Borough of Tottenham TOTTENHAM'S HEALTH 1959 The Annual Repot of the Medical Officer of Health Borough of Tottenham TOTTENHAM'S HEALTH 1959 The Annual Report of the Medical Officer of Health Town Hall, Tottenham, N. 15. August, I960. To the Worshipful the Mayor, Aldermen and Councillors. Mr. Mayor, My Lady, Ladies and Gentlemen, I have the honour to present to you my Annual Report on many aspects of the health of the Borough for the year 1959- Since the end of the last World War the Council has pursued, year by year, a vigorous policy of slum clearance and rebuilding, which has resulted in a notable improvement in the living conditions of very many families. In the matter of rehousing attention, too, has been directed to urgent cases of overcrowding; and the special housing needs of the aged and/or physically handicapped. This great improvement in housing together with better economic and employment conditions, is bound to be reflected in the future health and happiness of citizens of the borough generally. The attention of members of the Council is specially drawn at this time to an account at the end of this Report of the many-sided activities of the local personal and school health services, which prior to 1948 formed part of the functions of the Borough Council. The future administration of these services has been very much in the forefront in recent months; and much evidence in favour of the return of such functions has been submitted to the Royal Commission on Local Government in Greater London. In addition to acknowledging the assistance given by all who have contributed to the preparation of this Report, I wish to express my deep sense of gratitude to the Chairmen and Members of Committees concerned for their help and encouragement during the past year in maintaining the smooth running of the health services under their direction. I am, Your obedient servant, G. HAMILTON HOGBEN, Medical Officer of Health. 1 MEMBERS OF BOROUGH COUNCIL MAYOR Councillor A.J. Davies, J.P. DEPUTY MAYOR Councillor H. Langer ALDERMEN C.H. Colyer F.A.F. Keay, J.P. *A.F. Remington (Mrs.) E.J. Field *A.R. Turner Alderman The Lady Morrison R.W.H. Ford H.W. Turner W.S. Herbert *A. Reed, A.C.I.I., J.P. *R.H. Warren COUNCILLORS G.W. Barker E.V. Garwood S.C. Morris E.E. Brown (Mrs.) A.R. Gillham I.L. Peirce E.J. Brown, M.B.E. W-K- Gomm A.T. Protheroe E.J.J. Carter *L-R- Harrington, J.P. (Mrs.) *M.E. Protheroe (Mrs) A.W. *F.E. Haynes (Mrs.) A.W. Catley *P.H. Roberts *A.J. Lyne Douglas Clark J.R. Searle J.D. Mcllwain *E.J. Clook „ „ *S.A. Berkery Smith (Mrs.) *G.C. Marson L.H. Collis j Mather J- Watkins *E. Cooper A.A. Miller (Mrs.) (Mayoress) *J L- Williams E.P. Deakins *M.T. Morris J. Wolsey Note: * Indicates member of Health and Housing Committee. The Mayor and Deputy Mayor are ex-officio members. Committee Chairman ... Alderman R.H. Warren Vice Chairman ... Councillor J.L. Williams Totvn Clerk.: Medical Officer of Health: M. Lindsay Taylor, LL.B. G. Hamilton Hogben, M.R.C.S., D.P.H. 2 GENERAL STATISTICS Area of District (in acres) 3,013 Population: Census, April, 1951 ... 126,929 1958 1959 Mid-year:; Registrar General's estimate 117,700 116,100 Rateable Value at 1st April £1,742,841 £1,950,099 Sum represented by penny rate £7,030 £7,940 Approximate Number of Dwellings in District 30,790 30,741 Registered live-births : (a) Legitimate: Males 847 82 Females 779 7£ Total 1,626 1,61 (b) Illegitimate Males 58 78 Females 64 56 Total 122 134 (c) Total live-births Males 905 907 Females 843 854 Total 1.748 1.752 Birth-rate per 1,000 estimated population: 14.86 15.09 Stillbirths (a) Legitimate Males 6 15 Females 15 13 Total 21 28 (b) Illegitimate Males 4 2 Females 3 1 Total 7 3 (c) Total Males 10 17 Females 18 14 Total 28 31 Stillbirth rate per 1,000 total (live and still) births 15.77 17.39 3 Deaths: 1958 1959 Males 687 701 Females 632 651 Total 1,319 1,352 Death-rate per 1,000 estimated population 11.21 11.65 Maternal Deaths Puerperal Sepsis 0 0 Other puerperal causes 1 1 Total 1 1 Maternal Death-rate per 1,000 total (live and still) births .563 .561 Deaths of Infants under 1 year of age (a) Legitimate Males 14 24 Females 18 16 Total 32 40 (b) Illegitimate Males 3 2 Females 3 0 Total 6_ 2_ (c) Total Infantile Deaths Males 17 26 Females 21 16 Total 38 42 Infantile Death-rate per 1,000 live births 21.74 23.97 Movement of Population There is a continuous substantial movement of population both into and out of the Borough although since 1949 the outward movement has consistently exceeded the inward with a consequent steady fall in population. In 1959, although there was a natural increase in population arising from births exceeding deaths by 400, the Registrar General's estimate of population shows a reduction of 1,600 meaning that the outward movement of population was greater than the inward by 2,000. Since the 1951 Census the population is estimated by the Registrar to have fallen by 10,800. The fall in the electorate for the Borough over this period appears to confirm this. The number of dwellings has been more or less constant for many years so that the average number of persons per dwelling is steadily falling and now stands at 3.78 compared with 4.13 in 1951. 4 Classification of Deaths Deaths are classified under the 36 headings based on the abbreviated list under 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 or mental hospital where the deceased had been a patient for six months or more. 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 .99 for births and 1.06 for deaths. Birth-rate There has been a slow but steady recovery in the birth-rate during the past 4 years. In 1959 it reached 15.09 per 1,000 population, the highest since 1949- The highest post-war rate was in 1947 - 21.57 and the lowest 12.37 in 1954. Illegitimate Births It is a matter of concern to observe the growing percentage of illegitimate births in recent years. Of the babies born in Tottenham in 1959, 7.6% or one in thirteen, was illegitimate. This is the highest figure recorded during the past 40 years although 7.4% was recorded in 1945. Between the two world wars the rate never exceeded 4.6% and in only 5 years was 4.0% exceeded. Infantile Deaths A total of 42 deaths under 1 year of age is recorded by the Registrar General, giving a rate of 23.97 per thousand live births. Local records can be traced for only 41 and of these three occurred at home and the remaining 38 in hospital. Thirty-one of the deaths were perinatal deaths, i.e., they occurred in the firstweek of life, and a further 3 occurred in the firstfourweeks. The Causes (i) Prematurity. (17 deaths) Eight of these deaths occurred within 24 hours and seven others within 48 hours and a further two within a week. (ii) Congenital Malformation (10 deaths) The malformations included serious deformities of the heart, brain and spinal cord. (iii) Birth Injuries. (4 deaths) Two cases were due to cerebral haemorrhage and two cases to other intracranial haemorrhages. (iv) Atelectasis (4 deaths) These deaths occurred within two days of birth and in three cases were associated with prematurity. 5 (v) Diseases of Respiratory Tract. (2 deaths) One was due to pneumonia and occurred at three months. The remaining death was from staphylococcal pneumonia at two months. (vi) Other causes. (4 deaths) (a) Inhalation of vomit. Age 2 months. (b) Umbilical hernia. Age 5 hours. (c) Convulsions after artificially induced labour. Age 11 hours (d) Haemolytic disease of new born. Age 5 minutes Cancer Deaths In 1959 there were ten less cancer deaths than in the previous year but the corrected death rate of 2.60 per 1,000 population remains higher than the national rate which in 1958 was 2.10. Lung cancer caused seventy-two deaths, (64 males, 8 females) giving a corrected deathrate of 0.66 which is 50% above the national rate of 0.44 in 1958. Whilst cigarette smoking is an important contributory cause of this disease, there may be other factors giving rise to the much higher incidence in urban areas. Atmospheric pollution is now being tackled in an energetic manner and long term benefits should accrue, in the reduction of chronic respiratory diseases which are much more common in urban areas. Diseases of Arteries These include coronary heart disease, angina and vascular lesions of the central nervous system, and together account for just over a quarter of all deaths. It is to be expected that this should be so since they are often a consequence of the natural ageing process and as the proportion of older people increases a rise in death-rate from these causes will follow. In modern society there continues to be a high number of deaths due to these causes amongst people under 65 years particularly amongst males. In Tottenham 87 of the 369 persons dying between the ages 15 and 64 years arose from these causes and with cancer they accounted for 60% of all deaths in this age group. With the virtual conquest of so many communicable diseases more and more attention is now being focussed on the functional diseases but there remains much to be learned of both their cause and treatment before the rising trends are to be reversed. 6 INFANTILE DEATHS IN AGES AND SEXES DURING THE YEAR 1959 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- Bronchopneumonia - - - - - - - - - - - - - 1 - - - - - - - 1 - 1 Other diseases of respiratory system - - - 1 - 1 1 - Gastritis, enteritis and diarrhoea - - - - - Congenital malformation 1 1 - - - 1 - 2 - 5 - 2 1 - - 1 - - 1 - 10 8 2 Prematurity 8 2 5 - - -• 1 l - - 17 - - - - - - - - - - 17 9 8 Atelectasis 1 2 1 - - - - - - - 4 - - - - - - - - - - 4 3 1 Birth Injuries - 2 - 2 - - - - - 4 - - - - - - - - - - 4 3 1 Other causes 3 - - - - - - - - - 3 - 1 4 2 2 Total 13 7 6 2 - 1 1 l 2 - 33 1 3 2 - - 1 - - 1 - 41 26 15 (NOTE Although Registrar General's return shows 42 infantile deaths local records show only 41) 7 CLASSIFIED DEATHS OF TOTTENHAM RESIDENTS SHEWING AGE GROUB AND SEX DISTRIBUTION DISEASE Total Under 1 year 1- 4 5 - 14 15- 24 25 - 44 45 - 64 65 - 74 75 + M F M F M F M F M F M F M F M F M F Tuberculosis, respiratory 12 1 - - - - - - - - - - 6 - 4 - 2 1 Tuberculosis, other 2 - - - - - - - - - - - 1 _ - - 1 _ Syphilitic disease 1 - - - - - - - - - - - - - 1 - - - Diphtheria - - - - - - - - - - - - - - - - - - Whooping Cough - - - - - - - - - - - - - - - - - - Meningococcal infection - - - - - - - - - - - - - - - - - - Acute poliomyelitis - - - - - - - - - - - - - - - - - - Measles - - - - - - - - - - - - - - - - - - Other infective & parasitic disease - 1 - - - - - - - - - - - 1 - - - - Malignant neoplasm, stomach 26 26 - - - - - - - - 1 - 12 10 7 5 6 11 Malignant neoplasm, lung bronchus 64 8 - - - - - - - - 1 - 31 4 23 1 9 3 Malignant neoplasm, breast - 28 - - - - - - - - - 2 - 14 - 6 _ 6 Malignant neoplasm, uterus - 5 - - - - - - - - - - - 4 - - - 1 Other malignant & lymphatic neoplasm 61 62 - - - - - - 1 1 2 1 16 21 22 17 20 22 Leukaemia, Aleukaemia 2 2 - - - - - 1 - - - 1 1 . 1 . . . Diabetes 4 5 - - - - - - - - 1 - 1 1 1 1 1 3 Vascular lesions of the nervous system 63 80 - - - - - - - - - 2 14 8 18 23 31 47 Coronary disease, angina 138 89 - - - - - - - - 4 1 42 16 54 33 38 39 Hypertension, with heart disease 3 23 - - - - - - - - - - 1 3 - 6 2 14 Other heart disease 54 94 - - - - - - - - - 4 6 15 11 15 37 60 Other circulatory disease 24 41 - - - - - - 1 - - 1 6 3 8 13 9 24 Influenza 3 5 - - - - - - - - - - 2 1 1 3 - 1 Pneumonia 53 36 1 1 - - - - - - 2 1 9 4 13 8 28 22 Bronchitis 62 31 - - - - - - - - - - 15 3 26 9 21 19 Other diseases of respiratory system 9 2 1 - 1 - - - - - - - 4 - 1 2 2 - Ulcer of stomach & duodenum 10 8 - - - - - - - - 1 - 3 2 2 - 4 6 Gastritis, enteritis & diarrhoea 1 6 - - - - - - - - - - - 1 1 71 - 3 Nephritis & nephrosis 4 4 - - - - - - - - 2 - - - 1 4 1 - Hyperplasia of prostate 6 - - - - - - - - - - - - - 2 - 4 - Pregnancy, childbirth & abortion - 1 - - - - - - - 1 - - - - - - - - Congenital malformations 8 3 7 2 1 - - - - - - 1 - - - - - - Other defined & ill defined diseases 54 63 17 12 - - - 2 1 - 4 2 8 12 15 16 9 19 Motor vehicle accidents 9 4 - - - 1 - - 2 - 2 - 2 1 1 _ 2 2 All other accidents 13 18 - 1 - 1 - - 3 . 3 - 3 3 1 3 3 10 Suicide 15 5 - - - - - - - - 4 - 4 2 5 3 2 - Homicide & operations of War - - - - - - - - - - - - - - - - - - Total 701 651 26 16 2 2 - 3 8 2 27 16 187 129 219 170 232 313 00 CANCER DEATHS 1959 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 - - - - - Digestive Organs and Peritoneum 53 56 - - - - - - - - - - - - 2 - 7 5 13 13 15 13 12 18 4 7 Respiratory system 66 9 - - - - - - - - - - - - 1 - 10 1 20 3 25 2 10 2 - 1 Breast and Genitourinary system 16 47 - - - - - - - - - - - - - 2 - 9 2 16 7 8 6 10 1 2 Other and unspecified sites 11 14 - - - - - - 1 - 1 4 2 2 2 2 6 1 2 1 1 Lymphatic & Haemato poietic Tissues 5 5 - - - 1 - - - - - 1 1 - - 1 1 - 1 2 2 - - - - - TOTAL 153 131 - - - 1 - - 1 - 1 1 - 3 4 22 17 38 36 53 29 29 32 6 11 9 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 *1940 119,400 1,703 14.26 1,666 (a) 13.95 64 41.05 20 103 28 178 19 225 1,559 (b) *1941 105,620 1,418 13.43 1,560 (a) 14.77 61 46.35 13 103 73 161 28 194 1,316 (b) 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 1947 124,830 129,140 1,491 1,461 11.94 11.31 2,580 2,785 20.67 21.57 88 76 34.11 27.29 13 24 323 272 83 22 198 171 24 18 266 223 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 2,29,400 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 10.90 1,511 12.38 25 16.55 1 75 1 126 18 308 1956 120,700 1,252 10.40 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 1959 116,100 1,352 11.65 1,752 15.09 42 23 97 1 122 - 71 15 284 NOTE: * 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 infantile death rates. 10 CERTAIN VITAL STATISTICS FOR THE YEAR 1959 District Estimated population mid-1959 Live birth rate per 1000 population Death rate per 1000 population Specific death rates per 1000 population Infant mortality per 1000 live births Crude Adjusted Crude Adjusted Coronary disease, angina (a) Cancer (a) Infant (a) Neo-natal (a) (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) Acton 64,800 16.0 15.2 11.6 11.8 2.1 (134) 2.1 (136) 19.2 (20) 17.3 (18) Brentford and Chiswick 56,970 14.3 13.6 10.5 10.5 1.8 (104) 2.1 (121) 27.1 (22) 22.2 (18) Ealing 182,700 14.7 14.3 10.8 11.7 1.9 (341) 2.2 (393) 16.7 (45) 12.6 (34) Edmonton 94,420 13.6 13.6 10.9 12.1 1.6 (152) 2.4 (231) 23.3 (30) 20.2 (26) Enfield 109,700 13.4 13.4 10.1 10.8 1.5 (167) 2.1 (227) 19.7 (29) 14.2 (21) Feltham 51,750 15.6 15.0 8.6 13.5 1.3 (69) 1.4 (71) 24.8 (20) 19.9 (16) Finchley 68,920 13.5 13.0 11.5 10.4 2.0 (136) 2.4 (164) 20.4 (19) 13.9 (13) Friem Barnet 28,660 12.0 13.4 14.8 10.5 2.0 (57) 2.3 (66) 43.6 (15) 40.7 (14) Harrow 213,700 13.7 14.1 9.7 11.4 1.8 (379) 2.1 (444) 15.0 (44) 11 6 (34) Hayes and Harlington 68,670 16.2 15.2 8.0 13.0 1.5 (104) 1.8 (122) 18.0 (20) 14 4 (16) Hendon 151,500 13.0 12.5 10.9 11.6 1.9 (286) 2.3 (347) 19.3 (38) 16.3 (32) Heston andlsleworth 105,000 12.1 12 1 10.9 11.1 1.7 (181) 2.2 (227) 16.5 (21) 14.1 (18) Hornsey 96,430 18.0 16.7 12.3 10.9 2.4 (227) 2.3 (225) 24.8 (43) 21.4 (37) Potters Bar 22,750 16.0 14.2 8.8 12.2 1.6 (37) 1 5 (34) 19.3 (7) 8,3 (3) Ruislip and Northwood 75,330 13.4 13.4 8.2 10.3 1.4 (106) 19 (143) 16.8 (17) 12 9 (13) Southall 52,900 14.0 14.6 12.1 11.4 2.2 (114) 2.1 (113) 22 9 (17) 17.5 <13) Southgate 70,680 12.0 13.0 13.3 10.9 2.5 (177) 3.0 (211) 15.3 (13) 12 9 (11) Staines 47,910 18.7 17.2 9.6 12.2 1.7 (82) 2.0 (97) 15.7 (14) 13.4 (12) Sunbury 29,710 19.4 17.3 10.7 12.3 1.3 (38) 2.3 (68) 17.3 (10) 12.1 (7) Tottenham 116,100 15.1 14.9 11.6 12.3 2.0 (227) 2.4 (280) 24.0 (42) 19.4 (34) Twickenham 103,600 13.2 13.6 12.1 11.5 2.3 (237) 2.2 (229) 16.8 (23) 12,4 (17) Uxbndge 63,730 16.7 15.0 9.1 11.7 1.5 (93) 1.7 (110) 19 7 (21) 19,7 (21) Wembley 126,300 12. 6 12.7 9.7 11.3 1.9 (237) 2.2 (278) 14.4 (23) 13.2 (21) Willesden 172,800 19.6 18.2 10.5 11.9 1.8 (303) 2.4 (420) 19.5 (66) 14.5 (49) Wood Green 48,520 14.1 14.2 12.4 11.9 2.1 (104) 2.9 (141) 20.5 (14) 14,7 (10) Yiewsley and West Drayton 23,450 18.8 16.9 7.4 10.7 1.4 (34) 1.7 (41) 18.1 (8) 13.6 (6) COUNTY (1959) 2,247,000 14.7 14.4 10.6 11.4 1.8 (4126) 2.2 (4939) 19.4 (641) 15.5 (514) England and Wales (1959) 45,386,000 16.5 11.6 N/A 2.1(97116) 22.0(16471) 15.8(11881) NOTE (a) Absolute numbers are given in parenthesis in addition to rates to afford valid comparison. 11 SANITARY CIRCUMSTANCES OF THE AREA Water Supply Dr. E. Windle Taylor, Director of Water Examination of the Metropolitan Water Board 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 1959- 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 in the following tables. 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 radioactivity and monitoring of the Board's supplies, this matter is dealt with fully for the first time in my 38th Report for the years 1957-58, page 8. This is rather too long to quote in full, but to compress the results into as brief a space as possible, one may say that up to the present the amount of strontium-90in the Board's river-derived waters is a small fraction of one micro-micro curie per litre and in the underground waters there is none at all. Such traces as have been found are quite insignificant compared with the concentration considered by competent authorities to be permissible. Regular monitoring is carried out on all the Board's sources of supply but during these early phases the procedure of sampling and analysis is liable to frequent modification as new knowledge is acquired." Fluoridation of Water This subject continues to be of great interest in the Borough where the natural fluoride content in the water supplies is .2 milligrammes per litre. Small traces of this substance of the order of 1 milligramme per litre have been found by experience in other countries to be of great benefit in the promotion of dental health and so far as can be ascertained, no harm is caused by drinking water with this concentration of fluoride. 12 Although demonstration trials have been proceeding in some areas in this country since 1956 there is no indication of any immediate Government pronouncement of national policy. My Council, after considering representations from a local organisation, were of opinion that the experience gained in other countries was sufficient to justify the immediate implementation of a policy to bring the fluoride content of water up to an approved standard. They accordingly made representations to the Ministry of Health and to the Metropolitan Water Board. In addition the support was sought of local authorities whose districts were served by the Metropolitan Water Board. Thirty agreed with Tottenham's view and a further three gave conditional support, but the Metropolitan Water Board were not prepared to act until some Government pronouncement was made in the light of experience gained in the demonstration areas. The Ministry replied that in view of the fact that the demonstrations at present taking place have only been running for a comparatively short period, the Government would not wish to give any general encouragement to the initiation of new fluoridation schemes for the time being. At the same time the Ministry advised that because of the highly controversial nature of this measure there should be a long period of preparation particularly in the field of public relations before the introduction of fluoridation. The comments of the Board and the Ministry were received with regret by this authority, and further representations for a speedier action were also unsuccessful. It is noted from the 38th Report of the Board's Director of Water Examination, Dr. E. Windle Taylor, that experimental trials have been proceeding to find the most accurate and efficient technique for supplementing the natural fluoride content, if and when the Board so decide. Drainage and Sewerage Separate soil and surface systems of drams and sewers continue to operate in the Borough. Work on the East Middlesex drainage scheme is still in progress but it is not yet known when the pumping station will cease to function. The work on flood relief schemes continues and the benefits of this are now being felt during the heavy summer storms. 13 AVERAGE RESULTS OF THE CHEMICAL AND BACTERIOLOGICAL EXAMINATION OF THE WATER SUPPLIED TO THE BOROUGH OF TOTTENHAM FOR THE YEAR 1959 (Milligrams per litre (unless otherside stated)) Description of the Sample No. of Samples Amnonia Nitrogen Album, inoid Nitrogen Oxidised Nitrogen (Nitrate) Chlorides as CI Oxygen abs. from Permanganate 4 hrs. at 27°C- Turbidity in terms of Silica Colour m.m. brown 2ft. Tube Burgess s Tintometer Hardness (Total) Hardness (ncncar bonate) PH Value Phosphate as P°4 Silicate as Si02 Sulphate as so4 Fluoride as F Magnesium as Mg. Potasium K Electrical Conductivity (gemmhos) New River water fil tered at Homsey and/or Stoke Newington works 104 0.018 0.050 5.4 32 0.50 0.1 5 298 70 78 0.55 12 59 0.2 50 625 River Thames derived filtered water 386 0.030 0 074 3.6 28 1.04 0.4 9 254 56 7 8 0 90 9 54 0.2 4.0 525 Park well 3 160 ,034 0.1 21 0.20 1.8 10 278 74 7 4 6 0 525 BACTERIOLOGICAL RESULTS - YEARLY AVERAGES, 1959 BEFORE TREATMENT - AFTER TREATMENT Number of samples Agar plate count per ml. Coliform count Escherichia coli count Number of samples Agar plate count per ml. Coliform count Escherichia coli count 20-24 hours at 37°C. 3 days at 22°C. Per cent samples negative in 100 ml. Count per 100 ml. Per cent samples negative in 100 ml. Count per 100 ml. 20-24 hours at 37°C. 3 days at 22°C. Per cent samples negative in 100 ml. Per cent samples negative in 100 ml. New River water filtered at Homsey works and/or Stoke Newington works 514 4.8 99.61 100.0 River Thames derived filtered water 3344 9.8 99.46 99.97 Park well 145 0.5 5 80,69 0.6 98.62 - 147 0.2 2 100 0 100.0 14 Public Baths and Laundry Services The Baths Superintendent, Mr. P.E. Lusher, B.E.M., has kindly supplied the following report on the public baths and laundry services. Establishments CENTRAL BATHS; Opened 1904 2 Swimming Baths, 100 ft. x 35 ft. 75 ft. x 25 ft. 34 Private Baths Municipal Hall EstabHshment Laundry THE LJDOj Opened 1937 Open Air Pool 165 ft. x 75 ft. Restaurant CONWAY ROAD BATHS Opened 1926 18 Private Baths BROMLEY ROAD Opened 1932 Public Laundry 14 Private Baths TIVERTON ROAD Opened 1932 Public Laundry 22 Private Baths Indoor Swimming Baths Swimming as a recreational facility has achieved considerable popularity in recent years, in fact the demand now exceeds the accommodation available during hot summer months. Indoor bathing in Tottenham is provided at the Central Baths only. There is a large swimming pool, 100 ft. x 35 ft., and a small pool 75 ft. x 25 ft. In common with most baths of the period (1904) these were never designed to cope with the present demand. Whereas the pool dimensions are adequate for day to day use, dressing room accommodation is extremely limited. Notable improvements have been, and are, taking place in the large pool which is converted to a public hall in the winter months. Such improvements are provided for in an ambitious modernisation project. Excessive noise by children in swimming pools discourages adults from attending indoor pools. This was an important factor overlooked by the designers of fifty years ago. Now that the first phase of the Central Baths modernisation project is completed the reverberation factor has been reduced considerably. A major item of the first phase was the new ceiling works. The entire ceiling has been cased and sprayed with an acoustical material which will absorb sound and also reduce condensation to a minimum. The second phase of the modernisation project includes a heating and ventilating system which will overcome all these defects and maintain comfortable conditions within the hall at all times. New collapsable cubicles are also scheduled to be installed during the current year and the materials employed will obviate the necessity of periodical redecoration. Vertical stainless steel steps have been installed to afford access to and from the pool thus replacing the cumbersome wooden steps which had the disadvantage of obstructing competitors at aquatic functions and also required annual maintenance in respect of repairs and painting. A tubular steel diving stage, designed and constructed by the Department, has been installed also a springboard which is easily removable when not required. 15 The height of the new diving stage is lower than the cumbersome structure which it has replaced, this being necessary in the interest of safety in view of the depth of the water (6ft.) available. Purification of Swimming Pool Water The capacity of the large pool is 105,000 gallons and the small pool 50,000.gallons. The total capacity of 155,000 gallons is continuously filtered and sterilised at the rate of 40,000 gallons per hour. Thus it will be seen that the total capacity of the pools is treated every four hours. Sterilisation is by chlorine and sufficient residual is maintained in the water at all times to destroy all harmful bacteria which may be introduced by bathers. Frequent and regular tests are taken daily to ensure that the water is maintained in accordance with the standards laid down by the Ministry of Health and samples taken for analysis by the department of the Medical Officer of Health have consistently indicated a highly satisfactory condition of chemical and bacterial purity. The water supply for all services except the drinking water is drawn from a bore hole 421 ft. deep. Whereas the transmission of waterborne disease through contact with swimming pool water is infinitely remote the problem of maintaining the pool surrounds and cubicles free from contamination is difficult if not impossible while dressing accommodation is not apart from the precincts of the po ols. Unfortunately there is no practical solution to this problem in the large pool but the accommodation in the small pool may well be separated by the construction of adj oining dressing rooms to serve the small pool only. This scheme is under consideration by the Baths Committee. The general appearance of the swimming pool water, more often than not, reflects the condition or "quality" of the water. It is to be noticed that while the small pool consistently indicates an almost crystal clear bluish colouring, the large pool presents rather uninviting water with a greenish tinge and lacking sparkle. While the latter conditions often indicate a sub-standard quality it is not so in our case. The cause of this illusion is the glazed brick floor of the pool which has long since lost its white relective properties. Open Air Pool The Lido becomes a popular resort at the height of the summer season and our patrons are drawn from many parts of the North London Area, and as many as 5,600 persons have passed the turnstiles in a single day. The pool itself measures 165 ft. x75 ft. with depths varying from 3 ft. to6 ft. A recessed diving area 60 ft. x 18 ft. with a depth of 10 ft. provides for a five metre diving stage with intermediate firm boards and springboards at 1 and 3 metres. The total capacity of the pool is 490,000 gallons and is continuously filtered and sterilized at the rate of 90,000 gallons per hour. Samples taken for analysis by the department of the Medical Officer of Health have consistently indicated a high standard of bacterial purity. This establishment's water supply is drawn from the town mains. 16 Swimming Instruction for Schools Facilities for the instruction of classes during school hours continues throughout the year. Full time instructional staff, employed by the Education Authority, are available for the tuition of primary school children who utilise the small pool. The Committee have recently afforded exclusive facilities to schools attending the small pool between 9 a.m. and 4 p.m. During the summer months, secondary and grammar schools attend the large pool. When conditions are suitable instruction is also undertaken at the Lido. Special facilities are afforded to physically handicapped children of the Vale Road Day Special School. Swimming Proficiency Tests The Baths Committee continue to offer inducements to scholars who make progress in swimming and free passes, valid for one year, are awarded to those passing a suitable test during their first year of tuition. Such awards are restricted to scholars attending Junior Schools. Eighty-two Awards were made during the year 1958/1959. Swimming Clubs The swimming pools are let on most evenings of the week after public hours to swimming clubs at a nominal charge. The Tottenham Central Swimming Club is the only competitive one, however, and may be considered to be truly representative of the Borough. Attendance at Swimming Baths Year ended 31st March Indoor Pools Open Air Lido Total General Public School Classes General Public School Classes 1948 66,954 71,413 141,480 6,872 286,719 1949 93,660 67,226 75,363 6,193 242,442 1950 107,746 61,448 141,900 8,963 320,057 1951 77,557 59,561 81,564 7,351 226,033 1952 84,214 60,534 72,496 8,198 225,442 1953 88,581 56,062 88,689 8,918 242,250 1954 96,629 64,315 79,743 4,257 244,944 1955 92,608 68,662 37,850 4,544 203,664 1956 107,110 68,588 111,164 6,740 293,602 1957 98.623 73,587 41,393 5,588 219,191 1958 101,676 61,613 82,724 5,175 251,188 1959 111,872 60,599 59,737 6,738 238,946 1960 116,027 59,706 136,742 6,513 318,988 Private Baths The private bath suites at four of the establishments were modernised as recently as 1953/54 and still continue to afford a valuable contribution to public health. The service is available on six days of the week at the branch baths and is also available on Sunday mornings at the Central Baths. Special concessions are available on certain days of the week to old age pensioners (free) and juniors (under 16) 2d. The tabulation of attendances indicates the heavy demand still being made on the service despite the large amount of re-housing that has taken and is still taking place. The retention of this form of service will be essential in Tottenham for many years to come. 17 Private Bath Attendances Year ended 31st March Central Tiverton Bromley Conway Total Ordinary Baths Pine Baths 1948 106,014 2,950 48,048 36,147 28,927 222,086 1949 104,351 2,392 49,610 37,262 30,220 223,835 1950 108,592 2,464 48,476 35,803 32,300 227,635 1951 100,693 2,641 45,646 36,073 27,845 212,898 1952 103,677 2,682 45,230 35,250 27,646 224,485 1953 102,070 2,764 40,253 *23,527 27,149 195,763 1954 *64,587 1,322 39,312 35,753 31,876 172,850 1955 110,294 3,594 *21,393 32,758 30,898 198,937 1956 107,461 4,589 38,517 32,021 28,016 210,604 1957 116,997 6,617 40,192 30,378 *12,448 206,632 1958 106,410 6,175 37,731 30,081 26,389 206,786 1959 103,018 6,091 35,798 28,891 30,630 204,428 1960 104,679 6,272 35,745 28,477 30,746 205,919 * Attendances affected by closing of the private baths section for re-construction Public Laundries Two public laundries were opened in Tottenham during 1932 and it is significant to note that patronage at both establishments has fluctuated but little. The trend has been one of a gradual increase in post-war years when the highest attendance figures were attained. Public Laundry Attendances Year Ended 31st March Bromley Road Tiverton Road Total 1948 20,190 20,240 40,430 1949 22,765 22,109 44,874 1950 22,879 21,876 44,755 1951 22,813 20,964 43,777 1952 21,355 22,023 43,378 1953 22,922 21,491 44,413 1954 21,838 21,450 43,288 1955 21,505 19,347 40,852 1956 23,132 20,291 43,423 1957 22,610 19,804 42,414 1958 22,130 20,083 42,213 1959 20,541 19,238 39,779 1960 23,720 18,728 42,518 At the time of their construction, both laundries were equipped in accordance with the generally accepted practice associated with 'Public Wash-houses". To-day the term "'washhouse* is a stigma and may be itself a deterrent to potential users. As in Tottenham many local authorities are substituting the term "laundry". After twenty-seven years of almost continuous operations the obsolete equipment in inadequate to meet the modern housewife's requirements. In December 1959 the Bromley Road Laundry was reopened as a self-service laundry following an 8 week period of closure for modernisation. The project provides for a complete wash, dry and machine ironing process for any single classification of work up to a maximum of 25 lbs. dry weight for 3/6d. The total time for processing is less than 1 hour. Automatic control has been exploited to the fullest possible extent and by virtue of its economy of operation, plus increased revenue from increased income a substantial reduction in the rate charge has been already made. 18 Before modernisation this establishment operated at 80% capacity and provided for 395 users per week. Present attendances are now approaching 1,200 per week at 75% utilisation. The Tiverton Road Laundry will need to receive similar attention in the near future and in view of the rapid development on blocks of flats nearby it would seem desirable that the exterior of the building should be improved in order that it may be in keeping with the surrounding estate. Inspections Carried out by the Public Health Inspectors Appointment and Interviews 688 Cinemas and Halls 33 Complaints Investigated 3246 Conveniences and Urinals 26 Drains defective 229 Drains tested 345 Factories with Mechanical Power 227 Factories without Mechanical Power 22 Food Poisoning 21 Food Premises Bakehouses 54 Butchers 181 Cafes 158 Dairies 201 Factories 36 Factory Canteens 42 Fishmongers 76 Greengrocers 78 Ice Cream Premises 116 Slaughterhouses 922 Other Food Premises 296 House to House 54 Improvements 72 Infectious Disease 464 Other Visits 3330 Outworkers 164 Rat Infestation 542 Re-Inspections 6543 Schools 82 S.D.A.A. & Housing Act Advances 273 Smoke Observations 55 Stables and Mews 34 Workplaces 18 Smoke Control Order 4715 Defects Re medied Drains reconstructed 8 Drains repaired 193 Drains cleared 114 W.C. Cisterns repaired or renewed 117 19 W.C. Pans renewed 62 W.C. Pans cleansed 9 Waste Pipes repaired or renewed 72 Rainwater pipes repaired or renewed 125 Roofs repaired or renewed 443 Eaves Gutters repaired or renewed 217 Drinking Water Cisterns renewed 4 Drinking Water Cisterns covered . 3 Water Service Pipes repaired 86 Water Supply reinstated 15 Yards repaired or reconstructed 45 Sinks renewed or provided 15 Floors repaired or renewed 215 Floors ventilated 66 Dampness remedied by insertion of damp proof courses 11 by pointing of brickwork 62 by internal rendering 197 by miscellaneous remedies 107 Window Frames and Sashes repaired, or renewed, or painted 296 Coppers repaired or renewed, or provided 2 Fireplaces, Stoves & Ovens repaired or renewed 97 Flues and Chimney Stacks repaired 77 Brickwork of Walls repaired and Walls rebuilt 86 Ventilated Food Stores provided 3 Rooms cleansed 45 Staircases, Passages & Landings cleansed 16 Staircases, Balconies and Steps repaired or renewed 68 Noxious Accumulations removed 28 Nuisances arising from Animals abated 6 Miscellaneous Defects remedied 606 Notices Served Statutory:- Housing Act, 1957s Section 9 70 70 Public Health Act, 1936: Section 24 26 „ 39 41 „ 45 7 „ 79 2 „ 92 163 239 Tottenham Corporation Act, 1952: Section 36 19 „ 43 117 „ 54 2 138 Total 447 Informal Notices 1065 20 Repair of Houses by the Council Work carried out in default or by agreement with the owners during 1959. Housing Act, 1957 £ s. d. Section 9 7 premises 241 16 10 Public Health Act, 1936 Section 24 26 premises 84 16 4 „ 39 11 „ 251 1 4 „ 94 3 „ 143 13 1 Tottenham Corporation Act, 1952 Section 36 6 premises 10 4 3 „ 38 5 5 9 9 „ 43 22 „ 294 13 5 „ 54 1 „ 2 1 4 £1,033 16 4 Abatement Notices Legal Proceedings Summonses were issued in six instances for non-compliance with abatement notices, but in three of these the work was carried out before the hearing and proceedings were withdrawn on payment of the Corporation's costs. Penalties were imposed in two cases and the final case was adjourned sine die to enable the premises to be dealt with as an unfit house under section 16 of the Housing Act. Cleansing and Disinfecting Station The equipment at the Borough's Cleansing Station at Markfield Road had reached the end of its useful life and during the year a new station was completed at Park View Road adjacent to the Refuse Disposal Works. The new station is equipped with a Manlove Alliott horizontal elliptical steam disinfector which can also be used for formaldehyde disinfection, if required. In addition there are baths for the cleansing of persons in accordance with the provisions of section 85 of the Public Health Act, 1936. By resiting the station in Park View Road it has been possible to make use of the steam generated at the Refuse Disposal Works with a consequent saving in fuel costs. Summary of Disinfection Work During 1959 Rooms disinfected after occurrence of infectious disease or death 38 Bedding disinfected after occurrence of infectious disease or death 49 Library Books disinfected 128 Baths for verminous persons 24 Insect Pests The long warm summer of 1959 resulted in an increase in the number of complaints of insect pests, particularly in respect of bugs and wasps. 157 houses were treated for bugs, the highest number recorded for many years and more than twice the figure for 1958. Forty six wasps nests were destroyed compared with nine in the previous year. 21 Inspections prior to removal to Council houses numbering 313 have been made on notification by the Housing Manager, and disinfestation required in 23 cases, the furniture being treated in a cyanide chamber. Premises Treated Houses Other Premises Bugs 157 - Fleas 7 1 Cockroaches 38 8 Wasps 46 3 Ants 10 9 Flies 3 6 Miscellaneous 10 - Total 271 27 Rodents In my annual report for last year I indicated the department's intention to use new methods of treatment once they have been officially approved. In so far as the public sewer treatments are concerned a new form of technique is now in operation. Hitherto sewer treatments have consisted of baiting with conventional poisons, viz., zinc phosphide, alternated with arsenious oxide and antu, the baiting being done over a number of days, the whole treatment taking place twice yearly. The present system, which takes place four times a year, consists of direct poison baiting with sodium fluoroacetate. This is a highly toxic substance and requires great care on the part of the operator. It has the advantage of one visit only being made to each manhole and is therefore more economic in the use of labour. The following is a summary of dwelling houses and business premises treated during 1959:- (1) Dwelling houses 694 (2) Factory premises 32 (3) Shops 46 (4) School Canteens 67 (5) Miscellaneous 23 (6) Total charge for 2 - 5 above £122. 5s. 4d. Factories There is a wide variety of light industry in the Borough ranging both in size and in the nature of their products. Regular visits are made to ensure compliance with those parts of the Factories Acts which are enforced by the local authority and there is a frequent exchange of information with the Factories Inspector which is of mutual assistance. Tottenham's development in the past led to a scatter of industry in the residential areas resulting in nuisances to residents of smoke, fumes or noise associated with industry. Steps are taken wherever possible to eliminate or mitigate these nuisances but it is only by proper planning that the problem can be solved satisfactorily; and action taken to locate factories in separate industrial zones. As Tottenham is fully built-up the process will be inevitably slow. 22 FACTORIES ACTS, 1937 - 1959 Inspections for purposes as to health made by Public Health Inspectors Premises No. on Register NUMBER OF Inspections Written Notices Occupier Prosecuted (i) Factories in which sections 1, 2, 3, 4 & 6 are enforced by local authority 57 22 _ _ (ii) Factories not included in (i) in which section 7 is enforced by local authority 656 227 8 _ (iii) Other premises in which section 7 is enforced by local authority (excluding outworkers premises) 11 11 Total 724 260 8 - Summary of defects found in factories Number of cases in which defects were found Particulars Found Remedied Referred to Factories Inspector Referred by Factories Inspector Want of cleanliness (s.l) 1 1 - 1 Overcrowding (s.2) - - - - Unreasonable temperature (s.3) - - - - Inadequate ventilation (s.4) - - - - Ineffective drainage of floors((s.6) - - - - Sanitary conveniences (s.7) (a) Insufficient 1 1 - - (b) Unsuitable or defective 23 22 - 21 (c) Not separate for sexes - - - - Other offences against the Act (not including offences relating to outwork) Total 25 24 - 22 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:- 23 Wearing apparel 364 Household linen 9 Curtains & furniture hangings 3 Artificial flowers 11 Paper bags 4 Cardboard boxes 35 Brushes 4 Feather sorting 1 Boxing, carding of buttons 7 Christmas crackers & stockings 17 Weaving of any textile fabric 1 Lampshades 5 461 164 visits were made during 1959 to outworkers' premises. No contraventions were reported. Shops 1,678 shops have been inspected; prescribed notices, records of employment, etc., have been examined and the necessary information obtained for keeping an up-to-date register of shops in the Borough. During the year the following contraventions were noted: - Section 17(2) Assistants weekly half holiday notice not affixed in the shop 102 Section 32(2) Record of hours of employment of young persons not being maintained 23 Section 32(3) Abstract of regulations relating to employment of young persons not exhibited 16 Section 37(2) Notice re: seats for females not exhibited 76 Weekly Half Holiday The following contraventions were noted:Section 1(1) Shops not closed at 1.00 p.m. 4 Section 1(2) Alternative closing notice not displayed 16 Section 13(1) Exempted trade notices not displayed or in possession of the occupier 26 Legal proceedings were taken in one case where sales took place on the weekly half holiday. The other cases were dealt with by warning letters or informal notices. General Closing Hours Several cases of ladies' hairdressers being open after the permitted hours were noted. In each case the occupier claimed that work upon the customer had commenced before the closing hour. Legal advice was taken on this point and it was found that no offence is committed providing customers enter the premises before the closing hour. Special attention was paid to 24 the employment of young persons in these cases. Sunday Trading The following contraventions were noted:- Section 47 Sale of goods not exempted by the Fifth Schedule 12 Section 50 Sunday trading notices not exhibited or in possession of occupier 19 Legal proceedings were taken in five cases concerning the sale of unscheduled articles; in one other case the occupier died before the summons was served. Proceedings were also taken in two cases where Sunday Trading notices were not exhibited. Jewish Traders Three cases of trading on the Jewish Sabbath were reported. In one case a warning letter was sent to the occupier, and legal proceedings were taken in the other two cases. Sixty-nine informal notices were served inrespect of these contraventions and re-inspections made to ensure compliance with the regulations. 1,840 male, 2,242 female adult assistants and 122 male and 356 female young persons under the age of 18 years were employed at the premises inspected. Special attention was paid to their conditions of employment, working hours, meal times, etc. Street Trading 24 sites weie licensed for the year 1959/60. One licence for a site in the West Green area was surrendered due to ill health and the site was not re-let. The licensed sites are inspected weekly and no complaints have been reported. Unlicensed Street Trading Special attention has been paid to the Green Lanes area where unlicensed trading appears to persist, usually on Thursdays. As a result of these patrols, 27 cases of unlicensed trading were observed. 15 were dealt with by way of verbal warning. 12 were reported, resulting in 8 warning letters being sent and legal proceedings being taken in 4 cases. 25 Shops Act, 1950 and Middlesex County Council Act, 1944 Prosecutions Offence Section Fine Costs Total Case No. 1 Failing to close on the weekly half holiday 1(1) 20s. £1.1.0. £2.1.0. Case No. 2 Sale of articles not mentioned in the Fifth Schedule (Sunday trading) 47 20s. £1.1.0, £2.1.0. Case No. 3 - do - 47 20s. £1.1.0. £2.1.0. Case No. 4 Failing to close on the Jewish Sabbath 53 40s. £1.1.0. £3.1.0. Case No. 5 Sale of articles not mentioned in the Fifth Schedule (Sunday trading) 47 40s. £2.2.0. £5.2.0. Failing to exhibit exempted trade notice 57 20s. Case No. 6 Sale of articles not mentioned in the Fifth Schedule (Sunday trading) 47 - - - Case No. 7 - do - 47 40s. £1.1.0. £3.1.0. Case No. 8 Failing to close on the Jewish Sabbath 53 40s. - £2.0.0. Case No. 9 Unlicensed street trading 320 329 20s. £1.1.0. £2.1.0. Case No. 10 - do - 320 329 20s. £1.1.0. £2.1.0. Case No. 11 - do - 320 329 20s. £1.1.0. £2.1.0. Case No. 12 - do - 320 329 20s. £1.1.0. £2.1.0. Case No. 13 - do (Two summonses) 320 329 40s. 40s. £2.2.0. £6.2.0 * Case dismissed TOTAL £33.13.0. Rag Flock & Other Filling Materials Act, 1951 There are no establishments licensed for the manufacture of rag flock. At 31st December, 1959 there were 23 premises registered for the use of filling materials. Pet Animals Act, 1951 At 31st December, 1959, 9 premises were licensed as pet shops in accordance with the Pet Animals Act, 1951. 26 CLEAN AIR Continuing a progressive policy in connection with the Clean Air Act, 1956 the Ministry of Housing and Local Government addressed a circular to local authorities in January, 1959, on the question of smoke control areas. Emphasising that about 50% of the smoke in the atmosphere comes from domestic stoves, the Minister requested local authorities to consider their domestic smoke problem as a whole. Authorities were asked to submit by 30th June, 1959, a five year programme for dealing with smoke control areas. A phased programme for the Borough was submitted to the Health and Housing Committee and approved by the Council. This provides for conversion and/or adaptation in some 4,000 houses per annum and covers the whole of the Borough. On the question of including industrial premises in smoke control areas, in July, 1959 the Minister of Housing and Local Government made an order giving exemption to mechanical stokers installed on or after 31st December, 1956. This order has been received with some misgivings since "automatic" exemption takes away from the Council the power to exercise their own discretion. It is known, for example, that certain mechanical stokers in Tottenham are by no means smokeless in operation. It is hoped that the National Coal Board will co-operate with local authorities through their technical and commercial representatives. ATMOSPHERIC POLLUTION RECORD, 1959 Month Park Lane St. Ann's Tottenham Technical College Rainfall (ins.) Insoluble Deposit Soluble Deposit Rainfall Insoluble Deposit Soluble Deposit Smoke Sulphur Dioxide Monthly Average Highest Daily Reading Monthly Average Highest Daily Reading (Tons per square mile) (ins.) (Tons pet square mile) (mg P#r 100 m3) (mg per 100m3) (Parts per 100 million) January 2.09 6.09 7.27 2.15 5.86 7.14 36 234 8 19 February 0.04 4.98 3.85 0.03 6.46 4.33 26 139 12 48 March 1.59 7.96 6.21 1.79 7.83 6.21 14 35 9 25 April 2.03 6.40 5.25 2.05 7.24 5.78 10 24 6 15 May 1.05 6.27 3 27 0 71 6 06 2 77 6 12 5 13 June 0.75 5 61 4.05 0 54 5 86 2 69 5 10 4 12 July 1.11 5.77 3.22 1.17 6.16 3.10 2 7 3 8 August 0.96 5.21 1.72 2.50 3.54 9.63 3 6 2 5 S eptember 0.01 4.78 1 96 0.01 4.52 1.42 3 7 3 7.2 October 1.99 8,55 6,45 1.93 8.53 6.26 10.6 24 3.7 7.6 November 2.44 7.36 7.38 2.56 6.19 6.70 22 56 7.0 21.8 December 3.33 6.29 7.22 3.42 6.28 8.47 20 41 3.2 9.4 Radiation Hazards During the year the Council expressed concern particularly at their lack of local knowledge of the steps taken for the monitoring of food and water for radioactivity and the use in local industry of radioactive substances and the disposal of trade waste. In response to an enquiry, the Ministry of Housing and Local Government gave a general indication of the amount of radioactive material in use in local factories. In a later letter they 27 stated that whilst they were unable to undertake to give details of every single delivery to establishments in the Borough a watch was kept on deliveries and should there be any significant change the Medical Officer of Health would be informed. In October, 1959 the Ministry of Housing and Local Government issued a Memorandum to all local authorities summarising the action the Government were taking in connection with radioactivity. Dealing with monitoring it advised that arrangements had been approved under which the Agricultural Research Council was responsible for monitoring soil, herbage, farm animals, and milk and other foods, and the Medical Research Council for measurements of radioactivity as affecting man. The Atomic Energy Authority retained responsibility for the analysis of radioactivity in air and rainwater, and this Authority, in conjunction with the Ministry of Housing and Local Government, also measured the activity in selected sources of drinking water. A joint Committee of the Agricultural and Medical Research Councils and the Development Commission supervises the monitoring programme. National and local surveys now being undertaken involve the annua] collection of several thousand samples of milk, water, green vegetables, potatoes and flour. In a circular letter to medical officers of health, Sir John Charles, chief medical officer to the Ministry of Health, stated it was largely because of the extent of these arrangements that the Ministers concerned have said that they see little advantage in widespread monitoring by local authorities. Further it has sometimes been argued that, whatever the Government may be doing to watch the national situation, local authorities have a duty to their residents to make sure there is no local hazard. I doubt if this is a truly valid distinction, at any rate in relation to fall-out. Such levels of contamination as there is reason to think exist are too low to be detected except by complicated apparatus and highly refined analysis, and the level in any one sample is in most cases very small in comparison with the comparable radioactivity from elements naturally present in the sample. The standards by which levels of radioactivity from fall-out" are judged are those whichhave been recommended by national and international research organisations as acceptable for continuous consumption over a whole lifetime of seventy years. A level at which it would seem desirable to withdraw a product from consumption over a short term would be so many thousands of times higher that, so long as the present low average levels persist, there can hardly be presumed to exist the possibility of local contamination of food within the meaning of the Food and Drugs Act, such as might justify local monitoring on this account. HOUSING It is difficult to define, in measurable terms, the effect on health and well being of unsatisfactory housing conditions. What contributes to making housing conditions unsatisfactory include such matters as structural unfitness, overcrowding and lack of amenities. Nothing can be more frustrating to the occupier of a bad house than the continuous battle to be waged in keeping it in a reasonably habitable condition. Inadequate facilities, and lack of amenities play their part in adding to this difficulty and where overcrowding exists the problem is even greater. One could cite numerous cases of parents becoming embittered because the children are ashamed to bring home their friends. Irritability becomes the keynote in such households' 28 relationship and this inevitably reduces the level of family health. Some however do rise above their surroundings and it is a source of wonder at the fortitude displayed by families who live under such adverse conditions. In the post war years housing has assumed a service of increasing importance in the work of local authorities. But in the clamour for rehousing the significance of the work carried out by the Health Department should not be overlooked. Much of it is unspectacular, on the other -hand the department can derive a great deal of satisfaction in the cleared sites of old worn out houses, now replaced with dwellings complete with modern amenities. Unfit Houses It is perhaps opportune at this time to review the work of the department for the past five years in relation to unfit houses. The Housing Repairs and Rents Act, 1954 introduced, for the first time, a standard of what constitutes an unfit house and as it will be of interest to members the relevant section is set out below. 4. (1) In determining for any of the purposes of this Act whether a house is unfit for human habitation, regard shall be had to its condition in respect of the following matters, that is to say - (a) repair. (b) stability; (c) freedom from damp; (d) natural lighting; (e) ventilation; (f) water supply, (g) drainage and sanitary conveniences, (h) facilities for storage, preparation and cooking of food and for the disposal of waste water; and the house shall be deemed to be unfit for human habitation if and only if it is so far defective in one or more of the said matters that it is not reasonably suitable for occupation in that condition." From this it will be noted that the Housing Act, 1936 items of "disrepair and sanitary defects" no longer apply, neither indeed, does reference to the Byelaws. Since June, 1954, nineteen clearance areas have been "officially represented" comprising a total of 715 unfit houses. Compulsory purchase orders were made in respect of 17 of these areas. Up to December, 1959 the Minister of Housing and Local Government had confirmed 555 houses as being unfit. The remainder are awaiting inquiries or confirmation. During the year under review a Public Local Inquiry was held in respect of the Tewkesbury School Site comprising 88 houses. Also during 1959 the Minister confirmed the Albert/Richmond Road area as being unfit. Of the 200 houses included in the Official Representation only 3 were excluded from the unfitness order. In addition to representation of large areas for clearance, the department is called upon to exercise its judgment in dealing with individually unfit houses. Thus if an individual unfit house is incapable at reasonable expense of being made fit an official representation" is submitted recommending a demolition or closing order. During the year 1959 a number of these orders were made and the Council accepted the responsibility for rehousing the occupiers. When unfit houses can be repaired at reasonable cost, notices under sections 9 and 10 of the Housing Act, 1957 are served and this has continued throughout the year. 29 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 11.57 - No. 2 123 1. 6.54 22 2.55 9. 7.55 2.60 - Tewkesbury No. 2 71 29. 6.54 28. 3.55 27.10.55 - - No. 3 2 30. 8.55 Purchased by agreement £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 29.11.55 11.10.56 14. 2.57 10.59 12.59 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 200 4. 6.57 30. 9.58 and 13. 5.59 - - Nos. 1, 2, 3 & 4 2.12.58 Tewkesbury No. 5 4 1. 4.58 17.12.58 - - - Tewkesbury No. 6 88 14.10.58 2. 6.59 - - - Tewkesbury No. 7 3 14.10.58 - 27.10.59 - - Markfield Redevelopment 50 18.11.58 . . - _ Tewkesbury No. 8 6 30. 6.59 - - - - 30 HOUSING ACTS 1936 & 1957 SECTIONS 9 & 10 WORK IN DEFAULT Year Number of Houses Cost £ s. d. 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 1959 7 241 16 10 Premises the subject of Demolition Orders not demolished as at 31st December, 1959 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 58 Tewkesbury Road 12. 5.59 28 Avenue Road *23.10.59 * These premises were still occupied at 31st December, 1959 Overcrowding This term is apt to be misunderstood since it has come to be applied more specifically where large families occupy parts of houses. Statutory overcrowding, on the other hand, is clearly defined in section 77 of the Housing Act, 1957 - "77. (1) A dwelling-house shall be deemed for the purposes of this act to be overcrowded at any time when the number of persons sleeping in the house either - (a) is such that any two of those persons, being persons ten years old or more of opposite sexes and not being persons living together as husband and wife, must sleep in the same room; or 31 (b) is, in relation to the number and floor area of the rooms of which the house consists, in excess of the permitted number of persons as defined in the Sixth Schedule to this Act." It is of interest to note that sub-section (a) refers to persons of opposite sexes who MUST sleep in the same room, and not to persons who DO. In other words if it is possible, by rearrangement, for the sexes to be separated then statutory overcrowding would not exist. The general standard whereby all rooms are taken into account is a low one, but in present day conditions it is unlikely that the standard of taking into account only the bedrooms will come into operation. Lack of Amenities In addition to the hazard of overcrowding which exists in dwellings let to multiple families, lack of amenity is a feature which makes this type of letting undesirable. It is not uncommon for the multi-let dwelling, let as such by the owner, to have separate water supply and cooking facilities for each letting. The dwelling which is sub-let by the tenant, however, is usually without these facilities. These houses are often decontrolled and sub-letting becomes an economic necessity. Fear of eviction is a factor which deters occupiers from complaining. Rehousing on Medical Grounds The Council's points system for assessing priority for rehousing makes some allowance on grounds of ill health, but it is recognised that the effect of unsatisfactory housing conditions on the medical conditions of some applicants may warrant special consideration by the Housing Lettings Sub-Committee. To meet this need arrangements exist for the Housing Manager to forward to the Medical Officer of Health details of housing applications where medical evidence has been submitted supporting the need for rehousing. These cases are then visited and an assessment made of the medical grounds and the amount of priority which could be recommended, special regard being given to the relationship of housing to the disease and the prevention of infection of others. Whilst in a large proportion of the medical cases a decision can be made without reservation whether or not to recommend the application for medical priority, others are less easily determined. Particularly difficult are the cases of mental ill health for most families living in cramped and difficult housing conditions are subject to mental stress and care is taken to ensure that priority over other deserving cases is not given unless the medical aspect can be clearly established. When any doubt exists and it is not possible to give unqualified support for medical priority, the facts are placed before the Sub-Committee for their consideration and decision. Needs of Special Classes (a) Physically Handicapped. The needs of physically handicapped persons are best catered for in the design and provision of new housing. Such dwellings may require purpose designed corridors and rooms with wide doorways free from sharp turns and floors which are of one level with ramps in place of steps. These facilities are particularly desirable where the handicapped person has to operate a wheel chair. In certain cases purpose made fitments may be necessary, e.g., baths with facilities for easy entry and exit. Accommodation in all such cases should be on the ground floor. (b) Aged Persons. Provisions of housing for aged persons is the subject of much controversy, should they be segregated or not. A balanced community would seem the most desirable and 32 provision for the aged catered for in the design of general redevelopment. As with the physically handicapped, it would be generally desirable that ground floor accommodation is provided. Units for space heating should be proofed against fire risks. (c) Problem Families who seem unable to adj ust themselves to the general standard of society. Quite often their living conditions are most undesirable To rehouse them in new dwellings is to invite trouble and some form of graduation is desirable This can be achieved by putting families of this type into acquired houses, this coupled with the social welfare services provide a means of rehabilitation or re-adj ustment, Sub-Standard Houses (a) There are large numbers of houses which, although structurally sound and capable of many years life, are sub-standard by reason of lack of amenities. It is to deal with such houses that provision is made whereby grants are available for improvement. The grants make it possible to provide bath, wash basin, hot water supply, VI.C., and proper food stores. Since 1949 these grants have been available at the discretion of the Council but in 1959 an Act of Parliament made available standard grants. These grants cannot be refused and there are certain financial limitations set for particular items. The response has been disappointing, less than 150 discretionary grants have been applied for and in the case of standard grants the applications total less than 50. In almost every case the applications have come from owner occupiers and whilst this is commendable, the majority of these sub-standard houses are tenanted. There must be some reason for the owners not taking advantage of these facilities to modernise their properties. The short answer is economics, owners argue that the financial return for the initial outlay involved is not worth it. It should be emphasised in this respect that owners obtaining grants are subject to a rent control. (b) It is appropriate at this time to try to assess what the 1957 Rent Act has done to improve sub-standard property. In so far as providing amenities, no improvement is noticeable. In the matter of decorative repairs, many houses have been painted externally and some have been pointed. Certain works of internal repair too have been done voluntarily by the owners, but much of this repair work has resulted from the tenants' action in serving Forms G. The weakness of the Rent Act as we see it is that it does not allow for the remedying of fundamental or inherent defects. One must always have regard to the age and character and locaility of the house. Many houses are very damp due to lack of damp proof courses and there is no acti on that can be taken to remedy this under the Rent Act. Certificates of Disrepair Although there was a fall in the number of applications for certificates under the Rent Act, 1957 there was no indication of a discontinuation in the use of these provisions 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: 62 (2) Number of decisions not to issue certificates: 1 (3) Number of decisions to issue certificates: 61 (a) in respect of some but not all defects: 24 (b) in respect of all defects: 37 33 (4) Number of undertakings given by landlords under paragraph 5 of the First Schedule: 36 (5) Number of undertakings refused by Local Authority under proviso to paragraph 5 of the First Schedule: 2 (6) Number of certificates issued: 24 Applications for Cancellation of Certificates (7) Applications by landlords to Local Authority for cancellation of certificates: 38 (8) Obj ections by tenants to cancellation of certificates: 13 (9) Decisions by Local Authority to cancel in spite of tenant's objection 4 (10) Certificates cancelled by Local Authority: 29 (11) Number of certificates outstanding at 31st December, 1959 including those under the Housing Repairs and Rents Act, 1954: 212 Certificates as to the Remedying of Defects listed in Landlords' Undertakings (12) All defects remedied: 29 (13) Some defects not remedied: 28 (14) No defects remedied 8 Accidents in the Home With the co-operation of the Prince of Wales's Hospital a study has been made of the home accidents coming to their notice during the latter part of 1959. 29 cases were investigated in this way, of which 13 were due to falls, 8 to burns, 7 to scalds and 1 to dropping furniture on foot. Falls-(13) These involved 2 infants aged 11 and 14 months, 9 women, and 2 men. Causes Falling from bed accounted for the 2 babies, a man aged 70 years and 2 women aged 70 and 80 years. 3 middle aged women fell downstairs, in one instance while carrying a number of articles. 2 middleaged women had falls associated with standing on chairs. One fell off and in the other case the chair, which was old, collapsed. A man aged 40 slipped and fell. 2 women aged 65 and 88 had falls associated with other physical disabilities. Conclusions Most of these accidents lend emphasis to points frequently made regarding safety in the home. 1. Babies and young children should sleep in cots and senile old people should have similar protection from falling from bed. 34 2. Care should be taken on stairs especially when carrying articles. 3. Steps should be used when it is not possible to reach from the floor. Improvisation is dangerous. 4. Special care is needed by those with disabilities. Burns and Scalds (15). These involved 6 infants, 2 older children, 1 man and 6 women. Causes 4 infants were scalded, in two of the cases by pulling tea pots off the table and in another a 4 month baby on the floor was splashed when the mother was pouring boiling water above her. A man aged 37 slipped while carrying a large pot of tea - scalding himself. A boy aged 12 years was scalded when a hot water bottle burst in his bed and an old lady was scalded when she spilt water from a hot water bottle. A baby of 8 months was burnt when an oil heater caught fire and a child of 18 months was burnt when he touched against a hot pressing iron. A boy of 13 received burns after igniting some methylated spirits with which he had been experimenting. 3 middle aged women received burns associated with gas stoves. In one case the stove was not lit immediately and when lit exploded, in another a line of clothes fell on a lighted stove and in the other a pan of cooking fat caught fire. An old lady was burnt when a box of matches ignited in her pocket after she had Jit the gas and another old lady was badly burnt and died after her clothes were caught alight by an electric fire. Conclusions Here again precautions recommended by home safety authorities would have eliminated most of these accidents. 1. Infants should be protected from burns and scalds by keeping hot things from their reach and by not using overhanging table cloths which can be pulled down by the child. 2. Articles should not be hung over fires or gas stoves where they might fall and be ignited. 3. Hot water bottles should be examined periodically for signs of weakness and should also be covered. 4. Fires, including gas and electric fires, should be properly guarded. FOOD CONTROL The supervision of premises concerned with the preparation and manufacture of food for human consumption has continued to receive energetic attention. Since the Food Hygiene Regulations have been in operation much work has been done in securing improvements. The provision of sinks for personal washing and for washing utensils and the supply of hot water has been achieved in most of the premises concerned. One aspect of food hygiene which has taken on a new significance is that of the slaughterhouses. The Slaughterhouse (Hygiene) Regulations, 1958 and the Slaughter of Animals (Prevention of Cruelty) Regulations, 1958 both came into operation on the 1st January, 1959. 35 The former Regulations deal with construction, layout, lighting, ventilation, cleanliness, equipment and hygiene practices in slaughterhouses, The latter deal with lairages, stunning pens for cattle, and the keeping of records where horses are slaughtered and in knackers yards. It should be made clear that whilst all these requirements are in operation for new slaughterhouses, for existing slaughterhouses they will come into force in the future on a day to be appointed. The Slaughterhouse Reports (Appointed Day) Order, 1959 came into operation on the first February, 1959 and this Order laid down the 2nd November, 1959 as the appointed day for submitting the slaughterhouse report. Members will be aware that there are two slaughterhouses in the borcugh and the slaughterhouse report for submission to the Minister was approved by the Council on the 19th November, 1959 and sent to the Minister in December. The report indicates the deficiencies of the slaughterhouses and the work required to bring them up to the standard required by the Regulations. It has been suggested that the appointed day for Tottenham, i.e., the date by which all the requirements of the Regulations operate, should be the 31st December, December, 1961. Failure to meet the requirements of the Regulations would mean refusal to licence the slaughterhouse. The work of meat inspection continues to occupy a great deal of the public health inspectors' time. There is however, an apparent change in the policy of the wholesale slaughterhouse in that there has been a marked reduction in the number of cows and cattle slaughtered and it is possible that the owners are concerned with the consequences of the slaughterhouse construction regulations. The total number of food shops as at 31st December, 1959 was 1,049, made up as follows:- Bakers 50 Butchers 91 Coffee stalls & cafes 25 Confectioners 331 Dairymen 32 Dining rooms 93 Domestic stores 128 Fishmongers 49 Fruiterers & greengrocers 119 Grocers & provisions 287 Ham & Beef Dealers 3 Off-licences 82 Public Houses 58 Registered Food Premises At the 31st December, 1959, 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 397 Manufacture and sale of ice-cream 2 Storage of ice-cream 1 Cooking of hams and other meat 37 Fish frying 39 Sausage manufacture 58 Preparation of jellied eels 3 Shellfish 1 36 In addition the following classes of food hawkers and their storage accommodation are registered under section 11 of the Middlesex County Council Act, 1950 Food Hawkers Articles No. of Hawkers Registered No. of Storage Premises Registered Fruit and vegetables 96 85 Shellfish 15 6 Fish 8 4 Ice-cream 5 - Light refreshments 4 1 Peanuts 3 1 Eggs 1 - Milk (Special Designation) Regulations, 1949-53 The following is a summary of licences issued during 1959, namely:- Designation No. of Licences f Supplementary Licences Pasteurised 86 15 Sterilised 156 17 Tuberculin Tested 45 15 During the year 16 applications for registration as milk distributors were dealt with. No applications were received in respect of dairies. Of the 16 new registrations, 6 were for new premises and the other 10 were in respect of the change of proprietorship of previouslyregistered premises. The number of premises and distributors registered at 31st December, 1959 was as follows:- No. of distributors 156 No. of dairies 8 Meat Inspection The amount of slaughtering at the two slaughterhouses in the borough was roughly the same as in preceeding years. The number of cattle slaughtered was less but this was offset by an increase in the number of sheep killed. The department continues to maintain a 100% inspection of all animals slaughtered as far as this is possible, a rota system being worked by the inspectorial staff to ensure that an inspector is on duty at all notified slaughtering times. Slaughtermen Thirteen men were licensed as slaughtermen, of whom nine were licensed to slaughter horses. 37 SUMMARY OF CARCASES INSPECTED 1959 Horses Cattle excl. Cows Cows Calves Sheep & Lambs Pigs excl. Sows Sows Goats Number killed 1262 33 298 1222 3585 15080 1836 14 Number inspected 1262 33 298 1157 3573 15068 1831 14 All Diseases except Tuberculosis Whole carcases condemned - - 6 - 1 43 3 - Carcases of which some part or organ was condemned 173 6 56 1 275 1631 134 - Percentage of number inspected affected with disease other than tuberculosis 13.71 18.18 20.86 .09 7.72 11.11 7.48 - Tuberculosis Only Whole carcases condemned - - 2 - - 1 - - Carcases of which some part or organ was condemned - - 3 - - 145 60 - Percentage of number inspected affected with tuberculosis - - 1,68 - - .97 3.28 - NOTE: NO CASE OF CYSTICERCOSIS WAS REPORTED DURING THE YEAR 38 Prosecutions Food & Drugs Act, 1955 S.2 Sale of bread containing a label. Fined £5-5s.0d. and £5.5s.0d. costs. Food Hygiene Regulations, 1955 Smoking whilst handling fish. Fined £1. Defective sink, no first aid materials, no lockers for clothing, inadequate washing facilities and dirty floor. Fined £5.5s.0d. and £l.ls,0d. costs. Condemned Food Tinned Articles Baby Food 88 Milk and Cream 385 Beverages 70 Preserves 63 Fish 254 Rice 3 Fish Paste 6 Soups 527 Fruit and Fruit Pulp 2058 Tomatoes 274 Fruit Juice 148 Tomato Products 74 Meat (Processed) 1265 Vegetables 1401 Other Articles of Food Condemned Apples 1890 lbs. Meat 1553 lbs. 6 ozs. Butter 2 lbs. 15 ozs. Pickles 43 jars Cheese 26 lbs. Preserves 60 jars Dried Fruit 934 lbs. Salad Cream 98 jars Fish 35 lbs. Sandwich Spread 31 jars Ground Nut Flakes 28 lbs. Sauce 38 bottles Honey 34 jars Walnuts 165 lbs. Lard 24 lbs. Miscellaneous 19 packets Food Sampling The Public Control Department of the Middlesex County Council has supplied the following table of information on food and drugs sampling in the Borough during 1959:- Articles Total Samples procured Unsatisfactory Milk (Various) 111 1 Butter 5 - Bread 2 - Cakes 19 - Cheese 5 1 Cooked Meat 27 1 Cream 5 - Drugs 25 - Pish and Pish Products 35 2 Fruit, Fresh and Canned 24 5 Ice Cream 18 - Liver 11 - Margarine 7 - Meat and Meat Products 60 1 Preserves 8 - Sausages etc. 20 1 Slimming Products 5 - Spirits 13 - Sweets 5 - Vinegar 12 1 Miscellaneous 21 - Totals 438 1? 39 Commenting upon the unsatisfactory samples, the Public Control Officer makes the following observations: - "Milk (Various). The presence of glass was detected in a bottle of milk supplied to St. Thomas More Secondary School, and the matter was dealt with by the sending of an official caution. Cheese. One sample of cream cheese was found to be deficient in milk fat. A cream cheese should contain at least 50 per cent fat on the whole cheese to justify this description; in the case concerned the whole milk cheese contained 37 per cent fat. The sample was in fact a whole milk cheese described by the makers as a "Creamery" cheese, this description having misled the retailers. In view of the special circumstances an official caution was issued. Cooked Meat. A pack of pork luncheon meat was analysed and its meat content found to be below the minimum standard accepted in this country. There is no statutory standard" for luncheon meat, and the power of deciding a standard, and of maintaining the quality of the article, is in the hands of the court. A court can decide upon the evidence before it what is a reasonable standard and current practice would be taken as evidence. In this case there is an agreement between the manufacturers for a minimum meat content of 80 per cent, and this would be accepted as evidence of normal trade practice. It was not possible to trace the importers, but enquiries disclosed that the sample was of old stock. No further action was taken. Fish and Fish Products. A retailer sold cod when the request was for smoked haddock. At another shop fried coley was sold when fried cod was ordered. In each case other purchases subsequently made from the shops were genuine, and the wrong sales were dealt with leniently as isolated instances. Fresh Fruit. A multiple firm of greengrocers sold Kazerine apples as "Worcesters",anda verbal caution was given. Another trader, a newcomer to the district, was cautioned for displaying Belle de Louvain plums marked "Victorias". "Seedless" mandarins and "seedless" Clementines were purchased from retailers and found to contain seeds; both these firms were also cautioned. An official caution was sent to a firm for describing Dutch tomatoes exposed for sale as "English", other displays being correctly marked. However, proceedings were taken against this firm for selling Monarch plums as "Victorias", and they were fined a total of £4.0s.0d. with £2.2s.0d. costs. Meat and Meat Products. A sample of canned minced steak procured from a trader in the district was found to be minced steak in gravy, but the amount of gravy was negligible so that it was decided to take no action. Sausages, etc. A sample of Sausage Roll was found to contain very little meat. However, a subsequent sample from the same source proved to be genuine so that no further action was taken. Vinegar. A sample of vinegar was found deficient in acetic acid; subsequent sampling revealed genuine vinegar, andno further action was taken." The Public Control Officer has also furnished the following report upon associated work under other Acts: - Labelling of Food Order, 1953. This Order requires prepacked 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 in the case of a compounded food, with the names of the ingredients in descending order of proportion by weight. Furthermore 40 it controls the manner in which the presence of vitamins and minerals is disclosed and prescribes specific labelling of certain foods. A total of 818 articles of prepacked food was examined at 134 different premises to verify compliance with these Regulations. Only minor infringements of the Order were discovered, although as to false or misleading labelling, see below. Merchandise Marks Acts, 1887 - 1953. The maj ority of the inspection work carried out under the provisions of the above Acts is to ensure compliance with the requirements of the various Marking Orders made under the provisions of the Act of 1926. These Orders apply to the marking of the country of origin on imported foodstuffs, principally meat, apples, tomatoes, dried fruits, bacon, ham, poultry, butter and honey, upon sale and exposure for sale. Inspections were made at 383 premises of 1,709 displays of these foodstuffs, and minor infringements detected were dealt with by verbal cautions. Meat and Poultry. A firm of retail butchers was summoned for exposing for sale Argentine lamb falsely described as '"New Zealand". They were fined a total of £75.0s.0d. and £10.10s.0d. costs. Further summonses against the company's servant for removing the brands indicatingthe country of origin resulted in a fine of £30.0s,0d. Another firm of butchers was summoned for exposing for sale Argentine beef falsely described as Scotch" and English*. Fines totalling £15.0s.0d and £3.3s.0d. costs were inflicted. The company was also summoned for exposing for sale Argentine beef and liver not marked with country of origin. For these offences fines of £15.0s.Qd. and £3.3s.0d. costs were given. Official cautions were sent to two firms of butchers for failing to mark with an indication of the country of origin imported beef, offals and turkeys. Preserves. The false trade description of weight 5 kilos" was applied to prepacked apricot pulp supplied to the school canteen of St. Ignatius Roman Catholic School. The description was applied by the importers as "nominal" 5 kilos. There is no obligation to mark the weight on this type of pack intended for catering use, and an official caution was sent to the wholesale merchants responsible. False and Misleading Descriptions Food advertisements and labels have been scrutinised for false and misleading statements and descriptions. Corrective action taken within the whole area of the County has equal effect within each County district, and work under this heading is combined with inspections made under the terms of the Merchandise Marks Acts and the Labelling of Food Order. A large confectionery manufacturer advertised one of its products in a manner suggesting considerably increased weight. The actual increase was small, and the advertisement was immediately withdrawn upon the issue of an official caution. Examples where corrective action was sought are set out as follows - The percentage fat content marking on Continental Cheeses when set out as a percentage "I.D.M.", changed to a comprehensible statement of Fat on the dry matter". A Continental biscuit marked as "Cheese Filled", which contained a filling only 20percent cheese. Such descriptions of Continental soft cheeses as Super-Creme", "Triple-Creme" and "Cream" etc., amended to indicate the true nature of the product, i.e., whole-milk cheese, cheese spread, etc. Rice puddings marked as "Creamed Rice", fruit syrups" labelled as fruit "juices", a "Seedless Fig Bar* which was found to contain crushed seeds, and cheese spreads described as "processed cheese". 41 Slimming claims in respect of lemon juice drinks were challenged, and a claim that a particular breakfast cereal had twice as much honey as any other cereal was also challenged. Some extravagant claims in respect of medicalremedies were challenged and the advertisements withdrawn. Special Designated Milk. During the year under review 8 samples of designated milk were taken in your area, all of which were certified as being satisfactory." CONTROL OF DISEASE The total number of notifications of infectious disease for the year was 1,550 as compared with 985 the previous year. The increase was mainly due to the biennial variation in measles and an increase in the number of notified cases of dysentery. Tuberculosis The number of cases on the tuberculosis register on 31st December, 1959 was 1,812 an increase of 13 on the previous year. There were 86 new cases of tuberculosis notified (71 pulmonary and 15 non-pulmonary) compared with 115 in 1958 (102 pulmonary and 13 non-pulmonary). Distribution of New Tuberculosis Cases notified during 1959 Age Periods New Cases Deaths Pulmonary Non-Pulmonary Pulmonary Non-Pulmonary Male Female Male Female Male Female Male Female Under 1 year - - - - - - - - 1-4 years 1 1 1 - - - - - 5-9 ,, 1 1 1 1 - - - - 10 - 14 ,, 1 1 - - - - - 15 - 19 ,, 3 1 - - - - - - 20 - 24 ,, 6 8 - 1 - - - - 25 - 29 ,, - 5 1 1 - - - - 30 - 34 ,, 2 3 1 1 - - - - 35 - 39 ,, - 2 - - - - - - 40 - 44 ,, 4 2 - - - - - - 45 - 49,, 3 4 1 1 1 - - - 50 - 54,, 1 3 - - - - 1 - 55 - 59 ,, 3 - 1 - 3 - - - 60 - 64 ,, 3 1 - - 2 - - - 65 - 69 ,, 3 1 1 1 1 - - - 70 - 74 ,, 3 - - 1 3 - - - 75 Years and Over 2 2 1 - 2 1 1 1 Total 36 35 8 7 12 1 2 1 The fifteen non-pulmonary tuberculosis cases notified related to infections of bones and joints in three cases, the genito urinary system in six cases, the lymphatic system in four cases, the meninges in one case and an eye in one case. 42 Changes in Tuberculosis Register during 1959 Pulmonary Non-Pulmonary Total Male Female Male Female Number on Register at 1st January, 1959 904 707 85 103 1,799 New cases notified during 1959 36 35 8 7 86 Transfers into Tottenham 14 15 1 2 32 Restored to Register 1 2 - - 3 955 759 94 112 1,920 Cases removed from Register Deaths of cases on register 12 3 - - 15 Transfers out of Tottenham 36 29 1 - 66 Recovered 3 3 1 3 10 Lost sight of 8 6 - 3 17 59 41 2 6 108 Number on Register at 31st December, 1959 896 718 92 106 1,812 Ward Distribution of Cases of Tuberculosis on the Register at 31st December, 1959 Ward Estimated Population Male Female Total Rate per 1,000 population Pulmonary NonPulmonary Pulmonary NonPulmonary White Hart Lane 10,951 117 14 89 8 228 20.8 Park 10,438 80 15 81 15 191 18.3 Coleraine 11,034 65 8 57 8 138 12.5 West Green 10,738 68 - 64 12 144 13.4 Bruce Grove & Central 10,718 57 3 47 4 111 10.4 High Cross & Stoneleigh 10,587 82 13 63 13 171 16.1 Green Lanes 10,326 91 9 70 7 177 17.1 Chestnuts 10,682 81 7 71 10 169 15.8 Seven Sisters 9,802 81 9 59 8 157 16.1 Town Hall 10,498 83 8 69 10 170 16.2 Stamford Hill 10,326 91 6 48 11 156 15.1 Total 116,100 896 92 718 106 1,812 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. Work of the Chest Clinic (Tottenham and Wood Green) Dr. T.A.C. McQuiston, the Physician at the Tottenham Chest Clinic, which also serves Wood Green has kindly supplied the following details of the work of the clinic in 1959. Commenting on these figures he observes that the Chest Clinic is still a very busy Unit and the overall number of notified cases remaining on the Clinic register has not diminished. 43 Attendances Total number of attendances 22,871 New Cases (a) Having full examination 2,456 (b) Having miniature X-ray only 2,505 4,961 No. of new cases found to be tuberculous 98 No. of new contacts seen 831 No. of new contacts found to be tuberculous 19 Comparisons Year Total Attendances New Cases New Notifications New Contacts Notified cases 1959 22,871 4,061 98 831 2,046 1958 23,711 5,170 139 906 2,049 1957 28,254 5,636 108 801 2,123 1956 33,686 5.910 127 937 2,096 1955 30,998 5,642 163 1,064 2,139 1954 28,420 3,930 162 781 2,021 Poliomyelitis Six cases of poliomyelitis were notified during the year although only four were domiciled in the Borough. Notification of the other two cases were accepted as the diagnosis was made after admission to St. Ann's Hospital. Of the four, three were of the paralytic type and one non paralytic. The two cases from outside the borough who were admitted to St. Ann's Hospital were of the paralytic type. Another child of 4½ months who moved into the borough from a neighbouring borough was found to be a carrier of polio virus type 1. A period of five months elapsed before faeces from this baby were clear of the virus. Encephalitis There were two notified cases of acute infective encephalitis in boys aged 11 years and 14 months and a post infectious case in a youth aged 18 years who had been suffering from streptococcal tonsillitis. Typhoid Fever A case of typhoid fever was notified in the year in a boy aged 12 years. Upon investigation it was found that the boy had been on holiday with his family in Spain twelve days prior to onset of his illness and it is likely that the disease was contracted there. No other members of the family were affected. The boy was 46 days in hospital and made a satisfactory recovery. Paratyphoid Fever Two cases of paratyphoid fever "B" were notified but in neither case was it possible to identify the source of infection. 44 Food Poisoning There were 18 notified cases, of which 16 were admitted to hospital. The causal organism was identified in 11 cases as follows:- 9 cases of Salmonella Typhi murium 1 case of Salmonella newport 1 case of Salmonella bovis morbificans The cases were sporadic and scattered throughout the last three quarters of the year. One case of Salmonella typhi murium proved fatal, where the patient was an 82 year old woman. In no case was it possible to identify the food giving rise to the illness. Dysentery A total of 251 cases of sonne dysentery were notified, compared with 49 in the previous year. 26 cases were admitted to hospital. The increase was probably attributable to two causes. (i) the prolonged warmer summer being responsible for a greater prevalence of flies, which can carry the disease and (ii) an outbreak at a school which resulted in the diagnosis and notification of many cases which might otherwisehave been missed. The disease is generally of a very mild type so that often the patient does not consult a doctor and the case remains unnotified but at times of an outbreak specimens are collected from many school contacts with symptoms, with a consequent increase in the number of diagnosed cases. It has been the practice to exclude all notified cases from school until three consecutive negative specimens had been obtained. However, because of the ubiquitous nature of the disease and the number of symptomless carriers, it was found that this action had little effect in controlling school outbreaks. For this reason it was decided to adopt a revised scheme of exclusion from school which would reduce interference with the children's education. Experience has shown that the chances of infection are greatest when the patient has symptoms of diarrhoea and it was therefore decided that children suffering from dysentery should remain away from school until 3 days after they were free from such symptoms, with a minimum period of exclusion of one week. Contacts were not excluded if they were symptom free. The revised scheme was put into operation during the year without any adverse effects. Scarlet Fever There were 122 corrected scarlet fever notifications during the year, but no deaths were attributed to the disease. 14 cases were admitted to hospital, the diagnosis being amended in one instance to measles. The average stay in hospital was 7½ days, which is an indication of the mild nature of the disease. Whooping Cough There were only 12 notified cases during the year, the lowest figure recorded since this disease was made notifiable in October, 1939. No deaths were attributed to the disease. 1 case was admitted to hospital for 40 days. Measles There were 949 notifications of measles during the year, and 15 eases were admitted to hospital with complications. There were no deaths from this cause. it*, v/i Table of Cases of Infectious Diseases coming to the knowledge of the Medical Officer of Health during the year 1959 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 - 1 1 4 2 5 6 6 4 34 39 7 10 1 1 _ - - - - - - - 122 Measles 17 14 35 53 71 54 68 52 101 65 214 184 9 4 1 3 1 2 - - - 1 - - 949 Whooping Cough 1 - 2 1 1 1 1 1 1 1 - 2 - - - - - - - - - - - - 12 Pneumonia 2 2 - 4 3 2 1 1 1 - 6 4 2 1 5 - 3 - 3 1 10 4 8 7 70 Erysipelas - - - - - - - - - - - - - - - - - - 1 - 2 2 - 1 6 Food Poisoning - - - - - 1 - - - - -1 2 2 - - - 2 2 - - 2 2 2 2 18 Puerperal Pyrexia - - - - - - - - - - - - - - - - - 1 - - - - - - 1 Ophthalmia Neonatorum 1 - - - - - - - - - - - - - - - - - - - - - - - 1 Acute Encephalitis Infective - - - - - - - - - 2 - - - - - - - - - - - 2 Post-infectious - - - - - - - - - - - - - - 1 - - - - - - - - - 1 Acute Poliomyelitis Paralytic - - 1 1 - - 1 1 - - 1 - - - - - - - - - - - - - 5 Non-paralytic - - - - - - - - - - 1 - - - - - - - - - - - - - 1 Meningococcal Infection - - - - - 1 - - - - - 1 - - - - - - - - - - - - 2 Diphtheria - - - - - - - - - - - - - - - - - - - - - - - - - Typhoid - - - - - - - - - - - - 1 - - -- - - - - - - - - 1 Paratyphoid - - - - - - - - - - 1 - - - - - - - - - - - - - 2 Dysentery 7 - 3 8 10 9 12 8 15 5 46 36 14 13 1 4 12 19 6 8 7 4 1 3 251 Scabies - - 1 - 1 - - - - - 1 2 2 9 - - 2 1 1 - - - - - 20 Tuberculosis Respiratory _ _ _ _ 1 _ _ _ 1 1 1 1 1 3 1 8 16 4 4 10 8 8 3 71 Meninges & C.N.S. - - - - - - - - - - - - - - - - - - - - - - - - 1 Other - - - - - - - - - - 1 1 - - - - 2 3 - - 2 1 2 2 14 Total 29 16 43 68 91 70 88 69 125 76 307 272 40 38 12 9 30 44 15 13 34 22 21 18 1550 46 MEDICAL EXAMINATION OF STAFF 92 candidates for appointment to the Council's staff were medically examined in 1959 prior to admission to the superannuation scheme Seven, of whom 5 were aged 54 or over, failed to pass the examination for the reasons below. Hypertension 1 Bronchitis and Emphysema 1 Lung Cancer 1 Prolapsed intervertebral disc and other defects 1 Chronic leg ulceration 1 Psychosis 1 Multiple Defects 1 Special medical reports are submitted on staff when sickness absence in the year exceeds 72 days. In a number of cases it has been found that although an employee may be permanently unfit to carry out the duties of his post, he could perform some lighter duties. In order to keep this type of case in employment the Council have earmarked a number of posts for staff fit for light duty only and wherever it is possible transfers are made to these posts rather than recommending retirement on grounds of permanent disability. Such cases are reviewed periodically to ensure that the duties are within their limited physical capabilities. Also where the disability is not of a permanent character the man may be cleared to return to his former employment. Four cases were resettled in light employment in 1959. Three Year Survey of Staff Sickness Stimulated by the findings of two occupational health surveys carried out by the Health Department at local industrial firms in 1952 and 1956 and described in my annual reports for those years, it was decided to seek information about the incidence of illness and accidents among Corporation employees. By co-operation with all departments, detailed information has now been collected, over a period of three years, by weekly returns to the Health Department of all absenteeism due to either illness or accident. The information requested was given under the following headings:- (1) sex; (2) age; (3) occupation; (4) marital status of female employees; (5) whether holding established or non-established post; (6) nature of illness or accident (International Statistical Classification cf Diseases was used for classification); (7) date of onset of illness or accident; and (8) number of working days lost. The in and out-door staff of the Corporation number approximately 1,269 of which 900 are manual workers. During the three years under review 60,329 working days were last by sickness or accident, representing an average absence of 47.4 days per person over this period or one day lost in every nineteen. 47 Annual Sickness and Accident Absence Sate related to Age Groups Category of Staff Age Group All Groups Under 25 25/ /44 45/ /54 Over 54 (a) MALE STAFF (i) Manual Workers Number in each age group 60 221 254 297 832 Days absence in 3 years 1519 10872 12201 21686 46278 Annual Absence Rate in working days 8.4 16.4 16.0 24.3 18.5 (ii) Non-Manual Workers Number in each age gr cup 49 118 64 50 281 Days absence in 3 years 756 1402 1413 2764 6335 Annual Absence Rate in working days 5.0 4.0 7.4 18.4 7.5 (b) FEMALE STAFF (i) Manual Workers Number in each age group 1 23 31 43 98 Days absence in 3 years 53 1038 1401 2524 5016 Annual Absence Rate in working days 17.7 15.0 15.1 19.6 17.1 (ii) Non Manual Workers Number in each age group 21 42 17 8 88 Days absence in 3 years 761 914 769 256 2700 Annual Absence Rate in working days 11.7 7.3 15.1 10.9 10.2 The overall absence amongst male manual staff was more than double that of the indoor staff, the greatest difference being in the 25-44 age group where absenteeism was four times as great. Among female staff the difference was not so marked but here again the difference was most noticeable in the 25-44 age group No significant difference was observed in those medically examined on entrance (established posts) and those not so examined (unestablished). In analysing sickness spells commencing during the three years under review the whole period of sickness up to the date of return to duty has been included although this might be extended to the following year and cases already absent at the beginning of the period have been disregarded. Where prolonged ''spells" were not concluded at the time the data was analysed the sickness period was taken up to the 31st March, 1959 with a consequent curtailment of the related days' sickness to 59,283 compared with the 60,329 days actually lost in the three years. There was a total of 5,583 sickness spells, an average of 4.3 periods of continued absence per employee or an annual inception rate of 1.4. Over half of these periods, 2,943, involved absences of one to three days each and under the sick pay scheme did not require the production of medical certificates. In six cases the absence lasted longer than one year, the causes being pulmonary tuberculosis, psychoneurosis, degenerative heart disease, hypertension, and twocases of vascular lesions of the central nervous system. 48 The following diagram shows the number of working days lost as a result of sickness periods of varying duration. It will be noted that approximately a quarter of the number of days absence was caused by illness lasting up to two weeks and a further quarter as a result of illnesses lasting from two to four weeks. Working days lost related to duration of sickness 49 Seasonal Incidence of Sickness New cases of sickness arising in the latter half of 1955 are shown in the following table so that incidence of sickness can be seen for three full winters. The winter of 1956/7 was comparatively free from winter epidemics, January was the month when sickness was most prevalent, although in 1957/8 a second peak occurred in October at the time of the "Asian" influenza epidemic. During each of the peak periods when new cases numbered more than 250 the number of employees absent in a week reached more than 160, i.e. 12 per cent or one in eight of the staff were absent owing to sickness. Number of New Cases of Sickness arising in four-weekly periods Year Four-weekly Period Total 7 8 9 10 11 12 13 1 2 3 4 5 6 1955/56 98 76 89 130 171 180 141 259 199 134 84 117 83 1761 1956/57 94 59 95 118 148 205 143 174 164 151 103 110 103 1667 1957/58 92 91 91 192 253 196 183 279 194 165 124 127 107 2094 1958 101 74 90 131 187 207 168 958 J J A S O N D J F M A' M J n a u o c o e a e a P a n e y g t t V c n b r r y e 50 Common Causes of Absence (i) The Common Cold caused 754 spells of absence Involving a loss of 2,501 days. However, 601 spells consisted of absence only involving a loss of between one to three days. This accounts for the comparatively small number of days lost. The common cold was the only disease where the absence rate was higher in non-manual workers than manual workers. It appeared to affect older workers less than the younger, but this is probably due to complications arising in older persons resulting in a diagnosis of another respiratory disease such as bronchitis. (II) Bronchitis (485 spells, 10,544 days) The average absence of manual workers was much greater than was non-manual workers (approximately four times.) As would be expected, greater absence occurred in the older manual worker. Bronchitis appeared to be heaviest among refuse disposal works labourers and plant attendants. Park keepers and gardeners then follow with the next highest average number of days absence although the increased incidence in park keepers is largely accounted for by the high proportion of older workers. There was no significant difference between established and unestablished workers. (III) Influenza (566 spells, 6,709 days) As is so well known influenza is no respecter of persons when an epidemic is widespread, and large numbers of persons suffer from this highly infectious disease in all age groups and trades. There are no significant conclusions, therefore, to draw from the absenteeism due to this cause in established and unestablished workers. It can be said, however, that the absence in non-manual workers was less than half of that in the manual workers. It is considered that because of the heavier nature of their work, manual workers must be fully fit before returning to duty, whereas the non-manual workers are able to return to duty sooner, with less convalescence. (iv) Rheumatism and Aithrius (381 spells, 5,371 days) As can be expected absence among non-manual workers was considerably less than manual workers. It was anticipated that those with arduous physical occupations would show high average of absence due to these causes, but it was not found to be greatly so. In this instance, the average absence of established staff was greater than unestablished 7.2 days compared with 4.7 days. Street orderlies had nearly double the average period of absence. Painters, and building trade andrefuse destructor labourers showed a slightly above average absence due to these diseases. A steady rise is shown in the period of absence as the age of the worker increases, this trend is applicable to both established and unestablished workers. 51 (v) Diseases of the Alimentary Tract (473 spells, 4,568 days) There were no significant points in the occurrence of these diseases, except that in the case of unestablished lorry drivers and unestablished carpenters absence was above average. The high figure of absence in the over 65 age group has no significance as the average number of persons at risk was only between three to four. However, the age group 25 - 44 years shows a slightly higher rate of absence then the other age groups. (vi) Psychoneurosis (99 spells, 2,782 days) There was an insignificant difference in the absence caused by this type of illness in established and unestablished staffs. The prolonged absence of a few persons has brought the total number of days, in this group, to a fairly high figure. Discounting the few cases of prolonged absence, the sickness in the various trades and age groups is fairly low. In the few cases where the diagnosis is of a serious nature, it is usualforthe absence to be prolonged, due to the nature of the illness; for example, the absence of one man alone has amounted to 534 working days. The tendency, if any, shows greater mental stability in the older worker. (vii) Accidents Accidents occurring both during and outside working hours are included in this classification. The analysis has been sub-divided according to the part of the body affected and the remaining unspecified, multiple and other accidents, such as stings, form a final general group. The overall accident rate for the 832 male manual workers was 10.9% per annum, the rate being the highest amongst younger workers, falling from 18.3% for those under 25 years to 7.3% for those over 54 years. Accidents to the extremities of the body accounted for a large proportion of all accidents, approximately one fifth affecting the foot and ankle (53 cases) and another fifth the hand and wrist (51 cases). There were 34 cases of inj uries to the spine, usually resulting from lifting strains. Injuries affecting the head and neck accounted for 33 absences. The highest accident rate, (24.3%) was amongst Refuse Disposal Works Labourers and Plant Attendants, and was more than twice the average rate. Building and Road and Sewer Labourers also had high rates; 16.6% and 16.4% respectively. 52 Duration of Sickness Spells related to Disease Disease Group Duration of Absence Total 1 day 2 dys 3 dys 4 dys 5 dys 6 dys 1/2 wks 2/3 wks 3/4 wks 4/8 wks 8/12 wks 12/16 wks 16/20 wks 20/24 wks 24/52 wks Over 1 yr Spells Working days Respiratory Tuberculosis 1 - - - - - - - - - - . . - - 1/(356) 2 357 Cancer - - - - - 1 - - - - 1 3 - 2 5 - 12 1447 Psychoneuroses & psychoses 8 4 3 2 1 6 12 18 10 24 6 3 - 1 . 1/(534) 99 2782 Heart disease 1 2 1 1 1 - 2 1 1 2 4 2 - - 1 1/(397) 19 1176 Hypertensive disease 1 1 - - - - - 2 1 7 2 2 - - 1 1/(361) 18 1133 Diseases of veins 6 1 - 1 - 1 5 4 2 8 - 1 - - - - 29 537 Common cold 279 226 96 15 19 27 66 14 7 4 1 - - - - - 754 2501 Acute pharyngitis & tonsillitis 12 11 10 7 9 19 28 13 5 2 1 - - - - - 117 956 Influenza 29 35 35 19 25 46 183 106 51 36 1 - - - - - 566 6709 Bronchitis 9 18 18 5 7 33 115 95 47 90 26 14 5 1 2 - 485 10544 Pneumonia & other respiratory diseases 10 3 3 4 4 5 17 15 5 5 8 1 1 - . . 81 1411 Hernia - - - - - - 1 2 2 9 2 - - - - - 16 516 Diseases of Alimentary tract 177 54 26 5 14 23 60 46 21 27 16 3 - 1 - - 473 4568 Boils, abscesses etc. 8 11 8 13 9 12 25 16 6 7 - - - - 115 1043 Rheumatism & arthritis 40 26 24 13 10 33 79 71 38 33 8 2 2 - 2 - 381 5371 Diseases of bones 3 3 5 - 1 4 7 11 4 13 5 3 - - 1 - 60 1552 Accidents 73 33 30 16 12 13 77 33 24 22 12 4 4 1 2 - 357 4811 Uncertified & unspecified 688 228 44 7 - 1 2 - 1 1 - - - - - - 972 1386 Other specified & illdefined diseases 459 125 55 22 31 33 114 68 31 49 23 5 1 2 7 3/0243) 1027 10483 TOTAL 1804 781 358 130 143 257 793 515 256 339 116 43 13 8 21 6/(2891) 5583 59283 53 MALE STAFF - WORKING DAYS LOST IN 3 YEARS THROUGH SICKNESS AND ACCIDENTS IN PRINCIPAL TRADES Manual Staff Number Employed Psychoneurosis Influenza Bronchitis Diseases of Alimentary tract Rheumatism & Arthritis Common Cold Accidents All Sickness All Causes Days lost Average per man Days lost Average per man Days lost Average per man Days lost Average per man Days lost Average per man Days lost Average per man Days lost Average per man Days lost Average per man Days lost Average per man Bath Attendant 14.7 45 3.1 16 1.1 177 12.0 18 1.2 24 1.6 17 1.2 35 2.0 556 38 591 40 Carpenter 28.9 30 1.0 101 3.5 124 4.3 173 6.0 146 5.1 39 1.3 127 4.4 842 29 969 34 Convenience Attendant 23.6 - - 134 5.7 298 12.6 26 1.1 86 3.6 16 .7 173 7.0 1034 44 1027 51 Gardener 31.9 31 1.0 185 5.8 519 16.3 53 1.7 106 3.3 66 2.1 174 5.0 1516 48 1690 53 Building Labourer 73.4 110 1.5 568 7.9 778 10.5 304 4.1 491 6.7 126 1.7 281 4 0 3472 47 3752 51 Garden Labourer 36.5 40 1.1 78 2.1 461 12 6 75 2.1 199 5.5 20 .6 57 1.5 1154 31.5 1211 33 Road & Sewer Labourer 75 0 124 1.7 593 79 743 9 9 415 5 5 420 5.6 177 2.4 547 70 4170 56 0 4717 63 Painter 89 9 346 3.9 801 8.9 864 96 474 5.3 624 69 118 1.3 472 50 6753 71 0 6825 76 Park Attendant 468 249 5.3 180 3.7 860 18 4 241 5 1 213 4.3 14 3 101 2 2 2551 54.5 2652 57 Refuse Collector 50 7 262 5,2 246 4.9 329 6 5 195 3 6 301 6.0 96 1.9 323 6.4 2514 49.5 2837 56 Loader/Driver 20 4 - - 134 6 6 189 9 3 113 5.5 121 5.9 14 .7 80 4.0 950 47 0 1030 51 R.D. Labourer & Plant Attendant 31.5 57 1.8 160 5.1 637 20.2 119 3.8 198 6.3 30 1.0 329 10,5 2153 68.5 2482 79 Street Orderly 63.5 739 11.6 433 6.8 873 13.7 364 5.7 583 9 2 141 2.2 312 5.0 4093 64.0 4405 69 Others 245.3 265 1.1 1246 5.1 2188 8.9 1200 4.9 1406 5.7 346 1.4 1321 5.4 10588 43.0 11909 48 832.1 2298 2.8 4875 5.9 9040 10.7 3770 4.5 4918 5.9 1220 1.5 4332 4.5 41946 50.0 46278 56 Non-Manual Staff 281 168 .6 672 2.4 597 2.1 500 1.8 149 .5 600 2.1 248 1.0 6087 21.5 6335 22.5 54 ACCIDENTS AMONGST MALE MANUAL WORKERS AND RESULTANT ABSENCE Part of Body affected 55 and over 45 54 25 44 24 and under All Groups No. of Cases Resultant Absence No. of Cases Resultant Absence No. of Cases Resultant Absence No. of Cases Resultant Absence No. of Cases Resultant Absence Foot and Ankle 11 192 16 228 18 316 8 56 53 792 Wrist and Hand 10 77 12 183 23 358 6 39 51 657 Spine 4 39 12 188 17 209 1 1 34 437 Head and Neck 9 106 10 69 11 186 3 23 33 384 Leg 4 221 8 370 11 61 5 20 28 672 Arm and Shoulder Girdle 8 152 5 113 10 227 4 64 27 556 Chest 7 103 3 82 4 24 - - 14 209 Abdomen - - - - 1 9 1 3 2 12 Pelvic Girdle and Hip 1 3 - - - - - - 1 3 Multiple, Unspecified, and Other 11 70 3 79 9 42 6 23 29 214 All Accidents 65 963 70 1321 104 1426 33 226 272 3936 Number at risk 297 254 221 60 832 Rates per cent per annum 7.3 108 9.2 173 15.7 215 18.3 125 10.9 157 55 ACCIDENTS AMONGST MALE MANUAL WORKERS IN PRINCIPAL TRADE GROUPS Part Affected Crpnts (28.9) Lav. Aits. (23.6) Grdnrs. (31.9) Bidg. Lab. (73.4) Bdni. Lab. (36.5) Rd. & Swr Lab. (75)) R.D.Lab. &Pl.Att. (31.5) Painter (89.9) Park Att. (46.8) Refuse Colltr. (50.7) Loade* Driver (20.4) Sheet Orderly (63.5) Others (260) All (832) C* AR* C* AR* c* AR* C* AR* C* AR* C* AR* C* AR* C* AR* C* AR* C* AR* C* AR* C* AR* C* AR* C* AR* Foot & Ankle - - 2 2.8 - - 2 .9 - - 10 4.4 8 8.5 - - 1 .7 6 3.9 - - 2 1.1 22 2.8 53 2.1 Wrist & Hand 2 2.3 - - 2 2.1 6 2.7 2 1.8 7 3.1 6 6.3 8 3.0 1 .7 2 1.3 1 1.6 1 .5 13 1.7 51 2.0 Spine 1 1.2 - - 1 1.0 5 2.3 - - 3 1.3 3 3.2 3 1.1 1 .7 2 1.3 4 6.5 1 .5 10 1.3 34 1.4 Head & Neck 1 1.2 - - 1 1.0 5 2.3 2 1.8 3 1.3 2 2.1 5 1.8 1 .7 1 .7 - - - 12 1.5 33 1.3 Leg 2 2.3 - - - - 5 2.3 1 .9 3 1.3 1 1.1 3 1.1 2 1.4 4 2.6 - - 1 t5 6 .8 28 1.1 Arm & Shoulder Girdle 1 1.2 - - 1 1.0 5 2.3 1 .9 3 1.3 2 2.1 3 1.1 - - 2 1.3 1 1.6 2 1.1 6 .8 27 1.1 Chest - - - - 2 2.1 3 1.4 - - - - 1 1.1 2 .7 - - 1 .7 1 1.6 - - 4 .5 14 .6 Abdomen - - - - - - 1 .5 - - - - - - - - - - - - 1 1.6 - - - - 2 .1 Pelvic Girdle & Hip - - - - - - - - - - - - - - - - - - - - - - - - 1 .1 1 0.0 Unspecified & Multiple & Other 1 1.2 - - - - 5 2.3 2 1.8 8 3.6 - - 1 .4 - - 1 .7 - - 2 1.1 9 1.2 29 1.2 All Accidents 8 9.2 2 2.8 7 7.3 37 16.6 8 7.3 37 16.4 23 24.3 25 9.3 6 4.3 19 12.5 8 13.1 9 4.7 83 10.6 272 10.9 * NOTE *C* = Number of Cases. *AR* - Annual Accident Rate per cent 56 OLD PEOPLE'S WELFARE The lengthening of life resulting from improved living conditions and advances in medicine together with the reduced sizes of modern families has meant that an increasing proportion of the population are over retiring age. Whereas in 1921 only one in twenty was over 65, today one in eight is in this age group. This has meant a gradual adj ustment of society, not only to meet the problems which come with advancing years but also to ensure that those in this age group of whom a large proportion are fully active and able citizens are able to continue to play their part in the activities of the Borough. Fortunately in the present times of full employment many continue in useful employment well beyond the age of 65 and providing the physical efforts are not too arduous this is usually beneficial in keeping them active and healthy. A time must come when help becomes necessary, whether this be from members of the family, neighbours or by voluntary or statutory services. It is not possible to detail the work that is done by relatives and friends but there is no doubt that they play a most important part in the care of the aged. The following is a brief summary of services provided in Tottenham for old people. Old People s Welfare Committee Chiropody Service 977 old people received treatment; 5,258 treatments were given, an increase of 1,078 on last year. Christmas 1959 1,500 parcels were packed and delivered by voluntary effort to the homes of the aged, sick and housebound. Much assistance was given to the old people at Christmas by persons and organisations in the Borough. Club Dinners 9,740 meals were served to the old people at the St. Ann's and Lord Morrison Hall Clubs. Holidays and Outings 70 old people were able to have two weeks' holiday through the help of the Women's Holiday Fund; many people and organisations gave old people a day out. Many outings have been arranged for the housebound due to the generosity of many voluntary organisations and Messrs. Ardleys who gave the free use of a coach for a day. Optical Service 41 housebound old people were visited by the Optician. Shoe Repairs 3 dockets were issued to enable old people to get footwear repaired at a reduced rate. Barber Service 66 old people in their homes, and 109 club members were visited by the Barber. Harvest Festival 600 old people benefited by the kindness and generosity of schools and Churches who sent their Harvest Festival Thanksgiving for distribution by the Committee. 57 Meals-on-Wheels 7,529 meals were delivered through the service organised by the Committee; and 3,962 by the Women's Voluntary Service. General Welfare During the year 1,839 office interviews were conducted, 761 domiciliary visits and 204 club visits made; in addition, numerous enquiries and problems were dealt with by letter and telephone. Borough Services for the Aged Laundry Service for the Incontinent Aged The service is provided under section 84 of the Public Health Act, 1936, and in 1959 705 collections were made by the Public Health Department. Baths Many old people received assistance from the facilities provided for free baths and are reassured that if they need help they can rely on the Baths Attendants. Library Service 31 housebound old people were visited regularly during the year and deliveries totalled 4,238. Hospital Services St. Ann's General Hospital has wards providing 100 beds (60 female and 40 male) for the chronic sick, and the possibilities are being explored of providing also *day hospital* treatment. Facilities for occupational and physiotherapy would cater for those patients not requiring fulltime hospital care and would help to meet the problem of infirm old people who are alone all day, but whose relatives can look after them during the evening and night. Weekly notification is received from St. Ann's General Hospital of the names of patients put on their waiting list for admission to the geriatric wards. These cases are visited and a report furnished to the hospital on the home circumstances to enable the hospital to give priority to those cases in most urgent need of hospital care. Welfare Homes It is the statutory duty of the County Council to make this provision but there is at present no home in Tottenham. Admission to the homes outside the Borough is still difficult owing to the shortage of accommodation, and a number of beds at the hospital become blocked by patients who are considered by the hospital authorities as suitable for transfer to a welfare home but for whom accommodation is not available. National Assistance Act, 1948, Section 47 It was found necessary to exercise these powers on one occasion in 1959. This step was taken after all other possibilities had been explored of dealing with the problem without resorting to compulsion. The person concerned was an old lady living in rooms behind a grocer's shop. She was in a very neglected condition with clothing badly soiled and smelling as a result of a discharge, but she strongly resisted all efforts to assist her. 58 A court order was obtained for her removal to hospital where it was found she was suffering from a chronic condition which could be remedied by surgery. She was later transferred to a mental hospital, suffering from senile dementia. National Assistance, Act, 1948, Section 50, Burials Nine burials were arranged where deaths occurred and suitable arrangements would not otherwise have been made. GENERAL Health Services provided by other Authorities (a) Hospitals - North-East Metropolitan Regional Hospital Board. The hospitals in the Borough are locally administered by the Tottenham Group Hospital Management Committee whose offices are at the Prince of Wales's General Hospital. The Group comprises the undermentioned hospitals:- Hospital Bed Complement Beds Open Remarks Bearstead Memorial Hospital 38 38 Maternity Hospital Annexe at Hampton Court 33 33 St. Ann s General Hospital 706 576 Includes infectious diseases wards and special poliomyelitis unit Prince of Wales's General Hospital 223 215 Annexe at Nazeing (Princess Louise Convalescent Home) 20 20 Tottenham Chest Clinic - - A table giving details of the out-patient clinics provided at the Prince of Wales's General Hospital is set out on the following page. 59 Prince of Wales s Hospital Time-table of Out-Patient Clinics Monday Tuesday Wednesday Thursday Friday Saturday Medical p.m. a.m. p.m. p.m. a.m. - Endocrine a.m. 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 & Eat 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. p.m. a.m. p.m. a.m. a.m. p.m. a.m. p.m. - X ray 9 a.m. until 5 p.m. every day Saturdays 9 a.m. - 12 noon Orthopaedic - a.m. - a.m. - - Fractures a.m. - - - a.m. - Allergy - - - p.m. - - Veneral Diseases Medical Officer a.m. p.m. Males 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 Service The personal health services which since 1948 have been controlled by the Middlesex County Council are administered from the Area Health Offices, Somerset Road, Tottenham, N.17. (c) Area Welfare Service 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 60 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. Outfits may be obtained from the Public Health Department where specimens are collected daily by a special messenger for examination at the Hornsey Branch Laboratory, Coppett's Road, N.10. Collecting times are 3.00 p.m. Monday to Friday and 10.00 a.m. Saturday. A twenty-four hour emergency service is maintained by the Central Laboratory at Colindale. The following is a summary of work carried out for Tottenham by the Laboratory Service :- RECORD OF EXAMINATIONS Throat/Nose Swabs:- Total specimens 60 Diphtheria Bacilli 0 Haemolytic Streptococci 2 Vincents Angina 0 Staph Aurius 1 Negative 57 Faeces: - Total specimens 1317 Shigella 375 Salmonella Typhi-murium 11 Polio Virus 2 Unidentified Salmonella 2 Negative 927 Sputum: - Total specimens 0 Positive 0 Negative 0 Ice-Cream;. Total specimens 2 Water: - Total specimens 0 Miscellaneous specimens 2 Total number of specimens 1381 Middlesex County Council Act, 1944 Part XII Seven establishments were registered for chiropody and special treatment, at 31st December, 1959. PERSONAL AND SCHOOL HEALTH SERVICES TOTTENHAM AND HORNSEY (Joint Population 216,000) 61 THE AREA HEALTH COMMITTEE Members of Hornsey Borough Council Councillor Miss O.R. Anderson, J.P. Councillor Mrs. J. Carter Councillor Mr. D.H.P. Levy Councillor Mr. J.T. Wilkins (Chairman) Councillor Mr. C.R. Williams Members of Tottenham Borough Council Alderman Mr. A,.Reed, A.C.I.I., J.P. Alderman Mrs. A.F. Remington Councillor Mrs. L.R. Harrington (Vice-Chairman) Councillor Mr. H. Langer Councillor Mr. M.T. Morris Councillor Mrs. M.E. Protheroe Members of Middlesex County Council County Councillor Mr. F.H. Brooks County Councillor Mr. V. Butler County Councillor Mrs. S.G. Child County Councillor Mr. A.H. Miller County Councillor Mrs. M.E. Soall County Councillor Mrs. J. Thexton Members nominated by appropriate Hospital Management Committee Mrs. R.M. Fry Mr. L. Hayward Persons who may attend in an advisory capacity Dr. L. Hornung (Middlesex Local Medical Committee) Mr. R.W.D. Brownlie (Middlesex Local Dental Committee) Mr. L. Hayward (Middlesex Local Pharmaceutical Committee) Miss V. Edey (Royal College of Midwives) TOTTENHAM DIVISIONAL EXECUTIVE EDUCATION COMMITTEE Chairman Alderman Mrs. A.F. Remington Vice-Chairman Councillor Mrs. M.E. Protheroe Alderman C.H. Colyer Alderman F.A.F. Keay, J.P. E.J. Field The Lady Grace Morrison R.W.H. Ford A. Reed, A.C.I.I., J.P. Councillor G.W. Barker Councillor J.D. Mcllwain Mrs. S.A. Berkery-Smith M.T. Morris Douglas Clark I.L. Peirce Mrs. F.E. Haynes P.H. Roberts H. Langer J. Watkins J. Mather E.P. Deakins Representing County Council County Councillor H.H. Godwin-Monck County Councillor firs. M.E. Soall Co-opted Members Mr. R.C. Ablewhite Mr. D. Edgington Mr. H.R. Cheetham Mr. R.W. Nutting Borough Education Officer - J. Power, M.A. 62 CARE OF MOTHERS AND YOUNG CHILDREN 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 seven years and the percentage of hospital confinements was 81.7%, compared with 80% in 1958. 1959 1958 1957 Live Births (a) Domiciliary 649 708 566 (b) Hospital or Nursing Home 2881 2799 2679 Still Births (a) Domiciliary 4 6 3 (b) Hospital or Nursing Home 49 59 63 3583 3572 3311 Ante-natal clinics The arrangements for four assistant medical officers with post graduate obstetrical qualifications to staff the ante-natal clinics in Tottenham and also to attend as honorary clinical assistants at the North Middlesex and Bearsted Memorial Hospitals have worked well. During the year discussions have taken place locally with the Medical Liaison Committees as to the implications of the Cranbrook Report on the Maternity Services. The Minister of Health has decided that many of the recommendations made require consultation with the authorities and organisations concerned before final decisions can be taken. The percentage of expectant mothers making at least one attendance at one of the local authority ante-natal clinics was 63.6% during 1959 compared with 65.7% the previous year. The following table gives details of attendances at all clinics in the Area:- No , of sessions held No. of new cases Total attendances Average attendance per session A.N. P.N. A.N. P.N. Burgoyne Road 76 207 115 1386 119 19.8 Church Road 74 128 71 1072 79 15.6 Fortis Green 101 241 104 1797 110 18.9 Hornsey Town Hall 154 382 168 2710 173 18.7 Mildura Court 66 204 101 1381 108 22.6 Stroud Green 53 166 73 851 73 17.4 The Chestnuts 154 422 180 2831 183 19.6 Lordship Lane 154 284 144 1894 150 13.3 Park Lane 104 255 136 1321 136 14.0 Totals 1959 936 2289 1092 15243 1131 17.5 Totals 1958 1001 2347 1157 15536 1234 16.7 Totals 1957 1029 2267 1120 15131 1238 15.9 Midwives Ante-natal Clinics The following table shows the attendances made during the year. 63 Midwives Clinics No. of sessions held Total No. of attendances Average attendance per session Burgoyne Road 24 154 6.4 Fortis Green 16 91 5.7 Hornsey Town Hall 13 123 9.5 Mildura Court 24 124 5.2 Stroud Green 25 232 9.3 Park Lane 89 326 3.7 Total 191 1050 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 38 42 200 5.3 Church Road 46 66 232 5.0 Portis Green 47 67 389 8.3 Hornsey Town Hall 50 153 625 12.5 Mildura Court 39 31 143 3.7 The Chestnuts 50 98 577 11.5 Lordship Lane 52 71 402 7.7 Park Lane 49 46 292 6.0 Total 371 574 2860 7.7 Infant Welfare Clinics These clinics have continued to run smoothly throughout the year. The mothers bring their babies regularly and derive great comfort from knowing that their offspring thrive. A careful check can be kep on those babies who do not progress satisfactorily mentally or physically and mothers can be given guidance in management and feeding problems. The health visitors conductseparate sessions which help the doctors to see only those cases in which medical advice is necessary. The doctors' sessions are thus kept within reasonable numbers so that an unharrassed atmosphere can be created. This is becoming increasingly necessary and allows time to penetrate into special difficulties and give suitable advice the kind of advice which is most likely to betaken. The importance of recognising as early as possible any signs which might lead later to some permanent handicaps cannot be overstressed. Routine urine testing of young babies is now carried out in order to find those rare cases of mental retardation. Very early hearing tests are carried out with a view to detecting congenital deafness and referenence to the Audiology clinic. There is a regrettable trend, as the baby grows older, for mothers to attend clinics less often. The toddler sessions thus seek to obtain more regular supervision of the 2-5 age group; as only in this way the developmental defects and behaviour problems can be found before they become serious. All the personnel working in these clinics have been impressed with the improvements in the higher standard of health and physique among young babies, but all are like- 64 wise impressed with the upsurge of emotional problems of young mothers. There seems to be an increased urge by parents to do the "best" for children and this calls for deep understanding, sympathy, tact andresourcefulness on the part of the health visitors and doctors and an increasing need for an intimate knowledge of all the social and special services. In turn this calls for even closer co-operation between the many services available and those who work in them, both by personal contacts and through the medium of liaison committees. 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 Over 2 but under 5 Burgoyne Road 153 304 4888 753 193 5834 1416 38.1 Church Road 177 238 3298 554 116 3968 1556 22.4 Portis Green 156 324 3878 782 166 4826 1840 30.9 Hornsey Town Hall 207 521 6093 1029 263 7385 2830 35.7 Mildura Court 104 252 3609 693 65 4367 1394 42.0 Stroud Green 101 264 3123 421 123 3667 1422 36.3 The Chestnuts 245 500 6607 922 204 7729 2539 31.5 Lordship Lane 258 412 5654 1122 169 6945 1772 26.9 Park Lane 204 358 5312 1093 305 6710 1697 32.9 Somerset Road 144 287 4167 903 204 5274 1609 36.6 Totals 1959 1749 3460 46625 8272 1808 56705 18075 32.4 Totals 1958 1733 3550 47444 7907 1605 56956 17839 32.9 Totals 1957 1691 3154 44667 7091 1980 53738 17017 31.8 Toddlers Clinics These sessions for the pre- school child continue to be conducted at all the centres; and present a challenge to all our staff. Ideally, after the second birthday the "toddler" should be seen by appointment at six monthly intervals or more frequently if necessary. In this way, defects, mental, physical or environmental, can be found and rectified before the child enters school. Those defects which are most likely to be a hindrance are those connected with sight, hearing, speech, motivation, mental acuity or social adjustment. The routine examination of children before they enter school is thus of the utmost importance and makes it possible to reduce the number of untreated defects found in school entrants. 65 The following table gives details of attendances at the individual clinics:- Name of Centre No. of sessions held Total attendances No. of cases seen by M.O. Average attendance per session Burgoyne Road 28 508 508 18.1 Church Road 24 370 346 15.4 Fortis Green 28 405 405 14.5 Homsey Town Hall 61 679 663 11.1 Mildura Court 50 680 629 13.6 Stroud Green 23 314 314 13.7 The Chestnuts 50 668 662 13.4 Lordship Lane 52 680 680 13.1 Park Lane 23 235 235 10.2 Somerset Road 39 504 504 12.9 Totals 1959 378 5043 4946 13.3 Totals 1958 408 5010 4892 12.3 Totals 1957 433 5407 5256 12.5 Daily Guardian Scheme This scheme was re-introduced in 1947 for children of working mothers who are not eligible for day nursery accommodation for their pre- school age children. So far there has been no difficulty in finding a suitable number of women to undertake daily care of children who are taken to them and recovered from them by their parents each day. Proper safeguards are established for the welfare of such children and a written copy of the obligations of parents and daily guardians is given to each of the parties to the agreement to ensure that they are known. While the authority acts as an agent between parent and guardian, the actual placing is the responsibility of the parents. The scheme works easily. The children are seldom moved again after being accepted by a guardian unless the mother gives up work. The main reasons for using the scheme are financial ones. Health visitors are responsible for the approval of guardians for registration and for periodic visiting of children placed in their care. No person is registered if there is any doubt that the rules of the scheme will be followed and that a good standard of care can be maintained It follows, therefore, that some applicants for registration are rejected and the authority is not involved if those rejected accept children for daily minding. Guardians are paid one shilling a day for each child minded (not exceeding two children) irrespective of what payment the parent may make to the guardian. During the year a larger number of children have been minded for a greater number of days. Daily Guardian Scheme Return for Year ended 31st December 1959 No. of Daily Guardians on Register 166 No. of Daily Guardians minding Children 90 No. of Children being minded 106 Total No. of Children minded during the year 231 Total No. of days minded 23,591 Total Payments made to Guardians £1179. 11s. 0d. 66 Day Nurseries All three day nurseries, Park Lane, Plevna and Stonecroft, are approved as training schools for student nursery nurses. The nursery matrons report that during the year there were more children admitted from broken homes or homes where there is only one parent than ever before. This is borne out by our records as regards children wholly supported by one parent and there is evidence to show that more than 50% of the children on the registers were in the 0-2 years age group. The periods for which children attended were in many cases shorter than in the past and during the year approximately 30% stayed in the nurseries for up to one month; 50% for periods under one year, and 20% over one year. The constant change-over of children adds to the strains of day nursery work associated with the settling-in of so many children. Staff absences due to sickness lowers the actual ratio of staff to children to what must be considered a dangerously low level so that in practice students or an inadequate number of staff may be left to supervise a considerable number of children. Students are away from the nurseries at the technical college on two days of each week for their theoretical training, and when they return, their practical training is reduced to a minimum. There is unlikely to be proper supervision of students or children in such circumstances and the amount of absenteeism may produce overstrain resulting from inadequate staffing in our day nurseries. The remedy may be either to consider students as supernumerary or that the nurseries be given a higher proportion of trained nursery nurses for the 0-2 age group. Student nursery nurse training and examination arrangements have been revised by the National Nursery Examination Board and in connection with this, nursery matrons were invited to attend a meeting at the Tottenham Technical College in January for a full discussion of the necessary modifications. The following table shows the attendances at individual nurseries during the year. Name of Day Nursery No of approved places at end of year No. of children on register at end of year Total No. of attendances Average daily attendance Under 2 2 - 5 Under 2 2 - 5 Under 2 2 - 5 Total Stonecroft 15 43 19 42 2673 10267 12940 50.8 Park Lane 20 30 21 26 3376 3466 6842 26.8 Plevna 20 30 19 35 3746 6435 10181 39.9 Totals 1959 55 103 59 103 9795 20168 29963 117.5 Totals 1958 55 113 56 99 9632 22941 32573 127.7 Totals 1957 55 113 51 113 10084 20838 30922 121.7 Distribution of Welfare Foods 67 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) 1959 36350 98855 11676 11048 1958 39005 104980 12571 10420 1957 48243 156962 17347 10545 Priority Dental Service for Mothers and Young Children The following table gives details of attendances made and treatment given at all clinics during the past three years 1959 1958 1957 Expect ant 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 131 572 174 562 190 568 No. referred for treatment 127 467 171 523 188 548 New cases commenced " 127 421 155 479 172 531 Cases made dentally fit 55 178 64 172 84 323 Forms of dental treatment provided:- Teeth extracted 159 369 274 432 205 432 Anaesthetics - (a) Local 68 26 100 56 85 69 (b) General 24 156 36 187 36 175 No. of fillings 220 474 372 469 358 847 No. of root fillings - - 1 - - - No. of inlays - - 1 1 2 - Scalings and gum treatment 90 - 108 - 76 - Silver nitrate treatment - 478 - 503 - 550 Dressings 114 162 126 150 86 338 Other operations 10 1 10 10 30 64 No. of radiographs:- (a) at County Council clinics 16 2 14 - 13 1 (b) at hospital 1 - 1 - - - Denture dressings 163 - 178 - 112 - Dentures fitted:- (a) full 16 4 14 - 8 - (b) partial 32 - 29 - 32 - No. of attendances 588 872 758 981 634 1154 No. of appointments not kept 138 199 145 186 187 227 No. of half days devoted to treatment 155 192 221 68 MIDWIFERY SERVICE Throughout the year difficulty has been encountered in maintaining a sufficient number of midwives to ensure a safe and workable service. Fortunately, it has been possible to find replacements for those midwives who left the service but it has been impossible to maintain a full establishment. Every effort is being made to attract midwives into the local service. Two were recruited from pupil midwives trained in the area and one other mainly because it was possible to offer housing accommodation. There is no doubt that facilities for transport and housing play an important part in the recruitment of midwives. The introduction of a shift system which would afford the midwife some undisturbed nights is proposed as soon as a sufficient number of staff can be obtained. Each midwife has undertaken more than the recommended number of deliveries. Any difficulty encountered is often due to the fact that people do not avail themselves of the services provided and there are still small numbers of pregnant women who do not receive adequate ante-natal care. One hundred per cent ante-natal care is the key to trouble-free confinements. An increasing number of general practitioners are undertaking ante-natal care and engaging in the practice of obstetrics. Their co-operation with the midwives has been excellent. Early discharges from hospital continue to form a part of every midwife's work. Patients are commonly sent home on the third day following confinement and receive two visits on this day and a daily visit thereafter by their midwives until the fourteenth day. All midwives are at present up to date with refresher courses. These are found to be useful and stimulating and much appreciated by the midwives. One midwife is at present taking the course for the Midwife Teachers Diploma Five or six pupil midwives are continuously in training on the district from the Alexandra Maternity Home at Muswell Hill. Seventeen pupils were trained in 1959, fifteen of whom were successful at the examination. The following table shows the work for the past three years:- 1959 1958 1957 No. of deliveries attended 640 698 555 No. of visits made 13572 14730 12163 No. of hospital confinements discharged before 14th day 231 98 76 No. of visits made 2424 910 708 No. of cases in which medical aid was summoned 287 297 176 No. of cases in which gas and air analgesia was administered 470 588 431 No. of cases in which pethidine was administered 418 483 322 No. of cases in which trichloroethylene was administered 121 65 46 HEALTH VISITING SERVICE The main work of the health visitor is still basically the teaching of the principles of health and well being. Guiding towards health in clinics and homes is applied to the family as it is needed in consultation with parents or members of a family or individuals living alone. In those 69 situations where the need is seen first by the health visitor she uses all her ingenuity and skill to move the family towards the attainment of health and the desire to achieve it. Listening, interpreting, counselling, instructing, encouraging, preventing, are some of the words used to described the activities of the health visitor with each person who seeks her help or is sought out by her. In the wider field, the health visitor has been used by local health departments, hospitals, the Medical Research Council and other investigators connected with problems of peri-natal death rates, the health and development of children and other age groups. 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:- 1959 1958 Sxpectant Mothers First Visits 2285 1982 Total Visits 3511 3358 Children under 1 year of age First Visits 4234 4136 Total Visits 16056 16025 Children aged 1-2 Total Visits 8101 7771 Children aged 2 -5 Total Visits 13202 12643 Other cases - Total Visits as Health Visitor 6246 6051 - Total Visits as School Nurse 878 911 A new feature of health visiting in the Area is the extension of the service to a Group Practice Centre in Tottenham. A health visitor attends the Centre for two sessions each week. One is a baby welfare session to offer advice and to make a selection of children to see the doctor for examination or opinion. This procedure conforms to much the same method as is used in local authority welfare centres. The second session the health visitor is present to listen to and to give counsel on various difficulties expressed to herself or the doctors by patients attending the Centre. Problems connected with the care of the aged and care of the family during the mother's absence in hospital for confinement or other reasons are talked over with patients and resolved where it is possible. The statutory and voluntary services available in the Area are made known, clarified and put into motion where they can help to overcome difficulties. The health visitor concerned also collects particulars of any patients for whom the general practitioners request a home visit. Some of these are dealt with by the health visitor herself, but those living outside her district are handed on to the health visitor on whose district the patient lives. This method of co-operation has not presented any complications. Mental Health Case Conference Health visitors presentation to the Case Conferences for health visitors has continued to be held at monthly intervals during the year. Eighteen cases were selected for discussion. Several individuals who were the topic of observation and were in need of psychiatric help were subsequently seen by Dr. J.C. Sawle-Thomas, Regional Psychiatrist to the North East Metropolitan Regional Hospital Board and Consultant to the Prince of Wales's Hospital. The conferences are held under his guidance. Those family doctors who have been concerned with particular patients have been most co-operative throughout in assessing those indicated by the health visitor and by making ultimate 70 referral to the consultant. Early signs of breakdown were the subject of report in some cases. There were others who were regarded as being unable to benefit from further psychiatric treatment or who have resisted the assistance that psychiatrists or psychiatric social workers can give them. It may be expedient for psychopaths to be returned to their homes when no further treatment or hospitalisation is of any value to the patient but the burden of contending with them falls first of all on the family and relatives. It is also inevitable that the one constant visitor to the family, i.e. the health visitor, finds these cases come back to her or the special services health visitor who with the family doctor help to sustain them and their worried relatives. Student Health Visitors have been received for practical experience and observation visits for three terms during the year. Each is attached to one health visiting team and arrangements for continuity of visiting a few families are made. A balanced programme of special experience connected with all aspects of health visiting including contacts with schools and social agencies is also provided for them. Special Services for Problem Families Miss H.J. Howse, special services health visitor for the Hornsey part of the Area reports:- "As so many agencies dealing with problem families of families with special difficulties feel that even after intensive work any improvement obtained does not last, endeavour has been made, where possible, to keep a check on the families dealt with. After 2¾ years the result of my observations of some 28 families, having between them 105 children, is as follows:- Children: - Four who were in care" are now at home with their parents. Two children who were rejected by their mothers have had to be taken into care. Six children (three families) are in care because of severe mental illness of the mother. Two children (of one family) are in institutions because they are imbeciles. In all but one of the remainder of the cases the children have been kept together with their own parents; the exception is with its grandparents. It has been possible to keep 95 children at home with their parents and to bring home again to their parents four children who were "in care". Families:- Fourteen families have had association with the N.S.P.C.C. Twenty four parents have been under the supervision of probation officers, on probation or in prison. Twenty six parents suffer from mental illness or mental subnormality. In dealing with problem families my experience has shown that;- 1. From the beginning every opportunity must be taken to get families back into and supported by the community. This means helping them to improve their relationships within their own families, with the schools their children attend and with all the activities offered by religious and other institutions. The first few weeks of intensive work when all the materials matters are being dealt with must be used to developsuch a good relationship that the attitudes of the family may gradually be changed and the services of the special worker be reduced. 2. When a family moves from furnished accommodation to unfurnished, secondhand furniture must be obtained and the family persuaded not to buy anything on hire purchase. 71 3. The less severe psychopath will work regularly if he can be helped to find work that he likes. For the severe psychopath there should be controlled workshops so that his time can be fully occupied away from his home for part of every day. 4. Those who are severely ill mentally can be helped but will always need support until a cure can be found for their illness. I have been very surprised at the amount of detailed work required in dealing with these families. A full day-to-day history must be kept so that at any moment information required is forthcoming. Reports have to be sent to different local authority departments, to general practitioners, hospitals, marriage guidance counsellors and other organisations, and the writing of them is very time-consuming. Although there is a great deal of publicity about all services available to the family, I get very many enquiries from various people needing help. Once they have been told of the statutory and voluntary services available, they are quite well able to deal with their own problems. I have felt for sometime that a ®Family Advice Bureau" would be of great value". Miss M. Spooner, special services health visitor for the Tottenham part of the Area commenced her work on problem families at the beginning of October 1959. She reports that during her first two weeks in Tottenham she visited with the health visitors 24 families which were said to be in need of more intensive care than they were able to give. Of these, four were taken over as considered urgent and five from her predecessor who needed constant visiting in order to keep up the standard already reached. Since then, four more families have been taken over by request from health visitors and one by request from a head teacher. Action taken includes arrangement for the settlement of debts, attention to the health of mothers including visits to hospital, psychiatric advice for two mothers, the provision of school meals and assistance with clothing. In one case primary education for a father was arranged at his own request, and another has been persuaded to undertake minor house repairs and attention to the garden. Appointments were made for a number of children to attend clinics from, which they had defaulted and to return to school. The children of these families have a characteristic lack of contact with society of any kind outside home and school. Successful contacts have been made for many of them to attend boys andgirls organisations. Fourteen families have been assisted in rehabilitation by the special services health visitor and the number of children concerned in them was no less than eighty. HOME NURSING SERVICE The treatment of cases during the year may be calssifiedas follows:- Injections 1058 General nursing care 604 Blanket baths 313 Enemas 218 Dressings 263 Preparation for diagnostic investigation 264 Pessaries changed 48 Wash-outs, douches, etc. 45 Attendance at minor operation 1 Other treatments 77 72 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 17 15 5 - 15 40 32 16 - 39 62 173 40 - 64 274 472 65 and over 525 1191 920 1881 Cases attended during the year were referred from the following sources:- General Practitioners 2037 Hospitals 734 Chest Physicians 12 Public Health Department 4 Direct 14 It has been possible to keep a reasonably full staff of home nurses during 1959- Over the year, 28 nurses were employed in this service (including two male nurses). The number of part-time nurses has been reduced to four for the whole Area. This is a desirable change as it allows the work to be more evenly distributed over the whole of the nurses' working day. Very little change has been noted in the types of work, a preponderance of time is still spent with the aged and the aged sick. Many of the problems of these old people are the result of trying to maintain life when alone or feeble or helpless. Nurses Work and Education The nurses have been most co-operative and helpful with the observation visits of students from various training schools. Two nurses have themselves attended refresher courses during the year. Equipment An Oxford type hoist was received early in the year and has been in almost constant use since its arrival. It is of great use to both the nurse and the patient's relatives. Also it is easily transportably by private car. Other equipment and nursing aids have been obtained from the British Red Cross Society who have, as usual, been most helpful with all the many calls on their service. Transport The situation has improved considerably, particularly in Hornsey where cycling is so difficult, and ten of the fourteen nurses now use some form of motorised transport. 73 The following table shows the work of the service during 1959:- Type of Case No. of new cases attended by home nurses during year No. of cases on register at end of year No. of visits paid by home nurses during year M F Total M F Total Medical 670 1270 1940 146 426 572 63875 Surgical 46 107 153 6 16 22 4712 Infectious Diseases 6 15 21 - - - 216 Tuberculosis 15 28 43 6 10 16 2977 Maternal Complications - 10 10 - .1 1 176 Others 2 3 5 - - - 31 Totals 1959 739 1433 2172 158 453 611 71987 Totals 1958 889 1437 2326 174 455 629 79286 VACCINATION AND IMMUNISATION Vaccination against Smallpox The percentage of children under one year of age vaccinated against smallpox rose from 66.6% to 71.3% since my last Report. The following table records the number of persons known to have been vaccinated or revaccinated 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 2516 79 48 54 83 2780 No. of re vaccinations 1 1 8 45 351 406 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. It was decided to introduce a scheme for immunising children against diphtheria, whooping cough and tetanus, using a triple antigen. The scheme involves four injections during the first eighteen months of life as compared with five or six injections using separate antigens. The new scheme was brought into operation on 1st January, 1960. The following table shows that the increase in the number of children immunised against diphtheria in 1958 continued during the year:- Age at date of Immunisation No. of children immunised No. of children given reinforcing injections Diphtheria only Combined Diphtheria & Whooping Cough Whooping Cough only Diphtheria only Combined Diphtheria & Whooping Cough Under One 1309 613 292 - - One 671 438 1019 - - Two to Four 93 48 62 617 62 Five to Fourteen 253 12 3 1173 37 Fifteen and Over 3 - 1 - - Totals 1959 2329 1111 1377 1790 99 Totals 1958 2485 940 1085 1764 53 74 Poliomyelitis Vaccination The death of a well-known sporting personality from poliomyelitis in April 1959 stimulated interest in vaccination among young persons. As a consequence open sessions were held on Saturday mornings and during lunch hours. A total of 1,845 persons received first injections at these open sessions. Since the new year the scheme has been extended to include all persons up to the age of 40. The following table shows the number of persons completing courses of injections during 1959:- Number of Persons who during 1959 completed a course of Two Injections Three Injections Children born in the years 1943 to 1959 9097 1816 Young Persons born in the years 1933 to 1942 5421 3032 Expectant Mothers 632 672 General Practitioners and Families - 95 Ambulance Staff and Families - 18 Hospital Staff, Medical Students and their Families 430 182 Total 15,580 22,160 PREVENTION OF ILLNESS, CARE AND AFTER CARE Recuperative Holidays The Area health staff continued to be responsible for dealing with applications for recuperative holidays and during 1959 197 applications were received compared with 177the previous year. Of these, 176 were approved. DOMESTIC HELP SERVICE The total number of cases provided with home help during the year was 1,755, 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 over 1,000 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 1958 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) 107 6 113 7 Tuberculosis 11 30 41 26 Chronic Sick (including aged and infirm) 517 945 1462 972 Others 126 13 139 19 Total 761 994 1755 1024 75 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 two cases were served for a total of 72 hours. HEALTH EDUCATION Programmes of special significance are planned from time to time in welfare centres and school clinics. This year a special effort on the Dangers of Home Accidents was arranged. Welfare centres were loaned display stands and informatory notices in co-operation with the Boroughs. To support these and to focus attention on to the theme, posters and leaflets on display dealt with the same subj ect. At the same time a more positive trend was taken up by health visitors in talks and mothercraft classes and schools. The stress here was that the home should be a safe place for all members of the family, particularly those prone to accidents (e.g. the young and the elderly), attention being drawn to the common causes of dangerous and fatal accidents. Flannelgraphs were also used. The campaign stirred up considerable interest, discussions and questions. Some of these were kindled by press publicity on oil fires and promoted arbitrary questions such as MWhich is the safe type of oil stove which can be bought for the home?" Health Visitors and School Nurses are engaged in some form of Health Education in every aspect of their work, but a special programme of talks to school children has been operating in this Area for a number of years. The talks are given to secondary modern school girls during their last year at school in Hornsey and Tottenham at the request of head teachers. This year 318 talks were given in schools alone. The substance of the instruction given is related to parentcraft, home-making and the local health services. The girls take a very active part in it and are usually taken to a local welfare centre sometime during the series. Health Education programmes are also arranged for mothers attending welfare centres. They are held on a session free of other clinics. All mothers are welcome and mothers attending family doctors' surgeries and who do not attend the welfare centres for any other reason are also welcomed. Some family doctors send their expectant mothers to these sessions which are mainly concerned with the teaching of mothercraft. These sessions are popular and lively discussions are promoted amongst those attending. Members of the staff have given talks and taken classes during the year.to a number of local organisations including CivilDefence, Young Wives'Clubs and young people's organisations. Some have also acted as examiners for the British Red Cross Society. SCHOOL HEALTH SERVICE Area School Populations The school population for the Area is 10,760 in Hornsey and 17,647 in Tottenham. 76 This shows an overall decrease of 720 compared with the previous year. Hornsey Tottenham Primary Schools and Nursery Classes 6,017 8,632 Nursery Schools - 204 Secondary Modern Schools 2,839 5,735 Grammar and Technical Schools 1,904 2,884 Special Schools - Physically Handicapped - 92 Blanche Nevile School for Deaf - 100 10,760 17,647 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 % 1955 & Later 480 473 98.5 7 1.5 1954 1244 1225 98.5 19 1.5 1953 756 749 99.1 7 0.9 1952 150 147 98.0 3 2.0 1951 208 205 98.6 3 1.4 1950 1720 1707 99.2 13 0.8 1949 373 370 99.2 3 0.8 1948 445 445 100.0 - - 1947 2145 2135 99.5 10 0.5 1946 1134 1132 99.8 2 0.2 1945 663 658 99.2 5 0.8 1944 & earlier 2963 2955 99.7 8 0.3 Total 12281 12201 99.3 80 0.7 As an experiment permitted under the School Health Service and Handicapped Pupils Regulations to dispense with routine medical inspections for specified aged groups and to substitute periodic visits to schools to see selected cases, a pilot survey was carried out at one school among the eight to nine year olds, totalling 111 children. Of these, 40 were chosen by the teachers and head teacher for a special medical inspection. When the children were seen, however, it was found that almost all of them were either known to the School Health Service as being under treatment at for example the Chest Clinic or Children's Hospital, etc. Nevertheless it was obvious that the teachers wished to have advice concerning these children and this advice was given. During the following term the 71 "healthy" children were seen at periodic medical inspections to serve as controls. Of these, 50 were regarded as fit and not in need of advice or treatment. Of the remaining 21, it is considered that nine had defects, e.g. vision and hearing, which would have been picked up by the school nurse or audio metrician. (In fact the two children with hearing defect had been so picked up and were under investigation). Of the remaining 12 children, six were referred for treatment and six for observation. 77 As a result of this experiment the medical officer concerned is of the opinion that this is not a substitute for periodic medical inspections. Infectious Diseases in School Children, 1959 Unlike the previous year, 1959 was an eventful year from the point of view of infection. There was, in the early months of the year the usual biennial visitation of measles, over 700 cases being notified in school children. Poliomyelitis During the summer term there was an outbreak of poliomyelitis in school and pre-school children. In all 13 cases of paralytic poliomyelitis and nine non-paralytic cases were notified. Details of the vaccinal state of these children are given below. It can be seen that only one fully vaccinated child developed paralytic poliomyelitis and in this case the third injection was almost certainly given while the child was incubating the infection. As some 60% of school and Dre- school children in Tottenham and Hornsey are vaccinated, these figures are suggestive of a protective effect. Not vaccinated One dose Two doses Three doses Total Paralytic poliomyelitis 9 3 - 1 13 Non-paralytic poliomyelitis 5 1 1 2 9 Total 14 4 1 3 22 Of the paralytic cases four, including the fully vaccinated boy, made an almost complete recovery, two removed from the district, four were left with weakness in one limb, and three preschool children were sufficiently handicapped as to make it likely that they will need to attend a special school. Dysentery. Cases occurred sporadically over both boroughs during the year. In one school in Hornsey and another in Tottenham there was an explosive outbreak in the spring term which smouldered on for some time despite the usual measures taken to control it. Family doctors were notified of the outbreak and of the fact that the organism concerned was resistant to the sulphonamide drugs, the usual form of treatment. Tuberculosis. There were nine cases of tuberculosis in school children over the whole Area, seven pulmonary, one of bone and one of eyes. The figure nine is misleading, however, as only five of these were new cases, the others being flare-ups of old infection or inward transfers. The five bona-fide new cases compare with six in 1958 and three in 1957. These cases were discussed with the appropriate Chest Physicians and in one case epidemiological investigation was considered necessary at the school, X-ray of all adult members of teaching and ancillary staff being recommended. All were X-rayed and found to be clear. B.C.G. Vaccination. Possibly because of the effort involved in promoting poliomyelitis vaccination, the B.C.G. vaccination figures were not quite as impressive in 1959 as in previous years. 78 By a change in operating the scheme a number of children over 14 were included in this year's results and it is instructive to compare these with the children aged. 13. 1959 1958 Under 14 Over 14 Total Total Number % Number % Number % Number % Parents approached 1655 587 2242 3108 Parents accepting 1086 66.0 299 44.0 1345 60.0 2185 71.0 Number tested 1010 223 1233 2034 Mantoux positive % of those 70 6.9 25 11.0 95 7.7 297 14.0 Mantoux negative tested 940 93.1 198 89.0 1138 92.3 1737 86.0 Total vaccinated (% of those approached) 923 55.0 197 33.5 1120 50.0 1713 55.0 Those parents who did not respond to the invitation to have their child B.C.G. vaccinated in 1959 will be given a further opportunity in I960. As a result of the Mantoux testing one girl aged 14 was found to be strongly positive. X-ray chest in the summer was normal but on re-X-ray later in the year the girl was found to have an early tuberculous lesion and was admitted to hospital for treatment. School Dental Service During the past year the staff position has been:- Area Dental Officer 1 Full-time Dental Officers 5 Part-time Dental Officers (equivalent to 9/11 full-time) 2 Part-time Orthodontist (7/11) 1 The work of the department was maintained during the year though handicapped by the unfortunate absence through illness of the Area Dental Officer during the last Quarter. The following tables show the work undertaken during the year:- DENTAL INSPECTIONS AND TREATMENT Age Groups No. inspected No. found to require treatment No. referred for treatment at the County Council's Dental Clinics Under 5 326 194 194 5-16 and over 21835 11996 11989 Specials 2607 2512 2507 Total 24768 14702 14690 No. of pupils treatment commenced 7884 No. of pupils treatment completed 6176 No. of attendances made by pupils for treatment 17796 No. of appointments not kept 5006 No. of half-days devoted to (a) Inspection 161 (b) Treatment 2653 Fillings. Permanent Teeth 11430 Temporary Teeth 2728 No. of teeth filled. Permanent Teeth 10453 Temporary Teeth 2564 Extractions. Permanent Teeth 1031 Permanent Teeth for Orthodontia 118 Temporary Teeth 5063 Anaesthetics. (a) General 1908 (b) Local 1563 (c) Regional 159 Other operations. (a) Permanent Teeth 2170 (b) Temporary Teeth 4258 79 SPECIAL DENTAL TREATMENT UNDERTAKEN BY DENTAL OFFICERS Number of impressions, etc. 283 Number supplied with dentures 89 Number of crowns and bridges 45 Number of inlays 6 Number of radiographs (a) at Dental Clinics 123 (b) at Hospitals - ORTHONDONTIC EXAMINATION AND TREATMENT AGE GROUPS TOTALS 5 6 7 8 9 10 11 12 13 14 + Number of pupils examined 3 1 7 14 13 7 10 13 3 7 78 Number of pupils selected for treatment 2 - 6 9 8 4 8 6 3 6 52 Number of pupils commenced treatment (first attendance) 307 Number of attendances made for treatment 3137 Number of consultations 13 Number of impressions, etc. 3003 Number of fixed appliances fitted 26 Number of removable appliances fitted 216 Number of radiographs (a) at Dental Clinics 709 (b) at Hospitals 1 Number of pupils treatment completed 48 Number of orthodontic sessions (half days) 434 Ear. Nose and Throat Clinics In Hornsey weekly sessions were continued on similar lines to previous years. Dr. F.P.M. Clarke, visiting consultant, reports that the conditions for which children were referred varied considerably from comparatively simple complaints to those of more serious import. Of those requiring investigation and treatment, apart from a small number of cases of chronic otorrhœa, most came within the category of "nasal conditions", e.g. sinus infection, rhinitis and excessive hypertrophy of adenoidal tissue. Prevention of some permanent disability in later life continues the main function of the clinic's work and the special techniques evolved over many years have been shown to give excellent and lasting results. In Tottenham the ear, nose and throat clinic is now more closely related to the out-patient department of the Prince of Wales's General Hospital, both departments being under the direction of Mr. W. McKenzie, F.R.C.S. One of the school medical officers (Dr. Nora Webster) assists in co-ordinating the work of this clinic with the audiology clinic and with the work undertaken in the Area for the ascertainment and educational treatment of the deaf. Audiology Clinic The appointment of Dr. L. Fisch as consultant otologist to the Area, as from July, 1959, made it possible to establish an audiology unit at the medical centre in Park Lane , without waiting, perhaps twelve months, for more suitable premises to be erected on a site adjacent to the Blanche Nevile School for the Deaf, Tottenham. Eventually it is expected that all children who need investigation of their ability to hear, training and supervision from a wide Area will attend the audiology unit. 80 Already excellent teamwork exists in the close collaboration seen between consultant otologist, head master of the special school and classes for the deaf, parents, school medical officers, general medical practitioners and health visiting staff. A total number of 56 new cases were seen and appropriate action taken in respect of their educational needs. The number of pre-school children referred for advice was comparatively large, namely, 17 out of 56. Four of these were found to be severely deaf; ten probably not deaf but in need of further observation to eliminate some possible hearing loss, and in three a final diagnosis of no loss of hearing showed that deafness was not the cause of retardation. Dr. Fisch further reports that the functioning of the audiology unit during 1959 provided valuable experience for planning the work for the future. The improved facilities should ensure that no child whose hearing is impaired suffers either because of late detection of the disability or lack of adequate training after a diagnosis has been made. Parents should get all essential help, guidance and encouragement when it happens that their child suffers from a hearing disability. PRE-SCHOOL CHILDREN REFERRED TO AUDIOLOGY UNIT No. Age Sex Reasons for referral F.H. Remarks Source of Referral Decision and Disposal 1 2 F Known deaf. Not coping at day nursery Yes - School Medical Officer. Tottenham Admission to nursery at Blanche Nevile School. 2 1 6/12 M ? Deafness Yes Has goitre School Medical Officer, Hornsey Probably not deaf. 3 3 P ? Deafness No Coloured School Medical Officer, Hornsey Probably not deaf. 4 2 M ? Deafness Yes School Medical Officer. Tottenham Probably not deaf. To ordinary day nursery 5 4 M ? Deafness Yes Poor speech School Medical Officer, Hornsey Not deaf. 6 1 10/12 M ? Deafness No Delayed speech Indian School Medical Officer, Hornsey Deaf. To nursery unit at Blanche Nevile School 7 1 M For adoption ? Deafness No Illegitimate Backward School Medical Officer, Potters Bar Not deaf. Backward, 8 2 4/12 M ? Deafness No Delayed speech School Medical Officer, Edmonton Not deaf. 9 2% M ? Deafness Yes Delayed speech School Medical Officer Tottenham Not deaf. To normal day nursery. 10 4 M ? Deafness No Delayed speech School Medical Officer, Hornsey Probably not deaf. To nursery school. 11 3 M ? Deafness No Delayed speech School Medical Officer, Tottenham Not deaf. Possibly backward. 12 4 M ? Deafness No Articulation defect School Medical Officer, Edmonton. Not deaf. 13 4 F ? Deafness No Delayed speech School Medical Officer, Hornsey Not deaf. 14 6/12 M ? Deafness Yes - School Medical Officer, Southgate Deaf. For auditory training. 15 3 M Known deaf. Prom Great Ormond Street for supervision No - Great Ormond Street Hospital To nursery unit at Blanche Nevile School. 16 5/12 M Mother suspected deafness No - School Medical Officer, Hendon Probably not deaf. 17 5/12 M Slaw. Matron at day nursery suspected deafness. No Illegitimate School Medical Officer, Southgate Probably not deaf. Backward. 81 AUDIOLOGY UNIT, 1959 Number of children seen 56 Pre- school children 17 Attending infant and junior schools 20 Attending senior schools 17 Over 5, but not at school 2 Reason for referrals among these 56 children were as follows:- For diagnosis 32 Immigrants to Area known to be deaf 4 Partially deaf children, advice as to placement 4 Children known to be deaf - 9 application for admission to nursery class, Blanche Nevile School or partially deaf unit Transfer from hospital out-patient departments 5 Advice as to placement where deafness might 2 be the cause of backwardness Source of Referrals Tottenham and Hornsey 38 Other boroughs in Middlesex 17 London neighbouring boroughs 1 Vale Road School for Physically Handicapped Children Cerebral Palsy Unit During the year 29 children suffering from cerebral palsy were cared for at the Vale Road Day Special School for Physically Handicapped, Tottenham. Under the supervision of the visiting consultant (Dr. Dunham) and with the help of parent, teacher, nurse and therapists, it is possible to help the children to learn how to tackle normal tasks in a normal way both in and out of school, despite in most cases a grossly handicapped condition. Special arrangements are made for parents of children too young to attend the nursery class at the School, to be given advice and continued supervision. ANALYSIS OF CASES SEEN AT CEREBRAL PALSY UNIT IN 1959 Male Female Total Under 5 years 2 1 3 5-10 years 2 3 5 10 - 15 years 3 1 4 Over 15 years - 1 1 Total 7 6 13 Diagnosis Male Female Total Cerebral Palsy 4 3 7 Amyotonia Congenita 1 - 1 Mental Retardation 2 - 2 Epilepsy and Mental Retardation - 2 2 Emotional upset, minor motor defect - 1 1 Total 7 6 13 82 7 CONFIRMED CASES OF CEREBRAL PALSY - ACTION TAKEN Admitted to Vale Road School in 1959 3 (Admitted to Vale Road School in January 1960) 1 Admitted in 1959 and awaiting place in educationally sub-normal school 1 Waiting for vacancy in Vale Road School 1 Under school age 1 7 NEW CASES SEEN AT CEREBRAL PALSY UNIT IN 1959 Case No. Date of Birth Sex Referred by Diagnosis Disposal 1 31. 8.57 F Consultant Orthopaedic Surgeon, Tottenham Cerebral Palsy Right hemiplegia Under supervision of Cerebral Palsy Unit 2 6.11.53 F Area Medical Officer, Palmers Green 1. Severe mental retardation 2. Epilepsy Ascertained as ineducable. For Occupation Centre 3 21. 4.47 M Area Medical Officer, Tottenham Mental retardation To remain at residential E.S.N, school 4 23. 9.53 M School Medical Officer, Hendon Amyotonia Congenita Vale Road P.H. School 5 13.11.53 F School Medical Officer Enfield Cerebral Palsy 1. Left hemiplegia 2. Mental retardation Vale Road P.H. School To be transferred to E.S.N. School 6 12. 9.54 M School Medical Officer, Enfield Cerebral Palsy Spastic Dipiegia Vale Road P.H. School 7 29. 3.52 M School Medical Officer, Tottenham Cerebral Palsy Left hemiplegia To remain at ordinary school. Under supervision of Cerebral Palsy Unit. 8 28. 9.49. M School Medical Officer, Southgate Cerebral Palsy 1. Mild generalised spasticity 2. Emotional upset Vale Road P.H. School 9 18.11.46 M Paediatrician, Royal Northern Hospital Cerebral Palsy Generalised spasticity Waiting list for Vale Road School 10 24. 4.54 F Area Medical Officer, Enfield Cerebral Palsy Generalised spasticity Vale Road P.H. School 11 4. 8.48 F Consultant Psychiatrist 1. Emotional upset. 2. Minor motor defect Remain at ordinary school, and attend Child Guidance Clinic. 12 17. 8.58 M Consultant Otologist, Tottenham 1. Mental retardation 2. Minor motor defect Under supervision of Cerebral Palsy Unit. 13 21. 3.44 F Area Medical Officer, Hornsey 1. Epilepsy 2. Mental retardation Lingfield Epileptic Colony. 83 Orthopaedic Clinics Specialist clinics have continued to be held in both Boroughs for children found, in course of routine medical inspections or by reference from general medical practitioners, to have orthopaedic or postural defects. Remedial treatment is undertaken by the physiotherapists associated with the particular clinic. Hornsey The visiting consultant, Mr. E.T. Bailey, F.R.C.S., reports that of the new cases seen at the clinic, five were referred to the Highlands General Hospital for operative treatment. Following the outbreak of poliomyelitis in 1959, four children were treated at the clinic for residual paralysis with the probability that treatment will continue throughout the remainder of their school life. Two are of moderate severity unlikely adversely to affect their schooling. One is rather more severe but with the tenacity so often seen in such cases he has managed to attain the grade necessary for him to return to his original school. The fourth is under five years of age but her disability is of such severity that she will in all probability require to be educated at the Special Day School for Physically Handicapped. Special reference is made by Mr. Bailey to children who in the past have had to grow up with one leg shortened by reason of poliomyelitis, congenital defect or due to some other cause and to wear shoes raised to correct the defect. This may be unsightly and resented by the wearer. Such cases taken sufficiently early can, at the appropriate time, have an operation carried out upon the normal leg, which slows its growth so that at the time when growth ceases the legs are equal in length. One such attending case the clinic has been so treated, and further cases will have similar treatment in due course. Tottenham The visiting consultant, Mr. E. Hambly, F.R.C.S., emphasises an important aspect of the clinic's work in the treatment of postural defects in teenagers, which appear to be more in evidence as children appear to grow taller every year. Supervision of the orthopaedic cases at the Special (Day) School for Physically Handicapped children at Vale Road, Tottenham, is Mr. Hambly's special care, and with one of the school medical officers (Dr. V. Tracey), and the school health visitor and the physiotherapists, close co-operation is maintained with the head master (Mr. Ives) and his teaching staff. Ophthalmic Clinics Homsey The visiting consultant, Dr. R. Welch, reports that in addition to a busy year correcting errors of refraction responsible for a defective vision and symptoms of eye strain, special attention has been given at the clinic to the treatment of cases of squint and particularly those with amblyopia. It cannot be over-stressed that once the error of refraction has been corrected and occlusion of fixing eye adopted, cases of squint require the closest supervision until the defective vision is restored to normal or is greatly improved. If during this period the visual axes have not become parallel, then surgical procedure is essential to cure the squint. The orthoptist (Miss Cobb) at the clinic is able to give follow-up training to re-establish and maintain binocular single vision which is of such vital importance. Three unusual cases occurred during the year requiring reference to hospital. One was a congenital nystagmus with bilateral cataract and microphthalinos. Finally considered as 84 unsuitable for operative treatment this boy has been recommended admission to a special school for the partially sighted. Another, a case of nystagmus, occurred in an infant of eight months old and could therefore not be described as a congenital defect. A provisional diagnosis made in this case was a typical spasmus nutans although there was no sign of head nodding. Lastly a case of a girl of 14 years of age, recently arrived from Ghana, was found to have a complicated cataract in the right eye, and the left eye presented a picture of retinitis proliferans. Further investigations into the aetiology arc being made by serological tests, not yet available, but her condition was considered to be the sequelae of Eale's disease. Tottenham The visiting consultant, Mr. T.G. Kletz, reports;- "As in previous years the cases attending the clinic ranged in age from young infants to school leavers of 18 years. Whilst the majority of cases seen are refractive including squints andmuscle imbalances, a number of cases requiring ophthalmic treatment both medical and surgical were seen including two cases requiring surgery following trauma:- a retinal detachment and a perforating injury. Although more cases of strabismus and suspected strabismus are being seen in very young children, there are still too many cases of we thought he (she) would' grow out of it". The opportunity is taken of impressing the need to get these children investigated and treated at the first sign or suspicion of a squint, no matter how young they are - even under six months old if there is a strong family history of squint. Apart from the suspected or manifest squints there were about 28 cases including the higher age groups or school leavers referred as having strabismus or "lazy eye" and who had neither visual defect, muscle defect or appreciable refractive error. The congenital defects included muscle paresis, ptosis, nystagmus and cataracts." ORTHOPTIC CLINIC New cases for investigation 136 Cases treated Complete success 56 Improving 76 Failing to improve 12 144 Cases failing to attend for treatment 33 Child Guidance Clinic in Tottenham The visiting psychiatrist, Dr. W.H. Craike, commenced duties on the 5th May 1959 for two sessions per week. Dr. Craike reports that the problems were difficult behaviour at home and school, nocturnal enuresis and other psychosomatic symptoms, three cases of multiple tics and three children with physical defects as well as emotional disturbances. They all came from working class backgrounds, some of the homes were materially good and some poor. There were eleven children of average intelligence, nine were of superior intelligence, and six were of below average intelligence. Four parents refused treatment at the outset, or broke off treatment after one session. There were four cases in which it was doubtful whether the parents would accept treatment, they are being kept under occasional observation, the patents being seen by the psychiatric social workers and the children by the Psychiatrist. 85 Speech Therapy The senior speech therapist, Miss Came, reports that the "case load" of children suffering from speech defect continues to be heavy. The most economical use of the therapist's time lies in early assessment followed by early treatment. Stammering, Miss Came points out, most commonly manifests itself between the ages of two to five years - later it is rare. If treatment which is usually indirect can be given during the early years of plasticity, the prognosis is more hopeful; and every successfully treated case represents the prevention of perhaps years of later suffering. Children who have attained normal speech after treatment are reviewed periodically. Stammerers who have regained fluency of speech may be kept under observation for periods up to five years. The Handicapped Child Distribution as at 31st December 1959 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 - - 6 4 - - - - - - 6 4 Partially Sighted Pupils 2 4 2 - - - - - - - 4 4 Deaf Pupils 5 5 3 3 - - - - 1 - 9 8 Partially Deaf Pupils 9 9 2 - 2 1 - - - - 13 10 Educationally Sub-normal Pupils 67 44 15 5 2 3 - - - - 84 52 Epileptic Pupils - - 4 2 - - - 1 - - 4 3 Maladjusted Pupils - - 16 2 4 1 13 3 1 - 34 6 Physically Handicapped Pupils 13 11 8 - - - - - 6 3 27 14 Pupils with Speech Defects 4 - - 1 204 104 9 3 3 1 220 109 Delicate Pupils 5 5 15 11 3 1 - - - - 23 17 Pupils with Multiple Defects 3 4 1 1 2 - - - - - 6 5 Totals 108 82 72 29 217 110 22 7 11 4 430 232 Grand Totals 190 101 327 29 15 662 Rheumatism Supervisory Centre Fortnightly sessions continue to be held at the pædiatric department of the Prince of Wales's General Hospital under the direction of Dr. Ian M. Anderson, M.D., F.R.C.P., consultant paediatrician. The number of new cases seen during the year was eight. Of these, six were female and two male. All of these were either rheumatic fever or chorea. 197 children remain on the register of the supervisory centre and of these 69 made 127 attendances, while in addition a number were seen in the ordinary pædiatric out-patient sessions. 86 These 197 cases are classified as follows:- Rheumatic fever 63 Rheumatic carditis 42 Rheumatic carditis with chorea 5 Chorea - uncomplicated 5 Rheumatic arthritis 5 Congenital heart lesions 54 Rheumatic pains 1 Streptococcal Allergy 1 Other cases 21 197 93 males 104 females Hospital School I am indebted to Mr. J. Power, M.A., Borough Education Officer, Tottenham, for the following report :- "During the past year, in addition to the continued teaching of the children at St. Ann's Hospital, in the Prince of Wales's Children's Unit, and the Poliomyelitis Ward, there has been an extension of individual teaching in several other wards. The age range of the children in both hospitals is from 4 to 15 years of age and teaching incorporates lessons to children, preparing for General Certificate of Education, commercial courses and individual tuition to a child with muscular dystrophy who is fitted in a special chair. Although a well equipped schoolroom is established in one of the wards, teaching is individual. Work follows the child's school curriculum as closely as possible and to thi s end, for long term pupils, close liaison is maintained with the day schools. Children who are not well enough to attend school receive bedside tuition. During the past year an 18 year old girl in the Poliomyelitis Ward passed her General Certificate of Education in Art despite the handicap of complete paralysis. Always the children's hobbies are followed up, and often new interests developed. To this end we are endeavouring to arrange during the next holiday period a visit to the Royal Mint with a few children now in hospital who should have recovered by then. During the summer vacation two part-time teachers were employed to cater for the children in the long break from schoolwork. Handwork, embroidery, story reading, etc. kept the children happy and busy during this period. It is quite evident that the children enjoy school and welcome the teacher's arrival. Parents too are most appreciative and welcome the knowledge that the children's education continues while in hospital. Statistical Information Certain statistics relating to the work of the school health service not included in the body of the report are contained in the Appendix. APPENDIX SCHOOL HEALTH SERVICE STATISTICS FOR 1959 87 SCHOOL HEALTH SERVICE STATISTICS FOB 1959 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 1955 & Later 6 116 119 1954 23 288 301 1953 22 177 191 1952 7 40 45 1951 27 46 65 1950 199 365 520 1949 58 102 139 1948 93 97 174 1947 308 344 601 1946 169 181 304 1945 99 140 215 1944 &earlier 606 423 932 Total 1617 2319 3606 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 35 68 97 147 354 455 892 9 5 Eyes (a) Vision 53 39 512 40 1617 211 185 53 (b) Squint 67 10 49 6 276 34 15 3 (c) Other 18 9 19 10 96 54 123 7 6 Ears (a) Hearing 17 38 16 23 94 132 173 33 (b) Otitis Media 40 114 12 66 82 405 22 3 (c)Other 8 24 10 21 45 121 107 5 7 Nose and Throat 124 313 31 121 302 944 142 60 8 Speech 34 47 6 16 74 115 60 9 9 Lymphatic Glands 3 96 - 5 5 165 4 5 10 Heart 14 34 12 70 53 246 20 36 11 Lungs 73 58 47 67 239 276 31 34 12 Developmental (a) Hernia 2 6 1 3 6 16 - - (b)Other 8 13 8 23 33 145 11 12 13 Orthopaedic (a) Posture 2 24 18 105 58 294 11 11 (b) Feet 91 111 92 108 444 500 31 17 (c) Other 24 81 25 65 144 251 165 17 14 Nervous System (a) Epilepsy 8 2 3 5 24 19 2 2 (b) Other 3 11 10 10 39 59 8 3 15 Psychological (a) Development 5 22 3 9 20 76 11 10 (b) Stability 15 111 8 134 68 608 29 17 16 Abdomen 9 30 4 16 50 90 23 1 17 Other 28 60 16 37 96 258 752 79 (a) Requiring Treatment (b) Requiring Observation 88 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 139 (a) External and other, excluding errors of refraction and squint (b) Errors of refraction, including squint 2100 Total 2239 (c) Number of pupils for whom spectacles were prescribed 1124 GROUP 2. Diseases and Defects of Ear, Nose and Throat Received operative treatment for (a) Diseases of the ear 1 (b) Adenoids and Chronic Tonsillitis 209 (c) Other nose and throat conditions - Received other forms of treatment 455 Total 665 Total number of pupils in schools known to have been provided with hearing aids (a) During the current year 37 (b) In previous years (excluding any pupils shown at (St) above who were provided with an aid in a previous year) 10 GROUP 3. Orthopaedic and Postural Defects Number of pupils known to have been treated at clinics or at out patient departments 1168 GROUP 4. Diseases of the skin (excluding uncleanliness) Ringworm (i) Scalp - (ii) Body 1 Scabies 10 Impetigo 25 Other skin diseases 1065 Total 1101 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 arrange ments made by the County Council) 119 GROUP 6. Speech Therapy Number of pupils treated by speech therapists under arrangements made by the authority 281 GROUP 7. Other treatment given (a) Number of miscellaneous minor aliments treated by the County Council 650 (b) Treatment other than (a) above and excluding convalescent treatment 97 89 EDUCATION ACT 1944 - SECTIONS 57(3), 57(4) and 57(5) Cases dealt with under Section 57, Education Act 1944: Sub-section 3 8 Sub-section 4: Sub-section 5 9 Cases de-notified under Section 8, Education (Miscellaneous Provisions) Act 1948 - MEDICAL EXAMINATION OF TEACHERS (a) Number of Teachers examined as to fitness for appointment 15 (b) Number of Students examined as to fitness for first appointment 64 (c) Number of Students examined as to fitness to undertake training course 70 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 Classification of other Staff No. Public Health Inspectors 12 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 90 County Area Health Department (Tottenham and Hornsey) Deputy Area Medical Officer A. Yarrow, M.B., Ch.B., D.P.H. Senior Assistant Medical Officer Alice Wheildon, M.B., B.S., M.R.C.O.G. Area Dental Officer V. Sainty, L.D.S., R.C.S. Superintendent Health Visitor Miss H. Townsend, S.R.N., S.C.M., H.V. Non-Medical Supervisor of Midwives Miss F.E. Curtis, S.R.N., S.C.M., and Home Nursing Superintendent H.V., M.T.D. Home Help Organiser Mrs. J.D. Mcllroy (Resigned 27.9.59) Miss D. Williams (Appointed 23.11.59) Assistant Home Help Organisers Mrs. F.G. Wills Miss D. Buck (Resigned 24.3.59) Miss J.E. Caplin (Appointed 8.6.59) Area ChiefClerk 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 10 6 Dental Officers 6 3 Supervisory Nursing Staff 2 - Administrative and Clerical Staff 36 8 Health Visitors/School Nurses 25 - Student Health Visitors - 2 Clinic Nurses 8 - Midwives 8 - Home Nurses 24 4 Speech Therapists 3 - Physiotherapists 2 - Occupational Therapists 1 - Chiropodists - 2 Gramophone Audiometrician 1 - Orthoptists - 2 Dental Attendants 7 2 Day Nursery Staff 31 1 Home Help Service 5 164 Manual workers, domestic grades, etc. 10 22 179 216 91 INDEX Page Accidents in the home 33 Aged, Welfare of 56 Aged Persons, Housing 31 Ambulance Service 60 Ante Natal Clinics 62 Area Health Committee 61 Area Health Service 6l Area Health Staff 90 Area Welfare Service 59 Arteries, Diseases of 5 Atmospheric Pollution 26 Audiology Unit 79 Baths and Laundry Services 14 B.C.G. Vaccination 77 Births and Deaths 2 Births, Notification of 62 Borough Council, Members 1 Burials 58 Cancer, Deaths 5 & 8 Cerebral Palsy Unit 81 Certificates of Disrepair 32 Chest Clinic 42 Child Guidance Service 84 Child Welfare Centres 63 Chiropody Service - Old Peoples 56 Clean Air Act, 1956 26 Cleansing and Disinfecting Station 20 Clearance Areas 29 92 Page Comparability Factors 4 Council, Members of 1 Daily Guardian Scheme 65 Day Nurseries 66 Deaths, Classification of Defects, Sanitary: Remedied 18 Demolition Orders 30 Dental Service, Priority 67 School 78 Diphtheria Immunisation 73 Disinfection 20 Disinfestation 21 Domestic Help Service 74 Drainage and Sewerage 12 Dysentery 44, 77 Ear, Nose and Throat Clinics 79 Education Committee 61 Encephalitis 43 Factories 21 Fluoridation of Water Supply 11 Food - Condemned 38 Control 34 False or Misleading description of 40 Hawkers 36 Hygiene 38 Labelling 39 Poisoning 44 Prosecutions 38 Registered Premises 35 Sampling 38 Shops 35 93 Page Handicapped Child, The 85 Hazards, Radiation 26 Hawkers of Food 36 Health and Housing Committee 1 Health Education 75 Health Services provided by other Authorities 58 Health Visiting Service 68 Home Nursing Service 71 Hospital Services, Old People 57 Hospitals 58 Hospital Schoo 1 86 HousesUnfit 28 Housing 27 Housing Act, s. 9 & 10 30 Individual Unfit Houses 30 Part III 29 Ice Cream 35 Immunisation, Diphtheria and Whooping Cough 73 Infantile Deaths 4, 6 Infant Welfare Clinics 63 Infectious Diseases in School Children 77 Infectious Diseases, Table of Cases 45 Insect Pests 20 Inspections carried out by Public Health Inspectors 18 Labelling of Food Order, 1953 39 Laboratory Service 60 Laundries, Public 17 Laundry Service for the Incontinent Aged 57 Lunacy and Mental Treatment Acts 60 Lung Cancer 8 94 Page Maternal Deaths 3 Meals on Wheels 57 Measles 44 Meat Inspection 36 Medical Grounds for Rehousing 31 Members of Borough Council 1 Merchandise Marks Acts 1887-1953 40 Midwifery Service 68 Midwives' Ante-Natal Clinics 62 Milk and Dairies 36 Monitoring of Radioactive Fallout 27 Mothercraft Clinics 63 National Assistance Act, 1948, s. 50: Burials 58 s. 47 57 Notices Served 19 Old People's Welfare 56 Ophthalmic Clinics 83 Orthopaedic Service 83 Out-Patient Clinics at Prince of Wales's Hospital 59 Outworkers 22 Overcrowding 30 Paratyphoid Fever 43 Personal Health Service 59 Pet Animals Act, 1951 25 Physically Handicapped - Housing 31 Poliomyelitis 43, 77 Vaccination 74 Population Movementof 3 Preserved Foods 40 Prince of Wales's Hospital, Out-Patient Clinics 59 Problem Families - Housing 32 PublicHealth Department, Staff 89 95 Page Public Health Act, 1936 19 Prosecutions 20 Radiation Hazards 26 Radioactive Fallout 27 Rag Flock and other Filling Materials Act, 1951 25 Recuperative Holidays 74 Rehousing on Medical Grounds 31 Rent Act, 1957 32 Repairs in Default 20 Respiratory Diseases 5 Rheumatism Supervisory Centre 85 Rodent Control 21 Routine Medical Inspections 76 Sanitary Circumstances of the Area. 11 Scarlet Fever 44 School Health Service 75 Sewerage and Drainage 12 Shops 23 Prosecutions 25 Slaughterhouses 35 Slaughtermen 36 Slum Clearance 29 Smallpox Vaccination 73 Smoke Control Areas 26 Speech Therapy 85 Staff Medical Examinations 46 Staff Sickness 47 - 55 Statistics 2- 10 Stillbirths 2 Street Trading 24 Sub-standard Houses 32 96 Page Superannuation Medical Examinations 46 Swimming Baths 14 Toddlers' Clinics 64 Tuberculosis 41, 77 In Schools 77 Typhoid Fever 43 Unfit Houses 28 Vale Road School for Physically Handicapped Children 81 Water Supply 11 Welfare Homes 57 Welfare Service, Area 59 Whooping Cough 44 Immunisation 73 Work in Default 30 ' '