AC 439 (1) TOTTENHAM TOT 32 TOTTENHAM'S HEALTH 1957 The Annual Report of the Medical Officer of Health, Borough of Tottenham TOTTENHAM'S HEALTH 1957 The Annual Report of the Medical Officer of Health, Borough of Tottenham Health Department, Town Hall, Tottenham, N 15 28th July, 1958- To the Worshipful the Mayor, Aldermen and Councillors Mr Mayor, My Lady, Ladies and Gentlemen, The following pages record many activities in local government which, during the year 1957 contributed to a high standard of health in the Borough As a first priority the Health and Housing Committee pursued its policy for improving local housing conditions; by stepping-up the repair of individual unfit properties; by keeping ahead of schedule in their programme for "slum" clearance and by making considerable progress in the building of new housing accommodation both within and outside the Borough New legislation during the year was implemented; in particular the Clean Air Act, by immediate preparation for progressive extension of smoke control areas In matters of health education special attention was given to the subjects of food hygiene prevention of accidents in the home, atmospheric pollution and discouragement in the development of a smoking habit in young people Details of the school health and personal health services are also set out in the body of this Report although no longer a statutory duty to do so, as it must be apparent that, for the successful administration of these services in a large borough such as Tottenham, a keen interest and sense of local responsibility is essential Not only in the preparation of this Report but also in the management of a smallpox outbreak during the year, I am much indebted to all my medical, nursing, auxiliary and lay colleagues in the borough and area health services In particular to my deputies - Dr Epsom and Dr Yarrow, the chief public health inspector - Mr, E T Jenkins and the chief clerks - Mr, A W Lawrence and Mr W LN Relleen In the fortunately successful attempt to control the spread Of infection during the smallpox outbreak, I am also specially indebted to members of the Council, general medical practitioners, hospital staffs, school teachers, colleagues in central and local government and to the local and national press for their helpful co-operation during a busy and anxious period I have the honour to be Your obedient servant G, HAMILTON HOGBEN Medical officer of Health 1 MEMBERS OF BOROUGH COUNCIL MAYOR Alderman HW„ Turner JP DEPUTY MAYOR Alderman The Lady Morrison ALDERMEN CH Colyer F„ A P Keay, JP E J Field A Reed, A CI I, J P R W H„ Ford A F, Remington (Mrs ) W S Herbert A R Turner R H Warren COUNCILLORS G W Barker W K Gomm SA Berkery (Miss) L R Harrington, JP (Mrs) EM Bohringer (Mrs) (Resigned) F E, Haynes (Mrs ) F G„ Bohringer H Langer E, E Brown (Mrs) A A Miller (Mrs) EJ Brown, M B E M, T, Morris EJJ Carter S C Morris A,w Catley j j pagin IR Cato (Mrs) IL Peirce Douglas Clark A T Protheroe E J clook M E Protheroe (Mrs) E Cooper J R Ramshaw (Resigned) S L Cope PH Roberts AJ Davies j, watkins J Egdell J„ L Williams EV Garwood A Wise (Mrs) J Wo1sey Town Clerk: M Lindsay Taylor, LL B 2 HEALTH AND HOUSING COMMITTEE Chairman Alderman RH Warren Vice Chairman Councillor J , L Williams Alderman A, Reed, ACI I, JP Alderman Mrs A P Remington Councillor F„ G Bohringer Councillor MT Morris " E J, Clook " Mrs M E Protheroe " E Cooper B J R Ramshaw w Mrs L„ R„ Harrington,, J,P„ " jw watkins " Mrs p, E Haynes " Mrs A Wise Ex officio The Mayor and Deputy Mayor TOTTENHAM DIVISIONAL EXECUTIVE EDUCATION COMMITTEE Chairman Alderman Mrs A F Remington Vice-Chairman Councillor Mrs M E Protheroe Alderman CH Colyer Alderman F A F Keay, J P „ EJ Field „ The Lady Morrison " RWH Ftird „ A Reed, A CII, JP Councillor G„ W Barker Councillor H„ Langer „ Miss S A Berkery „ M, T Morris v Douglas Clark „ JJ Pagin " E V Garwood „ I L Peirce „ WK Gomm " RH Roberts „ Mrs, F E Haynes " J watkins Representing County Council Cbunty Councillor Mrs S G Child County Councillor Mrs M E, Soall Co-opted Members Mr R C Ablewhite Mr L Collis Mr H R Cfaeetham Mr W Neary Borough Education Officer J power, M A 3 LOCAL AREA HEALTH COMMITTEE Chairman Councillor Miss OR Anderson (Hornsey MB) Vice-Chairman Councillor Mrs M E Protheroe (Tottenham MB) Representing Tottenham Borough Council Alderman A Reed ACII „ JP Alderman Mrs A F, Remington Councillor H Langer Councillor MT Morris Councillor J R Ramshaw Representing Hornsey Borough Council Alderman Miss J Richardson Councillor J„T Wilkins Councillor Miss M E West " C R Williams Representing Middlesex County Council County Alderman M W Burns County Councillor Mrs, s,G Child County Councillor F H Brookes " H H Godwin Monck " " V Butler " " Mrs mE Soall Representing Hospital Management Committee Mrs R, M Fry Co-opted in advisory capacity Dr l Hornung (Local Medical Committee) Mr R w D Brownlie L D S (Local Dental Committee) Mr l Hayward (Local pharmaceutical Committee) Miss E Hazell (Royal College of Nursing) Miss V Edey (Royal College of Midwives) 4 Borough Health Department Medical Officer of Health, School and Area Medical Officer G Hamilton Hogben, MRC&, DPH Deputy Medical Officer of Health and Assistant Cbunty Medical Officer J Epsom, MRCS, D P H, D I,H, Chief Public Health Inspector E T Jenkins„ p A P H I, Senior District Public Health Inspector E, S Glegg MA PHI Chief Administrative Assistant A w Lawrence, M, A P H I Senior Administrative Assistant W, E Lawson Classification of other Staff No Public Health Inspectors 11 Pupil Public Health Inspectors 2 Slops and Street Trading Inspector 1 Administrative and Clerical Staff 7 Rodent Operatives 2 Cleansing and Disinfection Staff 3 Other Manual Staff 7 County Area Health Department Deputy Area Medical Officer A Yarrow,, M B, 5 Ch B„ DPH Senior Assistant Medical Officer Mrs J H Garrow MB „ Ch B , DPH, Area Dental officer V Sainty, L D S „ R C S Superintendent Health visitor Miss H Townsend, S R N,, S C M, HV NOn-medical Supervisor of Midwives Miss F E Curtis, S R N, S, C M, H V,, and Home Nursing Superintendent M T D Home Help Organiser Mrs D Edwards, S„RN„, Dip Soc Sc (Resigned 11 1 58-) Mrs J M Mcllroy (Jippointed 13158 ) Assistant Home Help Organisers Mrs WE Pickard, SRN (Resigned 313 57) Mrs F G Wills Miss D Buck (Appointed 11657) Area Chief Clerk WLN Relleen, TD, D P A Deputy Area Chief Clerk T W Hadley, LL B (Resigned 30457) J B Bambrook, D M A (Appointed 1 757) Sectional Heads A Balls NP Child H, J Dunham B A 5 Classification of Staff Pull-Time Part Time Medical Officers 8 8 Dental Officers 7 3 Supervisory Nursing Staff 2 - Administrative and Clerical staff 37 8 Health visitors/School Nurses 29 - Clinic Nurses 8 - Midwives 9 - Home Nurses 20 10 Speech Therapists 2 2 Physiotherapists 1 3 Occupational Therapists 1 - Chiropodists - 2 Gramophone Audiometrician 1 - Orthoptists - 2 Dental Attendants 8 - Day Nursery Staff 36 1 Home Help Service 6 177 Manual Workers, domestic grades, etc 8 26 183 242 6 GENERAL STATISTICS AREA OP DISTRICT IN ACRES 3,013 POPULATION: Census 8th April, 1951 126,929 Estimate of Registrar General of Population - Mid-year, 1957 119,300 APPROXIMATE NUMBER OP DWELLINGS IN DISTRICT 30,691 RATEABLE VALUE OP DISTRICT at 1st April, 1957 £1,737,776 SUM REPRESENTED BY PENNY RATE at 1st April, 1957 £7,009 LIVE BIRTHS Legitimate 1,554 Illegitimate 104 1 658 Birth Rate (per 1,000 population) 1390 STILL BIRTHS , 33 DEATHS 1,314 Death Rate (per 1,000 population) 1102 Infantile death rate (per 1,000 live births) 2533 Maternal death rate (per 1,000 live and still-births) 1183 COMPARABILITY FACTORS Deaths 107 Births 0 97 NOTE: Detailed vital statistics appear on pages 68 to 78 in the Statistical Summary) 7 CONTENTS PAGE CONTROL OP DISEASE 8 POOD CONTROL 27 SANITARY CIRCUMSTANCES OP THE AREA 36 FACTORIES AND SHOPS 52 GENERAL 58 STATISTICAL SUMMARY 68 AREA PERSONAL HEALTH SERVICES 79 AREA SCHOOL HEALTH SERVICE 99 8 CONTROL OP DISEASE The total number of notifications for the year was 2,221 as compared with 812 the previous year, The increase was due to the normal biennial increase in measles notifications Tuberculosis The number of cases on the tuberculosis register on 31st December, 1957 was 1,856 an increase of 2 on the previous year There were 90 new cases of tuberculosis notified during 1957 (86 pulmonary and 4 non pulmonary) compared with 101 in 1956 (92 pulmonary and 9 non-pulmonary) Distribution of New Tuberculosis Cases notified during 1957 Age Periods New Cases Deaths Pulmonary Non Pulmonary Pulmonary Non Pulmonary Male Female Maie Female Male Female Maie Female Under l year - « - - - 1-4 years 1 2 - - = - - - 5-9 " - - « 1 - - - 10 -- 14 " - - - - - - - - 15-19 " 2 3 - - - - - 20 - 24 " 3 4 1 - - - - - 25 29 " 4 4 - 1 - - - 30 34 " 8 1 - - - - - - 35 - 39 " 5 2 - - - 1 - - S 0 O 4 4 - - - 1 - - 45 - 49 " 5 - ~ 1 - - - 50 - 54 " 6 1 » - 2 1 - - 55 - 59 " 10 2 - - - - - - 60-64 " 6 - - - - - 0 65-69 " 2 1 1 - - 1 - 0 70-74 " 4 - = - 2 - - 0 75 Years and Over 1 1 - - - - - 1 Total 61 25 2 2 5 4 - 1 The four non pulmonary tuberculosis cases notified during 1957 related to infections of bones and joints in two cases, the genito urinary system in one case and the lymphatic system in the other 9 Changes in Tuberculosis Register during 1957 Details Pulmonary Non Pulmonary Total Male Female Male Female Number on Register at 1st January,1P57 902 756 88 108 1,854 New cases notified during 1957 61 25 2 2 90 Transfers into Tottenham 22 18 = 3 43 Transfers from Non Pulmonary - 2 - 2 Restored to Register - - - 1 1 985 801 90 114 1,990 Cases removed from Register Deaths of cases on register 22 3 1 26 Transfers out of Tottenham 33 35 «= 5 73 Recovered 12 15 2 1 30 Lost sight of - 1 2 - 3 Transfers to Pulmonary - - - 2 2 67 54 4 9 134 Number on Register at 31st December, 1957 918 747 86 105 1,856 Ward Distribution of Cases of Tuberculosis on the Register at 31st December, 1957 Ward Estimated Population Male Female Rate per 1,000 population Pulmonary Non Pulmonary Pulmonary Non Pulmonary Total White Hart Lane 11,254 119 11 105 8 243 21.6 Park 11,064 76 14 79 15 184 16.6 Coleraine 11,376 67 7 63 8 145 12.7 West Green 10,990 69 3 65 12 149 13.6 Bruce Grove & Central 10 806 63 3 47 4 117 10.8 High Cross & Stoneleigh 10,923 92 13 63 10 178 16.3 Green Lanes 10 587 86 7 70 6 169 15. 9 Chestnuts 10,979 85 6 75 10 176 16.0 Seven Sisters 10,217 81 8 60 8 157 15.4 Town Hall 10,585 84 8 67 12 171 16.2 Stamford Hill 10,519 96 6 53 12 167 15.9 Total 119,300 918 86 747 105 1,856 15.6 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 10 Tuberculosis in Tottenham during past 25 years The remarkable fall in the number of new cases of tuberculosis and deaths resulting from this disease illustrates the enormous progress which has been made in recent years in the control and treatment of tuberculosis This once dreaded illness which took such a heavy toll in deaths is now successfully treated by modern techniques utilising the newly discovered antibiotics of biological and chemical origin In addition, protection of the more susceptible groups of the population is being achieved by systematic BCG vaccination 11 Dr TAC McQuiston the Physician in Charge at the Tottenham Chest Clinic which also serves Wood Green, has kindly supplied the following figures of the work during 1957:- Work of Chest Clinic Number of Clinic sessions 1,071 Total number of attendances 28,254 Number of X-rays taken (a) Large films 14,542 (b) Odelca films 7,441 21,983 Number of persons inoculated with BCG 268 Number of new contacts seen 1,071 Number of new contacts found to be tuberculous and formally notified 26 The Chest Clinic Welfare Officer has also supplied the following return of patients assisted during the year In addition to obtaining assistance from statutory bodies, the Welfare Officer has been instrumental in obtaining help for patients from many voluntary organisations Summary of Work of Chest Clinic Welfare Officer (1) GENERAL Number of patients dealt with by the Welfare Officer 814 (2) EMPLOYMENT AND TRAINING (a) Number of patients who consulted the Welfare Officer regarding employment and training 130 (b) Number for whom employment or training was found 120 (3) NATIONAL ASSISTANCE BOAKD Individual patients referred to the National Assistance Board for grants of:- (a) Bedding 9 (b) Clothing 19 (c) Extra Nourishment 48 (d) Any other purpose (ie maintenance grants etc) 117 Total individual, patients referred * to the National Assistance Board 134 (4) HOUSING (a) Cases recommended for rehousing 84 (b) Families rehoused 54 * The total individual patients referred to the National Assistance Board will not necessarily be the total of (a), (b), (c) and (d), as a patient may be included in more than one of these sub-heads but be included only once in the total The significant factor in this return is the number of individual Patients and not the number of times the patients are dealt with 12 Outbreak of Smallpox The following is a Report by the Medical Officer of Health in conjunction with Dr GDW McKendrick, Consultant Physician, St Ann's General Hospital and Dr c G Nicol, Medical officer, Jflinistry of Health and which in modified form was published in the "Lancet" on the 17th May, 1958 Looked at in retrospect and in the graphic picture below, the smallpox outbreak in Tottenham in the summer of 1957 appears small in size and neatly disposed of as an epidemiological study This does not mean, however, that the incident was other than a full scale exercise in accepted methods of investigation and control; nor that it was without clinical, social and administrative features of special interest What may not be so easy to explain is why the disease did not spread more widely in this and other districts, despite the measures taken 13 Foremost in the experience gained was the sense of close co-operation which existed from the moment the first case was suspected, and remained throughout subsequent events: between the Ministry of Health; the North-East Metropolitan Regional Hospital Board- the Virus Reference Laboratory, Colindale; the members of the panel of smallpox opinion; local hospitals' medical and administrative staffs; general medical practitioners and the medical officer of health's department The early stages Over the telephone at 1015 a m Friday 28th June, 1957, the medical officer of health (G H H ) was informed by the consultant physician for infectious diseases (GD McK ) at St Ann's General Hospital, Tottenham, of a case of suspected smallpox in that hospital The patient, an unvaccinated male child, aged 6 (M B) had been admitted to the poliomyelitis unit of the hospital on 23rd June, with a history of backache fever, abdominal pain and vomiting, Examination on admission had revealed an ill child with abdominal tenderness and guarding,, and a temperature of 102°FIt was also observed that there were both general ichthyosis and superimposed patches of eczema The practitdoner"s provisional diagnosis of poliomyelitis was not borne out by this further examination, which suggested an acute abdominal emergency, At laparotomy the appendix (which was removed) was found to be normal but the mesenteric glands were seen to be enlarged During the following three days the patient remained febrile and ill and there was some bleeding around the abdominal wound On admission a few macules had been noted in the inter-scapular area and by 27th June it was evident that there was a rash, predominantly papular in character and peripheral in distribution additional to the chronic skin condition At the time, eczema herpeticum was considered to be more likely than smallpox, but skin scrapings and fluid from one or two vesicular lesions were sent to the Virus Reference Laboratory, Colindale By the following morning there was a striking change in the child's appearance, The rash was vesicular and becoming confluent and a diagnosis of smallpox could be confidently made on clinical grounds Following the telephoned report of these facts to the medical officer of health an immediate consultation was held at the hospital when it was agreed to call in a second member of the panel of smallpox opinion (Dr. AM Ramsay) and to report the situation by telephone to the Principal Medical Officer of the Epidemiology Division of the Ministry of Health (Dr W H Bradley) Before 12 noon both Dr 14 Ramsay and a medical officer from the Ministry (CGN) had arrived at the hospital and agreed to the clinical diagnosis of smallpox Arrangements were made for the immediate transfer of the patient to Long Reach Hospital, Dartford, under the care of the late Dr M, Mitman During the same day a preliminary report was received from the Director of the Virus Reference Laboratory (Dr PO Maccallum) that the complement fixation test was strongly positive for variola-vaccinia Subsequently, on the 5th July, the boy died Throughout his stay at St Ann's Hospital he had been barrier-nursed in single cubicles - for the first four hours in the poliomyelitis unit and for the remainder of the time in another cubicle block Before the clinical diagnosis had been confirmed the parents of the patient had been interviewed by the chief public health inspector (Mr E,T, Jenkins) and detailed information of the members of the household and their occupations obtained The father, employed by the London Transport Executive as a bus conductor, had reported at his depot early that morning; and as an obvious risk the medical officer of health at once spoke on the telephone to the chief medical officer of the London Transport Executive This early inquiry into the home circumstances revealed a further case of' smallpox the boy s grandmother (Mrs A) living in the same house and by this time convalescent This patient, vaccinated in childhood and now aged 61» had fallen ill on the 8th June and developed a rash (which was considered by her medical attendant to be chickenpox) on the 12th June She was seen by two of the present writers (GHH and CGN) in consultation with Dr Ramsay, The clinical findings were equivocal but consistent with a modified attack of smallpox In view of the satisfactory vaccinal state of the rest of the household, now refreshed by further vaccination, it was considered justifiable to await the result of laboratory examination of scrapings taken from the most suitable of the few remaining lesions To complete this patient's subsequent history, the complement fixation test was reported as positive on the following day, when she was removed to Long Reach Hospital, and a positive egg culture was reported as further confirmation two days later This patient continued an uninterrupted convalescence and was in due course discharged from hospital Prom the chief public health inspector's inquiries, it was learned that the patient was employed as a domestic worker in the pathological laboratory at another hospital in the Tottenham 15 group of hospitals, a circumstance which it was felt must afford some explanation of her infection (This matter is referred to later in the account of the outbreak) Action taken at St Ann's Hospital It was agreed that immediate responsibility for vaccination' and other control measures at St Ann's Hospital should be undertaken by one of us (G D McK ) who had arranged for the supply of sufficient lymph to vaccinate the whole complement of the hospital and the preparation of a list of all primary contacts on the staff with their vaccinal history and that of the other patients on the two wards in which MB had been nursed There were 42 primary contacts among the staff and 31 patients on the two wards, only six of the latter having previously been vaccinated Permission to vaccinate these children was sought by telegram and all but two were vaccinated within twelve hours - the remaining two being vaccinated the following day when permission was received On discovering the inadequate vaccinal state of the children nursed in the cubicles adjacent to M B, it was decided to give them hyperimmune anti-variola gamma globulin, and accordingly these 15 children each received 5 ml of this prophylactic All 42 primary contacts among the staff had been vaccinated at some previous time, but in 9 there was no satisfactory proof of recent successful vaccination, and each was therefore given 10 ml hyperimmune gamma globulin, Our findings agree with the observation of Kempe and his fellow-workers (Kempe, cH Berge, T 0 England, B 1956 Ped XVIII 2,177) that the administration of hyperimmune gamma globulin 24 hours after vaccination does not interfere with the course of vaccination, for all 24 vaccinations were successful Vaccination of the remaining hospital patients and staff (approx 1,000 persons) was started on the 29th June, and continued through out the early part of the following week,, re vaccinations being done where necessary The hospital was closed for admissions and discharges on Friday morning (28th June) and visiting was restricted to those seriously ill During the week-end a zone of isolation was set UP (on the "hospital within a hospital" principle) using one previously empty ward which was made into living quarters and the two wards where the patient MB had been nursed This area was roped off and all 26 primary contacts among the resident staff of the hospital were isolated within it Entrance was restricted to 16 the infectious disease physicians, the senior administrative nursing staff, physiotherapists and engineers protective clothing was worn (cap mask, gown and boots) Pood was supplied in destructible containers and all combustible material was removed to the incinerator in bins on a trolley reserved for the purpose On 1st July a further ward was prepared to receive staff with vaccination reactions and doubtful illnesses requiring isolation and investigation This proved a valuable adjunct and during the fourteen days it remained open 8 cases were admitted St Ann's is a general hospital of 520 beds, of which 120 form an infectious diseases unit There is normally considerable interchange of staff both between this unit and other departments and between the hospital and the other hospitals in the group By re allocation of duties it was readily possible to avoid or reduce such interchange to the minimum but the situation within St Ann's Hospital of the central laundry for the whole group gave rise to much concern It was found that no articles used by m B had been sent for laundering, and it was therefore decided to maintain the existing laundry services, save that the zone set aside for smallpox contacts would be provided with a washing machine for each ward No material therefore left the smallpox zone other than that destined for the incinerator The closure of the group laundry would have caused considerable disruption in the work of all the contributing hospitals, so much so that the Group Laundry Manager (Mr CH Adams) subsequently followed up the matter elsewhere, with the co-operation of one of us (CGN) and we understand that it is possible to hire military mobile laundry units of varying capacities to meet such an emergency It would appear that the precautions taken were adequate, for there was no secondary case in the hospital or within the group, and with the uneventful effluxion of the sixteen days surveillance it was possible to determine all isolation measures on the 15th July, Reporting of outbreak During the afternoon of the first day His Worship the Mayor and the Chairman of the Health Committee (Alderman R,H Warren) were informed of the action being taken An official telegram was sent to the Ministry of Health confirming the earlier telephone 17 message; the County Medical officer was notified and the Senior Administrative Medical Officer of the NE Metropolitan Regional Hospital Board was informed of the position and a circular letter (thereafter issued daily) stating the situation was sent to all general medical practitioners in the Borough and to medical officers of health in adjoining local authorities The Chief Medical Officer of the Ministry of Health notified all medical officers of health in the country and port medical officers of the progress of the outbreak by circular letters issued on the 28th June, 1st July and finally on the 5th July Contacts of M B before admission to hospital The patient MB had been attending school until Friday, 2lst June, The school was visited before closure for the week end and duplicate registers and names and addresses of staff obtained for purposes of offering vaccination or revaccination A list of recent visitors to the patient"s home was prepared, including relatives, friends, neighbours and tradesmen A list of patients since conveyed in the same ambulance was obtained from the local depot Arrangements were made with the Central Public Health Laboratory, Colindale, for the supply of 2,000 capillary tubes of calf lymph fior immediate vaccination or revaccination of primary contacts and the staff of the health department Public relations On Saturday, 29th June a joint statement was issued to the Press by the hospital and public health authorities "In view of the suspected case of smallpox transferred from St Ann's General Hospital on the 28th June, the hospital has ceased to admit or discharge cases Members of the staff who were in direct contact with the patient have been confined within the hospital or if non-resident asked to remain within their own homes The remainder of the staff of the hospital will continue to work in the usual way and are not confined to the hospital All contacts of the suspected case will have been vaccinated during the week-end The clinical diagnosis of smallpox has been confirmed and a relative of the patient has been admitted to a smallpox hospital as a suspected case There is no indication for mass vaccination of the general public All those who might receive immediate benefit from vaccination are being visited16 Vaccination within the Borough A sustained effort followed on Saturday afternoon and Sunday to secure the vaccination of all known contacts in their own 18 homes. For this purpose the deputy medical officer of health (Dr. Epsom) organised three parties comprising doctor, health visitor and public health inspector to carry out house-to-house vaccination of all contacts. Concurrently the deputy area medical officer(Dr A. Yarrow) and area chief clerk (Mr. Relleen) opened an emergency vaccination centre at Chestnuts, St. Ann's Road which was continuously staffed over the week-end and for as long as necessary thereafter. Hyperimmune gamma globulin Since doubts were felt about the effectiveness of vaccination, so late after contact with the primary case it was decided to reenforce vaccination with anti-variola gamma globulin. Application was at once made to the Ministry of Health and half the available stock was released. This amount was divided equally between the hospital and public health departments A dose of 10 ml (1,000 mgms.) for an adult and 5 ml (500 mgms) for a child was given to the previously unprotected primary contacts. in practice it was found that much patience was required in preparing the injection. The protein proved extremely difficult to get into solution or suspension and each dose took approximately 10-15 minutes to prepare. Origin of the infection A report of smallpox, in midsummer, and in a patient with no known history of recent arrival from or links with, those parts of the world in which smallpox is endemic must immediately arouse two considerations in the minds of those in the central government department who are concerned with smallpox. The first, that there has been a misdiagnosis, for smallpox in this country is nearly always imported during our winter. The second, that if the diagnosis proves correct, the disease must, have been present in the country, unsuspected, for some little time, and that evidence of this can be found if search is made in the right quarter. In the incident now related, examination of the patient M.B. had left no doubt as to the diagnosis. It was a matter of general knowledge that no case of smallpox had been notified for some three years and within the personal knowledge of one of us that there had been no recent suspicion of this disease. It was quickly established that there was no link or association between the patients, M.B. and Mrs. A. and any foreign country. Few could have led a more circumscribed existence than the widowed grandmother, and the boy M.B.s small world did - 19 - not extend outside his part of the borough. By inference therefore, it seemed wellnigh certain that a study of recent and not-sorecent death certificates would provide a lead to the source of infection. The complete absence of any reported cases of smallpox elsewhere in the country suggested that the earlier missed case (or cases) must either have been modified clinically and have occurred in a subject who was himself vaccinated and belonged to a small wel1-vaccinated group or the earlier case must have died before his disease had reached the infectious stage. The search was therefore at once narrowed to a retrospective inquiry for someone who had died in the early stages of haemorrhagic smallpox, and the presumption was that the cause of death most likely to have been assigned would be leukaemia. Accordingly, at the suggestion of one of us (C.G.N.) a scrutiny was made of all death returns for the past four months, and four deaths which had occurred during that time seemed worthy of investigation, the stated cause of death in all cases including the term "leukaemia"'. Further inquiries readily disposed of any possible suspicion in the first three cases, late residents of Tottenham, but in the case of the fourth (Mr. Y.) a licensee lately of the adjoining metropolitan borough of Islington, an interview with the widow revealed that she and her late husband had visited his brother (Mr, X.) in Wembley, who with his daughter (Miss X. aged 8) had been suffering from "chicken pox" Thirteen days later Mr. Y. became very ill and was admitted late at night to St Ann's General Hospital. This patient had Had an acute febrile illness with haematuria, massive purpura and an enlarged liver and spleen from which he died four hours after admission. A white blood count done before death showed 28,000 cells per ml. 48% of which were primitive cells of the polymorph series. Haemophilus influenzae and pneumococci were recovered in large numbers from a blood culture. As the cause of death was uncertain the coroner was notified and body removed to the Prince of Wales' s General Hospital for autopsy. The purpuric condition, with a leukaemoid blood film suggested a diagnosis of acute leukaemia, but in retrospect he must be regarded as a case of haemorrhagic smallpox. Post mortem specimens were sent to the pathological laboratory from where it may be assumed the cleaner (Mrs. A.) became infected. The brother-in-law (Mr. X. ) of Wembley, a well vaccinated subject, had returned to this country by air from Lagos, West Africa, on the 29th March and on the 11th April had developed a mild illness diagnosed at the time as chicken pox. The young daughter, vaccinated in infancy, became 20 ill on the 25th April also with a mild attack of "chicken pox" but was said to have had a previous attack of chicken pox. In retrospect both father and daughter must be considered as cases of smallpox and the source of infection of Mr Y. Subsequent progress of the outbreak within the Borough Throughout Sunday, 30th June the immediate focus of attention was on the primary contacts. Systematically the lists were worked through and gamma globulin and vaccination, or revaccination alone was given to the members of the public at greater risk - there were no refusals One child, a girl aged 11, not a contact of the case, was under special observation and was sent on suspicion to Long Reach Hospital, but later proved to be a case of chicken pox, An aunt of the boy patient (Mrs C.) vaccinated in infancy who had nursed Mrs A (her mother) became unwell and the following day was admitted to Long Reach Hospital where she was later confirmed as suffering from smallpox In due course she made a slow but uneventful recovery The engineering firm where Mrs. C. worked was visited and the staff advised vaccination Other primary contacts of special mention., living in the neighbourhood, included a Mr and Mrs, D and their married daughter (Mrs. E. ) wife of a U„s A F_ airman, who was expecting her first baby at the titne She was given gamma globulin intra muscularly. Later in the week the mother was admitted to an isolation cubicle at the American Hospital; Ruislip for a normal delivery. The public health inspectors meanwhile continued to obtain names and addresses of groups of persons at special risk e.g., laundry workers who might have handled contaminated linen from families involved, and directed them to the emergency vaccination centre Gradually the public at large pressed in ever increasing numbers for vaccination. These were diverted to their own general medical practitioners who obtained supplies of calf lymph held at the Town Hall In the meantime vaccination of children at the school attended by M B. proceeded well and was undertaken by the mobile teams of medical officers and health visitors. The class room of the patient had been sealed and disinfected as also the rooms at the houses where his and other cases of smallpox occurred. Vaccination or revaccination of the ambulance personnel at the Edmonton depot was arranged by the medical officer of health of Edmonton On Tuesday and Wednesday, July 2nd and 3rd routine home visiting of primary contacts was continued, also numerous cases 21 required daily observation including hospital out-residents and special cases referred by doctors in the district and health visitors - many of the latter concerned reactions to vaccination. This surveillance continued for a period of sixteen days. Notification of chicken pox Because of the close contact with local doctors who agreed to report all cases of chicken pox it appeared unnecessary in the early stages to seek action under Section 147, Public Health Act, 1936. General liaison Under the direction of the chief clerk (Mr. AW. Lawrence) rapid compilation of records and distribution of information became the first task of the public health offices Other work was put aside except for matters of absolute urgency and the whole staff concentrated on control of the outbreak This called for sustained work until late at night throughout the first week-end and following week. Bulletins to general practitioners and adjoining medical officers of health were sent out daily Lists of contacts which arrived from St Ann's Hospital and other sources were classified according to the districts in which the persons resided. The medical officers of health of the districts concerned were first telephoned and the information confirmed the same day by letter. For those living within the borough contact sheets were made out and passed to the district public health inspectors who undertook surveillance for sixteen days In addition to the information which required to be telephoned out there were continuous incoming telephone messages and enquiries. As a result, despite six telephone extensions in the department there was often an acute shortage of telephone facilities. It was also necessary to arrange for the switchboard operators to stay on duty to deal with calls which continued throughout the evenings. National Health Insurance Benefits None of the smallpox patients was a contributor for National Health Insurance benefits but a number of primary contacts were able to claim upon the certificate of the medical officer of health A special emergency procedure laid down in a Ministry of Pensions and National Insurance memorandum for dealing with claims arising 22 from an outbreak of smallpox relieves the local national insurance office of any direct contact with the claimants. The effect of this was that the public health department was called upon to act as agent for all the claimants It was thus necessary to arrange for the contacts to complete various benefit claim and authorisation forms which were retained in the department and from these to complete weekly certified summaries which were forwarded to the Ministry of Pensions and National Insurance, A lump sum covering the benefits accruing was paid weekly to an officer in the public health department who was responsible for its distribution to the claimants Compensation for loss of earnings Section 51 of the Tottenham Corporation Act, 1952, enabled the local authority to compensate primary contacts for loss of earnings resulting from their exclusion from work The Corporation agreed that compensation should be paid to the extent of making up the difference between the earnings lost and the national insurance benefits received Fortunately the early restriction of the outbreak limited the number of primary contacts so that expenditure on this account did not exceed £100 Supplies of goods to households in isolation A particular difficulty experienced in this connection was that whole households had become primary contacts and were subjected to isolation within their homes, This meant there was nobody available to carry out essential shopping, nor, in one or two cases, had the families any ready money available to pay for the goods required A health visitor was therefore, asked to visit these families daily and to do any necessary shopping on their behalf Recognition is due to the local tradesmen for their ready co-operation in providing goods on credit pending settlement of the families' claims for National Health Insurance benefit„ Distribution of Calf Lymph Lymph was made available to medical practitioners at the Town Hall The demand grew rapidly after the first week-end and altogether 11,500 units were obtained for use by family doctors and at the public, vaccination centre 4,291 units were issued to medical practitioners and the remainder used by the local author- 23 ity staff, A certain amount of wastage resulted from the use of lymph supplied in multiple units of 10, 25 and 50, This outbreak of smallpox, though small, stresses the ever present risk of importing the disease into this country by the ease and speed of modern transport That the four recoveries from smallpox had all been vaccinated in infancy and that the two who died had not been vaccinated is once again a convincing demonstration of the value of vaccination as a means of protection that may well be life saving. Poliomyelitis The number of cases through the year was 4, of these, 3 were of the paralytic type Paralytic Non-Paralytic Male Female Male Female 1 2 1 - All four cases were children between 6 and 10 years of age, Although one child was in hospital for six months all were treated to a successful conclusion and are now back at school. Measles There were 1,716 notifications of measles during the year. 27 cases were removed to hospital with complications. Where were no deaths. Dysentery A total of 46 cases were notified. Of these 9 cases were admitted to hospital. Food Poisoning There were 15 notified cases, of which 4 were admitted to hospital. In 5 of the total cases the causal organism was identified as Salmonella typhimurium. The cases were unconnected and scattered throughout the year. Diphtheria No cases of diphtheria occurred during 1957. 3 24 Paratyphoid Fever One case of paratyphoid fever was notified in a male aged 13 years. The patient returned from a continental holiday with symptoms of diarrheoa and a fortnight later was admitted to hospital where he remained for six weeks. Scarlet Fever There were 92 corrected scarlet fever notifications during the year, but no deaths were attributed to the disease. Of 27 cases admitted to hospital the diagnosis was amended in one instance to German Measles. 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 22 11.2 1 8 Other Hospitals 4 24.7 - - Whooping Cough The number of notified cases during the year was 133. No deaths were attributed to the disease, 14 severe cases were admitted to hospital and the average stay in hospital of the cases was 22 days 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 (b) Cancer of other sites 25 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 43,955,000 130,817 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 1956 44,667,000 149,277 3.34 92,710 2.07 18,186 .41 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 1957 119,300 341 2.9 296 2.48 81 .68 A very slight fall in the rate of death from cancer of lung and disease of arteries is shown in Tottenham, but for cancer as a whole there is a very slight rise, Asian Influenza Following outbreaks of influenza in the Far East in mid April, the spread of the disease was observed in the daily press. Every body was thus kept informed of "Asian Flu"': and it received more attention than it probably deserved. In early June the Ministry of Health circulated information on the outbreaks. From this it was apparent that onset was sudden and that most cases were clinically mild with headache. generalised pains and fever lasting two or three days, and followed by about 4 days disability. Later in the month cases were reported in England and some were confirmed pathologically. In Tottenham the first case occurred in late August; with similar symptoms as above Throat <0. and nasal swabs were taken but isolation of the virus was not consfirmed by Colindale Public Health Laboratory By September influenza began to spread and definite cases appeared. Fortunately most cases were mild; but the young and the aged were more liable to complications. Large numbers of persons were confined to bed each week and the Local Ministry of Pensions and National Insurance Offices kept the department informed of the weekly sick rate. The number of new sickness claims reached 4,456 over a four week period compared with the average figure of 1,104. The epidemic then receded, the 26 peak being passed in late October. Some cases occurred in the Town Hall staff and leaflets were circulated to Departments explaining elementary hygiene precautions to be taken, SUMMARY OF DISINFECTION WORK DURING 1957 Rooms disinfected after occurrence of infectious 129 disease Bedding disinfected after occurrence of infectious 92 disease or death Library Books disinfected 158 27 POOD CONTROL A good standard of food hygiene is desirable in any community and to obtain this the department has continued the work of inspection in food premises in an energetic manner. Much has been done following the campaign in 1956 but much remains to be done. The standard of hygiene in any premises must, in the end, depend on the individual. No amount of new or up-to-date equipment is of any use if the person using it is not, in himself, clean in habits. Health education has done a great deal but the hard core of the problem can only be dealt with by enforcement of the regulations. This applies particularly in certain of the catering establishments where there are frequent changes in management. Installation of washing sinks with hot water supply has been achieved in many cases. Factory managements have been glad to seek advice from the department in the setting up or alteration of factory canteen arrangements. During the year the Government published a white paper Cmnd 243 dealing with standards of construction, layout and equipment in slaughterhouses. The proposals in this paper cannot however be brought into force until new legislation is presented to Parliament. Such a bill "The Slaughterhouse Bill" is, I understand, now before Parliament. The number of shops selling food in Tottenham 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 50 Butcher 94 Coffee Stall and Cafe 24 Confectioner 333 Dairyman 32 Dining Rooms 93 Domestic Stores 124 Fishmonger 50 Fruiterer and Greengrocer 124 Grocer and Provisions 289 Ham and Beef Dealer 3 Off Licence 80 Public House 58 28 Registered Food Premises At the 31st December, 1957, the following premises were registered under the Pood 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 370 Mfr, and Sale of Ice Cream 2 Storage of Ice Cream 1 Cooking of hams and other meats 38 Pish prying 38 Sausage Mfr. 59 Preparation of jellied eels 3 Boiling shell fish 2 Heat treatment of ice cream is now restricted to one manufacturer, who has a wholesale and retail trade. A good standard of hygiene is maintained at this establishment and the bacteriological grading of the ice cream samples taken are generally of a grade one standard. Middlesex County Council Act„ 1950 Registration of Hawkers The following is a summary of hawkers and their storage premises registered at the 31st December 1957, under section 11 of the Middlesex County Council Act 1950 - Articles NO. of persons Registered for sale No. of storage premises Fruit & vegetables 95 82 Shellfish 14 6 Fish (incl. 2 jellied eels) 8 4 Ice Cream 4 - Peanuts 2 1 Light refreshments' (mobile canteen) 4 1 Milk and Dairies All milk sold in Tottenham must be specially designated, and every milk dealer in the Borough holds a licence under the Milk (Special Designation) Regulations. There are now no premises in the Borough which are licensed for the pasteurisation or sterili- 29 sation of milk. The following is a summary of licences issued during 1957, namely:- Designation No. of Licences No. of Supplementary Licences Pasteurised 72 10 Sterilised 153 12 Tuberculin Tested 35 10 During the year 19 applications for registration as milk distributors were dealt with. No applications were received in respect of dairies. Of the new registrations 2 were for new premises and the other 17 were in respect of the change of proprietorship of previously registered premises. The number of premises and distributors registered at 31st December, 1957 was as follows:- No, of distributors 148 No. of dairies 8 Meat Inspection The two slaughterhouses in the Borough continue to operate and the output of carcase meat has been maintained. At the slaughterhouse dealing with horses there has been some diminution in the number of these animals slaughtered, but this has to some extent been offset by increase in the number of cattle dealt with at this slaughterhouse. The meat inspection work continues to be carried out by the public health inspectors on a rota system. Their ready co-operation ensures that no meat passes out of the slaughterhouses without proper inspection, notwithstanding that slaughtering often continues into the late evening and at weekends and bank holidays. The one knackers yard in the Borough is regularly visited to ensure compliance with the byelaws and for the inspection of records. 30 SUMMARY OF CARCASES INSPECTED 1957 Horses Cattle Excluding Cows Cows Calves Sheep and Lambs Pigs excluding sows Sows Number Killed 1094 298 702 1485 2191 13244 1452 Number Inspected 1094 298 702 1472 2176 13244 1452 All Diseases except Tuberculosis & Cysticercosis Whole carcases condemned 13 - 6 - 1 1 . Carcases of which some part or organ was condemned 154 46 104 7 104 1228 84 Percentage of number inspected affected with disease other than tuberculosis & cysticercosis 15.27 15.44 15. 67 .48 4.83 9.28 5.79 Tuberculosis Only Whole carcases condemned - 1 17 - - - - Carcases of which some part or organ was condemned - 24 108 - - 181 57 Percentage of number inspected affected with tuberculosis - 8.39 17.81 - - 1.37 3.93 Cysticercosis Only Whole carcases condemned - - - - - - - Carcases of which some part or organ was condemned - 1 - - - - - Percentage of number inspected affected with cysticercosis - .34 - - - - - 31 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 Baby Food 16 Marmalade 24 Barley 3 Meat 94 Cereals 1 Milk 689 Chicken 3 Milk (Dried) 14 Cocoa 2 Paste 28 Cream 21 Processed Meat 589 Creamed Rice 17 Pease Pudding 5 Custard 1 Salad Cream 62 Pish 252 Salmon 2 Frozen Egg 2 Soup 295 Fruit 3, 374 Spaghetti 23 Fruit Juices 37 Sponge Pudding 2 Ham 118 Strained Food 13 Horseradish 69 Tomatoes 1,338 Jam 28 Tomato Juice 8 Kidney 6 Tomato Puree 17 Lemon Curd 1 Tongues 23 Liquid Egg 28 Vegetables 1,520 Macaroni 1 Other Articles of Food Condemned Bacon 68¼ lbs. Milk (Lacta) 1440 boxes Beef Fat 46 lbs. Pickles 1 jar Chicken 16 lbs. Pig (1) 120 lbs. Chocolate 84 bars Pigs' Heads 7 Fish 33 lbs. Pigs' Hocks 24 lbs. Ham 116 lbs. 4 oz. Pork 42 lbs. Honey 1 jar Prunes 90 lbs. Lambs" carcases 95 Sauces 2 bottles. Lambs plucks 53 lbs. Sausages 10 lbs. Lard 50 lbs. Teacakes 320 Meat 1088 lbs. 5 oz. Vermicelli 27½ lbs. Food Sampling The Public Control Department of the Middlesex County Council has supplied the following information on food and drugs sampling in the Borough during 1957:- 32 Articles Total samples Procured Unsatisfactory Milk (various) 106 4 Butter 5 - Cakes 49 5 Cheese 2 - Cream 3 1 Drugs 13 - Pish and pish Products 11 2 pruit„ presh, Canned etc. 15 5 Pruit Squash etc. 5 - Ice Cream 13 - Meat and Meat Products 105 4 Margarine 7 - Non-Brewed Condiment 1 1 Peas 14 - Preserves 5 - Spirits 13 - Sweets 7 - Vinegar 30 4 Miscellaneous 17 - Totals 421 26 Commenting upon the unsatisfactory samples, the Public Control Officer makes the following observations:« "Milk: One of the unsatisfactory samples of milk was found to be deficient in milk fat. This was one of a number of samples of new milk taken from a number of churns consigned to a dairy within your area. All the remaining samples from this consignment were satisfactory and no further action was called for The other 3 unsatisfactory samples of milk each contained small fragments of glass in the bottle. In one case a caution letter was sent to the processors concerned, but in the other 2 cases the evidence which could be obtained was not sufficient to justify any further action being taken. "Cakes: A cake sold as "Buttercake" was found not to contain butter but to have an artificial butter flavouring; the manufacturer was cautioned. Two samples of cream cakes from one baker and a sample of cream trifle from another manufacturer were all found to contain imitation cream. Caution letters were sent to these two 33 manufacturers. A sample of cakes described as "Macaroons" contained no almond and an undertaking was received from the manufacturer concerned that a suitable amendment would be made to the wording on the wrappers used for this food. "Cream A sample sold as "double cream" was found to be slightly deficient in milk fat. A subsequent sample taken shortly afterwards from the same source was found to be genuine and no further action was called for. "Fish Two purchases of fish from the same retailer were found to be smoked cod and not smoked haddock which had been requested. An official caution was sent to the retailer concerned. "Fresh Fruit Five samples sold as "William pears" were each found to be Packham's Triumph pears. Two of these samples were purchased from one retailer who was prosecuted and who was fined £4 with £2 2s. Od costs. The three other traders from whom the other 3 samples were purchased were also prosecuted and each was fined £2. with £1. Is. Od. costs. "Meat and Meat Products Two samples of calves' liver purchased from a butcher were both found to be ox liver; the retailer was prosecuted and fined £6. Two samples of lambs* liver purchased from another butcher were found to be pigs liver against whomr proceedings were taken and who was fined a total of £6, with £2 2s, Od costs. "Non Brewed Condiment A sample of non brewed condiment was found to be 13% deficient in acetic acid and an official caution was sent to the retailer concerned. "Vinegar: = In response to a request for vinegar a trader sold nonbrewed condiment A subsequent sample purchased shortly afterwards was found to be satisfactory and no further action was called for Two purchases of vinegar were made from another retailer and non-brewed condiment was supplied on each occasion; an official caution was sent to this trader. Another trader also supplied non-brewed condiment when vinegar was requested, Shortly afterwards when another purchase was made from the same shop the trader correctly declared to the purchaser that he was supplying non-brewed condiment and no further action was called for with regard to the first unsatisfactpry sample," The Public Control Officer has also furnished the following report upon associated work under other Acts:- 34 "Merchandise Marks Acts, lSST-iasS: 275 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. 1,188 separate displays of meat, apples, tomatoes, poultry, dried fruit and bacon were examined, and in addition a number of test purchases were made, A trader was found to have exposed for sale in her shop window curtain material which was falsely described by means of a show ticket as being 48" wide, whereas it measured only 46&"i Proceedings were taken against this trader who was fined £5. 5s. Od. and ordered to pay £4. 4s, Od. costs Seventy-five summonses were issued against seven retail butchers and three butchers managers in respect of offences against the Merchandise Marks Act, 1887„ and the Marking Orders made under the Merchandise Marks Act, 1926 There were 6 summonses for selling unmarked imported meat when English meat was requested; 23 summonses for falsely describing by label Argentine beef as "English" A further 22 summonses were issued against a butchers manager for aiding and abetting his employer in falsely labelling Argentine meat as "English", and another 2 against another manager for aiding and abetting his employers in not marking imported meat. There were 22 summonses against retailers for failing to mark imported meat and offal with a prescribed indication of origin. One retail company against whom three such summonses were issued in turn summonsed their manager as being the actual offender. In this case the employers were convicted but exempt from penalty and their manager was convicted and fined, In all the other cases the defendants were found guilty of all the offences alleged and the total amount of fines imposed amounted to £209, together with a total of £22. Is. Od. costs." "Labelling of Food Order, 1953 At 245 premises 982 articles of prepacked food were examined to see that they bore a label which gave a clear statement of the designation of the food and, in the case of compound foods, the ingredients, and also the name and address of the packer or labeller. No infringement of this Order was detected. "False or Misleading Descriptions" As in previous years a considerable amount of work has been done in the detailed scrunity of advertisements and the labels on pre-packed foods, and taking suitable action in those cases where a label or advertisement contains a false or misleading description of the food to which it relates. This work is of benefit to the whole County irrespective 35 of where within the County offences may be detected. During the year under review corrective action has been secured in respect of salmon with potato salad, crystallised jelly pineapple slices, pure egg mundelech, cherry juice, lime juice, imitation cream, cream filled biscuits, cream filled Easter eggs and cheese. In every case the person responsible agreed to make necessary suitable amendments to labels as a result of my representations. In no case was it necessary to institute proceedings. "Special Designated Milk Three samples of milk sold under a special designation were purchased and all were certified as being satisfactory " r 36 SANITARY CIRCUMSTANCES OF THE AREA Water Supply I am indebted to the Medical Director of Water Examination of the Metropolitan Water Board for the following report upon water supplied to the borough during 1957 "The supply to the Tottenham area has been satisfactory both in quantity and quality during the year 1957 Details of the analytical results of the water passing into supply are given in the following table 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 is now in operation at Stoke Newington. (b) River Thames water stored in the Board's reservoir and treated at the Board's filtration works in the Thames Valley, 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 ." Drainage and Sewerage Separate systems of soil and surface water sewerage continue to operate throughout the Borough. Reports of pollution in water courses are received from time to time and investigations are carried out to ascertain the source. Such investigations present a problem in a Borough of this character where much of the drainage is very old. Domestic pollution 37 Average Results of the Chemical and Bacteriological Examination of the Water Supplied to the Borough of Tottenham for the Year 1957 Milligrams per litre (Unless otherwise stated) Description of the Sample No, of Samples Ammoniacal Nitrogen Album inoid Nitrogen Oxidised Nitrogen (Nitrate) Chlorides as cl. Oxygen abs. from Permanganate 4 hrs. at 27 C Turbidity Units Colour m. m brown 2ft. Tube Burgess' s Tintometer Hardness (Total) Hardness (Non carbonate) pH. Value Electrical Conductivity (gemmhos) New River water filtered at Hornsey works 238 0.012 0.046 5.6 34 0.60 0.1 5 300 64 7.8 625 New River water filtered at Stoke New ington works 238 0.028 0.045 5.5 34 0.59 0.1 6 298 62 7.9 600 River Thames derived filtered water 1882 0.027 0. 074 3.9 29 1.16 0.3 11 260 56 7.9 550 Bacteriological Results After Chlorination (Water Passing into Supply) Description of sample No. of Samples Plate count (average per m. 1.) Colonies counted on agar after 20-24 hrs. at 37°C Coliform Test Percentage of Samples negative in 100 m. 1. Coliform E. Coli New River water filtered at Hornsey works 256 9.4 99.61 100 New River water filtered at Stoke Newington works 256 11.2 100 100 River Thames derived filtered water 3438 6.4 99.33 99.91 38 is invariably more difficult to trace than industrial. It is hoped that the work on the East Middlesex drainage and on the flood relief schemes now in progress will assist in resolving the question of pollution. No serious flooding occurred during the year and it is anticipated that as the work of flood relief progresses the risk of flooding will be greatly reduced. Closet Accommodation The water carriage system is in operation in the Borough. One aspect of closet accommodation should be mentioned With the continuing influx of West Indian and other overseas families attention will be required to the houses they occupy. In many of these houses extensive sub-letting occurs and the question of adequate closet accommodation could present a problem. Atmospheric Pollution Certain sections of the "Clean Air Act 1956" came into operation on the 3lst December 1956 and this therefore, is the first annual report which deals with its administration The sections with which this report is mainly concerned are those dealing with the establishment of Smoke Control Areas, viz Sections 11 12 etc Certain preliminary work was done in the department regarding the extension of the existing Markfield Smokeless Zone and in April 1957 I was able to report to the Committee details of the proposals. These were to extend the boundaries of the area as follows: from Broad Lane south to the Borough boundary High Road - east to the River Lee. This represents an area of approximately 180 acres comprising 2,000 dwelling houses and other buildings. Estimates were prepared regarding the cost of replacing adapting and converting the existing domestic appliances totalling £43,000. Approval in principle was given to these proposals by the Council and the officers instructed to discuss the project with the Ministry. It was decided to proceed under the Clean Air Act. 39 ATMOSPHERIC POLLUTION RECORD 1957 Park Lane St, Ann's Tottenham Technical College Rainfall Insoluble Deposit Soluble Deposit Rainfall Insoluble Deposit Soluble Deposit Smoke Sulphur Dioxide Monthly Average Highest Daily Reading Monthly Average Highest Daily Reading (ins) (Tons per square mile) (ins) (Tons per square mile) (Mg/m3) (Mg/m3) (Parts pe • Million) January 1.12 7.41 5.85 1.19 9.25 4.75 .22 .64 .06 .13 February 3.08 6.80 7.01 3.08 10.81 6.98 .32 . 69 .08 .18 March 0.98 7.54 5.38 0.90 15.99 5.96 .25 .74 .08 .19 April 0.13 5.48 2.58 0.17 7.99 2.90 .13 .55 .05 .17 May 1 28 7.66 4.57 1.19 9.70 4.07 .09 .27 .04 .08 June 4.30 12.31 9.87 3.97 13.48 10.64 05 .12 .04 .08 July .03 .08 - - August 2.05 5.89 4.18 2.04 6.05 5.94 .04 .12 .03 .08 September 2.10 3.83 3.89 2.12 5.15 5.70 .07 .17 .03 .06 October 1.75 5.80 5.41 1.90 5.85 6.24 .23 .72 .06 .14 November 2.16 6. 71 5. 52 2.25 6.73 7. 88 .20 .38 .06 .11 December 1.49 7.77 7.02 1.56 7.63 6.58 .45 2.55 .08 .27 40 Ministerial approval in principle was subsequently received and the work of making a detailed survey started. Since,, it has become evident that the Council's proposals are being favourably received by occupiers of the houses in the area. In order to give publicity to other requirements of the Clean Air Act a meeting was held in November 1957 to which all sections of the manufacturing and industrial bodies were invited when a film was shown and the meeting addressed by the Town Clerk, Medical Officer of Health and chief public Health Inspector. Regarding the atmospheric pollution generally proceedings were taken in the Magistrates Court against a local laundry The Court made an order in favour of the Council and the offending firm have now installed a chain grate stoker. Housing The clearance area programme prepared under Section l, Housing Repairs and Rent Act., 1954 is being adhered to subject to certain amendments mentioned in my Annual Report for 1956. One large area comprising 200 houses was officially represented during the year. Public Inquiries were held by the Ministry inspector in respect of four clearance areas during 1957. objections having been received against the inclusion of a large proportion of the houses condemned. Five clearance areas represented in 1956 and 1957 received official confirmation, but in respect of one area an appeal against the official confirmation was lodged in the High Court The outcome of this appeal, which is of great importance to the Council. will be awaited with interest. Sections 9 and 10 The provisions of these sections continue to be operated as occasion demands. It is as yet, too early in the life of the Rent Act, 1957 to assess whether the intentions of this Act are being fulfilled. To establish this some consideration must be given to the question of reverting to our former practice of house to house inspection. As stated in previous reports, the bulk of the complaints relating to housing repairs come from the occupiers of the older houses Many of these are in areas already scheduled for clearance and the use of sections 9 and 10 is not advisable. There 41 POST WAR CLEARANCE AREAS Area Number of Dwellings Date Demolition of Premises Completed Represented Inquiry Confirmation Rehousing Occupants Completed Arthur Road 19 28.11.50 13.11.51 19.1.52 10.53 1.54 Markfield No.1 17 28.10.52 5.5.53 13.8.53 7.55 8.55 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 8.57 10.57 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 29.11.56 11.10.56 14.2.57 - - Northumberland Park 26 28.2.56 19.12.56 26.4.57 - - Markfield No.3 57 3.7.56 7.5.57 5.9.57 - - Braemar Road/ Kent Road 21 2.10.56 23.10.57 6.2.58 - - Cunningham Road 5 27.11.56 23.10.57 6.2.58 - - Tewkesbury No.4 15 30.10.56 27.10.57 24.12.57 - - Albert Road/ Richmond Road Nos.1,2,3 &4 200 4.6.57 - - - - 42 are, however, other areas of the Borough from which complaints are received, not so scheduled and it is in these areas where one must expect the Rent Act to prove its purpose. It is to be regretted that so few owners of tenanted houses seek to take advantage of the grant provisions of the Housing Act. 1949 to obtain assistance in improving existing houses Such applications as the Council do receive mainly come from owner/ occupiers who want to provide bathrooms. HOUSING ACTS 1936 & 1957 SECTIONS 9 & 10 WORK IN DEFAULT YEAR NUMBER OP HOUSES COST £ s. d. 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 1957 17 510 13 9 43 Individual Unfit Houses During 1957 nine individual unfit houses which were not considered capable at reasonable expense of being rendered fit for human habitation were dealt with under the Housing Act and in five cases demolition orders were made In the other four closing orders were made where houses were in terraces and the demolition would have affected the adjoining property Premises the subject of Demolition Orders not demolished as at 31st December, 1957. Premises Date of Order 5 8 Union Row 11.8.43 78 Stamford Road 29.1.57 97 Markfield Road * 4.11.57 33 Waverley Road * 4.11.57 38 St Ann s Road * 6.12.57 * These premises were still occupied at 31.12.57 Rehousing Assessment of Applications with Medical Aspects When there are special medical circumstances affecting the rehousing needs of applicants on the Council s waiting list the Council give consideration to this in deciding the cases in most urgent need of rehousing However many medical conditions may not be affected by the home conditions nor benefit by rehousing To ensure a proper assessment of medical cases details of applicants claiming priority on these grounds are referred to the Medical Officer of Health The medical conditions are fully investigated and if necessary the applicant's permission is obtained for a direct approach to be made to the family doctor or the hospital for further information. In addition, the home is visited by the Medical Officer so that the environmental conditions can be related before making a final recommendation upon the degree of priority warranted. 44 Certificates of Disrepair The Rent Act,1957. which came into force on the 6th July, 1957. introduced a revised and more involved procedure for obtaining a rent abatement where premises are not in a satisfactory state of repair. The Act also brought about an important change in the standard which could be required. It is no longer possible to take into account many defects which may warrant action under the Housing Acts such as rising dampness due to the absence of dampproof courses, settlement and lack of natural lighting. A notice of increase in rent (except for rates improvements, etc.)is void if it is served at a time when the premises are in a clearance area or there is a demolition or closing order on the premises or there is an outstanding notice under S 9 of the Housing Act,1936 or S. 94 of the Public Health Act 1936 Also if one of these conditions should apply after service of the notice of increase but before it takes effect no increase will be recoverable until the premises are freed from that state Revised Procedure 1. Tenant must serve List of Defects of Repairs on owner 2. Landlord is allowed six weeks in which either to remedy defects or submit an Undertaking so to do 3. If after six weeks the landlord has done neither tenant may apply to Council for Certificate of Disrepair sending a copy of the notice he served on the landlord and paying a fee of 2/6d. 4. If Council satisfied a Certificate is warranted they must notify owner to this effect and list those defects contained in the tenant's original notice which they consider should be remedied There is no power to add defects to the list sub mitted by the tenant. 5. The landlord is allowed three weeks in which to submit an undertaking to remedy the defects 6. The Council may refuse to accept landlord s undertaking if (a) a certificate of disrepair in respect of the premises has previously been issued against him under the Rent Act, 1957; (b) he has previously defaulted under a repairs notice issued by a local authority in respect of the premises under Section 9 of the Housing Act,1936. 45 (c) he has not carried out an undertaking to remedy defects previously given by him in respect of the premises or any other premises of which he is the landlord in the area of the local authority; or (d) he has previously been convicted of certain offences under the Public Health Acts in respect of any premises in which he had an interest. 7. If after three weeks an undertaking is not received or is refused the Council may issue the Certificate of Disrepair, and must send a copy to the landlord. 8. When landlord has remedied defects he may apply for Certificate to be cancelled,paying a fee of 2/6d. 9. Council must notify tenant who has a right to object within three weeks. 10. If no objection received or Council consider any such objection is not justified the certificate must be cancelled. Where a landlord gives an undertaking to remedy defects a period of six months is allowed for him to discharge it. At the expiry of that time if the defects have not been remedied the tenant may apply to the Council for a certificate as to the remedying of defects which the landlord has undertaken, paying a fee of 2/6d. The position is then the same as if a Certificate of Disrepair were in force until the defects have been remedied. Position where a Certificate of Disrepair is in force or Defects have not been remedied within six months in accordance with Undertaking. 1. Any increase, except for rates, improvements etc. specified in a notice served not more than six months before certificate was applied for or undertaking given,ceases to have effect; 2. The rent must not exceed 1 1/3 times the gross value; and 3. The tenant may also deduct weekly an amount equal to the rent adjustment until he has recovered any past rental he would not have had to pay if the rent abatement dated back to the date of application for the certificate or the date of the landlord's undertaking. This weekly deduction cannot be continued after the certificate has been cancelled or the defects have been remedied. 46 Position of outstanding Certificates under the Housing Repairs and Rents Act, 1954. These certificates, so far only as they relate to defects of repair have the same effect as if issued under the 1957 Act. During 1957 there were 248 applications for Certificates of Disrepair. It was found that the majority of the applications were justified and in many cases the owners submitted undertakings to remedy the defects within six months upon being notified of the Council's intention to issue Certificates of Disrepair. In 74 cases Certificates of Disrepair were issued where the owners failed to give such undertakings There were 12 applications for Cancellation of outstanding certificates seven of which were issued under the 1954 Act The application was granted in each case Administration It has been found that the procedure under the new Act involves the department in considerably more work than that of the previous Rent Act. Much difficulty has been experienced in interpreting the terms used by the tenants on their original notices to the landlord which form the basis of all subsequent action. The surveying of property and preparation of schedules of defects is essentially a matter for a qualified technical officer but it has rarely been found that the tenants have been able to employ a surveyor to act on their behalf with the result that notices they prepared are often indefinite and ambiguous As far as possible the items listed by the tenants are interpreted by the department's officers when they make their survey and more concise terminology is used in subsequent notices The following sets out the number of applications for certiflcates of disrepair and the number of applications for cancellation of certificates. Applications for Certificates of Disrepair (1) Number of applications for certificates under Rent 248 Act, 1957. (2) Number of decisions not to issue certificates 2 (3) Number of decisions to issue certificates 246 (a) in respect of some but not all defects 117 129 (b) in respect of all defects 47 (4) Number of undertakings given by landlords under paragraph 5 of the First Schedule: 147 (5) Number of undertakings refused by Local Authority under proviso to paragraph 5 of the First Schedule: (6) Number of certificates issued: 74 Applications for Cancellation of Certificates: (7) Applications by landlords to Local Authority for cancellation of certificates: 12 (8) Objections by tenants to cancellation of certificates: (9) Decisions by Local Authority to cancel in spite of tenant's objection: (10) certificates cancelled by Local Authority 12 (11) Number of certificates outstanding at 31st December, 1957 including those under the Housing Repairs and Rents Act, 1954 166 Rag Flock and Other Filling Materials Act, 1951 At 31st December, 1957. twenty-three premises were registered for the use of filling materials Pet Animals Act, 1951 At 31st December, 1957. twelve premises were licensed as pet shops in accordance with the Pet Animals Act, 1951 Rodent Control Co-operation between the operatives responsible for rodent control treatment in dwelling-houses and the public health inspectors ensures thorough investigation into all complaints received. Where infestation is persistent drain tests are carried out and in a majority of cases defects in the drainage system are found to be the cause Sewer treatments were carried out in April and October and the variations in the baiting period as approved by the Ministry of Agriculture and Fisheries were adopted. By this method it has been possible to reduce the number of men engaged on the treatment. 48 Sewer Maintenance - Results of baiting manholes Poison take at Manholes Treatment No.25 April/May Treatment No. 26 Sep /Nov. Complete - = Good 124 130 Small 353 416 Nil 531 497 Estimated number of rats killed 4830 5386 Poison used 2½‰ zinc phosphide 10% arsenious oxide The following is a summary of dwelling houses and business premises treated during 1957 (1) Dwelling houses 686 (2) Business and Factory premises 198 (3) Total charge for (2) above £,137 7-10 Insect Pests The use of 5‰ D.D.T. solution in an emulsion form has been retained together with the application of D.D.T powder in certain cases. This is found to be an efficient and a reasonably cheap form of insecticide 167 inspections prior to removal to council houses have been made on notification by the Housing Manager, and disinfestation was required in twenty cases. The furniture being treated in a cyanide chamber Cause Private Houses Council Houses Other Premises Total Houses Rooms Houses Rooms Houses Rooms Others Ants 11 11 Beetles 1 1 Bugs 70 202 2 18 72 220 Cockroaches 28 13 13 28 13 13 Earwigs 6 1 6 1 Pleas 7 20 7 20 Flies 1 1 1 1 Lice 2 2 2 2 Red Mites 4 8 4 8 Spiders Wasps 3 3 Woodworm 1 1 1 1 49 Inspections carried out by the Public Health Inspectors Appointments and Interviews 795 Cinemas & Halls 45 Complaints Investigated . 3,043 Conveniences and Urinals 52 Drains defective 207 Drains tested 363 Factories with Mechanical Power 313 Factories without Mechanical Power 30 Food Poisoning 11 Food Premises Bakehouses 55 Butchers 207 Cafes 186 Dairies 255 Factories 45 Factory Canteens 60 Fishmongers 85 Greengrocers 93 Ice Cream Premises 108 Slaughterhouses 822 Other Food Premises 363 House to House 233 Improvement Grants 82 Infectious Disease 1,889 Other Visits 6,718 Outworkers 393 Rat Infestation 812 Re-inspections . 7,, 369 Schools 17 S.D.A.A. & Housing Act Advances 248 Smoke Observations 144 Stables and Mews 25 Tuberculosis 0 Work places 33 Defects Remedied Drains reconstructed 23 Drains repaired 187 Drains cleared 163 W.C. Cisterns repaired or renewed 112 W.C. Pans renewed 73 W.C. Pans cleansed 29 50 Waste Pipes repaired or renewed 80 Rain water pipes repaired or renewed 185 Roofs repaired or renewed 5117 Eaves Gutters repaired or renewed 273 Drinking Water Cisterns renewed 6 Drinking Water Cisterns covered 7 Water Service Pipes repaired 50 Water Supply reinstated 37 Yards repaired or reconstructed 61 Sinks renewed or provided 34 Floors repaired or renewed 207 Floors ventilated 73 Dampness remedied by insertion of damp proof courses 48 by pointing of brickwork 82 by internal rendering 201 by miscellaneous remedies 125 Window Frames and Sashes repaired or renewed or painted 245 Coppers repaired or renewed, or provided 5 Fireplaces, Stoves & Ovens repaired or renewed 113 Flues and Chimney Stacks repaired 63 Brickwork of Walls repaired and Walls rebuilt 76 Ventilated Food Stores provided 5 Rooms cleansed 226 Staircases, Passages & Landings cleansed 27 Staircases, Balconies and Steps repaired or renewed 53 Noxious Accumulations removed 28 Nuisances arising from Animals abated 6 Miscellaneous Defects remedied 581 Notices Served Statutory:- Housing Act, 1957 Section 9 75 " 17 5 " 18 1 81 Public Health Act, 1936: Section 24 9 " 39 30 " 45 7 " 94 177 223 51 Tottenham Corporation Act, 1952 Section 36 15 " 43 86 101 Miscellaneous 2 407 Informal Notices 1,056 Repair of Houses by the Council Work carried out in default or by agreement with the owners during 1957. Housing Acts 1936 & 1957 £ S. d. Section 9 17 premises 510 13 9 " 11 1 " 13 2 6 Public Health Act 1936 Section 24 10 premises 122 16 0 " 39 4 " 181 9 6 " 45 2 " 20 5 11 " 94 4 " 218 3 10 Tottenham Corporation Act 1952 Section 36 5 premises 27 5 5 " 38 2 " 30 13 1 " 43 37 " 435 7 7 " 54 2 " 6 12 5 1,566 10 0 52 FACTORIES AND SHOPS There is a wide range of products from the many factories which are scattered throughout the Borough with a greater concentration on the east side of the High Road in the vicinity of the River Lea, The industrial processes are largely of a light nature such as furniture manufacture and light engineering The 723 factories on the register vary in size from those employing only two to three people to the larger ones with 2 000 to 3,000 employees Regular systematic inspections are carried out by the public health inspectors to ensure cojnipliance 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 on Register NUMBER OF Inspections Written Notices Occupier Prosecuted (i) Factories in which sections 1,2, 3, 4 and 6 are to be enforced by local authority 56 32 - - (ii) Factories not included in (i) in which section 7 is enforced by the local authority 669 351 20 - (iii) Other premises under the Act (excluding Outworkers premises) 3 3 - - TOTAL 728 386 20 - 53 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 (So.1) - - - - Overcrowding (S.2) - - - - Unreasonable temperature (S.3) - - - - Inadequate ventilation (S.6) - - - - Ineffective drainage of floors (S.6) - - = - Sanitary Conveniences (S.7) (a) Insufficient 1 1 - - (b) Unsuitable or defective 27 25 - 13 (c) Not separate for sexes 1 1 - 1 Other offences against the Act (not including offences relating to Outwork) 2 2 2 - TOTAL:- 31 29 2 14 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 ... ... ... 389 Household linen ... ... . 5 Curtains and furniture hangings 4 Lace, lace curtains and nets 2 Umbrellas ... ... ... ... ... 1 Artificial flowers . . . ... ... ... 19 Paper bags ... ... ... ... ... 5 The making of boxes or other receptacles or parts thereof made wholly or partially of paper 46 Brushes ... ... ... ... ... 9 Feather sorting ... ... ... ... 2 Carding, etc. of buttons, etc. 2 Stuffed Toys ... ... ... ... 5 Cosaques, Christmas crackers, Christmas stockings, etc. ... ... ... ... 7 TOTAL 4 96 393 visits were made during 1957 to outworkers' premises No contraventions were reported. 54 Shops The control of shops and effective administration of the legislation relating thereto are secured by systematic visitation, 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 of unfair trading were promptly dealt with, Verbal and written advice and information has been given to many shopkeepers in the Borough and it has been found that the majority of them are willing to fulfil their obligations as required by the Act. The Shops Bill,introduced in the House of Lords in 1956 was after much discussion and many amendments finally dropped by the Government due to lack of Parliamentary time The loopholes and anomalies in the present legislation still exist. Such terms as "meals and refreshments" "newly cooked provisions" and "other articles of a perishable nature" are not defined and create difficulties for shopkeepers trying not to break the law, and for those who have to enforce the law It can only be hoped that consideration for some amending legislation will be made in the near future The following is a summary of inspections, patrols and observations made during 1957.and relevant action taken Inspections 1 284 shops have been systematically inspected prescribed notices, records of employment etc have been examined and the necessary information obtained for keeping an up to date register of shops in the Borough. During these inspections the following contraventions were noted Section 17(2) Assistants weekly half holiday notice not affixed in the shop 169 Section 32(2) Record of hours of employment of young person not being maintained 41 Section 32(3) Abstract of provisions relating to the employment of young persons not exhibited 38 Section 37(1) Seats for females not provided 1 Section 37(2) Notice re seats not displayed 97 55 In order to draw the attention of occupiers to these contra ventions 94 informal notices were served and 126 re inspections were made to ensure compliance. In this connection 221 forms and notices were sold. 746 male, 1,299 female adult assistants and 46 male and 127 female young persons, under the age of 18 years, were 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 11 Section 1(2) Alternative Closing notice not displayed 7 Section 13(1) Exempted trade notices not displayed or in possession of the occupier 49 In three of the cases where shops had failed to close on the weekly half-holiday no transactions were seen to take place and informal notices were sent. In the remaining eight cases seven warning letters 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 26 notices were sold, seven warning letters were sent and one occupier was prosecuted for failing to display the prescribed exempted trade notice, on the weekly half holiday General Closing Hours The following contraventions were observed Section 2 The sale after 8 p.m. of articles not exempted by the 2nd schedule 5 Sections 6 The sale of sugar confectionery after 9.30p.m. 1 Warning letters were sent to three shopkeepers for offences under section 2. Legal proceedings were instituted against two offenders under that section and against the offender under section 6. Sunday Trading The following contraventions were observed:- 56 Section 22(1) Compensatory holidays not being allowed for Sunday employment 2 Section 22(3) Record of Sunday employment not kept 12 Section 47 Sale of goods not exempted by the 5th schedule 20 Section 50 Sunday trade notices not displayed or in possession of the occupier 69 Informal notices were sent to the occupiers of shops with regard to holidays for Sunday employment and for not keeping a record. For failing to keep a record one shopkeeper was prosecuted. 3 Form VII (Record of Sunday employment) were sold, Warning letters were sent to 14 shopkeepers for illegal Sunday trading and in the remaining six cases legal proceedings were instituted. 42 notices were sold to occupiers under section 50 informal notices were sent requiring these notices to be exhibited on Sunday. Nine warning letters were sent in this connection, and it was found necessary to prosecute 4 shopkeepers for failing to comply with the Regulations. Section 53: Jewish Traders During the year the names of two traders were removed from the register and three were added; the total on the register now being six 57 Prosecutions OFFENCE SECTION PINE COSIS TOTAL Case 1 (1) selling cleaning powder on weekly half holiday 1 & 13 £2 £l.1.0. £3.1.0. (2) Non exhibition of notices (2 summonses) Case 2 (1) Selling cigarettes after 8 p.m. (2) Selling cigarettes after 8 p.m. (2 summonses) 2 £2 £l.1.0. £3.1.0. Case 3 (1) Selling crisps after 8 p.m. 2 & 6 • 4.0. £3. 5. 0. (2) Selling sugar confectionery after 9.30 p.m. (2 summonses) £2 £1.1.0. Case 4 Selling non-exempted articles on a Sunday 47 £1 10.6. £1.10.6. Case 5 (1) Selling non-exempted articles on a Sunday 47 & 50 £2 £1 .1.0. £3.1.0. (2) Non-exhibition of notices (2 summonses) Case 6 (1) Selling pkt. of tea on Sunday 47 & 50 £2 £1.1.0. £3.1.0. (2) Non-exhibition of notices (2 summonses) Case 7 Selling gravy mixture on Sunday 47 * 4.0. 4.0. Case 8 (l) Failure to keep record of N.B. Sunday employment (2) Selling non-exempted articles on Sunday 22 47 & 50 £6 £l.11.6. £7.11.6. (3) Non-exhibition of notices (3 summonses) Case 9 (1) Sale of paint brush on N.B. Sunday 47 & 50 £4 £1.1.0. £5.1.0. (2) Non-exhibition of notices £21 £8.16.0. £29.16.0. N.B. Proceedings taken in 1958 for offences occurring in 1957. * Absolute discharge. 58 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 Sto Ann's General Hospital 697 540 Includes infectious diseases wards and special Poliomyelitis unit,, Prince of Wales s General Hospital 223 215 Annexe at Nazeing (Princess Louise Convalescent Home) 20 20 Tottenham chest Clinic - - A table giving details of the out patient 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. - Endocrine a.m. Varicose veins a.m. - - - p.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 - — - am. - a.m. Neurological p.m. - - - - - Genito-Urinary - a.m. - - - - Psychiatric - p. m. - - p.m. - Physical Medicine a.m. p.m. a.m. p.m. a.m. a.m. p.m. a.m. p.m. - X-ray 9 a.m. until 5 p.m. every day Saturdays 9 a.m. 12 noon Orthopaedic - a.m. - a.m. - - Fractures a.m. - - - a.m - Allergy - - - p.m. - - Veneral Diseases Medical Officer Males p.m. - p.m. a.m. p.m. - a.m. Females - p.m. - a.m. p.m. a.m. Intermediate Treatment 8 a.m. 7 p.m. 8 a.m. 7 p.m. 8 a.m. 7 p.m. 8 a.m. 7 p.m. 8 a.m. 5 p.m. 8 a.m. 12 noon 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 controlled 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, N.17. telephone number TOTtenham 4500 (e) Ambulance Service Ambulances are stationed at the Edmonton Fire and Ambulance Station, but vehicles are retained at the Tottenham Central Fire Station and at Coombes Croft for accident and emergency cases. To call an ambulance 999 should be dialled. Public Health Laboratory Service The Public Health Laboratory service provides a comprehensive service for the bacteriological examination of specimens submitted by general practitioners and local authorities The existing system for the supply of containers and the delivery of specimens by the Public Health Department remains unchanged Specimens may be sent to the Public Health Department at the Town Hall, and providing they reach there not later than 3.0 p.m, on Monday to Friday and 11.0 a.m. on Saturday, they will be sent on the same day by special messenger to the Hornsey Branch Laboratory, As it is not possible to send a second messenger on any one day, it is essential that specimens be delivered to the Town Hall before the times stated. Alternatively specimens may be sent direct to the Hornsey branch laboratory, which remains open until 5.0 p.m. on Monday to Friday and 12 noon on Saturday, The address is - Public Health Laboratory, Coppett's Wood Hospital, Coppett's Road, N.10. 61 A 24 hour emergency service is maintained by the Central Laboratory at Colindale. The following is a summary of the work carried out during 1957, at the Coppett's Wood Hospital Branch in Hornsey Record of Examinations Throat/Nose Swabs - Total Specimens 42 Diphtheria Bacilli 0 Haemolytic Streptococci 1 Vincents Angina 0 Negative 41 Faeces:- Total Specimens 241 Shigella 32 Salmonella enterditidis 1 Salmonella typhi-murium 5 Salmonella bredeney 1 B. Coli 1 Negative 201 Sputum:- Total Specimens 5 Positive 0 Negative 5 Pertussis:- Total Specimens 4 Positive 0 Negative 4 Ice-Cream:- Total Specimens 10 Water:- Total Specimens 2 Swimming Pools 1 Paddling Pool 1 Miscellaneous Specimens:- 25 Total Number of Specimens 329 62 Welfare of Aged Persons The care and welfare of aged persons continues to be a growing social need The Annual Report for 1956 carried a full description of the local statutory and voluntary services working in this field The following therefore is but a brief summary of some of the activities during 1957 - Chiropody Service:- 804 old people received treatment; 3,522 treatments were given, an increase of 312 on last year. Christmas, 1957:- 1,026 parcels were packed and delivered by voluntary effort to the homes of the aged sick and housebound. Much assistance was given to the old people at Christmas by persons and organisations in the Borough Club Dinners:- A total of 10,312 dinners were served to the old people at Woodberry Down and the Lord Morrison Hall Clubs Holidays and Holiday Outings:- 100 old people were able to have two weeks holiday through the help of the Women s Holiday Fund: numerous old people were able to have a holiday at a cheaper rate by avoiding the high season costs; through the generosity of Grey Green Coaches Ltd. many outings were arranged for the housebound; and countless other people and organisations have given invaluable assistance to old people in a similar way Harvest Festival:- 744 old people benefited by the kindness and generosity of schools and Churches who sent their Harvest Festival Thanksgivings for distribution by the Welfare Committee. Meals-on-Wheels:- 5,725 meals were delivered through the service organised by the Welfare Committee and 3,662 by the Women s Voluntary Services Optical Service:- 16 housebound old people have benefited by this service Shoe Repairs:- 23 dockets were issued to enable old people to get footwear repaired at a reduced rate. Laundry Service:- 674 collections were made by the Corporation from incontinent persons. 63 Baths:- Many old people have received assistance from this facility and are reassured knowing that if they need help they can rely on the Bath Attendants. Library Service:- 38 housebound old people were visited regularly during the year and a total of 3,518 books were delivered. General Welfare:- During the year 3,206 office interviews were conducted and 451 home visits made. In addition, hundreds of enquiries and problems were dealt with by letter and telephone by the Old People's Welfare Organisation. Admission to Hospital:- 157 visits were made to aged persons awaiting admission to the geriatric wards at St. Ann's General Hospital and reports sent to the hospital to enable them to give priority to those in most urgent need of hospital care. National Assistance Act, 1948, Section 50: Burials During the year it was necessary to arrange three burials where deaths occurred and suitable arrangements for burial would not otherwise have been made. Superannuation Medical Examinations 94 persons were examined during the year for appointment to the Council's Staff. 88 of these were passed as fit to carry out their respective duties with efficiency. The causes of unfitness of the 6 persons found unfit are listed as follows:- (i) Chronic Bronchitis - emphysema 2 (ii) Heart Disease 2 (iii) Chronic Skin Disease 1 (iv) Deformity of Bones 1 64 Accidents in the Home During the year 1956 in England and Wales 6908 persons died as a result of accidents in the home 80% of these persons were in the age groups of the young and the old. Children and old people therefore are the main participants in this ghastly widespread and unnecessary domestic tragedy. The commonest type of accident was the fall. Palls accounted for some 58% of the fatalities Burns and scalds accounted for 12%. It is plain to see that by concentrating our efforts on accident prevention in the young and aged. with the possibility of falls burns and scalds in mind, the greater part of the problem can be met. A special effort in this direction has been made during the year by health visitors and public health inspectors who in visiting premises have advised on special dangers to the aged and the young Liaison with the National Assistance Board has in many instances enabled aged persons to be given grants for fire guards In one instance advice was sought from the Fire Prevention Officer The great wastage of life due to fatalities as a result of burns and scalds is indeed terrifying It is estimated that there are at present approximately 500 persons in hospital under treatment for burns in the country as a whole; about two thirds of them because their clothes caught alight Also approximately 125,000 of the public have at some time or another been in hospital for the same cause. It is hoped that the picture overleaf (published by the Central Office of Information) so realistically demonstrating the burning clothes of a child will instil a sense of importance of the problem in all those responsible for the care of children so that immediate action will be taken to 1. Guard that fire 2. Purchase flame proof materials This is in anticipation of the Government Sponsored National "Guard that Fire" Campaign for the ensuing year. 65 Atomic Radiation This subject is very much in the news today and promises to be a health problem for years to come. Statements by experts on varying aspects of radiation have tended to confuse the man in the street and often instil fear. An attempt here is made to clarify some basic principles. What is atomic radiation? In its simplest and widest sense it is a phenomenon of nature it is present everywhere to a greater or lesser degree and is known as the "natural background radiation" of the earth and its atmosphere. Following the discovery of X-rays by Roentgen in 1895, certain uranium salts were discovered a few months later to possess penetrating rays and shortly afterwards radium itself was discovered Why should some substances emit rays? The reason is that these substances are composed of atoms that are unstable and these break down and form other substances, and energy in the form of rays is produced. Uranium breaks down to form a series of unstable substances thorium - radium - radon polonium and so on until the stable form of the common metal, lead is formed Nowadays radioactive substances can be produced artificially in nuclear reactors, e.g. the numerous radioactive isotopes of iodine or phosphorus and many others which find a great number of uses in medicine and industry. What are the nature of these rays themselves? They are part of the Electro Magnetic Spectrum of rays Most of these rays are commonly accepted nowadays and appear in the form of heat (infrared), light (visible and ultra voilet). wireless waves (Hertzian waves) and X-rays. The true waves to atomic disintegration are known as Gamma rays (Alpha and Beta rays are particulate and cannot be classified as true rays) Gamma rays are similar to X-rays and have the power of great penetration Alpha and Beta rays have only slight penetration since they are electrically charged Particles. It has been established that all the rays of heat, light and radio, travel at the same speed, some thousands of miles per second. The crucial aspect of difference lies in the wave length (and its frequency) where the greater the wave length (and lower the frequency) the more harmless the ray, and conversely the shorter the wave length (and higher the frequency) the more 66 dangerous. Radio-waves, the longest, are harmless; Gamma and X-ray are the shortest and are the most dangerous X-rays and Gamma rays being the most powerful from the penetration aspect need to be handled with great respect. (Alpha and Beta rays present a problem of their own from the aspect of internal harm once inside the body), X-rays are produced artificially and are under control in so far as they can be stopped by switching off the electric current, but Gamma rays are emitted continuously from the radioactive substance in all directions. Some of these substances emit rays for short periods, others for centuries, and therein lies their great danger The action of Gamma and X-rays on the human body depends on several factors, the type of ray its period of action, the distance of the body from the source of ray, the amount of previous exposure, the part of the body exposed and the sensitivity of the person to the particular ray. Hazards 1. X-ray exposure (in the light of recent experience) must be more carefully controlled especially in regard to the exposure for diagnostic purposes of the pelvic organs, which are highly sensitive. Also great care must be taken to ensure that X ray machines are properly shielded The ordinary exposure to X-rays involved, in for example Chest X-rays, are of very minor proportions, but pedoscopes used in many shoe shops and any similar exposures of frequency can be unnecessary and dangerous from the long term aspect. 2. Radio Active Substances can be highly dangerous if used carelessly and unnecessarily. Strict control over exposure must be the keynote of precaution In hospitals careful regula tions are laid down in a code of practice for the storage, use, movement and disposal of wastes. Specialists supervise all aspects of the control. In industry an ever increasing use is being made of these substances and great care must be exercised by all involved. Disposal of radioactive wastes presents a grave problem covered by legal safeguards under the Radioactive Substances Act, 1948 3. Nuclear Reactors. Accidents can produce an outflow of radio activity as shown by the windscale accident. Prom this incident fresh knowledge and design will eliminate the risk of 67 similar mistakes. The Atomic Energy Act controls Nuclear Reactors. 4. Nuclear atomic explosions increase the existing natural background radiation long after the local violence and radio active "fall out"1 have been scattered by the winds. Very small increases of radio activity in the atmosphere can be recorded at vast distances away from the explosion, But though in radiation hazards it is the accumulative dose that is of importance, it has been authoritively stated that the number of world atomic explosion tests made, so far, is not such as may affect the health of the public in this country. Also the contrary has been said,, although expert opinion seems agreed as to the urgency of International Control. In the meantime assurance too has been given that syste: matic monitoring is carried out in relation to the atmosphere, food and water supplies. 68 STATISTICAL SUMMARY Deaths are classified under the 36 headings based on the abbreviated List of the International Statistical Classification of Diseases, Injuries and Causes of Death, 1948 Deaths are assigned to the area where the deceased normally resided, except where the death occurs in a residential home or in a chronic sick or mental hospital where the deceased had been a patient for six months or more. Although there was a natural increase in population which arose from the births exceeding deaths by 344, the Registrar General estimate of population shows a reduction of 1,400, meaning that the movement of population out of the Borough must have exceeded the inward movement by 1,744. 1956 1957 Area of District (in acres) 3,013 3,013 Population Census April, 1951 126 929 Mid-year: Registrar General's estimate: 120,700 119,300 Rateable Value at 1st April £1,827,527 £1,737, 776 Sum represented by penny rate £7,285 £7,009 Births Registered live-births (a) Legitimate: Males 737 795 Females 743 759 Total 1,480 1,554 (b) Illegitimate Males 37 47 Females 43 57 Total 80 104 (c) Total Live-births: Males 774 842 Females 786 816 Total 1,560 1,658 69 1956 1957 Birth-rate per 1,000 estimated population: 12.92 13.90 Stillbirths (a) Legitimate: Males 19 16 Females 18 14 Total 37 30 (b) Illegitimate: Males - 1 Females - 2 Total - 3 (c) Total Males 19 17 Females 18 16 Total 37 33 Stillbirth rate per 1,000 total (live and still) births 23 17 20,79 Deaths: Males 687 731 Females 565 583 Total 1,252 1,314 Death rate per 1,000 estimated population 10 4 11.02 Maternal Deaths Puerperal sepsis 0 0 Other puerperal causes 2 2 Total 2 2 Maternal Death-rate per 1,000 total (live and still) births 1.252 1,183 Deaths of Infants under 1 year of age (a) Legitimate Males 21 23 Females 12 11 Total 33 34 70 1956 1957 (b) Illegitimate Males 2 5 Females 3 3 Total 5 8 (c) Total Infantile Deaths: Males 23 28 Females 15 14 Total 38 42 Infantile Death-rate per 1,000 live births 24.36 25.33 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. These factors make allowance for the way in which the sex and age distribution of the local population differs from that for England and Wales as a whole . The death rate comparability factor has been adjusted specifically to take account of the presence of residential institutions in the area. To compare the crude birth and death rates for Tottenham with the national rates, Tottenham1 s figures must first be multiplied by the appropriate comparability factor which remains at 97 for births but is reduced from 1 09 to 1 07 for deaths Infantile Deaths, 1957 A total of 42 deaths under 1 year of age is recorded, giving a rate of 25 33 per thousand live births A close examination of the causes, however, can explain this apparently high incidence. Firstly it is important to note that only 4 of these deaths occurred at home. The remaining 38 occurred in hospital and it is obvious that the causes were of a serious nature. 34 of the deaths were neonatal deaths. i.e. they occurred in the first month of life The Causes (1) Prematurity. 19 deaths came under this heading and in two other cases this was a contributing factor Eight of these deaths 71 were within the first 24 hours. A further six occurred within 48 hours of birth. Six more followed within the next fortnight and one at one month With all the excellent new equipment available at the hospitals for the care of premature infants it is obvious that these were incapable of survival. (2) Congenital Malformations. Six deaths were primarily from this cause and in three other cases this was a secondary cause. The malformations included serious deformities of the brain, nervous system, intestinal canal and respiratory system. Only one case of pyloric stenosis, which died at one month, stood any chance of survival (3) Birth Injuries. The four deaths under this heading resulted from the hazards, to the brain and its blood vessels, by birth. Two were due to cerebral haemorrhage and two to cerebral damage Two died one day after birth, one after two days and the fourth by the fourth day (4) Atelectasis. Of these two deaths one was at three hours after birth and the other, at one day, was associated with an aspirative pneumonia (5) Broncho Pneumonia and other Diseases of the Respiratory System Six deaths came under this heading, two of which were associated with prematurity and lived for only one and 10 days respectively Spastic quadrlplegia was a contributing factor in a child who lived for one month The other three infants suffered from serious lung conditions; two died from acute capilliary bronchitis at three and four months respectively the third, aged three months, died in hospital from acute tracheobronchitis. Both cases of capilliary bronchitis occurred in the home. It is possible that early removal to hospital of these cases might have afforded some slighter chance of recovery but this condition, in the young, is a very grave state and even hospital treatment may not prove successful. (6) Other Causes. The five deaths listed here were (i) Haemolytic disease of the newborn (at six hours). (ii) Toxaemia of Pregnancy with cerebral damage as a contributing cause (at two days). (iii) Intracerebral Tumour in a hydrocephalic child (at 11 months). 72 (iv) Inhalation of amniotic fluid, (v) Subdural haematoraa following a fall (at six months). The first three cases occurred in hospital; the fourth case arose before the arrival of the district nurse. much is dependent on calling a midwife in time and precipitant birth is fortunately a rare hazard on the district; the fifth was due to a fall which is always a great risk with a young baby, especially a vigorous infant of six months. With more care this could have been prevented and thereby have helped to lessen the high incidence of accidents in the home. 73 Table of Cases of Infectious Diseases coming to the knowledge of the Medical Officer of Health during the year 1957 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 M F M F M F M F M F M F M F M F M F M F M F M F Total Scarlet Fever - - 2 - 4 5 1 1 7 13 22 25 5 2 1 1 3 - - - - - - - 92 Measles 15 18 74 80 112 90 109 102 145 129 372 417 17 16 2 7 4 7 - - - - - - 1,716 Whooping Cough 4 11 9 2 7 10 2 6 7 8 27 32 4 3 - - - 1 - - - - - - 133 Pneumonia 2 - 1 - - 1 - 1 - 1 - 3 - 1 1 - 3 7 3 5 18 10 22 14 93 Erysipelas - - - - - - - - - - - - 1 - - 1 - 1 - 2 5 1 1 12 Pood Poisoning - - - - - - 1 - - - 1 4 - - - 1 2 1 1 - - 2 - 2 15 Puerperal Pyrexia - - - - - - - - - - - - - - - - - 2 - - - - - - 2 Ophthalmia Neonatorum - - - - - - - - - - - - - - - - - - - - - - - - - Acute E cephalitis Infective - - - - - - - - - - - - - - - - - - - - - - - - - Post-infectious - - - - - - - - - - - - - 1 - - - - - - - - - - 1 Acute Poliomyelitis - - - - - - - - - - - 9 1 - - - - - - - - - - - 3 Paralytic Non-paralytic - - - - - - - - - - 1 - - - - - - - - - - - - - 1 Meningococcal Infection - - - - - - - - - - - 1 - - - - - - - - - - - - 1 Diphtheria - - - - - - - - - - - - - - - - - - - - - - - - - Typhoid - - - - - - - - - - - - - - - - - - - - - - - - - Paratyphoid - - - - - - - - - - - - 1 - - - - - - - - - - - 1 Dysentery 1 1 2 1 2 4 1 2 3 1 2 2 1 2 1 - 1 5 3 3 ' 3 1 - 4 46 Scabies - - 1 1 - 1 - - - - 1 - 1 1 - 1 2 2 - - - - - 1 12 Tuberculosis Respiratory - - 1 - - - - 1 - 1 - - - - 2 3 15 8 9 7 27 3 7 2 86 Meninges & C.N.S. - - - - - - - - - - - - - - - - - - - - - - - - Other - - - - - - - - - - - 1 - - - - 1 1 - - - - 1 - 4 Smallpox - - - - - - - - - - - - - - - - - - - 1 - 1 - - 3 Total 22 30 90 84 125 111 114 113 162 153 427 487 30 27 7 13 32 34 17 16 50 22 31 24 2,221 74 INFANTILE DEATHS IN AGES AND SEXES DURING THE YEAR 1957 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 - 1 1 - - - - - - 5 3 2 Other diseases of respiratory system - - - - - - - - - - - - - 1 - - - - - - - 1 1 - Gastritis, enteritis and diarrhoea - - - - - - - - - - - - - - - - - - - - - - - - Congenital malformations - - - - - - - 1 2 2 5 1 - - - - - - - - - 6 2 4 Prematurity 8 5 1 1 - - - 3 - - 18 - - - - - - - - - - 19 15 4 Atelectasis 1 1 - - - - - - - - 2 - - - - - - - - - - 2 1 1 Birth injuries - 2 1 - 1 - - - - - 4 - - - - - - - - - - 4 3 1 Other causes 2 - 1 - - - - - - - 3 - - - - - 1 - - - 1 5 3 2 Total 10 10 4 1 - - 5 2 2 34 3 - 2 1 - 1 - - - 1 42 28 14 75 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 5 4 - - - - - - - - - 2 3 1 2 1 - - Tuberculosis, other - 1 - - - - - - - - - - - - - - - . 1 Syphilitic disease 1 1 - - - - - - - - - - 1 1 - - - - Diphtheria - - - - - - - - - - - - - - - - - - Whooping Cough - - - - - - - - - - - - - - - - - - Meningococcal infections - - - - - - - - - - - - - - - - - - Acute poliomyelitis - - - - - - - - - - - - - - - - - - Measles - - - - - - - - - - - - - - - - - - Other infective & parasitic diseases 1 1 - - - - 1 - - - - - - - - 1 - - Malignant neoplasm, stomach 26 12 - - - - - - - - - - 12 3 11 4 3 5 Malignant neoplasm, lung bronchus 72 9 - - - - - - - - 1 - 36 1 26 3 9 5 Malignant neoplasm, breast 1 25 - - - - - - - - - 3 - 11 - 5 1 6 Malignant neoplasm, uterus - 5 - - - - - - - - - 2 - 2 - 1 - - Other malignant & lymphatic neoplasm 73 60 - - - - 1 - - - 4 7 26 19 21 16 21 18 Leukaemia, Aleukaemia 6 7 - - 1 - - - - - 1 1 1 1 1 2 2 3 Diabetes 3 6 - - - - - - - - 1 1 - - 1 3 1 2 Vascular lesions of the nervous system 57 74 - - - - - - - - 1 1 8 9 18 25 30 39 Coronary disease, angina 153 57 - - - - - - - 5 2 63 9 48 23 37 23 Hypertension, with heart disease 4 18 - - - - - - - - - - - 4 2 2 2 12 Other heart disease 65 102 - - - - - - - - 2 2 15 12 15 21 33 67 Other circulatory disease 25 32 - - - - - - - - - - 6 2 12 11 7 19 Influenza 6 4 - - - - - 1 1 - - 1 - 1 4 - 1 1 Pneumonia 41 32 3 2 - - - - 2 - - 1 9 8 12 7 15 14 Bronchitis 58 30 1 - 1 - - - - - - - 16 4 22 10 18 16 Other diseases of respiratory system 10 2 - - - - 1 - - - 1 - 3 - 3 - 2 2 Ulcer of stomach & duodenum 12 5 - - - - - - - - 1 - 8 1 - - 3 4 Gastritis, enteritis & diarrhoea 6 3 - - - - - - - - - 1 1 1 2 - 3 1 Nephritis & Nephrosis 6 4 - - - - - 1 1 1 1 - 1 - 1 - 2 2 Hyperplasia of prostate 7 - - - - - - - - - - 1 - 3 - 3 - Pregnancy, childbirth & abortion - 2 - - - - - - - 1 - 1 - - - - - - Congenital malformations 2 5 2 4 - - - - - - - - - - - 1 - - Other defined & ill defined diseases 60 57 21 7 1 - - - 2 - 2 2 12 19 7 16 15 13 Motor vehicle accidents 6 4 - - 1 - - - 1 - - 1 4 1 - - - 2 All other accidents 18 11 1 1 - - 1 - 2 - 1 1 5 2 3 1 5 6 Suicide 7 10 - - - - - - - - - 4 6 4 - 2 1 - Homicide & operations of War - - - - - - - - - - - - - - - - - - Total 731 583 28 14 4 - 4 2 9 2 21 33 237 116 214 155 214 261 76 CANCER DEATHS 1957 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 5 1 - - - - - - - - - - 1 - - - - - 1 - - - 3 1 - - Digestive Organs and Peritoneum 55 38 - - - - - - - - - - 1 - 2 8 - 13 8 20 15 13 10 1 2 Respiratory system 75 11 - - - - - - - - - - - - 1 - 9 2 29 - 26 3 10 5 - 1 Breast and Genito urinary system 21 43 - - - - - - - - - - - 1 - 6 3 6 5 13 8 7 5 10 - - Other and unspecified sites 14 14 - - 1 - - - - - - - 2 - 1 2 2 4 3 2 3 4 2 2 - - Lymphatic & Haematopoietic Tissues 8 11 1 - - - - - - - - - - 1 1 - - 1 2 2 2 2 2 5 - - TOTAL 178 118 1 - 1 - - - - - - - 3 3 3 10 22 13 53 25 59 31 35 33 1 3 77 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 1938 144,400 1,512 10.5 1,893 13.1 89 47.0 23 186 221 178 38 207 1939 (142,400*) 1,406 10.3 (1,776*) 12.5 66 37.95 15 335 60 182 30 209 (136,000 ) (1,739 ) 1940 119,400 1,703 14.26 (1,666*) 13.95 64 41.05 20 103 28 178 19 225 (1,559 ) 1941 105,620 1,418 13.43 (1,560*) 14.77 61 46.35 13 103 73 161 28 194 (1.316 ) 1942 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 1,665 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 1957 119,300 1,314 11.02 1,658 13.90 42 25.33 2 92 - 86 4 296 *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. 78 CERTAIN VITAL STATISTICS FOR THE YEAR 1957. District Population mid-1957 . Birth rate per 1000 population Death rate per 1000 population Specific death rates per 1000 population Infant mortality Per 1000 live births Maternal mortality per 1000 total births Crude Adjusted Crude Adjusted Pulmonary tuberculosis Cancer Infant Neo-natal (a) (a) (a) (a) (a) (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) Acton 65,840 14.2 13.3 10.6 11.1 0.08 (5) 2.2 (148) 19.2 (18) 13.9 (13) - (-) Brentford & Chiswick 57,700 13.8 13.0 10.9 11.0 0.07 (4) 2.3 (131) 16.3 (13) 13.8 (11) - (-) Ealing 183,600 14.5 13.9 10.3 11.2 0.11 (20) 2.2 (412) 17.6 (47) 10.9 (29) 0.74 (2) Edmonton 96,530 12.9 12.6 9.8 11.1 0.04 (4) 2.1 (202) 13.6 (17) 12.0 (15) - (-) Enfield 109.200 13.4 13.4 10.9 9.9 0.07 (8) 2.2 (242) 10.3 (15) 6.8 (10) 2. 01 (3) Feltham 50 000 16.3 15.8 7.0 11.1 0.02 (1) 1.5 (76) 19.6 (16) 16.0 (13) - (-) Finchley 69,380 13.3 12.8 11.3 10.3 0.10 (7) 2.4 (168) 17.3 (16) 15.1 (14) 1.06 (1) Friern Barnet 28.490 11.2 12.5 16.9 9.6 0.21 (6) 2.4 (69) 3.1 (1) 3.1 (1) - (-) Harrow 215.000 12.9 13.2 9.0 10.7 0.06 (12) 2.0 (425) 14.0 (39) 9.7 (27) 0.35 (1) Hayes & Harlington 67,190 15.9 14.9 7.6 12.3 0.10 (7) 1.8 (118) 14.0 (15) 10.3 (11) - (-) Hendon 152.600 12.6 12.0 10.0 10.6 0.07 (11) 2.2 (330) 21.9 (42) 17.2 (33) - (-) Heston & Isleworth 105.100 12.4 12.3 10.3 11.0 0.07 (7) 2.0 (205) 23.0 (30) 17.6 (23) - (-) Hornsey 96,890 16.2 15.1 11.5 10.2 0.07 (7) 2.3 (225) 17.2 (27) 15.3 (24) 0.62 (1) Potters Bar 20.370 15.5 14.3 8.5 11.2 0.05 (1) 1. 1 (23) 15.8 (5) 9.5 (3) - (-) Ruislip Northwood 75,280 13.4 13.4 7.4 9.3 0.05 (4) 1.7 (128) 23.8 (24) 17.8 (18) - (-) Southall 53.000 15.0 15.5 13.0 11.3 0.25 (13 ) 2.0 (108) 21.4 (17) 16.4 (13) - (-) Southgate 71.250 11.2 12.1 12.6 10.5 0.13 (9) 2.8 (202) 20.1 (16) 15.0 (12) - (-) Staines 45,770 18.4 17.1 7.9 10.0 0.09 (4) 1.3 (60) 14.3 (12) 8.3 (7) - (-) Sunbury 27,690 22.4 20.4 9.2 11.9 0.04 (1) 1.5 (41) 19.4 (12) 14.5 (9) - (-) Tottenham 119, 300 13.9 13.5 11.0 11.8 0.08 (9) 2.4 (283) 25.3 (42) 20.5 (34) 1.18 (2) Twickenham 103.600 12.9 13.3 10.8 10.4 0.08 (8) 2.2 (228) 16.5 (22) 12.0 (16) - (-) Uxbridge 60,780 17.1 15.6 9.1 12.0 0.10 (6) 1.7 (104) 21.1 (22) 15.4 (16) - (-) Wembley 127,500 11.4 11.4 9.2 10.9 0.05 (6) 2.0 (260) 18.5 (27) 14.4 (21) - (-) Willesden 174,100 16.5 15.2 9.7 11.2 0.07 (13) 2.3 (405) 16.7 (48) 11.8 (34) 0.68 (2) Wood Green 49,500 13.2 13.2 9.8 9.6 0.12 (6) 2.2 (107) 16.8 (11) 16.8 (11) - (-) Yiewsley & West Drayton 23,340 19.4 17.7 7.1 10.2 0.13 (3) 1.4 (33) 15.5 (7) 8.8 (4) 2.16 (1) COUNTY 2,249,000 14.1 13.8 10.0 10.9 0.08(182) 2.1 (4733) 17.7 (561) 13.3 (422) 0.04 (13) Note (a) Absolute numbers are given in parenthesis in addition to rates to afford valid comparison AREA PERSONAL AND SCHOOL HEALTH SERVICES TOTTENHAM AND HORNSEY (JOINT POPULATION 2 17,920) 79 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 five years and the percentage of hospital confinements was 82 8% practically the same as the previous year 1957 1956 1955 Live Births (a) Domiciliary 566 534 429 (b) Hospital or Nursing Home 2679 2589 2509 Still Births (a) Domiciliary 3 4 4 (b) Hospital or Nursing Home 63 56 53 3311 3183 2995 Ante natal clinics The percentage of expectant mothers making at least one attendance at one of the local authority ante natal clinics was 68 5% during 1957 compared with 69% the previous year Owing to increased attendances an additional fortnightly session was held at Burgoyne Road Clinic throughout the year The following table gives details of attendances at all clinics in the Area:- No. of sessions held No of new cases Total attendances Average attendance per session A. N. P. N. A. N. P. N. Burgoyne Road 72 174 96 1185 158 18.7 Church Road 74 155 76 1222 78 17.6 Fortis Green 100 250 115 1927 118 20.5 Hornsey Town Hall 156 328 154 2441 162 16.7 Mildura Court 64 202 80 1360 113 23.0 Stroud Green 51 164 56 859 57 18.0 The Chestnuts 203 392 191 2578 192 13.6 Lordship Lane 205 305 187 2176 193 11.5 Park Lane 104 297 165 1383 167 14.9 Totals 1957 1029 2267 1120 15131 1238 15.9 Totals 1956 997 2192 1132 14808 1193 16.0 Totals 1955 1016 2003 1187 14652 1261 15.7 80 Midwives'Ante-Natal clinics It was possible to re-institute sessions at Burgoyne Road and Mildura Court Clinics which were in abeyance the previous year owing to the shortage of midwives. The following table shows the attendances made during the year:- Midwives Clinic No. of session held Total No. of attendances Average attendance per session Burgoyne Road 12 81 6.8 Portis Green 27 188 6.9 Hornsey Town Hall 22 111 5.0 Mildura Court 14 54 3.9 Stroud Green 15 94 6.3 Park Lane 125 709 5.7 Total 215 1237 5.8 Health Education in Maternity and Child Welfare Clinics Health teaching is given in Mothercraft classes at special sessions in the clinics The best attended is Lordship Lane where there is a Mothercraft Centre separate from the clinic main building Health visitors undertake this work as well as the supervision of Relaxation Exercise classes for the expectant mother The atmosphere of group discussion has been promoted at all sessions A programme of matters for advice and discussion is available to all mothers attending the classes Student health visitors also attend for practical experience in health teaching 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 43 30 309 7.2 Church Road 45 29 265 5.9 Portis Green 42 84 429 10.2 Hornsey Town Hall 52 95 479 9.2 Mildura Court 44 30 151 3.4 The Chestnuts 51 97 605 11.9 Lordship Lane 52 112 723 13.9 Park Lane 51 59 393 7.7 Total 380 536 3354 8.8 81 Child Welfare Centres The percentage of children under one year of age who attended for the first time during the year continued the improvement noted in 1956 During the past five years this figure has risen from 89 1% to 97.2%. Towards the end of the year it was found necessary to hold an additional weighing session each week at the Somerset Road Centre owing to increased attendances. The following table shows details of attendances made at all centres during the year:- Name of Centre No. of sessions held No. of first attendances under 1 year No. of attendances Total attendances No. of cases seen by M. O. ge attendance per session Under 1 year Over 1 but under 2 years Over 2 but under 5 years Burgoyne Road 155 281 4871 537 246 5654 1494 36.5 Church Road 146 225 3204 495 86 3785 1636 25.9 Fortis Green 156 301 3230 621 209 4060 1592 26.0 Hornsey Town Hall 202 484 5940 829 287 7056 2957 34.9 Mildura Court 103 215 3383 569 63 4015 1552 39.0 Stroud Green 102 203 2353 501 113 2967 799 29.1 The chestnuts 256 549 7464 1057 276 8797 2399 34.3 Lordship Lane 253 344 5515 1061 302 6878 1676 27.2 Park Lane 207 323 4986 81 247 6044 1762 29.2 Somerset Road 111 229 3721 610 151 4482 1150 40.4 Totals 1957 1691 3154 44667 7091 1980 53738 17017 31.8 Totals 1956 1660 2945 41816 6716 2208 50740 15758 30.6 Totals 1955 1587 2709 40354 7176 2659 50189 15645 31.6 Toddlers clinics These clinics continued to be held at all maternity and child welfare centres and have been fully reported on in previous years. 82 The following the tables gives detail of attendances at the individual clinics:- Name of centre No. of sessions held Total attendance No of cases seen by M. O. Average attendance per session Burgoyne Road 29 479 479 16.5 Church Road 50 563 480 11.3 Fortis Green 24 302 302 12.6 Hornsey Town Hall 61 673 673 11.0 Mildura Court 50 722 659 14.4 Stroud Green 23 328 328 14.3 The Chestnuts 49 627 625 12.8 Lordship Lane 51 723 723 14.2 Park lane 50 471 471 9.4 Somerset Road 46 519 516 11.3 Totals 1957 433 5407 5256 12.5 Totals 1956 449 5296 5207 11.8 Totals 1955 392 4904 4769 12.5 Accident Survey Dr Helen Garrow Senior Maternity and Child welfare Officer reports that a survey of accidents occurring in the two to five year age group was undertaken for six months by Dr Trevor Evans. All children attending two toddler clinics had a history taken of any accident occurring in the home during the past six months. 290 children were examined and 46 of these had had an accident of sufficient gravity to receive medical attention 13% of the accidents were scalds or burns 53 5% of the accidents were falls. The remaining accidents (33 5%) were due to various factors. Scalds and burns badly fitting fire guards insecure fastenings were among the causes One child undipped a fire guard and stuck a metal spoon in an electric fire this caused a shock and severe burns to the hand. Falls commonest causes being objects left lying about, torn carpets Some children fell out of their cots on to their heads, causing bruising one actually had a fractured collarbone. Accident Prevention is being taught continually in the clinics and in the homes by the health visitors The mothercraft talks also present the subject of prevention of accidents in the home. Leaflets are distributed and posters are exhibited at the various centres. This form of health education should be extended vigorously in every way possible. 83 Formal Health Education By Health Visitors The provision of a film projector for use in this Area is still considered necessary, and though expenditure on this was refused during the past year application will be renewed Series of talks on parentcraft were given to all except one of the secondary modern schools in Hornsey and to five similar schools in Tottenham The teaching of parentcraft to boys by health visiting staff has not met with much success although it was undertaken by an experienced member of the staff this year for the first time. Talks given to schools this year numbered 372. Visits to clinics were arranged in some cases as part of the programme The continuance of this part of the health visitor/school nurse work is of the very greatest importance, as it is from this group that the young mothers of the future will come Already a number of mothers visiting local clinics have reminded health visitors that the first introduction they had to parentcraft was by this means Members of the health visitor/school nurse staff who undertake this teaching Have received the utmost co operation from head teachers and their staff. The school teaching of parentcraft as described above has been observed by representatives of the Ministries of Health and Education. Finally reference should be made to the policy of limiting the number of health visitors attending the courses on techniques of health teaching to one health visitor in each year Ten years seems an absurdly long time to wait for the opportunity to send a second member of the staff on such a valuable course of instruction. The Daily Guardian Scheme. This scheme was continued as in previous years for working mothers unable to make satisfactory arrangements for the daily minding of their children and not eligible for admission to the County Council's day nurseries in the Area. This system has worked exceedingly well for a number of years The few rules associated with it have only been imposed to safe guard the interests of the children. The number of individual children minded during the year was 72 and they were in the guardian's care for a total of 18,788 days. The cost of the scheme last year was £939 which is a fraction of the cost of 84 supervising children's care in day nurseries The standard of care is reasonably good although standards vary a little. All are supervised by health visitors. The mother has every opportune ity of being assisted to find a guardian suited to her own and her child's needs Mothers rarely remove their children from the care of a guardian after placing them unless they do so to remain at home and care for their own children or remove from the Area. It is: our experience, however, that mothers usually place their children in the care of a daily guardian as a second best arrangement, preferring either daily minding by a relative or day nursery as the first choice. The periods for which children are minded by daily guardians tend to be shorter than by other means Day Nurseries The average daily attendance at the three nurseries in the Area has risen from 111.4 to 121.1 There were 232 applications in respect of 284 children of which 32 (42 children) had to be refused. The number of children on the register at the end of the year totalled 164. Of all the reasons for admission the chief single one for providing the majority of places was that the child was wholly maintained by its separated or unmarried mother. The second major reason for admitting a child was on account of unsatisfactory home conditions and the third, illness, usually mental illness or near mental breakdown of the mother. Whatever the reasons for the breakdown of the mother s health, the day nursery provides relief from anxiety connected with the care of her child at a time when she is in most need of relief. The mother's confidence in the quality of child care provided by the Local Authority's day nursery service can be used as an instrument to prevent further deterioration of her health and in some cases the child's care. It is also a means of maintaining the continuity of home and parental care rather than separation from them at a time when there is exceptional strain on the family stability. A number of children who have been accepted during the year would probably have been accommodated in residential nurseries or with foster-parents at a much greater cost to the community if a day nursery was not available to them. Each day nursery has received a few children who were referred by hospitals or clinics for special observation associated with a physical handicap or a behaviour problem. Some of these have 85 made remarkable progress, due in some measure to the unremitting efforts of the day nursery staff in carrying out the prescribed treatment. These children absorb a larger proportion of time than the normal child. For this reason it will only be possible and perhaps desirable to admit a very small percentage of such children while the ratio of staff to children remains at its present level. The educational value of the day nursery to the child and mother of all types should not be under-estimated. The opportunities for learning and teaching by example are inexhaustible. Two student nursery nurses entered for the examination of the National Nursery Nurses Examination Board and were successful in obtaining the Board's Certificate. One nursery nurse attended a special course in child care which qualified her to be appointed a warden at Plevna Day Nursery. B. O. A. C. stewardesses and British Red Cross cadets were given opportunities for observation and practical experience in the day nurseries during the year. Residential student nurses were also accepted for similar experience. Outbreak of Dysentery at a Day Nursery On the 29th July, 1957 the Matron reported several of the younger children in one room as having diarrhoea. These children were immediately excluded and the mothers advised to consult their family doctors. Specimens were taken from the remainder of the children. During the next few days 14 children were excluded, 13 as cases of diarrhoea and one as a contact of these cases. Nine were proved to have Sonne type dysentery and one other child to have a bacillus coli infection. Pathogenic organisms were not recovered in three cases. At the start of the outbreak it was decided that no child should be admitted to the nursery without previous medical approval A thorough cleansing of the nursery, and especially of the toilets and washrooms, was undertaken and the toilets were cleansed after use and several times daily as a routine Faeces specimens from the nursery and kitchen staff were all negative. The first child was re admitted to the nursery on the 19th August and the last child to become negative returned on the 14th October. Several cases proved very resistant to treatment, largely because of poor hygienic facilities at home and three children were admitted to hospital and treated successfully there. 86 No new case has been reported since the 15th August and no case was discovered at any time in any other room in the Day Nursery. The following table shows the attendance 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 18 50 3618 7119 10737 42.3 Park Lane 20 30 15 34 2912 6765 9677 38.1 Plevna 20 30 18 29 3554 6954 10508 41.4 Totals 1957 55 113 51 113 10084 20838 30922 121.7 Totals 1956 55 113 37 106 6940 21367 28307 111.4 Totals 1955 55 113 39 111 9969 20963 30932 121.8 Distribution of Welfare Floods There was a decrease in the issue of nutrients during the year as compared with 1956 So far as National Dried Milk is concerned this is no doubt accounted for by the increase in price, as from April, from l0½d to 2s. 4d. per tin. As from November, the Minister of Health adopted the recommendation of the Joint Sub-Committee on Welfare poods that the supply of welfare orange juice to children should be discontinued from their second birthday. Children had previously been eligible up to the age of five years. The arrangements for issuing welfare foods were substantially the same as in the previous year. The W. V. C. Centre at Muswell Hill closed down at the end of the year owing to ill health of the member who had been operating it. National Dried Milk (tins) Orange Juice (bottles) Cod Liver Oil (bottles) Vit. A & D Tabs (packets) 1957 48243 156962 17347 10545 1956 59472 158725 21571 11132 Priority Dental Service for Mothers and Young Children The dental service as a whole is discussed later in this report under the school health service. The following table gives details of attendances made and treatment given at all clinics during the past three years: 87  1957 1956 1955 Expectant and Nursing Mothers Children under 5 Expectant and Nursing Mothers Children under 5 Expectant and Nursing Mothers Children under 5 No, examined by dental officer 190 568 234 670 271 657 No. referred for treatment 188 548 226 618 260 624 New cases commenced treatment 172 531 218 551 240 573 Cases made dentally fit 84 323 76 321 67 317 Forms of dental treatment provided - Teeth extracted 205 432 235 506 352 479 Anaesthetics - (a) Local 85 69 84 72 142 77 (b) General 36 175 39 213 48 203 No of fillings 358 847 380 1169 414 1247 No of root fillings - - - - 3 - No of inlays 2 - 1 - - - Scalings and gum treatment 76 - 128 - 136 - Silver nitrate treatment - 550 - 565 - 512 Dressings 86 338 163 674 144 519 Other operations 30 64 48 138 70 194 No. of radiographs:- (a) at County Council clinics 13 1 28 - 14 1 (b) at hospital - - 2 1 1 - Denture dressings 112 - 179 - 226 - Dentures fitted:- (a) full 8 - 18 - 46 - (b) partial 32 - 39 - 59 - No. of attendances 634 1154 873 1583 984 1606 No of appointments not kept 187 227 193 247 218 370 No. of half days devoted to treatment 221 296 338 MIDWIFERY SERVICE (Section 23) Miss F.E. Curtis, Non-medical Supervisor; reports that two midwives are now working in Hornsey and all other vacancies have been filled, bringing the total number of midwives employed to nine by the end of 1957. Five of these are approved by the Central Midwives Board as District Teachers Five pupil midwives were in training in the Area during the year. The character of the domiciliary midwife's work is changing with the now common use of modern analgesia Patients to whom trilene, pethidine or nitrous oxide and air is administered cannot be left and it is not unusual for the midwife to remain 36, 48 88 hours or even longer with these patients This calls for redistribution of work every day in order that those women already delivered may receive the necessary attention It may be that some "shift system" will have to be considered for the future There were 555 deliveries attended by the midwives during 1957 and 76 women were discharged from hospitals before the 14th day (usually the third day following delivery),, This work together amounted to 12,971 visits Most of the patients sent home by hospitals are s:ent in by the midwife who has already spent many hours with them before admission In addition to deliveries and nursing visits the midwives make visits to the patients" homes during the ante-natal period, attend ante natal clinics and also give instruction in the use of the gas and air and trilene apparatus. The present bookings still show an upward trend and the difficulty of obtaining a hospital bed often results in a home booking having to be made for the patient who on social circum stances should be delivered in hospital These patients sometimes cause very grave anxiety to doctors and midwives In addition some women including immigrants to this country make no arrangements for their confinements having been advised by their friends to telephone for an ambulance when labour begins Sometimes they are successful in obtaining an emergency bed but at other times it results in the mother having her baby at home as an emergency with no preparations made for the confinement The following table shows the work carried out by the midwives during the past two years:- 1957 1956 No. of deliveries attended. 555 509 No. of visits made 12163 8846 No. of hospital confinements discharged before 14th day 76 38 No. of visits made 708 354 No. of cases in which medical aid was summoned 176 143 No. of cases in which gas and air analgesia was administered 431 400 No. of cases in which pethidine was administered 322 265 No. of cases in which trichloroethylene was administered 46 33 89 HEALTH VISITING SERVICE (Section 24) Miss H. Townsend, Superintendent Health Visitor, reports that the pattern of health visiting has been slowly changing during the last ten years until today each health visitor is more adequately covering the demands for her services from all age groups and from a number of voluntary bodies, hospitals, family doctors and others. The health visitor is often the first to observe signs of mental ill-health or near breakdown in families on her district and also behaviour problems in children. It may be necessary to arrange more evening visits than formerly in order that each health visitor is able to see working fathers and mothers or the whole family together or single people in the evening or at other times when they are more likely to be at home Home visits by health visitors have risen slightly during the year and more visits to the aged have been undertaken The majority of visits to the aged have followed requests from almoners and family doctors for the health visitor to see that there are proper facilities for home care of the elderly people discharged from hospital, to assess the ability of the person to manage after having been discharged for some weeks or on account of the family doctor's opinion that help is required Most of these requests are made by telephone and the health visitor's report on each case is given directly to the initiator by telephone also This method works smoothly and avoids delay Written health visitor's home reports have increased slightly in response to requests chiefly from hospitals. These include replies to enquiries as to whether mothers should be admitted for hospital confinement on account of poor home conditions or for other social reasons Health Visitors' work in clinics of various kinds is well known and is carried out with the usual efficiency Special Investigations During last year, as in former years, health visitors assisted the Medical Research Council, the London County Council and other bodies in the home visiting of persons included in specific surveys who are resident in this Area The incidence of the outbreak of smallpox in July caused a 90 good deal of extra work for health visitors in Tottenham in satisfying the many enquiries from members of the public, in attending vaccination clinics each evening and on Sunday morning for the quarantine period Assistance was also given by health visitors to the few direct contact families who were confined to their homes Health visitors arranged for the purchase of food and other commodities and for deliveries of goods in accordance with the strict measures imposed to control the spread of infec tion. Health visitor/school nurses were also responsible for the daily examination of each child in the school affected and for the home visiting of absentees to ensure that no early signs of illness were overlooked Health Visitor Students Practical training was arranged for seven health visitor students during the year. These attended from The Royal College of Nursing, Battersea Polytechnic and Chiswick Polytechnic Some of these students came from overseas as far apart as Malaya and Jamaica The work of arranging programmes and for demonstrating the various aspects of the health visitor's work though of great importance is very time consuming Many voluntary and statutory bodies hospitals and other departments connected with the health services have accepted the students in our care for observation visits We consider that all the effort devoted to the student health visitor is well worth while as they bring with them a keenness to see as much as possible and enthusiasm for their future vocation Student Nurses The Middlesex Hospital w 1 and the Prince of Wales s General Hospital sent a number of nurses in training to the Area for observation visits connected with health visiting As far as possible different aspects of the work were shown so that a fairly balanced picture of health services outside hospital was seen Lectures on Social Aspects of Disease were given on seven occasions during the year to student nurses in training by the Superintendent Health Visitor, Other members of the staff gave evening talks on local youth groups. 91 Other Visitors included health visitors attending post-certificate courses, student teachers from several training colleges, university social science students, student ward sisters from the Staff College,, King Edward" s Fund for London, Public Health nurses from Israel, Barnardo"s students, student nursery nurses and others. Clinic Premises have been made available for the use of voluntary bodies - The National Blood Transfusion Service and The Family Planning Association. The Family Planning Association has the use of the School clinic, Hornsey Town Hail on Monday and Tuesday evenings each week, and on Wednesday evenings weekly at Lordship Lane School Clinic, Tottenham Prevention of Breakup of Families = Special Services Health Visitors As stated in my report for 1956, two health visitors were appointed to specialise in the care of problem families and their children in order to prevent the breakup of the family, to prevent deterioration in the well-being and health of the children and to promote better standards of home making Families are usually referred to the special services health visitor by the health visitor for the district,, but may be accepted from other agencies As soon as the case is accepted for intensive work all other health visiting ceases, the full responsibility for home visiting rests on the specialised worker A great deal of co op eration has been experienced from family doctors hospitals the clergy specialists of various kinds, including those in local authority's service, from voluntary organisations and private individuals The support given by the specialist health visitors has on the whole been most rewarding to families floundering in debt and other troubles and to the visitors themselves The demand on the Home Help Service has been negligible as only one family where the mother is seriously ill has been provided with this service In one case a debt of £153 has been reduced to £10 Some improvement has been achieved in all the families in some the recovery has been considerable and the amount of aid has been gradually reduced Miss Howse, one of the two specialist workers, states "all the children are secure and well looked after I have been able to reduce my aid to some families because of the support they are receiving from the contacts I have been able to make for them Only in the years ahead will the true value of 92 the work be known and results will show whether the improvement is of a permanent or temporary nature". Prom our experience so far it appears that these families could not lift themselves out of their difficulties without intensive aid of this sort and the real interest of the specialised visitors in them. There are certain disadvantages connected with the amount and kind of accommodation which we have been able to place at the disposal of these workers. One shares an office with the Supervisor of Midwives and the other occupies a small room in a clinic. Both are inadequate for the purpose of seeing clients away from their homes in premises that are central or easily accessible and which provide privacy and a certain amount of storage space It is essential that a parent can visit the worker away from his home where suitable conditions for a private talk are often completely lacking It is equally important that the premises should not appear too official so as to cause the client to shy away from entering It is hoped that these points can be borne in mind when more suitable accommodation becomes available. Voluntary Workers and Organisations It is a pleasure to pay tribute to the voluntary workers who give such regular and efficient assistance in the Hornsey Maternity and Child Welfare Clinics and whose time and interests are so generously given to them. During 1957 health visitors have received immediate help when required from a number of voluntary bodies including the Diocesan Moral Welfare, the Invalid Children s Aid Association, the Marriage Guidance Council, the Women's Voluntary Service, the British Red Cross Society, the National Society for the Prevention of cruelty to Children and the Old People s Welfare Association These voluntary organisations do a very great deal to fill in the gaps and support individual needs. Statistics The following table shows the number of visits paid by health visitors during the past two years. 93 No. of visits paid by Health Visitors working in the Area 1957 1956 Expectant Mothers First Visits 1781 1851 Total Visits 2850 2886 Children under 1 year of age First Visits 3759 3412 Total Visits 14568 13941 Children aged 1-2 Total Visits 7191 6828 Children aged 2-5 Total Visits 11952 12125 Other cases Total Visits as Health Visitor 5489 4310 - Total Visits as School Nurse 983 1027 HOME NURSING SERVICE (Section 25) Miss F.E. Curtis, Superintendent of Home Nurses,, reports that the Home Nursing Service continues to be used to capacity, work being received in the main from general practitioners and hospitals The figures show an increase in the total number of visits paid during 1957 and there have been some changes in the overall pattern of the work 1 Patients of all types are receiving care over a a longer period than in previous years, 2. There is a well marked increase in the number of patients over the age of 65 years These patients received 5,444 more visits than in 1956, 3. Twice the number of visits were paid in 1957 to children under the age of five than in 1956 Apart from these changes the work has followed its usual lines with still the preponderance of therapy by injection and care of the aged sick Hospital beds for patients in the latter category are still difficult to obtain and are often a very urgent need A check on the nursing attention given in Tottenham during one normal day early in the New Year showed the following result No. of home nurses on duty 10 No. of patients attended 200 94 Analysis of treatment given:- General nursing care 39 Dressings 24 Tube change 1 Baths 11 Enemas 2 Prostatectomy supervision 1 Bladder washout 1 No treatment,, patient recovered 1 Injections for congestive heart failure 58 Injections for diabetes 33 Injections for anaemia 9 Injections for cancer 1 Injections for disseminated sclerosis 1 Injections of streptomycin 14 Injections of penicillin 4 200 Equipment The nurses are still anxious to be supplied with some kind of lifting apparatus One lifting hoist is in use in Tottenham and both nurses and patients have benefited greatly since its installation This hoist was bought privately and has resulted in visits to this patient being necessary much less frequently then formerly when two people were required twice daily Allocation of Work The method of allocating work to the nurses has remained unchanged and has proved satisfactory in meeting the needs of the patients The smooth running of this service is due mainly to the very good team spirit amongst the nurses, to their willingness to work at unusual hours and their skilful improvisation to meet the patients' needs The service has again received excellent support and help from the voluntary services the British Red Cross Society the Women' s Voluntary Service and the Old People s Welfare Association The following table shows the work carried out during the year:- 95 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 815 1556 2371 196 606 802 77942 Surgical 49 92 141 13 14 27 5139 Infectious Disease - 1 1 - - - 4 Tuberculosis 39 26 65 11 7 18 4177 Maternal complications - 32 32 - - - 589 Totals 1957 903 1707 2610 220 627 847 87851 Totals 1956 1013 1765 2778 229 488 717 82698 Totals 1955 1063 1884 2947 197 479 676 87774 Analysis of treatment given to new cases during 1957 General Nursing 670 Other treatments 747 Injections 1193 Total 2610 VACCINATION AND IMMUNISATION (Section 26) Vaccination against Smallpox This work was stimulated by the outbreak of smallpox which occurred in Tottenham during the summer as the result of which the percentage of children under one year of age vaccinated against smallpox rose to 61.41% The following table records the number of persons known t have been vaccinated or re-vaccinated during the year by genera 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 1992 337 888 3656 3452 10325 No. of re-vaccinations 20 16 183 1129 3230 4578 Immunisation against Diphtheria and Whooping Cough As a result of an investigation by the Medical Research Council into provocation poliomyelitis following certain injections, the use of a combined vaccine against diphtheria and whooping cough was discontinued during the year. 96 This has naturally increased the clinical and administrative work and has made the operation of the scheme more complicated Nevertheless, the results obtained compare quite favourably with those of the previous year, as shown in the following table. 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 441 1291 214 - 4 One 91 249 57 - 8 Two to Four 147 95 10 168 18 Five to Fourteen 180 22 2 487 22 Fifteen and over - 1 - - - Totals 1957 859 1658 283 655 52 Totals 1956 289 2119 18 1123 68 Vaccination against Poliomyelitis During the year this scheme was extended to include children born in 1955 and 1956 in addition to the original registrations of children born in 1947 1954 inclusive Parents had the option of having their children vaccinated either by their family doctors or at their local clinic and during the year 4393 children received a full course of two injections and 637 children had received their first injection only by the end of the year Registrations continued throughout the year and at the end of 1957 there were 5285 children who had not received any injections PREVENTION OF 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 1957 253 applications were received compared with 210 the previous year Of these, 226 were approved. 97 DOMESTIC HELP SERVICE (Section 29) The total number of cases provided with home help during the year was 1815 This figure shows no sign of declining and, as stated last year, the bulk of the cases comprise the chronic sick, including aged and infirm, who need more or less permanent help The demands on the organisation can be readily appreciated when it it is realised that nearly 1000 patients now require help week by week. 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 1956 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) 120 14 134 10 Tuberculosis 24 40 64 34 Chronic Sick (including aged and infirm) 552 910 1462 941 Others 141 14 155 12 Total 837 978 1815 997 Night Service This service continued during the year 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 During the year seven cases were served for a total of 433 hours Training Scheme The plan to give some instruction to home helps was carried out for the first time during 1956 and has been repeated in 1957 A small group of ten attended on Thursday afternoons at 2 o'clock in the mothercraft room at Lordship Lane Clinic This Provides pleasant, warm and well lit accommodation and has an adjoining room used as a kitchen where the ever welcome cup of tea can be prepared. Five talks were given in the series with plenty of questions at the end. The subjects of discussion included accidents and their prevention; emergencies, e.g heart attacks, first aid for 98 cuts, scalds, fits; on general hygiene, how to look after a patient suffering from tuberculosis, or diabetes, or the aged sick, or sick children, followed by a film strip; on cookery, food values, quick meals, invalid cookery; on cleaning, dusting, washing and care of furniture; and lastly, the place of the home help service in the National Health Service, the relationship of the home help to nurses, midwives, voluntary workers, and the cost of the service There can be no doubt of the enthusiasm shown by the workers at these talks Their questions to the lecturer and among themselves showed a lively interest in the service 99 AREA SCHOOL HEALTH SERVICE Routine Medical Inspection Fifty years have elapsed since the Education (Administrative Provisions) Act 1907 authorised medical inspection of children attending State schools. While the administrative procedure for routine examination of each child on admission into school, and at stated intervals afterwards, has remained substantially unchanged over the years, the nature and number of defects found have changed almost beyond recognition. In the early days it was inevitable that the service should be an almost purely medical service. There were so many obvious defects and diseases for which little was being done and which equally obviously prevented or hampered the child from benefiting from the education it was supposed to received. The school physician concerned in the early days by sheer pressure of the volume of work, with the routine tasks of diagnosis and reference to others for treatment now has opportunity to practise also the more positive aspects of a health by assessment of individual optimum health standards and by giving advice on the maintenance of health and prevention of disease. With co-operation of teacher and parent he is able to study the child in school and family setting and in the case particularly of older children out of school life in their social recreational and occupational setting. This change from a medical to a health service is an answer in itself to critics who regard the duties of school medical inspection as merely the detection and recording of defects and complain that it leads to considerable expenditure in time and money on unproductive work. With health and education closely meeting in an expanding field of special education now available to the handicapped child,, the role of the doctor in the school health service need never be one of monotonous routine nor unrewarding in its opportunity to practise preventive medicine on a scale regrettably unknown, even after ten years working of the National Health Service, in hospital or general medical practice. As in this Area, now for nearly twenty years many local authorities encourage the practice of sessional interchanges with hospital practice - through medical officers undertaking sessional clinical work in hospital out patient departments (in particular Paediatrics) and registrars (specialists in training) undertaking sessional work in the local authority services. 100 Such arrangements may well enhance the quality of the doctor's work in the clinical aspects of routine school medical inspections. Periodic Medical Inspections Other inspections Entrants Age 10 and 11 years Leavers Total Additional periodic inspections Special Inspections Re inspections 2407 2615 2867 7889 3241 4521 3180 CLASSIFICATION OF THE GENERAL CONDITION OF PUPILS Age Groups No. of pupils inspected Satisfactory Unsatisfactory No. % No. % Entrants 2407 2397 99.6 10 0.4 Age 10 and 11 years 2615 2607 99.6 8 0.4 Leavers 2867 2864 99.9 3 0.1 Additional periodic inspections 3241 3219 99.3 22 0.7 Total 11130 11087 99.6 43 0.4 Survey into Defects of School Leavers At the request of the Research Committee of the School Health Service Group of the Society of Medical Officers of Health, the school physicians co-operated in an enquiry into the incidence of certain defects in children about to leave school. This enquiry was undertaken during the autumn term 1957 958 children were examined and a simple questionnaire completed for 81 children found to have such a defect or to have had it in the past. Of these 81 children 47 were considered to have a defect of some importance. The questionnaires have been forwarded to the sponsors of the enquiry for analysis in conjunction with the results obtained by other school medical officers and the results will be made known later. Infectious Diseases in School Children The year opened with the customary biennial increase in the incidence of measles - 1,300 cases were notified in the school population. At the end of June a fatal case of smallpox occurred in an unvaccinated boy aged six, who prior to admission to hospit al had attended Crowland Road Infants School, tottenham. This boy had probably been in contact during the early infective phase with his school classmates. Throughout a weekend, a team com prising medical officer health visitor and public health inspector was busy vaccinating or re vaccinating child contacts in their homes as well as all teaching and ancillary staff, and giving passive protection with gamma-globulin to those classmates never previously vaccinated. The class concerned was closed and then 101 children sent home for surveillance until the incubation period was over. Daily visits to the school were made and any child with a suspicious fever, malaise or rash carefully examined and kept under observation. Fortunately there were no secondary cases at the school. (Details of the smallpox outbreak are fully set out in the Medical Officer of Health's Annual Report). Later in the year Tottenham and Hornsey were affected by the influenza virus A (Asian) prevalent in this country. The first school to be affected was in the Muswell Hill area of Hornsey where many children were reported absent with gastric symptoms and indeed the first diagnosis considered was food poisoning, as true Asian influenza had not yet been diagnosed in the Greater London area. Together with a virologist from the Public Health Laboratories at Colindalei, visits were made to a number of children reported ill in their own homes and from the throats of two of these children influenza A (Asian) was cultured. Apart from prompt exclusion of cases, little could be done to stop the spread of illness. The same picture was later seen repeatedly, the attack beginning in the infant classes and spreading upwards to the juniors and seniors. The pandemic rolled across Hornsey from north west to south east and inexorably into Tottenham. Fortun ately, although morbidity was very high, mortality was very low only one school child dying of the illness. Five school children contracted paralytic poliomyelitis during the year of whom two were receiving physiotherapy at the end of the year. None is so handicapped as to be likely to require special schooling. There were no outbreaks of food poisoning or dysentery during the year. Tuberculosis in Schools The year 1957 saw a further reduction in the incidence of tuberculosis in school children, there being only three cases (all forms) compared with seven in 1956 and 14 in 1955. These three cases were discussed with the appropriate chest physicians, but in no instance was it considered necessary to carry out epidemiological investigations at the school. The patch testing programme was carried out in "entrants" on a somewhat restricted scale, partly owing to the influenza epidemic. 591 children were so tested and of these, 19 were positive, a total of 3,2%. Investigation of circumstances proved negative 102 and no infective cases were revealed in the children's families. Since the scheme of patch testing started, some 2,000 children have been tested, producing only one source case. The practice is not being continued during the coming year. B.C.G. Vaccination B.C.G. vaccination has been carried out in the schools in the 13-14 age group following the scheme outlined in the annual reports of 1955 and 1956o The service has continued to include non-maintained schools in the scheme including Highgate Public School. A total of 3,966 Tottenham and Hornsey children have now been vaccinated under this scheme since June 1955. Mantoux positive children referred to the chest clinic during the year were all found to be free from tuberculosis. Routine investigation of the family of one child referred to the chest clinic disclosed that the mother had tuberculous infiltration of the upper zone of the left lung and she was admitted to hospital for investigation and treatment. The accompanying table shows the figures for 1957 compared with those of 1956. There is a slight decline in the percentage of parents accepting, but as a greater number were approached, the final figure of children vaccinated was larger in 1957 than in 1956. 1957 1956 Parents approached 3256 % 2829 % Parents accepting 2188 67.2 1980 69.9 Number tested 1917 1741 Mantoux positive 203 10.6 209 12.0 % Strong positive 64.5 40.2 % Weak positive 35.5 59.8 Mantoux negative 1714 89.4 1532 88.0 Total vaccinated 1688 52.4 of children in group approached 1526 53.94 of children in group approached School Dental Service I am indebted to Mr. V. Sainty, Area Dental officer for the following report:- "During the year there was a reduction in staff owing to the appointment of Miss W.M. Hunt to the post of Area Dental Officer in Willesden. Miss Hunt left on the 15th June and it was not 103 possible to fill the vacancy until the 1st January 1958, thus staff for the second half of the year was:- Area Dental Officer, five full-time and two part- time dental officers and one part-time orthodontist. The two part-time dental officers together worked a total of nine sessions per week; in addition to this we had the services of one more part time dental officer for five sessions per week for the last eight weeks of the year. The two Boroughs have been fortunate in recent years in still having a good proportion of full-time dental officers. Owing to lack of incentive to take up full-time service as a career, coupled with the more advantageous remuneration for sessional work, the trend has been generally for a greater reliance to have to be placed on the part-timer to provide adequate staff and then often not very successfully. In this connection it is significant that it is almost twenty years since an application for a full-time post was received from a male British dental surgeon for employment here apart from one case of re • employment after retirement on pension, Yet in the years before the war a post as School Dental Officer was able, in many areas, to compete favourably with one in private practice, as is evidenced by the large number of applications when a vacancy was advertised one such case was in December 1936 when there were 106 answers to an advertisement in the British Dental Journal for a post under the Tottenham Education Committee 81 of whom were men. The service has been built up over a period of 44 years from one full-time dental officer in Tottenham to the present establistment figure of nine for the combined districts, A clinic was first started in Tottenham in April 1914 for the treatment of elementary school children only in May 1922 a second clinic was opened and at this time there were more than 24,000 pupils in the schools, divided between the two dental officers. In 1934 the inspection and treatment of secondary schools was added to these responsibilities. It was not until 1937 that a comprehensive scheme for the treatment of ante-natal and post natal mothers and pre-school children came into operation with the appointment of a third dental surgeon. 104 Prior to this, however,, a great deal of treatment had been given to cases in these categories; complete treatment was given including, when necessary, the fitting of dentures; these were supplied at charges based on those of the dental hospitals and as most of the patients were only able to repay gradually, a good deal of extra clerical work and account-keeping was involved. Orthodontic treatment for school children was commenced in 1921 and has continued without a break since then. Until 1938 all appliances used in this work were paid for in the same way as the dentures, in both cases, where the income was below a certain scale no payment was made. It seems ironical that in pre war days with much less in the way of first-class buildings and equipment than today, there was no difficulty in obtaining dental staff,, whereas now any loss is very difficult to replace. It is to be hoped that something will be done to see that the service becomes a real priority again and is put on a proper basis before it is too late". 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 5 334 170 170 5 - 16 and over 22329 13496 13427 Specials 3859 3698 3528 Total 26 5 22 17364 17125 Number of pupils treatment commenced 9575 Number of pupils treatment completed 7648 Number of attendances made by pupils for treatment 21130 Number of appointments not kept 5205 Number of half days devoted to (a) Inspection 171 (b) Treatment 2979 Fillings. Permanent Teeth 15515 Temporary Teeth 3577 Number of teeth filled. Permanent Teeth 13340 Temporary Teeth 3253 Extractions. Permanent Teeth 1003 Permanent Teeth for Orthodontia 179 Temporaiy Teeth 6011 Anaesthetics (a) General 1732 (b) Local 2580 (c) Regional 243 Other Operations (a) Permanent Teeth 2327 (b) Temporary Teeth 4839 105 SPECIAL DENTAL TREATMENT UNDERTAKEN BY DENTAL OFFICERS Number of impressions, etc. 279 Number supplied with dentures 65 Number of crowns and bridges 37 Number of inlays 8 Number of radiographs (a) at Dental Clinics 210 (b) at Hospitals 1 ORTHODONTIC EXAMINATION AND TREATMENT AGE GROUPS Totals 5 6 7 8 9 10 11 12 13 14+ Number of pupils examined 1 5 13 17 33 29 32 29 17 25 201 Number of pupils selected for treatment 1 3 13 17 32 26 28 25 13 21 179 Number of pupils commenced treatment (first attendance) 460 Number of attendances made for treatment 3011 Number of consultations 101 Number of impressions, etc 4675 Number of fixed appliances fitted 19 Number of removable appliances fitted 213 Number of radiographs (a) at Dental Clinics 510 (b) at Hospitals - Number of pupils treatment completed 202 Number of orthodontic sessions (half days) 440 The Handicapped Child Distribution as at 31st December 1957 Category In Special Day Schools In Special Residential Schools In Maintained Primary & Secondary Schools In Independent Schools Not at School Total B G B G B G B G B G B G Blind Pupils - - 5 5 - - - - - - 5 5 Partially Sighted Pupils 4 4 2 - - - - - - - 6 4 Deaf Pupils 8 6 5 1 - - - - - - 13 7 Partially Deaf Pupils 7 8 2 9 5 - - - - 18 13 Educationally Sub normal Pupils 59 44 11 4 10 4 - 1 2 - 82 53 Epileptic Pupils 1 - 3 1 - - - 1 - - 4 2 Maladjusted Pupils - - 13 - 4 2 20 3 - - 37 5 Physically Handicapped Pupils 20 9 5 1 - - 1 - 2 1 28 11 Pupils with Speech Defects 2 1 - - 225 91 5 2 5 1 237 95 Delicate Pupils 5 2 17 7 - 1 - - - - 22 10 Pupils with Multiple Defects 6 5 1 2 - - - - - - 7 7 Totals 112 79 64 21 248 103 26 7 9 2 459 212 Grand Totals 191 85 351 33 11 671 106 The care given to the handicapped child has for many years been a source of local pride. Reproduced in my annual report for 1956 was the letter from Miss Blanche Nevile describing the humbler beginnings of education of the deaf in Tottenham in the year 1895. In 1912 the school moved to Ashley and Linden House and in 1924 to the present site in philip Lane. Because of the changes in educational concepts concerning deaf children, a nursery unit was opened at the school in 1952 and later the partially deaf were separated from the deaf and educated in special but well integrated units at Devonshire Hill School (Juniors) and Markfield School (Seniors). The scholastic record of children educated at the Blanche Nevile School is of a high standard,, The developing science of electronics is beginning and will continue to make considerable advances possible in this field. Classes for physically handicapped children were started at Parkhurst School in Tottenham in 1924. Formerly these children were educated at residential schools or managed in ordinary schools with great difficulty; or remained at home with little or no education. In 1933 Vale Road Day Special School for Physically Handicapped Children was opened. After World War II the needs of the cerebral palsied child became more obvious and a cerebral palsy unit was opened at the school, appointment of staff pre ceding construction of the medical rooms. The latter were occupied during 1957. In 1930 Tottenham Education Committee acquired Suntrap Open Air School at Hayling Island. After extensive rebuilding on the site, the school was opened for the residential care of delicate children. Orchard House and Downhills Park Open air classes in Tottenham continued to provide for those for whom residential care was considered unnecessary, Before the Education Act 1944, arrangements were made in co-operation with other neighbouring boroughs for the education of partially sighted and educationally sub normal children and with voluntary organisations for the care of the epileptic and the blind child. The existence of widespread maladjustment among school children was becoming increasingly recognised in the inter world war years and many children failed to make the progress they should. In 1937 the Tottenham Education Committee in co operation with the Mental Welfare Association arranged for an educational psychologist (Miss Grace Rawlings, B. A. ) to make a survey of Tottenham's need or the setting up of a child guidance centre. 107 Accepted in principle before the outbreak of World War II in 1939, the first appointment was made of a psychologist, though it was not until ten years later that the child guidance team could be appointed in full Events in Hornsey in establishing a child guidance centre moved rather faster, the first educational psychologist being appointed in 1944 and the child psychiatrist in January 1948. Vale Road School for Physically Handicapped Children Cerebral Palsy Unit I am indebted to Dr. William Dunham for the following report on the year's work. "As in previous years, special provision has been made at the Vale Road Special School for Physically Handicapped Children for children with cerebral palsy ("spastics"), who accounted for 27 of the 94 children in attendance. Although this special provision is made necessary because these children differ as regards ease of movement from normal children in other ways they are normal. They are driven by the same emotions. They have the same interests and ambitions. These are forces which can be used in their training whether in ordinary school subjects or in ordinary everyday activities both at school and at home. Finding out the exact training needed by a child may call for medical skill,, but training itself is the job of the parents and the teachers. In providing for children with cerebral palsy, therefore, parents, teachers and doctors must all collaborate. At the school, medical guidance is provided by a consultant who attends weekly arrangements have been made for a school medical officer also to attend. Parents are advised how best to help their children at home methods of helping the children at school are discussed with the teachers, whose care is supplemented by the services of a whole time therapist For swimming help is given by pupils of the South Grove Girls School Domestic science instruction is provided at the Markfield Secondary School Woodwork and metalwork for the boys is in abeyance owing to lack of an instructor. Much of the early training in movement of the child with cerebral palsy should of course, be completed before the child reaches school, and for this reason arrangements have been made for parents to bring their children to the school for advice before they reach school age. During the year, 13 pre-school 108 children and four other children have been brought to the school in this way, Details of these cases are given in the accompanying table. Arrangements of the kind described are new, and it is pleasing to note that the school receives a number of visitors from the Institute of Education, including post-graduate students taking the Diploma of Education. Visitors are also sent by the Staff College for Ward Sisters and from overseas, by the British Council", Children seen for the first time at the Cerebral Palsy Unit in 1957 Case No. Age Sex Source of Referral Diagnosis Disposal 1 6½ F School Medical Officer. Enfield. Cerebral palsy. Mental defect. To attend Cerebral Palsy Unit. 2 6 F School Medical Officer, Hendon. Cerebral palsy. Probably educable. Vale Road P.H. School. 3 4 F School Medical Officer, Wood Green. Deaf severe. Mild cerebral palsy. Educable. Blanche Nevile School and supervision by Dr. Dunham. 4 4 M School Medical Officer, Tottenham. Cerebral palsy. Mental defect. To attend Cerebral Palsy Unit. 5 5 M Paediatrician. Cerebral palsy. Probable mental defect. Home care. 6 2 M School Medical Officer, Tottenham. Paediatrician. Cerebral palsy. Probably educable. To attend Cerebral Palsy Unit. 7 3 M School Medical Officer, Hornsey, Mild cerebral palsy. Gross retardation. Report to Local Mental Health Authority. 8 5 M School Medical Officer, Priern Barnet. Not cerebral palsy. Mental defect. Referred back to School Medical Officer. 9 4 M School Medical Officer, Hendon, Cerebral palsy. Probable mental defect. To attend Cerebral Palsy Unit. 10 12 M Principal Medical Officer, M.C.C. Cerebral palsy. Mental defect. Attends occupation centre. 11 9 F principal Medical Officer, M.C.C. Moderate cerebral palsy. Mental defect. Attends Cerebral Palsy Unit. 12 3 F Paediatrician. Cerebral palsy. Educable. Vale Road P.H. School. 13 7 M School Medical Officer, Wood Green. Partially deaf. Mild spasticity. Attends Partially Deaf Unit, Tottenham, For supervision by Dr. Dunham. 14 3 M Paediatrician. Hydrocephalic. Cerebral palsy. Educable. To attend Cerebral Palsy Unit. 15 13 M School Medical Officer, Tottenham. Cerebral palsy. Mental defect. For hospital care. 16 3 F Paediatrician. Mental defect. At home. Later occupation centre. 17 4 F School Medical Officer, Tottenham. Deaf. Cerebral palsy (minor). Blanche Nevile School. 109 Summary Sex Age Groups 7 Female 0-4 years 9 10 Male 5-11 years 6 11 + years 2 Diagnosis Cerebral palsy educable or probably educable 4 7 Cerebral palsy educable 3 Deaf and partially deaf Cerebral palsy ineducable 8 Mental Defect Mental defect alone 2 Source of referral School Medical Officers, Middlesex 11 Principal Medical Officers, Mental Health Department, M.C.C. 2 Paediatricians 5 (one case referred by Paediatrician also referred by School Medical Officer) Audiology Unit 1957 was the first full year in which the audiology unit was in use. Statistics relating to the work of this clinic are as follows:- Number of children seen 21 Preschool children (age from 5 months to 3 years) 7 Attending infant and junior schools 9 Attending or about to attend senior schools 5 Reasons for referrals among these 21 children were as follows:- For diagnosis 6 Immigrants to Area, known to be deaf 3 Partially deaf children, advice as to correct placement 2 Children known to be deaf, application for amission to nursery class, Blanche Nevile School or partially deaf unit 10 Source of referrals:- Tottenham and Hornsey 7 Other Boroughs in Middlesex 10 London neighbouring Boroughs 4 Further details are given herewith of the seven children under school age as these are of special interest. 110 NO. Age Sex Reason for referral Remarks Decision and/or disposal 1 2 11/12 F ? Deaf - For further observation. 2 5/12 F ? Deaf Parents and sister deaf. Deaf. For auditory training and supply of hearing aid. 3 3¼ M Suitability for nursery school for the deaf - Deaf. Admitted to nursery class. 4 3 F ? Deaf ? Mentally defective Several back ward siblings Admitted to nursery at Blanche Nevile School. Later excluded as ineducable and perhaps slightly deaf as well. 5 3 M Suitability for nursery for deaf Pakistani child Admitted to Blanche Nevile nursery class. 6 1 4/12 F ? Deaf Sister and parents deaf Not deaf. Admitted to day nursery half-time in order to obtain hearing environment. 7 3½ F Suitability for nursery class for deaf Celebral palsied child Admitted to Blanche Nevile nursery class. Under supervision of Dr. Dunham, Rheumatism Supervisory Centre Fortnightly sessions continue to be held at the Paediatric Department of the Prince of Wales's General Hospital under the direction of Dr, I.M, Anderson, Consultant Paediatrician,, New cases totalled 29 as against 27 in the previous year, Medically these cases were allocated as follows:- Rheumatic Fever 11 Rheumatic Carditis 7 Rheumatic Carditis with Chorea 2 Rheumatic Arthritis with Carditis 1 Rheumatic Pains 2 Other cases 6 29 Distribution of new cases:- School Children 26 P.H. School 1 Pre-school 1 Not at School 1 It will be noted that no new cases of congenital heart disease were referred this year. A review of all cases on the register since the Inception of the scheme gives the position as follows:- Cases under supervision 191 Discharged 36 Males 140 Transferred on removal 18 Females 133 Lapsed 16 Deaths 12 273 111 During 1957, cases both new and old were dealt with as follows:- Admitted to hospital 26 Discharges 3 Transfers 3 Deaths 1 Medically the cases under supervision are classified as follows:- Rheumatic Fever 59 Rheumatic Carditis 41 Rheumatic Fever with Chorea 1 Rheumatic Carditis with Chorea 5 Chorea - uncomplicated 4 Rheumatic Arthritis 5 Congenital Cardiac Lesions 54 Rheumatic Pains 2 Other Cases 20 19l Of the children under supervision,; 103 children made 229 attendances at the Clinic during the year. in addition a number of children were seen in other children's out patient clinics under the supervision of Dr. I M. Anderson The problems of future careers and occupations of the children approaching school leaving age continue to be discussed with the parents. Many cases after leaving school are still supervised for some time to ensure they have become firmly established in a suitable occupation Older cases still requiring supervision are referred to an adult medical clinic or in some cases their family doctor. Ear, Nose and Throat Clinics I am indebted to Dr, P.P.M, Clarke, the visiting Aural Surgeon, for the following report:- "The ear, nose and throat clinics, at the Medical Centre,, Park Lane, Tottenham and at the Town Hall, Hornsey have been carried on during the year 1957 along similar lines to those set out in previous Annual Reports. Two sessions a week have been held at Park Lane and one a week at Hornsey. In addition to the patients referred mostly from the routine school medical inspections, and school and child welfare clinics, a number of deaf children and children suspected of being deaf have been examined at the Audiology Unit (Park Lane) for admission 122 APPENDIX SCHOOL HEALTH SERVICE STATISTICS FOR 1957 PUPILS FOUND TO REQUIRE TREATMENT AT MEDICAL INSPECTION Number of individual pupils found at periodic medical inspections to require treatment (excluding dental diseases and infestation 112 to the School for the Deaf among whom are children from other boroughs In London and Middlesex. in this Report for 1957, a brief review of the origin and growth of the special ear, nose and throat clinics is given. They are special in the sense that they differ very greatly in the methods of treatment used and in certain instances in the class ification and diagnosis of defects from the routine procedure followed in most ear, nose and throat clinics. The consistently high percentage of successful and lasting results obtained in the cure and relief of the various ear, nose and throat ailments met with among school and pre school children in comparison with other routine methods of practice gives ample justification for the establishment of these special clinics, their necessity and their usefulness to the community. The first of these clinics to be established was under the Tottenham Education Committee more than twenty five years ago, followed later by similar clinics in London and other areas in the country. Soon after the first world war, the increasingly large number of cases of chronic discharging ears and resultant deafness present among the school population of the Borough and the very indifferent results obtained as regards cure or amelioration from the lines of treatment then available, or of no treatment became a matter of very serious concern to the school health authorities. About this time,, Dr, A. R. Friel, a consultant ear, nose and throat surgeon with a long and wide experience in his speciality introduced in London a special method of electrical treatment known as ionization for the treatment of chronic otorrhoea in school children,, This method was originally developed in Prance by Professor Leduc and used with marked success by Dr. Friel for some years in Johannesburgh, and later, in collaboration with Professor Leduc, in Prance. This new method was introduced by Dr. priel in Tottenham and was the first ionization clinic for the treatment of chronic otorrhoea in school children in this country, Dr. Friel was appointed visiting ear, nose and throat consultant to the Tottenham Education Committee, The resulting successes in the cure of the large majority of those hundreds of cases of chronic otorrhoea was comparatively rapid, and indeed remarkable. Within a period of about two years, practically all the cases of existing otorrhoea among the school population of the Borough, with the exception of 113 a small number which required radical mastoid operations - due to their long-standing chronicity - were healed and "dry" and as a result, the hearing in most cases was remarkably improved. This was a great advance in solving what was, up till then, a most intractable problem, Further, and an important point, the results, with very few exceptions, were lasting. Dr. Friel realising that the successful treatment of such ear conditions as otorrhoea, deafness, etc. depended, apart from the local treatment of the ear itself also on the recognition and removal of any complicating factors, frequently present in the nose and throat decided to recommend enlargement of the scope of the ear clinic by making it a complete unit for ear, nose and throat affections. The required equipment for this unit was installed. Diseased or abnormal conditions in the nose and throat are by far the most common factors in the causation of ear disease, and consequently their successful removal is the first and most important step in the prevention and cure of deafness. To meet this situation, special methods of treatment, found to be the most successful, many of them new and quite different from those usually employed, were adopted at the clinic. These included,, in addition to zinc ionization, the new method of diastolization, a French procedure invented by the late Dr. Gautier of Paris,, and introduced to London by Mr„ A. G. Wells, F.R.C.S., Ear, Nose and Throat Consultant London County Council, adopted for the treatment of certain nasal conditions and impaired hearing: aural suction for acute otorrhoea: Proetz "sinus displacement" for the diagnosis and treatment of sinus suppuration. Wells' (New York) nascent iodine vapour inhalation for infections in the nasopharynx and sinuses: Peters' tonsil-suction treatment for diseased tonsils, as well as a number of certain prescriptions and medicaments found to be of exceptional value. These methods are still being employed at the clinics, modified, of course, from time to time, over the years, as experience in their use and the discovery of new preparations suggest. Audiometry From the beginning, the question of impaired hearing played an important role in the function of the clinic and the school medical inspections. Special emphasis was laid on the prevention as well as the cure of deafness for herein lay the best means and most hopeful prospect of reducing the incidence of defective 114 hearing both in the school and later, adult population. To deal effectively with the question of deafness in a large population of school children it is essential to have an exact means of detecting the hearing loss, from the slightest impairment to the most severe. It is also necessary that this detectionexamination of a very large number of pupils should be carried out within a reasonable time without sacrificing accuracy. The ordinary routine methods of clinical testing such as "conversational voice", watch, tuning forks, etc. would be unsuitable and unreliable as regards the time involved and accuracy. The invention of the audiometer in America in 1927 was the answer to the large and growing demand for a suitable method of detecting quickly and accurately any defect in hearing among large numbers, such as in schools, industrial works, etc. The audiometers, there are two types - the "Speech" and the "Pure Tone" are very highly developed scientific, electrical instruments and so sensitive that they can detect and measure accurately in "units of hearing loss" the slightest to the most severe impairment over the whole hearing range. From 1927 onwards the hearing of thousands of children has been investigated in various cities in U.S.A. The first similar investigation of hearing loss, on a large scale among school children in this country an audiometric survey was conducted in the Tottenham Schools in 1930 by Professor G. p Crowden of the London School of Hygiene when he completed a survey of 2,000 children (Prof. Roy. Soc. Med. 27 1934) and in Hornsey in 1931. (Annual Report of M.O.H. 1930). From then onwards regular routine audiometer testing has been carried out in Tottenham schools with the exception of an unadvoidable interruption during the war years. Those children who "failed to pass" the tests were referred to the ear clinic where a detailed enquiry and clinical examination was made in each case as to the "history", cause, duration, complications any treatment already received etc. and a course of special treatment was carried out. The results of the special treatments given at the clinics are very interesting. The following account taken from "Children with Defective Hearing", Board of Education publication, 1938 and 1950 is an example. "Between 1932 and 1936, 10,171 individual children were tested as a routine by gramophone audiometer in Tottenham. Of these children, 8,8% "failed to pass" in either or both ears Yet after treatment had been given where necessary only one child (0 1 per thousand) had to be sent to a special school as Grade II. 115 B, and 19 children (l.9 per thousand) were found to require favourable position in class", The Pre-School Child The primary object of the clinic from its beginning to the present time has been to emphasise the importance of prevention as well as the treatment of diseased conditions, Many of the defects, including deafness, found in the ear, nose and throat in school children originated before the child attended school, and many such as otitis media, during early infancy. Prevention is the most important of all the problems connected with defective hearing and it is during early preschool age that prevention can play its important part. The advisability, therefore of including pre school children in the clinic scheme becomes obvious and was recognised by the Ministry of Health in its issue of Circular 1337 (a), in the early thirties,, This urged local authorities to arrange for co-operation between the school medical and child welfare services and make provision for the inclusion of preschool children in the specialist school clinics. This is important particularly in the case of the detection and treatment of defective hearing and its potential causative factors. It is very gratifying to be able to record that Tottenham was again among the earliest authorities to make provision for the inclusion of infants and pre school children in its ear, nose and throat clinic scheme,, The wisdom of this decision has been amply proved over the years in the results obtained by the discovery and removal of many defects ia their early stage in pre'school life, which, if left untreated,, would have insidiously progressed into a state of chronicity by the time the children had reached school age and this advancement of the disease in certain instances, would inevitably tend to make its final cure much more difficult and uncertain. At the present time and for a number of years past the ear, nose and throat clinic provides for the examination and treatment of all children, infants, pre school and school. It is fully equipped to deal with the varying ear, nose and throat diseased conditions met with among these children, with the exception of those cases, a small number, which require operations in hospital. The defects most commonly found among the clinic patients are those due to the ill effects of "nasal obstruction", such as deficient nasal respiration and mouth-breathing;; rhinitis in its 116 different forms,, sinusitis, impaired hearing,, otitis media (with or without discharge), functional hypertrophy of tonsils, etc. Cases of chronic otorrhoea which used to be very common some years ago have become greatly reduced and only a comparatively small number is now seen, A detailed account of those various ailments, their effects, immediate and remote,, complications and treatment is not included here as this is not intended to be a clinical article, Local authority specialist clinics conveniently situated have many advantages. The travelling problem, as regards safety, distance and time is much less acute than if these young patients were obliged to attend, say,, the out-patient department of a hospital* At the local clinics children may attend for treatment, by themselves after the first one or two attendances with aparent, thus saving the parent s time. A most important point is that the administration of these clinics is under the supervision of the school medical officer who is well acquainted with the particular conditions of the patients attending and the treatment given, and can link this up with his general overall direction of the public health of the community for which he is responsible as medical officer of health. Further, the full clinical records of all the patients attending the clinic are within easy access of the medical officers and staff when an urgent enquiry is made for the clinical record of any child, as often happens". Orthopaedic Service Tottenham I am indebted to Mr. E.H. Hambly. F. R.C. S., for the following report:- "These clinics continue to be heavily attended in figures for new patients and old patients. Certain difficulties arise in advising remedial exercises for children aged 10 to 11 on account of the 11 plus examination, and also in older age groups, about the age of 15, on account of higher examinations. This is unfortunate, as it is the girls who stoop over their desks working hard for such higher examinations who are in the greatest need of these remedial exercises. The expense of surgical appliances has been borne in mind constantly throughout the year, as this is now a major financial item. At first sight, it appeared that wedges to shoes were 117 cheaper than insoles, but on looking closer into the problem, the constant renewal of wedges constituted far greater expense, and much more trouble to the parents, Our relations with the School for the Physically Handicapped at Vale Road, are close and cordial, both with Dr Dunham and his department and also with Mr. Ives and his staff. These clinics work also in conjunction with the Prince of Wales's General Hospital, and St Ann's General Hospital, inasmuch as all in patient operations are performed at these hospitals by me, Orthopaedic Service, Hornsey I am indebted to Mr. E. Palser, M.R.C.S for the following report.- "During the year attendances at this clinic have been 726 for examination and 1,194 for treatment by the physiotherapist, The number of new cases seen was 374, and the number whose treatment ceased was about the same Development abnormalities especially of the spine, legs and feet, often require prolonged treatment and supervision until growth is completed A certain number have, therefore, required treatment or supervision until they have reached school leaving age and where treatment is still required they have been referred to the adult services of the National Health Service. This year a fitter has been in attendnace at all clinics, and this has reduced the previous time interval between the ordering and supplying of instruments and appliances At the same time, decisions on exact specifications, measurements and fittings have been undertaken in closer co operation with the makers. A few children have been referred for special out-patient treatment to the Hornsey Central Hospital Here also X-rays required are taken The Hornsey clinic now has its own viewing box which has been of great use, and of equally great interest to the patients and their parents. Ten children have required operative treatment, and of these, five males and four females have been admitted to the Orthopaedic Unit at Highlands General Hospital, Winch more Hie11, N 21 One infant was admitted to the Hospital for Sick Children, Great Ormond Street, W.C.1. " 118 Child Guidance Service Dr. C. Phillips,, M. R. C. S., D. P. M., visiting psychiatrist to the Child Guidance Centres in Hornsey and Tottenham reports "The year under review has seen a continuation of the progress which is being made in extending the area of co-operation between the Child Guidance Team and the other organisations within the community which are concerned with children, namely the teachers, probation officers and school medical officers. The task of prevention of mental illness by increasing the understanding of the emotional problems of infancy and helping mothers to bring up their babies in a way which is best designed to give the maximum emotional health has reached a new landmark All maternity and child welfare, and school medical officers in the Boroughs of Hornsey and Tottenham have spent three months each in working with the visiting psychiatrist at a special clinic session for mothers, infants and toddlers In all cases the three months have been spent in a series of clinical demonstrations which involved both diagnosis of the disorder, such as an eating or sleeping difficulty the formulation of the forces at work in the child which have led to the problem and the technique of therapy so that natural development can once more begin to go on uninhibited. With the beginning of the next administrative year it is planned to begin a similar series with the health visitors who will be able to bring such problems for consultation and discussion Although this is being done on a very small basis only since one day a week between two boroughs is not very much compared with the need, it nevertheless is a pilot scheme which could lay the foundation for expansion later. In the meantime, experience of the technique of dealing with the teaching and demonstration programme is being built up. The second major approach to the task of integrating psychia trie knowledge and educational difficulties has been taken in the Borough of Tottenham It is hoped that the time will come when it will be possible to do this in Hornsey as well The initiative in Tottenham came most gratifyingly, from the head teachers them selves, who requested to meet the visiting psychiatrist in order to hear his personal statements on the work he does and to be able to question him and discuss ideas and problems This request was enlarged beyond the original plan and culminated in a meeting with 119 the Tottenham head teachers with the Borough Education Officer in the chair, and the entire Child Guidance Team present Each member of the team described his work Questions had been sub mitted in advance and copies distributed to the members of the Child Guidance Team in order to give them an idea of the scope of the information required and the kind of problems that needed to be met and to the head teachers for information and reference during the meeting A very large number of questions were sent in and these were dealt with for the most part Since then there has been a marked improvement in the co-operation with the Child Guidance Team and a very much greater ease of access and inter change of information and ideas It is necessary to add that the subject which I raise each year namely the extent of psychological illness among school children is still hardly appreciated The recent Report on Maladjusted Children suggested this as possibly 80 per 1,000 which would mean that there are over 2 000 children in the two Boroughs who are appreciably disturbed It would be appropriate that the next stage of the development of the School Health Service which has its 50th anniversary this year should be concerned with extending the scope of the psychiatric services Regrettably this is not generally appreciated It must be said in extenuation that psychiatric understanding of children and particularly infants„ derives largely from the most recent discoveries and observations of psycho analysis and there must necessarily be a lag between possession of such psychological knowledge by a few highly trained persons and the general understanding by the large mass of people concerned with child development. It is however, particularly exciting to find that the know ledge is in existence and to know what the next stage must be so that it is possible to make plans to get on with the job An increase in the number of psychiatric sessions and in the staffing of the Child Guidance Team was requested earlier and has already resulted in an extra educational psychologist being appointed in Tottenham, and there is a possibility of extra psychiatric sessions being arranged there The appointment of a full-time child psychotherapist (or part time equivalents) has also been approved Here again the question of assessment of the needs of the Child Guidance Team at Hornsey and its staffing in relation to the amount of emotional ill health among school children in the Borough, could be something which needs further consideration. 120 Altogether this has been a year in which some really constructive work has been accomplished. Speech Therapy Miss Came, Senior Speech Therapist: reports as follows:- "Since speech therapy"s introduction early in this century the general public's conception of its aims as the mechanical correction of "speech impediments" has radically altered The intimate relationship of speech to the whole personality structure of the individual is more generally realised. The speech therapist in the school health service deals with the whole child including the family of which it forms an integral part and not just the speech defect. The wider environment of school may also need adjustment Speech improve ment is seldom the only outcome of successful treatment In creased stability, confidence social adjustment or even better educational progress are equally important. Speech cannot be divorced from language The pre school years., when these skills may break down or show abnormal slowness of development offer great opportunities for preventive work. The difficulties in discovering every stammerer in time to offer maximum help are great largely owing to our big school populations We are still concerned at the occasional referral of the older child who is known to have stammered from an early age If the teachers of the first classes in the junior and infant schools i e age groups five plus and seven plus could be encouraged to bring any cases not previously diagnosed to the medical officer8s attention, this delay in treatment with all its adverse consequences could be avoided. Hospital School I am indebted to Mr J Power, M A Borough Education Officer, Tottenham for the following report:- "Tottenham Education Committee now employs two full time teachers to provide tuition for children at St Ann s and the Prince of Wales's Hospitals Priority is given to long stay patients but every effort is also made to cater for children who are in hospital for shorter periods An average of from 35 to 40 children, aged from five to sixteen years, receive tuition each week. 121 In St. Ann's Hospital, where the main bulk of the work is carried out, part of a ward is equipped as a schoolroom,, where those children who are well enough to be moved take their lessons Other children are dealt with individually at their bedside,, and tuition is provided in the poliomyelitis and tuberculosis eye wards, as well as in others The schoolroom is well equipped with school furniture a library a wireless set, an electric gramophone a colour duplicator, a shop and a puppet theatre The hospital authorities have provided a television set which can be used for school programmes. There is also a full set of equipment for infant children. It is the aim of the teachers to ensure that each child con tinues his school studies and individual interests are also pursued To this end a close liaison is maintained with the Tottenham schools to ensure the correct orientation of the child ren" s studies The school also receives valuable help from the Tottenham Library Service in the provision of books for both educational and recreational purposes. At Christmas projects were carried out in individual wards In one a Robin Hood theme was developed with help from the Inde pendent Television Authority who loaned the "props" from their Robin Hood programme, while in another a Circus theme was developed and the children were delighted by the visit of two clowns from the Circus. Appreciation is due to the Hospital staff without whose ready co operation the scheme could not work successfully The children appear to welcome the school and many parents have expressed their appreciation. Statistical Information Certain statistics relating to the work of the school health service not included in the body of the report are contained in the Appendix. 122 APPENDIX SCHOOL HEALTH SERVICE STATISTICS FOR 1957 PUPILS FOUND TO REQUIRE TREATMENT AT MEDICAL INSPECTION Number of individual pupils found at periodic medical inspections to require treatment (excluding dental diseases and infestation with vermin). periodic age groups inspected For defective vision (excluding squint) For any of the other conditions recorded Total Individual Pupils Entrants 77 305 362 Age 10 and 11 384 427 715 Leavers 480 368 772 Total 941 1100 1849 Additional periodic inspections 355 432 712 Grand Total 1296 1532 2561 DEFECTS FOUND BY MEDICAL INSPECTION Defect Code NO Defect or Disease periodic inspections Special Inspect ions Entrants Leavers Total including all other age groups inspected (a) (b) (a) (b) (a) (b) (a) (b) 4 Skin 31 69 63 153 269 437 991 10 5 Eyes (a) Vision 77 64 480 70 1296 315 163 21 (b) Squint 82 21 43 6 234 48 10 3 (c) Other 16 23 27 16 106 95 252 3 6 Ears (a) Hearing 1 16 5 23 35 95 146 26 (b) Otitis Media 10 88 10 121 37 436 19 - (c) Other 2 6 3 8 7 10 103 4 7 Nose and Throat 49 320 25 76 168 787 155 1 8 Speech 19 46 6 13 35 99 41 5 9 Lymphatic Glands 4 98 - 7 8 181 - - 10 Heart 2 40 15 71 40 215 2 - 11 Lungs 30 98 14 82 83 309 28 3 12 Development (a) Hernia 1 7 3 - 13 18 1 = (b) Other 3 9 4 10 18 123 10 6 13 Orthopaedic- (a) Posture - 19 17 84 48 271 12 3 (b) Feet 35 81 113 90 321 406 10 1 (c) Other 28 95 26 55 126 310 244 12 14 Nervous System- (a) Epilepsy 6 6 8 8 27 26 3 - (b) Other 1 10 4 13 24 129 11 4 15 Psychological- (a) Development 1 19 - 7 5 64 13 2 (b) Stability 3 67 2 125 29 500 12 5 16 Abdomen 2 21 3 13 15 94 - 17 Other 19 14 8 15 35 82 1578 54 (a) Requiring Treatment (b) Requiring Observation 123 TREATMENT OF PUPILS ATTENDING MAINTAINED PRIMARY AND SECONDARY SCHOOLS (INCLUDING SPECIAL SCHOOLS) Number of cases known to have been dealt with by the County Council Otherwise GROUP 1. Eye Diseases (e.g. blepharitis, conjunctivitis), Defective Vision and Squint (a) External and other, excluding errors of refraction and squint 208 88 (b) Errors of refraction (Including squint) 320 2413 Total 528 2501 (c) Number of pupils for whom spectacles were prescribed - 1243 GROUP 2. Diseases and Defects of Ear, Nose and Throat Received operative treatment for (a) Diseases of the ear (b) Adenoids and Chronic Tonsillitis 156 (c) Other nose and throat conditions - - Received other forms of treatment 272 313 Total 272 469 Total number of pupils in schools known to have been provided with hearing aids (a) During the current year - 2 (b) In previous years (excluding any pupils shown at (a) above who were provided with an aid in a previous year) - 79 GROUP 3 Orthopaedic and Postural Defects Number of pupils known to have been treated at clinics or at out-patient departments 442 1312 Number of cases treated or under treatment during the year by the County Council GROUP 4. Diseases of the Skin (excluding uncleanliness) Ringworm (i) Scalp (ii) Body 9 Scabies 11 Impetigo 55 Other skin diseases 1541 Total 1616 GROUP 5, Child Guidance Treatment Number of pupils treated at child guidance clinics under arrangements made by the County Council (including children sent to the Tavistock and other hospital clinics under arrangements made by the County Council) 130 GROUP 6. Speech Therapy Number of pupils treated by speech therapists under arrangements made by the authority 305 GROUP 7, Other treatment given (a) Number of miscellaneous minor ailments treated by the County Council 805 (b) Treatment other than (a) above and excluding convalescent treatment 453 124 EMPLOYMENT OF CHILDREN AND YOUNG PERSONS 1 Number of children medically examined in order to ascertain whether they were physically fit to undertake employment of a light nature outside school hours 312 2 Number of instances in which the state of health was found to be such that certificates were withheld 3 3 Number of children examined as to fitness to take part in entertainments 5 4 Number of cases in which certificates to take part in entertainments were withheld EDUCATION ACT 1944 SECTIONS 57(3), 57(4) and 57(5) Cases dealt with under Section 57 Education Act 1944 Sub-section 3: 14 Sub section 4: - Sub section 5: 7 Cases de notified under Section 8 Education (Miscellaneous Provisions) Act 1948: 2 MEDICAL EXAMINATION OF TEACHERS (a) Number of Teachers examined as to fitness for appointment 11 (b) Number of Students examined as to fitness for first appointment 58 (c) Number of students examined as to fitness for training course 68 INFESTATION WITH VERMIN Total number of examinations 66590 Total number of pupils found to be infested 148 125 INDEX Page Accidents in the home 64 Accident Survey 82 Aged, welfare of 62 Ambulance Service 60 Ante Natal clinics 79 Area Health Committee 3 Area Health Service 79 Area Welfare Service 60 Arteries, Diseases of 24 Asian Influenza 25 Atmospheric Pollution 38 Atomic Radiation 65 Audiology Unit 109 Audiometry 113 B C.G Vaccination 86, 107 Births and Deaths 68 Burials 63 Cancer 24 Deaths, Table 76 Cerebral Palsy Unit 108 Certificates of Disrepair 44 Chest Clinic 11 Child Guidance 118 Child Welfare Centres 81 Chiropody Service - Old People's 62 Clean Air Act 1956 38 Clearance Areas 41 Closet Accommodation 38 Closing Orders 43 Comparability Factors Council, Members of 1 Daily Guardian Scheme 83 Day Nurseries 84 Deaf, School for 113 Deaths, Classification of, Table 75 Defects sanitary: Remedied 50 Demolition Orders 43 126 Dental Service, Priority 86 School 102 Diphtheria 23 Diphtheria Immunisation 95 Disinfection 26 Disinfestation 48 Domestic Help Service 97 Drainage and Sewerage 36 Dysentery 23. 85 Ear Nose and Throat Clinics 1ll Education Committee 2 Expectant Mothers, care of 80 Eye Clinic 118 Factories 52 Family Planning Association 91 Flooding 38 Food - Condemned 31 Hawkers 28 Hygiene 27 Labelling 34 Poisoning 23 Registered Premises 28 Sampling 31 Shops 27 Guardian Scheme, Daily 83 Handicapped Children 105 Hawkers of Food 28 Health and Housing Committee 2 Health Education 80 83 Health Services provided by other Authorities 58 Health visiting Service 89 Holidays, Recuperative 96 Home Nursing Service 93 Hospitals 58 Hospital School, St. Ann's General Hospital 120 Housing Act, S.9 40 " " Individual Unfit Houses 43 " " Part III 40 127 Ice Cream 28 Immunisation, Diphtheria and Whooping Cough 95 Infantile Deaths 70, 74 Infectious Diseases, Table of Cases 73 Influenza, Asian 25 Insect Pests 48 Inspections carried out by Public Health Inspectors 49 Knackers' Yards 29 Labelling of Pood Order, 1953 34 Laboratory Service 60 Laundry Facilities for Old Persons 62 Lunacy and Mental Treatment Acts 60 Lung Cancer 24 Maternal Deaths 69 Maternity Services 79, 87 Meals on Wheels 62 Measles 23 Meat Inspection 29 Medical Defects in School children 122 Medical Examination of Staff 63 Merchandise Marks Acts, 1887-1953 34 Metropolitan Water Board 36 Midwifery Service 87 Midwives" Clinic 80 Milk and Dairies 28 Mothercraft Classes 80 Mothers and Young Children, Care of 79 National Assistance Act, 1948. S.50 63 Notices Served 50 Nurseries, Day 84 Nursing, Home 93 Nursing Homes 104 Old People's Welfare 62 Ophthalmic Service 118 Orthodontic Treatment 105 Orthopaedic Service 116 Orthoptic Treatment 118 Out-Patient Clinics at Prince of Wales' s Hospital 59 128 Outworkers 53 Parentcraft 83 Paratyphoid Fever 24 Patch Testing 107 Personal Health Service 60 Pet Animals Act, 1951 47 Physically Handicapped Children 107 Poliomyelitis 23 " Vaccination 96 Preserved Foods 28 Prevention of Illness, Care and After-care 96 Prince of Wales s Hospital, Out Patient Clinics 59 Problem Families 91 Public Health Department, Staff 4 Radiation Hazards 65 Rag Flock and other Filling Materials Act, 1951 47 Recuperative Holidays 96 Rehousing Medical Aspects 43 Rent Act 1957 44 Repairs in Default 42. 51 Rheumatism Supervisory Centre 110 Rodent Control 47 Sanitary Circumstances 36 Scarlet Fever 24 School Health Service 99 School Leavers, Defects in 100 Sewerage and Drainage 36 Shops 54 Slaughterhouses 29 Slum Clearance 40 Smallpox Outbreak 12 Compensation for loss of earnings 22 Hyperimmune anti-variola gamma globulin 15 18 Origin of infection 18 National Health Insurance Benefits 21 Vacc inat ion 95 Smoke Control Areas Speech Therapy 120 Staff Medical Examinations 63 68 Statistical summary Stillbirths 69 129 Toddlers' Clinics 81 Tuberculosis 8 In schools 101 B. C. G. Vaccination 102 Welfare of Patient 11 Vaccination Poliomyelitis 96, 106 Smallpox 95 Vermin Infestation in school children 124 Water Supply 36 Welfare Poods, Distribution 86 Welfare Service, Area 60 Whooping Cough 24 Immunisation 95 Work in default 42. 51