59(1) ACK 4/4/59 TOT 33 Borough of Tottenham Tottenham's Health 1958 The Annual Report of the Medical Officer of Health Borough of Tottenham Tottenham's Health 1958 The Annual Report of the Medical Officer of Health Health Department, Town Hall, Tottenham, N. 15. 20th September, 1959. To the Worshipful the Mayor, Aldermen and Councillors. Mr. Mayor, My Lady, Ladies and Gentlemen, I have the honour to submit the Annual Report on the health of the Borough for the year ending the 31st December, 1958. The policy for improving local housing conditions has been pursued with vigour and good progress has been made during the year in "Slum1' Clearance and in the provision of new housing accommodation both within and outside the Borough. Implementation of the Clean Air Act has made a good start and public respo nse to its anticipated benefits widely recognised. In the preparatory work for securing "Smoke Control Areas" the public health inspectors and clerical department accomplished a great deal having regard to the many other duties imp osed upon them. Under the leadership of the Chief Public Health Inspector, Mr. E.T. Jenkins, and the Chief Clerk, Mr. A.W. Lawrence, the Council can feel the utmost pride and confidence in the work of these departments. During the year the Council has given special thought and consideration to such new health problems as the increase in radiation in the atmosphere and the merits of fluoridation of water supplies, and has sought the guidance of Government Departments on these matters. The vital statistics for the year have shown little change and compare favourably with other towns in the Greater London Area. The infectious disease rate has given no cause for anxiety. Progress in the poliomyelitis immunisation programme has been generally up to expectations; but the erratic supplies of vaccine created many problems in attempting to meet all the demands of general medical practitioners, hospital authorities and those of our own special clinics. The medical, nursing and clerical staff, however, coped well with the exceptional pressures and difficulties as they arose. As for many years past the arrangements for interchange of medical staff between hospital and local authority continued to the benefit of both. Further opportunity too was afforded during the year for co-operation in research by members of the staff and in particular the health visitors. Of special interest are the recommendations contained in the recent report of the Royal Commission on Mental Health - in particular the proposed re-orientation of the mental health services towards community care and the necessary expansion in many spheres of local authority work. Already conferences have been held jointly between hospital and local authority staffs, and in Tottenham too the consultant psychiatrist to the Prince of Wales's General Hospital has held regular meetings with the health visitors and mental welfare officers. In the care of the Aged, progress has been made in providing specially designed housing accommodation; and financial support and encouragement given to the valued activities of the Old People's Welfare Committee. During the year there have been various changes in the Staff, but particular reference must be made to the retirement of Dr. Esther Rickards who for so many years gave such outstanding service to the expectant and nursing mothers at our clinics in Tottenham. A well merited tribute has been paid by the Council to her excellent work. In conclusion I wish to acknowledge my deep appreciation of the support given me by the Chairmen and Members of the Committees concerned with the health services; and to thank my deputies and heads of the various departments for their assistance and loyal support throughout the year. I have the honour to be Your obedient servant G. HAMILTON HOGBEN Medical Officer of Health. 1 MEMBERS OF BOROUGH COUNCIL MAYOR Alderman The Lady Morrison, J.P. DEPUTY MAYOR Councillor A.J. Davies ALDERMEN C.H. Colyer A. Reed, A.C.I.I., J.P. E.j. Field A.F. Remington (Mrs.) R.W.H. Ford A.R. Turner W.S. Herbert H.W. Turner F.A.F. Keay, J.P. R.H. Warren COUNCILLORS G.W. Barker L.R. Harrington, J.P. (Mrs.) S.A. Berkery (Miss) F.E. Haynes (Mrs.) E.E. Brown (Mrs.) H. Langer E.J. Brown, M.B.E. A.J. Lyne E.J.J. Carter G.C. Marson I.R. Cato (Mrs.) A.A. Miller (Mrs.) Douglas Clark M.T. Morris E.J. Clook S.C. Morris L.H. Collis I.L. Peirce E. Cooper A.T. Protheroe S.L. Cope M.E. Protheroe (Mrs.) E.P. Deakins P.H. Roberts j. Egdell j.r. searle E.V. Garwood J. Watkins A.R. Gillham J.L. Williams W.K. Gomm J. Wolsey Town Clerk: M. Lindsay Taylor, LL.B. 2 HEALTH AND HOUSING COMMITTEE Chairman Alderman R.H. Warren Vice-Chairman Councillor J.L. Williams Alderman A. Reed, A.C.I.I., J.P. Alderman Mrs. A.F. Remington Alderman A.R. Turner Councillor Miss S.A. Berkery Councillor Mrs. F.E. Haynes " E.J. Clook " M.T. Morris " E. Cooper " Mrs. M.E. Protheroe " S.L. Cope " P.H. Roberts " Mrs. L.R. Harrington, J.P. " J. Watkins Ex officio - The Mayor and Deputy Mayor TOTTENHAM DIVISIONAL EXECUTIVE EDUCATION COMMITTEE Chairman Alderman Mrs. A.F. Remington Vice-Chairman Councillor Douglas Clark Alderman C.H. Colyer Alderman F.A.F. Keay, J.P. " E.J. Field " The Lady Morrison, J.P. " R.W.H. Ford " A. Reed, A.C.I.I., J.P. Councillor G.W. Barker Councillor H. Langer " Miss S.A. Berkery " M.T. Morris " L.H. Collis " I.L. Peirce " E.P. Deakins " Mrs. M.E. Protheroe " E.V. Garwood " R.H. Roberts " Mrs. F.E. Haynes " J. Watkins Representing County Council County Councillor D.G. Smith County Councillor Mrs. M.E. Soall Co-opted Members Mr. R.C. Ablewhite Mr. D. Edgington Mr. H.R. Cheetham Mr. R.N. Lee Borough Education Officer - J. Power, M.A. 3 LOCAL AREA HEALTH COMMITTEE Chairman Councillor Mrs. M.E. Protheroe Vice-Chairman Councillor Miss M.E. West Representing Tottenham Borough Council Alderman A. Reed, A.C.I.I., J.P. Alderman Mrs. A.P. Remington Councillor Mrs. P.E. Haynes Councillor M.T. Morris " H. Langer " Mrs. M.E. Protheroe Representing Hornsey Borough Council Councillor Miss O.R. Anderson Councillor Miss M.E. West " Mrs. J. Carter " J.T. Wilkins Councillor C.R. Williams Representing Middlesex County Council County Councillor V. Butler County Councillor Mrs. M.E. Soall " " Mrs. S.G. Child " " Mrs. J. Thexton " " Mrs. R.A. Preedman " " A.H. Miller Representing Hospital Management Committee Mrs. R.M. Pry Mr. M.W. Bums Co-opted in advisory capacity Dr. L. Hornung (Local Medical Committee) Mr. R.W.D. Brownlie (Local Dental Committee) Mr. L. Hayward (Local Pharmaceutical Committee1) Miss E. Hazel (Royal College of Nursing) Miss V. Edey (Royal College ofMidwives) STAFF Borough Health Department Medical Officer of Health, School and Area Medical Officer G. Hamilton Hogben, M.R.C.S., D.P.H. Deputy Medical Officer of Health and Assistant County Medical Officer J- Epsom. M.R.C.S., D.P.H., D.I.H. Chief Public Health Inspector E.T. Jenkins, F.A.P.H.I. Senior District Public Health Inspector E.S. Glegg, M.A.P.H.I. Chief Administrative Assistant A.W. Lawrence, M.A.P.H.I. Senior Administrative Assistant W.E. Lawson 4 Classification of other Staff No. Public Health Inspectors 10 Pupil Public Health Inspectors 2 Shops and Street Trading Inspector 1 Administrative and Clerical Staff 9 Rodent Operatives 2 Cleansing and Disinfection Staff 3 Other Manual Staff 7 County Area Health Department Deputy Area Medical Officer A. Yarrow, M.B., Ch.B., D.P.H. Senior Assistant Medical Officer Mrs. J.H. Garrow, M.B., Ch.B., : (Retired 15.1.59) Area Dental Officer V. Sainty, L.D.S., R.C.S. Superintendent Health Visitor Miss H. Townsend, S.R.N., S.C. Non-medical Supervisor of Midwives Miss F.E. Curtis, S.R.N., S.C.M and Home Nursing Superintendent M.T.D. Home Help Organiser Mrs. J.D. Mcllroy Assistant Home Help Organisers Mrs. p.G. Wills Miss D. Buck Area Chief Clerk W.L.N. Relleen, T.D., D.P.A. Deputy Area Chief Clerk J.B. Bambrook, D.M.A. Sectional Heads A. Balls N.P. Child H.J. Dunham, B.A. Classification of Staff Full-Time Part-Time Medical Officers 9 7 Dental Officers 6 2 Supervisory Nursing Staff 2 Administrative and Clerical Staff 37 8 Health Visitors/School Nurses 29 Clinic Nurses 8 Midwives 8 Home Nurses 20 6 Speech Therapists 3 - Physiotherapists 1 3 Occupational Therapists 1 - Chiropodists - 2 Gramophone Audiometrician 1 - Orthoptists - 2 Dental Attendants 7 1 Day Nursery Staff 36 1 Home Help Service 9 164 Manual workers, domestic grades, etc. 9 24 186 220 5 GENERAL STATISTICS AREA OF DISTRICT IN ACRES 3,013 POPULATION: Census 8th April, 1951 126,929 Estimate of Registrar General of Population - Mid-year, 1958 117,700 APPROXIMATE NUMBER OF DWELLINGS IN DISTRICT 30,790 RATEABLE VALUE OF DISTRICT at 1st April, 1958 £1,742,841 SUM REPRESENTED BY PENNY RATE at 1st April, 1958 £7,030 LIVE BIRTHS: Legitimate 1,626 Illegitimate 122 1,748 Birth Rate (per 1,000 population) 14.86 STILL BIRTHS 28 DEATHS 1,319 Death Rate (per 1,000 population) 11.21 Infantile death rate (per 1,000 live births) 21.74 Maternal death rate (per 1,000 live and still-births) 0.563 COMPARABILITY FACTORS: Deaths 1.07 Births 0.98 NOTE: Detailed vital statistics appear on pages 53 to 61 in the Statistical Summary) 6 CONTENTS PAGE CONTROL OP DISEASE 7 FOOD CONTROL 16 SANITARY CIRCUMSTANCES OP THE AREA 25 FACTORIES AND SHOPS 41 GENERAL 45 STATISTICAL SUMMARY 53 AREA PERSONAL HEALTH SERVICES 62 AREA SCHOOL HEALTH SERVICE 81 7 CONTROL OF DISEASE The total number of notifications of infectious disease for the year was 985 as compared with 2,221 the previous year. The decrease was mainly due to the biennial variation in measles. Tuberculosis The number of cases on the tuberculosis register on 31st December, 1958 was 1,799 a decrease of 57 on the previous year. There were 115 new cases of tuberculosis notified (102 pulmonary and 13 non-pulmonary) compared with 90 in 1957 (86 pulmonary and 4 non-pulmonary). Distribution of New Tuberculosis Cases notified during 1958 Age Periods New Cases Deaths Pulmonary Non-Pulmonary Pulmonary Non-Pulmonary Male Female Male Female Male Female Male Female Under 1 year - - 1 - - - - - 1-4 years 1 2 - - - - - - 5-9 " 1 - 1 - - - - - 10-14 " 1 2 - - - - - - 15-19 " 4 2 - 1 1 - - - 20-24 " 3 6 - 1 - - - - 25-29 " 7 10 1 - - - - - 30-34 " 4 2 1 1 - - - - 35-39 " 2 2 - - - - - - 40-44 " 4 2 - 1 - - 1 - 45-49 " 13 4 - - - - - - 50-54 " 6 2 1 1 - - - - 55-59 " 3 1 - 1 - - - - 60-64 " 2 3 1 - 4 - - - 65-69 " 7 - - 1 3 1 - - 70-74 " 4 1 - - 1 - - - 75 Years and Over - 1 - - - - 1 - Total 62 40 6 7 9 1 2 - The thirteen non-pulmonary tuberculosis cases notified related to infections of bones and joints in four cases, the genito urinary system in four cases, the lymphatic system in two cases, the meninges in two cases and the skin in one case. 8 Changes in Tuberculosis Register during 1958 Details Pulmonary Non Pulmonary Total Male Female Male Female Number on Register at 1st January, 1958 918 747 86 105 1,856 New cases notified during 1958 62 40 6 7 115 Transfers into Tottenham 32 19 1 4 56 Transfers from Non-Pulmonary - 1 - - 1 Restored to Register - - - - - 1,012 807 93 116 2,028 Cases removed from Register Deaths of cases on register 16 4 1 - 21 Transfers out of Tottenham 47 58 1 9 115 Recovered 42 35 6 4 87 Lost sight of 3 3 - - 6 108 100 8 13 229 Number on Register at 31st December, 1958 904 707 85 103 1,799 Ward Distribution of Cases of Tuberculosis on the Register at 31st December, 1958 Ward Estimated Population Male Female Total Rate per 1,000 population Pulmonary NonPulmonary Pulmonary Non-onPulmonary White Hart Lane 11,254 120 10 98 8 236 21.6 Park 11,064 77 14 72 15 178 16.6 Coleraine 11,376 66 7 59 7 139 12.7 West Green 10,990 65 3 63 11 142 13.6 Bruce Grove & Central 10,806 59 3 46 4 112 10.8 High Cross & Stoneleigh 10,923 84 12 61 12 169 16.3 Green Lanes 10,587 92 7 67 7 173 15.9 Chestnuts 10,979 83 7 72 10 172 16.0 Seven Sisters 10,217 82 8 57 8 155 15.4 Town Hall 10,585 81 8 66 10 165 16.2 Stamford Hill 10,519 95 6 46 11 158 15.9 Total 119,300 904 85 707 103 1,799 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. 9 Work of Chest Clinic Dr. T.A.C. McQuiston, the Physician in Charge at the Tottenham Chest Clinic which also serves Wood Green, who has kindly supplied the following figures of the work during 1958, states that there has been a fall in the total attendances at the Chest Clinic during 1958 as compared with 1957, but this is wholly due to the fact that treatment of pulmonary tuberculosis by artificial pneumothorax and pneumoperitoneum has now been discontinued, and previously there were some hundreds of such cases attending for treatment at weekly or fortnightly intervals. Total number of attendances 23,711 Total number of new cases during 1958 5,170 Total number of new cases notified as suffering from tuberculosis 139 Total number who attended for miniature X-ray 6,655 Total number of new contacts 906 Miss B.S. Johnston, B.Sc., Acting Welfare Officer at the Chest Clinic in commenting on the welfare work in 1958 states "It is difficult to draw a true picture of the year s activities because of the lack of continuity in the casework and because of differences in approach to keeping statistics. This report is therefore mainly an impression of approximately six months work at the clinic. The statistics may not be strictly accurate but merely serve as an indication of the kind of work being carried out in the department. The work undertaken in the Welfare Department at Tottenham shows a continuation of the declining trend experienced in most other clinics in the country. The number of tuberculous patients referred to the Welfare Officer has declined absolutely and there has been no compensatory increase in the number of cases of carcinoma, bronchitis and other chest conditions referred. Of 756 patients seen in the department, only 69, or just over 9%, had "other" chest diseases or conditions. This is a surprisingly small total in view of chronic bronchitis and lung cancer. A large proportion of "other" cases referred had heart conditions. The employment figures quoted in the statistics are an indication of the very useful service provided by the Disablement Resettlement Officers in this area. Relations between the D.R.O.s and the clinic are extremely cordial and difficult cases are discussed with the D.R.O. at the clinic. Rehabilitation and training has been arranged for thirteen patients, seven of whom have been successfully placed in industry at the completion of their course. Five patients commenced training late in the year and are still attending training courses. There have been some failures and ten patients have been carried forward into the new year as requiring employment. Some patients referred to the D.R.O. in the late summer became unfit for work again before they found suitable employment but the service on the whole is adequate. 10 Patients at Tottenham make very full use of all the statutory social services and also require much help from local authority, and voluntary resources. There is a lack of self-sufficiency and self pride in some of the patients, who know only too well what can be obtained from voluntary societies. Although the number of patients seen for welfare purposes has declined the department is still busy, as it now undertakes the majority of the work deputed to the County Council under Section 28 of the Health Act." Summary of Work of the Chest Clinic Welfare Officer (1) GENERAL Number of patients dealt with by the Welfare Officer 756 (2) EMPLOYMENT AND TRAINING (a) Number of patients who consulted the Welfare Officer regarding employment or training 59 (b) Number for whom employment or training was found 61 Individual patients referred to the National Assistance Board for grants of:- (3) NATIONAL ASSISTANCE BOARD (a) Bedding 7 (b) Clothing 11 (c) Extra Nourishment 37 (d) Any other purposes (i.e. Maintenance grants etc.) 80 *Total individual patients referred to the National Assistance Board 104 (4) HOUSING (a) Cases recommended for rehousing 98 (b) Families rehoused 38 *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. It is emphasised that the significant factor in this return is the number of individual patients and not the number of times the patients are dealt with. Smallpox No case of smallpox was notified during the year. Paratyphoid Fever No case of paratyphoid fever was notified. Scarlet Fever There were 147 corrected scarlet fever notifications during the year, but no 11 deaths were attributed to the disease. Of 39 cases admitted to hospital the diagnosis was amended in two instances 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 38 10.3 2 5 Other Hospitals 1 14 - - Whooping Cough The number of notified cases during the year was 29. No deaths were attributed to the disease. 1 case was admitted to hospital for 41 days. Poliomyelitis There was only one case of poliomyelitis notified (a boy of 5 years of age) . It was of the paralytic type. Measles There were 543 notifications of measles during the year. 20 cases were removed to hospital with complications. There were no deaths. Dysentery A total of 49 cases were notified. Of these 5 cases were admitted to hospital. Food Poisoning There were 29 notified cases, of which 5 were admitted to hospital. In four cases the causal organism was identified as salmonella typhimurium. The cases were unconnected and scattered throughout the year. A small outbreak of food poisoning occurred at the Town Hall canteen, affecting 37 persons. The symptoms were comparatively mild and the attack was of short duration. It was confirmed as being caused by Bacillus Welchii infection of stewed steak. The reason why this organism multiplied in the meat was probably due to the lack of rapid cooling after the cooking of the meat; and when due to be served the lack of rapid reheating. This type of food poisoning can be easily avoided by not allowing meat to remain for any length of time at intermediate temp eratures namely between 50° F and 145º F. 12 Diphtheria No cases of diphtheria occurred during 1958. Respiratory Diseases The following table comprises Tottenham death rates arising from diseases affecting the respiratory system with rates for the country as a whole. In common with other districts in the Greater London area and other industrialised urban areas, the death rates from certain respiratory diseases in Tottenham are higher than the national average. Whilst this may arise from a complexity of reasons there is no doubt that the urban environment is an important factor. The biggest difference occurs in Lung Cancer and Bronchitis and to a lesser extent Pneumonia shows higher rates. In the large industrial areas many irritants find their way into the lungs from the air polluted with smoke, and fumes. These irritants may cause inflammation and thus weaken resistance to air borne bacterial infections or they may react on the lung tissues to produce disease conditions. For this reason every possible action must be taken to ensure that the air we breathe is kept as clean and wholesome as possible. The unceasing efforts in the latter part of the 19th century to secure a clean water supply eventually eliminated many alimentary diseases and an important public health aim must now be to secure that the air we breathe is similarly protected. Dr. McQuiston, the Physician in Charge at the Tottenham Chest Clinic, states, "The winter of 1958, from the point of view of chest illness, was certainly one of the worst that I have experienced during my twelve years in Tottenham. We had a very busy time at the Clinic and there were lots of cases who had respiratory illnesses complicating influenza, and also illnesses in the bronchitic and emphysematous patients aggravated by smog. Our beds in the Inpatient Unit at St. Ann s Hospital proved invaluable for the prompt treatment of respiratory infections, and of course, in the many patients whose respiratory function is already much curtailed by chronic pulmonary disease, it is vital to treat acute infections at the earliest moment to avoid death from cor pulmonale. In a later section of this report the Council's smoke control programme shows that Tottenham is tackling local air pollution in an energetic manner. 13 Tottenham Deaths front Respiratory Diseases with comparative National Death-rates. Disease 1952 1953 1954 1955 1956 1957 No. Rate per 105 National Rate 105 No. Rate per 105 National Rate 105 No. Rate per 105 National Rate 105 No. Rate per 105 National Rate 105 No. Rate per 105 National Rate 105 No. Rate per 105 National Rate 105 Pulmonary Tuberculosis 25 20 21 24 19 18 23 19 16 23 19 13 18 15 11 9 8 9 Lung Cancer 57 45 32 68 54 34 57 46 37 71 58 39 85 71 41 81 68 43 Influenza 6 5 4 19 15 15 1 1 4 3 2 7 3 2 6 10 8 15 Pneumonia 64 51 44 79 63 49 52 42 43 66 54 49 56 46 52 73 60 52 Bronchitis 137 109 62 132 106 69 98 80 58 142 116 65 96 80 66 88 72 60 Other Respiratory Diseases 15 12 10 7 6 11 5 4 11 15 12 12 12 10 11 12 10 11 All respiratory diseases 304 242 173 329 263 196 236 192 169 320 261 185 270 224 187 273 226 190 14 Local and National Death-rates per 100,000 for ALL Respiratory Diseases Diseases of Arteries and Cancer There was a slight fall in the rate of death from lung cancer in Tottenham, but for cancer as a whole there is a very slight rise. The death rate for diseases of arteries has risen by 0.25 per thousand. The latter group of diseases includes coronary heart disease, angina and vascular lesions of the central nervous system. Diseases of Arteries and Cancer National and Local Rates Compared Year Population Deaths from Diseases of Arteries Deaths from Cancer (Totals 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 1957 44,907,000 149,993 3.34 94,017 2.09 19,119 .43 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 1958 117,700 382 3.24 304 2.58 76 .64 15 SUMMARY OF DISINFECTION WORK DURING 1958 Rooms disinfected after occurrence of infectious disease 136 Bedding disinfected after occurence of infectious disease or death 54 Library Books disinfected 65 Legal Proceedings Public Health Act, 1936, Section 172 For the first time in Tottenham, it was necessary to apply to the Magistrates' Court for an order under section 172 of the Public Health Act, 1936 requiring the removal to hospital of an infectious patient. The patient, a girl aged 17 years, was suffering from acute extensive pulmonary tuberculosis and sharing a bedroom with four other people two of whom were twins aged 10 years. The Chest Clinic were unable to get any co-operation from the family. After the removal of the patient to hospital the remainder of the family were persuaded to attend for examination at the Chest Clinic, and three sisters were found to be infected and were admitted to hospital. The original case in the family was the father who had discharged himself from hospital and up to this time refused further treatment. He was also persuaded to return to hospital. 16 FOOD CONTROL The work of food control continues to occupy an important place in the work of the department. Systematic inspections and visits by the public health inspectors ensure that a reasonably high standard of hygiene is maintained in premises where open food is handled. It cannot be too strongly emphasised, however, that the standard in any particular premises will depend on the individuals employed. Complaints continue to be received regarding foreign bodies in articles of food. The complaints relate to all types of food and it is difficult to point to the reason for such occurrences. Inevitably manufacturers draw attention to the modern equipment and up-to-date methods in use in producing and packing foodstuffs until one is left with the thought that the machine - however efficient - is only as efficient as the person operating it. How, for example, is one to account for the extraneous articles which appear from time to time in bottles of milk ? In last year s Annual Report I commented on the Government's plan for dealing with slaughterhouses. The Slaughterhouses Bill, then before Parliament, was duly passed into law and on 1st August, 1958 became operative. This Act has three main objects:- (1) To provide for new and strict minimum standards for the construction and equipment of slaughterhouses. (2) To preserve the existing system of licensing of private slaughterhouses by local authorities and of providing public slaughterhouses. (3) To achieve improvement of slaughterhouses: by stages:- (a) by allowing traders to establish slaughterhouses subject only to planning approval and certain standards. (b) by introducing a measure of control after a given period. Section 3 of the Act, lays an important duty upon local authorities. It requires them to prepare, and submit to the Minister, a report on the slaughterhouse facilities in the area. The appointed day by which these reports have to. be submitted had not at the end of the year been fixed. Food Shops The number of shops selling food in Tottenham is 1,052. Several shops have more than one trade, and the following list shows the number dealing in each food trade. 17 Baker 50 Butcher 93 Coffee stall & cafe 24 Confectioner 331 Dairyman 32 Dining rooms 93 Domestic stores 127 Fishmonger 49 Fruiterer & greengrocer 118 Grocer & provisions 287 Ham & Beef Dealer 3 Off-licence 81 Public House 58 Registered Food Premises At the 31st December, 1958, the following premises were registered under the Food and Drugs Act, 1955, for the manufacture, storage or sale of ice-cream, or for the preparation of sausages or preserved foods:- Sale of ice-cream 388 Mfr. and sale of ice-cream 2 Storage of ice-cream 1 Cooking of hams and other meat 38 Fish frying 38 Sausage manufacture 59 Preparation of jellied eels 3 Shellfish 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 following is a summary of the bacteriological grading of the ice-cream samples taken:- Results Total Grade 1 Grade 2 Grade 3 Grade 4 Samples of Ice-cream produced in Tottenham 46 6 6 2 60 Middlesex County Council Act, 1950: Registration of Hawkers The following is a summary of hawkers and their storage premises registered at the 31st December, 1958, under section 11 of the Middlesex County Council Act, 1950:- 18 Articles No. of Hawkers Registered No. of Storage Premises Registered Fruit & vegetables 97 84 Shellfish 14 6 Pish 8 4 Ice-cream 5 - Light refreshments 4 1 Peanuts 2 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 sterilisation of milk. The following is a summary of licences issued during 1958, namely:- Designation No. of Licences No. of Supplementary Licences Pasteurised 77 10 Sterilised 156 12 Tuberculin Tested 37 10 During the year 28 applications for registration as milk distributors were dealt with. No applications were received in respect of dairies. Of the 28 new registrations, 11 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, 1958 was as follows:- No. of distributors 153 No. of dairies 8 Meat Inspection During the year under review there has been no increase in the work of the department in the inspection of carcase meat at the two slaughterhouses. Both establishments have maintained their normal output and the inspectorial staff engaged in this work have ensured that the meat of all animals killed is inspected before leaving the slaughterhouse. 19 SUMMARY OF CARCASES INSPECTED 1958 Horses Cattle excl. Cows Cows Calves Sheep & Lambs Pigs excl. Sows Sows Number killed 1460 157 821 1334 754 15930 2039 Number Inspected 1460 157 821 1297 754 15927 2014 All Diseases except Tuberculosis & Cysticercosis Whole carcases condemned 1 - 13 - 5 3 2 Carcases of which some part or organ was condemned 283 14 189 5 89 1211 105 Percentage of number inspected affected with disease other than tuberculosis and cysticercosis 19.45 8.92 24.48 .39 12.47 7.62 5.31 Tuberculosis Only Whole carcases condemned - 1 15 - - - 2 Carcases of which some part or organ was condemned - 2 86 - - 229 73 Percentage of number inspected affected with tuberculosis - 1.91 12.30 - - 1.44 3.72 Cysticercosis Only Whole carcases condemned - - - - - - - Carcases of which some part or organ was condemned - - 1 - - - - Percentage of number inspected affected with cysticercosis - - .12 - - - - 20 Food Hygiene Publicity In addition to the personal advice given to food handlers by medical officers and public health inspectors talks have been given to meetings of local organisations. Posters published by the Ministry of Health and the Central Council for Health Education were displayed at intervals on the Council's announcement stations and other prominent points in the borough.. As a contribution to the Borough Arts and civics Week a Food Hygiene Exhibition was arranged in the Council Chamber. This was well attended by the general public and parties of senior school children were conducted round daily. Prosecutions Food & Drugs Act, 1955 S,2. This case concerned a tin of condensed milk in a caramelised and stale condition. Defendants pleaded Guilty; fine of £5.0s.0d. imposed and the Corporation awarded £5.5s.0d. costs. Food & Drugs Act, 1955 S.2. This case concerned a cigarette-end in a loaf. Defendants pleaded Guilty and admitted a previous offence; fine of £l0.0s.0d. imposed and the Corporation awarded £5.5s.0d. costs. Food Hygiene Regulations, 1955 Regulations 32(3) and 9 (e). Legal proceedings were taken against the husband of the proprietor of a provisions shop for smoking behind the counter of a shop in which there was open food. Defendant pleaded Not Guilty; fine of £2.0s.0d; no costs awarded to the Corporation. Food Hygiene Regulations, 1955. Legal proceedings were taken against a firm of butchers in respect of two of their shops for the following contraventions:- Regulation 12(2) (one shop): Failing to trap inlet into the soil drainage system of the food premises. Regulation 14(1 )(a) (one shop): Failing to keep clean and in efficent order sanitary convenience situated in the food premises. Regulation 14(5) (both shops): Failing to keep affixed and maintained in prominent and suitable position near sanitary convenience a clearly legible notice requesting users to wash their hands. Regulation 16(1) (both shops): Failing to provide and maintain suitable and sufficient wash hand basins. Regulation 17 (one shop): Failing to provide and maintain suitable and sufficient bandages dressings and antiseptic. Regulation 23(1) (both shops): Failing to keep ceiling (at one shop) and walls and rails (at other shop) clean and in such good order and condition as to enable them to be effectively cleaned and prevent infestation. 21 Regulation 24 (one shop): Failing to take all reasonable steps to prevent accumulation of refuse in the food premises. A total fine of £45.0s.0d. on nine summonses was imposed; the defendant company did not enter an appearance; the Corporation were awarded £5.5s.0d. costs. Food Hygiene Regulations, 1955. Legal proceedings were taken against a firm of butchers for the following contraventions;- Regulation 6(1) Failing to keep a counter being equipment with which food comes into contact or is liable to come into contact clean and in such good order, repair and condition as to comply with the requirements of the Regulation. Regulation 16(1); Failing to provide and maintain suitable and sufficient wash hand basins. Regulation 19(1 )(a): Failing to provide and maintain suitable and sufficient sinks for washing food and equipment used in the food business. Regulation 23(1): Failing to keep walls and ceiling of a food room clean and in such good order, repair and condition as to enable them to be effectively cleaned and prevent infestation. The offences were proved in each case and a total fine of £8.0s. Od. was imposed and costs of £5.5s.0d. awarded to the Corporation. Condemned Food The bulk of the condemned tinned food comes from the wholesale provision merchants and disposal of this food stuff, 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 73 Marmalade 12 Beverages 83 Meat (Processed) 968 Cereals 35 Milk 317 Cream 51 Milk Foods 5 Pish 133 Soups 179 Fruit (Mixed) 1,584 Tomatoes 289 Fruit Juice 45 Tomato Juice 1 Jam 5 Tomato Puree 59 Vegetables 1,531 22 Other Articles of Food Condemned Cereals (cartons) 21 Macaroons 28 lbs. Cheese 19 lbs. Mayonnaise 306 jars Condiments 44 jars Meat 789 lbs. Currants 75 lbs 7 ozs. 18 pkts. Pastes 69 jars Custard Powder 23 ozs. Peanut Butter 10 jars Fish 53 stone Pickles 8 jars 8½ lbs Prunes 203 lbs. Honey 28 jars 14 ozs. Jam 7 jars Tomato Ketchup 7 jars 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 1958:- Article Total Samples Procured Unsatisfactory Milk (various) 120 - Butter 10 - Cakes 10 - Cheese 8 4 Cooked Meat 19 1 Cream 6 - Drugs 23 - Fish and Fish Products 34 - Fruit - Fresh and Canned 3 1 Fruit Juice, Cordial, etc. 5 - Ice Cream 8 - Lard 4 - Liver 3 - Margarine 4 - Meat and Meat Products 48 1 Non-Brewed Condiment 5 2 Preserves 10 - Sausages, etc. 15 - Spirits 22 - Vinegar 29 6 Miscellaneous 18 1 Totals 404 16 23 Commenting upon the unsatisfactory samples, the Public Control Officer makes the following observations:- ''Cheese. Two samples of cream cheese were found to be deficient in milk fat; the traders were cautioned and advised. Two samples of cheese spread obtained from different traders, but the product of the same manufacturers, were unsatisfactory. Each was a box of assorted cheese products some of the portions being incorrectly labelled as to the type of cheese and the ingredients of which it was composed. An official caution was sent to the manufacturers who took immediate steps suitably to amend all the stocks of this pack of cheese which they held. "Cooked Meat. A sample of atin of cooked meat described on the label as "Chopped Ham and Pork" was found to contain an appreciable proportion of cereal filler and the correct description for this product should have been "Luncheon Meat*. The manufacturers agreed to correct the labelling of this product. "Fruit. A retailer sold and exposed for sale Buerre Hardy pears as William pears. The trader was prosecuted and was fined a total of £6.0s.0d. and ordered to pay £2.2s. 0d. costs. "Meat and Meat Products. A firm of retail butchers sold as "Steak and Kidney" a mixture consisting of meat and ox liver. They were prosecuted and fined £3.0s.0d. together with £2.2s.0d. costs. "Non-Brewed Condiment. Two samples of this food were obtained from the same retailer and each was slightly deficient in acetic acid. Pull enquiries were made but it proved impossible to establish whether the cause was due to a fault of the retailer or the manufacturer, and since the deficiencies were only slight, no further action was taken. "Vinegar. A sample of vinegar was purchased from each of two retailers, but the articles were found to be non-brewed condiment. A follow-up sample was obtained in each case and as each of these was found to be satisfactory, no further action was taken. Samples of vinegar were also obtained from two other retailers and both of these, and also the follow-up samples which were taken in each case, were found to be non-brewed condiment. An official caution was sent to both these traders. "Miscellaneous. A sample of soup described as "Mushroom Cream Soup" was found, when made up in accordance with the manufacturer's directions, to contain less than the minimum fat which must be present in a soup described as "cream soup". An official caution was sent to the manufacturers concerned." The Public Control Officer has also furnished the following report upon associated work under other Acts:- Merchandise Marks Acts, 1887- 1953. The majority of the inspection work carried 24 out under the provisions of the above Acts relates to ensuring that the requirements of the various Marking Orders made under the provisions of the Act of 1926, and which relate to the marking with an indication of origin of certain imported foodstuffs when exposed for sale or sold, are complied with. Inspections were made at 343 separate premises of 1,406 displays of meat, apples, tomatoes, poultry, bacon and dried fruit. One firm of retail butchers was prosecuted for two offences of exposing for sale New Zealand meat falsely described as "Argentine" and for six offences for exposing for sale imported meat not marked with the necessary indication of origin. They were fined a total of £32.0s.0d. together with costs. A second firm of butchers was prosecuted for four offences of exposing for sale imported meat and imported offal not marked with the necessary indication of origin. They were fined a total of £20.0s.0d. together with £5.5s.0d. costs. Another retailer received an official caution for removing the indication of origin from imported dead poultry and for exposing this poultry for sale." "Labelling of Food Order, 1953. This Order requires pre packed food to be marked with the name and address, or with the registered trade mark, of the packer or labeller. It also requires such food to be labelled with its common or usual name (if any) and with the names of the ingredients of a compounded food. It also controls the manner in which the presence of vitamins and minerals is disclosed and prescribes specific labelling of certain foods. A total of 1,593 articles of pre-packed food was examined at 386 premises to ascertain whether the above requirements were complied with; no serious infringements of this Order were detected." "False or Misleading Description. As in previous years food advertisements and labels have been scrutinised for false or misleading statements and descriptions. Much of this scrutiny of food labels can be combined with inspection work under the Labelling of Pood Order. No serious infringements were disclosed. Corrective action was secured in relation to descriptions applied to "milk block", Double Tea, and imitation cream powder, cakes filled with a mixture of butter and sugar, canned mixed vegetables, raspberry syrup, powdered soup mixes, medium red salmon, gorgonzola cheese spread and cheese spread." Special Designated Milk. During the year 13 samples of designated milk were taken in your area and all were certified as being satisfactory." 25 SANITARY CIRCUMSTANCES OP THE AREA Water Supply If there is anything in our country that is taken for granted it is the adequate and pure supply of water. The mere turning of a tap at will produces a seemingly endless quantity. Its purity is rarely questioned by the public. Water is such a common commodity that hardly any of us think about it at all we just use it in ever increasing quantities and the daily demand rises. Since early times man has settled near rivers, lakes and springs for obvious reasons. He carried his water needs from these sources of supply in containers. In the Middle Ages (thirteenth century) the City of London obtained permission from a landowner in the Oxford Street area to run leaden pipes from springs there into the City. Other similar schemes followed to supply London s needs until the era of Peter Morrys, who in 1582 is thought to have been the first person to effect a mechanical supply in a small way to the city. He had obtained a lease of an arch of London Bridge and by means of a water wheel and wooden conduits supplied houses close at hand. This ultimately led with other concerns to the formation of the London Bridge Waterworks many years later. The New River Scheme was an important step forward. After Parliamentary approval in 1606 it was proposed to bring water from the springs in the neighbourhood of Ware into the City. The project was completed in 1613. In 1822 an Act of Parliament merged the London Bridge Waterworks and the New River concern into the New River Company. With the new company and the many other small concerns there was considerable competition. Finally as a result of a Royal Commission into the Supply of Water for London, legislation was recommended and the Metropolis Water Act of 1902 instituted the Metropolitan Water Board. A wonderful feat is performed by the Metropolitan Water Board today in procuring, purifying and protecting the supply of water to our homes. Last year's figures reveal that for the 6½ million people in the Board's area there was an average daily supply of 327, 000, 000 gallons of water. In other words the average daily requirement per person was around 50 gallons. The Board through the Thames Conservancy and Lee Conservancy Catchment Boards meet this daily demand by making use of all the natural resources available, surface rivers, streams and wells. 26 Water from wells sunk in chalk does not present much difficulty. It is usually of high quality and has only to be chlorinated. The water from streams and rivers, however, presents great difficulty in view of the amount of sewage and industrial pollution. Infinite care is taken to render it safe and wholesome by (i) Storage (ii) Filtration and (iii) Chemical treatment Each of these processes is carried out under strict supervision and continuous testing of samples. Last year 110,000 examinations of water were carried out in the Board's laboratory. These consisted of chemical and bacteriological analyses as well as tests for taste. These tests showed that London" s water supplies reached the high standard of purity the Board sets for its water. Each year in my annual report I include a report from Dr. E. Windle Taylor, Director of Water Examination of the Metropolitan Water Board,who this year has kindly supplied the following information regarding Tottenham's water supplies:- "The supply to the Borough of Tottenham has been satisfactory both in quantity and quality during the year 1958. The Borough is supplied from two main river derived sources, namely the New River and the River Thames together with well water from Park Well Pumping Station during the summer months in the locality of Northumberland Park. Details of the analytical results of the water passing into supply are set out on the attached sheet. Samples are collected on five days in every week, or more often if necessary, at each stage of the purification process and from the distribution system. Tests include physical, chemical and micro-biological examination. All new and repaired mains are disinfected with chlorine before being put into service 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. With regard to fluoridation the policy of the Metropolitan Water Board with regard to London's water supply remains the same, namely that they do not propose to make any decision until some definite pronouncement or lead is forthcoming from the Ministry of Health on the question of the fluoridation of water supplies generally in this country. Four areas were chosen for artificial fluoridation, namely Andover, Anglesey, Kilmarnock and Watford, and addition of fluoride to the water supplies in these areas commenced in 1956. Andover ceased to apply fluoride to the water in July 1958 as a result of public opinion. 27 AVERAGE RESULTS OF THE CHEMICAL AND BACTERIOLOGICAL EXAMINATION OF THE WATER SUPPLIED TO THE BOROUGH OP TOTTENHAM FOR THE YEAR 1958 (Milligrams per litre (unless otherwise stated)) Description of the Sample Ammonia Nitrogen Albuminoid Nitrogen Oxidised Nitrogen (Nitrate) Chlorides as C1 Oxygen abs. from Permanganate 4 hrs. at 27°C Turbidity in terms of Silica Colour m.m. brown 2ft. Tube Burgess's Tintometer Hardness (Total) Hardness (noncar bonate) PH Value Phosphate as PO4 Silicate as sio2 Sulphate as SO4 Fluoride as F Magnesium as Mg. Iron Electrical Conductivity (gemmhos) New River water filtered at Hornsey and/or Stoke Newington works 0.026 0.054 6.0 32 065 0.1 6 302 78 7.8 0.60 11 0.15 625 River Thames derived filtered water 0.027 0.077 4.2 26 1.26 0.3 12 270 66 7.9 0.85 9 58 0.15 5 550 Park well 0.160 0.029 0.4 22 0.24 1.6 13 252 46 7.5 0.65 18 0.27 500 BACTERIOLOGICAL RESULTS AFTER CHL0RINATI0N (WATER PASSING INTO SUPPLY) Description of the Sample Plate counts (average per ml) Colonies counted on agar Coliform count Percentage samples negative in 100 ml Escherichia count Percentage samples negative in 100 ml 37°C (20-24 hours) 22°C (3 days) New River water filtered at Hornsey and/or Stoke Newington works 6.0 97. 09 100.0 River Thames derived filtered water 9.7 99.07 99.88 Park well 0.2 5.5 98.05 100.0 28 It will be some time before the results of these demonstrations become known and no doubt the decision of the Ministry of Health with regard to the excessive application of fluoride to the water supplies in this country will depend upon their outcome. The official view is that by arranging these demonstrations in selected areas sufficient steps have been taken to give full opportunity for the public to become informed and to express its opinion within the next few years". Drainage and Sewerage Separate systems of soil and surface water drains and sewers operate throughout the Borough. It will be appreciated that in a Borough of the character of Tottenham much of the drainage is old. Many of the complaints relating to rat infestation are traceable to defective house drains or public sewers. Work on flood relief schemes is already proving valuable and no serious flooding has occurred during the year. Pollution of water courses is less than in previous years. Closet Accommodation The water carriage system is in operation throughout the Borough. Continuing co-operation between the department and H.M. Factory Inspectors of the Ministry of Labour and National Service ensures the closest supervision of sanitary accommodation in factory and other premises. Atmospheric Pollution Continuing their application of the Clean Air Act, 1956 to the question of atmospheric pollution, the Government brought into operation on the 1st June, 1958 those sections of the Act dealing with industrial and commercial premises. Briefly they are as follows:- Section 1 Prohibits the emission of dark smoke from chimneys. fies the limiting periods for the emission of smoke from certain classes of chimney. Provides a defence e.g., in the case of lighting up a furnace which was cold. Section 2 Provides certain temporary exemptions. Sections 5/9 Deal with the emission of dust and grit new furnaces to be provided with plant to arrest grit and dust. Section 16 Provides for the abatement of smoke nuisances, other than from private dwelling houses, or for dark smoke. 29 Section 19 This section brings railway engines within the provisions of section 1. Section 20 Applies sections 1 and 2 to ships. Section 23 Makes provision for dealing with Crown premises. The Minister has exercised his power to make regulations dealing with smoke and these also came into operation on 1st June, 1958. The regulations state that no offence is committed if dark smoke is emitted for less than 10 minutes in the aggregate in an 8 hour period. The 10 minute period is increased according to the number of furnaces, but continuous emission of dark smoke over 4 minutes or black smoke for 2 minutes, in any period of & hour, is an offence In my view, the most that can be said of these regulations is that they provide a standard, but not a very stringent one. To succeed in taking action against the chimney that smokes "little and often" it will be necessary to keep a continuous observation for 8 hours. Local Action under the Clean Air Act Members were informed in my annual report for 1957 that a detailed survey of the proposed Smoke Control Area was in progress. This survey was duly completed and an Order made by the Council was subsequently confirmed by the Minister. The survey covered an area of approximately 180 acres with 2,104 buildings the Order comes into operation on 1st September, 1959. A booklet prepared in the department, containing the relevant information for intending applicants, was circulated to all the houses affected by the Order. To stimulate interest in the area and to provide information and guidance, in collaboration with the Coal Utilisation Council, an exhibition hut was erected in the garden fronting on Page Green Terrace. The hut, which had a number of approved appliances under fire, was to be on site for 4 months. Industrial Air Pollution Further difficulties arose during the year regarding a laundry in South Tottenham. After repeated representations and meetings a second chain grate was installed. As a further step to mitigating the nuisance an electricity sub-station has been erected on the site and it is the Management's intention to take a supply into the laundry and so reduce the demand on the boiler plant. 30 THE MARKF1ELD/STAMFORD HILL SMOKE CONTROL AREA ATMOSPHERIC POLLUTION RECORD, 1958 Month 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 per 100m3) (mg per 100m3) (Parts per 100 million) January 2.39 16.51 6.71 2.54 8.25 6.89 .29 90 6 13 February 2.10 7.85 5.13 2.37 8.98 6.34 17 48 5 9 March 0.96 9.31 4.86 1.03 9.14 4.40 18 30 9 25 April 1.52 6.04 4.31 1.66 7.34 4.55 7 11 5 13 May 2.40 7.02 4.37 2.35 7.58 4.90 5 12 4 12 June 5.76 6.64 6.26 4.96 7.24 5.69 4 8 3 9 July 2.19 5.74 5.95 1.93 6.13 4.50 3 8 3 8 August 3.94 5.50 4.95 3.16 4.91 4.28 5 10 2 9 September 3.51 4.74 5.64 3.62 5.50 5.23 4 15 3 7 October 2.53 5.55 9.82 2.54 5.74 5.54 10 57 3 7 November 1.74 6.52 5.24 1.85 3.03 4.47 31 149 6 23 December 2.65 7.32 6.08 2.78 7.05 6.34 33 75 6 21 31 32 Housing Slum Clearance Two of the clearance areas represented in 1957 received official confirmation during the year. The appeal to the High Court, against confirmation of one area, was heard in February, The appeal was decided in favour of the Borough Council but as a result of this case certain alterations have been made in the method of submitting "official representations". A Public Inquiry was held in September in respect of the largest area yet submitted, some 200 houses. The inquiry extended over a period of two whole days, the many objectors being represented by learned Counsel and others. The question of re-phasing the clearance area programme has again received consideration and amendments were agreed to during the year. As a result of this, an "official representation" was submitted to the Council in October in respect of 88 houses on the Tewkesbury Estate. These houses occupy the proposed school site and the representation resulted in a "Clearance Order" being made. Representations of "declared unfitness" were also submitted in respect of the houses in Markfield and Stamford Roads, on the proposed industrial site. Prom the foregoing it will be seen that it is necessary to keep a constant review of housing conditions in the Borough. The ideal would be to achieve a degree of flexibility in the clearance programme which allows for the deterioration in the older properties. This, however, is not possible because the final fulfilment of the programme depends on cleared sites providing land for redevelopment. Repair of Unfit Houses Continuing use is made of sections 9 and 10 of the Housing Act, 1957, as the occasion demands but a large volume of work is done on the receipt of preliminary notices. It is of interest to note that once a specification of the work required is made on the form of a section 9 notice the necessity for any item can only be challenged in the County Court. If, on the other hand, owners seek to vary the requirements of a preliminary notice, it is sometimes possible to meet them. The most common item in this respect is the question of remedying dampness, where rendering may be allowed in place of the provision of damp proof courses. It is becoming apparent however that since the Housing Repairs and Rents Act, 1954 introduced "the matters to be taken into consideration" in assessing what is an unfit house, the service of section 9 notices requires the most careful consideration. This is emphasised when one considers the varying judgments given in cases appearing before the County Courts. 33 POST-WAR CLEARANCE AREAS Area Number of Dwellings Date Represented Inquiry Confirmation Rehousing Occupants Completed Demolition of Premises Completed Arthur Road 19 28. 11.50 13. 11.51 19. 1.52 10.53 1. 54 Markfield No. 1 17 28.10.52 5. 5.53 13. 8.53 7.55 8.55 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 6.58 8.58 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 30.9.58 and 2.12.58 - - - Tewkesbury No. 5 4 1. 4.58 17.12.58 - - - " No. 6 88 14. 10. 58 - - - - " No. 7 3 14. 10. 58 - - - - Markfield Redevelopment 50 18.11.58 - - - - 34 HOUSING ACTS 1936 & 1957 SECTIONS 9 & 10 WORK IN DEFAULT Year Number of Houses Cost 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 1958 8 527. 1. 6 Premises the subject of Demolition Orders not demolished as at 31st December, 1958 Premises Date of Order 5-8 Union Row 11. 8.43 78 Stamford Road 29. 1.57 33 Waverley Road 4.11.57 38 St. Ann's Road * 6.12.57 10 Markfield Road *30.10.58 * These premises were still occupied at 31st December, 1958 35 Certificates of Disrepair There was a steady flow of applications for certificates under the Rent Act, 1957 and the following is a summary of the Department's work in this connection - Applications for Certificates of Disrepair (1) Number of applications for certificates under Rent Act, 1957 240 (2) Number of decisions not to issue certificates: 2 (3) Number of decisions to issue certificates: 238 (a) in respect of some but not all defects 139 (b) in respect of all defects: 99 (4) Number of undertakings given by landlords under paragraph 5 of the First Schedule 162 (5) Number of undertakings refused by Local Authority under proviso to paragraph 5 of the First Schedule: 15 (6) Number of certificates issued 105 Applications for Cancellation of Certificates (7) Applications by landlords to Local Authority for cancellation of certificates 71 (8) Objections by tenants to cancellation of certificates: 20 (9) Decisions by Local Authority to cancel in spite of tenant s objection 6 (10) Certificates cancelled by Local Authority: 57 (11) Number of certificates outstanding at 31st December, 1958 including those under the Housing Repairs and Rents Act, 1954: 217 Certificates as to the Remedying of Defects listed in Landlords' Undertakings (12) All defects remedied 63 (13) Some defects not remedied 73 (14) No defects remedied 72 Public Health Act, 1936 and Tottenham Corporation Act, 1952 Of the many complaints received by the Department it is possible to deal with a great number under the provisions of the Public Health Act, 1936. Experienced inspectors are by this time fully aware of the owners who take an intelligent interest in their property. 36 In cases where it is otherwise the Tottenham Corporation Act is proving to be a valuable piece of legislation. Urgent defects such as badly leaking roofs can be dealt with in a comparatively short space of time. Other sections of the local Act which are proving most useful are those concerned with drainage. Rag Flock and Other Pilling Materials Act, 1951 At 31st December 1958 there were no establishments licensed for the manufacture of rag flock. 23 premises were registered for the use of filling materials. Pet Aninals Act, 1951 At 31st December, 1958. 10 premises were licensed as pet shops in accordance with the Pet Animals Act, 1951. Disinfestation and Rodent Control In an effort to provide reasonable standards of living for the community we are still confronted with the problem of insect pests, and rat infestation. Rodents The basic problem in rat infestation is that of reducing the rat population in the sewers to a reasonably low level. We must face the position that the present methods of treatment do no more than touch the fringe. The introduction of new poisons and techniques of application is under constant review by technical officers of the Ministry and we are prepared to use them once they are officially approved. Sewer Maintenance - Results of baiting manholes Poison take at Manholes Treatment No 27 April/May Treatment No. 28 Sept./Nov. Complete - - Good 156 177 Small 350 281 Nil 516 564 Estimated number of rats killed 5,455 5,415 Poison used 2% Antu and 0.25% Paranitrophenol 2½% zinc phosphide and 0.25% paranitrophenol The following is a summary of dwelling houses and business premises treated during 1958:- (1) Dwelling houses 574 (2) Factory premises 40 (3) Shops 33 (4) School Canteens 48 (5) Miscellaneous 29 (6) Total charge for 2-5 above £137.2.11 37 Insect Pests The bed bug is no longer the problem of years ago, but flies are still a menace, particularly in food premises. The application of D.D.T. as an insecticide continues but we must recognise the probability of immunity or resistance being developed in the course of time. 371 inspections prior to removal to Council houses have been made on notification by the Housing Manager, and disinfestation was required in sixteen cases, the furniture being treated in a cyanide chamber. Summary of Disinfestation Work Cause Private Houses Council Houses Other Premises Total Houses Rooms Houses Rooms Houses Rooms Others Ants 15 - - - - 15 - - Bugs 62 136 - - - 62 136 - Cockroaches 35 33 - - 5 35 33 5 Fleas 16 27 - - - 16 27 - Flies 5 - - - 1 5 - 1 Red Mites 6 - - - - 6 - - Wasps 9 - - - - 9 - - Woodworm 2 - - - - 2 - - Inspections Carried out by the Public Health Inspectors Appointments and Interviews 678 Cinemas and Halls 49 Complaints Investigated 3,337 Conveniences and Urinals 29 Drains defective 207 Drains tested 337 Factories with Mechanical Power 275 Factories without Mechanical Power 16 Food Poisoning 20 38 Pood Premises Bakehouses 37 Butchers 147 Cafes 154 Dairies 245 Factories 26 Factory Canteens 28 Fishmongers 66 Greengrocers 64 Ice Cream Premises 98 Slaughterhouses 869 Other Food Premises 256 House to House 62 Improvement Grants 19 Infectious Disease 212 Other Visits 3,576 Outworkers 183 Rat Infestation 654 Re-inspections 7514 Schools 9 S.D.A.A. & Housing Act Advances 304 Smoke Observations 71 Stables and Mews 20 Tuberculosis 0 Work places 21 Defects Remedied Drains reconstructed 24 Drains repaired 239 Drains cleared 165 W.C. Cisterns repaired or renewed 97 W.C. Pans renewed 84 W.C. Pans cleansed 28 Waste Pipes repaired or renewed 89 Rain water pipes repaired or renewed 171 Roofs repaired or renewed 667 Eaves Gutters repaired or renewed 357 Drinking water Cisterns renewed 4 Drinking Water Cisterns covered 3 Water Service Pipes repaired 62 Water Supply reinstated Yards repaired or reconstructed 33 58 Sinks renewed or provided 25 39 Floors repaired or renewed 244 Floors ventilated 81 Dampness remedied by insertion of damp proof courses 31 by pointing of brickwork 91 by internal rendering 221 by miscellaneous remedies 131 Window frames and Sashes repaired or renewed, or painted 341 Coppers repaired or renewed, or provided 6 Fireplaces, Stoves & Ovens repaired or renewed 210 Flues and Chimneys Stacks repaired 116 Brickwork of Walls repaired and Walls rebuilt 110 Ventilated Food Stores provided 4 Rooms cleansed 85 Staircases, Passages & Landings cleansed 45 Staircases, Balconies and Steps repaired or renewed 79 Noxious Accumulations removed 34 Nuisances arising from Animals abated 6 Miscellaneous Defects remedied 770 Notices served Statutory:- Housing Act, 1957: Section 9 75 75 Public Health Act, 1936: Section 24 2 " 39 70 " 45 5 " 79 2 " 92 264 343 Tottenham Corporation Act, 1952: Section 36 11 " 43 80 91 Total 509 Informal Notices 1361 40 Repairs of Houses by the Council Work carried out in default or by agreement with the owners during 1958. Housing Act 1957 £ s d Section 9 8 premises 527 1 6 Public Health Act, 1936 Section 24 12 premises 49 9 10 " 39 11 " 202 9 9 " 45 3 " 12 12 0 " 79 1 " 1 0 0 " 94 1 " 86 7 3 Tottenham Corporation Act, 1952 Section 36 4 premises 11 13 8 " 38 3 " 8 19 3 " 43 8 " 85 1 5 984 14 8 Prosecutions Public Health Act, 1936, S. 93 Legal proceedings to secure abatement of nuisances were taken in nine cases. In six cases summonses were withdrawn and costs totalling £14.14. 0d were awarded no costs were awarded in the seventh case. In the eighth case the owner of a private dwelling failed to comply with an abatement notice served upon him. A summons was issued and eventually the owner appeared before the court when an order was made for the work to be carried out within 42 days and he was required to pay £2.2.0d costs. He failed to comply with the justices order, a further summons was issued and the defendant in his absence was fined £2.0.0d and costs of £2.2.0d were awarded. He again failed to comply and a further summons was before the court when a daily penalty of five shillings was imposed in respect of each of the 60 days he had failed to comply with the court order since conviction and costs of £2.2.0d were awarded. The work was eventually completed in default. The ninth case was of failure to comply with an abatement order giving rise to a continuing smoke nuisance; there was a fine of £10. 0.0d and £5.5.0d costs were awarded. 41 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 724 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 compliance with those parts of the Factories Acts which are enforceable by the local authority. FACTORIES ACTS, 1937 and 1948 Inspections for purposes of provisions as to health (including inspections made by Public Health Inspectors) Premises Number on Register NUMBER OF Inspections Written Notices Occupier Prosecuted (i) Factories in which sections 1, 2, 3, 4 and 6 are to be enforced by local authority. 58 16 - - (ii) Factories not included in (i) in which section 7 is enforced by local authority. 666 275 15 - (ili) Other premises in which section 7 is enforced by local authority (excluding Outworkers premises). - - - - TOTAL 724 291 15 - 42 Summary of Defects found in Factories Particulars Number of cases in which defects were found Pound Remedied Referred to Factories Inspector Referred by Factories Inspector Want of Cleanliness (s. 1) - - - - Overcrowding (s.2) - - - - Unreasonable temperature (s„3) - - - - Inadequate ventilation (s.4) - - - - Ineffective drainage of floors (s.6) - - - - Sanitary Conveniences (s.7) (a) Insufficient - - - - (b) Unsuitable or defective 23 23 - 15 (c) Not separate for sexes - - - - Other offences against the Act (not Including offences relating to Outwork) - - - - TOTAL 23 23 - 15 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 357 Household linen 8 Curtains & furniture hangings 3 Artificial flowers 12 Paper bags 4 Cardboard boxes 46 Brushes 9 Feather sorting 1 Boxing, carding of buttons 7 Stuffed toys 2 Christmas crackers & stockings 15 Lampshades 4 468 183 visits were made during 1958 to outworkers' premises. No contraventions were reported. 43 Shops Inspections of shops under the Shops Act, 1950 have been carried out during the year; visits and patrols have been made during week-ends and in late evenings to ensure that the requirements of the Act are complied with. Some dislocation was experienced during the year due to the resignation in July of the Shops Inspector, Mr. L.H. Williams, who left to take up an appointment with Walthamstow Borough Council. Mr. T.E. Goodwin was appointed to succeed him and took up his duties at the end of September. Traders generally have been co-operative and in most cases have immediately, taken steps to rectify any infringement brought to their notice. In a few cases where this is not so, warning letters or legal proceedings have been necessary in order to ensure that the regulations are complied with. Inspections 886 shops have been inspected, prescribed notices, records of employment, etc., have been examined, and all necessary information obtained: an up-todate register of shops within the Borough has been maintained. During the year the following contraventions were noted:- Section 17 (2) Assistants weekly half holiday notice not exhibited 62 Section 32 (2) Record of hours of employment of young persons not maintained 14 Section 32 (3) Abstract of provisions of employment of young persons not exhibited 13 Section 37 (2) Notice re seats for females not exhibited 48 Weekly Half Holiday The following contraventions were observed:- Section 1 (1) Shops not closed at 1 p.m. 4 Section 1 (2) Alternative closing notice not exhibited 7 Section 13 (1) Exempted trade notices not exhibited 27 General Closing Hours The following contravention was observed:Section 6 The sale of sugar confectionery after 9.30 p.m. 1 44 Sunday Trading The following contraventions were observed:- Section 22 (3) Record of Sunday employment not maintained 5 Section 47 Sale of non-exempted articles 2 Section 50 Exempted trade notices not exhibited 20 Jewish Traders Section 53 The register of Jewish Traders was maintained and inspections made. No infringements of the regulations were observed. In connection with the infringements recorded above, 65 reinspections were made , 61 informal notices sent to traders, and five formal warning letters sent. Legal proceedings were taken in five cases under the Shops Act, 1950 and in two cases under the Middlesex County Council Act, 1944. The effect of the latter two cases has been to discourage unlicensed street trading in the North Tottenham area. Prosecutions Shops Act, 1950 and Middlesex County Council Act, 1944 Offence Section Pine Costs Total Case 1 No exempted trade notice 50 £ 2. 0.0. £1. 1.0 £ 3. 1.0 Case 2 Sale of tin of peas and packet of cooking fat on a Sunday 47 £ 2. 0.0 - £ 2. 0.0 Case 3 Sale of razor on a Sunday 47 £ 2. 0.0 10.6 £ 2.10.6 Case 4 (1) Sale of non-exempted articles on a Sunday 47 & 50 £ 1. 0.0 10.6 £ 2. 0.6 (2) No exempted trade notice (2 summonses) 10.0 - - Case 5 Sale of articles after 8 p.m. 2 £ 2. 0.0 10.6 £ 2.10.6 Case 6 Unlicensed street trading 320 & 329 £ 2. 0.0 £1. 1.0 £ 6. 2.0 £ 2. 0.0 £1. 1.0 Case 7 Unlicensed street trading 320 & 329 £ 1. 0.0 £1. 1.0 £ 2. 1.0 £14.10.0 £5.15.6 £20. 5.6 GENERAL 45 Health Services provided by other Authorities (a) Hospitals:- North-East Metropolitan Regional Hospital Board. The hospitals in the Borough are locally administered by the Tottenham Group Hospital Management Committee whose offices are at the Prince of Wales' s General Hospital. The Group comprises the undermentioned hospitals - Hospital Bed Complement Beds Open Remarks Bearsted Memorial Hospital 38 38 Maternity Hospital Annexe at Hampton Court 33 33 St. Ann's General Hospital 712 525 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. 46 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 p.m p.m. Varicose veins a.m. p.m. p.m. - - - Surgical Varicose ulcers p.m. - p.m. - - - Diseases of Women - p.m. - p.m. - - Children (Medical) - a.m. - a.m. - - Eye - - a.m. - - - Throat, Nose & Ear p.m. - - p.m. - - Skin - - p.m. - a.m. - Teeth - - - a.m. - a.m. Neurological p.m. - - - - - Genito-Urinary - a.m. - - - - Psychiatric - p.m. - - p.m. - Physical Medicine a.m. a.m. a.m. a.m. a.m. p.m. p. m. - p.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. - - Venereal Diseases Medical Officer a. m. Males p.m. - p.m. p.m. - a.m. Females - p.m. - a.m. p.m. a.m. Intermediate 8 a.m. 8 a.m. 8 a.m. 8 a.m. 8 a.m. 8 a.m. treatment 7 p.m. 7 p.m. 7 p.m. 7 p.m. 5 p.m. 12 noon Doctors" Letters required All Patients seen by appointment The Casualty Department is always open for medical and surgical emergencies (b) Personal Health Services The personal health services which since 1948 have been controlled by the Middlesex County Council are administered from the Area Health Offices, Somerset Road, Tottenham, N. 17. 47 (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, telephone number EDMonton 5544, 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 10.0 a.m. on Saturday, they will be sent on the same day by special messenger to the Hornsey Branch Laboratory. As it is not possible to send a second messenger on any one day, it is essential that specimens be delivered to the Town Hall before the times stated. Alternatively, specimens may be sent direct to the Hornsey Branch Laboratory, which remains open until 5.0 p.m. on Monday to Friday and 12 noon on Saturday. The address is Public Health Laboratory, Coppett's Wood Hospital, Coppett" s Road, N. 10. A twenty four hour emergency service is maintained by the Central Laboratory at Colindale. The following is a summary of the work carried out during 1958 at the Coppett's Wood Hospital Branch in Hornsey. 48 RECORD OF EXAMINATIONS Throat/Nose Swabs:- Total specimens 630 Diphtheria Bacilli 0 Haemolytic Streptococci 6 Vincents Angina 0 Negative 624 Faeces;- Total specimens 433 Shigella 64 CI. Welchi 3 Salmonella typhi-murium 11 Salmonella bredeney 2 B. Coli 4 Negative 349 Sputum:- Total specimens 6 Positive 0 Negative 6 Ice-Cream:- Total specimens 60 Water:- Total specimens 4 Swimming Pools 2 Paddling Pool 2 Miscellaneous Specimens:- 18 Total number of specimens 1,151 Welfare of Aged Persons The following information has been extracted from the Annual Report of the Chairman of the Old People s Welfare Committee. Chiropody Service Since last year the number of weekly sessions has been increased. The Committee now operate 9 sessions a week at clinics, at each of which ten old people receive treatment, and 2 sessions a week under the domiciliary service giving a total of 12 old people a week treatment in their homes. Even so, there is still a waiting list of eight to ten weeks between treatments. In order not to lengthen the time between treatments the Committee decided that a waiting list should be compiled of new patients and these would be included in the scheme as and when a vacancy arose. There are at present 76 patients on the waiting list. 49 This year 1,011 old people received foot care and 4,180 treatments have been given, an increase of 658 on last year. The cost to the old people remains 1/- each foot. Christmas Parcels 1,125 parcels (an increase of 100 parcels on last year) were delivered by voluntary effort to the homes of the aged sick and housebound. Clothing Donated articles of cast-off clothing and bed linen were given to the needy old people. In this connection home nurses and health visitors have made many calls for assistance in emergency, when dealing with incontinent patients. Surplus clothing is disposed of at jumble sales where useful articles are sold to the old people for a few coppers, the proceeds benefiting the Committee s funds. Clubs Meals are served at the Woodberry Down and the Lord Morrison Hall Clubs twice weekly and during the year 10,216 meals were served to the old people. The cost of the meals to the old people is l/2d each. Summer outings and Christmas Parties were arranged for each of the Clubs and enjoyed by all. Holidays and Outings With the help and co-operation of the Women s Holiday Fund, approximately 96 old people were able to have two weeks holiday at the seaside. The approximate cost is £2.2.0. weekly, inclusive of coach fare, and the Women's Holiday Fund have also given some financial assistance to a few couples who have arranged their holidays at addresses supplied by the Old People's Welfare Office. Many opportunities exist throughout the year for the old people to have trips to the seaside. Our own Clubs, the Evergreens and the O.A.P. Associations and many others do valuable work in organising outings which the old people enjoy in the company of their own friends. Harvest Festival Many of the Schools and some Churches sent the produce of their Harvest Festival Thanksgiving. This was made up into basketsand sent to the aged sick and needy. In all 755 old people benefited by the kindness and generosity of the givers. 50 Meals-on-Wheels Here again there is another increase in this very necessary Service, so that now meals are delivered into the homes of the sick and housebound on four days each week. The Committee organise delivery on Tuesdays, Wednesdays and Thursdays, and the Women's Voluntary Services on Fridays. Meals delivered this year were- Old People s Welfare Committee 6,459 W.V.S. 5,724 Optical Service Requests for help come from many sources including the Officers of the National Assistance Board who often notice the difficulty the old people have with reading. 22 housebound old people have been visited by the Optician who has tested their eyes at home and there is no doubt this service has been of great help. Shoe Repairs 7 dockets have been issued to enable old people to get footwear repaired at a reduced rate. Visiting Several voluntary visitors have been enrolled during the year, but because they are mostly at work during the day, they can only visit one or two people each week. Many lonely old people are also visited by members of other organizations, i.e. the Churches, W.V.S., the British Red Cross, and sick visitors attached to the O.A.P. Associations and Old People's Clubs. Borough Services for the Aged Baths Old people are allowed to use the public sitz baths free of charge. Library Service By means of the Libraries Service Van, 47 housebound old people were visited regularly during the year and deliveries total 4,732. The old people were first visited by a member of the staff to ascertain the type of books they prefer and in some cases the books were actually delivered to the bedside of the readers. 51 Laundry Service for the Incontinent Aged Each year a very useful but little known service has been taken advantage of in a number of necessitous cases and in 1958 the number of collections made by the Public Health Department was 745. But for such a service it would have been impossible for those looking after many of the cases to have coped with the difficulties of keeping the patient at home, and so relieve the demand for beds in hospitals or for the admission of old people to homes. One of the problems in looking after the bedridden aged in their own home is the laundering of soiled bed linen and other articles, particularly of the incontinent cases. Before the Corporation established this personal service, the home helps tried to deal with this problem as it arose but often the situation could not be dealt with adequately in the cramped accommodation in which so many old people are living. In 1954 a scheme was drawn up with the co-operation of the Tottenham Hospital Management Committee for use by this service of the facilities at St. Ann's General Hospital Laundry. Soiled linen is collected twice weekly by the Public Health Department's van and returned three days later when the next soiled bundle is collected. To prevent any risk of infection all soiled articles are steeped in a disinfectant before collection any faecal matter having first been sluiced off. The laundry is then taken to St. Ann s Hospital Laundry where, after a cold rinse, it is boiled for fifteen minutes and then laundered. The efficient working of the service is due to the excellent assistance received from all concerned the home helps who carry out preliminary cleansing of articles before despatch to the laundry; the public health staff who operate the collection and delivery arrangements and the laundry staff who so readily co-operate in meeting this very real need of the community. Visits to the Aged awaiting Hospital Treatment Visits were made by the Councils Medical Officers to aged persons awaiting admission to the geriatric wards at St. Ann's General Hospital and reports sent to the hospitals to enable them to give priority to those in most urgent need of hospital care. Narional Assistance Act, 1948, Section 50 Burials During the year it was necessary to arrange six burials where deaths occurred and suitable arrangements for burial would not otherwise have been made. 52 Superannuation Medical Examinations 102 persons were examined during the year for appointment to the Council's Staff. 92 of these were passed as fit to carry out their respective duties with efficiency. The causes of unfitness of the 10 persons found unfit are listed as follows:- (i) Chronic Bronchitis - emphysema 3 (ii) Heart Disease 1 (iii) Arterial Disease 2 (iv) Deformity of Bones 1 (v) Pulmonary Tuberculosis 2 (vi) Diabetes Mellitus and Arterial Disease 1 53 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, 1955. 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 429, the Registrar General estimate of population shows a reduction of 1,600, meaning that the movement of population out of the Borough must have exceeded the inward movement by 2,029. 1957 1958 Area of District (in acres) 3,013 3,013 Population Census, April, 1951 126,929 Mid-year Registrar General's estimate 119,300 117,700 Rateable Value at 1st April £1,737 776 £1,742,841 Sum represented by penny rate £7,009 £7,030 Births: Registered live-births (a) Legitimate Males 795 847 Females 759 779 Total 1,554 1,626 (b) Illegitimate Males 47 58 Females 57 64 Total 104 122 (c) Total live-births Males 842 905 Females 816 843 Total 1,658 1,748 Birth-rate per 1,000 estimated population: 13.90 14.86 Stillbirths (a) Legitimate Males 16 6 Females 14 15 Total 30 21 (b) Illegitimate Males 1 4 Females 2 3 Total 3 7 54  1957 1958 (c) Total Males 17 10 Females 16 18 Total 33 28 Stillbirth rate per 1,000 total (live and still) births 20.79 15.77 Deaths; Males 731 687 Females 583 632 Total 1,314 1,319 Death-rate per 1,000 estimated population 11.02 11.21 Maternal Deaths Puerperal Sepsis 0 0 Other puerperal causes 2 1 Total 2 1 Maternal Death-rate per 1,000 total (live and still) births 1.183 .563 Deaths of Infants under 1 year of age (a) Legitimate Males 23 14 Females 11 18 Total 34 32 (b) Illegitimate Males 5 3 Females 3 3 Total 8 6 (c) Total Infantile Deaths Males 28 17 Females 14 21 Total 42 38 Infantile Death-rate per 1,000 live births 25.33 21.74 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, Tottenham's figures must first be multiplied by the appropriate comparability factor .98 for births and 1.07 for deaths. 55 Infantile Deaths A total of 38 deaths under 1 year of age is recorded, giving a rate of 21.74 per thousand live births. Five of these deaths occurred at home and the remaining 33 in hospital. 28 of the deaths were neonatal deaths, i.e. they occurred in the first month of life. The Causes (i) Prematurity. 13 deaths are listed under this heading. Six of these deaths occurred within 24 hours and three others within 48 hours and a further two within a week. The remaining two died within a month. (ii) Congenital Malformation. Six deaths from this cause are listed. The malformations included serious deformities of the heart, brain and spinal cord. (iii) Birth Injuries. Five deaths were due in three cases to cerebral haemorrhage and in two cases to other intracranial haemorrhages. (iv) Atelectasis. The four deaths from these causes occurred within three days. Two of the cases were associated with prematurity. (v) Other Diseases of Respiratory Tract. Five deaths occurred from broncho pneumonia at one week, one month, three months, seven and 11 months respectively. The death at one week was associated with prematurity. Of the four other cases two were due to acute capillary bronchitis, another suppurative bronchitis, and the last to severe bronchitis. (vi) Enteritis Two deaths under this heading were due to acute gastro-enteritis at ages one month and twelve weeks. (vii) other causes (a) Fracture of skull and subarachnoid haemorrhage. This was an open verdict after coroner s inquest. Age 5 minutes. (b) Inhalation of amniotic fluid at birth. (c) Cause unknown probably malignant disease association with Ascites or Hepatomegaly. 56 Table of Cases of Infectious Diseases coming to the knowledge of the Medical Officer of Health during the year 1958 in the Borough of Tottenham, classified according to Diseases and Ages Disease Under 1 1 2 3 4 5-9 10 - 14 15 - 19 20 - 34 35 - 44 45 - 64 65 : up Total M F M F M F M F M F M F M F M F M F M F M F M F Scarlet Fever - - 1 3 7 3 7 3 10 7 40 45 12 5 - - - 4 _ _ - - - - 147 Measles 11 15 16 22 29 30 29 26 44 39 136 131 1 6 - 2 1 4 1 - - - - - 543 Whooping Cough 2 1 4 1 2 7 - 1 - 1 5 3 1 - - - - - - 1 - - - - 29 Pneumonia 1 2 - - - - - - 1 - - - 1 1 - 1 2 4 3 3 7 2 4 6 38 Erysipelas - - - - - - - - 1 - - - 1 - - - 2 - - - 3 - - - 7 Food Poisoning - - 1 - 1 - - 1 1 - 1 1 - 3 3 - 3 2 1 1 1 6 1 2 29 Puerperal Pyrexia - - - - - - - - - - - - - - - - 2 - 2 - - - - 4 Ophthalmia Neonatorum - - - - - - - - - - - - - - - - - - - - - - - - - Acute Encephalitis Infective - - - - - - - - - - - 1 - - - - - - - - - - - - 1 Post-infectious - - - - - - - - - - 1 - 1 - - - - 1 - 1 - - - - 4 Acute Poliomyelitis Paralytic - - - - - - - - - 1 - - - - - - - - - - - - - 1 Non-paralytic - - - - - - - - - - - - - - - - - - - - - - - - - Meningococcal Infection - - 1 1 - - - - - - 1 - - - - - - - - - - - - - 3 Diphtheria - - - - - - - - - - - - - - - - - - - - - - - - - Typhoid - - - - - - - - - - - - - - - - - 1 - - 1 - - - 2 Paratyphoid - - - - - - - - - - - - - - - - - - - - - - - - - Dysentery 1 1 3 2 2 2 1 1 3 2 9 4 1 1 - 1 1 7 - 2 2 2 1 - 49 Scabies - - - - - - - - - - 3 1 2 3 2 - - 1 - 1 - - - - 13 Tuberculosis Respiratory - - - 1 - - 1 - - 1 1 - 1 2 4 2 14 18 6 4 24 10 11 2 102 Meninges & C.N.S. 1 - - - - - - - - - - - - - - 1 - - - - - - - - 2 Other - - - - - - - - - - 1 - - - - - 2 2 - 1 2 2 - 1 11 Total 16 19 26 30 41 42 38 32 60 50 199 186 21 21 9 7 25 46 11 16 40 22 17 11 985 57 INFANTILE DEATHS IN AGES AND SEXES DURING THE TEAR 1958 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 - - - 1 - - 1 4 2 2 Other diseases of respiratory system - - - - - - - 1 - - 1 - - - - - - - - - - 1 1 - Gastritis, enteritis and diarrhoea - - - - - - - - - - - 1 - 1 - - - - - - - 2 1 1 Congenital malformation 3 - - - - - - 1 - - 4 - 1 - - - - 1 - - - 6 1 5 Prematurity 6 2 1 - - - - 2 - 1 12 1 - - - - - - - - - 13 5 8 Atelectasis 1 2 - 1 - - - - - - 4 - - - - - - - - - - 4 2 2 Birth injuries 3 2 - - - - - - - - 5 - - - - - - - - - - 5 4 1 Other causes 2 - - - - - - - - - 2 - - - - 1 - - - - - 3 1 2 Total 15 6 1 1 - - - 4 - 1 28 3 * 1 2 - 1 - 2 - - 1 38 17 21 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 9 1 - - - - - - 1 - - - 4 - 4 1 - - Tuberculosis, other 2 - - - - - - - - - 1 - - - - - 1 - Syphilitic disease 1 - - - - - - - - - - - - - 1 - - - Diphtheria - - - - - - - - - - - - - - - - - - Whooping Cough - - - - - - - - - - - - - - - - - Meningococcal infection - - - - - - - - - - - - - - - - - - Acute poliomyelitis - - - - - - - - - - - - - - - - - - Measles - - - - - - - - - - - - - - - - - - Other infective & parasitic disease - - - - - - - - - - - - - - - - - - Malignant neoplasm, stomach 27 16 - - - - - - - - - - 13 3 7 9 7 4 Malignant neoplasm, lung bronchus 66 10 - - - - - - - - 3 1 34 4 26 1 3 4 Malignant neoplasm, breast - 36 - - - - - - - - - 5 - 16 - 10 - 5 Malignant neoplasm, uterus - 7 - - - - - - - - - 1 - 3 - 1 - 2 Other malignant & lymphatic neoplasm 71 64 - 1 - 1 - - - - 2 2 26 25 25 12 18 23 Leukaemia, Aleukaemia 6 1 - - - - - - - - - - 2 1 1 - 3 - Diabetes 2 1 - - - - - - - - - - - - - 1 2 - Vascular lesions of the nervous system 76 86 - - - - - - - - 2 1 14 10 20 22 40 53 Coronary disease, angina 122 98 - - - - - - - - 1 1 35 16 48 34 38 47 Hypertension, with heart disease 7 12 - - - - - - - - - 1 1 - 1 4 5 7 Other heart disease 58 109 - - • - - - - - 2 3 10 7 12 22 34 77 Other circulatory disease 21 27 - - - - - - - - 2 - 2 4 9 7 8 16 Influenza 1 2 - - - - - - - - - - - - - - 1 2 Pneumonia 35 27 2 2 2 1 - 1 - - 1 - 9 3 14 6 7 14 Bronchitis 65 30 1 - - - - - - - 1 1 14 6 23 4 26 19 Other diseases of respiratory system 12 5 - - - - - - - - 2 - 3 2 5 - 2 3 Ulcer of stomach & duodenum 14 5 - - - - - - - - - - 5 - 6 1 3 4 Gastritis, enteritis & diarrhoea 5 4 1 1 1 - - - - - - - 1 - - - 2 3 Nephritis & nephrosis 3 4 - - - - - - - 1 2 1 - - - 1 1 1 Hyperplasia of prostate 4 - - - - - - - - - - - - - - - 4 - Pregnancy, childbirth & abortion - 1 - - - - - - - - - 1 - - - - - - Congenital malformations 3 5 1 5 1 - 1 - - - - - - - - - - - Other defined & ill defined diseases 42 55 11 11 1 1 2 - - - 2 2 6 12 9 14 11 15 Motor vehicle accidents 9 4 - - - - - - 3 - 1 - 1 1 2 2 2 1 All other accidents 16 11 1 1 - - - - 2 - 2 - 3 1 3 3 5 6 Suicide 10 11 - - - - - - - - 3 1 5 4 1 3 1 3 Homicide & operations of War - - - - - ~ — ~ - - - - - - - - - - Total 687 632 17 21 5 3 3 1 6 1 27 21 188 118 217 158 224 309 58 CANCER DEATHS 1958 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 2 2 - - - - - - - - - - - - - - - 1 - - 1 - 1 1 - - Digestive Organs and Peritoneum 54 53 - 1 - - - - - - - - - - - - 5 2 20 11 15 19 12 16 2 4 Respiratory system 69 11 - - - - - - - - - - - - 3 1 10 - 26 5 26 1 4 4 - - Breast and Genitourinary system 22 59 - - - - - - - - - - - - 1 7 1 16 3 14 10 12 6 8 1 2 Other and unspecified sites 8 8 - 1 - - - - - - - - - 1 - - 2 - 2 2 3 1 - 2 1 1 Lymphatic & Haematopoietic Tissues 15 1 - - - - - - - - - - 1 - - - 2 - 4 1 4 - 4 - - - TOTAL 170 134 - 2 - - - - - - - - 1 1 4 8 20 19 55 33 59 33 27 31 4 7 59 * 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. 60 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 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 1,666 13.24 34 20.41 1 356 - 163 16 277 1953 124,400 1,347 10.83 1,642 13.20 43 26.19 1 215 1 143 20 284 1954 123,200 1, 187 9.63 1, 524 12.37 27 17.72 1 92 - 126 5 251 1955 122,100 1, 331 10. 9 1,511 12.38 25 16.55 1 75 1 126 18 308 1956 120,700 1,252 10.4 1,560 12.92 38 24.36 1 80 1 92 9 281 1957 119,300 1,314 11.02 1,658 13.90 42 25.33 2 92 - 86 4 296 1958 117,700 1,319 11.21 1,748 14.86 38 21.74 4 147 - 102 13 304 Note: (a) Absolute numbers are given in parenthesis in addition to rates to afford valid comparison (b) Provisional CERTAIN VITAL STATISTICS FOR THE YEAR 1958 District Population mid-1958 Live birth rate per 1000 population Death rate per 1000 population Specific death rates per 1000 population Infant mortality per 1000 live births Maternal mortality per 1000 total births (a) Crude Adjusted Crude Adjusted Pulmonary Tuberculosis (a) Cancer (a) Infant (a) Neo-natal (a) (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) Acton 65,360 15.1 14.2 11.0 11.4 0.06 (4) 2.2 (147) 22.2 (22) 18. 2 (18) - (-) Brentford & Chiswick 57,150 14. 0 13. 2 11.2 11.2 0.12 (7) 2.2 (127) 17.5 (14) 12.5 (10) 1.23 (1) Ealing 183,000 14.4 14.0 10.4 11.2 0.05 (10) 2.2 (398) 14.8 (39) 11.4 (30) - (-) Edmonton 95,180 13.0 12.9 9.9 11.2 0.07 (7) 2.1 (200) 17. 0 (21) 13.0 (16) 0.80 (1) Enfield 109,300 13. 8 13.8 10.6 10.5 0.06 (7) 2. 1 (228) 19.2 (29) 15.2 (23) - (-) Feltham 50,780 16.6 16.1 7.4 11.7 0.02 (1) 1.4 (73) 21.3 (18) 16.6 (14) - (-) Finchley 69,080 13.1 12.6 11. 9 10.8 0.03 (2) 2.2 (153) 20. 0 (18) 10.0 (9) 1.09 (1) Friern Barnet 28, 540 11.5 12.9 14. 1 9.0 0.04 (1) 2.2 (62) 12.2 (4) 3.0 (1) - (-) Harrow 214,300 13.2 13.5 9.3 11.1 0.04 (8) 1.9 (414) 17.0 (48) 13.8 (39) 0.70 (2) Hayes & Harlington 67,780 16.6 15.6 7.4 12.0 0.06 (4) 1.5 (101) 15.1 (17) 13.3 (15) - (-) Hendon 151,500 12.9 12.4 10.4 11.1 0.07 (10) 2.2 (330) 13.9 (27) 10.3 (20) 0.51 (1) Heston & Isleworth 105,100 12.0 12.0 10. 6 11.3 0.05 (5) 2.0 (214) 16.6 (21) 12.7 (16) - (-) Hornsey 96,670 18.1 16.8 11.8 10.6 0.06 (6) 2.2 (214) 18.9 (33) 16. 6 (29) - (-) Potters Bar 22,000 18.1 16.3 7.7 10.6 0.18 (4) 1.4 (31) 10. 1 (4) 5.0 (2) - (-) Ruislip-Northwood 74,930 13.4 13.4 8.0 10.1 0.04 (3) 1.8 (137) 12.9 (13) 9.9 (10) - (-) Southall 52,830 15.5 16.0 12.0 10.1 0.08 (4) 2.6 (136) 20.7 (17) 15.9 (13) - (-) Southgate 70,940 11.4 12.3 13.3 10.9 0.11 (8) 2.2 (155) 21.0 (17) 16.1 (13) - (-) Staines 46, 850 18.2 16.7 8.8 11.2 0.02 (1) 2.0 (94) 23.5 (20) 15.3 (13) - (-) Sunbury 28,440 19.6 17.6 10.5 11.9 0.14 (4) 2.0 (58) 14.4 (8) 5.4 (3) - (-) Tottenham 117,700 14.9 14.6 11.2 12.0 0.08 (10) 2.5 (297) 21.7 (38) 16.0 (28) 0.56 (1) Twickenham 103,500 13.3 13.7 11.4 10.8 0.13 (13) 2.1 (222) 24.0 (33) 17.4 (24) - (-) Uxbridge 63,120 17.7 16.1 9.9 12. 9 0.06 (4) 1.9 (119) 29. 6 (33) 26. 9 (30) 0. 88 (1) Wembley 126,800 12.0 12.1 8.8 10.3 0.06 (7) 2.1 (262) 19.1 (29) 12.5 (19) - (-) Willesden 173,100 18.6 17.1 10.0 11.3 0.08 (14) 2.1 (363) 21.5 (69) 16.5 (53) 0.61 (2) Wood Green 49,100 12.9 12.9 11.7 11.3 0.08 (4) 2.6 (129) 23.6 (15) 15.7 (10) 1. 54 (1) Yiewsley & West Drayton 23,950 17.2 15.5 7.3 10.5 - (-) 1.4 (34) 19.4 (8) 14.5 (6) 4.75 (2) COUNTY 2,247,000 14. 5 14.2 10.3 11. 1 0.07 (148) 2. 1 (4698) 18.9 (615) 14.2 (464) 0.39 (13) England & Wales 45, 109,000 16.4 (b) 11.7 0.09 4000) 2. 1 (95,799) 22.5 (16,620) 16. 2 (11,969) 0.43 (326) 61 AREA PERSONAL HEALTH SERVICES (Tottenham and Hornsey) 62 CARE OF 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 six years and the percentage of hospital confinements was 80%, compared with 82.8% in 1957. 1958 1957 1956 Live Births (a) Domiciliary 708 566 534 (b) Hospital or Nursing Home 2799 2679 2589 Still Births (a) Domiciliary 6 3 4 (b) Hospital or Nursing Home 59 63 56 3572 3311 3183 Ante-natal Clinics Following the retirement of Dr. Esther Rickards, consultant obstetrician in Tottenham, negotiations took place with the North East Metropolitan Regional Hospital Board and the Tottenham and Edmonton Group Hospital Management Committees, as a result of which links were established with the North Middlesex Hospital and Bearsted Memorial Hospital in respect of consultant cover. The staffing of the ante-natal clinics in Tottenham will in future be taken over from the North East Metropolitan Regional Hospital Board by four assistant medical officers with obstetrical qualifications appointed as honorary clinical assistants at either the North Middlesex or Bearsted Hospital for alternate weekly sessions. The percentage of expectant mothers making at least one attendance at one of the local authority ante-natal clinics was 65.7% during 1958 compared with 68.5% the previous year. During the last quarter of the year, the number of sessions at The Chestnuts and Lordship Lane clinics were reduced by one a week in each case. The following table gives details of attendances at all clinics in the Area:- 63  No. of sessions held No. of new cases Total attendances Average attendance per session A.N. P.N. A.N. P.N. Burgoyne Road 73 193 116 1376 119 20.5 Church Road 72 171 82 1291 83 19.1 Fortis Green 102 216 122 1657 129 17.5 Hornsey Town Hall 155 363 170 2574 176 17.7 Mildura Court 64 214 101 1563 105 26.0 Stroud Green 52 138 71 604 71 13.0 Chestnuts 193 445 206 2885 208 16 0 Lordship Lane 185 299 167 2033 170 11.9 Park Lane 105 308 122 1602 124 16.4 Totals 1958 1001 2347 1157 15536 1234 16.7 Totals 1957 1029 2267 1120 15131 1238 15.9 Totals 1956 997 2192 1132 14808 1193 16.0 Midwives Ante-natal Clinics The following table shows attendances made during the year:- Midwives Clinic No. of sessions held Total No. of attendances Average attendance per session Burgoyne Road 20 115 5.8 Fortis Green 14 61 4.4 Hornsey Town Hall 15 105 7.0 Mildura Court 12 76 6.3 Stroud Green 24 171 7.1 Park Lane 130 653 5.0 Total 205 1143 5.5 Mothercraft Clinics 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 40 282 6.6 Church Road 45 40 287 6.4 Fortis Green 47 77 427 9.1 Hornsey Town Hall 51 100 452 8.9 Mildura Court 42 37 195 4.6 The Chestnuts 51 107 597 11.7 Lordship Lane 51 84 527 10.3 Park Lane 50 53 263 5.3 Total 380 538 3030 8.0 64 Child Welfare Centres There are ten Centres in the Area where child welfare clinics are held. The percentage of children under one year of age who attended for the first time during the year continued the improvement noted in 1956 and is now at the maximum level. Here mothers seek the advice and counsel of doctor and health visitor. The majority of children are weighed at each attendance and the combination of weight check and discussion on the child's beahviour, feeding, progress and general care continues to be the basis on which mothers anxieties and fears are dispelled. There are so many booklets and journals which publish information and articles on infant feeding and child care as to be confusing to many who read them. Mothers find that the child welfare centre is a good place in which to sort out and obtain information which will be useful for the individual child. Arrangements for vaccination and immunisation are also made at these centres. The continuance of this preventive work has eliminated many conditions which were common among children in the past and could well be present today without this service. There is no doubt that the standard of child well-being amongst those who attend the centres is very good indeed. In general the children who attend are healthy, but if treatment is necessary the matter is referred to the family doctor. Co-ordination between clinic, health visitor and family doctor grows steadily in cordiality to the advantage of all concerned. The following table shows details of attendances made at all centres during the year- Name of Centre No. of sessions held No. of first attendances under 1 year No. of attendances Total attendances No. of cases seen by M.O. Average attendance per session Under 1 year Over 1 but under 2 years Over 2 but under 5 years Burgoyne Road 152 300 4700 830 189 5719 1413 37.6 Church Road 153 252 3282 516 63 3861 1391 25.2 Fortis Green 152 320 4082 527 155 4764 1889 31.3 Hornsey Town Hall 206 508 6084 938 260 7282 2726 35.3 Mildura Court 105 271 3958 733 44 4735 1609 45.1 Stroud Green 100 240 3162 392 110 3664 1300 36.6 The Chestnuts 256 603 7129 1088 224 8441 2351 32.9 Lordship Lane 253 438 5942 1176 222 7340 1766 29.0 Park Lane 205 314 4813 910 199 5922 1693 28.9 Somerset Road 151 304 4292 797 139 5228 1701 34.6 Totals 1958 1733 3550 47444 7907 1605 56956 17839 32.9 Totals 1957 1691 3154 44667 7091 1980 53738 17017 31.8 Totals 1956 1660 2945 41816 6716 2208 50740 15758 30.6 65 Toddlers clinics These clinics continued to be held at all maternity and child welfare centres. During the year, owing to low average attendances, the Church Road clinic was changed from a weekly to a fortnightly one. It is usual for children between the ages of two and five years to attend these clinics. Many of them emanate from infant welfare clinics. For others it is more suitable and convenient to attend by appointment at intervals of approximately six months than to attend a busy infant welfare session. Every child attends by appointment and is seen by the doctor. Parents are most co-operative about these attendances and appear to be fully conscious of their value. It is now common for the child's parent to telephone the health visitor for another appointment if for any reason the child is unable to attend. Such action cuts down the number of follow-up visits which might be made by the health visitor and is evidence of the easy bond that exists between them. The aim of these periodic medical examinations is to maintain the health and well-being of the child until he reaches school age and is subject to medical examination provided by the school health service. Small defects are sometimes found and arrangements made for correction before further deterioration occurs. This visit also gives parents an opportunity of a quiet discussion with the clinic doctor on any matter of concern to them and the child. Numbers are limited in order to preserve the quiet unhurried character of these occasions. Most children enjoy these visits and are sometimes reluctant to leave. Suitable toys are always available and give obvious pleasure to these youngsters. The following table gives details of attendances at the individual clinics:- Name of Centre No. of sessions held Total attendances No. of cases seen by M.O. Average attendance per session Burgoyne Road 29 477 477 16.4 Church Road 31 402 362 13.0 Fortis Green 24 340 340 14.1 Hornsey Town Hall 61 631 630 10.3 Mildura Court 49 680 632 13.9 Stroud Green 24 307 307 12.8 The Chestnuts 50 597 584 11.9 Lordship Lane 51 644 629 12.6 Park Lane 50 437 436 8.7 Somerset Road 39 495 495 12.7 Totals 1958 408 5010 4892 12.3 Totals 1957 433 5407 5256 12.5 Totals 1956 449 5296 5207 11.8 66 Health Education A very important part of the health visitor/school nurse's work is the teaching of parentcraft and home making in schools, welfare centres, to individuals in their own homes, and to local organisations. Class teaching in schools (particularly secondary modern girls schools) in the Area has developed since 1950, until this year a total of 389 talks have been given in schools alone. This is a heavy but worth-while programme. The aim is that as many girls as possible shall take part in discussions and demonstrations on health and home making and acquire a knowledge of the services available to the family before leaving school. We have now reached the position where young mothers attending maternity and child welfare centres renew their acquaintence with health visitors from whom they have had guidance as adolescents. All maternity and child welfare centres in the Area hold mothercraft classes at weekly intervals at which health visitors lead the discussions among young mothers or expectant mothers. Advance programmes of the subject to be discussed are arranged at each centre. Film strips and other visual demonstrations are used to illustrate the subject under discussion. Home safety exhibitions were arranged at each maternity and child welfare centre to coincide with the national campaign on "Accidents in the Home". Tottenham Road and Home Safety Officer was very co-operative in supplying and transporting models to the three main maternity and child welfare centres. A number of health visitor/school nurses have also given talks to various women's clubs and have acted as lecturers and examiners for the British Red Cross Society's Cadets and young people s, mothercraft, first aid and home nursing groups. Daily Guardian Scheme This well tried scheme for the daily minding of children who are not eligible for admission to day nurseries has been in operation for eleven years. The number of guardians registered has always exceeded the demand, but this is useful providing they are well spread over the Area. It is essential from the working mother s point of view that the daily guardian s home should be within easy reach of the mother s home or work place. There are proper safeguards to ensure that both parents and guardians understand their responsibilities under the scheme and that a reasonably good standard of care is maintained. Health visitors are responsible for the selection and approval of guardians for registration and for periodic visits to the guardian's home after the child has been placed. The majority of children minded by this means are placed for comparatively short periods. 67 Daily Guardian Scheme Return for Year ended 31st December 1958 No. of Daily Guardians on Register 160 No. of Daily Guardians minding Children 73 No. of Children being minded 85 Total No. of Children minded during the year 175 Total No. of days minded 16628 Total Payments made to Guardians £831.8s.0d. Day Nurseries Day nursery accommodation for children of working mothers and others is still much sought, after and is easily the most popular method of daily minding. This year 39 applications for admission concerning 46 children had to be refused as not complying with the necessary conditions for admission. In all these cases either daily guardian or other arrangements were made. No application was refused where health or social conditions were such as to come within the scheme. There are, however, a substantial number of enquiries made by parents who wish to improve their position either by saving money for house purchase or similar purpose. During the year the number of coloured children admitted has increased and they attract attention in each nursery. Nursery matrons state that there are certain features connected with these children which call for different handling. Coloured children appear to take longer to settle in and are more demanding of staff time. They appear to be more affectionate, more vigorous and physically more mature. For this reason attempts have been made to up-grade them to the next age group, without success. Experience shows that they are more dependent, that their mental growth does not conform with their physical advancement and therefore they do not easily fit into the higher age group. These children are quite popular with the staff and the other children. Handicapped Children There has been a slight rise in the number of handicapped children admitted to the nurseries solely on medical grounds. They include hearing children of deaf parents who have the opportunity in the nurseries of developing a reasonably correct speech pattern instead of remaining retarded. Others include children who were disabled by p oliomyelitis, cerebral palsy and mental retardment. All these children have made very considerable progress. On the whole they are accepted and helped by the other children and the devoted attention of members of the day nursery staff. The acceptance of such children in a nursery involves certain adjustments such as arranging for individual responsibility for the care of the child and care in placing in the age group best fitted for their disabilities and giving them short periods with children in their own chronological age group. Most of the parents of these children are very cooperative but there are a few who would withhold the child from this treatment because of financial assessment to pay the nursery charges. 68 The following table shows the attendances at individual nurseries during the year:- Name of Day Nursery No. of approved places at end of year No. of children on register at end of year Total No. of attendances Average daily attendances Under 2 2 - 5 Under 2 2 - 5 Under 2 2 - 5 Total Stonecroft 15 53 17 54 3521 10176 13697 53.7 Park Lane 20 30 19 19 2498 5852 8350 32.7 Plevna 20 30 20 26 3613 6913 10526 41.3 Totals 1958 55 113 56 99 9632 22941 32573 127.7 Totals 1957 55 113 51 113 10084 20838 30922 121.7 Totals 1956 55 113 37 106 6940 21367 28307 111.4 Distribution of Welfare Foods There was a decrease in the issue of nutrients during the year as compared with 1957 which was expected owing to the increase in the price of National Dried Milk and the restrictions on the supply of orange juice operating during a full year. The arrangements for issuing welfare foods were substantially the same as in the previous year. National Dried Milk (tins) Orange juice (bottles) Cod Liver Oil (bottles) Vit. A & D. Tabs (packets) 1958 39005 104980 12571 10420 1957 48243 156962 17347 10545 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:- 69 The following table gives details of attendances made and treatment given at all clinics during the past three years:- 1958 1957 1956 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 174 562 190 568 234 670 No. referred for treatment 171 523 188 548 226 618 New cases commenced treatment 155 479 172 531 218 551 Cases made dentally fit 64 172 84 323 76 321 Forms of dental treatment provided:- Teeth extracted 274 432 205 432 235 506 Anaesthetics (a) Local 100 56 85 69 84 72 (b) General 36 187 36 175 39 213 No. of fillings 372 469 358 847 380 1169 No. of root fillings 1 - - - - - No. of inlays 1 1 2 - 1 - Scalings and gum treatment 108 - 76 - 128 - Silver nitrate treatment - 503 - 550 - 565 Dressings 126 150 86 338 163 674 Other operations 10 10 30 64 48 138 No. of radiographs (a) at County Council clinics 14 . 13 1 28 _ (b) at hospital 1 - - - 2 1 Denture dressings 178 - 112 - 179 - Dentures fitted:- (a) full 14 - 8 - 18 - (b) partial 29 - 32 - 39 - No. of attendances 758 981 634 1154 873 1583 No. of appointments not kept 145 186 187 227 193 247 No. of half days devoted to treatment 192 221 296 MIDWIFERY SERVICE (Section 23) At the end of the year nine midwives were employed in the Area, two of whom live and work in Hornsey. Seven of the midwives are approved teachers and during the year 21 pupil midwives were received for the district part of their training. As was foreseen there has been a considerable increase in the number of home confinements and the midwives each had a heavy case load. They have worked well together and have done much more than the usual quota of work laid down per midwife. The number of women delivered in their own homes totalled 698, while 98 women were nursed at home following confinement in hospital. The tendency is to send mothers home much earlier than previously and most were sent home on the second day following delivery. A small number were sent home a few hours after delivery. 70 In addition to duties in the clinic, ante-natal and other visits, the midwives undertook work in connection with the National Birthday Trust's investigations into the causes of perinatal mortality. The survey lasted over a period of three months, March, April and May. During the first week in March a detailed and comprehensive questionnaire was completed for every delivery and for the rest of the period, in the case of every death or stillbirth. It is significant of the midwives good relationship with their patients that no woman refused to complete the form although much of the required information was of a personal and intimate nature. This is an important investigation as the neo-natal death rate is causing concern throughout the country. The large number of removals into the Area, particularly in Stroud Green, has caused an increase in the number of late bookings and in the calls to the midwife of patients in labour who have made no arrangements at all. These latter cases are causing much concern amongst the midwives as they have no prior information about the patient s obstetric history and there is often difficulty in getting a doctor to attend such cases. A great deal of time is spent on these patients who usually contact every possible source of help when labour is well advanced and such a case recently involved the following services - police who visited the patient s house and the midwife s house, ambulance service who sent an ambulance to "stand by", an L.C.C. midwife who lived nearby, a midwife from Tottenham who was sent to the house. Two hospitals were also contacted. In addition telephone calls were received at a clinic, at three midwives' houses, at the Area Health Office and at the Supervisor of Midwives' house. The cost in time and petrol on such a case is considerable in addition to disrupting the normal work of the services involved. Transport With the present extreme shortage of midwives, it is vital that every midwife who is able to drive should have the use of a car, primarily because she is able to do more work in less time and also while working at such pressure to conserve her energy. An analysis of the work of the service during the past three years is shown in the table below:- 1958 1957 1956 No. of deliveries attended 698 555 509 No. of visits made 14730 12163 8846 No. of hospital confinements discharged before 14th day 98 76 38 No. of visits made 910 708 354 No. of cases in which medical aid was summoned 297 176 143 No. of cases in which gas and air analgesia was 431 400 administered 588 No. of cases in which pethidine was administered 483 322 265 No. of cases in which trichloroethylene was administered 65 46 33 71 HEALTH VISITING SERVICE (Section 24) The main work of the health visitor in the welfare centre and the home is well known and is concerned with the maintenance of health and well-being of each member of the family from the youngest to the oldest. Health visitors receive a great many telephone calls from parents, almoners, family doctors and others during the year. This direct and harmonious interchange between those concerned shows how much team work has advanced in recent years. The majority of these calls are requests for home visits, for advice or reports of one kind or another. Requests also come in for early visits to those being admitted or discharged from hospitals. Visits of this kind are increasing and give the health visitor an opportunity to prevent or relieve distress and provide a firm intermediate link between patients, their homes and hospitals. Local hospitals have provided medical reports this year on the condition of aged persons discharged from hospital and these have been of considerable help to health visitors in making the follow-up home visits. In the field of mental health a worth while experiment resulted from a talk given in March 1958 by Dr. J.C. Sawle-Thomas, Regional Psychiatrist to the North East Metropolitan Regional Hospital Board and Consultant Psychiatrist to the Prince of Wales's General Hospital, to members of the medical and health visiting staff on 'The implications of the Royal Commission Report on Mental Health". He made a plea for closer co-operation between hospital and local authority services. Later arrangements were made for a monthly case discussion session for health visitors in the psychiatric department at the Prince of Wales's General Hospital at which health visitors presented cases known to them of early signs of mental breakdown. It was not intended that the Consultant should see any patient who might be the subject of the case conference, except by referral from the family doctor, and no person concerned was asked to attend while the case was under discussion. The purpose of such case conferences is to assist health visitors to obtain a fuller understanding of mental health and methods by which health visitors can more adequately assist individuals and families: and are particularly helpful where families find it difficult to cope with a mentally sick adult or one nearing breakdown living at home. The first case conference was held in the late afternoon of 2nd June and at 72 monthly intervals for the rest of the year. These occasions have proved to be a very real help to health visitors who have presented cases and others who have attended as observers. It is perhaps too early to assess the effect this may have beyond emphasising that the conferences are fulfilling the purpose for which they were started and to state how fortunate we are to have the guidance and counsel of Dr. Sawle-Thomas at a time when a great many people are pondering on the effect that new legislation may have in this country. This is also the first year in which the health visitor has been able to refer young children directly to a psychiatrist specialising in child guidance. The health visitor makes appointments for parents to attend with the child and she is herself present throughout the interview. The psychiatrist (Dr. C. Phillips) attends one session a week to see children of under two years of age who are revealing early patterns of behaviour which cause disquiet or uneasiness for their parents. Children suffering from sleeplessness, feeding difficulties, retardment of speech, over-activity and other disorders have been seen. While it is common for mothers to be the sole parent present at the initial interview it is not at all unusual for both parents to attend subsequently or for fathers to offer to be present. Children, parents and health visitors have profited from these interviews although the reaction to the technique used varies considerably. Time cannot be allowed to be a pressing factor if the underlying motives for behaviour are to come to the surface. It is for this reason that a small number of interviews is arranged for each session. Student Health Visitors Eight students from Battersea Polytechnic, the Royal College of Nursing and County Council sponsored students were accepted for practical training during the year. Considerable care is taken in the preparation of their programme to ensure that they have as wide experience as possible of all the services which may have a bearing on their future work. Health visitors, education authorities, local voluntary bodies and the chief officers of various statutory services have been most co-operative in making this possible. Student Nurses Programmes of observation visits for student nurses from the Prince of Wales's General Hospital and from the Middlesex Hospital, W.l. have been arranged in the Area during the year. The visits follow lectures on Social Aspects of Disease" and are intended to give practical and visual illustration of work done in the public health field of the National Health Service. The intention is to give each student an opportunity to observe a different 73 aspect of the public health services so that as much as possible can be reported upon in the general discussions which are held when the student nurses return to hospital. Lectures During the year the Superintendent Health Visitor (Miss Townsend) gave eight lectures on the Social Aspects of Disease to student nurses in training at the Prince of Wales's General Hospital. A number of other talks to local bodies and one to a Ministry of Education Course for Western European Union delegates have also been given. Visitors Visitors to the Area include ward sisters from the Staff College of King Edward's Fund for London, student nursery nurses from residential nurseries, health visitor students from the Royal College of Nursing, student teachers, Barnardo s Home Office Course students, student sister tutors and others studying Occupational Health Nursing. Two Birmingham University social science students also attended and other small local groups of young people. The majority of these are interested in the health visitors functions and many of the programmes arranged for these visitors include actual experience with the health visitor. Voluntary Organisations Clinic premises have been made available to voluntary bodies, the National Blood Transfusion Service, the Family Planning Association and the Old people's Welfare Committee. The Family Planning Association has had the use of the School Clinic, Weston Park, Hornsey on Monday and Tuesday evenings each week and on Wednesday evenings at Lordship Lane School Clinic, Tottenham. Voluntary Workers. The secretaries and members of clinic voluntary workers have given considerable reliable and efficient service in Hornsey Maternity and Child Welfare Centres and are commended on their loyal support throughout the year. Specialised Visiting of Problem Families Two special services health visitors have undertaken this work for families in particular need. There can be no doubt that only health visitors of considerable vocation and experience are likely to continue in this sphere of distressing but rewarding work of rehabilitating problem families or those bordering on a "breakup" of family life. It is not enough to call to give advice since these families are generally incapable of acting upon advice without considerable support and assistance. Our experience has shown that it is necessary for the specialised worker 74 to be in the home a good deal to show the family what they can do for themselves and to wait upon the unfolding of concealed unsolved personal frustrations which are so often part of the source of the family s downfall. The state of the home is in general indicative of the level to which the family has descended and from which it must be encouraged to rise. It is no solution to arrange for the services of a home help or other person to do the work. Of those referred to the special services health visitors a substantial number of the parents are either suffering from mental defect, mental illness, physical deterioration, have been "in trouble" or "inside" or have a combination of two or more of these failings. Both special services health visitors received the greatest assistance and support from family doctors local clergy, statutory and voluntary agencies and individuals. All appear to have recognised the significance of this work and ar e very willing to be called upon for help. Every home visited showed evidence of the intensive work done with the family. The combined efforts of members of the family in redecorating their rooms does much to pull them together in making the best of their homes and giving them pride in their efforts. In general it is not easy to get them moving into doing this but once started they work well and have great pleasure in the results. Considerable debts have been accumulated by most problem families, but by constant encouragement these can be, in a comparatively short time, very substantially reduced. Saving in public funds Apart from uniting and rehabilitating the family into the community as a whole, the work of these visitors shows considerable saving in the expenditure of public monies on each family, as will be seen illustrated in the following two examples:- Weekly expenditure from public funds before being taken over by the Specialist Health Visitor Family A Father on N.A.B. £3.17s.6d. plus 15s.0d. rent £4. 12s. 6d. (Family allowances paid to the Children s Department) 6 children in care:- 3 in residential nurseries - approximate cost £30. 0s. 0d. 2 in residential homes - approximate cost £24. 0s. 0d. £58. 12s. 6d. Free meals to returned school children 15s. 0d. 3 children at day nurseries free (chargeable at full rate) £9. 15s. 0d. Expenditure entailed by keeping the family together for school meals and day nursery accommodation £10. 10s. 0d. This shows a weekly saving of public expenditure of £48. 2s. 6d. 75 Family B Mother ill and unable to cope. Five children in care:- 3 of these at approximate weekly cost £24. 0s. 0d. 2 of these at approximate weekly cost £20. 0s. 0d. £44. 0s. 0d. After the children returned home the following help was given 3 free dinners for school children 15s. 0d. 2 children in day nursery free (charged at full cost) £6. 10s. 0d. Home help 10 hours weekly (charged at full cost) £2. 0s. 0d. £9. 5s. 0d. Saving to public expenditure a weekly sum of £34. 15s. 0d. It will be seen from these two illustrations that support by public funds in the case of divided families is tremendously costly. By keeping the family together with some, but considerably less, financial expenditure, the family gains confidence, self respect and is happier than it is when separated. It would be too sanguine to think that every case can be entirely left to its own devices once the main difficulties have been settled. It is for this reason that the visitor slowly relinquishes her support and in some cases finds others to take her place in this respect. It is our opinion, however, that this work is very essential to the family in grave difficulties and to the community in which it lives. Statistics The following table shows the number of visits paid by health visitors during the past two years:- No. of visits paid by Health Visitors working in the Area 1958 1957 Expectant Mothers First Visits 1982 1781 Total Visits 3358 2850 Children under 1 year of age First Visits 4136 3759 Total Visits 16025 14568 Children aged 1-2 Total Visits 7771 7191 Children aged 2-5 Total Visits 12643 11952 Other cases - Total Visits as Health Visitor 6051 5489 Total Visits as School Nurse 911 983 76 HOME NURSING SERVICE (Section 25) The number of nurses employed in the Area at the end of the year was 19 full-time and 7 part-time, and again care of the aged sick made the greatest demand on the service. The total number of visits paid by home nurses during the year was 79286. The treatment of cases during the year may be classified asfollows:- Injections 1431 General nursing care 576 Blanket baths 354 Enemas 332 Dressings 324 Preparation for diagnositc investigation 186 Pessaries changed 58 Wash-outs, douches, etc. 42 Attendance at minor operation 1 Other treatments 152 The sex and age of patients at the time of the nurse's first visit may be classified as follows:- Age Males Females 0-4 21 15 5-15 39 36 16-39 88 179 40-64 372 631 65 and over 589 1203 1109 2064 Cases attended during the year were referred from the following sources:- General Practitioners 2363 Hospitals 789 Chest Physicians 18 Public Health Department 3 The shortage of car transport must again be emphasised in that only 25% of the nursing staff have any form of individual motorised transport, the remainder being dependent on bicycles and public transport. Co-operation with voluntary and other outside services has been well maintained and in particular with the British Red Cross Society who deal with the distribution of nursing equipment on loan, the W.V.S.,and the Old People's Welfare Organisations who have assisted in the supply of clothing and bed linen in approved cases. 77 Further details of the work of the home nursing service is shown in the following table:- 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 788 1306 2094 157 439 596 70499 Surgical 79 107 186 11 10 21 4874 Infectious Diseases 3 1 4 - - - 51 Tuberculosis 19 21 40 6 6 12 3850 Maternal complications - 2 2 - 12 Totals 1958 889 1437 2326 174 455 629 79286 Totals 1957 903 1707 2610 220 627 847 87851 VACCINATION AND IMMUNISATION (S ection 26) Vaccination against Smallpox The percentage of children under one year of age vaccinated against smallpox rose to 66.6%. The following table records the number of persons known to have been vaccinated or re-vaccinated during the year by general practitioners and clinic medical officers:- Under 1 year 1 year 2 - 4 years 5 - 14 years 15 years and over Total No. of primary vaccinations 2337 88 48 66 132 2671 No. of re-vaccinations 4 5 8 40 357 414 Immunisation against Diphtheria and Whooping Cough The policy of using separate vaccines in clinics for immunisation against diphtheria and whooping cough continued during the year. The following table shows a considerable increase in the number of children being immunised against diphtheria, and efforts are being made, in spite of administrative difficulties, to achieve equally satisfactory results in regard to whooping cough immunisation. 78 Age at date of Immunisation No. of children immunised Diphtheria only Combined Diphtheria & Whooping Cough Whooping Cough only No. of children given re-inforcing injection Diphtheria only Combined Diphtheria & Whooping Cougn Under One 1558 484 267 One 547 396 786 Two to Four 133 52 25 415 26 Five to Fourteen 247 8 7 1359 27 Fifteen and over - - Totals 1958 2485 940 1085 1764 53 Totals 1957 859 1658 283 655 52 Poliomyelitis Vaccination (a) Extension of Scheme As a result of Ministry of Health Circular 20/58, the poliomyelitis vaccination scheme was extended to persons born in the years 1933-42, so that infactall persons up to and including 25 years of age, as well as special categories of any age, became eligible for this protection. Publicity was given to the extended scheme during the week commencing 27th October, 1958 by means of advertisements in the local press, B.B.C. radio and television broadcasts, posters, car stickers and leaflets. General practitioners have been kept fully informed and have given valuable assistance in vaccinating patients who preferred to attend their own doctors' surgeries. In this Area an approach was made to all factories with more than 50 employees and as a result, leaflets explaining the scheme were distributed through pay packets. Many of the firms also asked for posters and car stickers which were immediately supplied. An experiment was tried with -'open" sessions on Saturday mornings at which eligible persons could attend without appointment and which were publicised in the local press. Four such sessions have been held but only 55 persons availed themselves of this opportunity. This scheme also provides for evening sessions to suit the convenience of persons who may be working and unable to attend during the normal day-time sessions. Only 17 persons, however, have asked for an evening appointment and as they are scattered over the Area and it would not be possible to arrange a session convenient for them all, they have been offered the alternative of approaching their family doctors or attending a normal day-time session. Three of the factories in the Area have asked for sessions to be arranged during working hours in their factories and some 300 persons will receive protection in this way. 79 (b) Third Injection The Ministry of Health also decided that third injections should be offered to all persons who had had two injections provided that the third injection was given not less than seven months after the second injection. Third injections were commenced at the beginning of October 1958 and by the end of the year 6,939 persons had received this extra protection. 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 1958 177 applications were received compared with 253 the previous year. Of these, 142 were approved. (c) Progress of Scheme Total number of persons receiving two injections during the period 1st January to 31st October 1958 either from general practitionc or at clinics:- 18,165 Vaccinations carried out during the period 1st November to 31st December, 1958:- No. of persons who completed a course of two injections during the period No. of applicants not yet vaccinated with one or two injections No. of persons who have received one injection only at any time up to 31.12.58 Children born in years 1943-1958 1591 1540 601 Young persons born in years 1933-1942 494 102 119 Expectant mothers 136 15 38 General practitioners and families 10 - - Ambulance staff and families 1 - - Hospital staff, medical students and their families vaccinated by general practitioners 25 Totals 2257 1657 758 In addition, 1,450 doses of vaccine were issued to general practitioners for first injections, but it will not be known into which of the above categories these fall until completed record cards have been received. 80 DOMESTIC HELP SERVICE (Section 29) The total number of cases provided with home help during the year was 1715, the bulk of the cases comprising 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 is realised that nearly 1000 patients 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 1957 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) 106 10 116 6 Tuberculosis 13 34 47 30 Chronic Sick (including aged and infirm) 481 941 1422 945 Others 118 12 130 13 Total 718 997 1715 994 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 five cases were served for a total of 96 hours. Training Scheme The scheme to give some instruction to home helps was continued during the year, three courses being arranged. 81 SCHOOL HEALTH SERVICE General The year was an extremely busy one for the school health service. Owing to the priority given to poliomyelitis vaccination the number of sessions devoted to periodic medical examinations had to be curtailed, the cut being made in the intermediate examinations as it was felt that the entrants and leavers examinations must be held. Despite difficulties the B.C.G. vaccination and diphtheria booster dose programmes in schools were proceeded with. Much credit is due to the clerical staff responsible for organising these overlapping programmes. That all the work is worth while is shown by the vital and infectious disease statistics for the area. The work of the cerebral palsy unit at Vale Road Day Special School for the Physically Handicapped continues to increase, 51 children being under supervision as against 44 in 1957. Further reference to the work of the unit will be found in the report of the Consultant on page 91. It appears likely that further provision for educable cerebral palsied children is likely to prove necessary at this School. The number of partially deaf children in attendance at the Senior and Junior partially deaf units continues to increase and discussions have taken place with a view to increasing the number of classes for these children. The work of the audiology unit has been rather hampered by lack of suitable facilities and by a delay in decisions as to the appointment of a permanent audiologist. Writing now in May 1959 it does appear that these problems will shortly be overcome. Routine Medical Inspection The following table shows the number of children inspected by years of birth and the classification of their physical condition. Year of birth Number of pupils Inspected Physical Condition of Pupils Inspected Satisfactory Unsatisfactory Number % Number % 1954 & Later 502 502 100.0 - - 1953 1163 1159 99.7 4 0.3 1952 373 370 99.2 3 0.8 1951 107 107 100.0 - - 1950 238 237 99.6 1 0.4 1949 1748 1743 99.7 5 0.3 1948 279 278 99.6 1 0.4 1947 512 511 99.8 1 0.2 1946 1925 1921 99.8 4 0.2 1945 890 887 99.7 3 0.3 1944 697 696 99.8 1 0.2 1943 & earlier 2665 2661 99 8 4 0.2 Total 11099 11072 99 8 27 0.2 82 Infectious Diseases in School Children With the exception of tuberculosis which showed a slight increase, the year 1958 was uneventful from the point of view of infection. Three cases of poliomyelitis occurred in unvaccinated children; two of the three were brothers and unfortunately one died and the other is still in hospital with residual paralysis. The third case made an excellent recovery. There were no cases of diphtheria and no outbreaks of food poisoning or dysentery during the year. B C.G vaccination Despite the special effort involved in carrying out poliomyelitis vaccination in 1958 it was felt that B.C.G. vaccination should be maintained as heretofore. Considerable difficulties were met in ensuring that the two schemes did not overlap. It might have been expected that parental response to offers of B.C.G. vaccination might have been less enthusiastic in the face of these difficulties. In fact this was not so and the proportion accepting, which had fallen slightly the previous year,rose again to a slightly higher level. which had fallen slightly the previous year,rose again to a slightly higher level. 1958 1957 % % Parents approached 3108 3256 Parents accepting 2185 70.3 2188 67,2 Number tested 2034 1917 Mantoux positive 297 14.6 203 10.6 % Strong positive 34.4 64.5 % Weak positive 65.6 35.5 Mantoux negative 1737 85.4 1714 89.4 Total vaccinated 1713 55.1 of children in group approached 1688 . 52.4 of children in group approached It is interesting to note that as a result of investigation of strongly Mantoux positive children and their families at the Chest Clinic two cases of tuberculosis were discovered; 1. a girl of 13 was Mantoux tested at school and found by X-ray to have early tuberculosis and was admitted to High Wood Hospital. In January 1959 she was reported as fit to return to school on chemotherapy. 2. a boy of 13 was found to be strongly tuberculin positive. His X-ray was clear but that of his father showed bilateral active pulmonary tuberculosis and he was admitted to hospital for treatment. 83 Tuberculosis in Schools During 1958 a total of six cases of tuberculosis were notified in school children, five pulmonary and one of bone. This compares with three in the previous year and seven and fourteen in 1956 and 1955 respectively. These cases were discussed with the appropriate chest physicians and in two instances epidemiological investigations were considered necessary at the school. 1. A case of pulmonary tuberculosis was discovered in a senior pupil at a special school in Tottenham. This boy's parents had not accepted the offer of B.C.G. vaccination for him. Following on consultation with the chest physician, it was decided to undertake epidemiological investigations at this school. As a result of skin testing, four children were found to be tuberculin positive. These plus seven children who had had B.C.G. and two who had tuberculous meningitis, in all of whom the tuberculin test was of no value, were referred for X-ray. In addition, all of the teaching and domestic staff were X-rayed. In all cases X-rays were negative, but in view of the highly infective nature of the primary case, the chest physician has asked for a repeat X-ray of the children early in the new year. 2. Following the notification of a case of tuberculosis in a girl attending a primary school in Hornsey, epidemiological investigations were undertaken at the school. As a result of skin testing of her classmates, all the children were found to be Mantoux negative and no further action was, therefore, necessary. All the teaching and domestic staff were X-rayed and found to be fit. School Nursing Service The field covered by the school nurse has included preparation for and attendance at routine medical inspections of schoolchildren, attendance at various specialist and minor ailment clinics, certain home visits to parents of school children including those required for the follow-up of defaulters from clinics, home reports for hospitals or for the giving of advice to parents. Every school was visited at the beginning of each term in order to carry out hygiene inspections and further visits were made as often as appeared necessary. School visits of this kind are an important part of the measures taken by the school nurse for the maintenance of the cleanliness and health of the school child. The discovering of minor defects and verminous conditions before these develop into matters of serious concern are the primary duties of the school nurse and are intended to fill in the gaps between routine medical inspections which occur on at 84 least three occasions in the life of each school child. Close contact between the head teachers, class teachers and the school nurse is maintained at all times. It may be the occasion when the nurse makes recommendations to the head teacher that the child should see his family doctor, attend a clinic or temporarily be excluded from school. The problem of reducing the number of vermin infested children in schools has been the grave concern of school nurses for many years and has taxed their resolution, patience, ingenuity and tact. It is not uncommon today for parents to seek the help and advice of the school nurse before the condition has had a chance to affect others and to submit each member of the family for scrunity in order to clear up the matter. This new commonsense attitude of parents appears to be replacing the old antagonisms and feelings of parental guilt associated with infestation. Family doctors and industrial firms have also been amongst those who have sought the assistance and advice of the school nurse. Modern insecticides, smaller families, health teaching and improved standards of hygiene in schools and home may be some of the factors which together have reduced the infestation figures, as shown in the following table - which together have reduced the infestation figures, as shown in the following table:- 1947 Homsey - Total number of examinations 21595 Total number of pupils found to be infested 105 1947 Tottenham - Total number of examinations 71251 Total number of pupils found to be infested 170 Total number of pupils in respect of whom cleansing notices were issued (Section 54, Education Act 1944) 16 1958 Homsey and Tottenham (combined figures) Total number of examinations 62927 Total number of pupils found to be infested 161 Total number of pupils in respect of whom cleansing notices were issued - The decline in the school nurse s work connected with verminous conditions and minor ailments has, to some extent, been replaced by work linked with B.C.G. and poliomyelitis vaccination campaigns. In general the trend of the school nursing service is more preventive in character than it has ever been. There is more opportunity for the school child to meet the school nurse as a friend with whom all sorts of things can be discussed unhurriedly. This is a healthier position from which the school child can view the machinery of the health services and may have far-reaching results. In the School for the Physically Handicapped a fulltime nurse is employed, and her duties regarded as an integral part of the life of the school. She sees the children into and out of school transport, deals with minor disorders, attends medical inspections, carries out treatment prescribed by the school medical officer and by visiting consultants. She also visits the homes of pupils where necessary; is present at school meals and takes part in out-of-school activities by accompanying school parties to various Saturday 85 functions. It may be said that her continued presence in the school relieves pupils and teachers from anxieties which are common to special schools of this type. Health Education in Schools Our programme of health education in schools has continued. This was started in co-operation with head teachers mainly because of concern about problem families and early marriages for which it seemed the adolescent had very little preparation. Also that general instruction on health was not fully covered by the normal school curriculum. Encouragement to develop and increase these programmes was given by the keenness of the children, demands from other schools and in at least one unexpected occurrence. Here a girl of a problem family who had been present at a series of health talks in the school arrived one day at a welfare centre. She told the health visitor that she had brought her baby sister to see her because she was worried about the child and while her mother allowed her to take the baby to the health visitor she could not be bothered to do so herself. During the year 389 talks were given in secondary modern schools. Health visitors and one school nurse with training and a special flair for teaching undertook this work. School Dental Service The Area Dental Officer (Mr. Sainty) reports During the past year the staff position, in addition to the Area Dental Officer, has been Full time Dental Officers to 31st July 6 Pull time Dental Officers thereafter 5 Part time Dental Officers 2 (equivalent to 9/llths of one full time appointment) Part time Orthodontist 1 There was a slight falling off in the number of school children attending for treatment and, consequently, in some categories of treatment. One reason for this may be that treatment is now more readily obtainable under the National Health Service than previously. Evidence of increased treatment outside the school dental service is seen at routine dental inspections and it is only natural that some parents may prefer to have their children treated by their family dentist. The fact that evening treatment is welcomed by many is shown by the continuing success of this at the dental clinic in the Park Lane Centre where it has been in operation for several years. This Area, in company with others, took part in the quinquennial survey of the Ministry of Education into the incidence of dental caries in school children. Two age-groups are involved - 5 year olds and 12 year olds. Previous surveys 86 took place in 1948 and 1953. In this Area 446 5-year olds and 740 12-year olds were inspected for this purpose. The long waiting list for treatment at the Orthodontic Clinic continues and there seems little prospect of improvement. The treatment of maternity and child welfare cases has continued as in recent years and there is nothing fresh to report. The following tables show the work carried out during the year:- SPECIAL DENTAL TREATMENT UNDERTAKEN BY DENTAL OFFICERS Number of impressions, etc, 251 Number supplied with dentures 55 Number of crowns and bridges 37 Number of inlays 15 Number of radiographs (a) at Dental Clinics 148 (b) at Hospitals . 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 5 240 146 146 5 - 16 and over 21864 12625 12602 Specials 3063 2917 2887 Total 25167 15688 15635 Number of pupils treatment commenced 8255 Number of pupils treatment completed 6412 Number of attendances made by pupils for treatrment 18684 Number of appointments not kept 4642 Number of half days devoted to (a) Inspection 161 (b) Treatment 2724 Fillings. Permanent Teeth 11951 Temporary Teeth 3209 Number of teeth filled. Permanent Teeth 10649 Temporary Teeth 3073 Extractions. Permanent Teeth 1192 Permanent Teeth for Orthodontia 137 Temporary Teeth 5172 Anaesthetics, (a) General 1672 (b) Local 2114 (c) Regional 154 Other operations (a) Permanent Teeth 2020 (b) Temporary Teeth 4064 87 ORTHODONTIC EXAMINATION AND TREATMENT AGE GROUPS TOTALS 5 6 7 8 9 10 11 12 13 14 + Number of pupils examined 2 5 11 12 30 23 23 23 14 9 152 Number of pupils selected for treatment 2 4 9 9 23 21 21 14 13 4 120 Number of pupils commenced treatment (first attendance) 401 Number of attendances made for treatment 3061 Number of consultations 48 Number of impressions, etc 4104 Number of fixed appliances fitted 24 Number of removable appliances fitted 246 Number of radiographs (a) at Dental Clinics 652 (b) at Hospitals - Number of pupils treatment completed 59 Number of orthodontic sessions (half-days) 407 The Handicapped Child Distribution as at 31st December 1958 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 - - 7 4 - - - - - - 7 4 Partially Sighted Pupils 3 4 2 - - - - - - - 5 4 Deaf Pupils 9 5 5 1 - 14 6 Partially Deaf Pupils 7 9 2 - 4 2 - - - - 13 11 Educationally Sub-normal Pupils 63 44 12 5 6 5 - - - 1 81 55 Epileptic Pupils - - 3 1 - - - 1 - - 3 2 Maladjusted Pupils - - 13 2 1 1 21 3 1 - 36 6 Physically Handicapped Pupils 17 9 5 - - 1 - - 2 1 24 11 Pupils with Speech Defects - - - - 230 104 4 2 4 2 238 108 Delicate Pupils 7 2 11 7 - - _ 1 - - 18 10 Pupils with Multiple Defects 5 4 2 1 1 - - - - - 8 5 Totals 111 77 62 21 242 113 25 7 7 4 447 222 Grand Totals 188 83 355 32 11 669 The Deaf Child During 1958 the International Congress on the Modern Educational Treatment of Deafness took place in Manchester at which many hundreds of delegates from all over the world attended. An opportunity was thus afforded of taking stock of our progress and of new trends in the educational treatment of the deaf child. 88 Ascertainment The first essential in any such programme is early ascertainment. The results of recent research have shown us the vulnerable groups in which to look for deaf children. Audiometry in school children by means of the gramophone and pure tone sweep test audiometer has become routine now in most of Great Britain. At the same time it should not be looked upon as an instrument of case-finding of severely deaf children. Case finding of such children should take place long before the age of compulsory school attendance. Professor and Mrs. Ewing have suggested a method of routine screening tests of hearing of all babies by health visitors. This method while crude does get results though there is evidence to show that the same results could be obtained by a more selective method of screening those at known risk. The audiology clinic plays a most important part in early ascertainment. By now the example set by such clinics as that at the Royal National, Throat, Nose and Ear Hospital, London, is well' known and it is generally agreed that an extension of these clinics to all parts of the country is required, Their aim is the detection of deafness in children at the earliest possible age and to give subsequent aid to the child and his family in overcoming the handicap. Auditory Training The necessity for auditory training is well recognised and accepted by all. Beyond this, however, is the great schism - at least in this country and apparently in the United States as well. There are those who 'hold these truths to be selfevident" - that all deaf children recognised early enough, fitted with a hearing aid and spoken to according to the recognised methods of auditory training, will learn to understand and reproduce spoken language without the necessity of education in a special school. There are some who will accept virtually no qualification of this assertion. Others reply that it is wholly false. An objective assessment of the results of this treatment is an urgent necessity. It is possible that the happiness and well being of some children is being sacrificed to what may be theory rather than fact. Prosthetics Advances in electronics have been astonishingly rapid in recent years with the risk of rendering expensive apparatus rapidly out of date. The cumbersome battery aids are being replaced by transistor aids. The induction loop system enables children to move freely about in class while still remaining in contact with the teacher's voice. Integration The undoubted achievements made possible by earlier and more accurate 89 diagnosis, auditory training and hearing aids have made the integration of deaf and partially deaf children into the hearing community and in particular in ordinary day schools, a very live issue. Many papers were read at last year's conference on this subject. At the same time it is widely felt in the educational field that the claims for results of such integration are exaggerated. There are undoubtedly cases where children theoretically able to manage in a hearing environment become maladjusted there and improve on removal to a special unit where they are able to mix with other children handicapped like themselves. It is also true that deaf adults left to themselves do tend to mix with other deaf persons although they are quite able to manage in a hearing community. The Noil-oral Child To the outsider there would appear no doubt that some children leave schools for the deaf unable to communicate orally with their hearing fellows. Various reasons have been given for these failures - late diagnosis, residential schooling as opposed to day schools, insufficient use of hearing aids, separation from the hearing community. Some teachers say they have no such failures. It may be, however, that for some reason, either of disordered physiology, or psychology, that some deaf children can never become oral and it is important to try and ascertain if this is so, to discover such children and to teach them appropriately by the best form of sign language. Such views are by some regarded as heresy but this should not deter the research worker. Conclusions There is need for further fundamental research into many problems of deafness A good deal of work is being done but it is either un-co-ordinated or ill-coordinated. It is felt that a central body should be set up to be responsible for overall planning of research, to draw up a list of priorities and to allocate research fields to the various centres engaged in research - both University and clinical centres.' If a lead were given by the Ministry of Education - the most appropriate body - other interested organisations such as the Medical Research Council, the National Institute of Teachers of the Deaf, the voluntary societies, the University centres and the school medical group of the Society of Medical Officers of Health would no doubt respond. 90 AUDIOLOGY UNIT No. Age Sex Reasons for referral F.H. Remarks Source of Referral Decision & Disposal 1 3 M ? Deaf ? Mentally defective N.K. Illegitimate School Medical Officer, Pinchley Not deaf Ineducable 1 2 9 M Suitability for Partially Deaf Unit. Maladjusted in ordinary school None High intelligence Audiology Unit Gray's Inn Road Junior Partially Deaf Unit. 13 10 M Suitability for Partially Deaf Unit N.K. Partially sighted Diabetic School Medical Officer, Ealing Blanche Nevile School 4 11 M Suitability for Partially Deaf Unit Erythroblastosis Epileptic School Medical Officer, Willesden Trial at Partially Deaf Unit unsatisfactory 5 1 1/12 M ? Deaf N.K, Cleft palate Illegitamate School Medical Officer, Southgate Deaf - for training 6 8 3/12 F Suitability for Partially Deaf Unit Nil Chronic suppurative otitis media School Medical Officer, Ealing Junior Partially Deaf Unit 7 12 M Suitability for Partially Deaf Unit Nil Educationally sub-normal Maladjusted School Medical Officer, Willesden Unsuitable for Partially Deaf Unit 8 11 M Suitability for Partially Deaf Unit Nil Backward London County Council Under consideration 9 13 F Transfer from Wales N.K. Backward School Medical Officer, Horns ey Senior Partially Deaf Unit 10 4 M ? Deaf ? Backward Nil - Paediatrician Backward Not deaf 11 11 M Suitability for Partially Deaf Unit. Lack of progress in ordinary school Nil Chronic suppurative otitis media School Medical officer, Potters Bar Senior Partially Deaf Unit 12 3 M ? Deaf ? Mentally Defective Nil Blind. In care of County Council School Medical Officer, Tottenham Not Deaf Mentally Defective 13 3 9/12 M Suitability for Nursery at Blanche Nevile School Nil - School Mfidical Officer, Hendon For Nursery Unit 14 11 M Suitability for Partially Deaf Unit Nil Meningitis School Medical Officer, Hounslow Senior Partially Deaf Unit 15 8 M Suitability for Partially Deaf Unit N.K. In Catholic Children's Home School Medical Officer Enfield Junior Partially Deaf Unit Number of children seen 15 Pre-school children 5 Attending infant and junior schools 7 Attending senior schools 3 Reason for referrals among these 15 children were as follows:- For diagnosis 4 Immigrants to Area, known to be deaf 1 Partially deaf children, advice as 7 to placement Children known to be deaf - 3 application for admission to nursery class, Blanche Nevile School or partially deaf unit. 91 Source of Referrals Tottenham and Hornsey 3 Other Boroughs in Middlesex 11 London - neighbouring Boroughs 1 Vale Road School for Physically Handicapped Children Cerebral Palsy Unit The number of children at the Vale Road School for Physically Handicapped Children at the end of the year was 94, of whom children with cerebral palsy, poliomyelitis or heart disease accounted for rather more than 75%. The aim of the school is, of course, to provide for each child so far as possible a normal education under the special conditions made necessary by his handicap. For such children, the requirements are normal schooling, medical treatment and modified activity, and in many cases each of these can be treated as a separate problem. The Consultant (Dr. Dunham) in charge of the children with cerebral palsy comments that the normal schooling and modified activity - together with out-of-school work and play - can all be "medical treatment", training in doing things of everyday life in a normal way. In the school, therefore, the aim of those whose special concern is with the 29 children with cerebral palsy is to help the children to learn how to tackle normal tasks in a normal way, and advise others how they also may do this. The team operates, therefore, in the classroom, the playground and the swimming baths, rather than in a "treatment room". Girls from South Grove School, who share domestic science, needlework and swimming with children from the school, collaborate in the work. Parents attend for advice. And, in order that normal habits of movement should be established from the first, special provision is made for parents of children too young to attend even the nursery classes to be given advice. The "medical treatment" provided is thus a co-operative effort by parents, teachers, nurse, therapist and doctor to carry out what may be called "training by the direct method". The Consultant wishes to pay tribute to the keen co-operative spirit of all engaged in the work. During the year advice has been given from the school on the management of 22 pre-school children, of two children attending occupation centres and of two children attending the Blanche Nevile School for the Deaf. Of the 22 preschool children, three are in attendance at County Council Day Nurseries. 92 Children seen for the first time at the Cerebral Palsy Unit in 1958 Case No. Age Sex Referred by Diagnosis Disposal 1 4 F School Medical Officer, Tottenham Congenital deafness Cerebral palsy generalised spasticity Blanche Nevile School, supervised by Dr. Dunham 2 4 4/12 F School Medical Officer, Hendon Mental retardation Referred back to School Medical Officer, Hendon 3 3 F Paediatrician Mental retardation, probably ineducable Minor motor defect Home care. ? institution later 4 2 4/12 F Area Medical Officer, Tottenham Mental retardation Minor motor defect Supervised at cerebral palsy unit 5 6 8/12 F School Medical Officer, Friern Barnet Cerebral palsy variable rigidity Mental retardation, probably ineducable Home care Occupation centre later 6 4 9/12 M School Medical Officer, Tottenham Psychological; post T.B M Child Guidance Clinic. Normal schooling 7 4 11/12 F School Medical Officer, Edmonton Cerebral palsy - generalised spasticity Vale Road P.H School 8 1% M Area Medical Officer, Homsey Minor motor defect Supervised at Cerebral Palsy Unit 9 5 F Paediatrician Cerebral palsy generalised spasticity. Probably mentally retarded Vale Road P.H. School 10 5 10/12 F School Medical Officer, Wood Green Cerebral palsy - generalised spasticity Vale Road P.H. School 11 2 11/12 M Area Medical Officer Hendon Mental retardation, probably ineducable Referred back to Area Medical Officer 12 7 M School Medical Officer, Wood Green Cerebral palsy variable rigidity Probably mentally retarded Vale Road P.H. School 13 9 7/12 F School Medical Officer, Tottenham Left hemiplegia Emotional problem Vale Road P.H. School 14 4 2/12 F Paediatrician Left hemiplegia (post influenzal meningitis). Epilepsy. Mental defective Occupation Centre 15 2 8/12 F Area Medical Officer, Tottenham Cerebral palsy. variable rigidity Waiting List for , Vale Road School 16 4 M School Medical Officer Tottenham Cerebral palsy generalised spasticity Mental retardation Waiting List for Vale Road School 17 5 6/12 M School Medical Officer Homsey Mental retardation Infants School For mental assessment 93 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. Ian M. Anderson, M.D., P.R.C.P., consultant paediatrician. There was a sharp fall in the number of new cases seen during the year, from 29 in 1956 57 to 9 in 1957/58. Of the nine new cases seen, six were female and three male and of the total, four were cases of congenital heart disease. 196 children remain on the register of the supervisory centre and of these 91 made 174 attendances, while in addition a number were seen in the ordinary paediatric out-patient sessions. These 196 cases are classified as follows:- These 196 cases are classified as follows:- Rheumatic fever 61 Rheumatic carditis 40 Rheumatic fever with chorea 1 Rheumatic carditis with chorea 5 Chorea - uncomplicated 5 Rheumatic arthritis 5 Congenital heart lesions 57 Rheumatic pains 1 Other cases 21 196 96 males 100 females Ear, Nose and Throat Clinics The visiting Aural Surgeon (Dr. F.P.M. Clarke) reports that the usual weekly sessions of the ear, nose and throat clinics have been held at Park Lane Medical Centre, Tottenham and at the Town Hall Centre, Homsey. The procedure at these clinics as regards administration, treatment and recommendations, has followed along the customary lines adopted in the past and discussed in previous Annual Reports. Age and Sex Distribution of Cases M F Total Under 5 years 4 6 10 5 -10 years 2 5 7 6 11 17 M F Total Cerebral palsy - educable or probably educable 2 4 6 Cerebral palsy with deafness " " - 1 1 Cerebral palsy - ineducable or probably ineducable 3 3 10 Mental defect with minor motor lesion 2 3 5 Post T.B. meningitis - psychological 1 - 1 Minor motor defect - probably normal 1 1 7 94 On average, there has been a very good attendance, of children, school and pre-school, at all the clinics throughout the year, and in those instances requiring special treatment over a long period attendance was equally good, almost all completing the courses prescribed for them. The results were, on the whole, very satisfactory and appreciated by the parents. The primary object of these special clinics since their establishment in the early twenties has been chiefly in the field of prevention. In no other group can the ideals of preventive medicine be better illustrated, or the excellent effects of its correct practice be more clearly demonstrated than among school and preschool children. It is well known that many of the chronic ailments and debilitating conditions met with among the adult public had their origin during school age, and are the results of undetected, or incorrectly treated, or neglected symptomatic predisposing factors in childhood. During childhood there are many signs, symptoms or "complaints" which may be considered only trivial by parents but which to the trained and competent observer indicate, if not treated a portent of serious consequences to follow - perhaps a permanent disability in later life. It is to these "complaints" among school and pre-school children that this preventive work can be most suitably adopted, by detecting, investigating and treating the very earliest stages of many diseases and abnormal conditions and thus prevent their development into a chronic form requiring perhaps later, radical surgical procedures. The frequency with which the early signs of certain serious defects occur in the ear, and nose particularly - less often in the throat - among children of school and even pre-school age would appear not to be sufficiently realised. They are often very slight but significant symptoms and may sometimes pass unnoticed or incorrectly appreciated. This tendency may be due to a too cursory general examination, or to the situation of the symptoms being remote from the ear or nose their relationship with their real site of origin is not suspected. As well, the symptoms may be slight and cause no great discomfort at this stage and so their presence is not regarded as of much consequence. In the case of the ear, perhaps the most common defect is deafness in school and adult life, which can be traced in very many instances to an otitis media, neglected or improperly treated during early school or pre-school years. We have found from experience that the correct treatment can be carried out satisfactorily only at the clinics. Home treatment is usually unreliable. Chronic deafness, t oo, can be due to abnormal conditions left untreated in the nose, such as "nasal obstruction", sinusitis, rhinitis, whose early symptoms are quite common in young children. They act by interference with the necessary aeration of the middle ear, or by the extension of infection into the middle ear and set up a suppurative otitis media which may progress to the chronic form and permanent deafness. The normal functions of the healthy nose owing to their controlling influence over the fine working of the chest organs, lungs, heart and circulation, certain abdominal organs, and the brain are of special importance in the maintenance of the health of body and mind. Many of the early signs of defects which interfere 95 with and upset these normal functions in later life are clearly discernible on close examination of the nose and naso-pharynx during school age. "Nasal obstruction" on account of its far-reaching and serious effects is perhaps one of the most frequent and important nasal defects to look out for during a school child's medical examination. It is very common and is, unfortunately, only too frequently overlooked. It is surprising how little understood are and how little attention is given to the widespread detrimental effects of defective nasal breathing; and it is all the more so when it is realised that a large number of the symptoms of nasal obstruction and impaired hearing originate during childhood and if at this stage were detected and correctly treated the whole train of widespread ill-effects and disease set up by their progressive development could be eliminated. It is well to emphasise here the importance and urgency of "following-up" the very earliest symptoms of ear trouble, otitis media and impaired hearing. Orthopaedic Service, Tottenham I am indebted to Mr. E. Hambly, F.R.C.S., for the following report:- "This clinic has been well attended during 1958- Any operative cases were done at the Prince of Wales5s General Hospital and referred back to the clinic again afterwards. The clinic has also provided for children from the Vale Road School for Physically Handicapped Children. These are mainly advanced cases of progressive muscular atrophy, spastic paraplegia and infantile paralysis all requiring most complicated splints and, in some cases, operative procedures. Dr. Dunham, who is in charge of the spastic unit at Vale Road School, is a very pleasant colleague to work with. Team work is the essence of treatment in the difficult cases, which comprise the majority of children in Vale Road School. I would like to pay tribute to the excellent work of the physiotherapists both for their work at the clinics and at the Vale Road Day Special School". Orthopaedic Service, Hornsey I am indebted to Mr. E. Palser, M.R.C.S., for the following report:- "During the year attendances at the Orthopaedic Clinic have been 698 for examination and 1,281 for treatment by the physiotherapist. The number of new cases was 283, and the number of discharges was a comparable figure. This represents an increase in the total work of the clinic, but a reduction in the number of new cases seen during the year. 96 The running of the clinic in its present form with the help of the Hornsey Central Hospital in taking X-rays and carrying out some patho logical investigations has been smooth and without complications which could not be dealt with under the present set up. The variety and degree of severity of the cases which the school medical officers have referred to this clinic shows an acute appreciation of the type of case we wish to see. A small number do not requite immediate active treatment but are still welcome, as they may require observation. The majority require treatment and receive it at the clinic. Some again require operative treatment. This year there were eight, and of these, seven have been admitted to the Orthopaedic Unit at Highlands General Hospital. The parents of the remaining one are unfortunately unable to make up their minds. This is unusual as the parents and children are usually most co-operative in carrying out the treatment suggested". Ophthalmic Clinic, Tottenham I am indebted to Mr. T.G. Kletz, M.B., Ch.B., D.O.M.S., for the following report:- "The work at this clinic in 1958 has been concerned mainly with refractions and squint cases referred from School Medical Examinations and the Minor Ailments Clinic and, to a lesser extent, cases of medical ophthalmological interest requiring treatment or investigation. A few cases of eye injury have also been seen. Age groups seen were from young infants of a few weeks to school leavers aged 18 years. During the year a number of pathological and congenital conditions have been seen, some of whom were referred to hospital for further investigations. A small number of new cases were registered as partially sighted, whilst some of the children already registered were issued with a spare pair of glasses where this was considered advisable. The question of unilateral visual defect being detected at routine school medical inspections is giving rise to some anxiety and I feel that if possible it would be advisable for the children to have each eye tested on a different chart. A number of cases arriving for refraction are found to have one extremely defective eye, but manage to memorise the chart and read off the letters which in fact they are not seeing. I set out below a few points of interest in respect of the ophthalmic and orthoptic clinics:- 97 Ophthalmic Clinic New cases, Under 5 years of age 110 Over 5 years of age 1486 Partially sighted registrations 3 (These include two brothers with myopic and congenital nystagmus) Congenital anomalies - New cases. Congenital cataract 1 Congenital nystagmus 3 Congenital gliosis of disc 1 Cases referred to hospital (excluding squints): For treatment Detachment of retina (traumatic) 1 Contusion of eye (traumatic) with hyphaema 1 Iritis and keratitis 1 For investigation and second opinion Suspected optic atrophy 2 Post haemorrhagic macular degeneration 1 Pseudopapilloedema 1 Of cases referred to this clinic 20 "squints" and 3 "Lazy eye were found to have no abnormality of either muscles or vision Ophthalmic Clinic, Hornsey I am indebted to Dr. R. Welch, M.D., for the following report;- "During 1958 I have been in charge of the eye clinics at Hornsey Treatment Centre and during this period they have been exceptionally busy. The cases seen are for the most part referred after routine school medical examinations, generally because of defective vision in one or both eyes. Others have symptoms suggestive of eye-strain such as headaches and blurred vision especially after close work. A smaller group of cases are those who have developed an obvious or Orthoptic Clinic No. of attendances 2628 No. of new cases 96 No. of cases treated 120 Of 73 cases continuing treatment Complete success - 34 - (a) Heterophoria 12 (b) Intermittent squint 16 (c) Constant squint 6 Improving 18 Failed to improve 21 Of 47 cases starting treatment in 1958 Complete success 16 Improving 25 Failed to improve 6 Total No. of occlusions - 46. Complete success 33 Partial improvement 9 Still on treatment 2 Failed to improve 2 98 suspected squint and as these are serious they are given priority in arranging appointments. Another class of cases examined at the clinic are those sent by doctors in charge of welfare clinics. The importance of the latter I shall show later. Where indications are present for doing a refraction. Atropine is used as a cycloplegic for very young children. For older children Gutt. Hyoscine or Gutt. Homatropine and Cocaine are used as a mydriatic so as not to interfere with their school work and progress. In many cases refractions are done without a mydriatic. Where necessary, glasses are prescribed and the child is kept under supervision and examined at appropriate intervals of about one year. This re-examination at intervals is necessary as during years of growth refractions often change, especially in cases of myopia. Supervision is also necessary to ensure that glasses are worn as prescribed and are in good repair and also to determine when glasses are no longer necessary. Incidentally I deprecate the practice of prescribing glasses for all and sundry errors of refraction as a routine practice. Only when specific indications for their need are present should glasses be prescribed. Attention is specially directed to those cases who are found to have a unilateral amblyopia - often unsuspected - whether it is associated with a manifest or latent squint or anisometropia. After correcting the error of refraction with the appropriate glasses, occlusion is immediately begun and the visual acuity, especially in the amblyopic eye, is reviewed weekly. Very close supervision of these cases is kept by the orthopist to ensure that the occlusion is efficient and not tampered with. Full explanations are given to parents as to the necessity and importance of this treatment and to secure their co-operation which is usually forthcoming. In this way, results obtained have been most satisfactory and visual acuity in the amblyopic eye has very often improved from 6/60 or 6/36 to 6/6 or near 6/6. This is followed by a course of orthoptic exercises to reestablish and maintain binocular vision. A most valuable part of the work at the clinics is the opportunity afforded of seeing very young children - sometimes infants - in the pre-school age. Squints can then be treated at their inception which in many cases alone can guarantee a successful result. Such cases - where squint appears in the first or second year of life and where there is a family history of a "lazy eye" - may develop an intractable and irretrievable amblyopia by the time school age is reached. It is gratifying to be able to see and treat these cases usually referred by the doctors at the child welfare clinics. Another type of case which is closely supervised at the clinic is the patient with progressively increasing myopia. Advice is given as to their management with a view to arresting it and where the clinical signs of progressive myopia are 99 pronounced and associated with poor vision, a partially sighted school is recommended. I am indebted to the orthoptist for her invaluable help in treating the above-mentioned cases of squint and also those who present symptoms due to anomalies of oculo-motor balance and who have not acquired full binocular vision". Child Guidance Service Dr. C. Phillips, M.R.C.S., D.P.M., visiting psychiatrist, reports:- "The year under review has seen the work of the Child Guidance Centres at Hornsey and Tottenham continuing in much the same way as has been described in previous reports. We have been fortunate in filling the somewhat longstanding vacancy for a part-time psychotherapist for the Tottenham Child Guidance Clinic, and this has greatly increased our facilities for treatment, since the time of her appointment in April 1958. Work with the treatment and investigation of behaviour disorders in children under five is going on, and health visitors have been encouraged to bring cases for consultation and treatment. A scheme is in progress whereby each health visitor in turn is present at the diagnostic interview and the subsequent treatment interview(s). By this means it is hoped to give them an insight into simple methods that can be used to deal with emotional disturbances in young children at the beginning before they have become difficult and complicated. It is hoped, too, that this will make a significant contribution to the prevention of illness in school children and consequently dimini sh the amount of instability in adults whose mothers have had the benefit of sound advice and help during the formative years". Speech Therapy Miss Came, Senior Speech Therapist, reports as follows:- '"Once again, many schools were visited in 1958. Their support and cooperation have been invaluable, Teachers show increasing awareness of the crippling effects of a speech handicap on emotional growth and/or educational progress. Infant school head teachers commonly consult the speech therapist about children with such difficulties. The head master and staff of Tottenham Grammar School have shown equal concern that every stammerer should receive treatment. In Hornsey, the speech therapist reports a less satisfactory position, possibly arising through staff changes in the past. She mentions that some children have not reached her until long past the optimum age for treatment. The dangerously unscientific statement "he'll grow out of it", may also account for some delayed referrals. A future survey of Hornsey children needing speech therapy is suggested." 100 Hospital Classes I am indebted to Mr. J. Power, M.A., Borough Education Officer, Tottenham, for the following report:- "The tuition of children at St. Ann's and the Prince of Wales's General Hospitals has continued during the past year under the two full-time teachers provided by the Tottenham Education Committee. An average of 29 long-term patients regularly receive tuition and in addition every effort is made to cater for children who are patients for shorter periods. At St. Ann's Hospital, a schoolroom is established in one of the wards in which those children who are well enough to be moved take their lessons. The schoolroom is very well equipped with school furniture, a library, a wireless set, an electric gramophone, etc. and the hospital authorities have provided a television set which can be used for school programmes. The Tottenham Library Service also assists in the provision of books. As the age of the children ranges from 5 to 15 years, teaching is mainly individual. Other children are taught at their bedside in a number of wards, including the poliomyelitis ward. In the latter ward there is a 17 year old girl who despite complete paralysis, has obtained a scholarship from the Swiss Foot and Mouth Painting Association. The Education Committee have arranged for an art teacher to give instruction in art twice weekly in this case and, as a result, arrangements are in hand for her to take the G.C.E. examination in art this year. Pour teaching sessions per week are given at the Prince of Wales's General Hospital. As far as possible, each child continues his school studies and to this end close liaison is maintained with the day schools. Encouragement is also given in the pursuit of hobbies which stimulate interest and avoid boredom. Interest in the Hospital Classes has been aroused by the publication of photographs in the national press. On the whole, the children are eager to have lessons while in hospital and, after returning to normal day school, many write expressing appreciation of the help given. The parents, too, welcome the knowledge that their children's education continues while they are in-patients. The classes enjoy the ready co-operation of the hospital staff which is so essential to the success of the scheme". Statistical Information Following are certain statistics relating to the work of the school health service not included in the body of the report. 101 SCHOOL HEALTH SERVICE STATISTICS FOR 1958 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) Year of Birth For defective vision (excluding squint) For any of the other conditions recorded Total Individual Pupils 1954 & Later 7 76 80 1953 31 171 196 1952 12 46 55 1951 7 8 14 1950 25 41 60 1949 187 234 384 1948 34 30 59 1947 99 68 155 1946 287 286 511 1945 111 113 190 1944 96 76 163 1943 & earlier 491 301 728 Total 1387 1450 2595 DEFECTS FOUND BY MEDICAL INSPECTION Defect Code No. Defect or Disease Periodic Inspections Special Inspections Entrants Leavers Total including all other age groups inspected (a) (b) (a) (b) (a) (b) (a) (b) 4 Skin 23 60 84 122 278 373 658 14 5 Eyes (a) Vision 52 25 494 50 1387 255 232 43 (b) Squint 45 14 24 4 179 47 11 5 (c) Other 6 5 12 7 54 54 158 6 6 Ears (a) Hearing 3 23 6 27 35 116 178 30 (b) Otitis Media 15 109 10 99 45 320 10 1 (c) Other 1 12 12 4 31 37 131 2 7 Nose and Throat 58 260 23 71 168 669 166 42 8 Speech 19 21 2 10 49 78 47 4 9 Lymphatic Glands 5 63 1 10 8 117 1 10 10 Heart 5 33 3 79 17 216 3 21 11 Lungs 39 82 24 86 114 294 50 39 12 Developmental (a) Hernia 4 5 1 - 7 12 1 1 (b) Other 1 4 3 8 16 68 26 9 13 Orthopaedic (a) Posture 4 18 19 77 58 232 14 15 (b) Feet 39 69 74 115 250 363 19 8 (c) Other 23 66 22 63 119 311 255 20 14 Nervous System (a) Epilepsy 1 2 5 5 16 20 6 5 (b) Other 1 7 12 20 23 60 8 1 15 Psychological: (a) Development 2 8 2 5 14 35 26 12 (b) Stability 5 32 3 86 23 308 24 24 16 Abdomen 8 17 - 12 28 59 18 21 17 Other 9 13 6 15 47 70 1031 53 (a) Requiring Treatment (b) Requiring Observation 102 TREATMENT OF PUPILS ATTENDING MAINTAINED PRIMARY AND SECONDARY SCHOOLS (INCLUDING NURSERY AND SPECIAL SCHOOLS) GROUP 1. Eye Diseases (e.g. blepharitis, conjunctivitis , Defective Vision and Squint Number of cases known to have been treated (a) External and other, excluding errors of refraction and squint 239 (b) Errors of refraction, including squint 2365 Total 2604 (c) Number of pupils for whom spectacles were prescribed 1152 GROUP 2. Diseases and Defects of Ear, Nose and Throat Received operative treatment for (a) Diseases of the ear - (b) Adenoids and Chronic Tonsillitis 200 (c) Other nose and throat conditions - Received other forms o f treatment 577 Total 777 Total number of pupils in schools known to have been provided with hearing aids (a) During the current year 5 (b) In previous years (excluding any pupils shown at (a) above who were provided with an aid in a previous year) 29 GROUP 3. Orthopaedic and Postural Defects Number of pupils known to have been treated at clinics or at out patient departments 1217 GROUP 4. Diseases of the skin (excluding uncleanliness) Ringwo rm (i) Scalp - (ii) Body 2 Scabies 9 Impetigo 46 Other skin diseases 1388 Total 1445 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) 114 GROUP 6. Speech Therapy Number of pupils treated by speech therapists under arrangements made by the authority 324 GROUP 7. Other treatment given (a) Number of miscellaneous minor ailments treated by the County Council 740 (b) Treatment other than (a) above and excluding convalescent treatment 269 103 PUPILS FOUND AT PERIODIC MEDICAL INSPECTION WHO HAVE UNDERGONE TONSILLECTOMY Year Birth Number of pupils inspected Number who have undergone tonsillectomy at any time Percentage of those inspected found to have had tonsillectomy Boys Girls Boys Girls Boys Girls 1954 & Later 269 233 9 2 3.3 0.9 1953 588 575 33 29 5.6 5.0 1952 166 207 18 11 10.9 5.3 1951 69 38 11 4 15.9 10.5 1950 107 131 16 16 15.0 12.2 1949 901 847 186 150 20.6 17.7 1948 136 145 24 22 17.6 15.2 1947 279 233 75 53 26.9 22.8 1946 1024 901 264 205 25.8 22.7 1945 460 430 99 85 21.5 19.8 1944 343 354 91 79 26.5 22.3 1943 & earlier 1450 1215 392 333 26.3 27.4 Total 5792 5309 1218 989 21.0 18.6 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 213 2. Number of instances in which the state of health was found to be such that certificates were withheld - 3. Number of children examined as to fitness to take part in entertainments 20 4. Number of cases in which certificates to take part in eTitertainnfents 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: 11 Sub-section 4: 2 Sub-section 5: 9 Cases de-notified under Section 8, Education (Miscellaneous Provisions) Act 1948 1 MEDICAL EXAMINATION OF TEACHERS (a) Number of Teachers examined as to fitness for appointment 7 (b) Number of Students examined as to fitness for first appointment 53 (c) Number of Students examined as to fitness to undertake training course 30 104 INDEX Page Aged, Welfare of 48 Ambulance Service 47 Ante Natal Clinics 62 Area Health Committee 3 Area Health Service 62 Area Health Staff 4 Area Welfare Service 47 Arteries, Diseases of 14 Atmospheric Pollution 28 Audiology Unit 90 Auditory Training 88 B.C.G. Vaccination 82 Births and Deaths 53 Births, Notification of 62 Burials 51 Cancer 14 Deaths, Table 59 Cerebral Palsy Unit 91 Certificates of Disrepair 35 Chest Clinic 9 Child Guidance Service 99 Child Welfare Centres 64 Chiropody Service - Old Peoples 48 Clean Air Act, 1956 28 Clearance Areas 32, 33 Closet Accommodation 28 Comparability Factors 54 Council, Members of 1 Daily Guardian Scheme 66 Day Nurseries 67 Deaf Child, The 87 Deaths, Classification of, Table 58 Defects Sanitary; Remedied 38 Demolition Orders 34 Dental Service, Priority 68 School 85 105 Page Diphtheria 12 Diphtheria Immunisation 77 Disinfection 15 Disinfestation 37 Domestic Help Service 80 Night Service 80 Training Scheme 80 Drainage and Sewerage 28 Dysentery 11 Ear Nose and Throat Clinics 93 Education Committee 2 Expectant Mothers, Care of 62 Eye Clinic 96 Factories 41 Fluoridation of Water Supply 26 Food - Condemned 21 False or misleading description of 24 Hawkers 17 Hygiene 16 Labelling 24 Poisoning 11 Prosecutions 20 Registered Premises 17 Sampling 22 Shops 16 Food Hygiene Publicity 20 Guardian Scheme, Daily 66 Handicapped Child, The 87 Handicapped Children 67 Hawkers of Food 17 Health and Housing Committee 2 Health Education 66 Health Education in Schools 85 Health Services provided by other Authorities 45 Health Visiting Service 71 Student Health Visitors 72 Student Nurses 72 Visits 73 106 Page Home Nursing Service 76 Hospitals 45 Hospital Classes 100 Housing 32 Housing Act, s. 9 and 10 32, 34 Individual Unfit Houses 34 Part III 32, 33 Ice-Cream 17 Immunisation, Diphtheria and Whooping Cough 77 Infantile Deaths 55, 57 Infectious Diseases in School Children 82 Infectious Diseases. Table of Cases 56 Insect Pests 37 Inspections carried out by Public Health Inspectors 37 Labelling of Food Order, 1953 24 Laboratory Service 47 Laundry Service for the Incontinent Aged 51 Lunacy and Mental Treatment Acts 47 Lung Cancer 14 Markfield/Stamford Hill Smoke Control Area - Map 30 Maternal Deaths 54 Maternity Services 62 Meals on Wheels 50 Measles 11 Meat Inspection 18 Medical Defects in School Children 101 Merchandise Marks Acts, 1887-1953 23 Midwifery Service 69 Midwives' Ante-Natal Clinics 63 Milk and Dairies 18, 24 Mothercraft Clinics 63 Mothers and Young Children, Care of 62 National Assistance Act, 1948, s. 50: Burials 51 Non-Oral Child, The 89 Notices Served 39 Nurseries, Day 67 Nursing, Home 76 107 Page Old People's Welfare 48 Ophthalmic Clinics 96 Orthodontic Treatment 87 Orthopaedic Service 95 Orthoptic Treatment 96 Out-Patient Clinics at Prince of Wales's Hospital 46 Outworkers 42 Parentcraft 66 Paratyphoid Fever 10 Personal Health Service 46 Pet Animals Act, 1951 36 Physically Handicapped Child, The 87 Poliomyelitis 11 Vaccination 78 Preserved Poods 17 Prevention of Illness, Care and After-care 79 Prince of Wales's Hospital, Out-Patient Clinics 46 Priority Dental Service for Mothers and Young Children 68 Problem Families, Specialised Visiting of 73 Public Health Department, Staff 3 Public Health Act, 1936 35 Prosecutions 40 Section 172 15 Prosthetics 88 Rag Flock and other Filling Materials Act, 1951 36 Recuperative Holidays 79 Rent Act, 1957 35 Repairs in Default 40 Respiratory Diseases 12 Respiratory Diseases Local and National Death Rates 13 & 14 Rheumatism Supervisory Centre 93 Rodent Control 36 Routine Medical Inspections 81, 101 Sanitary Circumstances of the Area 25 Scarlet Fever 10 School Dental Service 85 School Health Service 81 Routine Medical Inspection 81, 101 Infectious Disease in Schoolchildren 82 B.C.G. Vaccination 82 Tuberculosis in Schools 83 108 Page School Nursing Service 83 Sewerage and Drainage 28 Shops 43 Prosecutions 44 Slaughterhouses 16, 18 Slum Clearance 32 Smallpox 10 Vaccination 77 Smoke Control Areas 29 Speech Therapy 99 Staff Medical Examinations 52 Statistical Summary 53 Stillbirths 53 Superannuation Medical Examinations 52 Toddlers Clinics 65 Tottenham Corporation Act, 1952 35 Tuberculosis 7 B.C.G. Vaccination 82 In Schools 83 Welfare of Patient 9 Vaccination and Immunisation 77 B.C.G. 82 Diphtheria and Whooping Cough 77 Poliomyelitis 78 Smallpox 77 Vale Road School for Physically Handicapped Children 91 Cerebral Palsy Unit 91 Voluntary Organisations, Clinic Premises for 73 Water Supply 25 Welfare Foods, Distribution 68 Welfare Service, Area 47 Whooping Cough 11 Immunisation 77 Work in default 40 Published by the Tottenham Corporation, Town Hall, N.15, and Printed by their Public Libraries Department