 257 3393 601 237 4231 1397 28.0 Hornsey Town Hall 203 421 5411 786 391 6588 2805 32.4 Mildura Court 102 215 3152 572 88 3812 1401 37.4 Stroud Green 101 192 2866 475 133 3474 844 34.4 The Chestnuts 256 547 6716 913 288 7917 1958 30.9 Lordship Lane 255 374 5489 1158 272 6919 1720 27.1 Park Lane 205 293 4826 793 300 5919 1803 28.9 Somerset Road 91 200 2932 343 144 3419 897 37.6 Totals 1956 1660 2945 41816 6716 2208 50740 15758 30,6 Totals 1955 1587 2709 40354 7176 2659 50189 15645 31.6 Totals 1954 1604 2675 40891 7963 3059 51913 16024 32.4 Use of clinics for B C G Vaccination During the year the Mildura Court. Burgoyne Road and Stroud Green Road Welfare Centres have been used on a number of occasions by the Chest Physician for Hornsey for the purpose of carrying out tuberculin testing and B C G vaccination of contact cases. It is hoped that eventually a chest clinic will be established in Hornsey and in the meantime this temporary arrangement saves many patients the long hourney to the chest clinic in Pinchley. Toddlers Clinics In the Annual Report for 1954 it was stated that more effort was to be made to widen the knowledge of medical officers on the mental health aspect in the care of young children, The psychiatrist (Dr. Cyril Phillips). who attends both Child Guidance clinics in Hornsey and Tottenham. devotes one session per week to "sit in with" a medical officer and discuss some of the problems of these children with the mother present. This has proved both interesting and rewarding. Gravely disturbed children are not included but the common problems of the phsically healthy child who, for instance, refuses food has disturbed sleep or resents toilet training are considered. 87 This psychological approach yields satisfactory and in some cases quite rapid results in young children attending the Toddler and welfare clinics, As each medical officer spends three months with the psychiatrist for one session per week, confidence in this new approach is assured, A major problem is to get the mothers to attend for such advice. It is a curious fact that a woman will bring her healthy baby regularly to the clinic to be weighed, and to get advice on minor matters, but as soon as the baby can walk, talk and eat ordinary food, the anxiety about him eases off, and small deviations from normality are either not noticed or neglected. An unruly toddler can cause much unhappiness in a family. So often the story of his bad behaviour is the first thing that is told to father on his return from work, which causes annoyance to the father, and in consequence more aggression in the child. The following table, showing referrals to special clinics gives some indication of the scope of inspection of the child on the physical side but no idea of the amount of discussion between parent and doctor which actually takes place. E.N.T. Ophthalmic Orthopaedic Child Guidance Dental Chiropody Arti ficial Sunlight Spceech Therapy 14 50 109 7 185 6 6 23 The work of this clinic is unhurried and gives adequate time for the mother to talk about her child to ask questions about various injections to p ro tect the chil d from infection operations, treatments feeding. should he be sent to a nursery school or not, what shoes should he wear and so on, In fact the mother has a sympathetic atmosphere in which to discuss the child s and her own problems. 88 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 28 470 467 16.8 Church Road 49 468 423 9.6 Portis Green 36 422 422 11.7 Hornsey Town Hall 61 671 671 11.0 Mildura Court 51 698 659 13.7 Stroud Green 23 326 326 14.2 The Chestnuts 51 617 617 12. 1 Lordship Lane 52 647 647 12.4 Park Lane 51 474 472 9.3 Somerset Road 47 503 503 10,7 Totals 1956 449 5296 5207 11.8 1955 392 4904 4769 12 ., 5 1954 389 5196 5040 13.4 Anxiety of Mothers about Young Children Parental anxiety is clearly shown in the following summary of the experiences of a medical officer who also attended sessions for two years at a children's out patient department. Here the medical officer met the same mothers who attended the local clinics, asking all the time the same questions and getting the same answers. Not being convinced that the answers were true, these mothers go from hospital to clinic and vice versa in an attempt to get further advice or change the child into one they can accept. In their view it is the child that must be changed but not themselves. Liaison between the Hospitals and the Welfare Services A medical officer of the Department (Dr. V. Tracey) reports that at the end of two years as Clinical Assistant in a busy children s out patient department an impression remains of great similarity between the types of cases making frequent attendances at hospitals and those commonly seen at the various Welfare Centre sessions. When those children attending hospital because of serious illness are eliminated, one is left with a large, familiar group of conditions common to both - children suffering from recurrent respiratory infections, particularly school entrants, the child who won' t eat, or sleep, and children of all ages who show physical symptons in response to the stresses and strains of growing up and 89 adjusting to school life, Not only are the conditions familiar. often the individuals have been met before at clinics and routine medical inspections. The co operation of the personal health services seems most often to be sought by the hospital doctor in the case of children of school age. One is often called upon to answer questions about the types of special schooling available and then to pass on the necessary case details to the office so that places in the special schools can be applied for with the least loss of time. Sometimes, having someone immediately avai1able to answer a mother s questions about what is entailed in sending a child to a special school, for example, will help her to agree promptly and without anxiety to the course recommended. Occasionally questions arise about the types of courses followed and the standards likely to be expected in the various categories of day schools, and here, someone who has visited the schools and so can give a clearer picture of what is meant by the newer and relatively unfamiliar terms, such as "secondary "modern" "central" or grammar" school. There seems at present to be a less close link between hospitals and clinics in the case of infants and pre school children. Babies fortunately form a relatively small part of the hospital attenders, but their difficulties frequently centre round diet and feeding, either as a sequel to other illness or as an initial complaint. Even while attending an out patient department every one or two weeks, many mothers continue to attend regularly at their usual welfare centre. Could this perhaps, be a point at which a closer liaison could be established, with the hospitals making a more deliberate use of the clinics to steer mothers through their difficulties between hospital attendances? The health visitors in such cases could follow a recommended line of manage ment, reinforced, if necessary, by home visits, It would probably be appreciated by many mothers who find it difficult to travel quite long distances to hospital with a baby, andpossibly a toddler too, while the clinic is just round the corner. The Toddler Clinics might also be made use of when longer and more leisurely discussion of developmental 01 behaviour problems is needed. The busy, bustling atmosphere of an out patient department is not necessarily the best setting for such discussion, with little to divert the child s attention, and too much to divert the adults' minds. 90 Investigation into the probable cause of Leukaemia The Department of Social Medicine, Oxford, has undertaken to investigate all deaths in England and Wales from malignant disease or leukaemia of children under the age of ten years, which took place from 1953 to 1955. In this Area there were four deaths. During the last 25 years, the leukaemia death rate in this country has nearly trebled. There is an abrupt increase in the risk of death from leukaemia between one and three years of age. The Senior Medical Officer for Maternal and Child Welfare, Dr. Helen Garrow, took part in finding out the environmental factors surrounding each child who died of malignant disease in this Area, and also of another set o f chil dren o f the same age and social circumstances who were alive and well. As great interest is already aroused on the subject of irradiation from atomic power plants and waste material, and it is also known that radiologists have a death rate nine times greater than other physicians, special attention was paid in the investigation to rays of all kinds. Luminous clocks, watches, television and pedescopes in shoe shops therapeutic and diagnostic x rays of all kinds were carefully noted. A preliminary report has been given that x-rays of the baby before birth may have a harmful effect. This finding has given all doctors caring for the expectant mother a warning to be careful of having her x rayed, and has also made radiologists extremely careful of the number and times of exposure of the films. Daily Guardian Scheme Under the general supervision of the Superintendent Health Visitor, Miss Townsend, this scheme is operated to assist working mothers who are unable to obtain day nursery accommodation for their children under five years of age. The scheme is administered from the Area Health Office and payment of 1s. Od. per day is made by the local health authority to approved guardians for each child minded for the day,, All daily guardians must fi rst be app roved by the health visitor for every child cared for under the scheme and thereafter kept under her observation. No daily guardian is approved to mind more than two children and in the maj ority o f cases approval is given for one child only and a statement of the conditions of the scheme is given to approved daily guardians and to mothers using the scheme. The number of guardians and children involved in the scheme increased very slightly during the year. 91 Though the Daily Guardian Scheme is outside the sphere of the Nurseries and Child Minders Act 1948. it is our opinion that the Act should apply to all persons receiving children under the age of five years for the purpose of daily minding. There is no doubt that there is a proportion of daily minders who operate outside the purview of the Act and the Daily Guardian Scheme, who because they are aged or for other reasons are incapable of providing proper care for young children. The number of guardians on the register at the end of the year was 119 of whom 63 were minding 71 children. The number of individual children minded during the year was 131 and they were in the guardians care for 15,246 days. Day Nurseries There are three day nurseries in the Area with a total of 168 places. The average attendance during the year was 111,4 per day and the number of children on the register at the end of the year totalled 143, The number of applications for day nursery admission during the year was 239 of which 42 were refused. All appeals against the decisions made in accordance with the County Council s regula tions are heard by the Day Nurseries Panel appointed by the Area Health Committee for this purpose. Appeals against financial assessment of the charges made for admission are also considered by a similar panel. The health and general care of day nursery children is very good indeed. Pour student nursery nurses entered for examination of the Nursery Nurses Examination Board and were successful in obtaining the Board' s Certificate. Two of the day nurseries are recognised by the Ministry of Health as training nurseries for the 0 5 age group and one for the 0-2 age group. The latter will be passed for the whole age range as soon as a warden is appointed for the toddlers group. We anticipate that we shall be able to send a member of the present staff for the special course of training early next year which will qualify her for the post. All children admitted to the nurseries are received from families where there are special difficulties, some of a temporary and others of a more permanent nature. Generally speaking mothers 92 regard the local authority's day nurseries as a safer place for daily minding than any other method of minding outside their own homes and the standard of care and the improvement in the conditions of the children admitted to nurseries does much to endorse this view. Day nursery matrons are to be commended not only on the standard of the nurseries in their charge but also for their interest and handling of the mothers' problems which are unfolded to them B.O.A.C Stewardesses Eight stewardesses attended Park Lane Day Nursery for one day each to receive practical instruction in the care of healthy children. British Red Cross Cadets were also accepted in day nurseries during August for practical experience. 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 33 2,719 8.504 11,223 44.2 Park Lane 20 30 12 33 1,392 5,357 6,749 26.6 Plevna 20 30 11 40 2,829 7,506 10,335 40.7 totals 1956 55 113 37 106 6,940 21,367 28,307 111.4 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 has continued throughout the year with the valuable co-operation of the Women's Voluntary Services in both Boroughs. Issues of the various nutrients, which varied little from the previous year are shown in the following table National Dried Milk (tins) Orange Juice (bottles) Cod Liver Oil (bottles) Vit. A & D Tabs. (packets) 59,472 158,725 21,571 11,132 93 Priority Dental Service for Mothers and Young Children The dental service as a whole is discussed later by the Area Dental Officer, Mr. V. Sainty, under the work of the school health service. Reference was made in last year's report to a visit made to this Area by Miss E M. Knowles, O.B.E. F D„ S , H. D.D a Senior Dental Officer of the Ministry of Health, Her report on her visit to the County as a whole has caused the Minister to comment particularly favourably on the average number of 2.7 teeth conserved per child treated in Middlesex which, in 1954 was stated to be the best performance in the country. In this connection it is interesting to compare the figures for this Area with those for the County as a whole bearing in mind that as this Area s figures are included in the County's, some of the latter appear more favourable than they should be for the purpose of this comparison:- Treatment for 100 patients in 1954 Expectant and Nursing Mothers Scalings Fil1ings Extractions Dentures County Area County Area County Area County Area 58 63 218 23 7 167 167 30 17 Pre-school Children Fillings and Conservations Extractions County Area County Area 270 337 102 90 94 The following table gives details of attendances made and treatment given at all clinics during the past three years:- 1956 1955 1954 Expectant and Nursing Mothers Children under 5 Expects ant and Nursing Mothers Children under 5 Expectant and Nursing Mothers Children under 5 No, examined by dental officer 234 670 271 657 253 590 No. referred for treatment 226 618 260 624 241 534 New cases commenced treatment 218 551 240 573 233 603 Cases made dentally fit 76 321 67 317 50 246 Forms of dental treatment provided Teeth extracted 235 506 352 479 389 541 Anaesthetics - (a) Local 84 72 142 77 132 115 (b) General 39 213 48 203 42 206 No. of fillings 380 1 169 414 1 247 553 1 278 No. of root fillings - - 3 - - - No. of inlays 1 - - - 1 - Scalings and gum treatment 128 - 136 - 148 - Silver nitrate treatment - 565 - 512 - 758 Dressings 163 674 144 519 133 560 Other operations 48 138 70 194 40 159 No. of radiographs (a) at County Council clinics 28 - 14 1 10 6 (b) at hospital 2 1 1 - - - Denture dressings 179 - 226 - 100 - Dentures fitted (a) full 18 - 46 - 17 - (b) partial 39 - 59 - 22 - No. of attendances 873 1,583 984 1,606 930 1,732 No. of appointments not kept 193 247 218 370 258 349 No, of ½ days devoted to treatment 296 338 343 MIDWIFERY SERVICE (SECTION 23) The Supervisor of Midwives, Miss Curtis, reports that there has been a slight increase in the number of domiciliary confinements during 1956 as was anticipated in 1955. The number of midwives employed has remained at eight, The number of deliveries conducted by the Area midwives was 509, an average of 63,6 per midwife. 95 In spite of the low number of home confinements four pupil midwives were constantly in training throughout the year, These pupils are directed from the Alexandra Maternity Home with which the domiciliary midwifery service works in close co-operation. Analgesia of all available types is now in common use and it is the exception for a mother not to receive this type of relief, Three midwives were sent for one week s residential refresher course during the year. Transport for midwives has improved and five midwives now use cars with very great benefit to the service. The following table shows an analysis of the midwives' work: No. of deliveries attended 509 No, of visits hiade 8 846 No. of hospital confinements discharged before 14th day 38 No. of visits made 354 No. of cases in which medical aid was summoned 143 No. of cases in which gas and air analgesia was administered 400 No. of cases in which pethidine was administered 265 No. of cases in which trichloroethylene was administered 33 HEALTH VISITING SERVICE (SECTION 24) The Report of the working party on the field of work, training and recruitment of health visitors published during the year gives Local Health Authorities a clear guide as to the requirements of the service and the position of the health visitor as "truly a medico- social worker playing a full part in both preventive medicine and social action. The recommended average case load of one health visitor to 4,300 population is one of a number of important recommendations and conclusions reached by the working party which have so far not been attained in this Area, Case loads in this Area are approximately 1 - 6 000 of the population. This heavy case load makes a considerable demand on the time of health visitors who deal with emergency home visits visits for hospital reports; visits to the aged and other special groups, the follow-up of premature infants special investigations as well as routine visits, and routine clinic work, resulting in more selective 96 visiting than was the case inprevious years. Inevitably therefore the number of actual home visits must fall although the quality of each visit is likely to be more valuable to the individual visited. Home visits arenot infrequently undertaken during the evening, that is, where it is necessary in order to see working parents and others who are not accessible at other times. Scheme for the Health Visiting of Problem Families In this Area a detailed scheme was prepared as an attempt to assist in the prevention of the break up of families or their rehabilitation in their own homes. Two Special Services Health Visitors were appointed for this purpose as from March 1957 one for Hornsey and one for Tottenham. In taking over this specialised work they call on other services and voluntary organisations available in the area to assist them when necessary. The Superintendent Health Visitor, Miss Townsend, reports as follows:- Home Visiting of families in the flooded areas of Tottenham and Hornsey was undertaken during August. In all 737 houses were visited to ensure that the health of children in these areas was not impaired by the unexpected and unfortunate occurrences. Sponsored Health Visitor Training The Local Health Authority's scheme for the training of health visitor students has proved valuable in providing a source of qualified health visitors to supplement wastage through retirement and other reasons. At present one sponsored student is receiving practical training in this Area under the scheme. Training of Health Visitor Students Practical training was arranged in the Area for six student health visitors for varying periods during the year and in addition one Public Health Administration student. The students attended from the Royal College of Nursing, Battersea and Chiswick Poly technical Colleges, 97 Student Nurses Lectures Eleven lectures on Social Aspects of Disease were given, at the Prince of Wales's General Hospital. Tottenham PreliminaryTraining School, by the Superintendent Health Visitor during the year. The Superintendent and other members of the health visiting staff also gave lectures on first aid home nursing and the local health services to various organisations in their own time and in some cases acted as examiners for the British Red Cross Society, Church groups, etc. The Superintendent and another health visitor acted as consultants at careers evenings arranged by the Youth Employment Officer of the Tottenham Youth Employment Bureau, Student Nurses from the Prince of Wales s General Hospital and from the Middlesex Hospital, W.l, were given a variety of public health visits accompanied by health visitors during the year. Other Visitors interested in health visitor and clinic services were also received from interested bodies and from overseas. Health-visitors Hospitals, Family Doctors and Voluntary Organisations A number of voluntary workers in Hornsey give valuable and regular assistance in infant welfare clinics by weighing young children and undertaking some clerical work as well as the sale and distribution of welfare foods. We wish to acknowledge their voluntary services to the Area and would welcome others who are willing to undertake similar work. Liaison between hospital almoners and health visitors has been very good indeed, 457 health visitor reports have been sent during the year to almoners and other bodies connected with the health and welfare of families. In addition 348 reports were sent to the Medical Research Council in following up children and young persons in connection with B C G vaccination in the prevention of tuberculosis, Co operation and assistance from family doctors, voluntary organisations and statutory services have done much to assist health visitors in the course of their work. We are pleased to express our recognition of the cordial team work of the Children s. Social Welfare, School Welfare Departments, the Borough Health Departments and officers of the National Assistance Board, the N.S. P.c. C W V S Public Health Inspectors. Old People's Welfare Organiser and Diocesan Moral Welfare, 98 Family Planning Association Hornsey Two sessions were held in the Clinic at the Hornsey Town Hall each week during the year, on Monday and Tuesday evenings. Tottenham On Wednesday evening, 4th January, 1956, the first weekly session was held at Lordship Lane Medical Centre, Tottenham, National Blood Transfusion Service The North London Blood Transfusion Service were allowed the use of the School Clinic, rear of Hornsey Town Hall for six sessions during the year for the purpose of holding blood donor sessions. Statistics The following table shows the number of visits paid by health visitors during the past two years:- No. of visits paid by Health Visitors working in the Area - 1956 1955 Expectant Mothers First Visits 1,851 1.858 Total Visits 2,886 2.955 Children under 1 year of age First Visits 3,412 3.149 Total Visits 13,941 15.392 Children aged 1 2 Total Visits 6,828 7,025 Children aged 2 - 5 Total Visits 12,125 13,953 Other cases- Total Visits as Health Visitor 4,310 4,686 Total Visits as School Nurse 1,027 1,144 HOME NURSING SERVICE (SECTION 25) The Superintendent of the Home Nursing Service, Miss Curtis, reports that notwithstanding the closure of the District Nurses' Homes in Hornsey and Tottenham, the volume of work is unimpaired. The year's working has shown that this service can be efficiently run from an office and use of the telephone service. It took. 99 however, some time for the public to get used to the idea of the nurses living in their own homes, though in fact the majority had been doing so for years, and only a few lived in the Nurses Homes. It would appear from this year's numbers that some stability has been reached in requests for the nurses' help. The same relationship exists in calls for general nursing, other treatments and injections. The slight drop in the number of injections given by the nurses is due to the fact that penicillin is now more often administered orally. 22 full time and eight part time nurses areatpresent employed in the Home Nursing Service. Apart from four nurses who are kept for relief duties each nurse has a localised district where she works permanently, This has proved to be the most satisfactory method of using the staff. During the year five home nurses attended refresher courses each of one week s duration, The work has varied little from that of 1955 injections of various drugs and the care of the aged sick still forming-a preponderence. With the increasing demand for nursing the helpless patients at home a need has become obvious in that some type of lifting apparatus is required to enable a nurse to move heavy patients without injury to herself. It is hoped to provide a simple type of hoist for this work in the near future. Also in connection with nursing these patients, the Hornsey Nursing Association has kindly made a gift of two Dunlopillo mattresses for use in Hornsey, These mattresses were sent out to patients a few days after delivery and have been in constant use ever since. They have afforded great relief and comfort to the long term bed patients. Surgical cases discharged home for care of post operative wounds has continued in an effort to release hospital beds earlier than would otherwise be possible. As reported in previous years lack of adequate motor transport affects efficiency. 100 During the cold and wet winter of 1955 much discomfort for the nurse and much delay was encountered in carrying out visits. Type of Case No- of new cases attended by home 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 861 1,537 2,398 195 458 653 70,315 Surgical 95 121 216 23 17 40 6,814 Infectious Disease 2 3 5 2 1 3 40 Tuberculosis 55 62 117 9 8 17 4,832 Maternal complications - 42 42 - 4 4 696 Totals 1956 1,013 1,765 2,778 229 488 717 82,698 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 1956 General Nursing Other treatments Injections 667 805 1, 306 Total 2 778 VACCINATION AND IMMUNISATION (SECTION 26) Vaccination against Smallpox There was a slight falling off in the percentage of children under one year of age vaccinated against smallpox in 1956 compared with the previous year. Nevertheless the figure of 49,3% is fairly satisfactory and with a variable birth rate minorfluctuations from year to year are to be expected, The following table records the number of persons known to have been vaccinated or re vaccinated during the year^ 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 1,541 58 26 23 106 1,754 NO. of re-vaccinations - - 3 25 356 384 101 Immunisation against Diphtheria and Whooping Cough Owing to an outbreak of poliomyelitis in Tottenham during the summer, the diphtheria immunisation campaign was suspended during July and August. Efforts to make up the arrears were intensified during the latter part of the year and the results achieved over the whole year compared not unfavourably with the previous year. The following table shows the total number of immunisations of all age groups carried out during 1956:- 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 38 1,663 - - 2 One 41 326 9 - 1 Two to Four 40 107 6 451 30 Five to Fourteen 169 23 3 672 35 Fifteen and Over 1 - - - Totals 289 2,119 18 1,123 68 Vaccination against Poliomyelitis In accordance with Ministry of Health Circular No. 2/56 the County Council decided to take part in a limited scheme to provide vaccination against poliomyelitis during May and June for children born between 1947 and 1954, In the early part of the year leaflets and consent cards were distributed through the schools to children to take home to their parents. Publicity in respect of vaccination for children born before 1955 and not attending school was arranged through the welfare centres and by the distribution of leaflets locally in addition to the publicity given in the National Press. The number of consents received was 5 983 equivalent to 23% of children in the eligible age groups. Vaccination of children in Nationally selected age groups was carried out at local clinics during May and June and a few children who received only one injection then were given their second injection in December when a further small supply of vaccine was received. 102 The following table shows the number of children, by years of birth, who received a complete course of two injections during 1956: Year of Birth No. of Children vaccinated 1947 108 1948 101 1949 77 1950 69 1951 74 1952 39 1953 28 1954 21 Total 517 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 1956 210 applications were received compared with 235 the previous year. Of these 178 were approved. DOMESTIC HELP SERVICE (SECTION 29) The total number of cases provided with home help during the year was 1,781. This figure shows no sign of declining and has in fact risen by over 500 in the past four years. As stated last year the bulk of the cases comprise the chronic sick, including aged and infirm, who need more or less permanent help, and the demands on the organisation can be readily appreciated when it is realised that nearly 1,000 patients now require help week by week. 103 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 1955 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) 128 8 136 14 Tuberculosis 36 38 74 40 Chronic sick (including aged and infirm) 585 828 1,413 910 Other 138 20 158 14 Total 887 894 1,781 978 Night Service The service was extended during the year by the introduction of a night service scheme intended to provide help for patients who are very ill or dying and who need night attention, and so enable relatives or others who normally provide this assistance to get a certain amount of relief. The scheme came into operation in June 1956 and details were forwarded to the local representatives of the British Medical Association and to hospital almoners. The scheme, although not widely publicised in its early stages, has shown that it meets a need, and is to be continued on a gradually developing basis. Training Scheme During the year, by arrangement with the Eastern Electricity Board a number of home helps attended at the local showrooms for instruction in the use of electrical appliances. In addition, ten home helps attended a departmental course of five lecture demonstrations designed to make the personnel more able to deal with emergencies, teaching them elementary precautions which they can take to avoid infection and advising them how their services may be of most use in families where financial or material resources are limited. Further courses have been arranged for 1957. 104 NURSING HOMES The Senior Medical Officer, Dr. Helen Garrow reports there were, up to November 1956 five Nursing Homes in Hornsey, Since then one has changed to an Old People s Home, 1 eaving four registered Nursing Homes. The position of the private Nursing Home has grown steadily more difficult, mainly but not entirely due to the rising cost of commoditi es. Heating of the large houses has been one of the greatest expenses, as wel 1 as increased cost of linen, mattresses, dressings, etc. Difficulty of getting adequate nursing staff of the right type, and the cost of staff has also been great. Few nursing homes can compete with the "Private Wings'1 of the big general hospitals, and the four remaining Homes in Hornsey do not attempt to do so. They cater for the aged sick and chronic cases.= They supply all the comforts and care necessary for the treatment of these old people, whether they are in for a short rest, or for many months. Strathlene Creighton Avenue 16 beds Claremont Colney Hatch Lane 9 beds Kenwood Annexe Princes Avenue 14 beds Kenwood Nursing Home, transferred to Old People s Home November 1956 St. Mary s North Hill 6 beds SCHOOL HEALTH SERVICE The work of the school health service was maintained and expanded during 1956, Routine medical inspections continue to prove of real value and much appreciated by parents who attend in such large numbers. It is important to bear in mind that the health assessment and health promoting functions of these examin ations are at least as important as the discovery of defects. This year was the first full year of the B. C. G (antituberculosis campaign) and the good response of parents seen in 1955 was well maintained. 105 The orthoptic clinic opened at Lordship Lane in June 1956, has filled a great need for the people of Tottenham saving much time and expense for parents who formerly took the children to hospital. The clinic was inaugurated with six sessions weekly and has expanded to nine sessions. Extension of the work of the Cerebral Palsy Unit at Vale Road School for the Physically Handicapped is mentioned later in the report. During the previous year the Minister of Health gave approval to the diagnostic and advisory functions of this unit being extended to pre school children under Section 22 of the National Health Service Act, General Health and Infectious Diseases The health of the school population was in general well maintained during 1956 as is shown in the following table.- The general condition of pupils is now classified as "satisfactory" and "unsatisfactory" and not as "A", "B" or w, th e classification used heretofore. This new assessment must be regarded as an improvement the noting of a child as unsatisfactory is an immediate stimulus to action by the doctor and health visitor concerned to take steps to see that the child is restored to optimum health, PERIODIC MEDICAL INSPECTION Periodic Medical Inspections Additional periodic inspections Other inspections Entrants Second Age Group Third Age Group Total Special Inspections Re-inspect ions 2,368 1,163 2,682 6,213 4,834 4,831 4,201 CLASSIFICATION OF THE GENERAL CONDITION OF PUPILS Age Groups No. of pupils inspected Satisfactory Unsatisfactory No. % No. % Entrants 2,368 2,341 98.9 27 1.1 Second Age Group 1,163 1,156 99.4 7 0.6 Third Age Group 2,682 2,662 99.2 20 0.8 Additional periodic inspections 4,834 4,765 98.6 69 1.4 Total 11,047 10,924 98.9 123 1.1 106 As far as the notifiable infectious diseases in school children are concerned, 1956 was. with the exception of poliomyelitis an uneventful year. The outbreak of poliomyelitis in Tottenham is referred to elsewhere but it should be notedhere that 15 cases occurred in school children of whom six were at Lancasterian School and the Nursery Classes at this school were in fact closed from the 3rd July until the summer vacation. One of the children concerned was left with a paralysed arm and has been admitted since to Vale Road School for Physically Handicapped Children. Two others were not yet fit to return to school at the end of the year and may require to attend at a special school when discharged. One case of diphtheria, rather unusually, of the ear, occurred in an immunised school child but this case was extremely mild and made an entirely satisfactory recovery. There were no outbreaks of food poisoning or of dysentery in the schools of either borough during 1956. Tuberculosis in Schools Notifications of tuberculosis (all forms1 in school children during 1956 were seven in number compared with 14 in 1955. These cases were discussed with the appropriate chest physicians and where the child was infectious, or where no source of infection was found in the home, epidemiological investigation was carried out at the school. In 1956 this was necessary in only one case, when a boy at South Grove Secondary Modern School was discovered to have tuberculous pleurisy. As no contact could be found in the home, epidemiological investigations were carried out at the school. One boy was found to have tuberculosis of the right lung and has been admitted to Highwood Hospital. The School Meals staff have been x rayed and all x-rays were found to be negative. Nine of the teaching staff were x-rayed and found to be negative, Tuberculin testing undoubtedly proved its value in this case bringing to light an adolescent with active tuberculosis. Mantoux testing at another school as part of the B C G vaccination programme revealed an unusually high number of strong positives. An epidemiological investigation had been carried out during the previous year at this school as the result of the discovery of a case of tuberculosis in a school child. Nevertheless after consultation withthechest physici an i t was thought desirable to recommend that all the teachers be x-rayed and this was done. Fortunately all were found to be healthy. 107 PATCH TESTING IN SCHOOLS District Patches applied and read Results Positive Negative % Hornsey 701 15 2.1 686 Tottenham 542 19 3.5 523 Totals 1,243 34 2.7 1,209 During 1956 patch testing of school entrants was carried out on all children whose parents gave consent and the results are given above. The percentage positive is very small a fact in line with the findings at Mantoux testing of J3 year olds. The Tottenham percentage of positives is higher than in Hornsey but the number is small. All of these children were referred to the chest clinic for further investigation and follow up of family contacts but no case of active tuberculosis was discovered in this way. It may well be that the routine annual patch testing of children attending as toddler clinics may prove to be a more fruitful source of primary cases and this has indeed begun at one clinic., B C C, Vaccination The B C G vaccination campaign has continued in our schools in 1956 and followed the scheme outlined in last year s Annual Report, The service has been extended to include schools other than those of the Local Education Authority and the B C G vaccination team visited Highgate School in December, Vaccination against tuberculosis by means of the avirulent B C G vaccine, was carried out on all tuberculin negative children in the 13 14 age group whose parents gave consent. The accompanying table shows that the successful start made n 1955 has been continued in 1956. 1956 1955 Parents approached 2,829 % 1 373 % Parents accepting 1,980 69.9 956 69.6 Mantoux positive 209 12.0 71 8.6 % Strong positives Reaction greater than 20 mms in diameter 40.2 25.7 % Weak Positives 59.8 74.3 Mantoux negative 1,532 88.0 755 91.4 Total vaccinated 1,526 53.94 of children in group approached 752 54.8 of children in group approached 108 Seventy per cent of the parents accepted in 1956, which was the same percentage as in 1955, 12% of those tested were tuberculin positive compared with 8,6% the mean figures for the two years being 10% tuberculin positive. There appears to be an increased reaction to the Mantoux test in 1956 compared with 1955, For 1955 there were 25,7% "strong" Mantoux positive reactions, while in 1956 there were 40.2%,. The B.C.G. vaccination reactions again showed no excessive ulceration or abscess formation, (2,278 children have now been B.C.G. vaccinated in this Area under the present scheme). The Mantoux positive children referred to the chest clinic during the year were all found to be free from tuberculosis,. The general medical practitioners in the Area have been notified of the results of Mantoux testing and informed when each child has been vaccinated. The staff of the schools visited and the chest physicians have throughout the year shown the utmost consideration and co-operation. M.B.C. Clinical Trials with B.C.G. In 1956 the Medical Research Council published the first progress report of their Tuberculosis Vaccines Clinical Trials undertaken by Dr. T M Pollock. It has been previously reported that school leavers in this Area in 1951 volunteered to take part and that they have been followed up by the health visitors since. The investigation consisted of a controlled clinical trial of B.C.G, and Vole bacillus vaccines in the prevention of tuberculosis in adolescent boys and girls. The results in the test areas appeared satisfactory in so far as the trials indicated that each vaccine conferred a substantial and similar degree of protection against tuberculosis over the period of the trial. In the above trials the participants were investigated towards the end of their 15th year by which time 4 0% were tuberculin positive using old tuberculin for the Mantoux test. In 1955 and 1956 in this Area the 13 - 14 age group were Mantoux tested using Purified Protein Derivative and only 10% found to be tuberculin positive. This figure is therefore far below that of the Medical Research Council trials, but other information available has shown that other neighbouring areas vaccinating the same age group and using P.P.D for the Mantoux test have a percentage of tuberculin positive children which is similar to ours. 109 The Medical Research Council's report stated that in the light of present results the vaccination of tuberculin negative school children in the 13 14 age group, as carried out in the present B.C.G. vaccination scheme, is a valuable measure. The Handicapped Child DISTRIBUTION AS AT 31st DECEMBER 1956 Category In Special Day Schools In fecial Residential Schools In Maintained Primary & Secondary Schools In Independ ent Schools Not at School Total B G B G B G B G B G B G Blind Pupils - - 4 5 - - - - - - 4 5 Partially Sighted Pupils 5 6 2 - - - - - - - 7 6 Deaf Pupils 6 6 5 1 - - - - - - 11 7 Partially Deaf Pupils 7 4 3 2 13 8 - - - - 23 14 Educationally Sub normal Pupils 55 51 11 4 10 7 - 1 2 - 78 63 Epileptic Pupils - - 1 2 - - - - - 1 1 3 Maladjusted Pupils - - 25 5 12 - - - - - 37 5 Physically Handicapped Pupils 17 11 4 - - - 1 - 1 1 23 12 Pupils with Speech Defects 2 1 - - 212 85 5 2 3 1 222 89 Delicate Pupils 4 3 9 9 3 2 - - - - 16 14 Pupils with Multiple Defects 6 5 5 3 2 - - - 1 - 14 8 Totals 102 87 69 31 252 102 6 3 7 3 436 226 Grand Tbtals 189 100 354 9 10 662 Dr, Yarrow Deputy Area Medical Officer, reports as follows on the local provisions for the care of the physically handicapped child. This year has been one of consolidation of the work done in previous years in this field of the School Health Service. The opening of special schools for physically handicapped and deaf children elsewhere in the County has entailed some alteration in Placement of children at Vale Road School fo rPhysically Handicapped Children and at the Blanche Nevile School for Deaf Children in Tottenham although no child was moved where this was thought undesirable on medical or education grounds. The provision of further school places elsewhere forE,S N children meant a consid erable easing of the position at Oak Lodge (Pinchley) and this has had the result of virtually eliminating the Hornsey waiting list for such children. 110 During 1956 consent was obtained from the Ministry of Education to the opening of an Audiology Unit in Tottenham for the ascertainment and supervision of young deaf children. Unfortunately its opening was followed shortly after by the prolonged absence through illness of the Visiting Aurist, Dr, F.P.M Clarke, so that a real start could only be made with this on his return to health. The separation of partially deaf children from the deaf has been of great value in the younger age group and it is hoped that a unit for senior partially deaf pupils will, during 1957, beopened at the new Markfield (Secondary Modern) School in Tottenham. The degree of integration with normal hearing children would be much greater with these older children than is at present the case at the Devonshire Hill class for junior partially deaf children. With so much work accomplished in the field of provision of new facilities for handicapped children in the past few years, it is useful now to have a period in which we can take stock. As is well known, there has been a revolution in medicine over the past few years and this has had far reaching effects on the type of child needing special educational treatment, and less apparent effect on the numbers, An attempt has been made here to consider these changes as they affect the problems of the deaf and physically handicapped categoriesofschool children- The use of prophylactic technique (e.g. B C G vaccination of infants' and chemotherapeutic drugs and antibiotics has wrought far reaching changes in the types of children reaching the B1anche Nevile School for the Deaf, These drugs, the sulphonamides, penicillin and streptomycin at first succeeded in saving the lives of a great many children who would otherwise have died of meningitis but unfortunately many of the survivors were afflicted wi th deafness some as a result o f streptomycin therapy. This phase has been succeeded by another in which therapeutic techniques seem to have greatly improved so that the survivors are not being deafened. Tables A and B illustrate these phases admirably. Table A shows the causes of deafness in the various age groups among deaf and partially deaf chiIdren atspecial schools (both day and residential) in the Autumn term of 19 56. Table B was prepared from the register of the Blanche Nevile School as at September 1951 and the two together illustrate the changes that have taken place in five years. 111 TABLE A Ascertained Deaf or Partially Deaf Children in Tottenham and Hornsey at special schools in Autumn Term 1956 Age Cause 2-4 Congeni tal 5 5-10 Congenital 7 T. B. Meningitis 2 (1950 52) (1953) Suppurative Otitis Media 2 (1949 50, (1953) 11-16 Congenital 13 Pneumonia 1 (1946) Meningitis 3 (1943) (1945) (1947) T.B. Meningitis 2 (1951 52; <1950) Suppurative Otitis Media 1 (1948 51) Dates in brackets show date of causative illness. TABLE B Tottenham and Hornsey Children at Blanche Nevile School in September 1951 Present Age Cause 10 - 15 Congenital Deafness 11 T. B. Meningitis 1 (1950) Purulent Meningitis 2 (1945) (1947) 16-20 Congenital 1 T. B. Meningitis 1 (1950) Purulent Meningitis 3 (1937, (1941) (infancy). Suppurative Otitis Media 2 (1938) (Not known; Dates in brackets show dates of causative illness. It will be seen that the cases of purulent meningitis occurred soon after the discovery of the clinical uses of the sulphonamides circa 1935 and cover the years 1937 to 1947 but no child has been admitted to the school roll who has had meningitis since that date. Similarly cases of tuberculous meningitis first began to recover soon after the initiation of streptomycin therapy circa 1948, but many of these children were deafened. Once the dangers of excessive streptomycin therapy became apparent these cases too have appeared to lessen and no child has so far been admitted who was treated with streptomycin later than 1953. 112 As far as suppurative otitis media is concerned, the picture is not very clear but it does appear to be a continuing cause of deafness. Clinical impressions lead one to believe that the disease, at least in its chronic form is less common and more efficiently treated and it is to be hoped that fewer cases will require to attend special schools in the future. Admissions then are likely to be more and more confined to the group of congenital defects, It is of interest to note that in no case of the group of congenitaily deaf children (Table A) did the mother give a history of rubella in pregnancy, and in only one case (in the nursery group) was there a history of erythroblas tosis foetalis, a much more easily diagnosed and remembered condition. Of course, congenital deafness of hereditary origin is often a diagnosis of exclusion but it is of interest to note that of the 25 cases of congenital deafness (Table A) ten gave a family history and of the remainder four were Jewish children. As far as absolute numbers are concerned, the above considerations would lead one to expect a drop in the total number of deaf children but the national figures (Health of the School Child 1954 55) do not yet support this and perhaps it is too soon to expect it. It may be, too that fuller ascertainment partially accounts for this. The Physically Handicapped Child A review of the children ascertained as physically handicapped in Tottenham and Hornsey as at December 1956 reveals a similar picture:- 1. Congenital deformities and disorders 14 21 2. Congenital heart disease 7 3. Infantile cerebral palsies 13 4, Tuberculosis 2 5, Post rheumatic fever 2 6. Post paralytic poliomyelitis 3 7, Perthe's disease 1 8. Still's disease 1 9, Bronchiectasis (infective origin) 1 10. Cerebral accidents 2 46 Only in groups 4, 6, 9 and probably in 5 and 8 can there be said to be an infective origin, a total of only 9 out of 46 children. All of these groups show a declining incidence, apart from poliomyelitis which will probably give way soon to prophylactic technique. 113 Improved obstetrics and operative techniques will, however, increase the number of children with congenital deformities who are likely to survive and require special educational treatment. Improved obstetrics may, however, reduce the number of cases of cerebral palsy (and perhaps of deafness). It would appear that in this field at least only further research into the causes of congenital defects and the elimination of harmful ante-natal influences can further reduce the number of handicapped children. Change of Name of the Tottenham School for the Deaf In a letter to the Borough Education Officer, Mr. J. Power, MA., Miss Nevile, the first headmistress to the School, writes:- "In giving my permission for the Tottenham School for the Deaf to be renamed "The Blanche Nevile School", I wish to say how greatly I appreciate the honour done me by such a suggestion. My mind goes back to a certain day in 1895 when, in pursuance of the Deaf Education Act of 1893, the then Tottenham School Board appointed me to open the school. I did so - in one room - where I found 7 deaf mute children boys and girls - ranging in age from 5 to 15 years. I was fresh from a special training college and this was a stiff problem in classification! I could only solve it by dividing each session into 5 periods of speech and language training and devising suitable and varied occupation for the restless pupils not under special instruction. The strain was severe and it naturally became my ambition to interest the neighbouring authorities and so to increase numbers, thereby making possible proper classification, so that every child could receive full-time instruction. This took years and as my mind goes back, I realise how much I owed in those difficult times to the sympathetic understanding from the Inspectorate of the Board of Education, the help of the local Education Authority, the wonderful co-operation of my staff and the great courtesy of other schools in England, Germany and America. In these schools I was welcome to gather anything I could to assist me in solving my own problem. 114 In 1925 I left the school to take up other work for the deaf but I still think of what Tottenham taught me.- To educate the deaf what is it ? To give to the deaf, who are deprived of the only natural means of learning it, the power to understand and use that huge complicated system of symbols (spoken and written) we term language, in which the mind of Man lives and moves and has its being. Surely there cannot be any job in the world more intellectually and spiritually rewarding than the Education of the Deaf", Vale Road School for Physically Handicapped Children Cerebral Palsy Unit I am indebted to Dr. William Dunham forthe following report- "Twenty seven of the 94 children now at this Special School have cerebral palsy and parents of al± but four of these are now participating in a programme of comprehensive management in which parents teachers and medical staff collaborate to provide for the child the help he needs in attaining to the best of his ability normal activity. Parents attend from time to time for advice at the school and, where necessary the therapist visits the parents in their homes during the holidays. Only two of the children have left school during the year, both being transferred to another school ind their places taken by other children with cerebral palsy, My work as Consultant has included giving advice on 11 children with cerebral palsy other than those attending the school including two who attend Occupation Centres, It is hoped that in the future moreof the babies and children of pre school age who have cerebral palsy will be referred so that, through early treatment they may be given the best chance of winning for themselves a place in normal society , The Vale Road Day Special School continues to provide mainly for other forms of physical handicap references to the type of cases and change in pattern being referred to on page 112. The demand for ancillary medical workers at the school has increased and during the autumn term two physiotherapists were engaged to devote seven sessions in all to children other than those suffering from cerebral palsy, the work of the physiotherapists being under the general direction of Mr, E, Hambly, F.R.C.S of the Prince of Wales' s General Hospital and of Mr. E.T Bailey, F.R.C.S. at 115 Highlands Hospital, Formerly many of these children had lost two three half days a week travelling to hospital for physiotherapy. The speech therapists, too, have continued their work with several difficult and interesting cases referred to in Miss Cames report. Speech Therapy Miss Came, Senior Speech Therapist reports as follows:- "The accompanying table shows that the majority of children suffering from dyslalia were referred before six years of age. This satisfactory result is largely due to teachers recognition that speech therapy frequently assists educational progress. In stammering, early treatment has also proved the most effective. The speech therapists aim to prevent (a) the fixing of early speech non fluency through the parents well intentioned but ill informed interference, and then labelling the child "a stammerer"; Cb) the formation of abnormal secondary symptoms, due to anxiety and increasing awareness of speech difference, causing the disorder to become self perpetuating. It is therefore most important that all concerned with small children should refer those with any speech defect or del ayed speech to the speech therapist as early as possible. During 1956, treatment was carried out in the various groups on the following lines 1. Pre school children. Treatment was mainly indirect, through talks with the mother. This preventive work has proved of particular value in cases of primary stammering. Improvement is more rapid, and final recovery more complete. 2. Infant school children. These formed the largest group treated. Many were discharged as normal speakers, before entry to the junior school. 3. Older children. These were fewer in number, but their difficulties slower in responding to treatment. Work with the older stammerer aims to reduce anxiety and increase insight. 4. Children with severe speech abnormality. sometimes associated with such disabilities as cerebral palsy. These are treated at Vale Road School for the Physically Handicapped. In all cases the improvement resulting from speech therapy has been measurable, although it is inevitably achieved far more slowly." 116 Children suffering from speech defects as at 31st December,, 1956 Individual defects Boys Girls Under 6 6-10 11- 15+ Total Under 6 6- 10 11- 15+ Total Dyslalla 65 39 2 106 28 9 1 38 Stammer 11 44 9 64 1 9 3 13 Stammer with defective articulation 6 4 - 10 4 2 - 6 Interdental sigmatism 8 11 - 19 4 10 2 16 Lateral sigmatism 1 5 - 8 2 2 1 5 Cleft palate speech 2 1 3 2 1 - 3 Delayed speech development 6 - - 6 3 - - 3 Excessive nasality 1 » - 1 1 - 1 Insufficient nasality - 2 - 2 - 1 - 1 Dysarthria - 2 - 2 - - - - Inco ordinated speech _ » - - 1 - - 1 Slightly deaf - - - - - 2 - 2 100 108 13 221 45 37 7 89 Children with multiple defects receiving speech therapy Boys Girls Under 6 6-10 11-15+ Total Under 6 6-10 11 -15+ Total Dyslalia 1 1 - 2 - - - - Dysarthria - 1 - 1 - 2 - 2 Aphasia - - - - 1 - - 1 Delayed speech development 3 - - 3 - - - - Congenital suprabulbar paresis - 1 - 1 - - - - 4 3 - 7 1 2 - 3 School Dental Service The Area Dental Officer Mr. V. Sainty L.D.S., reports there have been several staff changes during 1956. One full time dental officer resigned in June a part time one, becoming full-time from July 1st took over the post. Another dental officer resigned his full-time appointment but remained on a part time sessional basis. Also there have been other part time changes in personnel. The net result has been one less full time staff then in 1955 viz. seven including the Area Dental Officer as compared with eight, plus approximately the same amount of part time assistance. This decrease in full-time dental officers emphasises the general trend of a growing difficulty in replacing resignations in the service other than by part-time appointments, and these are . sometimes of short duration. 117 In spite of the somewhat less favourable staff situation, compared with the previous year, the amount of treatment carried out has shown little change in fact as regards fillings inserted in permanent teeth there was a small increase, 15,992, as against 15 537 in 1955. The ratio of fillings to permanent teeth extractions was also better, viz- 12.2:1 as compared with 11.4:1. During the year 19,134 children were inspected at the schools by the dental officers. All age groups in many of the schools have had an annual inspection during the last two years. Orthodontic Clinic It has not yet been possible to extend this work beyond the six-seven session a week basis and consequently there is still the same long waiting list for treatment, in spite of the quite considerable number of cases treated by some of the dental officers. At the moment the orthodontic situation seems to be the most urgent problem requiring solution. The following tables show the work carried out during the year 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 5 312 185 179 5-16 and over 18,822 13,147 12, 805 Specials 4,027 3,817 3,758 Total 23,161 17,149 16,742 Number of pupils treatment commenced 9,348 Number of pupils treatment completed 7,331 Number of attendances made by pupils for treatment 21,971 Number of appointments not kept 4,733 Number of half days devoted to (a) Inspection 140 (b) Treatment 3,081 Fillings. Permanent Teeth 14,067 Temporary Teeth 4,133 Number of teeth filled. Permanent Teeth 12,318 Temporary Teeth 3,780 Extractions. Permanent Teeth 1,235 Permanent Teeth for Orthodontia 222 Temporary Teeth 6,722 Anaesthetics (a) General 2,007 (b) Local 2,805 (c) Regional 384 Other operations (a) Permanent Teeth 2,691 (b) Temporary Teeth 4,956 118 SPECIAL DENTAL TREATMENT UNDERTAKEN BY DENTAL OFFICERS Number of impressions, etc. 277 Number of dentures fitted 53 Number of crowns and bridges 41 Number of inlays 2 Number of radiographs (a) at Dental Clinics 230 (b) at Hospitals 2 ORTHODONTIC EXAMINATION AND TREATMENT AGE GROUPS TOTALS 5 6 7 8 9 10 11 12 13 14 Number of pupils examined 1 9 7 21 18 14 9 9 7 16 111 Number of pupils selected for treatment 1 7 6 20 16 10 5 2 6 11 84 Number of pupils commenced treatment (first attendance)416 Number of attendances made for treatment 3,323 Number of consultations 42 Number of impressions, etc. 3,313 Number of fixed appliances fitted 19 Number of removable appliances fitted 296 Number of radiographs (a; at Dental Clinics 730 b) at Hospitals Number of pupils treatment completed 48 Number of orthodontic sessions (½days)445 Tottenham Eye Clinic I am indebted to Mr. T.G. Kletz, M.B. Ch.B. D.O.M.S Visiting Ophthalmologist for the following report:- The total number of cases seen was 1,790. Orthoptic Department During the first year of having an orthoptist at the Clinic this department has been very busy. No. of cases (for investigations and reports) 283 No. of cases having treatment (including 48 cases of occlusion for amblyopia) 170 Orthoptic treatment successful 44 partially successful and still being treated 66 unsuccessful 12 Occlusion cases - successful 20 improved 10 unsuccessful 18 No. of cases referred for surgery 8 In addition, 37 cases have not been treated due to failure to attend or refusal of treatment. 119 Blind certification. One case only was certified as blind and no cases as partially-sighted during the year, Glasses. The concern, which I have previously mentioned about the high rate of loss and breakages is fully justified, A total of 1,367 prescriptions for glasses (Form H.E.S.1.B. ). were dispensed by the Clinic optician. The number of repairs and complete replacements during the same period totalled 429 (Form H.E.S.1.A ) or nearly 32%. "E" Testing.From March to December the number of cases referred following "E" Test was 61 of whom 34 were given glasses, 55.7%. Orthopaedic Service Mr. E Palser M.R.C.S. ; reports that there has been considerable activity in the orthopaedic services in Hornsey. In addition to the clinics and treatment necessary, the Hornsey orthopaedic service has the advantage of being In close liaison with Highlands General Hospital N.21. where Mr, Palser and the Orthopaedic Unit directed by Mr, E. T, Bailey F.R.C.S can carry out operative treatment, or specialised treatment and further investigations which may be required. The following table gives figures for the above activities:- Under 5 Over 5 Clinic attendances 206 620 Treatment session attendances 72 1,112 Operative treatment at Highlands General Hospital 5 Further investigations and specialised treatment 3 at Highlands General Hospita One case of rickets was seen this year the first for many years. Rheumatism Supervisory Centre This clinic has continued to hold specially allocated fortnightly se ssions at the Prince of Wales's Hospital in association with the Children's Outpatient Department under the control of Dr.I.M. Anderson, Consultant Paediatrician, 120 The review of the register commenced during 1954/55 has now been completed and some lapsed cases have been reclaimed, whilst others have been removed from the register, In spite of this review the number of new cases exceeds the cases removed, indicating that the field of supervision is enlarging. Distribution of new cases Male Femal2 Tottenham area 7 8 Outside area 6 6 Medically these cases were allocated as follows Tottenham Area Outside Area Rheumatic Fever 1 - Rheumatic Carditis 1 5 Chorea 2 - Rheumatic Limb Pains 1 - Congenital Cardiac Lesions 6 5 Other cases 4 2 Totals 15 12 A review of all cases on the Rheumatic Register shows the following present distribution Cases under supervision 169 Discharged 33 Transferred on removal 15 Males 125 Lapsed 16 Females 119 Deaths (total) 11 244 244 Of the children under supervision 111 children made 266 attendances at the clinic during the year. In addition a number of children were seen in other children s outpatient clinics under the supervision of Dr. I.M. Anderson, 121 The present classification of cases under supervision is: Tottenham Area Outside Area Total Rheumatic Fever 32 17 49 Rheumatic Carditis 23 13 36 Rheumatic Fever with Chorea 1 - 1 Chorea (uncomplicated) 4 - 4 Chorea with carditis 3 - 3 Rheumatic Arthritis 2 3 5 Congenital Cardiac Lesions 35 22 57 Other cases 11 3 14 111 58 169 Male 81 Female 88 It will be seen that congenital cardiac lesions now form a larger group than other cases of true rheumatic heart disease in childhood. The supervision of these congenital cases is regarded as an important additional aspect of the work of this clinic. Many of these children need no restrictions and are able to lead an active normal life. In other cases, full exercise is not possible, and periodic review is necessary the increasing possibilities of cardiac surgery may make it possible to advise the parents that the child's condition can be improved in certain carefully selected cases. Another group of children are approaching the school leaving age the problems of future careers and occupations are discussed with their parents and it is often possible to supervise the early school leavers for one or two years subsequently, to ensure that they have become firmly established in a suitable occupation. Hospital School The Borough Education Officer for Tottenham reports that over the past year the Tottenham Education Committee have provided tuition for the children in the paediatric wards in St. Ann s Hospital and to a few children in special wards in the Prince of Wales' s Hospital. This has covered an average of 25 children weekly with an age range of 5 - 16 years. Although practically all the teaching is individual work part of a ward at St. Ann' s Hospital is used as a schoolroom for pupils 122 who are well enough for tuition (beds being wheeled into the class room) and for children from other wards who are well enough to attend. The schoolroom is equipped with a table for the youngest children and desks for the older pupils. We are fortunate in having a library bookcase on wheels (filled with a great variety of books).a wireless set and a recorder besides a shop (where children can but and sell with imitation money) and a puppet theatre, For the younger children, there is a sandtray.a doll's house and many other playthings. As far as possible each child continues its studies where they left off at school and each child's individual interests are pursued. Apart from tuition in the schoolroom, there is bedside teaching for the many children who cannot attend the class. From September a second teacher was employed on a part time basis to give tuition in the poliomyelitis ward. From January 1957, however, she is to be employed full time and will thus be able to give more time at the Prince of Wales's Hospital besides helping with teaching on other wards at St. Ann's Hospital. In the case of children who stay for long periods we are able through the Education Authorities to establish contact with their normal schools. Much help has been given to the school by the Tottenham library service, which has provided books for educational and recreational purposes. Considerable interest has been shown in the school, As a result of a photograph of the school appearing in a Danish newspaper we had a visit last July from two Danish teachers one of whom was employed in hospital teaching in Copenhagen. They both showed great interest in the work. On the whole, the children welcome 'school" and the parents are most appreciative. Child Guidance Service I am indebted to Mr.J.Power, M.A.,Borough Education Officer Tottenham, for the following report on the work of the Child Guidance Service in Tottenham. 123 "The majority of the children seen at the Child Guidance Centre during the past year were referred by Head Teachers and School Medical Officers. Others were referred by Officers of the Children's Department, Magistrates, Probation Officers, Hospitals, General Practitioners, and in some cases by parents direct. After diagnostic interview, many of these children were helped through advice to their parents, teachers or others, by effecting changes in their environment, by placement in one of the four Borough Opportunity Classes for children who are maladjusted and working below the level of their real ability or by Remedial Teaching. In some cases it was found necessary for a child to be given psychiatric treatment at the Child Guidance Clinic, In a few, where it was deemed essential that the child be removed from home, placement in a boarding school or residential school for maladjusted children was recommended. In addition, each year adds to the number of previous cases who need follow-up interviews in which further help and advice is given. In psychological work it is often essential to keep in close contact with "old" cases. The work o f the Chil d Guidance Centre during 1956 was handicapped through lack of sufficient staff, and a further serious setback was caused through the departure of the psychotherapist in November, (Recommendations have now been passed by the Tottenham and Middlesex Educational Committees for increases in the staff of the Child Guidance Centre). In September 1950 a teacher with a psychological background was appointed to undertake Remedial Teaching under the direction of the Education Psychologist, with individual or small groups of children who were handicapped in their school work through specific educational difficulties.This work is still continuing and in September 1956 a second and additional Remedial Teacher was appointed Most of the children attend for sessions of approximately an hour, two or three times a week. One of the most important aspects of psychological work lies in the field of prevention-the furthering of understanding of the conditions making for mental health, and of the causes likely to give rise to psychological disturbance in children and combined with this, the need for earlier detection and treatment of disturbance when this does arise. This work is furthered by the Psychiatric Social Worker in her interviews with parents of school and pre school children by 124 the Educational Psychologist in her frequent contacts with the schools, and the Courses she has given for teachers and lately an attempt has been made to carry out this prevention work in an experimental way, with the joint attendance of one Medical Officer and the visiting Psychiatrist once a week at a special Clinic, to which are referred mothers with a child under five years of age with whom there is some difficulty." Dr. C.Phillips, M.R.C.S. D.P.M visiting psychiatrist to the Child Guidance Centres in Hornsey and Tottenham, reports "During the past year, the work of the Child Guidance Centre in both boroughs has suffered a setback because of the departure of the Psychotherapists,so that treatment facilities for the school children referred are depressingly inadequate. Since the latter are, for the most part, only the grossly severe or abnormal cases it may fairly be said that facilities for treatment and advice are not proportional to the very high number of school children in this Area who might otherwise benefit from it. The need for the appointment of Psychotherapists to fill the gap is, of course, well known to the Authorities, As yet I am unable to find a way of conveying to the lay public, and particularly to those of them who are parents or teachers, the extent depth and importance of mental ill health among school children which goes unrecognised, and extends from minor and easily remedied problems to the most severe degree of disturbance. This lack or recognition of the quantity and quality of mental ill health seems to be based upon two major factors. The internal factor is the general reluctance to notice illness in other people of a type which is called psychological but which might equally well be called mental or emotional because such recognition is painful and disturbing to the observer it may stir up his own anxieties and awareness of his own internal difficulties. This is a problem which every one of us faces with varying degrees of sensitivity and defensiveness or courage. The second major factor is an external one in that the parents, and from the point of view of our own Child Guidance Centres the teachers, may not have sufficient knowledge or training to know what is within the normal range of variation so far as personality is concerned, and what constitutes a symptom, This would seem to stem from lack of contact between teacher and psychiatrist, which cannot be entirely made good by the efforts of the Educational Psychologist.I have long felt that there needs to be more contact between the teaching staff of various grades and the Child Guidance 125 Clinic team in general, but you have not yet found a way of ensuring that this fruitful type of meeting takes place at anything but rare intervals, so that one important part of our potential ability to make easier the task of educating large numbers of school children is not used. As a visiting psychiatrist, I am always pleased to extend a welcome to our Clinic case conferences to any teacher, and to modify my personal arrangements or rearrange my work in order to make it possible for them to attend. Since cases of mental ill-health amongst school children must have a beginning, it is important that we should extend further a generally little-known field of knowledge which concerns itself with the beginning of these disorders. As mentioned in my last year's report, we have already started on such work in an experimental way, with the joint attendance of one Medical Officer and the visiting psychiatrist for one half day a week at a special Clinic, to which are referred mothers with a child under five years of age with whom there is some difficulty. The method we have tentatively adopted is for each Medical Officer to work with the psychiatrist for three months. It has also been decided that the children should be preferably less than three years old, because above that age the problem is already complicated and is usually suitable for a Child Guidance team to assess.The interview has been conducted, if possible, by the Medical Officer, but where it has been felt that the case requires considerable psychiatric knowledge to unravel, the psychiatrist has taken the lead in conducting the session. A very small number of cases were actually seen, in order to allow time for observation of behaviour and to leave time for a discussion and instruction in the interval between one case and the next. This is not intensive enough to be called a training programme, but it was thought that it could be a valuable series of Clinic demonstrations of the technique of the clinical management of the interview and of finding ways to help the mother both to understand and manage the child. It is not possible to report much of the clinical material because this might more appropriately be the subject of a scientific Paper, but certain conclusions are beginning to make themselves apparent. I intend to mention only three categories of difficulty with a brief comment, and hope that this will not involve too great a frustration to readers of this report. The commonest problems are feeding, sleeping, and general restlessness and over-activity. 126 The theoretical basis upon which understanding of these problems restsis essentially psycho-analytic, and it has been found possible to apply much of the knowledge of the origins of human behaviour revealed thereby to this work with small children where the difficulties are in statu nascendi.All the cases seen had already resisted the therapeutic armoury of the health visitor and, quite often, of the family doctor. The feeding problems were found to be the ones which responded best and it was rare for a child of 10-24 months to continue to be a feeding problem after three or four weekly half hour interviews. My impression is that this is because there is quite often a specific, localised, and fairly easily determined set of factors at work, with perhaps a single instinctual drive as a basis. The sleep disorders are more difficult, and my way of looking at it has developed to the point where I regard a sleep disorder as commonly of a non-specific nature in the same way as a temperature, or albuminaria, or jaundice in physical medicine. The treatment, therefore, has involved a survey covering a fairly wide range of domestic activities and routines in infant and child handling, in an examination of events in the household preceding the sleep disorder in question, a study of the emotional attitudes of the mother and their effect on the child, and quite often and more difficult, an understanding of the frightening meaning to the child of what grown ups consider to be ordinary events, As each facet of the problem is dealt with there tends to be a general improvement, but any one of these factors which has not been dealt with in the clinical survey which takes place during the interview is 1iable to re-stimulate a further sleep disturbance. Therefore we have had cases which have taken ten or more interviews. The most serious disturbance which has come to light in the children seen, of those which it is possible to discuss briefly here, is that of restless over activity. I have got to the point of considering that it is an indication of a gross emotional disturbance in the mother and that it may be a disorder in the child itself as well, or simply a reaction by the child and, of course, the second of these two has the best prognosis (though there is no simple way of telling at the original consultation). It is most disturbing to see this state of affairs in a one year old child and to realise that in this particularly plastic time when a tremendous amount of growth and development has yet to take place the child is already developing mechanisms of behaviour which are of a grossly pathological type in order to deal with his inner emotional forces, 127 There are three further comments appropriate here. The first is that there is no general awareness that there can be such severe disturbances at such an early age and therefore, of course, facilities for the diagnosis and treatment of them have not been provided. The second is that it is possible to know from this clinical work that there can be such a severe disturbance at the age of one year, that it is recognisable, and that it is treatable. The third thing is that although these disturbances are of a grossly pathological type and, if continued carry a very bad prognosis., they are, at this age, almost certainly reversible, and this is of tremendous importance for the task of raising a healthy generation and preventing breakdowns in future life as well as enabling a child to realise his full, natural potentialities. It is not possible to substantiate those details in a report of this nature but I feel it is important to draw attention to such matters at the earliest possible date". 128 INDEX Page Aged, care of 62 Ambulance Service 60 Anaemia, investigation at Ante-natal Clinic 81 Ante Natal Clinics 80 Area Health Service 79 Area Welfare Service 60 Arteries, Diseases of 14 Atmospheric Pollution 30,31 B.C.G. Vaccination 86,107 Births and Deaths 69 Burials 68 Cancer Bronchial Carcinoma 8 Deaths, Table 75 Certificates of Disrepair 36 Chest Clinic 8 Child Guidance 122 Child Welfare Clinics 85 Chiropody Service-Old People's 65 Clean Air Act 1956 32 Clearance Areas 33 Closet Accommodation 30 Closing Orders 35 Comparability Factors 4,71 Council, Members of 1 Daily Guardian Scheme 90 Day Nurseries 91 Deaf, School for 113 Deaths, Classification of, Table 74 Defects Sanitary: Remedied 39 Demolition Orders 35 Dental Service, Priority 93 School 116 Diphtheria 13 129 Diphtheria Immunisation 101 Disinfection 16 Disinfestation 68 Domestic Help Service 102 Drainage and Sewerage 28 Dysentery 12 Expectant Mothers, Care of 80 Eye Clinic 118 Factories 41 Family Planning Association 98 Flooding 28 Food - Condemned 21 Hawkers 19 Hygiene Regulations, 1955 17 Label ling 24 Poisoning 12 Registered Premises 13 Sampling 22 Shops 17 Guardian Scheme.,Daily 90 Handicapped Children 109 Hawkers of Food 19 Health and Housing Committee 2 Health Education and Parentcraft 84 Health Services provided by other Authorities 58 Health Visiting Service 95 Holidays, Recuperative 102 Home Nursing Service 98 Hospitals 58 Hospital School, St. Ann's General Hospital 121 Housing Act,1936,S.9 34 " S. 11 and 12 35 Part III 33 Housing Repairs and Rents Act,1954 36 Ice Cream 13 Immunisation, Diphtheria and Whooping Cough 101 Industrial Health Survey 43 Infantile Deaths, Table 73 130 Infectious Diseases, Table of Cases 72 Insect Pests 37 Inspections carried out by Public Health Inspectors 38 Knackers'Yards 20 Laboratory Service 60 Laundry Facilities for Old Persons 67 Leukaemia Investigation 90 Lunacy and Mental Treatment Acts 60 Lung Cancer 15 Maternal Deaths 70 Maternity Services 83 Meals on Wheels 66 Measles 12 Meat Inspection 21 Medical Examination of Staff 68 Merchandise Marks Acts,1887-1926 24 Metropolitan Water Board 26 Midwifery Service 94 Midwives'Clinic 83 Milk and Dairies 19 Mothercraft Classes 84,85 Mothers and Young Children, Care of 88 National Assistance Act,1948 S.47 67 S.50 68 Notices served 40 Nurseries, Day 91 Nursing, Home 98 Nursing Homes 104 Old People's Welfare 65 Ophthalmic Service 118 Orthodontic Clinic 117 Orthopaedic Service 119 Orthoptic Treatment 118 Out-Patient Clinics at Prince of Wales's Hospital 59 Outworkers 42 Parentcraft 85 131 Paratyphoid Fever 13 Patch Testing 107 Personal Health Service 60 Persons in need of Care and Attention 67 Pet Animals Act, 1951 36 Physically Handicapped Children 112 Poliomyelitis 11 "Vaccination 101 Preserved Foods 18 Prevention of Illness, Care and After care 102 Prince of Wales's Hospital,, Out patient Clinics 59 Psittacosis 13 Public Health Department, Staff 2 Rag Flock and other Filling Materials Act,1951 36 Recuperative Holidays 102 Repairs in Default 34,40 Rheumatism Supervisory Centre 119 Rodent Control 36 Scarlet Fever 13 School Health Service 104 Sewerage and Drainage 28 Shops 41 Slaughterhouses 26 Slum Clearance 33 Speech Defects 116 Staff Medical Examinations 68 Statistical Summary 69 Stillbirths 69 Toddlers Clinics 86 Tuberculosis 6 In Schools 106 Patch Testing 107 B.C.G. Vaccination 107 Vaccine Trials 108 Welfare of Patient 9 Vaccination Poliomyelitis 106 Smallpox 100 Water Supply 26 132 Welfare Foods, Distribution 92 Welfare Service,Area 60 Whooping Cough 14 Vaccination 101 Work in defauIt 34,40 Published by the Tottenham Corporation, Town Hall, N.15. and Printed by their Public Libraries Department.