439(1) ??? ToT35 Borough of Tottenham TOTTENHAM'S HEALTH 1960. The Annual Report of the Medical Officer of Health Borough of Tottenham TOTTENHAM'S HEALTH 1960. The Annual Report of the Medical Officer of Health Public Health Department, Town Hall, N.15 18th July, 1961. To The Worshipful the Mayor, Aldermen and Councillors. Mr. Mayor, Ladies and Gentlemen, I submit herewith the Annual Report of the Health Services for the year ended 31st December, 1960. The population as estimated by the Registrar General continued to showa decrease, which at the time of writing is confirmed by the Census figure, now 113,126. The birth rate of 16.75 was the highest since 1948. The number of illegitimate births, 1 in 12, was regrettably the highest ever recorded in Tottenham; and twice the rate recorded before the last World War. The infantile death rate was 23.84 compared with 24.72 in the previous year. The Health Department continued to press forward its slum clearance programme, and during the year clearance procedure was initiated in respect of areas comprising 201 unfit houses. Two local Public Inquiries were held into representations made in the previous year; and three Orders affecting 144 dwellings were confirmed. To meetthese rehousing requirements and general housing needs, 237 new units of accommodation were completed and a further 507 were at various stages of building at the end of the year. In order to achieve maximum density of development on the limited sites available, providing space for garages and allowing sufficient surrounding land for landscaping, it has betcome necessary to provide more multi-storey housing accommodation. The illustration facing page 26 shows ten storey blocks of flats under construction in the White Hart Lane and Love Lane area. Schemes too are going forward for thirteen and seventeen storey blocks in the Markfield and Albert Road areas respectively. In planning future housing needs the Borough Council is conscious ofthe special facilities required by handicapped persons, and has agreed that two per cent of the accommodation be specifically designed for the purpose, in addition to the provision made over many years for the special needs of the elderly. During 1960 the report of a consultant firm in Organisation and Methods was adopted with certain modifications by the Council. After their visit to Departments it was gratifying to note their general satisfaction with productivity, quality, and output reached by the staff, and the efficiency and devotion to duty by all grades of employees. By streamlining the work ofthe Health department it has been possible, without addition to staff, to integrate the very considerable increase of functions introducedby the Clean Air Act. Further additional duties must be expected in the near future inconsequence of the Noise Abatement Act, Offices Act, I960, and the Housing and Public Health Bills now before Parliament. The second Smoke Control Order embracing more than 4,000 dwellings was confirmed during the year, which may be regarded as another stage in bringing the clean air of the countryside back to Tottenham; and in line with public health measures to ensure clean water and clean food available to its citizens . Though not a statutory duty since the changes in local administration brought about by the Education Act, 1944 and the National Health Service Act, 1946, I have continued at the end of this Report, as in previous years, to place on record the day-to-day functions of the Area Health Committee (Tottenham and Hornsey). involving as they do an essential part of the local health services Such a procedure seems all the more important this year, in the light of the recommendation made by the Royal Commission on Local Government in Greater London. A careful study of the facts and figures submitted show how well the services have been supported by the public and in particular by mothers and their babies and by children of school age and under. Special reference is made to the work for the care of handicapped children at the Blanche Nevile School for the deaf, Vale Road special school for the physically handicapped and in the hospital school at St, Ann's. Attention too is drawn to the shortage of hospital beds for the elderly and for maternity cases Domicilary midwives too often have to cope with unsatisfactory home conditions and conduct deliveries in small furnished rooms where other tenants share amenities and where children of the family have to be removed for the confinement. After several years delay a new service, known as the Retirement Clinic for men, has been started in the area This is designed to assist those about to reach retirement age in making necessary adjustments in their mode of living; and to meet mainly the needs of the able aged whose faculties are still little or not impaired. Advice is given by the medical officer in charge after a thorough medical overhaul and reference if necessary to the family doctor, on such matters as suitable diet, prevention of accidents, occupation of leisure or suitable remunerative employment (in co-operation with Ministry of Labour), and development of interests essential to mental health and activity in advancing age. Such a service may not only prolong a contented and useful life, but save admission of more elderly people to welfare homes and hospitals. Close co-operation has continued in all branches of the health department with the local hospital services, general medical practitioners, various local co-ordinating committees at officer level, Borough Education Officer, headteachers and the many voluntary organisations with whom the establishment of cordial relations is so necessary in the interests of the public and for the efficiency of the service. In addition to this my preface, a number of individual contributions to the report as a whole have been made by colleagues in all sections and to whom I acknowledge my indebtedness for their help and co-operation on this occasion and throughout the year, In conclusion Iwould like to express my thanks to members of the Council, especially to the Chairman of the Health and Housing Committee, the Education Committee and Social Services SubCommittee and the Chairman of the Area Health Committee for their understanding and encouragement. I am, Your obedient servant, G, HAMILTON HOGBEN, Medical Officer of Health. 1 MEMBERS OF BOROUGH COUNCIL MAYOR Councillor H. Langer, J.P. DEPUTY MAYOR Alderman W.S. Herbert ALDERMEN C.H. Colyer F.A.F. Keay, J.P. * A.F. Remington (Mrs.) E J. Field Lady Grace Morrison A.R. Turner * A. Reed, A.C.I3., J.P. R.W.H. Ford * R.H. Warren H.W. Turner COUNCILLORS * G.W. barker * E,C. Elphick * A.A. Miller (Mrs.) * E.E. Brown (Mrs.) E.V. Garwood L.L. Peirce E.J. Brown, M.B.E. A.R. Gillham A.T. Protheroe J.W.H. Brown W.K. Goman * M.E. Protheroe (Mrs.) E.J.J. Carter A.B. Russell A.W. Catley * L.R. Harrington. J.P. (Mrs.) J.R. Searle Douglas Clark * F.E. Haynes (Mrs.) * S.A. Berkery Smith (Mrs.) * L.H. Collis J.D. Mcllwain F.A. Warman E.P. Deakins G.W. Malin J. Watkins * G.A. DeVote G.C. Marson * J.L. Williams J.C. Dibble J. Mather J. Wolsey Note: * Indicates members of Health and Housing Committee. The Mayor and Deputy Mayor are ex-officio members. Committee Chairman Alderman R.H. Warren Vice-Chairman Councillor Mrs. L.R. Harrington, J.P. Town 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 1959 1960 Mid-year: Registrar General's estimate 116,100 115,030 Rateable Value as at 1st April £1,950,099 £1,964,652 Sum represented by penny rate £7,940 £8,020 Approximate Number of Dwellings in District 30,741 30,946 Registered live-births Males 907 979 Females 845 947 Total 1,752 1,926 Birth-rate per 1,000 estimated population: 15.09 16.75 No. of live births which were illegitimate 134 164 (7.7%) (8.5%) Stillbirths Males 17 16 Females 14 12 Total 31 28 Stillbirth rate per 1,000 total (live and still) births 17.39 14.38 No. of Stillbirths which were illegitimate 3 Nil (9.7%) Deaths: Males 701 660 Females 651 670 Total 1,352 1,330 Death-rate per 1,000 estimated population 11.65 11.56 Maternal Mortality Puerperal Sepsis 0 0 Other puerperal causes 1 1 Total 1 1 Rate per 1,000 total (live and still) births 0.561 0.512 3 1959 1960 Deaths of Infants under 1 year of age (Infant Mortality) (a) Legitimate Males 24 22 Females 16 20 Total 40 42 Death-rate per 1,000 legitimate live births 24.72 23.84 (b) Illegitimate Males 2 1 Females 0 2 Total 2 Death-rate per 1,000 illegitimate live births 14.93 18.29 (c) Total Males 26 23 Females 16 22 Total 42 45 Rate per 1,000 total live births 23.97 23.36 Deaths of Infants under 4 weeks (Neo-natal Mortality) 33 36 Rate per 1,000 live births 18.84 18.69 Deaths of Infants under 1 week (Early Neo-natal Mortality) 30 29 Rate per 1,000 live births 17.21 15.06 Stillbirths and deaths under 1 week (Perinatal and Mortality) 61 57 Rate per 1,000 live and still births 34.21 29.17 Movement of Population There is a continuous substantial movement of population both into and out of the Borough and since 1949 the outward movement has consistently exceeded the inward with a consequent steady fall into population. In 1960, although there was a natural increase in population arising from births exceeding deaths by 596, the Registrar General's estimate of population shows a reduction of 1,070 meaning that the outward movement of population was greater than the inward by 1,666. 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. 4 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 0.99 for births and 1.05 for deaths. Birth-rate There has been a steady recovery in the birth-rate during the past 5 years. In 1960 it reached 16.75 per 1,000 population, the highest since 1948. The highest post-war rate was in 1947 - 21.57 and the lowest 12.37 in 1954. Illegitimate Births There was again a marked increase in the percentage of illegitimate births. Of the babies born in Tottenham in 1960, 8.5% or one in twelve, was illegitimate compared with the previous highest figure in 1959 which was 7.6%. 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 45 deaths under 1 year of age is recorded by the Registrar General, giving a rate of 23.36 per thousand live births. Twenty-nine of the deaths occurred in the first week of life and a further 7 occurred in the first four weeks. Cancer Deaths The incidence of lung cancer gives no cause for com placency. The association between the regular inhalation of smoke - chiefly cigarette smoke - and the development of lung cancer some years later is no longer disputed in medical circles. The evidence has been collected many times over in several countries before and since the last war. The response of the public to this unpopular idea has been discouraging, since there has been no lessening of the consumption of tobacco, and the sales propaganda of the tobacco companies has become more streamlined and extensive than ever before. 5 Diseases of Arteries Including Coronary Heart Disease, Angina, Thrombosis and Cerebral Vascular Lesions. In many respects these are a consequence of natural ageing processes, although the recent increase in coronary disease in relatively young men is causing much concern and has stimulated several research programmes both in this country and abroad. As yet no one cause has been identified but such factors as a high fat diet, lack of constant exercise, and prolonged mental concentration seem to play their part. Coronary Disease During the past ten years there has been a 50% increase in deaths attributed to this disease. 6 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 Whooping Cough Scarlet Fever Diphtheria Tuberculosis Respiratory Other Forms *1941 105,620 1,418 13.43 1,560 (a) 1,316 (b) 14.77 61 46.35 465 103 73 161 28 194 1942 110,100 1,349 12.25 1,819 16.52 79 43.43 104 295 75 164 21 229 1943 110,350 1,513 13.71 1,970 17.85 86 43.65 225 340 107 174 24 232 1944 108,180 1,356 12.53 2,066 19.09 87 42.11 331 206 44 169 20 236 1945 110,600 1,371 12.40 1,988 17.97 78 39.24 212 214 47 139 16 213 1946 124,830 1,491 11.94 2,580 20.67 88 34.11 280 323 83 198 24 266 1947 129,140 1,461 11.31 2,785 21.57 76 27.29 285 272 22 171 18 223 1948 130,000 1,377 10.59 2,233 17.18 53 23.73 334 260 3 184 19 272 1949 130,040 1,440 11.07 2,009 15.45 50 24.89 199 251 4 210 22 264 1950 129,400 1,382 10.68 1,727 13.35 41 23.74 509 356 3 161 13 262 1951 126,800 1,520 11.99 1,673 13.19 43 25.70 427 245 - 192 9 273 1952 125,800 1,415 11.25 1,666 13.24 34 20.41 139 356 - 163 16 277 1953 124,400 1,347 10.83 1,642 13.20 43 26.19 360 215 1 143 20 284 1954 123,200 1,187 9.63 1,524 12.37 27 17.72 144 92 126 5 251 1955 122,100 1,331 10.90 1,511 12.38 25 16.55 98 75 1 126 18 308 1956 120,700 1,252 10.40 1,560 12.92 38 24.36 243 80 1 92 9 281 1957 119,300 1,314 11.02 1,658 13.90 42 25.33 133 92 - 86 4 296 1958 117,700 1,319 11.21 1,748 14.86 38 21.74 29 147 - 102 13 304 1959 116,100 1,352 11.65 1,752 15.09 42 23.97 12 122 - 71 15 284 1960 115,030 1,330 11.56 1,926 16.75 45 23.36 163 100 - 83 9 283 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. 7 INFANTILE DEATHS IN AGES AND SEXES DURING THE YEAR 1960 CAUSE OF DEATH DAYS Total Under 4 weeks MONTHS Total Deaths under 1 year Males Females 0 1 2 3 4 5 6 7- 14- 21- 1 2 3 4 5 6 7 8 9- 11- Broncho-pneumonia - 1 - - 1 - - 1 - - 3 1 - - 1 - - - - 2 - 7 3 4 Haemolytic Disease of Newborn - - 1 1 - - - - - - 2 - - - - - - - - - - 2 2 - Congenital malformation 1 3 1 - - - - 4 1 - 10 - - - - - 1 - - - - 11 9 2 Prematurity 5 4 2 - - - - - - - 11 - - - - - - - - - - 11 4 7 Atelectasis 2 - - - - - - - 1 - 3 - - - - - - - - - - 3 1 2 Birth Injuries 1 2 - - 1 1 - - - - 5 - - - - - - - - - - 5 2 3 Accidents 2 - - - - - - - - - 2 - - - - - - - - - - 2 1 1 Other Causes 1 - - - - - - - - - 1 - - - - - - - - 3 - 4 1 3 Total 12 10 4 1 2 1 - 5 2 - 37 1 - - 1 - 1 - - 5 - 45 23 22 8 CLASSIFIED DEATHS OF TOTTENHAM RESIDENTS SHEWING AGE GROUP AND SEX DISTRIBUTION DISEASE Total Under 1 year 1-4 5-14 15-24 25 - 44 45-64 65-74 75 + M F M F M F M F M F M F M F M F M F Tuberculosis, respiratory 3 _ - _ _ _ _ _ _ _ _ _ 1 - 2 - - - Tuberculosis, other 1 - - - - - - - - - - - 1 - . - - - Syphilitic disease 1 1 - - - - - - - - - - 1 - - - - 1 Diphtheria - - - - - - - - - - - - - - - - - - Whooping Cough - - - - - - - - - - - - - - - - - - Meningococcal infection - - - - - - - - - - - - - - - - - - Acute poliomyelitis - - - - - - - - - - - - - - - - - - Measles - - - - - - - - - - - - - - - - - - Other infective & parasitic disease 2 - - - - - - - - - - - 1 - 1 - - - Malignant neoplasm, stomach 25 17 - - - - - - - - 2 1 5 5 11 2 7 9 Malignant neoplasm, lung bronchus 58 13 - - - - - - - - 3 1 36 4 13 3 6 5 Malignant neoplasm, breast 1 30 - - - - - - - - - 3 1 14 - 8 - 5 Malignant neoplasm, uterus - 16 - - - - - - - - - 2 - 6 - 6 - 2 Other malignant & lymphatic neoplasm 56 60 - - - - - - - - 5 2 15 25 22 15 14 18 Leukaemia, Aleukaemia 4 3 - - - - - 1 - - - - 1 - 3 - - 2 Diabetes 1 9 - - - - - - - - - - - 3 1 3 - 3 Vascular lesions of the nervous system 52 81 - - - - - - - - - 2 8 8 11 24 33 47 Coronary disease, angina 147 108 - - - - - - - - 1 - 59 15 38 31 49 62 Hypertension, with heart disease 13 15 - - - - - - - - - - 5 2 2 5 6 8 Other heart disease 44 98 - - - - - - - - 1 - 5 17 11 17 27 64 Other circulatory disease 37 41 - - - - - - - - - - 10 6 8 10 19 25 Influenza 1 - - - - - - - - - - - 1 - . - - - Pneumonia 40 43 3 4 - 1 - - - - - 1 6 2 10 6 21 29 Bronchitis 54 25 - - 1 - - - - - - - 13 5 18 7 22 13 Other diseases of respiratory system 10 3 - - - - - - - - - - 2 - 4 1 4 2 Ulcer of stomach & duodenum 10 6 - - - - - - - - - - 4 2 1 2 5 2 Gastritis, enteritis & diarrhoea 4 3 - - - - - - - - 1 - 1 2 2 - - 1 Nephritis & nephrosis 9 1 - - - - 1 - - - 2 - 4 - 1 - 1 1 Hyperplasia of prostate 7 - - - - - - - - - - - 2 - 1 . 4 - Pregnancy, childbirth & abortion - 1 - - - - - - - - - 1 - - - - - - Congenital malformations 10 5 9 2 - - - - 1 - - 1 - 1 - 1 - . Other defined & ill defined diseases 47 70 10 15 - - - - - - 4 4 14 7 8 11 11 33 Motor vehicle accidents 5 5 - - - - - 1 2 - 2 1 - - - 2 1 1 All other accidents 11 9 1 1 - - 1 1 2 - - - 2 1 2 2 3 4 Suicide 7 6 - - - - - - 1 - - - 4 5 1 1 1 . Homicide & operations of War - 1 - - - - - - - 1 - - - - - - - - Total 660 670 23 22 1 1 2 3 6 1 21 19 202 130 171 157 234 337 9 CERTAIN VITAL STATISTICS FOR THE YEAR 1960 District Estimated population mid-1960 Live birth rate per 1000 population Death rate per 1000 population Specific death rates per 1000 population Infant mortality per 1000 live births Maternal mortality per 1000 total births (a) Crude Adjusted Crude Adjusted Coronary disease, angina (a) Cancer (a) Infant (a) Net-natal (a) (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) Acton 64,550 16.8 16.0 10.7 10.9 2.0 (131) 2.4 (153) 24.9 (27) 18.5 (20) - (-) Brentford and Chiswick 57,070 15.8 15.0 10.4 10.4 2.0 (113) 2.1 (122) 11.1 (10) 10.0 (9) - (-) Ealing 183,390 15.0 14.6 11.2 12.0 2.0 (369) 2.4 (438) 16.0 (44) 14.5 (40) 0.36 (1) Edmonton 93,890 14.1 14.1 10.2 11.2 1.7 (161) 2.2 (202) 23.5 (31) 18.9 (25) - (-) Enfield 110,240 14.7 14.7 10.1 11.1 1.8 (201) 1.8 (203) 21.0 (34) 17.3 (28) - (-) Feltham 52,290 17.9 17.2 7.2 11.4 1.3 (69) 1.6 (82) 18.2 (17) 12.8 (12) - (-) Finchley 68,980 15.3 14.7 10.7 9.6 2.3 (159) 2.1 (148) 13.3 (14) 10.5 (11) - (-) Friem Barnet 28,670 12.3 13.8 13.0 9.5 1.7 (48) 2.7 (77) 14.1 (5) 11.3 (4) - (-) Harrow 214,370 14.5 14.9 9.5 11.2 1.7 (358) 2.3 (493) 18.6 (58) 14.4 (45) 0.32 (1) Hayes and Harlington 69,400 16.4 15.4 7.3 11.8 1.3 (88) 1.6 (113) 21.1 (24) 17.6 (20) - (-) Hendon 151,850 12.9 12.4 10.6 11.1 2.0 (308) 2.4 (372) 21.9 (43) 16.8 (33) - (-) Heston and Isleworth 105,270 13.1 13.1 10.3 11.1 1.9 (202) 2.2 (230) 18.2 (25) 13.8 (19) - (-) Hornsey 96,570 19.6 18.4 11.5 10.2 2.5 (242) 2.5 (242) 19.0 (36) 14.2 (27) - (-) Potters Bar 23,140 17.1 15.2 8.1 11.3 1.8 (42) 1.3 (30) 20.2 (8) 15.2 (6) - (-) Ruislip and Northwood 75,470 14.3 14.3 8.1 10.1 1.6 (119) 1.7 (130) 19.5 (21) 15.8 (17) - (-) Southall 53,150 15.4 16.0 13.2 12.1 2.9 (156) 2.2 (116) 17.1 (14) 14.7 (12) 1.21 (1) Southgate 69,880 13.5 14.7 13.3 11.0 2.9 (200) 2.7 (189) 14.8 (14) 9.5 (9) - (-) Staines 49 400 19.0 17.3 8.3 10.9 1.5 (75) 1.8 (87) 18.1 (17) 11.7 (11) 1.04 (1) Sunbury 31,600 23.6 20.8 10.5 12.2 1.4 (45) 2.2 (71) 20.1 (15) 13.4 (10) - (-) Tottenham 115,030 16.7 16.5 11.6 12.2 2.2 (255) 2.4 (276) 23.4 (45) 18.7 (36) 0.51 (1) Twickenham 103 450 13.9 14.3 11.9 11.4 2.2 (230) 2.4 (247) 13.2 (19) 12.5 (18) - (-) Uxbridge 64,620 17.2 15 5 9.2 11.6 1.8 (117) 2.0 (128) 23 4 (26) 18.0 (20) 0.88 (1) Wembley 126,120 13.1 13.2 8.9 10.2 1.8 (232) 2.3 (286) 13.3 (22) 9.1 (15) - (-) Willesden 172,430 20.9 19.4 9.7 10.8 1.9 (329) 2.2 (386) 15.0 (54) 11.1 (40) 0.27 (1) Wood Green 48,160 15.0 15.2 11.5 11.0 2.5 (118) 2.3 (113) 30.4 (22) 23.5 (17) - (-) Yiewsley and West Drayton 23,430 16.9 15.2 8.6 12.4 2.0 (47) 1.6 (37) 25.3 (10) 15.2 (6) - (-) COUNTY 2,252,420 15.7 15.4 10.3 11.1 2.0 (4414) 2.2 (4971) 18.6 (655) 14.5 (510) 0.20 (7) England and Wales 1960 45,755,000 17.1 11.5 N/A 2.2(98691) 21.7(16961) 15.6(12188) 0.39 (311) NOTE: (a) Absolute numbers are given in parenthesis in addition to rates to afford valid comparison. 10 SANITARY CIRCUMSTANCES OF THE AREA Water Supply The provisions of the Tottenham Corporation Act, 1952 relating to the reinstatement of water supply to private dwelling houses where this has been cut off by the Metropolitan Water Board due to defective fittings etc., has proved a very useful addition to the general legal powers available for dealing with matters affecting the living conditions of occupiers. 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 1960. 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. The supply to all dwelling houses is direct and not by means of standpipes. No new sources of supply have been instituted nor have there been any important extensions to trunk mains and there were no changes in the general scheme of supply to the area. New mains were laid in the Borough of Tottenham to the extent of 589 yards." Fluoridation of Water Although children and young adults today are taller and generally healthier than ever before, the latter cannot be said of their teeth. Dental decay appears to be on the increase, no doubt aggravated by consumption of sweets both in children and young adults, a habit gained during the sweet rationing period of war years. Far too many school children today have bad teeth. Many parents remain unconcerned, and will only seek dental advice when the child gets toothache. By that time, of course, it is too late to save the tooth, and the loss of a tooth in a growing child is much more serious than in an adult. Some years ago it was noticed that people who drank from water supplies containing small amounts of fluorine had exceptionally good teeth with very little decay, so trials were carried out in one or two districts to see the effects of adding small quantities of fluorine to drinking water where it was not normally present. It was found that this step greatly improved the strength 11 of the teeth of children growing up in these districts. Except for mottled teeth in one area where the natural fluoride concentration is high, no-one has ever detected any ill effects, and countless thousands of people have drunk natural fluoridised water all their lives. In parts of America 32 million people drink water every day to which fluorine has been artificially added. Fluoridation of drinking water must now be regarded as a safe, tasteless and effective means of preventing dental decay. Radiation Hazards Turing the year The Radioactive Substances Act was passed. It is concerned with disposal of radioactive waste, vesting powers in the Ministry of Housing and Local Government and the Ministry of Agriculture. (1) To register all casual users of radioactivity and to notify their registration to the relevant Public Health Authority. (2) To require authorisation for radioactive waste disposal. (3) To prescribe methods and standards to be followed in such disposal. (4) To establish a national disposal service. (5) To appoint an inspectorate. (6) To impose penalties for violation, the nature of which is prescribed by the Act. This Act supersedes all incidental powers regarding radioactive waste, hitherto found in the Public Health and River Pollution legislation. The emphasis now is on adequate preventive measures, rather than taking action when a radioactive nuisance has become apparent. In December, I960 the Medical Research Council presented a second report on the Hazards of Nuclear and Allied Radiations which is a comprehensive technical survey of all aspects of radiation both natural and artificial and their medical and genetic effects. It records that the average bone marrow dose from radioactive fall out during the years 1958 and 1959 was only 1/15 of that from the natural background radiation which varies according to the amount of radioactive material in the local rock formations. The rib of an ancient Egyptian who died 4,000 years ago had much the same levels of natural alpha radiation as a present day man. Drainage and Sewerage As the work on floodrelief schemes proceeds it is becomingmore apparent that the Council's decision to undertake this workwas a wise one. Nocases of serious flooding have occurred during the year. Separate soil and surface water systems of drainage and sewerage continue in operation but as will be noted from the list of defects remedied, defective and/or choked drains continue to 12 AVERAGE RESULTS OF THE CHEMICAL AND BACTERIOLOGICAL EXAMINATION OF THE WATER SUPPLIED TO THE BOROUGH OF TOTTENHAM FOR THE YEAR 1960 (Milligrams per litre (unless otherwise stated)) Description of the Sample No of samples Amnonia Nitrogen Album inoid Nitrogen Oxidised Nitrogen (Nitrate) Chlorides as C1 Oxygen abs. from Permanganate 4 hrs. at 27°c. Turbidity in terms of Silica Colour m m. brown 2ft. Tube Burgess's Tintometer Hardness (Total) Hardness (noncar bonate) pH Value Phosphate as PO4 Silicate as sio2 Sulphate as so4 Fluoride as F Magnesium as Mg Surface Active Material as Manoxol Free CO 2 Electrical Conductivity (gemmhos) New River derived 104 0.024 0.058 5.5 33 0.64 0.1 6 298 80 7.8 0.50 11 70 0.25 5 0.10 625 River Thames derived (Ashford Common Group) 207 0.024 0.082 4.0 28 1.22 0.4 13 264 66 7.9 0.95 9 58 0.25 4 0.12 550 Park well 2 0.155 0.032 0.1 22 0.22 1.0 11 256 46 7.3 62 0.70 18 BACTERIOLOGICAL RESULTS-YEARLY AVERAGES. 1960 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 of 22°C. Per cent samples negative in 100 ml. Per cent samples negative in 100 ml. New River derived 515 5.2 99.42 100 River Thames derived (Ashford Common Group) 1778 14.4 98.71 100 Park well 139 0.2 4 88.49 0.8 97.84 0.1 142 0.1 2 99.30 100 13 require constant attention from the department. We are glad to acknowledge the assistance given by the Borough Engineer's Sewers Department in this work. Public Baths and Laundry Establishments The Baths Superintendent supplied a full report on these services which appeared in my report for 1959. The following is a brief summary of the facilities available. (1) Bathing Pools (a) Lido Open Air Pool: (165 ft. x 75 ft.). The total capacityis 490,000 gallons with continuous filtration and chlorination at the rate of 90,000 gallons per hour. Water supply is from the Metropolitan Water Board's mains. (b) Pools 1 and 2 at Central Baths (100 ft. x 35 ft. and 75 ft. x 25 ft.) The total capacity is 155,000 gallons with continuous filtration and chlorination at the rate of 40,000 gallons per hour. Water supply is drawn from a bore hole 421 feet deep. (2) Private Baths (a) Central 34 (b) Conway Road 18 (c) Bromley Road 14 (d) Tiverton Road 22 Total 88 (3) Public Laundries (a) Bromley Road (b) Tiverton Road The small pool at the Central Baths is open throughout the year, but the other two are available during the summer months only. During the winter the large indoor pool is converted into a Municipal Hall. Inspections Carried out by the Public Health Inspectors Appointments and Interviews 530 Cinemas and Halls 49 Complaints Investigated 2951 Conveniences and Urinals 22 Drains defective 202 Drains tested 252 14 Factories with Mechanical Power 400 Factories without Mechanical Power 21 Food Poisoning 9 Food Premises Bakehouses 62 Butchers 162 Cafes 170 Dairies 132 Factories 25 Factory Canteens 60 Fishmongers 57 Greengrocers 77 Ice Cream Premises 77 Slaughterhouses 732 Other Food Premises 288 Improvements 102 Infectious Disease 142 Other Visits 2625 Outworkers 153 Rat Infestation 505 Re-Inspections 6755 Rent Act 32 Schools 19 S.D.A.A. & Housing Act Advances 331 Smoke Control Order 2589 Smoke Observations 66 Stables and Mews 30 Workplaces 16 Defects Remedied Drains reconstructed 7 Drains repaired 176 Drains cleared 111 W.C. Cisterns repaired or renewed 93 W.C. Pans renewed 46 W.C. Pans cleansed 22 Waste pipes repaired or renewed 34 Rainwater pipes repaired or renewed 119 Roofs repaired or renewed 437 Eaves gutters repaired or renewed 262 Drinking water cisterns renewed 5 Drinking water cisterns covered 2 Water service pipes repaired 70 Water supply reinstated 13 Yards repaired or reconstructed 31 Sinks renewed or provided 9 15 Floors repaired or renewed 201 Floors ventilated 63 Dampness remedied by insertion of damp proof course 29 by pointing of brickwork 36 by internal rendering 127 by miscellaneous remedies 159 Window frames and sashes repaired, or renewed, or painted 210 Coppers repaired or renewed, or provided 4 Fireplaces, Stoves & Ovens repaired or renewed 60 Flues and Chimney Stacks repaired 50 Brickwork of walls repaired and walls rebuilt 71 Ventilated Food Stores provided 10 Rooms cleansed 79 Staircases, Passages & Landings cleansed 52 Staircases, Balconies and Steps repaired or renewed 58 Noxious Accumulations removed 26 Nuisances arising from Animals abated 4 Miscellaneous Defects remedied 548 Notices Served Statutory:- Housing Act, 1957: Section 9 65 65 Public Health Act, 1936: Section 24 8 „ 39 37 „ 45 3 „ 92 190 238 Tottenham Corporation Act, 1952: Section 35 18 „ 36 26 „ 43 99 143 Tottenham Urban District Council Act, 1900: Section 48 2 2 Total 448 Informal Notices 1143 16 Repair of Houses by the Council Work carried out in default or by agreement with the owners during 1960. £ s. d. Housing Act, 1957 Section 9 9 premises 543 9 10 Public Health Act, 1936 Section 24 5 premises 25 15 2 „ 39 4 „ 114 9 8 Tottenham Corporation Act, 1952 Section 36 7 premises 82 2 1 „ 38 4 „ 5 4 1 „ 43 31 „ 632 13 9 £1,403 14 7 Abatement Notices: Legal Proceedings The number of complaints received by the department does not diminish and as the majority relate to house repairs, abatement notices are served when necessary. Although a large volume of work is done upon the service of preliminary notices, statutory notices are served when the necessity arises. During the year summonses were issued in 13 instances for non-compliance with abatement notices. In 11 of these the work was carried out before the hearing and proceedings were withdrawn on payment of the Corporation's costs. Orders were made in respect of the remaining seven cases; one defendant failed to comply with the order and a penalty of £5 was imposed with £2.2s.0d. costs. Noise Nuisance During 1960 the Noise Abatement Bill became law with the passing of the Act, which came into operation on 27th November, 1960. It gives wider powers to Local Authorities to take action for noise and vibration by dealing with it as a statutory nuisance under the Public Health Act. In addition three or more persons may make a complaint to a magistrate. Part of the Act regulates the use of loudspeakers in streets, confining their use within limited hours and for limited purposes only. The Act does not apply to aircraft. The Council became a member of the new Noise Abatement Society which was formed to serve the useful purpose of keeping the need for noise abatement actively before the public. Cleansing and Disinfecting The new cleansing and disinfecting station sited at the Refuse Disposal Works has been fully operative during the year. It has proved to be more efficient and more flexible in meeting requirements made at short notice. 17 During the year the van driver retired and staff re-organisation has enabled the department to reduce the cleansing and disinfecting station staff. The requirements of the service continue to be administered efficiently and effectively without any loss of service to the public. This is in no small measure due to the manner in which the men concerned carry out their duties. Summary of Disinfection Work during 1960 Rooms disinfected after occurrence of infectious disease or death 30 Bedding disinfected after occurrence of infectious disease or death 29 Library books disinfected 128 Baths for verminous persons 9 females 7 males) Insect Pests Although less than the figures for 1959, there was again a comparatively large number of bug infestations reported. In many of these cases the infestation was slight and the incidence is still only a small fraction of what it was before DDT insecticides were available, but there is some concern at the possibility that resistant strains may be gaining ground. Other pests which gave rise to most complaints were cockroaches, where 50 infestations were dealt with and wasps: 23 nests were destroyed. Inspections prior to removal to Council houses numbering 269 have been made on notification by the Housing Manager and disinfestation was required in 15 cases, the furniture being treated in a cyanide chamber. Premises Treated Houses Other Premises Bugs 127 - Fleas 4 - Scabies 10 - Cockroaches 45 5 Wasps 22 1 Silver Fish 9 1 Woodworm 3 - Ants 8 11 Moths 1 1 Mosquitos - 1 Bees 1 - Flies and Maggots 3 1 Golden Spider Beetles 2 - Red Mite 3 - Total 238 21 18 Rodents The use of sodium fluoroacetate for rodent control in treating the sewers continues to operate. As previously indicated, this is a method of direct poisoning. In order to assess the effectiveness of this treatment it has been thought advisable to undertake at least one prebait or poison reading per year. In this way it becomes possible to decide on the quantity of poison bait required at any particular manhole or in any particular area. It also enables unnecessary baiting to be avoided. In the case of private dwellings and business premises, Warfarin rodenticide continues to be used. The following is a summary of dwelling houses and business premises etc. treated during 1960:- (1) Dwelling houses 619 (2) Factory premises 40 (3) Shops 36 (4) School canteens 94 (5) Miscellaneous 37 (6) Total charge for 2-5 above £137. 16s. 8d. Factories Haphazard development in past years has led to indiscriminate siting of industrial premises. In certain areas factories operate adjacent to residential property, with the resultant complaints from householders. All too frequent is the householder who complains of the noise or smell from a nearby factory which, in fact, was already functioning as a factory when the house was built and when the occupier moved in. Difficulties sometimes arise when, in order to meet the requirements of the Factories Inspector, nuisances are created outside the building. One example of this is the extractor fan from spray booths inside the building, discharging into the outside atmosphere. 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 56 21 1 - (ii) Factories not included in (i) in which section 7 is enforced by local authority 616 400 34 - (iii) Other premises in which section 7 is enforced by local authority (excluding outworkers premises) 10 10 - - Total 682 431 35 - 19 Summary of defects found in factories Particulars Number of cases in which defects were found Found Remedied Referred to Factories Inspector Referred by Factories Inspector Want of cleanliness (s.1) 2 2 - 2 Overcrowding (s.2) - - - - Unreasonable temperature (s.3) - - - - Inadequate ventilation (s.4) - - - - Ineffective drainage of floors (s.6) - - - - Sanitary conveniences (s.7) (a) Insufficient 3 3 - 2 (b) Unsuitable or defective 60 59 - 10 (c) Not separate for sexes - - - - Other offences against the Act (not including offences relating to outwork) 19 - 19 - Total 84 64 19 14 Outworkers Regular visits were made by the public health inspectors to the homes of persons notified to the department as outworkers in accordance with the provisions of sections 110 and 111 of the Factories Act, 1937. The following is a summary of the types of work undertaken by outworkers in the Borough Wearing apparel 356 Housing linen 1 Curtains & furniture hangings 4 Umbrellas 1 Artificial flowers 11 Paper bags 4 Cardboard boxes 37 Brushes 5 Boxing, carding of buttons 7 Christmas crackers & stockings 18 153 visits were made during 1960 to outworkers' premises. No contraventions were reported. Shops Inspections of shop premises under the Shops Act, 1950 have been carried out during the year; inspections have been made during weekends and in late evenings to ensure that the regulations are complied with. The change to "self service" continues to make itself evident throughout 20 the Borough, bringing with it in most cases more spacious, brightly lit, and well ventilated shops for the convenience of the public and of special benefit to the shop assistants. Inspections 1929 shops have been inspected, prescribed notices, records of employment, etc., have been examined, and all necessary information obtained. An up-to-date register of shops within the Borough has been maintained. 2214 male assistants, 2803 female assistants, and 163 male and 367 female young persons, were employed at the premises inspected. During the year the following contraventions were noted:- Section 17(2) Assistants weekly half holiday notice not exhibited 119 Section 32(2) Record of hours of employment of young persons not maintained 21 Section 32(3) Abstract of provisions of employment of young persons not exhibited 38 Section 37(2) Notice re. seats for females not exhibited 111 General Closing Hours Section 2(1) Failing to close at the prescribed hour 1 Weekly Half Holiday Section 1(1) Shops not closed at 1 p.m. 8 Section 1(2) Alternative closing notice not exhibited 29 Section 13(1) Exempted trade notices not exhibited 52 Section 1 Sale of unscheduled articles 9 Sunday Trading Section 22(3) Record of hours of employment not maintained 1 Section 57 Exempted trade notices not exhibited 29 Section 47 Sale of non-scheduled articles 12 Middlesex County Council Act, 1944 Street Trading Eight warning letters were sent and one prosecution taken for unlicensed street trading. Twenty-three trading sites were licensed. In connection with the infringements recorded above, 98 re-inspections were made and 37 formal notices were served. 21 Prosecutions Shops Act, 1950 and Middlesex County Council Act, 1944. Offence Section Fine Costs Total Case 1 Sale of packet of gravy salt on Sunday 47 £ 2. 0.0 £ 1. 1.0 £ 3. 1.0 Case 2 Sale of custard powder 47 £ 2. 0.0 £ flaked rice 47 £ 2. 0.0 - £ 6. 0.0 hairnet on Sunday 47 £ 2. 0.0 - Case 3 Sale of packet "Persil'' on weekly half holiday 1 £ 2. 0.0 £ 1. 1.0 £ 5. 2.0 Failing to exhibit notice 13(1) £ 1. 0.0 £ 1. 1.0 Case 4 Sale of tinned milk on Sunday 47 10.0 10.6 £ 1. 0.6 Case 5 Sale of hair shampoo on Sunday 47 £ 2. 0.0 £ 1. 1.0 £ 3. 1.0 Case 6 Sale of sage and onion stuffing on weekly half holiday 1 £ 1. 0.0 £ 1. 1.0 £ 4. 2.0 Failing to exhibit notice 13(1) £ 1. 0.0 £ 1. 1.0 Case 7 Sale of butchers meat on weekly half holiday (2 1 £ 1. 0.0 £ 1. 1.0 £ 3. 1.0 summonses) 1 £ 1, 0.0 Case 8 Failing to close on Sunday 47 Discharged £ 2. 2.0 £ 2. 2.0 Case 9 Failing to close on Sunday 47 Discharged £ 2. 2.0 £ 2. 2.0 Case 10 Sale of custard powder on Sunday 47 £ 1. 0.0 £ 2. 2.0 £ 3. 2.0 Case 11 Sale of disinfectant on Sunday 47 £ 2. 0.0 £ 1. 1.0 £ 3. 0.0 Case 12 Sale of tea on the weekly half holiday 1 £ 1. 0.0 £ 1. 1.0 £ 4. 2.0 Failing to exhibit notice 13(1) £ 1. 0.0 £ 1. 1.0 Case 13. Unlicensed street trading 320 & 329 10.0 - 10.0 £23. 0.0 £17. 6.6 £40. 6.6 Fabrics (Misdescription) Act, 1913 The Fabrics (Misdescription) Regulations, 1959 These new Regulations came into force during the year and are concerned with flameproof clothing and materials. Inspection is carried out by the Shops Inspector. The Regulations supersede Regulations made in 1914, which are revoked. 22 All the larger stores and most of the small shops selling night clothing and/or fabrics have been visited. At one shop visited by the Inspector he was told that when asked for flareproof material they offer NYLON. This material in its untreated form has been found NOT to conform with the Regulations and the trader has been advised accordingly. As a result of the enquiries made it was found that it was possible to buy flame resistant night clothing or fabrics at only one store in Tottenham. The reasons usually given by the shopkeepers are that the public rarely ask for this type of goods, the public are not prepared to pay the higher prices for flare resistant garments, and the shopkeepers themselves are reluctant to stock foods for which there is only a limited demand, although most are willing to obtain these goods for special orders. Rag Flock & Other Filling Materials Act, 1951 There are no establishments licensed for the manufacture of rag flock. At 31st December, 1960 there were 18 premises registered for the use of filling materials. Pet Animals Act, 1951 At 31st December, 1960, 10 premises were licensed as pet shops in accordance with the Pet Animals Act, 1951. CLEAN AIR Steady progress continues to be made in the establishment of Smoke Control Areas. During the year under review the Minister of Housing and Local Government confirmed the second smoke control area, the operative date for which was 1st September, 1961. An interesting feature of this area is that it contains a number of industrial establishments and includes the industrial pocket in the Vale Road/Tewkesbury Road part of the Borough. A preliminary survey of a third area has been submitted to, and approved by, the Council. Notifications under section 3 of the Clean Air Act, 1956 continue to be received, in many cases, however, they are conversions from coal to oil fired installation. In terms of visible pollution oil fired installations are no great problem if properly operated; what is probable however, is that the rate of invisible pollution is increased, particularly in terms of sulphur dioxide. Complaints are still received concerning wood waste installations and these present a real problem. In these cases the question of a remedy is mainly an economic one. 23 24 ATMOSPHERIC POLLUTION RECORD, 1960 Month Park Lane St. Ann's Tottenham Technical College Rainfall Insoluble Deposit Soluble Deposit Rainfall Insoluble Deposit Soluble Deposit Smoke Sulphur Dioxide Highest Monthly Average Highest Daily Reading Monthly Average Daily Reading (ins.) (Tons per square mile) (ins.) (Tons per square mile) (mg per 100m.3) (mg per 100m 3) (Parts per 100 million) January 1.63 5.19 5.68 1.81 5.51 6.14 66 167 6.7 20.1 February 2.33 6.68 8.66 2.49 6.85 8.21 23 52 7.6 19 5 March 1.41 9.21 7.57 1.51 8.78 7.15 13 28 4.7 9.9 April 0.52 7.97 4.40 0.52 8.00 4 60 9 16 5.3 10.3 May 1.63 6.19 4.76 1.72 6.85 4.88 6 16 5.7 18.8 June 1.44 6.76 4.29 1.38 6.60 4.77 3 9 3.7 9.0 July 3.36 4.70 3.74 3.45 4.90 4.58 2 5 1.7 3.7 August 2.44 6.78 5.91 2.21 5.09 4.82 3 7 2.3 4.7 September 4.08 6.55 5.30 4.52 4.39 2.83 5 13 2.9 6.7 October 5.08 6.12 3.49 5.48 4.94 5.14 10 28 3.9 7.7 November 3.69 5.65 8.82 3.73 5.20 7.03 18 58 3.1 6.7 December 2.82 8.00 7.17 2.91 5.66 6 02 27 65 4.1 7.3 Certificates of Disrepair There has been a further reduction during the year in the number of applications for certificates of disrepair under the Rent Act, 1957. It is perhaps appropriate to examine this matter and to seek for the reasons for the reduction. The original spate of applications was brought about by the proposed rent increase permitted by the Act. It can be assumed that the applications were prompted because tenants were determined either (1) where the house was not in a reasonable condition no increase in rent would be paid until certain repairs were done, or 25 (2) where the house was in reasonable condition, they were no longer prepared to tolerate certain minore defects and pay an increased rent. As an example of this latter attitude, many tenants wanted outside painting done purely on the grounds that it had not been done for many years. If these assumptions are correct, the reduction in present day applications may be accounted for either because having paid the new rents over a long period tenants have accepted them and have once again become accustomed to living with and putting up with those minor defects as part of the state of things. The other reason, and possibly the more likely one, many tenants are under the impression that applications for certificates of disrepair could only be made when the rent increase was imposed originally. It is still open to tenants living in rent controlled premises to make an application, at any time, if the disrepair of the dwelling makes it justifiable. Rent Act, 19 57 Part I - Applications for Certificates of Disrepair (1) Number of applications for certificates 65 (2) Number of decisions not to issue certificates 3 (3) Number of decisions to issue certificates (a) in respect of some but not all defects 34 (b) in respect of all defects 28 (4) Number of undertakings given by landlords under paragraph 5 of the First Schedule 29 (5) Number of undertakings refused by Local Authority under paragraph 5 of the First Schedule 4 (6) Number of Certificates issued 37 Part II - Applications for Cancellation of Certificates (7) Applications by Landlords to Local Authority for cancellation of certificates 24 (8) Objections by tenants to cancellation of certificates 5 (9) Decisions by Local Authority to cancel in spite of tenant's objection 1 (10) Certificates cancelled by Local Authority 20 HOUSING The pattern of activity under the provisions of the Housing Acts has undergone little change in the post war years. Individual unfit houses have been dealt with by means of the repair, closing, or demolition sections of the Housing Act, 1957. The group of unfit houses has been dealt with more generally, 26 under the provisions of the clearance area sections of the Act. Houses in an unfit condition are not, therefore, in themselves a particular problem. The repair and/or demolition provisions of the Housing Act have been adequate for the purpose It is now time to look forward, more particularly to that class of property which, whilst it may be in reasonably good structural condition, is lacking in amenities. There are many houses in the Borough in this category, without proper hot water supply and lacking in bathing facilities Surely in this day and age the provision of an adequate supply of hot water and proper facilities for bathing should no longer be considered as merely amenities. It is of interest to note that when an application is being considered for improvement grant, on completion of the improvement the house must satisfy a twelve point standard of condition-two of the items listed are hot water supply and a bath. Unfit Houses During the year under review "official representations" were submitted to, and Orders made by, the Council in respect of the following areas. Northumberland Park 2, 3, 4, 5 & 6 This was an area made up of 94 houses in Park Lane, Northumberland Grove, Northumberland Park (both sides), Willoughby Lane and part of Willoughby Park Road. The areas of compulsory purchase included a number of commercial premises. Gourley Street, Gourley Place, Purnford Street This is an area to be dealt with under the provisions of the Town and Country Planning Acts, and declarations of unfitness were submitted in respect of the majority of the dwelling houses in the area. Durnford Street was subsequently acquired by the Council in agreement with the owners. Public Inquiries were held in respect of two areas. (1) Tewkesbury No. 6-this was the second public inquiry held inrespect of what is known as the school site, the Council having resolved to acquire the area by compulsory purchase. (2) Markfield Development-a public inquiry was held inrespect of the compulsory purchase order under the Town and Country Planning Acts and also into the declaration of unfitness order in respect of the majority of the dwelling houses in the area. (3) In the case of the Tewkesbury Area No. 8, comprising part of the terrace of the even numbers in Tewkesbury Road, the Minister dispensed with a public inquiry but the houses were visited by one of his inspectors. Confirmations The Minister confirmed the following orders during the year, in some cases with slight modification. Tewkesbury Area No. 6 (school site) 88 houses Tewkesbury Area No. 8 6 houses Markfield Development 50 houses Photo by courtesy of Aerofilms & Aero Pictorial Ltd. WHITE HART LANE/LOVE LANE AREA: REDEVELOPMENT IN PROGRESS 27 From the foregoing details it will be noted that the department has not been inactive in the field of slum clearance. In addition, a number of individual unfit houses have been "officially represented" and repairs to other unfit houses secured by action under sections 9 and 10. 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 8.60 No. 2 123 1.6.54 22.2.55 9.7.55 2.60 8.60 Tewkesbury No. 3 71 29.6.54 28.3.55 27.10.55 5.60 9.60 No. 3 2 30.8.55 Purchased by agreement 8.57 10.57 Markfield Redevelopment 1955 25 28.9.54 25.5.55 13.1.56 12.57 1.58 Plevna Crescent Nos. 1, 2 & 3 26 29.11.55 11.10,56 Not Confirmed St. Ann's Road 5 29.11.55 11.10.56 14.2.57 3.59 Hartington Road 15 29.11.55 11.10.56 14.2.57 10.59 12.59 Northumberland Park (No. 1) 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 2.60 11.60 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 1.61 3.61 Albert Road/ 200 4.6.57 30.9.58 13.5.59 - - Richmond Road and 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 1st 2.6.59 2nd 15.3.60 -.9.60 Tewkesbury No. 7 3 14.10.58 - 27.10.59 - - Markfield Redevelopment 1958 50 18.11.58 5.7.60 -.12.60 Tewkesbury No. 8 6 30.6.59 Inspector's visit Northumberland Park 17.6.60 7.9.60 - - 2. 3, 4, 5 & 6 58 12.1.60 - . _ - Durnford Street/ Gourley Street Redevelopment 74 12.1.60 (40 Purchased by Agreement) 1 28 HOUSING ACTS 1936 & 1957 SECTIONS 9 & 10 WORK IN DEFAULT Year Number of Houses Cost £ s. d. 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 I960 9 543 9 10 Premises the subject of Demolition Orders not demolished as at 31st December, 1960 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 23.10.59 122 Tewkesbury Road *20. 5.60 15 Braemar Road *28. 6.60 40 Church Road *26. 7.60 124 Tewkesbury Road *20.10.60 126 Tewkesbury Road *20.10.60 128 Tewkesbury Road *20.10.60 33 Tewkesbury Road *28.10.60 35 Tewkesbury Road *28.10.60 37 Tewkesbury Road *28.10.60 39 Tewkesbury Road *28.10.60 *These premises were still occupied at 31st December, 1960 29 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 health of some applicants warrants special consideration by the Housing Lettings SubCommittee. 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 illness or risk of infection to others. Whilst in a large proportion of these 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 aspects can be clearly established. Wien 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. Assessments of 71 cases were made where applicants had submitted medical certificates in support of their applications for rehousing. After investigation the following recommendations were made:- 1. Urgent medical priority justified 10 2. Refer to Committee 37 3. Allow medical points 7 4. Unable to support 14 5. Circumstances changed making further action unnecessary 3 FOOD CONTROL In my annual report for 1959 I drew attention to the requirements of the new regulations governing the construction and operation of slaughterhouses. This "Slaughterhouse Report* was submitted to the Minister and was confirmed in 1960, to take effect as from 1st January, 1962. Local slaughterhouses operating at the present time will continue to do so under existing licences until the end of 1961. Nevertheless, every effort is made to ensure that all operations are carried out, and the carcases produced, consistent with a good standard of hygiene. Routine inspections continue to be carried out in all types of food premises and would seem to be the best method of attaining a good standard of hygiene. The vigilance of the staff engaged in this work has resulted in an increasing number of prosecutions against persons smoking whilst engaged in handling food. 30 The total number of food shops as at 31st December, 1960 was 1,049, made trp as follows:- Bakers 50 Butchers 91 Coffee stalls & cafes 25 Confectioners 330 Dairymen 33 Dining rooms 93 Domestic stores 127 Fishmongers 49 Fruiterers & greengrocers 118 Grocers & provisions 287 Ham & Beef dealers 4 Off-licences 82 Public Houses 58 Registered Food Premises At 31st December, 1960 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 412 Manufacture and sale of ice-cream 2 Storage of ice-cream 1 Cooking of hams and other meat 35 Fish frying 39 Sausage manufacture 58 Preparation of jellied eels 3 Shellfish 2 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 86 Shellfish 17 7 Fish 8 4 Ice-cream 5 - Light refreshments 5 1 Peanuts 3 1 Eggs 1 - 31 Milk (Special Designation) Regulations The following is a summary of licences issued during 1960, namely:- Designation No. of Licences No. of Supplementary Licences Pasteurised 94 14 Sterilised 163 16 Tuberculin Tested 48 14 During the year 26 applications for registration as milk distributors were dealt with. No applications were received in respect of dairies. Of the 26 new registrations, 7 were for new premises and the other 19 were inrespect of the change of proprietorship of previously registered premises. The number of premises and distributors registered at 31st December, 1960 was as follows No. of distributors 160 No. of dairies 8 Meat Inspection The work of 100% meat inspection has been maintained without any marked reduction in the number of carcases inspected. The slaughterhouses operate a full six day working week and therefore attendance at the premises during "out of office hours" continues to be necessary. Disposal of condemned meat in either slaughterhouse poses no problem, in the one case it is sent into the knackers yard and in the other it is collected and taken to the Refuse Disposal Works for incineration. Slaughtermen Eleven men were licensed as slaughtermen, of whom seven were licensed to slaughter horses. 32 SUMMARY OF CARCASES INSPECTED 1950 Horses Cattle excl. Cows Cows Calves Sheep & Lambs Pigs excl. Sows Sows Gloats Number killed 941 17 158 1046 2099 14305 1568 84 Number inspected 941 17 158 1046 2099 14281 1568 84 All Diseases except Tuberculosis and Cysticercosis Whole carcases condemned - - 10 - 1 6 1 - Carcases of which some part of organ was condemned 205 1 66 4 231 1783 107 4 Percentage of number inspected affected with disease other than tuberculosis and cysticercosis 21.79 5.88 48.10 .38 11.05 12.53 6.89 4.76 Tuberculosis Only Whole carcases condemned - - 3 - - - 2 - Carcases of which some part of organ was condemned - - 2 - - 132 53 - Percentage of number inspected affected with Tuberculosis - - 3.17 - - .92 3.51 - Qysticercosis Only Whole carcases condemned - - 1 - - - - - Carcases of which some part of organ was condemned - - - - - - - - Percentage of number inspected affected with cysticercosis - - .63 - - - - - 33 Condemned Food Tinned Articles Baby Food 111 Beverages 138 Custard Powder 6 Fish 506 Fruit 2146 Fruit Juice 62 Macaroni 1 Meat (processed) 1201 Milk and Cream 432 Pease Pudding 2 Pie Filling 3 Other Articles of Food Condemned Bacon 1039 lbs. 12 ozs. Beverages 6 packets 32 jars 2 bottles Biscuits 39 lbs. Cereals 4 packets 14 lbs. Cheese 10 lbs. Fish 12 stone Fish Paste 2 jars Flour 112 lbs. Fruit 1 box 1153 lbs. Potato Salad 8 Preserves 18 Ravioli 1 Rice 113 Soups 526 Spaghetti 80 Stew 2 Tomatoes 221 Tomato Products 153 Vegetables 1070 Meat 1525 lbs. 10 ozs. Meat Pies 8 Pie Filling 1 packet 1 jar Pickles 4 jars Preserves 82 jars Rice 221 lbs, Salad Cream & Mayonnaise 50 jars Sandwich Spread 20 jars Split Peas 28 lbs. Treacle Pudding 1 Vegetables 245 lbs. Legal Proceedings (1) Unsound Food (a) Butterfly in loaf. Plea of Guilty; fine of £5 and £2.2.0d costs and £2.10.0d public analyst's fee. (b) Faggots unfit for human consumption. Plea of Not Guilty and justices, having heard the evidence, gave benefit of doubt and dismissed the summons. (2) Smoking in Food Rooms (a) Plea of Not Guilty. Offence was found proved. Fine of £3. No costs awarded. (b) Plea of Guilty, Fine of £2 and £2.2.0d costs. 34 (3) Unsatisfactory Premises & Equipment Six summonses Defendant pleaded Guilty to three summonses and Not Guilty to three summonses The three latter summonses were proved Defendant fined £2 on each of three summonses and £1 on each of the remaining three, totalling £9 Costs of £2.2.0d. Food Sampling The Public Control Department of the County Council has supplied the following table of information on food and drugs sampling in the Borough during 1960:- Articles No of samples procured Unsatisfactory Milk (various) 103 3 Butter and Margarine 19 - Cakes and Biscuits 16 1 Cheese 10 - Cream 8 - Drugs 10 - Fish and Fish Products 36 - Fruit - Fresh, Canned and Dried 9 2 Ice Cream and Lollies 10 - Meat, Meat Products and Liver 117 10 Soft Drinks 5 - Spirits 20 - Sweets 10 - Vegetables (Fresh) 5 - Vinegar and N.B.C. 15 v Miscellaneous 25 - Totals 413 16 Commenting upon the unsatisfactory samples, the Public Control Officer makes the following observations "Milk. Two purchases of hot milk were made in a restaurant in the Borough and were submitted to the Public Analyst as formal samples. The Analyst reported that the milk was deficient in butter fat and also contained at least 12.2 per cent of added water. Legal proceedings were instituted against the owner of the restaurant. An absolute discharge was granted and an order was made for the payment of £3.3.0d costs. A bottle of milk delivered to Belmont Secondary Modern School, Tottenham, was found to contain splinters of glass. Legal proceedings were instituted against the dairy concerned and a fine of £5 was imposed and an order for costs of £3.3.0d was made. A further bottle of milk deliveredto West Green School was reported to have a stain inside the bottle The bottle was submitted to the Public Analyst whoreported thatthe stain consisted of a thin film of dust, dirt and organic debris An official caution was issued to the dairy concerned. 35 Cake. A sample of jam cream sponge was reported by the Public Analyst to contain imitation cream. Proceedings were instituted against the two partners of the bakery company, each of whom was fined £1 and ordered to pay costs of £3.7.0d. Fruit. A purchase of fresh apples made in the Borough was reported to be tainted with mustard oil and was unfit for human consumption. These apples were distributed over a wide area, including districts outside the Administrative County of Middlesex and the complaint was therefore handed over to the Public Health authorities, who investigated the matter and had all the apples withdrawn from sale and destroyed. A purchase of Victoria plums proved to be 'Giant Prunes. A caution was issued to the owner of the shop concerned. Meat. Seven samples of minced beef purchased from three different shops were found to contain preservative. In two cases legal proceedings were instituted. One Company was fined £3 and ordered to pay costs of £3.11.0d and in the second case a fine of £5 and and costs of £2.2.0d were imposed. In the third case an official caution was issued. A sample of pork sausages was also found to contain preservative and an official caution was issued. Two purchases of calves' liver were found to be ox liver. Legal proceedings were instituted for displaying ox liver for sale described as calves' liver and for selling a similar article A total fine of £4 was imposed and an order made for the payment of £4.4.0d costs". The Public Control Officer has also furnished the following report upon associated work under other Acts:- Labelling of Food Order 1953. This Order requires pre-packed food to be marked with the name and address or the registered trademark 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, it controls the manner in which the presence of vitamins and minerals is disclosed, and prescribes specific labelling of certain foods. A total of 1,450 articles was examined at 313 different premises to verify compliance with these regulations. Only minor infringements of the Order were discovered and these were dealt with by verbal warnings. Merchandise Marks Acts, 1887-1953. The majority of 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 401 premises of 1,367 displays ofthese articles and minor infringements detected were dealt with by verbal cautions. Stronger action, however, was taken in the following cases. A butcher was fined £5 on each of two summonses for failing to mark an indication of origin on imported meat, and was ordered to pay £3.3.0d costs. 36 Two butchery companies were prosecuted for delivering Canadian pigs' liver falsely described as "English" to a County Council establishment. The first company was fined a total of £35 and ordered to pay £5.5.0d costs and the second company was ordered to pay a total of £40 in fines and also ordered to pay £5.5.0d costs. Twenty summonses were issued against a further company for selling Uruguay meat falsely described as Argentine. Fines totalling £20 were imposed andan order was made for the payment of £5.5.0d costs. Two further companies were prosecuted for similar offences and fines of £20 and £35 were imposed and costs of £2.2.0d and £5.5.0d were ordered to be paid. Two official cautions were also issued for similar offences. It will be apparent that there was a high incidence of this type of offence in the Borough of Tottenham during the early months of 1960. Further inspections since these prosecutions have revealed a considerable improvement in the labelling and marking of butchers' meat. 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 in 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. Examples where corrective action was sought are set out as follows:- Oranges, tangerines and grapefruit were described as "seedless" but were found to contain seeds. Television and press advertisements falsely suggested that a cheese was a "Cream Cheese". Advertisements which falsely suggested a fruit content for sweets were challenged, and the labelling of further sweets for which an alcohol content was claimed was also challenged and amended. CONTROL OF DISEASE The incidence of notifiable disease was low in 1960, with no cases of diphtheria, meningococcal infection or typhoid fever and only one case of poliomyelitis. Altogether 791 notifications were received compared with 1550 in 1959 and 985 in 1958. Tuberculosis Notification of new cases continued at the rate which has been experienced in recent years although the figure 92 shows an increase of 6 on the previous year. Eighty three of the new cases (51 males and 32 females) had lung infections and the remaining 9 (1 male and 8 females) had involvement of the meninges in 1 case, lymphatic glands in 3 cases, joints in 4 cases and kidney in 1 case. 37 On two occasions where new cases of pulmonary tuberculosis were notified among factory workers in the district arrangements were made with the ready co-operation of the Chest Physician, Dr. T.A.C. McQuiston, for factory contacts to attend at the Chest Clinic for miniature X-rays. In another instance it was possible to get the Mass Radiography Unit to visit a Tottenham factory to check factory contacts. The most positive indication of the advances made in the treatment of tuberculosis is given by the fall in the number of deaths directly caused by this disease. In 1960 there were only 4 deaths in Tottenham compared with 109 in 1940 and 156 in 1920. Distribution of New Tuberculosis Cases and Deaths in 1960 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 - - - - - - - 5-9 " - - - 1 - - - - 10 - 14 " - 2 - - - - - - 15 - 19 " 2 4 1 - - - - - 20 - 24 " 5 7 - - - - - - 25 - 29 " 2 5 - 2 - - - - 30 - 34 " 3 2 - 1 - - - - 35 - 39 " 6 3 - - - - - - 40 - 44 " 6 - - - - - - - 45 - 49 " 1 2 - 1 - - 1 - 50 - 54 " 8 2 - 1 - - - - 55 - 59 " 4 3 - - 1 - - - 60 - 64 " 4 1 - - - - - - 65 - 69 " 6 1 - - 1 - - - 70 - 74 " 1 - - - 1 - - - 75 years and over 2 - - 1 - - - - Total 51 32 1 8 3 - 1 - 38 Changes in the Tuberculosis Register during 1960 Pulmonary Non-Pulmonary Total Male Female Male Female Number on Register at 1st January, 1960 896 718 92 106 1,812 Add New cases notified in 1960 51 32 1 8 92 Transfers into Borough 28 22 - 2 52 Restored to Register - - - - - 975 772 93 116 1,956 Deduct Transfers out of Borough 29 29 3 1 62 Deaths 10 - 1 - 11 Recovered Cases 98 87 4 8 197 Cases lost sight of 14 8 2 4 28 151 124 10 13 298 Numberon Register at 31st December, 1960 824 648 83 103 1,658 Ward Distribution of Cases of Tuberculosis on the Register at 31st December, 1960 Ward Estimated Population Male Female Total Rate per 1,000 population4 Pulmonary NonPulmonary Pulmonary NonPulmonary White Hart Lane 11,060 104 11 72 7 194 17.5 Park 10,170 71 14 72 15 172 16.9 Coleraine 11,330 60 9 58 9 136 12.0 West Green 10,640 60 1 58 11 130 12.2 Bruce Grove & Central 10,470 54 3 42 5 104 9.9 High Cross & Stoneleigh 10,620 75 12 57 12 156 14.7 Green Lanes 10,040 87 8 65 10 170 16.9 Chestnuts 10,590 81 6 60 8 155 14.6 Seven Sisters 9,790 72 7 56 7 142 14.5 Town Hall 10,050 79 6 64 10 159 15.8 Stamford Hill 10,070 81 6 44 9 140 13.9 Total 115,030 824 83 648 103 1,658 14.4 NOTE: To obtain the estimated population for each ward, the Registrar-General's estimate for the Borough has been divided in the same proportions as number of persons on the Register of Electors for each ward. 39 Tottenham and Wood Green Chest Clinic Dr. T.A.C. McQuiston makes the following comments on trends in the incidence of tuberculosis and the work of the Chest Clinic during 1960. The number of new notified cases does not change appreciably despite the very considerable fall in the death rate. The other notable feature is the preponderance of morbidity and mortality in the older age groups, particularly in males. The apparent high number of patients on the tuberculosis register is easily explained. According to the Ministry of Health classification, patients' names may be removed from the register after a period of five years' quiescence. In certain cases, even though this stage has been reached (Ministry classification "Recovered"), we may still retain their names on the register forvarious reasons which may be associated with the type of their work or their social conditions. This procedure means that a stricter check is still kept on their clinic attendance since, when their names are removed from the register as recovered, certain patients may be less likely to keep up regular yearly or half-yearly checks-a practice we try to encourage in every case for an indefinite period. The total number of attendances at the chest clinic per annum is, therefore, fairly constance and certainly the amount of work we have to do has not diminished in recent years. The number of miniature films requested by private doctors has increased this year2,205 films in 1959 and 2,859 in 1960. A considerable problem is presented by patients with chronic bronchitis and emphysema, generally middle-aged and elderly males. From this point of view we find it is a great advantage having beds available to the chest unit, particularly in the winter months, when we can admit them promptly for treatment of an acute respiratory infection or for cor pulmonale. Such conditions in those with very restricted respiratory function may prove rapidlyfatal if not dealtwith promptly. Most of such cases are probably known to us at the chest clinic since they are likely to have attended at some time or to be already under our constant supervision. I feel that the matter of notifying all tuberculous conditions should be emphasized to practitioners and general hospitals so that the chest clinic is in a position to check all contacts and to see that adequate supervision of such cases is carried out. It quite frequently happens that a patient may have been treated in a general hospital for months before we ever get to hear about it and much consternation is caused amongst contacts when we begin to follow them up at that late stage. Attendances Total attendances during 1960 21,121 Total of new cases sent for diagnosis by G.Ps in 1960 5,085 Those of above total notified as T.B. 100 " " " " having full examination 2,226 " " " " having miniature X-ray only 2,859 Total number of new contacts seen in 1960 946 Those of above found to be tuberculous 15 40 Poliomyelitis The benefits of mass vaccination against poliomyelitis are now being reflected in the reduced incidence of this disease. In 1960 there was only one notified case in the Borough. This related to a boy aged 3 years, not a Tottenham resident, whose condition was diagnosed after admission to St. Ann's General Hospital. Acute Encephalitis There were five cases of acute infective encephalitis notified in 1960. In four instances adults were affected, females aged 25 years, 30 years and 44 years and a male aged 34 years. The other case was a boy of 9 years. There was one case of post-infectious encephalitis following chickenpox in a boy aged 6 years. Smallpox No cases of smallpox occurred in the Borough in 1960. On one occasion it was necessary for the consultant to be called to see a suspected case but the final diagnosis was chickenpox. Scarlet Fever The incidence of scarlet fever remaind. about the average expected in recent years. There were 100 notified cases and the disease continued to be of the mild type with few complications and no deaths. Measles The incidence of this disease continues to have its biennial cycle, 1960 being a year of low incidence. There were 246 notifications compared with 949 in the previous year. No deaths arose from this cause. Whooping Cough This is a most distressing disease especially when it affects very young children, and parents are strongly advised to take advantage of the immunisation facilities which are now available. In 1960 there were 163 notified cases of whom 94 were under 5 years of age. 1958 and 1959 with respectively only 29 and 12 notified cases had given some hope that we were reaching the point where the disease might be eradicated but there was a comparatively heavy incidence in the springand summer of 1960 which resulted in the highest annual figure for four years. No deaths from whooping cough were recorded. 41 Food Poisoning There were 8 notified cases of food poisoning, all of which were unconnected. The agent giving rise to the illness was identified in three instances and in each case the cause was salmonella typhi-murium. Paratyphoid Fever There were two cases of paratyphoid fever, one affecting a girl aged 10 years occurred at the end of March andthe second arose at the beginning of July, the patient being a boy of 10 years. In neither case was it possible to trace the source of infection. Dysentery There were 66 cases of dysentery compared with 251in 1959 whenthe figure was inflated by two school outbreaks. In 1960 all age groups were affected, 24 of the cases being over 15 and 21 under 5. The disease is generally of a mild character but may be more serious in the very young or the very old. Staff Medical Examinations During the year 77 candidates for appointment to the Superannuation Scheme were medically examined. Six failed to pass for the reasons below:- 1. Previous T.B. case 2. Emphysema 3. Nephritis and oedema 4. Emphysema 5. Tuberculosis 6. Fibrotic changes of lungs and duodenal ulcer Special medical reports are made on staff whose sickness exceeds 72 days. In some cases an employee may be permanently or temporarily unfit for his appointed duties, and has to be transferred to lighter work. Such cases are subject to periodic review. If the disability is permanent and too severe for any light work, then the only course left is to recommend retirement on the grounds of permanent disability. It is distressing to note that chronic bronchitis is the cause of most of these permanent disabilities. 6 cases were recommended for lighter duties. 5 cases were superannuated. 42 Table of Cases of Infectious Diseases coming to the knowledge of the Medical Officer of Health during the year 1960 in the Borough of Tottenham, classified according to Disease and Ages Disease Under 1 1 2 3 4 5 - 9 10 - 14 15 - 19 20 - 34 35 - 44 45 - 64 65 & up Total M F M F M F M F M F M F M F M F M F M F M F M F Scarlet Fever - - 1 3 4 5 2 8 7 12 29 20 5 3 - - - 1 - - - - - - 100 Measles 6 3 14 16 19 19 13 24 10 15 60 44 - - 1 1 1 - - - - - - - 246 Whooping Cough 13 7 9 8 9 15 5 12 7 9 29 31 2 6 - - - - - 1 - - - - 163 Pneumonia 5 3 2 1 - - 1 - 2 1 3 1 1 - - - 1 3 2 3 8 6 6 9 58 Erysipelas - - - - - - - - - - - - - - 1 - - - - 1 1 3 - 1 7 Food Poisoning - - - - - - 1 - 1 - - - - - 1 - - - 1 1 1 1 - 1 8 Puerperal Pyrexia - - - - - - - - - - - - - - - - - 3 - - - - - - 3 Ophthalmia Neonatorum - 1 - - - - - - - - - - - - - - - - - - - - - - 1 Acute Encephalitis Infective - - - - - - - - - - 1 - - - - 1 2 - 1 - - - - - 5 Post-infectious - - - - - - - - - - 1 - - - - - - - - - - - - - 1 Acute Poliomyelitis Paralytic - - - - - - 1 - - - - - - - - - - - - - - - - - 1 Non-paralytic - - - - - - - - - - - - - - - - - - - - - - - - - Meningococcal Infection - - - - - - - - - - - - - - - - - - - - - - - - - Diphtheria - - - - - - - - - - - - - - - - - - - - - - - - - Typhoid - - - - - - - - - - - - - - - - - - - - - - - - - Paratyphoid - - - - - - - - - - - - 1 1 - - - - - - - - - - 2 Dysentery 2 1 4 7 2 2 2 1 1 1 6 1 8 4 - 2 3 7 3 2 3 3 1 - 66 Scabies - - 2 - - - 1 1 1 1 4 6 2 8 1 1 - 3 2 3 1 1 - - 38 Tuberculosis Respiratory - - - - - 1 - - - - - - - 2 2 4 10 14 12 3 17 8 9 1 83 Meninges & C.N.S. - - - - - - - - - - 1 - - - - - - - - - - - - - 1 Other - - - - - - - - - - - - - - 1 - 3 - - - - 2 - 2 8 Total 26 15 32 35 34 42 26 46 29 39 134 103 19 24 7 9 17 34 21 14 31 24 16 14 791 43 OLD PEOPLE'S WELFARE The problems associated with the increasing proportion of aged persons in the community are matters of vital concern to those associated with the health and welfare of the public. Unfortunately, reaching retirement age appears to infer automatic classification as an "old person" who is unfit for further work. Indeed this is very much the exception in modern times where improved living conditions and medical advances have considerably lengthened the span of active life. With retirement there is the need to readjust, and unless other useful objectives can be introduced there is a danger of losing interest. To help this transition it was decided to set up a retirement advice centre for men reaching the age of 65 years. Those active retired people who have not taken up other employment should continue to lead a full life, and for this purpose adequate recreational and social activities within the community should be available to them. It is in this field that the welfare clubs play an important part Equally important are the facilities provided by the Parks and Libraries Department for physical and mental recreation. The lengthening of active life has not eliminated the time when the mechanism of the body finally starts to run down and help is needed. It is then that services must be available for those without relatives or friends. Also help is often needed by those caring for infirm elderly relatives or neighbours when prolonged nursing and care may prove too great a burden, Finally there should be an adequate number of places available in hospitals or welfare homes for those who are respectively in need of hospital treatment or who are infirm and unable to get proper care and attention at home. The following is a survey of the services available in Tottenham, Retirement Advice Clinic For many years now there has been evidence of a serious gap in the personal services. Although a great deal has been done to ensure that children aarive at their productive years in the best possible state of body and mind, little or nothing has been done to see that they leave their working days behind in sucha healthy state of mind and body that they can enjoy the years of their retirements Studies in many authorities have shown that a large proportion of men approaching retirement have no idea how they will spend their time, in fact many have not considered their retirement at all Also many suffer from minor ailments and minor indispositions of which they may be scarcely aware because of their gradual onset and which could be corrected or treated were they to seek treatment, With the aims of remedying some of these defects a new kind of clinic began in Tottenham and Hornsey in December, 1960, by co-operation with the Ministry of Pensions and National Insurance, and of the Ministry of Labour. In this scheme men approaching sixty-five are invited toattend the clinic by appointment to see a medical officer, and to discuss their general welfare, health andinterests essential to their mental well being. In each case a physical examination is carried out and a report sent to the patient's own doctor. If the patient wishes to work on, a second interview with an officer of the Ministry of Labour is arranged. 44 The clinic, although in its early days, has already disclosed untreated ailments, some of a serious nature, in those who have attended. It is hoped the door is now open for a further advance in preventive medicine for the benefit of our senior citizens. Laundry Service for the Incontinent Aged The service is provided under section 84 of the Public Health Act, 1936, and in 1960 700 collections were made by the Public Health Department. Baths Free baths are available at the Public Baths for old people, who know that if they need help they can call upon the Baths Attendants. Library Service Housebound old people may obtain upon request regular deliveries of library books from the Public Libraries. During the year 4,784 books were delivered in this way to 45 infirm old people. Hospital Services St. Ann's General Hospital has wards providing 100 beds (60 female and 40 male) for the chronic sick, and the extension of geriatric services is under active consideration by the hospital authorities. There continues to be a waiting list of cases requiring hospital admission. Each week notification is sent by St. Ann's General Hospital of the new names on their waiting list. These cases are visited by a social visitor on the staff of King Edward Hospital Fund for London and she provides reports to the hospital on the home circumstances to enable priority to be given to those cases in most urgent need of hospital care. OLD PEOPLE'S WELFARE COMMITTEE Chiropody Service During the year the County Council were empowered to contribute towards or operate Chiropody Services and the Old People's Welfare Committee has received grants from this source towards their clinic services. Treatment is now free to all pensioners in receipt of a supplementary pension and those whose income, if single is less than £5 perweek, or forhusband and wife less than £8 per week. Persons above this income are required to pay 2s. per foot but with the right to appeal against this assessment. The demand for this service has continued to increase and during the year approximately 800 old people received foot care at clinics, and 4616 treatments were given. There has also been an increased demand for the Domiciliary Service and during the year 226 patients have been seen and 915 treatments given, an increase of 230 since last year. There is now a waiting list of 27 new patients requiring this service and the waiting time between appointments in 16 weeks. 45 Christmas Parcels Approximately 1,500 parcels were delivered by voluntary effort to those who were over 80 years of age or housebound. Meals-on-Wheels This service has been increased since last year and two further rounds have been started which means that the Committee now delivers meals on four days each week on a total of 9 rounds. With the co-operation of the Women's Voluntary Service whodeliver meals one day each week, it is now possible to supply meals every day (excluding week-ends) to those who are housebound and in need. 128 applications for this service have been received during theyear and 8,084 meals have been delivered by the Committee, an increase of 555 on last year, and 3,815 by the Women's Voluntary Service. This service is dependent on the voluntary workers who deliver these meals each week and become real friends to those they visit. Clubs The four Clubs still continue to flourish and there is now a total membership of approximately 600. Each Club enjoyed Summer Outings and Christmas Parties during the year and the Lord Morrison Hall now has an excellent Sports Section which won the Inter-Borough Shield presented by the "T ottenham & Edmonton Weekly Herald". Each month concerts have been held at the Lord Morrison Hall and trips to the "Intimate" Theatre have been arranged and these have all been greatly appreciated by the members. Meals are still served at the St. Ann's and Lord Morrison Hall Clubs twice weekly and five electrically heated containers were purchased by the Catering Committee to enable the old people to have meals which are really hot. A total of 9,235 meals have been served at Clubs during the year. Holidays and Outings With the co-operation of the Women's Holiday Fund 52 pensioners were able to enjoy a holiday by the sea at the minimum cost of £4.4.0d per fortnight including fare. Two groups spent a very enjoyable time at a Holiday Camp at Dymchurch. The first party of 66 went in May followed by 109 in September. The cost of the holiday, including return coach fare from the Town Hall, was £5.10.0d and payments were made each week to the office to cover the cost of this. Many outings have been arranged for the housebound due to the generosity of voluntary organisations and Messrs. Ardleys, and for many it was the first time out for a considerable number of years. Optical Service 38 housebound old people were visited by the Optician. 46 Shoe He pairs 11 dockets were issued to enable old people to get footwear repaired at areduced rate. Barber Service 57 old people were visited in their homes by the Barber. Harvest Festival 580 old people benefited by the kindness and generosity of schools and Churches who sent their Harvest Festival Thanksgiving for distribution by the Committee. Visits and General Welfare This essential service has increased considerably and there are now 2,000 patients on the books who are visited periodically. Since the 1st April, 1960, 18 voluntary visitors have been enrolled making a total now of 21 visitors and 36 voluntary workers altogether excluding those at clubs. This means that the elderly people can be visited more frequently. A house to house survey was started during the year to obtain the names of all Old Age Pensioners and from this we have found many who are in need of the services. The statistics show that during the year 1,100 domiciliary visits have been made by the Organiser and her Assistant. This is an increase of 339 since last year. In addition 300 visits have been made by voluntary workers besides the many social calls which visitors make to the old people. Many patients bring their problems to the office and during the year 2,440 office interviews have been conducted, an increase of 601 on last year and 167 visits made to clubs. These figures give only a slight indication of the amount of work and often hours of follow ' up is involved in some of the cases. Welfare Homes It is the statutory duty of the County Council to make this provision. Although there is at present no home in Tottenham, one is now under construction on part of the Broadwater Farm site adjoining Higham Road and it is expected that this will be completed in 1961. Great difficulty still exists in obtaining admissions to homes outside the Borough and very long delays may be experienced before a place can be obtained. National Assistance Act. 1948 , Section 47 It was necessary on one occasion to exercise these powers in 1960. An old lady of 87 years who had been bedridden for some time was being cared for by an elderly niece, who was far from well herself. Eventually the niece became ill and had to leave so that the old Jady was reliant upon others living in the house and the domiciliary nursing and home help services With some difficulty a hospital place was found for the patient, but at the last moment she refused to go. As a matter of urgency the provisions of the National Assistance (Amendment) Act, 1951 were invoked and a Magistrates Order obtained for her immediate removal to hospital. 47 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. 48 Prince of Wales's Hospital Time-table of Out-Patient Clinics Monday Tuesday Wednesday Thursday Friday Saturday Medical a.m. a.m. p.m. p.m. a.m. - p.m. p.m. Surgical a.m. p.m. p.m. - p.m. - Varicose ulcers p.m. - - - - - Diseases of Women - p.m. - p.m. - - Children (Medical) - a.m. - a.m. - - Eye - - a.m. - - - Throat, Nose & Ear p.m. - - p.m. - - Skin - - p.m. - a.m. - Teeth - - - a.m. - a.m. Neurological p.m. - - - - - Genito-Urinary - a.m. - - - - Psychi atric - p.m. - - p.m. - Physical Medicine a.m. a.m. a.m. a.m. a.m. a.m. p.m. p.m. - p.m. p.m. - X-ray 9 a.m. until 5 p.m. every day; Saturdays 9 a .m.- 12 noon Orthopaedic - a.m. - a.m. - - Fractures a.m. - - - a.m. - Allergy - - - p.m. - - Venereal Diseases Medical Officer Males 4.30 p.m. - 4.30 p.m.- 10.30 a.m. - - 10.30 a.m - 7.0 p.m. 7.0 p.m. 12.30 p.m, 12.30 p.m. 4.30 p.m.- 7.0 p.m. Females - 4.30 p.m- - 10.30 a.m.- 2.0 p.m.- 10.30 a.m. 7 0 p.m. 12 30 p.m. 4.30 p m. 12.30 p.m. Intermediate 9.0 a.m.- 9.0 a.m.- 9.0 a.m.- 9.0 a.m- 9.0 a.m.- 9.0 a.m,- Treatment 7 0 p.m. 7.0 p.m 7.0 p.m. 7 0 p.m. 7.0 p.m. 12.30 p.m. Doctors" Letters required All Patients seen by appointment The Casualty Department is always open for medical and surgical emergencies 49 (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 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, 50 The following is a summary of work carried out for Tottenham by the Laboratory Service:- RECORD OF EXAMINATIONS Throat/Nose Swabs Total Specimens 90 Haemolytic Streptococci 2 Staph Aurius 1 Negative 87 Faeces:- Total specimens 325 Shigella 41 Salmonella Typhi-murium 1 Negative 283 Sputum Total specimens 1 Negative 1 Miscellaneous specimens 16 Total number of specimens 432 Middlesex County Council Act, 1944: Part XII Seven establishments were registered for chiropody and special treatment, at 31st December, 1960. PERSONAL AND SCHOOL HEALTH SERVICES TOTTENHAM AND HORNSEY (Joint Population 211,600) 51 THE AREA HEALTH COMMITTEE Members of Hornsey Borough Council Councillor Miss O R. Anderson Councillor Mrs. J. Carter Councillor Mr. F.C.V. Hayward Councillor Mr. D.H.P, Levy Councillor Mr. J.T. Wilkins (vice-chairman; 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 J.P. (Chairman) Members of Middlesex County Council County Councillor Mr. F.H. Brooks County Councillor Mr. V. Butler County Councillor Mrs. S.G. Child Councillor Mr. H. Langer, J.P. Councillor Mrs. A.A. Miller Councillor Mrs. M.E. Protheroe 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 Member with knowledge and experience of Home Nursing Miss S.M. Quinn Persons who may attend in an advisory capacity Dr. L. Posner (Middlesex Local Medical Committer) 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 " E.J. Field " R.W.H. Ford Councillor G.W, Barker " Mrs. S.A. Berkery-Smith " Douglas Clark " L.H. Collis " E.V. Deakins " Mrs. F.E. Haynes Representing County Council County Councillor H.H. Godwin-Monck Alderman F.A.F. Keay, J.P. The Lady Grace Morrison " A. Reed, A.C.I.I., J.P. Councillor H. Langer, J P. " G.W. Malin " J. Mather " J.D. Mcllwain " I.L. Peirce " J. Watkins County Councillor Mrs. M.E. Soall Co-opted Members Mr. V.J. Puitcher Mr. D. Edgington Mr. H.R. Cheetham Mr. R.W. Nutting Borough Education Officer - J. Power, M.A. 52 CARE OF MOTHERS AND YOUNG CHILDREN (Section 22) Notification of Births The following table shows the births notified during the year compared with previous years The number notified last year was the highest for eight years and the percentage of hospital confinements was 79.6% compared with 81.7% in 1959 1960 1959 1958 Live Births (a) Domiciliary 799 649 708 (b) Hospital or Nursing Home 3084 2881 2799 Still Births (a) Domiciliary 3 4 6 (b) Hospital orNursing Home 55 49 59 3941 3583 3572 Maternity Services During 1960 the report of the Cranbrook Committee on the Maternity Services of the country continued to influence those administering maternity care. Many of its recommendations have not yet been implemented and there is cause for disappointment in the rate of improvement in the services. The report recommended that sufficient hospital maternity beds should be provided for a national average of 70% of all births to take place in hospital. In this Area we have 80% institutional confinements (hospital and nursing home) and still our greatest problem is lack of hospital beds. It is an unfortunate fact that hospitals appear so overwhelmed with numbers applying for booking that on occasions they are even forced to refuse admission to a mother whom they know to be a special medical risk during delivery. In the case of applications for admission on social grounds, e.g. where the house is considered unsuitable for a confinement, unless the request is made in the very early months of pregnancy it is common for the application to be refused. Our domiciliary midwives frequently have to conduct deliveries in small singly-rented furnished rooms where bathrooms and kitchens are shared by several other tenants and where other children of the family have to betaken intoa neighbour's room temporarily while the delivery takes place. Sometimes it is possible to arrange for admission to hospital through the Emergency Bed Service once labour has started but this is unsatisfactory for all, since the hospital has no prior knowledge of the mother and the mother is left in a state of indecision until the very last moment. To deal with this main problem and many others, special Maternity Liaison Committees have been formed where representatives of the three branches of the health service; hospitals, general practitioners and the health department can meet for discussions. Our department is represented on the North Central London and on the North Middlesex Liaison Committees. Both these have met twice in 1960 and it is hoped that their influence will make itself felt in the future. Ante-natal Clinics These clinics show no decline in numbers and continue to be busy sessions at almost all the centres. This is contrary to the experience in many parts of the country where local authority 53 natal clinics have tended to fall away as general practitioners have taken a renewed interest in caring for their pregnant patients. The majority of patients attending doctors' sessions at the centres are booked for hospital confinement. They are saved frequent long journeys to the hospital by receiving attention locally in the intermediate months of pregnancy. All the centres now have midwives' sessions, apart from the doctors' sessions, where those expecting domiciliary confinements are examined by the midwife who is likely to be present at the birth. Wherever possible, patients expecting to be confined at home are encouraged to book ageneral practitioner to attend them for the pregnancy and birth but where they do not do this the mothers have two or three supervisory examinations by the clinic doctor. In Hornsey the majority of patients are booked for confinement at the Alexandra Maternity Home. The ante-natal care for these patients continues to be undertaken entirely by the local clinics. The matron of the Home knows all the Hornsey health visitors personally, which makes co-operation much easier. In the course of the year further improvements have been made in the system of exchanging information with the Home. The percentage of expectant mothers making at least one attendance at one of the local authority ante-natal clinics was 61.3% in 1960 compared with 63.6% the previous year. The following table gives details of attendances at all clinics in the Area:- Number of sessions held Number of new cases Total attendances Average attendance per session A.N. P.N. A.N. P.N. Burgoyne Road 74 248 115 1553 115 22.5 Church Road 72 157 65 1015 65 15.0 Fortis Green 99 224 128 1927 132 20.8 Hornsey Town Hall 150 404 177 2862 182 20.3 Mildura Court 66 219 98 1543 100 24.9 Stroud Green 52 157 59 915 59 18.7 The Chestnuts 155 426 185 2832 186 19.5 Lordship Lane 151 301 135 1979 135 14.0 Park Lane 104 280 120 1525 120 15.8 Totals 1960 923 2416 1082 16151 1094 18.7 Totals 1959 936 2289 1092 15243 1131 17.5 Totals 1958 1001 2347 1157 15536 1234 16.7 Midwives Ante-natal Clinics The following table shows the attendances made during the year:- 54 Midwives Clinics Number of sessions held Total Number of attendances Average attendance per session Burgoyne Road 23 193 8.4 Fortis Green 21 126 6.0 Hornsey Town Hall 21 311 14.8 Mildura Court 17 131 7.7 Stroud Green 24 225 9.4 Park Lane 83 349 4.2 Total 189 1335 7.1 Mothercraft and Relaxation Classes An additional class was commenced during the year at Mildura Court Centre, Hornsey. Both the health visitor and the midwife take part in the classes held at this Centre. This totals eight weekly classes held in various welfare centres within the Area. The following table shows attendances at Mothercraft clinics during the year:- Clinics Number of sessions held Number of new cases Total Number of attendances Average attendance per session Burgoyne Road 42 55 317 7.5 Church Road 46 50 213 4.6 Fortis Green 46 95 450 9.8 Hornsey Town Hall 49 141 664 13.6 Mildura Court 45 38 228 5.1 The Chestnuts 51 61 349 6.8 Lordship Lane 50 62 435 8.7 Park Lane 51 43 282 5.5 Total 380 545 2938 7.7 Infant Welfare Clinics These clinics continue to be appreciated particularly by the young mothers of the Area and attendances have been much the same as in previous years. A considerable amount of the health visitor's time is spent with the mothers of very young babies who attend frequently in the early weeks until they have gained confidence in handling their own child. The need of a mother for reassuring support and advice during the early weeks following the birth of her child is apparent to everyone working in the clinics. At this time the mother may be faced with a physiological mild depression following the birth as well as with the new baby. Visits are usually less frequent as the baby gets older but often the problems presented are more serious. 55 In some cases the staff at the clinics find medical defects in the child, of which the mother was unaware, and they arrange for treatment to be carried out. Far more often, however, they find themselves reassuring mothers that certain suspected defects in the baby are within normal limits and that there is no need for them to seek treatment. This happens in cases of alleged tongue-tie, mild forms of umbilical hernia, certain types of naevi (birth marks) and mild forms of flat feet; all of which can occur for a short time in healthy children. Another trend towards a reversal in recent practice is seen in the advice given on certain behaviour disorders. The staff in recent years has worked hard to persuade mothers to take a more understanding and lenient attitude towards, for example, sleep problems, food refusal, and toilet training. Some mothers have conscientiously taken this a little too far and seem afraid to make even the mildest regulations for their babies, letting them do exactly as they please at all times. So now the clinic staff have to urge the introduction of some order and discipline in an increasing number of cases. All babies attending the clinics continue to have urine tests for phenylketonuria (a sign which shows that the child has an inborn error of metabolism which can lead to mental disorder) but in spite of the large number tested no case has, as yet, been confirmed. The number of children attending the centres is given below:- Name of Centre Number of sessions held Number of first attendances under 1 year Number of attendances Total attendances Number 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 154 371 5360 691 214 6265 1527 40.7 Church Road 208 269 3480 561 113 4154 1694 20.0 Fortis Green 149 399 4102 594 119 4815 1828 32.3 Hornsey Town Hall 204 544 6217 857 244 7318 3038 35.9 Mildura Court 104 269 3636 598 33 4267 1547 41.0 Stroud Green 106 260 2808 325 147 3280 1355 30.9 The Chestnuts 202 633 6456 814 154 7424 2459 36.8 Lordship Lane 247 408 5104 1081 309 6494 1532 26.3 Park Lane 207 364 4538 1134 276 5948 1613 28.6 Somerset Road 148 265 3529 834 270 4633 1210 31.3 Totals 1960 1729 3782 45230 7489 1879 54598 17853 31.6 Totals 1959 1749 3460 46625 8272 1808 56705 18075 32.4 Totals 1958 1733 3550 47444 7907 1605 56956 17839 32.9 Toddlers Clinics The clinics are held mainly by appointment. Cards are sent to the mothers at about the time of the child's birthday and at six-monthly intervals inviting them to bring their children between the 56 age of two and five for routine medical inspection. Time is also available for any mother who wishes to come with her young child without appointment and for those where more frequent examinations are considered advisable. Almost all the children are seen by the doctor and the interviews are unhurried particularly where problems discussed relate to behaviour disorders. At this age considerable patience and adaptability is required to gain a child's confidence. Often every approach is resisted at first and then when the toddler's co-operation is finally won it is almost as difficult to persuade him to leave. Many children are found to become bored and difficult especially in their fourth year when their brothers and sisters are all at school and there is insufficient playing space at home. Many of them would benefit from admission to nursery schools or nursery classes but these are in such short supply that there are long waiting lists for entry. Usually the foresighted parents who get their children's names on to waiting lists early are not the ones in the most need and it happens that a child before reaching compulsory school age urgently requires to spend some part of the day in school and no place can be found for him. The teeth are always examined and it is not infrequent to find that dental caries appears in two or three year olds. Cases are referred for dental treatment and advice is given on teethcleaning and the dangers of two much sweet eating together with the importance of conserving the teeth in early life. Much time is spent on children's feet also. Where definite abnormality exists referral is made for orthopaedic advice but more often there is discussion on suitable shoes and shoe-fitting. The following table gives details of attendances at the individual clinics Name of Centre Number of sessions held Total attendances Number of cases seen by M.O, Average attendance per session Burgoyne Road 26 480 480 18.5 Church Road 22 358 322 16.3 Fortis Green 28 432 432 15.4 Hornsey Town Hall 59 705 705 11.9 Mildura Court 49 694 621 14.2 Stroud Green 24 335 326 14.0 The Chestnuts 51 726 726 14.2 Lordship Lane 52 759 757 14.6 Park Lane 23 222 222 9.7 Somerset Road 39 475 474 12.2 Totals 1960 373 5186 5065 13.9 Totals 1959 378 5043 4946 13.3 Totals 1958 408 5010 4892 12.3 57 Daily Guardian Scheme There has been an increase in the number of children minded by the day under this scheme as can be seen from the following table 1960 1959 1958 Number of Daily Guardians on register 197 166 160 Number of Daily Guardians minding Children 111 90 73 Number of Children being minded 141 106 85 Total number of Children minded during the year 297 231 175 Total number of days minded 29,128 23,591 16,628 The number of women who offer their services has always exceeded the demand. The scheme is in operation for those working mothers who ask for assistance in finding suitable daily minders for their children It has proved to be a very useful service for those who do not qualify for day nursery admission. There are proper safeguards including the selection, registration and visiting of daily guardians by health visitors. The cost of payments made to daily guardians by the County Council is based on one shilling per day per child for each working day on which the child is minded Parents make their own arrangements direct with the daily guardian for payment in excess of this. Amounts charged vary considerably throughout the Area as do the services provided Day Nurseries The number of daily attendances at the three day nurseries has increased this year and is accounted for by the rise in numbers at Park Lane Nursery. All three nurseries are recognised by the Ministry of Health as suitable for training nursery nurse students who take the two-year course for the National Nursery Examination Board's examination, This course provides practical work in day nurseries and theoretical teaching at the Tottenham Technical College All qualified members of the day nursery staff assist in the practical training of student nursery nurses and in the care of normal children. The nursery day is a long one to enable working mothers to leave their children before they start work and to collect them at the end of their working day. Day nursery vacancies are allotted to children in certain priority groups The largest of these is one where the mother is the sole wage earner. Handicapped Children A few handicapped children have been admitted to the nurseries during the year. In each case there has been medical recommendation for day nursery accommodation, three of these have qualified in accordance with the categories of such children dealt with under Section 56 of the Education Act 1944 for the maintenance of which the Education Committee accepts responsibility. 58 Five others have not been accepted under this provision since they fit in to types of handicap which do not qualify, and therefore admitted on health grounds under Section 22 of the National Health Service Act This means that the parents in the latter case are assessed for payment or pay full cost. Three of the five children referred to above were found to be mentally retarded and two with a physical handicap resulting from poliomyelitis. Plevna Day Nursery The structure of this prefabricated building is rapidly deteriorating and its replacement is an urgent necessity, This nursery serves a very necessitous section of Tottenham The following tables shows the attendances at individual nurseries during the year:- Name of Day Nursery Number of approved places at end of year Number of children on register at end of year Total number of attendances Average daily attendances Under 2 2- 5 Under 2 2- 5 Under 2 2- 5 Total Stonecroft 15 43 18 43 3342 9050 12392 48.6 Park Lane 20 30 11 40 2880 6105 8985 35.2 Plevna 20 30 23 29 4668 6118 10786 42.3 Totals 1960 55 103 52 112 10890 21273 32163 126.1 Totals 1959 55 103 59 103 9795 20168 29963 117.5 Totals 1958 55 113 56 99 9632 22941 32573 127.7 Nurseries and Child Minders Regulation Act 1948 The supervision of private day nurseries and child minders under these regulations continued throughout the year. Inspections were carried out at two to three monthly intervals, giving special attention to the provision of plentiful accommodation for activity both indoors and out , adequate numbers of staff, and suitable safety measures to avoid accidents, All new applications for registration were inspected in the company of a member of the County Architect's staff who advised on structural alterations and repairs. The following premises or persons were registered at the end of the year:- 59 Private Day Nurseries Woodlands Nursery School Fortis Green Nursery Greygates Nursery 12 children 24 children 39 children 2 -5 years 2-5 years 0-5 years mornings only all day all day Child Minders Mrs. Stringer, 101 Crouch Hill, N.8. 12 children 2-5 years mornings only Mrs Kruger, 38 Crouch Hall Road, N.8. 8 children 0-5 years all day Mrs. Barnard, Moravian Church Hall, Priory Road, N.8. 16 children 2-5 years mornings only Mrs Summers, 53 Mount View Road, N.4, 9 children 2-5 years mornings only Mrs. Watson, 7 Jackson's Lane, N 6, 10 children 2-5 years mornings only Mrs. Best, 57 Collingwood Avenue, N.10. 9 children 2-5 years mornings only Mrs. Wigley, 46 Onslow Gardens, N.10, Not taking children at present Mrs. Keith, 2 Linzee Road, N.8. Miss Hermitage, 28 Bedford Road, N.15. During the course of the year three new registrations were approved by the Committee and one was not approved. Four registrations have been withdrawn as the owners have discontinued their service Distribution of Welfare Foods The arrangements for issuing welfare foods were substantially the same as in the previous year. 60  National Dried Milk (tins) Orange Juice (bottles) Cod Liver Oil (bottles) Vit., A & D Tabs, (packets) 1960 32910 99584 12790 12213 1959 36350 98855 11676 11048 1958 39005 104980 12571 10420 Priority Dental Service for Mothers and Young Children The dental officers have devoted 7% of their time to the inspection and treatment of the priority classes. There has been a slight increase in the number of expectant and nursing mothers inspected, compared with 1959, with a corresponding increase in the various forms of treatment. Although in respect of the children under five there has been a small reduction in inspection, the amount of conservative work carried out was larger. The average number of fillings and silver nitrate dressings per child treated was three, and extractions 0.95. A great need exists for dental health education, and a valuable opportunity is afforded when dealing with these mothers and young children. The following table gives details of attendances made and treatment given at all clinics during the past three years 1960 1959 1958 Expectant and Nursing Mothers Children under 5 Expectant and Nursing Mothers Children under 5 Expectant and Nursing Mothers Children under 5 Number examined by dental officer 162 539 131 572 174 562 Number referred for treatment 160 459 127 467 171 523 New cases commenced treatment 149 351 127 421 155 479 Cases made dentally fit 46 176 55 178 64 172 Forms of dental treatment provided:- Teeth extracted 243 334 159 369 274 432 Anaestetics: (a) Local - - 68 26 100 56 (b) General 81 179 24 156 36 187 Number of fillings 249 628 220 474 372 469 Number of root fillings - - - - - - Number of inlays 2 - - - 1 1 pcaiings and gum treatment 133 - 90 - 108 - Sliver nitrate treatment - 440 - 478 - 503 Dressings - - 114 162 126 150 Other Operations 240 151 10 1 10 10 Number of radiographs:- (a) at County Council clinics 21 1 16 2 14 - (b) at hospital - - 1 - 1 - Denture dressings - - 163 - 178 - Dentures fitted:- (a) Full 24 - 16 4 14 - (b) Partial 28 5 32 - 29 - Number of attendances 736 1061 588 872 758 981 Number of appointments not kept 208 216 138 199 145 186 Number of half days devoted to treatment 194½ 155 192 61 MIDWIFERY SERVICE (Section 23) The problem of recruiting new midwives continues to be a main anxiety in the Service. We have been fortunate in appointing four new midwives during the year, one of whom is now accommodated in a municipal flat rented by the County Council, specifically for a midwife, from the Tottenham Borough Council. It was a disadvantage to recruitment that this flat was not available for a part of the year as the resigning midwife (with two young children) had several delays and setbacks in finding other accommodation. Every year there are some changes in the staff to which attention is drawn in the report, but a special tribute should be paid to the midwives who have been with us for many years and who continue to give loyal and devoted service. They form the backbone of the service and have a very high standard of skill and dependability. They seem to be at their best during periods of special pressure through which every midwifery service passes, working tirelessly and cheerfully until the stress is over. All the midwives now take part in ante-natal sessions at the centres whenever their duties allow. In future it is hoped to arrange for a midwife to be present at general practitioners' antenatal sessions, but it is envisaged that this will only be possible where there will' be a sufficient number of patients to make this a justifiable use of the midwife's time. Co-operation between midwives and general practitioners continues to be excellent. Especially the long service midwives have come to know the doctors in their district very well and can work truly as a team. The minimum number of days after delivery on which the midwife must visit the patient has been reduced from fourteen days to ten days, by the Central Midwives Board. This is generally considered quite a safe alteration to the usual practice and has relieved the midwife from some unnecessary duties. However, there is still much pressure of work on the midwife. Each one of our staff has done more deliveries than the number recommended. The following table shows the work for the past three years:- 1960 1959 1958 Number of deliveries attended 792 640 698 Number of visits made 15223 13572 14730 Number of hospital confinements discharged before 14th day 143 231 98 Number of visits made 1288 2424 910 Number of cases in which medical aid was summoned 282 287 297 Number of cases in which gas and air analgesia was administered 508 470 588 Number of cases in which pethidine was administered 481 418 483 Number of cases in which trichloroethylene was administered 189 121 65 Number of cases in which gas and air and trichloroethylene were administered 32 - - 62 HEALTH VISITING SERVICE (Section 24) The follow-up of the newly born after their discharge from hospital with their mothers on the tenth day of puerperium or earlier is still a very important part of the work of the health visitor. Additionally, also, the health visitor now follows up those mothers confined at home earlier than formerly (i.e. on the eleventh day instead of the fifteenth). It is commonly found that this visit is very much welcomed and appreciated and in many cases is the basis on which the relationship between health visitor and mother and baby is formed. The health of mother and baby is very much in the balance at this stage and often causes the health visitor to make a number of visits to give the mother the advice and support she needs to ensure the well-being of herself and the child during the first year. The value of this type of home visiting cannot be over-estimated and where it does not exist the work of the midwife may well be wasted. Much has been said about selective visiting of one kind and another according to the need of the family. It has been our experience, however, that so much hangs on the first and subsequent visits in the early life of the child that this type of visiting cannot be omitted and is regarded as being essential in nearly every case. Toddlers clinics to some extent have helped to reduce the number of visits paid to children in the two to five age group. The number of toddlers visited because they are placed for daily minding has increased This is partly because there are more women offering themselves for daily minding to meet a known demand and also to see children placed with them for daily minding. Some women also have been reported as minding more than two children without being registered. Special visits have been made, therefore, to acquaint them of their legal responsibilities in this matter Some of the latter have not wished to be known to the local authority as they were unlikely to be registered. Attendances at Toddlers clinics have also increased and these clinics prove to be popular with children and with parents The idea of periodic overhaul for health appears to have appealed to most parents of children in this age group. Campaigns and Research Surveys Health visitors have been engaged in some special activities during the year to assist with surveys such as "The National Survey on the Health and Development of Children" promoted by the Population Investigation Committee Institute of Child Health, University of London and the Colour Blindness in Girls Ovarian Agenesis Survey promoted by the Department of Health, Guy's Hospital. The vision of girls in the intermediate age group has been tested by the Ishihara Method by health visitors and school nurses as part of the preparation for routine medical inspection. Material obtained from this Survey has been passed to the County Council for forwarding. Phenylketonuria Survey of all live births - this has involved the testing of urine of each new baby unless the tests have been completed elsewhere. Two suspected cases were found but on further investigations proved to be negative. The procedure connected with the survey of newly born infants and phenylketonuria still continues as a routine test. Parents have proved to be interested and co-operative. 63 Campaigns As part of their duty to inform the public on matters relating to or associated with health, health visitors/school nurses have taken part in publicising national and local campaigns on Accidents in the Home, Appeals for Blood Donors, Mass X-ray, Smoking and Lung Cancer, Mental Health, etc. Visual evidence of these which catch the eye of adults and children, such as flannelgraphs, posters and leaflets, have been displayed in the clinics to coincide with the timing of the campaigns. A very important part of the health visitor/school nurse's work is the teaching of parentcraft and home-making to individuals in their own homes and in schools. Married health visitors both full-time and part-time are being recruited to the Area and this has made it possible to keepup the number of health visitors on our establishment and to maintain the standard of the Health Visiting Service. Health Visiting and Mental Health Health visitors' contribution to mental healthhas beenmainly in supporting families in their day to day troubles and difficulties, in listening to a great many apparently small matters and in guiding parents towards their own solutions to problems and in encouraging them to act upon them. In the two Boroughs of Hornsey and Tottenham a great many people themselves seek out the health visitor by visiting her at the welfare centre or by telephoning her thereto make an appointment for a home visit. This early effort to talk over some particular problem does muchto attenuate it and torelieve anxieties before the difficulty expands to larger proportions. Some troubles relate to the care of the family during hospital confinement, the feeding and care of young children, the minding ofscLuol children until the parents return from work, school children getting "out of hand", housing difficulties, discharges from hospital, the care of the elderly, and matters causing trouble such as marital relationships and disharmony within the family. Social workers in other local authority or voluntary services have given full co-operation when requested. There is generally a very cordial relationship with all types of social welfare workers throughout the Area, Special Services for Problem Families The most difficult cases taken over by the special services health visitors have been those where one or both parents were either of sub-normal intelligence or unstable. Family doctors and hospital psychiatrists have given considerable support and advice to health visitors in such cases This triad of health visitor, family doctor and psychiatrist seems to be an intrinsic combination in dealing with early signs of breakdown or other psychiatric disturbance including those of long-standing. Mental Welfare Officers have taken over some in emergency and have referred back a few cases to the health visitor but these have proved to be very few numerically. It has been interesting to examine the sources of referrals of problem families to the special services health visitors. By farthe largest numberwere brought forward by health visitors themselves. The remainder were reported by various local authority departments, by probation officers, 64 almoners and family doctors. Before a particular case is accepted by the special services health visitor the health visitor for the district on which the family lives is consulted. Between them they decide whether the case is urgent and needs intensive work or can be carried by the health visitor This act of selection is important in the interest of really urgent problems and to prevent the overloading of the special services health visitor's caseload. The close contact between the specialist and other health visitors has been most rewarding in temporarily relieving health visitors of certain families until intensive workhas been completed and in providing the specialist worker with background knowledge of the case and a constant field worker to whom the family can be returned. Mental Health Case Conferences have been attended at the Prince ofWales's Hospital each month Health visitors discussed a variety of cases with Dr. Sawle-Thomas, Consultant Psychiatrist Statistics The following table shows the number of visits paid by health visitors during the past two years Number of visits paid by Health Visitors working in the Area:- 1960 1959 Expectant Mothers First Visits 2084 2285 Total Visits 3436 3511 Children under 1 year of age First Visits 4837 4234 Total Visits 15295 16056 Children aged 1-2 years Total Visits 7090 8101 Children aged 2-5 years Total Visits 11526 13202 Other cases - Total Visits as Health Visitor 6219 6246 Total Visits as School Nurse 776 878 HOME NURSING SERVICE (Section 25) The treatment of cases during the year may be classified as follows:- Injections 911 General nursing care 476 Blanket baths 254 Enemas 143 Dressings 309 Preparation for diagnostic investigation 224 Pessaries changed 59 Wash-outs, douches, etc, 37 Attendance at minor operation 1 Other treatments 52 65 The sex and age of patients at the time of the nurse's first visit maybe classified as follows:- Age Males Females 0-4 32 32 5 - 15 36 30 16-39 59 150 40 - 64 248 398 65 and over 459 1022 834 1632 Cases attended during the year were referred from the following sources:- General Practitioners 1759 Hospitals 672 Chest Physicians 17 Public Health Department 3 Direct 15 The work of the service has continued throughout the year without any significant change in the character or the amount of work undertaken and the staff has been maintained at near establishment level without undue difficulty in recruitment. Investigation into the use of Silicone During the months of January, February and March the nurses took part in an investigation into the prevention of bedsores by the use of Silicone. The silicone was used by the spray method and was supplied in two strengths which were used against controls of orthodox treatment. After the results had been submitted and reports considered the manufacturers found that the stronger solution gave better results although these were not as satisfactory as was hoped. A further test has, therefore, been initiated with the silicone suspended in a new medium. Home nurses are very actively concerned with the treatment and prevention of bedsores and they are awaiting with interest the final result of this work. Introduction of disposable equipment A change is rapidly taking place in the various materials used by the nurse in her daily Work, Much time used to be spent packing and sterilising dressings. Pre-packed sterile dressings are now available and in general use. Caps, gowns and masks all made of paper, sterilised and packed ready for use, are on the market and making their appearance in everyday use. Plastic 66 syringes complete with needle, sterile, and requiring no preparation before use, are also readily obtainable. All these items can be destroyed after use and it will readily be understood that these disposable goods collectively result in a considerable saving of the nurses' time and also (because of the guaranteed sterility) in a wider margin of safety for the patient. Nurses' day to day work The great increase of the past few years in the amount of drugs given by injection seems to have passed its peak and many practitioners are using more of the new drugs which are given by mouth. The influenza epidemic brought many calls but the disease seemed to be of a mild type and did not unduly overburden the service. The main work of the home nurse is still amongst the aged in the two boroughs. Old people tend to be left alone during the day and those who live entirely alone present a multitude of problems. Four nurses attended refresher courses during the year and, as in previous years, students from teaching schools have accompanied home nurses for observation visits. Co-operation with other services The working of the service generally has been helped by good relations with general practitioners, chest physicians, hospitals and the other health and welfare services within the boroughs. The British Red Cross Society continued to meet the numerous requests to provide equipment and aids for the ill and the handicapped. The following table shows the work of the home nurses during the year:- Type of case Number of new cases attended by home nurses during the year Number of cases on register at end of year Number of visits paid by home nurses during year M F Total M F Total Medical 578 1043 1621 131 443 574 60983 Surgical 78 100 178 21 24 45 5113 Infectious Diseases 1 5 6 - - - 53 Tuberculosis 17 14 31 10 4 14 2006 Maternal Complications - 15 15 - - - 154 Others 2 2 4 - - - 9 Totals 1960 676 1179 1855 162 471 633 69318 Totals 1959 739 1433 2172 158 453 611 71987 67 VACCINATION AND IMMUNISATION (Section 26) Vaccination against Smallpox The percentage of children under one year year of age vaccinated against smallpox fell from 71.3% to 43.7% 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 Number of primary vaccinations Number of re-vaccinations 1892 142 78 8 42 31 152 381 2306 420 Immunisation against Biphtheria Tetanus and Whooping Cough The scheme for immunising children against diphtheria, whooping cough and tetanus using a triple antigen proved very successful during 1960 which was the first year of its operation. It has called for very careful programming to fit in with other prophylactic measures and the parents of all children in the area have been offered appointments as soon as their children have reached the age of two months. There is provision for following up defaulters to achieve maximum acceptance rates. Parents have the option of taking the in children to their own family doctors for immunisation or attending at the clinics, and the following tables show the results: Age at date of immunisation Number of Children who completed a full course of Primary Immunisation Diphtheria only Whooping Cough only Tetanus only Combined Diphtheria and Whooping Cough Combined Diphtheria and Tetanus Combined Diphtheria Tetanus and Whooping Cough Under One 728 261 33 119 - 2569 One 494 915 15 38 3 232 Two to Four 126 92 4 15 1 96 Five to Fourteen 277 8 9 5 4 30 Fifteen and Over 2 - 2 1 - - Total 1627 1276 63 171 19 2927 Number of Children who received a Secondary (Re-inforcing) injection Diphtheria only Whooping Cough only Tetanus only Combined Diphtheria and Whooping Cough Combined Diphtheria and Tetanus Combined Diphtheria, Tetanus and Whooping Under One - - - - - - One - - - - - - Two to Four 662 24 6 16 1 22 Five to Fourteen 817 1 2 11 4 24 Fifteen and Over 1 - - - 1 - Total 1480 25 8 27 6 46 68 Poliomyelitis Vaccination The work of vaccinating persons up to the age of 40 continued to be undertaken both by general practitioner's and at the clinics. The following table shows the number of persons completing courses of injections during 1960:- Number of Persons who completed a course of:- Two injections Three injections Children born in the years 1943-1960 2585 8062 Young Persons born in the years 1933-1942 1190 6157 Persons born before 1933 who had not passed their 40th birthday 2365 1255 Others 9 52 Total 6149 15526 PREVENTION OF ILLNESS, CARE AND AFTER CARE (Section 28) Recuperative Holidays The Area health staff continued to be responsible for dealing with applications for recuperative holidays and during 1960 176 applications were received compared with 197 the previous year. Of these, 134 were approved. DOMESTIC HELP SERVICE (Section 29) The total number of cases provided with home help during the year was 1,879, the bulk of the cases comprising the chronic sick, includingaged andinfirm, who need more or less permanent help. The following table shows details of the cases served during the year:- Cases provided with help Number of new cases provided with help Number of old cases for which help was continued from 1959 Total number of cases provided with help during the year Total number of cases still being provided with help at end of year Maternity (including expectant mothers) 131 7 138 3 Tuberculosis Chronic Sick (including 10 26 36 24 aged and infirm) 594 972 1566 ilO 8 Others 120 19 139 18 Total 855 1024 1879 1153 69 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 their assistance to get a certain amount of relief. During the year two cases were served for a total of 56 hours. SCHOOL HEALTH SERVICE Area School Populations The school population for the Area is 10,720 in Hornsey and 17,458 in Tottenham, This shows an overall decrease of 229 compared with the previous year. Hornsey Tottenham Primary Schools and Nursery Classes 5798 8654 Nursery Schools - 205 Secondary Modern Schools 3015 5760 Grammar and Technical Schools 1907 2640 Special Schools- Physically Handicapped - 94 Blanche Nevile School for Deaf - 105 10720 17458 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 ] 1956 & later 627 623 99.4 4 0.6 1955 1381 1374 99.5 7 0.5 1954 641 633 98.8 8 1.2 1953 343 340 99.1 3 0.9 1952 384 383 99.7 1 0.3 1951 1818 1810 99.6 8 0.4 1950 281 278 98.9 3 1.1 1949 527 527 100.0 - - 1948 1799 1791 99.6 8 0.4 1947 1037 1035 99.8 2 0.2 1946 849 849 100.0 - - 1945 & earlier 3102 3093 99.7 9 0.3 Total 12789 12736 99.6 53 0.4 70 One gratifying feature of this total is that although the total number of children examined during 1960 had increased by 508 compared with the previous year, yet 27 fewer pupils were deemed tobe of unsatisfactory condition In this connection, however, the term unsatisfactory' applies only to the child s general physique and the referral of minor defects to the ophthalmologists, ear, nose and throat specialists and orthopaedic surgeons continued to fill the special clinics to capacity Infectious Diseases in School Children 1960 From the point of view of infection. 1960 was, generally speaking, an uneventful year and, as had been anticipated, measles remained relatively quiescent Poliomyelitis Only one case of poliomyelitis occurred in a school child during the year This was a boy, aged six years, who was admitted to hospital on the 30th November with evidence of paralysis On discharge from hospital, he was seen by a school medical officer who found some residual weakness in his left leg, but this has not prevented him from returning to his normal school. Dysentery From time to time throughout the year cases occurred in both boroughs but there were no explosive outbreaks in the schools. A smouldering infection in a day nursery during August had its repercussions amongstthe older siblings of the inmates, butthe general picture is indicated by the fall in recorded cases in Tottenham from 251 in 1959 to 66 in the year under review. Tuberculosis: In the year as a whole six new cases of tuberculosis were notified in children of school age, one more than the previous year; one child developed tubercular meningitis but the remaining cases were due to pulmonary infections Two of these children attend schools outside this Area and the source case of one of them was traced to his school in Wales. In three of the four remaining cases an adult iiving in the same house was found to be infected and appropriate action was taken. In the sixth case, a girl of fourteen years, the pulmonary infection was discovered as a result of a strongly positive reaction to routine Mantoux testing As no contact could be found in the household, in consultation with the chest physician, an epidemiological survey was instituted Sixteen of her class mates were Mantoux tested and had chest X-rays, all with satisfactory results; whilst the remainder of her class had been dealt with previously as part of the normal B.C.G. programme A similar investgation of her teachers revealed no source of infection. B C G Vaccination Throughout the year the B.C.G. programme was steadily pursued and more than twice the number of children were vaccinated compared with 1959 From the following table it will be seen that for the first time students from two technical colleges were brought into the scheme; an important innovation bearing in mind the susceptibility of the adolescent to this disease 71  School Children Students Total Number % Number % Number % Parents approached 3455 306 3761 Parents accepting 2565 74.3 146 47.7 2711 72.1 Number tested 2487 131 2618 Number found to be Mantoux positive 136 5.5 38 29.0 174 6.6 Number found to be Mantoux negative 2242 90.1 91 69.5 2333 89.1 Number failing to attend for Mantoux reading 109 4.4 2 1.5 111 4.3 Number vaccinated (% of those approached) 2122 61.4 90 29.4 2212 58.8 School Dental Service During the year the staff position has been as follows:5 Full-time Dental Officers 3 Part-time Dental Officers (equivalent to 1 6/11 full-time), with several changes in the first quarter of the year 1 Part-time Orthodontist (6/11 - 7/11) The vacancy caused by the illness and subsequent retirement in February of Mr, V„ Sainty, Area Dental Officer, was not filled until the end of September. One full-time and one part-time dental officers are re-employed after reaching pensionable age, and we are grateful for their services, but they can only be considered as a short term policy, with doubtful prospects of replacement. 19,438 children were inspected, and of these 60% required treatment. There is evidence that many children are receiving regular treatment through the National Health Service. The work of the department proceeded steadily during the year, and the ratio of permanent: teeth filled to permanent teeth extracted as a result of disease was 9.7: 1. 161 evening sessions were carried out and proved very populat. The orthodontic clinic continues to have along waiting list for treatment and there is urgent need for expansion of the service, especially in Hornsey. Dental officers themselves undertook cases in 108 sessions and thereby diverted time required for their basic dental surgery duties. A disturbing fact connected with all treatments is the large and increasing number of broken appointments. They have risen each year from 19 7% in 1957 to 22.1% in 1960. It is noticeable that these are fewer where there has been continuity of staff and where the patient can depend on being treated by the same dental officer. Equally important in this matter is the dental attendant of experience. 72 The old type of surgery is gradually. being re-equipped and brought into line with modern requirements, Good working conditions are necessary if dental officer staff are to be encouraged to enter our service. It is also planned to instal five high speed air turbines in 1961. The following tables show the work undertaken during the year:- DENTAL INSPECTIONS AND TREATMENT Number inspected 19438 Number found to require treatment 11838 Number referred for treatment at the County Council's Dental Clinics 11744 Number of pupils treatment commenced 6523 Number of pupils treatment completed 5086 Number of attendances made by pupils for treatment 17686 Number of appointments not kept 5005 Number of half-days devoted to: (a) Inspection 126½ (b) Treatment 2741½ Fillings: Permanent Teeth 10870 Temporary Teeth. 3299 Number of teeth filled: Permanent Teeth 9993 Temporary Teeth 3072 Extractions: Permanent Teeth 1038 Permanent Teeth for Orthodontia 232 Temporary Teeth 3901 General Anaesthetics 1835 Other operations: (a) Permanent Teeth 3333 (b) Temporary Teeth 4029 Number of pupils supplied with dentures 77 Number of crowns or inlays 49 Number of radiographs 243 ORTHODONTIC INSPECTIONS AND TREATMENT Number of pupils inspected 136 Number of pupils selected for treatment 122 Number of pupils commenced treatment (first attendance) 118 Number of cases carried forward from previous year 149 Number of cases discontinued during the year 18 Number of attendances made for treatment 2935 Number of appointments not kept 453 Number of impressions, etc. 2762 Number of pupils treated with appliances 155 Number of fixed appliances fitted 22 Number of removable appliances fitted 226 Number of radiographs 509 Number of pupils treatment completed 34 Number of orthodontic sessions (half-days) 380 73 Ear, Nose and Throat Clinics Weekly sessions were held by Dr. F.P.M. Clarke, the visiting consultant, for Hornsey children referred for a variety of conditions both in type and degree. Despite this antibiotic era, otorrhoea still constitutes a problem and the persistent and effective treatment of this complaint is a prerequisite in the prevention of conductive deafness. Sinus infection, recurrent tonsillitis and enlarged adenoidal pads were common causes of referral from the school clinics; yet familiarity must breed no contempt in these cases for they are sources of much general ill-health and frequent school absence. The close co-operation in Tottenham between the out-patient department of the Prince of Wales's General Hospital and the local authority clinic continued under the direction of Mr. William McKenzie, F.R.C.S., with the able assistance of one of the school medical officers (Dr. Nora Webster). During the year Mr. McKenzie addressed the school medical officers on some of the ear, nose and throat problems in connection with their work and a valuable and informative discussion followed his talk. Audiology Clinic As 1959 had seen the appointment of Dr. L. Fisch as consultant otologist to the Area, so 1960 was to herald the opening of the Audiology Unit in new premises on a site adjacent to the Blanche Nevile School for the Deaf at Tottenham. The investigation and ascertainment of deafness in children, and the subsequent training and educational placement of the child is essentially a matter of team-work. It is a pleasure, therefore, to record the good relations which exist between medical officers and educational personnel in the establishment of a full audiology service. In addition to the consultant otologist, a school medical officer and an audiometrician complete the medical component of the team, whilst their educational colleagues comprise the headmaster of the school (Mr. T.N. Brown), an educational psychologist and a peripatetic teacher of the deaf. Dr. Fisch reports that the accoustic conditions of the new premises are very satisfactory and when all the equipment, which has been ordered, has been assembled, the facilities for testing the hearing of children will be as good as at any audiology clinic in the country. It has been of great advantage to have the educational psychologist present at all sessions of the audiology unit, for she can observe the clinical examination of the child and will be no stranger to him should a full psychological assessment subsequently prove necessary. An important function of an audiology unit is to establish the differential diagnosis between deafness and otherpossible causes of communication difficulty, notably, mental retardation. In this connection, it is now the approved practice in this Area before any child is ascertained as unsuitable for education in school under the Education Act 1944, for him first to be screened at the Audiology Unit to ensure that deafness plays no part in his mental retardation. The peripatetic teacher of the deaf visits pre-school children in their own homes to provide the necessary training to ensure they gain the maximum benefit from their hearing aids and, at the 74 same time, to give the appropriate guidance to their parents. Children at ordinary schools, recommended for auditory training by the otologist, are visited by the peripatetic teacher after consultation with Mr, Brown and the head teachers of the schools concerned. As yet the peripatetic teacher has no room of her own at the unit where she can train children and interview parents but, ultimately, it is hoped that some such provision can be made. During the year a conference of the audiometricians in the employ of the Local Education Authority was held, under the chairmanship of Dr. Fisch. The aim of this conference, at which a number of school medical officers attended, was to consider methods of training and practice to ensure a uniform standard of audiometry. Perhaps the least satisfactory part of the Audiology service is in the making of good inserts for hearing aids and in the provision of these instruments without undue delay. At the present time children, having been recommended for a hearing aid at the Audiology Unit, then have to travel to a hospital in the Central London area for the inserts to be fitted, and there may be three to four months delay between the time the need for a hearing aid is confirmed and when it is in use by the child As one looks to the future it becomes increasingly apparent that a fullyfunctioning audiology unit must have provisions for taking impressions of the inserts and for issuing hearing aids at the unit itself. PRE-SCHOOL CHILDREN REFERRED TO AUDIOLOGY UNIT No Age Sex Reasons for referral F.H. Remarks Source of Referral Decision and Disposal 1 5/12 M ? Deafness No - School Medical Officer, Hendon Not deaf 2 4 7/12 M ? Deafness No Delayed speech School Medical Officer, Hornsey Probably not deaf To nursery school 3 3 1/12 M ? Deafness No Delayed speech School Medical Officer. Tottenham. Deaf To nursery unit at Blanche Nevile School 4 3 10/12 M ? Deafness No - School Medical Officer. Hornsey. Probably not deaf. 5 4/12 F Mother suspected deafness No - School Medical Officer Hendon Probably not deaf. 6 4 1/12 M ? Deafness No Delayed speech School Medical Officer , Tottenham Not deaf Backward 7 7/12 M ? Deafness No Illegitimate School Medical Officer Southgate Not deaf 8 4 M ? Deafness No Delayed speech School Medical Officer Pinchley Probably not deaf To nursery school 9 3 5/12 M ? Deafness Yes Articulation defect School Medical Officer, Hornsey Not deaf. 10 4 11/12 M ? Deafness No - School Medical Officer Southgate. Deaf For auditory training Possibly backward 11 2 1/12 M Mother suspected deafness No Delayed speech School Medical Officer, Tottenham Deaf To nursery unit at Blanche Nevile School 75 No Age Sex Reasons for referral F.H Remarks Source of Referral Decision and Disposal 12 7/12 F ? Deafness Yes Delayed speech School Medical Officer, Hornsey. Not deaf. To ordinary day nursery. 13 1 11/12 M ? Deafness No Delayed speech School Medical Officer, Hornsey Probably not deaf. 14 9/12 M ? Deafness Yes - School Medical Officer, Southgate. Deaf For auditory training. 15 4/12 M ? Deafness Yes - School Medical Officer, Hendon. Not deaf . 16 2 10/12 M ? Deafness No Delayed speech School Medical Officer, Hendon. Deaf. To nursery unit at Blanche Nevile School 17 2 11/12 M Partially deaf No - Great Ormond Street Hospital. Not deaf. To ordinary day nursery. 18 3 4/12 M ? Deafness No Delayed speech School Medical Officer, Edmonton. Not deaf. 19 3/12 F ? Deafness Yes - School Medical Officer, Tottenham. Probably not deaf. 20 2 3/12 F ? Deafness Yes - Aural Consultant, Tottenham. Deaf. To nursery unit at Blanche Nevile School. 21 1 F ? Deafness Yes - School Medical Officer, Hendon Deaf. For auditory training. 22 4 9/12 M To exclude deafness No Screening prior to ascertainment Borough Education Officer, Tottenham. Not deaf. Probably backward. 23 4 7/12 F Partially deaf Yes - School Medical Officer, Southgate. To Partially Deaf Unit, Tottenham 24 3 5/12 F Known deaf. From Gray's Inn Road. Yes - School Medical Officer, Southgate. To nursery unit at Blanche Nevile School. 25 3½ F ? Deafness No Delayed speech School Medical Officer, Enfield. To nursery unit at Blanche Nevile School 26 4 1/12 M ? Deafness No Delayed speech Transfer from Gray's Inn Road, Slightly deaf. Removal of tonsils and adenoids. For L. Q. assessment 27 4½ M ? Deafness No Articulation defect School Medical Officer, Southgate. Deaf, For auditory training 28 9/12 F ? Deafness Yes - School Medical Officer, Hornsey Not deaf 29 5 3/12 F ? Deafness No - Whittington Hospital Not deaf Backward. 30 4 1/12 F Partially Deaf No - County Medical Officer, Hertford. To Partially Deaf Unit, Tottenham. 31 9/12 F ? Deafness Yes - School Medical Officer, Homsey. Not deaf 32 1 5/12 M ? Unilateral deafness No - School Medical Officer, Potters Bar, Not deaf Backward. 33 3 3/12 M ? Deafness Yes Delayed speech School Medical Officer, Tottenham, Not deaf. To ordinary day nursery. 76 No. Age Sex Reasons for referral F.H Remarks Sowee of refe???al Decision and Disposal 34 M ? Deafness No Haemolytic disease of new born School Medical Officer Edgware Partially deaf For auditory training. 35 4 F ? Deafness Retarded language development No Maternal rubella County Medical Officer Hertford Transfer from Gray's Inn Road To nursery class at Blanche Nevile School 36 4 9/12 M ? Deafness Yes Articulation defect Aural Consultant. North Middlesex Hospital Not deaf Por speech therapy 37 2 9/12 F Known deaf Yes - School Medical Officer Tottenham. To nursery unit at Blanche Nevile School 38 3 5/12 F ? Deafness No Delayed speech L.C.C. Por admission to nursery unit at LCC School for the deaf. 39 3½ M ? Deafness No - School Medical Officer Hendon To nursery unit at Blanche Nevile School. 40 5 M ? Deafness No Articulation defect School Medical Officer, Edmonton. Not deaf For speech therapy, 41 4 3/12 F ? Unilaternal deafness No Delayed speech School Medical Officer, Hornsey Awaiting I.Q. assessment. 42 4 7/12 F Partially deaf No Retarded speech Transfer from Gray's Inn Road, To Partially Deaf Unit Tottenham AUDIOLOGY UNIT, 1960 Number of children seen - New 120 Re-exams 34 154 Pre-school children 42 Attending infant and junior schools 74 Attending senior schools 34 Over five, but not at school 4 Reason for referrals among the 120 new children were as follows- For diagnosis 79 Immigrants to Area known to be deaf 4 Partially deaf children, advice as to placement 6 Children known to be deaf - 11 application for admission to nursery class, Blanche Nevile School or partially deaf unit Transfer from hospital out-patient departments 19 Advice as to placement where deafness might 1 be the cause of backwardness Source of Referrals:- Tottenham and Hornsey 83 Other boroughs in Middlesex 31 London - neighbouring boroughs 2 Hertfordshire 3 Essex 1 77 Vale Road School for Physically Handicapped Children Cerebral Palsy Unit During the year 25 children suffering from cerebral palsy were cared for at the Vale Road Day Special School for Physically Handicapped Children, Tottenham, The visiting consultant (Dr. William Dunham) exercises close supervision of these children, reviewing them individually at regular intervals. Teachers, therapist, school nurse and parents all strive to one end; namely, to enable these severely handicapped children to tackle the everyday activities of home and classroom, as far as possible, in a normal way. At the end of the year plans were well advanced for the opening of a small class for three or four children suffering from partial deafness as well as cerebral palsy. Not all children with dual handicaps are so happily placed, however; and it is difficult to find a suitable environment for palsied children with severe mental retardation. The educational authorities, not unnaturally, tend to regard these children of very low intellect as unsuitable for education in school. On the other hand, their physical frailty and unsteady gait render their placement in a junior training centre a hazardous procedure; nor is it reasonable to expect that adequate treatment of their physical handicap can be provided at such a centre. ANALYSIS OF CASES SEEN AT CEREBRAL PALSY UNIT IN 1960 Male Female Total Under 5 years 4 1 5 5-10 years 1 3 4 10 -15 years 1 1 2 Over 15 years - - - Total 6 5 11 Diagnosis Male Female Total Cerebral Palsy 2 4 6 Mental Retardation 3 1 4 Spinal Paraplegia 1 - 1 Total 6 5 11 6 CONFIRMED CASES OF CEREBRAL PALSY - ACTION TAKEN Admitted to Vale Road School in 1960 and awaiting placement in residential P.H. School 1 Awaiting vacancy at Vale Road School 1 Referred back to home area for admission to special training school 1 For admission to ordinary school on trial (1961) 1 Referred back to home area for admission to nursery school 1 Under school age 1 6 78 NEW CASES SEEN AT CEREBRAL PALSY UNIT IN 1960 Case No. Date of Birth Sex Referred by Diagnosis Disposal 1 19.11.48 F Area Medical Officer. Enfield Cerebral Palsy 1. Left hemiplegia 2. Intellectual and emotional retardation For report as unsuitable for education, Special Training School. 2 6.12.47. M Area Medical Officer, Enfield Cerebral Palsy Spastic diplegia Vale Road P H. School 3 1 3.55 F Area Medical Officer, Friern Barnet, Cerebellar ataxia ? Post-encephalitic Nursery School. 4 5.356. F Area Medical Officer, Hornsey. Cerebral Palsy 1 Mild hemiplegia 2. Hyperkinetic. Ordinary school on trial. 5 6.1.59. M Area Medical Officer, Potters Bar. Cerebral palsy, mildMinor epilepsy Under supervision of Cerebral Palsy Unit. 6 25.5.50. F Area Medical Officer; Finchley. Mental retardation. Kindergarten school. Under supervision of Cerebral Palsy Unit 7 6.10.56. M Area Medical Officer, Mental retardation Special Care Unit. 8 24.12.55. M Area Medical Officer, Enfield. Mental retardation. School for delicate children. 9 16.1.54. M Area Medical Officer. Hornsey Spinal paraplegia Vale Road P.H. School. 10 25. 8.58 M Area Medical Officer, Hornsey, Mental retardation. Special Training School. 11 11. 7 50. F Area Medical Officer, Friern Barnet Cerebral Palsy. Spastic Triplegia. Vale Road P.H School. Children Unsuitable for Education in School The Mental Health Act,1959, by amending Section 57 of the Education Act 1944, introduced certain changes in the lawrelating to children suffering from adisability of mind which makes them unsuitable for education at school, These changes became operative on the 1st November 1960, and their feffeet broadly was to extend the rights of parents and to simplify administrative procedure Under the new provisions, children are no longer reported as "ineducable* but are recorded as unsuitable foreducation in school The object of this change was to implement a recommendation of the Royal Commission on the Law relating to Mental Illness and Mental Deficiency that children should not be declared ineducable', and that severely sub-normal children who cannot profit by education at an ordinary or special school should be recommended for training in training centres provided by local health authorities, or in hospital. The Minister has stressed that the small number of children who, although capable of profiting from education, are not satisfactorily 79 placed in an ordinary or special school, may well be provided with education under powers conferred by Section 56 of the Education Act, either at home or in hospital. A main object of the legislation was to ensure that parents are kept fully informed of the significance of each stage of the procedure and of their own rights. To this end, the letter sent to parents by the local education authority informing them that they will be required to present their child for examination includes a statement of the duties and functions of the local education and health authorities relating to their child's care, couched in friendly and non-legal language. In this way unnecessary distress to parents may well be avoided. When a child has been recorded as unsuitable for education in school, the letter sent by the local education authority to the parents informing them of this now has to include a statement of the type of provision which is likely to be made for their child's care. In order that this may be done, the medical officer who has carried out the statutory examination consults the senior medical officer for Mental Health, and their recommendation for the child's placement is included in the borough school medical officer's report to the local education authority for submission to the appropriate committee. When the local education authority has decided to record a child as being unsuitable for education in school, the parents have a right of appeal to the Minister against the authority's decision. The revised provisions also give to parents a new right to request a review by the education authority of their child's case at any time after twelve months and this right may be exercised annually thereafter. Should the parents stillreject the decision of the authority, the Minister acts as the final arbiter. Orthopaedic Clinics Specialist clinics in both boroughs for children found to have orthopaedic or postural defects have been very well attended throughout 1960. Such cases are found at routine school medical inspection or referred by general practitioners. The physiotherapists have been at full stretch to provide the remedial therapy and breathing exercises prescribed by consultants to the clinics. InHornsey,Mr. E.G.M. Palserhas deputised for Mr. E.T. Bailey, F.R.C.S. on occasions and, as the waiting list of new cases shows no signs of waning despite long and heavy clinics, the introduction of additional sessions is envisaged in 1961. The postural defects of teenagershas been the special concern of Mr. E. Hambly, F.R.C.S., the visiting consultant at Tottenham, and he also continues to supervise the orthopaedic cases at the Vale Road School for Physically Handicapped Children. Of all such cases, few call for more care than children with muscular dystrophy, yet patient and careful physiotherapy can do much to render school life more enjoyable for such children. To this end, every help and encouragement is given by the headmaster (Mr. Ives) and the teaching staff. 80 Ophthalmic Clinics During the past year the Hornsey Eye Clinic has continued to be very busy, the majority of cases being referred for defects of vision due to errors of refraction. These were dealt with in the usual way and glasses prescribed. The visiting consultant, Dr. R. Welch, has, however, drawn attention to the large number of children who required a period of continuous treatment, especially those suffering from uni-ocular amblyopia. Here, the vision in one eye is of a much lower standard than in the other, due either to a convergent squint or aniso-metropia. The requisite treatment, after the error of refraction has been corrected, consists of occludingthe non-amblyopic eye for periods varying from three to four months and during that period the children are seen at fortnightly intervals in the orthoptic clinic, where a careful record of thevisial acuity is kept. As soon as the vision in the amblyopic eye has improved to near that of the other eye a course of orthoptic treatment is given to establish and maintain binocular vision. To obtain the best results early detection of the condition is essential and enquiry should be made as to whether there is a family history of poor vision in one eye the so-called "lazy eye", since this is suggestive. On following the above routine, the results on the whole have been satisfactory, but in those few cases where correction of an error of refraction and orthoptic treatment have failed to cure a squint surgical treatment becomes essential, An equally busy year was experienced at the Tottenham Ophthalmic Clinic where many children with refractive errors and squints were referred to the visiting consultant, Mr. T. Kletz. Of a wide variety of other conditions two of outstanding clinical interest were a case of buphthalmos (infantile glaucoma), and a case of trachoma, Both these children received further investigation in hospital; but, although the diagnosis of trachoma was confirmed bacteriologically, a search for contacts proved unavailing. Happily, the infection cleared up satisfactorily with treatment. Two pupils were registered as partially-sighted during 1960; a case of congenital nystagmus and another of congenital dislocation of the lenses. In December, Mr. Kletz demonstrated a number of clinical cases to the school medical officers in the Area, including cases of "squint" and the orthoptic methods used. Such an occasion, both enjoyable and instructive, encourages early detection of ophthalmic defects which both consultants so rightly stress. 81 ORTHOPTIC CLINICS Number of new cases 88 Number of cases treated:- Complete success 62 Improving 47 Failed 7 Left district before completion of treatment 5 121 Total number of children occluded:- Complete success 34 Partial success 4 Still on treatment 4 Failed to improve 5 47 Number of cases referred for surgery 5 Child Guidance Clinics During 1960 Dr. W.H, Craike, the consultant psychiatrist to the Lordship Lane Clinic, held two sessions per week to deal with the multiple conditions referred to him. Difficult behaviour at home and school, truancy and nocturnal enuresis formed the hard core of his problems; but children presenting a broad spectrum of psychosomatic symptoms were referred to him by both school medical officers and teachers. Dr. C. Phillips, who also undertook two sessions a week, left in March to take up an appointment in the United States of America and a replacement had not been appointed by the end of the year. Consequently, Dr. Craike's case load was heavily increased and there was a long waiting list of children for diagnostic interview at the end of the year. The year under review was one of transition in the Hornsey Child Guidance Clinic owing to the departure of Dr. Phillips who attended this clinic as well as the one in Tottenham and we were fortunate in obtaining the services, as locum tenens, of Dr. Rachel Shackleton. Nevertheless, the problems and the pressure of cases remained essentially the same as in Tottenhamand much valuable work was done in maintaining this vital feature of the School Health Service. Speech Therapy During 1960the speech therapists held frequent consultations with parents, teachers, health visitors, school medical officers and other specialists, in addition to maintaining their regular treatment programme. School visiting formed an integral part of the work and it is now accepted practice for school staffs to consult the speech therapist about any child with a communication problem. This close liaison helps the child with a stammer during the stress periods of his school life, with their new pressures and demands. These most commonly occur during the first year in the infant, junior and senior schools, Miss Joan Came, the senior speech therapist, emphasises that deviation in language development may be significant from the age of two years, and requires early investigation. Where the speech therapist finds a history suggestive of brain damage, hearing loss, severe emotional 82 disturbance or other causative factors, further referral to the appropriate specialist is indicated The Handicapped Child Distribution as at 31st December 1960 Category In Special Day Schools In Special Residential Schools In Maintained Primary & Secondary Schools In Independent Schools Not at School Total B G B G B G B G B G B G Blind Pupils - - 5 2 - - - 1 - - 5 3 Partially Sighted Pupils 4 3 1 1 - - - - - - 5 4 Deaf Pupils 4 4 2 2 - - - - - - 6 6 Partially Deaf Pupils 10 8 1 1 2 - - - 2 - 15 9 Educationally Sub-normal Pupils 64 45 14 2 4 - 1 - - - 83 47 Epileptic Pupils - - 2 1 - - - 1 - - 2 2 Maladjusted Pupils - - 13 2 4 3 14 5 3 1 34 11 Physically Handicapped Pupils 15 12 7 1 1 - - 1 4 1 27 15 Pupils with Speech Defects 3 - - 1 208 1ll 9 3 7 1 227 116 Delicate Pupils 2 9 9 7 1 - 1 - 1 - 14 16 Pupils with Multiple Defects 3 3 1 2 1 - 1 - 1 - 7 5 Totals 105 84 55 22 221 114 26 11 18 3 425 234 Grand Totals 189 77 335 37 21 659 Rheumatism Supervisory Centre Fortnightly sessions continued to be held in the paediatric 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 nine. Of these, five were female and four male:- Rheumatic Fever 5 Innocent Cardiac Murmur (other cases) 2 Streptococcal State (Allergy) 2 9 202 children remain on the register of the supervisory centre, and of these, 52 made 108 attendances, while in addition a number were seen in the ordinary paediatric out-patient sessions These 202 cases were classified as follows:- Rheumatic Fever 64 Rheumatic Carditis 42 Rheumatic carditis with chorea 5 Chorea uncomplicated 5 Rheumatic arthritis 5 Congenital heart lesions 54 Rheumatic pains 1 Streptococcal Allergy 3 Other cases 23 202 96 males 106 females 83 Hospital School I am indebted to Mr J. Power, M.A., Borough Education Officer, Tottenham, for the following report ''The teaching of the children at St. Ann's Hospital and at the Prince of Wales's Hospital has progressed smoothly during the past year. Although the schoolroom is established in the Prince of Wales's Unit at St. Ann's Hospital, there has been considerable development of individual teaching in other wards, including tuition of pupils in cubicles in the tuberculosis wards. These patients, who are not in the infectious stage of the disease, are in their early teens. Tuition is specially important for them as often they are preparing for G.C.E. or other examinations. From time to time assistance is given to older boys and girls who have left school and who have decided to take up further studies. Lessons in the schoolroom are necessarily varied as they must cater for a wide age range. Children with severe muscular disability attend school (often in special fitted chairs) and derive great benefit and pleasure from special sense training and apparatus. Always the pupils' interests are at heart and to this end every effort is made to follow the child's own school curriculum including commercial subjects where necessary and to develop his particular hobbies. It has been possible on occasion to take the children for nature walks round the hospital grounds in wheelchairs and on foot. This has given much pleasure and been of real educational value. Part-time teachers were again employed duringthe longsummer vacation to keep the children happy and busy with handwork, stories, games, etc. As in past years the Tottenham Library Service has been most helpful when special books have been required. Parents have shown their appreciation of lessons received by their children while in hospital, and it is quite evident that the children enjoy their school work. As always, the hospital staff has been most co-operative and helpful". 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 1960 84 SCHOOL HEALTH SERVICE STATISTICS FOR 1960 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 1956 & Later 2 171 172 1955 13 388 390 1954 18 177 187 1953 29 104 119 1952 49 99 130 1951 252 436 599 1950 28 67 91 1949 105 117 196 1948 285 433 629 1947 194 241 374 1946 166 197 316 1945 & earlier 754 650 1249 Total 1895 3080 4452 DEFECTS FOUND BY MEDICAL INSPECTION Defect Code No. Defect or Disease Periodic Inspections Special Inspections Entrants Leavers Total including all other age groups inspected T O T O T O T O 4 Skin 53 92 127 176 524 537 1186 3 5 Eyes (a) Vision 33 70 647 35 1895 340 255 35 (b) Squint 80 13 49 3 327 28 19 1 (c) Other 15 14 9 13 98 60 129 8 6 Ears (a) Hearing 42 14 16 17 141 64 200 40 (b) Otitis Media 39 78 11 51 111 341 14 4 (c) Other 7 10 9 11 39 75 109 2 7 Nose and Throat 212 319 47 82 453 914 154 37 8 Speech 26 56 2 9 76 123 71 3 9 Lymphatic Glands 2 95 3 17 8 201 4 3 10 Heart 8 44 20 57 72 224 26 27 11 Lungs 88 65 97 29 418 205 68 19 12 Development (a) Hernia 8 4 2 - 14 11 - - (b) Other 7 10 12 29 54 126 16 9 13 Orthopaedic: (a) Posture 4 19 25 89 76 296 12 11 (b) Feet 92 148 92 130 455 653 32 25 (c) Other 39 56 40 59 193 339 139 7 14 Nervous System: (a) Epilepsy 2 2 11 5 40 14 12 7 (b) Other 5 13 14 20 49 71 19 8 15 Psychological: (a) Development 3 21 1 6 20 69 58 35 (b) Stability 21 197 6 108 97 743 59 27 16 Abdomen 16 14 14 16 76 119 14 5 17 Other 35 49 19 89 115 489 700 95 T = Requiring Treatment O = Requiring Observation 85 TREATMENT OF PUPILS ATTENDING MAINTAINED PRIMARY AND SECONDARY SCHOOLS (INCLUDING NURSERY AND SPECIAL SCHOOLS) GROUP 1. Eye Diseases (e.g. blepharitis, conjunctivitis) Defective Vision and Squint Number of cases known to have been treated (a) External and other, excluding errors of refraction and squint 121 (b) Errors of refraction, including squint 2019 Total 2140 (c) Number of pupils for whom spectacles were prescribed 1057 GROUP 2. Diseases and Defects ofEar, Nose and Throat Received operative treatment for: (a) Diseases of the ear 1 (b) Adenoids and Chronic Tonsillitis 287 (c) Other nose and throat conditions 7 Received other forms of treatment 610 Total 905 Total number of pupils in schools known to have been provided with hearing aids: (a) During the current year 10 (b) In previous years (excluding any pupils shown at (a) above who were provided with an aid in a previous year) 37 GROUP 3. Orthopaedic and Postural Defects Number of pupils known to have been treated at clinics or at out patient departments 1060 GROUP 4. Diseases of the skin (excluding uncleanliness) Ringworm (i) Scalp - (ii) Body - Scabies 26 Impetigo 12 Other skin diseases 1386 Total 1424 GROUP 5. Child Guidance Treatment Number of pupils treated at child guidance clinics (including cases sent to the Tavistock and other hospital clinics) 106 GROUP 6. Speech Therapy Number of pupils treated by speech therapists 271 GROUP 7. Other treatment given (a) Number of miscellaneous minor ailments treated by the County Council 448 (b) Treatment other than (a) above and excluding convalescent treatment 155 86 EDUCATION ACT 1944 - SECTIONS 57(3), 57(4) and 57(5) Cases dealt with under Section 57, Education Act 1944:- Sub-section 3: 4 - Sub-section 4: Sub-section 5: 6 Cases de-notified under Section 8, Education (Miscellaneous Provisions) Act 1948:- 4 MEDICAL EXAMINATION OF TEACHERS (a) Number of Teachers examinded as to fitness for appointment 24 (b) Number of Students examined as to fitness for first appointment 135 (c) Number of Students examined as to fitness to undertake training course 89 STAFF Borough Health Department Medical Officer of Health, School and Area Medical Officer Deputy Medical Officer of Health and Assistant County Medical Officer Chief Public Health Inspector Senior District Public Health Inspector Chief Administrative Assistant Senior Administrative Assistant G. Hamilton Hogben, M.R.C.S., D.P.H, J. Epsom, M.R.C.S., D.P.H., D.I.H. (Resigned 6.6.60) P.A.C. Wright, M.B., B.S., D.P.H. (Appointed 8.9.60) E.T. Jenkins, F.A.P.H.I. E.S. Glegg, M.A.P.H.I. A.W. Lawrence, M.A.P.H.I. W.E. Lawson Classification of other staff No. Public Health Inspectors 11 Pupil Public Health Inspectors 2 Shops and Street Trading Inspector 1 Administrative and Clerical Staff 9 Rodent Operatives 2 Cleansing and Disinfection Staff 2 Other Manual Staff 6 87 County Area Health Department (Tottenham and Hornsey) Deputy Area Medical Officer Senior Assistant Medical Officer Area Dental Officer Superintendent Health Visitor Non-Medical Supervisor of Midwives aa and Home Nursing Superintendent Home Help Organiser Assistant Home Help Organisers Area Chief Clerk Deputy Area Chief Clerk Section Heads A Yarrow, M.B., Ch.B., D.P.H. (Resigned 20.4.60) G.S. Udall, M.B., B.Chir., D.P.H., D.C.H. (Appointed 1.7.60) Alice Wheildon, M.B., B.S., M.R.C.O.G. (Resigned 28.2.60) Ruth Golder, M.B., Ch.B , D.R.C.O.G., D.P.H. (Appointed 2.5.60) V. Sainty, L.D.S., R.C.S. (Retired 12.2.60) Miss W.M. Hunt, L.D.S., R.F.P.S. (Appointed 26.9.60) Miss H. Townsend, S.R.N., S.C.H., H.V. Miss F.E. Curtis, S.R.N., S.C.M., H.V., M.T.D. Miss D. Williams, S.R.N. Miss J.E. Caplin Mrs. F.G. Wills (Resigned 29.7.60) Mrs. A. Orchard (Appointed 30.5.60) W.'L.N. Relleen, T.D., D.P.A. J.B. Bambrook, D.M.A. A. Balls N.P. Child H.J. Dunham, B.A Classification of Staff Full-Time Part-Time Medical Officers 10 6 Dental Officers 6 4 - Supervisory Nursing Staff 2 Administrative and Clerical Staff 35 88 Health Visitors/School Nurses 27 2 Student Health Visitors - 1 - - Clinic Nurses 7 Midwives 11 Home Nurses 24 4 Speech Therapists 2 2 - - Physiotherapist 1 Occupational Therapist 1 Chiropodists - 2 Gramophone Audiometrician 1 Orthoptists - 2 Dental Attendants 8 2 Day Nursery Staff 35 22 Home Help Service 7 164 Manual workers, domestic grades, etc. 10 23 187 222 88 INDEX Page Abatement Notices: Legal Proceedings 16 Aged, Welfare of 43 Ambulance Service 49 Ante Natal Clinics 52 Area Health Committee 51 Area Health Service 49 Area Health Staff 87 Area Welfare Service 49 Arteries, Diseases of 5 Atmospheric Pollution 24 Audiology Clinic 73 Baths and Laundry Services 13 B.C.G. Vaccination 70 Bed Sores: Prevention 65 Births and Deaths 2 Births, Notification of 52 Borough Council, Members 1 Cancer, Deaths 4 Cerebral Palsy Unit 77 Certificates of Disrepair 24 Chest Clinic 39 Child Guidance Clinics 81 Chiropody & Special Treatment Establishments: Licensing 50 Chiropody Service - Old People's 44 Clean Air 22 Cleansing and Disinfecting Station 16 Clearance Areas 27 Comparability Factors 4 Coronary Disease 5 Council, Members of 1 Daily Guardian Scheme 57 Day Nurseries 57 Deaths, Classification of 8 Defects, Sanitary: Remedied 14 89 Page Demolition Orders 28 Dental Service, Priority 60 School 71 Diphtheria Immunisation 67 Disinfection 17 Disinfestation 17 Domestic Help Service 68 Drainage and Sewerage 11 Dysentery 41,70 Ear, Nose and Throat Clinics 73 Education Committee 51 Encephalitis 40 Fabrics (Misdescription) Regulations 1959 21 Factories 18 Fluoridation of Water Supply 10 Food - Condemned 33 Control 29 False or Misleading Description of 35 Hawkers 30 Hygiene 29 Labelling 35 Poisoning 41 Prosecutions 33 Registered Premises 30 Sampling 34 Shops 30 Handicapped Child, The 57, 82 Hazards, Radiation 11 Hawkers of Food 30 Health and Housing Committee 1 Health Services provided by other Authorities 47 Health Visiting Service 62 Home Nursing Service 64 Hospital Services, Old People 44 Hospitals 47 Hospital School 83 90 Page Houses Unfit Housing 25 Housing Act, s. 9 & 10 28 Individual Unfit Houses 28 Part III 26 Immunisation, Diphtheria and Whooping Cough 67 Infantile Deaths 3, 7 Infant Welfare Clinics 54 Infectious Diseases in School Children 70 Infectious Diseases, Table of Cases 42 Insect Pests 17 Inspections carried out by Public Health Inspectors 13 Labelling of Food Order, 1953 35 Laboratory Service 49 Laundries, Public 13 Laundry Service for the Incontinent Aged 44 Lunacy and Mental Treatment Acts 49 Lung Cancer 4 Maternal Deaths 2 Maternity services 52 Meals on Wheels 45 Measles 40 Meat Inspection 31 Medical Grounds for Rehousing 29 Members of Borough Council 1 Mental Health 63 Merchandise Marks Acts, 1887-1953 35 Midwifery Service 61 Midwives' Ante- Natal Clinics 53 Milk andDairies 31 Mothercraft Clinics 54 National AssistanceAct, 1948, s. 47 46 Night Service 69 Noise Nuisances 16 Notices Served 15 Nurseries & Child Minders 58 91 Page Old People's Welfare 43 Ophthalmic Clinics 80 Orthopaedic Clinics 81 Orthoptic Clinics 79 Out-Patient Clinics at Prince of Wales's Hospital 48 Outworkers 19 Paratyphoid Fever 41 Personal Health Service 49 Pet Animals Act, 1951 Physically Handicapped - Housing 29 Plevna Day Nursery 58 Poliomyelitis 40, 70 Vaccinnation 68 Population, Movement of Preserved Foods 30 Prince of Wales's Hospital, Out-Patient Clinics 48 Problem Families 63 Public Health Department, Staff 86 Public Health Act, 1936 Legal Proceedings 16 Radiation Hazards 11 Rag Flock and Other Filling Materials Act, 1951 22 Recuperative Holidays 68 Rehousing on Medical Grounds 29 Rent Act, 1957 24 Repairs in Default 16, 28 Retirement Advice Clinic 43 Rheumatism Supervisory Centre 82 Rodent Control 18 Routine Medical Inspections 69 Sanitary Circumstances of the Area 10 Scarlet Fever 40 School Health Service 69 Sewerage and Drainage 11 Shops 19 Prosecutions 21 Slaughterhouses 29 Slaughtermen 31 Slum Clearance 26 92 Page Smallpox Smallpox Vaccination 67 Smoke Control Areas Speech Therapy 81 Staff Medical Examinations 41 Staff Sickness 41 Statistics 2-9 Stillbirths 2 Street Trading 20 Superannuation Medical Examinations 41 Swimming Baths 13 Tetanus Immunisation 67 Toddlers' Clinics 55 Tuberculosis 36 In Schools 70 Unfit Houses 26 Vaccination and Immunisation 67 Vale Road School for Physically Handicapped Children 77 Water Supply 10 Welfare Foods Distribution 59 Welfare Homes 46 Welfare Service, Area 49 Whooping Cough 40 Immunisation 67 Work in Default 16, 28 Published by the Toottenham Corporation Town Hall, Tottenham,N.5. and printed by their Public Libraries Department